Alzheimer's Prevention Education: If We Build It, Will They Come? www.AlzU.org.

BACKGROUND: Internet-based educational interventions may be useful for impacting knowledge and behavioral change. However, in AD prevention, little data exists about which educational tools work best in terms of learning and interest in participating in clinical trials. OBJECTIVES: Primary: Assess effectiveness of interactive webinars vs. written blog-posts on AD prevention learning. Secondary: Evaluate the effect of AD prevention education on interest in participating in clinical trials; Assess usability of, and user perceptions about, an online AD education research platform; Classify target populations (demographics, learning needs, interests). DESIGN: Observational. SETTING: Online. PARTICIPANTS: Men/Women, aged 25+, recruited via facebook.com. INTERVENTION: Alzheimer's Universe (www.AlzU.org) education research platform. MEASUREMENTS: Pre/post-test performance, self-reported Likert-scale ratings, completion rates. RESULTS: Over two-weeks, 4268 visits were generated. 503 signed-up for a user account (11.8% join rate), 196 participated in the lessons (39.0%) and 100 completed all beta-testing steps (19.9%). Users randomized to webinar instruction about AD prevention and the stages of AD demonstrated significant increases (p=0.01) in pre vs. post-testing scores compared to blog-post intervention. Upon joining, 42% were interested in participating in a clinical trial in AD prevention. After completing all beta-test activities, interest increased to 86%. Users were primarily women and the largest category was children of AD patients. 66.3% joined to learn more about AD prevention, 65.3% to learn more about AD treatment. CONCLUSIONS: Webinar-based education led to significant improvements in learning about AD prevention and the stages of AD. AlzU.org participation more than doubled interest in AD prevention clinical trial participation. Subjects were quickly and cost-effectively recruited, and highly satisfied with the AD education research platform. Based on these data, we will further refine AlzU.org prior to public launch and aim to study the effectiveness of 25 interactive webinar-based vs. blog-post style lessons on learning and patient outcomes, in a randomized, within-subjects design trial.

A genome-wide linkage study of bipolar disorder and co-morbid migraine: replication of migraine linkage on chromosome 4q24, and suggestion of an overlapping susceptibility region for both disorders on chromosome 20p11.

Migraine and Bipolar Disorder (BPAD) are clinically heterogeneous disorders of the brain with a significant, but complex, genetic component. Epidemiological and clinical studies have demonstrated a high degree of co-morbidity between migraine and BPAD. Several genome-wide linkage studies in BPAD and migraine have shown overlapping regions of linkage on chromosomes, and two functionally similar voltage-dependent calcium channels CACNA1A and CACNA1C have been identified in familial hemiplegic migraine and recently implicated in two whole genome BPAD association studies, respectively. We hypothesized that using migraine co-morbidity to look at subsets of BPAD families in a genetic linkage analysis would prove useful in identifying genetic susceptibility regions in both of these disorders. We used BPAD with co-morbid migraine as an alternative phenotype definition in a re-analysis of the NIMH Bipolar Genetics Initiative wave 4 data set. In this analysis we selected only those families in which at least two members were diagnosed with migraine by a doctor according to patients' reports. Nonparametric linkage analysis performed on 31 families segregating both BPAD and migraine identified a linkage signal on chromosome 4q24 for migraine (but not BPAD) with a peak LOD of 2.26. This region has previously been implicated in two independent migraine linkage studies. In addition we identified a locus on chromosome 20p11 with overlapping elevated LOD scores for both migraine (LOD=1.95) and BPAD (LOD=1.67) phenotypes. This region has previously been implicated in two BPAD linkage studies, and, interestingly, it harbors a known potassium dependant sodium/calcium exchanger gene, SLC24A3, that plays a critical role in neuronal calcium homeostasis. Our findings replicate a previously identified migraine linkage locus on chromosome 4 (not co-segregating with BPAD) in a sample of BPAD families with co-morbid migraine, and suggest a susceptibility locus on chromosome 20, harboring a gene for the migraine/BPAD phenotype. Together these data suggest that some genes may predispose to both bipolar disorder and migraine.

Spin injection in the nonlinear regime: band bending effects.

