Reference values of plasma apolipoproteins A-I and B, and association with nonlipid risk factors in the populations of two Canadian provinces: Quebec and Saskatchewan. Canadian Heart Health Surveys Research Group.

OBJECTIVE: To determine the population distribution of apolipoproteins A-I and B, and the relationship of apolipoprotein B to lipid risk factors for coronary artery disease. DESIGN: A stratified random sample of men and women aged 18 to 74 years selected from the provinces of Saskatchewan and Quebec in 1989 and 1990. OUTCOME MEASURES: Plasma concentrations of apolipoproteins A-I and B, triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol and nonhigh density lipoprotein cholesterol for subjects who provided a fasting blood sample. MAIN RESULTS: Apolipoprotein B mean values increased with age from 0.80 g/L at age 18 to 24 years to a maximum of 1.16 g/L in the 45 to 54 year age group for men. For women, the values increased more gradually from 0.81 g/L for ages 18 to 24 to 1.19 g/L at ages 65 to 74 years. The distribution of apolipoprotein A-I was unrelated to age. Means for men varied from 1.35 g/L to 1.42 g/L and for women from 1.50 g/L to 1.61 g/L. Apolipoprotein B was strongly correlated with nonhigh density lipoprotein cholesterol (r2=0.89), and this was used to define apolipoprotein B concentrations less than 1.04 g/L as indicating low risk for coronary artery disease, from 1.04 g/L to less than 1.22 g/L as moderate risk, from 1.22 g/L to less than 1.40 g/L as high risk, and 1.40 g/L or greater as very high risk. The prevalence of high risk plasma apolipoprotein B levels was higher in men and women with triglycerides greater than 2.3 mmol/L. Apolipoprotein A-I was strongly correlated with high density lipoprotein cholesterol (r2=0.67), and this was use to identify apolipoprotein A-I concentrations of less than 1.20 g/L as a risk factor and 1.65 g/L or greater as an antirisk factor for coronary artery disease. The prevalence of apolipoprotein A-I of less than 1. 20 g/L was 19% in men and 6% in women, whereas the prevalence of apolipoprotein AI 1.65 g/L or greater was 9% in men and 28% in women. CONCLUSION: Reference values for plasma apolipoproteins A-I and B in a Canadian population random sample are given. Plasma apolipoprotein B and apolipoprotein A-I provide information that is complementary to that provided by low density lipoprotein and high density lipoprotein cholesterol levels.

Assessing adherence to a rotary diversified diet, a treatment for 'environmental illness'.

OBJECTIVES: To develop and test a method to assess adherence to a rotary diversified diet (RDD), a treatment for environmental illness, which is a putative disorder characterized by multiple sensitivities to foods, chemicals, or inhalants. The RDD requires the elimination of prohibited foods and rotation of remaining nonprohibited foods and their "food families" within a 4- to 7-day cycle. The regimen has yet to be validated to the satisfaction of the scientific community. DESIGN: Details of the 2 components of the RDD prescription, elimination and rotation, were documented, and a food record method of assessing adherence was developed. Adherence to the RDD was then assessed in a cohort of women who were enrolled in a larger prospective study. Test-retest reliability of the adherence assessment method was determined by calculating ratings twice on the same set of patient food records, with 1 week between trials. SUBJECTS/SETTING: All patients were contacted through a private environmental medicine clinic in Toronto, Canada. Eight patients provided the food records needed for development of the method; adherence was then assessed in 22 women aged 25 to 67 years. STATISTICAL ANALYSES: Means, standard deviations, and 95% confidence intervals for adherence ratings were calculated. The reliability of the adherence assessment method was determined by calculating Pearson correlation coefficients for adherence ratings from each trial. A paired t test was also used to determine if the mean differences in ratings between trials were significant. RESULTS: Patients experienced difficulties following both components of the RDD: 37% to 44% of foods consumed were either prohibited or allowed, but were consumed on the incorrect day. The adherence assessment method was found to have high levels of reliability. APPLICATIONS: The adherence assessment method can be used in future evaluations of the RDD, although further testing of the method is recommended. Increased involvement of dietitians with patients diagnosed with environmental illness is recommended.

Variation of postprandial plasma glucose, palatability, and symptoms associated with a standardized mixed test meal versus 75 g oral glucose.

OBJECTIVE: To compare within-subject variability of plasma glucose measured 2 h after a glucose tolerance test (GTT) with that of plasma glucose measured 2 h after administration of a standardized test meal (diabetes screening product [DSP], Ceapro, Edmonton, Alberta, Canada) and to determine the relationship between the two sets of plasma glucose measurements. RESEARCH DESIGN AND METHODS: Plasma glucose and insulin responses of 36 overnight-fasted subjects (10 lean normal, 9 obese normal, 9 with impaired glucose tolerance [IGT], and 8 with mild diabetes) were studied on eight different mornings after they consumed 75 g oral glucose or 50 g carbohydrate from the DSP. Each test meal was repeated four times by each subject. Within-subject coefficients of variation (CVs) (CV = 100 x SD/mean) of plasma glucose concentrations 2 h after administration of the GTT and DSP were compared by repeated measures ANOVA and linear regression analysis. RESULTS: Mean plasma glucose 2 h after administration of the DSP (D) was linearly related to that 2 h after the GTT (G): G = 1.5 x D - 1.6 (r = 0.97, P < 0.0001). The CV of 2-h plasma glucose was significantly lower after administration of the DSP, 10.5 +/- 1.0%, than after the GTT, 12.7 +/- 1.18% (P = 0.025). The effect of test meal on CV differed in different groups of subjects (P = 0.018), with the largest difference found in IGT subjects, in whom the CV after DSP administration was 47% less than after the GTT (P = 0.0005). The DSP was significantly more palatable and produced fewer adverse symptoms than the GTT. CONCLUSIONS: Plasma glucose concentrations measured 2 h after DSP administration are closely related to those measured 2 h after the GTT but are more consistent than the 2-h post-GTT concentrations within the critical IGT range. This finding suggests that measurement of plasma glucose 2 h after administration of the DSP may allow more precise discrimination among normal glucose levels, IGT, and diabetes than measurement of plasma glucose 2 h after the GTT.

[HIV infection es IgA nephropathy]. / A HIV-fertózés és az IgA nephropathia.

Similar immunological abnormalities exist in IgA nephropathy and HIV infection and several IgA nephropathy cases were reported in HIV-infected patients. To estimate the number of HIV-infected patients in IgA nephropathy, 80 patients with IgA nephropathy were studied for HIV-1 and HIV-2 antibody seropositivity. Although they failed to detect HIV positivity among their IgA nephropathy patients, because of the increasing number of people are being infected with HIV, the screening of IgA nephropathy patients for HIV infection would warrant.

Dentists' variability in restorative decisions, microscopic and radiographic caries depth.

Restorative and dental caries depth decisions were recorded for 5168 un restored approximal tooth surfaces by 17 dentists who worked in the school dental clinics of the North York (Ontario) Public Health Department. Each dentist examined 15 pairs of experimental bitewing radiographs for which true caries depth had previously been determined by microscopy of the sectioned teeth following production of the radiographs. The dentists independently recorded their restorative decisions and radiographic caries depth perceptions. The relationship between the variation in the dentists' restorative decisions and their perceptions of caries depth based on a re-reading of the bitewings on the one hand, and true caries depth on the other was also examined. The percentages of total variability in each dentist's restorative decisions attributable to radiographic and to microscopic caries depth were estimated using regression analyses. Large variations were found among the 17 dentists' distributions of overall restorative and depth decisions. The relationship between microscopic caries depth and the dentists' restorative decisions was, understandably, less strong than that of the dentists radiographic perceptions of caries depth and restorative decisions. Relative to true caries depth, high numbers of false positive and false negative restorative decisions were made. Overall, 50% of the variability in the dentists' restorative decisions was explained by the perceptions of radiographic caries depth; however, among individual dentists, the range was from 29% for one dentist to 69% for another. A much lower percentage of the overall restorative variation was explained by microscopic depth, 18%. Like the finding of the only two previous European studies that quantified the role of radiographs on clinical decisions, this study demonstrated that dentists' perceptions of dental caries depth using bitewing radiographs play a major but variable role in their restorative decisions for approximal tooth surfaces.

Dentists' stated restorative treatment thresholds and their restorative and caries depth decisions.