We report on electrical spin-injection measurements into a nonmagnetic semiconductor in the nonlinear regime. For voltage drops across the interface larger than a few mV the spin-injection efficiency decreases strongly. The effect is caused by repopulation of the minority spin level in the magnetic semiconductor due to band bending at the interface.

Evaluation of the simple calculated osteoporosis risk estimation (SCORE) in older Caucasian women: the Rancho Bernardo study.

Osteoporosis is a major health problem in older women. A risk assessment tool, the Simple Calculated Osteoporosis Risk Estimation (SCORE), has been developed to identify postmenopausal women likely to have low bone mass who should be referred for bone densitometry. The objective of this study was to calculate the sensitivity, specificity and predictive values of SCORE in a community-dwelling sample of older women. A total of 1013 postmenopausal Caucasian women aged 44-98 years provided a standard medical history including history of osteoporotic fractures and medication use. Bone mineral density (BMD) was measured at the femoral neck using dual-energy X-ray absorptiometry. In accordance with the SCORE protocol, low BMD was defined as 2 or more standard deviations below the mean BMD in healthy young women. Among these older women (mean age = 72.5 years), 67% had low BMD. Using the recommended SCORE cutpoint of 6, the sensitivity of SCORE was 98% but the specificity was only 12.5%. The positive predictive value (PPV) and negative predictive value (NPV) were 69% and 75%, respectively, meaning that all but 5.5% of the women would be recommended for bone densitometry. Increasing the cutpoint of 11, based on ethnicity and the receiver operating characteristic (ROC) curve, reduced sensitivity to 80% but improved specificity to 46%. The PPV and NPV were 75% and 53%, respectively, meaning that bone scans would not be recommended for 28% of the women. However, 13% of the women with low BMD would be missed. Analyses restricted to women <74 years of age reduced the rate of recommended bone densitometry but increased the number of women with low BMD who would be missed. We conclude that SCORE has limited value as a method for appropriately referring older ambulatory women for bone densitometry.

Serum albumin and bone mineral density in healthy older men and women: the Rancho Bernardo Study.

Serum albumin has been found to be positively correlated with bone mass in small studies of ambulatory men or women with diagnosed osteoporosis. In this study the relation between serum albumin and bone mineral density (BMD) was examined in 1593 white, community-dwelling men and women aged 50-95 years. BMD was determined using single-photon absorptiometry (SPA) at the ultradistal radius and the midshaft radius, and using dual-energy X-ray absorptiometry (DXA) at the hip and spine. Albumin was measured from a fasting blood sample using the Technicon SMA 12 autoanalyzer. Mean albumin levels in both men and women decreased significantly with increasing age. All but four values were within the normal range (3.5-5.0 g/dl). BMD decreased with increasing age at all sites. In both sexes there was weak positive correlation between serum albumin and BMD in the unadjusted model (Pearson's r values < 0.3, p values < 0.005). After age adjustment, however, the relationship was no longer significant (Pearson's r values < 0.05, p values > 0.18). Men and women were divided into three sex-specific categories--osteoporotic, osteopenic and normal--based on World Health Organization criteria in relation to young adult means (normal, BMD > -1 SD; osteopenia, BMD between -1 SD and -2.5 SD; osteoporosis, BMD < -2.5 SD). Mean albumin values did not differ significantly across the three BMD categories in men or women. BMD levels stratified for albumin levels and calcium supplement status (a marker for osteoporosis awareness) also did not differ. Albumin levels were also not associated with a history of low-trauma fractures. In summary, there was no age-independent association between serum albumin within the normal range and low BMD or fractures in community-dwelling healthy older adults. We conclude that previously reported associations most likely reflect inadequate adjustment for the age-related decrease in albumin levels and the selection of very frail osteoporotic subjects.

Probabilistic division systems modeling the generation of mosaic fields.

The explanation of mosaic pattern in chimeric organs analyzed by in situ methods requires modeling of specific hypotheses. The use of computer simulations to achieve this has led to the conclusion that finely variegated mixtures of cell lineage within chimeric tissues does not require extensive cell movement. Cell division models were used to determine the distribution of patch size as mosaic fields are generated. The results establish that these distributions are sensitive to the proportion of the two cell types which comprise the mosaic.