OBJECTIVE: This study examines the relationships between stated restorative treatment thresholds of 16 dentists and both their restorative decisions and caries depth determinations for approximal tooth surfaces based on bitewing radiographs. METHODS: Sixteen dentists independently examined 15 pairs of experimental bitewing radiographs. They separately recorded restorative and dental caries depth decisions for 4,864 unrestored approximal tooth surfaces, 304 identical surfaces per dentist. In addition to caries depth and restorative decision data, these dentists provided their restorative thresholds using a five-point scale. RESULTS: Three dentists stated it would be appropriate to restore enamel lesions, nine would wait until caries had reached the dentinoenamel junction, and four would wait until caries extended into the dentine. Although dentists stating an enamel restorative threshold intended definitely or probably to restore relatively more surfaces and recorded relatively more surfaces with dentinal caries, ANOVA analyses revealed that the differences among the restorative and the depth means according to the restorative thresholds were not significant. Considerable variation existed in both the restorative and depth decisions among the dentists in each threshold group. CONCLUSION: Although interesting trends occurred in the restorative and depth decisions relative to the stated thresholds, this study suggests, like others in Europe, that these thresholds cannot be taken at face value to explain restorative decisions.

Estimation of procedure times in a publicly funded dental programme.

For the purposes of planning and evaluation, knowing the time-costs associated with each dental procedure carried out in a publicly funded dental programme is very helpful. This knowledge, along with the expected or known benefits, also allows researchers to assess the efficacy of a dental procedure. However, only a few estimates of dental procedure times exist in the literature, and most of these focus on restorative treatments. The North York Public Health Department operates a school-based public dental programme, where each dental procedure carried out by a dentist or hygienist is entered into a dental management information system database, along with the date of the procedure and the hours worked by the provider on that date. Using these data and multiple regression analyses it was possible to estimate the average time required to carry out the most common procedures in North York's dental programme. These estimates were found to be similar to estimates published in the dental literature and very similar to estimates of the Ontario Dental Association. Thus, this method of calculating procedure times appears valid and may be very useful to managers of public dental programmes and public dental health researchers.

Utilization of home-delivered meals by recipients 75 years of age or older.

OBJECTIVE: To compare the effects of gender, age, and living situation on utilization of home-delivered meals by elderly recipients. DESIGN: Cross-sectional cohort study. SETTING: The sample was recruited from five meals-on-wheels agencies in southern Ontario, Canada, representing both rural and urban settings. SUBJECTS: Participants were 150 white, independently living recipients of meals-on-wheels who were older than 75 years and able to communicate in English and who had access to a telephone. Of these, 137 (90 women and 47 men) completed the study (attrition rate = 9%). MAIN OUTCOME MEASURES: Meal utilization: the energy and nutrient content and the amounts of specific foods in the consumed portions of delivered meals calculated as percentages of the total received from the service agencies. STATISTICAL ANALYSES PERFORMED: Two-factor analysis of variance. RESULTS: Meal utilization in terms of energy of the consumed portion of the delivered meals was 81 +/- 18%. Nutrient utilization ranged from 83% (vitamin A) to 77% (vitamin C). For specific foods, utilization ranged from 67% (miscellaneous) to 83% (protein sources and soups). Utilization levels for energy, eight nutrients, and specific foods were significantly higher for men than for women. Women living alone showed higher utilization values for energy and 11 nutrients compared with those living with others. Age had no effect on meal utilization. CONCLUSIONS: Monitoring and consultation procedures are necessary to ensure maximum nutritional benefits to clients and cost-effectiveness of the meal service.

Impact of microbiological consultation on clinical decision making: a case-control study of clinical management of recurrent periodontitis.