Health in the United States.

On the whole, the American people consider themselves healthy and, according to the major health indicators, they are becoming healthier all the time. The expectation of life at birth is one and one-half times what it was at the beginning of the century. Many of the leading causes of death have experienced significant declines in rates in the last decade. Nevertheless, the minority populations frequently lag behind the white population with respect to health indicators. Prevention in the health field is being stressed through immunization programs and programs to influence individuals to change their habits. Nutrition is playing a larger role in public life; considerable publicity has been given to dietary goals for promotion of good health. The health service industry has grown rapidly. Health care has expanded and its costs have trebled since 1970. In the 1980s, interest will undoubtedly focus on minority populations and health, on how the economically disadvantaged may better be served, on the effects of an aging population on the health care system, and on how life-styles which undermine health care can be changed. The U.S. Surgeon General has established national health goals for the 1980s that will improve the nation's health if they are achieved.

Peripheral plasma levels of oestradiol-17 beta and progesterone in the bitch during the oestrous cycle, in normal pregnancy and after dexamethasone treatment.

Plasma oestradiol-17 beta concentrations in Labradors increased during pro-oestrus to an average maximal concentration of of 79-7 +/- 10-9 (S.D.) pg/ml, and then fell rapidly. In 6/7 bitches the peak occurred within 1 day of oestrus. No consistent changes in plasma oestradiol levels were observed during pregnancy and at parturition and the values were similar to those in late anoestrus. Plasma progesterone levels did not increase markedly during pro-oestrus. At oestrus, progesterone values rose and maximal concentrations, which varied from about 20 to about 55 ng/ml, were reached within a few days of the oestradiol peak. Plasma progesterone decreased in late pregnancy and in one of the three bitches studied in detail low or undetectable levels were reached 10 days before parturition. In the other two bitches an abrupt decrease in progesterone occurred just before parturition. Dexamethasone treatment (2 X 5 mg daily for 10 days) from Day 30 of pregnancy resulted in intrauterine death and resorption of the fetuses in the two bitches studied. Treatment from about Day 45 resulted in the birth of dead fetuses at Days 55 and 59 of pregnancy. The changes in plasma oestradiol levels were very small. No changes in plasma progesterone levels were seen when dexamethasone was given in late pregnancy, but an accelerated decline occurred after treatment in mid-pregnancy.

Demographic implications of the New United States certificates.

To assist in developing uniform reporting of vital events among the fifty states, Puerto Rico, and the Virgin Islands, the United States government prepares standard certificates of birth, fetal death, death, marriage, and divorce. These model forms are revised, with the assistance of the states, approximately every ten years. Revisions are now being prepared by the National Center for Health Statistics which will become effective beginning January 1, 1968. Important new source material for demography will be introduced.Most changes will appear in the Standard Certificate of Live Birth and in the Standard Certificate of Fetal Death. An item on education of father and mother will provide detailed national data on education and fertility. The date of the last live birth to the mother and the date of the last fetal death will provide information on previous pregnancy outcome and on child-spacing. The recording of state file numbers for mates born alive and dead in the same delivery will make it easier to match live birth and fetal death certificates for the preparation of detailed tabulations on multiple births. Several new items related to maternal and child health have also been added. No significent changes were planned for the Standard Certificate of Death.The Standard Certificate of Marriage will include as new items the education of the bride and groom, the date on which the last marriage, if any, ended, and specification of the officiant as a religious or civil official. The Standard Certificate of Divorce or Annulment will obtain information on the education of husband and wife, the approximate date on which the couple separated, the mode of dissolution of the previous marriage, and the total number of living children. It is anticipated that most of the new items will be included in the certificates of all the states. The National Center for Health Statistics will provide detailed tabulations related to these items, beginning with data year 1968.Demographers are making an increased use of vital records and at the same time are extending their contacts with state health departments; in some states collaborative projects have been undertaken. Because of the importance of the source documents, which in some cases have not been exploited fully, demographers should increase their contact with the state vital statistics offices which develop, collect, and process the records. By indicating an interest in vital registration and by making their research needs known, demographers can encourage the acceptance of new concepts and collaborate in the improvement of vital records for demographic research purposes.