Data obtained from diagnostic tests may influence the clinician's perception of the patient's state and in some instances may alter subsequent choices of therapeutic interventions. To determine if microbiological consultation influences the clinical management of patients with recurrent periodontitis, an observational, case-control study was conducted to measure the amount and type of periodontal treatment provided by periodontists (n = 13) who had referred patients with recurrent periodontitis for microbiological consultation. The control group consisted of periodontists (n = 10) who had not referred recurrent periodontitis patients for testing. Patients (n = 31; 20 females, 11 males; mean age 49.8 +/- 10.0 years) treated by the case group of periodontists were matched for age and sex to patients (n = 48; 22 females, 26 males; mean age 49.9 +/- 8.5 years) treated by the control group of periodontists. Questionnaires were administered to quantitatively assess the amount and type of treatment before and after receiving the microbiological report. Specific analyses were performed as a function of the time of receipt of the microbiology report. Case-control differences prior to the receipt of the report indicated that the amount of surgery/year was 43% greater for controls (P < 0.04), in spite of control patients exhibiting fewer deep pockets than case patients (P < 0.05). Case-control differences after the receipt of the report indicated that case patients were provided with 45% greater number of appointments/year (P < 0.005), 46% greater scaling/year (P < 0.02), and 79% greater antibiotics/year (P < 0.01) compared with controls. The report influenced 9 (69%) case periodontists to change treatment. Case patients who received a change in treatment (n = 21) exhibited greater number of deep pockets at the time of entry into the study (P < 0.05) as compared with case patients who did not receive a change in treatment. Paired t-tests of differences within groups before and after the report demonstrated that case patients had a significant increase in treatment after the report as shown by 22% greater number of visits/year (P < 0.05) and 54% greater number of antibiotic prescriptions/year (P < 0.01). In contrast, controls demonstrated no significant change in treatment. Further, contrasts of change in treatment before and after the report again indicated that case patients exhibited a significantly higher number of visits/year (P < 0.04) and number of antibiotic prescriptions/year (P < 0.02) compared with control patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Diabetes-related lower extremity amputations in Ontario: 1987-88 experience.

Lower extremity amputee rates were estimated for diabetic persons living in Ontario. The rates were specified for age, sex and six Health Regions. The 1987-88 Hospital Records Institute database supplied the information regarding the amputations and the prevalence of diabetes in Ontario was estimated from age/sex specific diabetic rates of the U.S. The crude amputee rate for Ontario is 40 amputees/year/10,000 diabetics and the amputation rate is 44 amputations/year/10,000. These rates are lower than the 101 amputees/year/10,000 reported in the U.K. and are reasonably close to those of the U.S. (59.7 amputations/year/10,000). Age and sex Standardized Morbidity Ratios indicated that Region 1 and 6 have significantly higher and Region 2 significantly lower amputee rates than the Province. There is an almost two-fold difference between the highest and the lowest DRLEA rates of the six regions. (Range: 60-30). These results should be interpreted with caution, since actual prevalence rates of diabetes are not available.

The effects of a single night's dosing with triazolam on sleep the following night.

This study was undertaken to determine whether a single night's use of triazolam by normal healthy sleepers leads to withdrawal insomnia on the subsequent night, and whether there is a dose response relationship to this phenomenon. Thirty normal sleepers of both sexes were randomly assigned to three parallel treatment groups. All subjects were studied for five consecutive nights by means of pre- and post-sleep questionnaires and all night polysomnography. Multiple sleep latency tests were conducted on the days following the second, third, and fourth nights in the laboratory. All subjects received placebo capsules on the first, second, fourth, and fifth nights in the laboratory and either placebo, 0.25 mg triazolam or 0.5 mg triazolam according to their assigned group on the third night. Both doses of the drug increased subjective estimates of sleep duration, but no objective increase was found. Neither dose altered daytime measures of sleepiness. No changes were found in any of the sleep parameters on withdrawal of the 0.25 mg dose of triazolam. However, discontinuation of the 0.5 mg dose did lead to significant objective and subjective withdrawal effects. It was concluded that higher doses of triazolam could lead to withdrawal effects in normal sleepers even when this drug was used for only a single night.

A comparative study on the effects of brotizolam and flurazepam on sleep and performance in the elderly.

This study was undertaken to compare the effects of 0.25 mg of brotizolam, 15 mg of flurazepam, and placebo on the sleep and performance of elderly subjects with chronic insomnia during a 2-week period of administration. Thirty-six male and female subjects who ranged in age from 60-72 years were divided into three treatment groups. All groups received placebo on the first three study nights, the active drug or placebo on the next 14 nights, and placebo again on the two following withdrawal nights. Sleep was assessed by means of questionnaires, and residual effects during the day were studied by means of the multiple sleep latency test and a variety of memory, performance, and vigilance tests. Sleep improved with all treatments. Rebound insomnia was noted on brotizolam withdrawal; flurazepam withdrawal had a milder impact. At the end of this 19-night study, only the placebo-treated group was sleeping significantly longer than at baseline. Both drug treatments increased daytime sleepiness and impaired performance on the first day after their administration. These effects waned after 2 weeks of treatment with brotizolam, but not flurazepam. The results of this study affirm the increased sensitivity of elderly subjects to benzodiazepine hypnotics and their indication for acute or intermittent insomnia, rather than for the more chronic forms of this disorder.

The glycemic index: variation between subjects and predictive difference.

It is not known whether the variability of the glycemic index (GI) in different subjects is due to within- or between-individual variation. In addition, it is not known how large a difference in GI between different meals is clinically important for individuals with diabetes. Therefore, insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetic subjects tested four foods, with each food taken by each subject on two separate occasions. For each food, most of the variation of absolute glycemic responses was due to differences between the subjects. However, when the results were expressed as the GI, there were no significant differences between the subjects, and most of the variation was due to within-individual variation. Using the within-individual variance, we estimated the so-called "predictive difference" of GI values. Its reliability was assessed by consideration of published data from eight studies where different mixed meals were taken by the same group of subjects. There were 37 cases where the difference between the GI of any two meals was greater than the predictive difference. Of these 37 pairs of meals, the GI correctly ranked the glycemic responses in 36 (97%). We conclude that GI values for the same food do not vary significantly between different individuals. For a subject with NIDDM a difference in GI of 34 will predict the ranking of glycemic responses of two meals with 95% probability. The corresponding value for a subject with IDDM is 50.

Determinants of hydronephrosis and renal injury in patients with myelomeningocele.

Renal injury is a major potential complication of patients with neurogenic bladder impairment. There are many clinical, radiological and urodynamic factors that are widely available and that may aid in predicting which patients are at risk of renal injury. This study aims at achieving an objective statistical analysis of these multiple risk factors. We have applied this statistical analysis in a prospective manner to 215 patients with myelodysplasia and neurogenic bladder impairment. Potential risk factors in the lower urinary tract include bladder capacity, contractility and dyssynergia. Each of these factors was assigned a numerical score of 0 to 3, which was correlated with the presence of vesicoureteral reflux. The upper urinary tracts in these patients were assigned a numerical score according to the degree of radiological changes observed. These results then were tested with a stepwise regression analysis using p equals 0.05 as the significance level. In this analysis significant determinants of vesicoureteral reflux included a change in bladder shape, the presence of uninhibited contractions and the presence of dyssynergia. Renal deterioration was noted, and it was predicted by the presence of vesicoureteral reflux, a high ureteral pressure profile and dyssynergia. We conclude from this clinical study that risk of renal injury is present in these children. We also conclude that the risk can be predicted by urodynamic and radiological criteria and that these data can be correlated and analyzed using statistical methodologies.

Wholemeal versus wholegrain breads: proportion of whole or cracked grain and the glycaemic response.

STUDY OBJECTIVE: To determine the effect on the glycaemic response to bread of the ratio of whole cereal grains to milled flour. DESIGN: Randomised assignment of groups of diabetic volunteers to test and control meals, taken after an overnight fast. Test foods were also analysed for in vitro digestion with human saliva. SETTING: Tertiary care centre. PATIENTS: Groups of six drawn from pool of 16 volunteers with diabetes mellitus (11 men, five women; mean age 64 (SE 3); 10 taking insulin, five taking oral agents, one controlled by diet; other characteristics comparable). INTERVENTIONS: All patients took standard white bread control meals on three occasions spanning the study and on different mornings took test meals containing varying ratios of whole cereal grains (barley or cracked wheat) to milled flour (75:25, 50:50, 0:100). All meals contained 50 g available carbohydrate and were eaten in 15 minutes. Capillary blood samples were taken for determination of glucose concentrations every 30 minutes for three hours. END POINT: Glycaemic index of foods (= increase in area under blood glucose concentration curve for test food divided by increase in area under curve for white bread control X 100). MEASUREMENTS AND MAIN RESULTS: Significant trend to lower glycaemic index with increasing proportion of whole cereal grains in test bread (p less than 0.05) and lower in vitro digestibility (p less than 0.001). Breads containing up to 75% whole grain were considered palatable. CONCLUSIONS: Breads containing a high proportion of whole cereal grains may be useful in reducing the postprandial blood glucose profile in diabetics because they are more slowly digested. These breads should be called "wholegrain" in distinction to "wholemeal" breads made from milled flour.

Serum and quantitative electroencephalographic pharmacokinetics of loprazolam in the elderly.

This study was undertaken to determine the serum pharmacokinetic parameters of loprazolam, a new benzodiazepine hypnotic, in elderly subjects and to compare these with the kinetics of the drug as determined by quantitative EEG analysis. In addition, a 14-day study was undertaken to determine the steady-state serum levels achieved in this population with repeated drug administration. The study was conducted on 16 male and female subjects between the ages of 62 and 72 years, randomly assigned to two groups treated with 0.5 or 1.0 mg of loprazolam. The serum half-life of loprazolam was found to be 5 hours, and the peak serum concentration was reached after 2 hours. Quantitative EEG changes were observed after 30 minutes suggesting rapid access of the drug into the nervous system. Quantitative EEG changes were evident for 9.5 hours, suggesting the persistent effects of an active metabolite. The 14-day study indicated that loprazolam did not accumulate with continued use.

Effects of flurazepam and zopiclone on the performance of chronic insomniac patients: a study of ethanol-drug interaction.

Three groups of ten middle-aged insomniac patients were treated with placebo, flurazepam, or zopiclone for 12 consecutive days in a study designed to compare the residual daytime effects of long-acting flurazepam and short-acting zopiclone on a variety of cognitive and motor tasks. These effects were examined independently and in combination with ethanol effects. The effects of the drugs on sleep parameters were also subjectively assessed by means of questionnaires during treatment and withdrawal. The study demonstrated persistent performance effects with flurazepam. Testing at the end of the treatment period showed that movement time was impaired in the flurazepam treated group. Flurazepam also enhanced the increment of movement time produced by ethanol. One subject became severely confused when given ethanol after using flurazepam for 12 days. None of these effects were found with zopiclone. The rapid elimination of zopiclone may account for these findings.

Spectral EEG correlates of dream recall.

Recent studies have shown that dreaming is not limited to rapid eye movement (REM) sleep, but can be found to varying degrees in any stage of sleep. This study attempted to quantify the EEG correlations of dreaming during Stage 2 sleep. Six normal volunteers were studied for 24 nights in the sleep laboratory. Electroencephalogram (EEG) recording prior to awakening from Stage 2 sleep and from other stages without awakening were subjected to computer spectral analysis. Although awakenings associated with dream recall tended to have lower total power, mean frequency in the beta band proved to be the best correlate of mental activity in Stage 2 sleep. Mean frequency had its highest values in REM sleep and wakefulness and declined in Stage 2 and Stage 4 sleep, in keeping with the decline in mental activity reported from these stages. Implications of these findings are discussed with regard to models of dream recall and clinical states.

Prediction of the relative blood glucose response of mixed meals using the white bread glycemic index.

Unexpected plasma glucose responses to different mixed meals fed to normal and diabetic volunteers have recently been reported. We have therefore examined in normal volunteers the effect of mixing carbohydrate foods of different glycemic indices (GIs) without the addition of fat and protein. The observed GI of the mixed meal was within 2% of the expected value. In studies in the literature where fat and protein were added to mixed meals, the observed blood glucose responses also related significantly to the meal GIs calculated from the individual foods. Addition of fat and protein in the quantities used did not obscure this relationship. Studies to determine sources of error in comparing glycemic responses showed that type II diabetic patients displayed the least within-individual variation, and type I diabetic patients the most. Expression of results as the GI rather than as absolute glycemic response areas reduced by 50% the between-subject variation. The mean GI values of rice tested in type I and type II patients were similar (82 +/- 22 compared with 74 +/- 19) and the reproducibility 22 mo later in the same group of subjects was excellent (81 +/- 15 compared with 83 +/- 15). However, the lack of precise GI values for all foods fed in the test meals indicates a need for GI values to be derived for a wider range of individual foodstuffs. The GI approach to classifying foods according to physiologic effect may play a useful role in planning meals and diets in which specific blood glucose profiles are required.