Long-term maintenance of efficacy of dapagliflozin in patients with type 2 diabetes mellitus and cardiovascular disease.

AIM: To evaluate the long-term efficacy, safety and tolerability of dapagliflozin versus placebo added to usual care in patients with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). METHODS: Data were pooled from two phase III studies (NCT01031680 and NCT01042977) in high-risk patients (N = 1887) with T2DM and CVD treated with dapagliflozin (10 mg/day) or placebo. Patients completing the double-blind treatment studies (24 weeks) entered one or two sequential double-blind, long-term (LT) extensions of 28 (LT1; n = 1649) and 52 (LT2; n = 568) weeks. RESULTS: Baseline and CVD characteristics were similar in the two groups. Patients entering LT1 and LT2 on dapagliflozin maintained a greater mean reduction in glycated haemoglobin (HbA1c) versus placebo at 52 weeks [LT1, -0.58% (95% confidence interval -0.68, -0.49)] and 104 weeks [LT2, -0.35% (95% confidence interval -0.59, -0.12)]. Mean body weight and systolic blood pressure (SBP) reductions versus placebo were maintained in patients entering LT1 (52 weeks; -2.23 kg and -3.25 mmHg, respectively) and LT2 (104 weeks; -3.16 kg and -2.03 mmHg, respectively). Patients on dapagliflozin had a better three-item composite endpoint of clinical benefit (glycaemia, weight and SBP) compared with placebo at week 24 (LT1, 10.1% vs. 1.1%) and week 104 (LT2, 6.7% vs. 1.4%). Genital and urinary tract infections were more frequent with dapagliflozin than with placebo. Events of hypoglycaemia, renal impairment/failure and volume depletion were similar between groups. CONCLUSIONS: The long-term efficacy of dapagliflozin to maintain reductions in HbA1c, SBP and body weight over 2 years, together with its tolerability profile, make dapagliflozin an appropriate option in high-risk patients with T2DM and CVD.

Dapagliflozin reduces albuminuria in patients with diabetes and hypertension receiving renin-angiotensin blockers.

AIMS: To characterize the effect of dapagliflozin on albuminuria and estimated glomerular filtration rate (eGFR) and to determine whether effects on albuminuria were mediated through changes in glycated haemoblogin (HbA1c), systolic blood pressure (SBP), body weight or eGFR. METHODS: We conducted a post hoc analysis of data pooled from two phase III clinical trials in hypertensive patients with type 2 diabetes (T2DM) on stable angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, randomly assigned to dapagliflozin 10 mg/day or matched placebo. This analysis included only patients with microalbuminuria or macroalbuminuria at baseline. RESULTS: Patients were randomized to receive dapagliflozin 10 mg (n = 167) or placebo (n = 189). Dapagliflozin resulted in greater 12-week reductions in albuminuria compared with placebo: -33.2% [95% confidence interval (CI) -45.4, -18.2]. The reduction in albuminuria was also present after adjusting for age, sex and changes in HbA1c, SBP, body weight and eGFR: -23.5% (95% CI -37.6, -6.3). There was a decrease in eGFR with dapagliflozin versus placebo that was readily reversed 1 week after last dose. No serious renal-related adverse events were observed in any group. CONCLUSIONS: Dapagliflozin was effective in lowering albuminuria in patients with T2DM and hypertension using renin-angiotensin system blockade therapy. Reductions in albuminuria were still present after adjusting for changes in HbA1c, SBP, body weight and eGFR. Dapagliflozin-induced improvements in glycaemic control and reductions in SBP, coupled with other potentially beneficial renal effects, may lead to a reduced long-term renal and cardiovascular risk.

Dual PPAR α / γ Agonism Normalizes Lipoprotein Profile of Renal Dyslipidemia.

Chronic kidney disease (CKD) is characterised by specific lipoprotein abnormalities and insulin resistance. Dual activation of the peroxisome proliferators-activated receptors (PPAR) α and γ can significantly improve insulin sensitivity. The aim of the study was to investigate the effects of a dual PPAR α / γ agonist on lipoprotein abnormalities in patients with CKD. One mg of the dual PPAR α / γ agonist tesaglitazar was given once daily during six weeks to CKD patients, and to healthy subjects. Plasma lipids, apolipoproteins (apo) and discrete lipoprotein subclasses were measured at baseline and end of treatment. In the CKD patients apoA-I increased significantly by 9%, and apoB decreased by 18%. There was an increase of apoC-III in HDL by 30%, and a parallel decrease of apoC-III in VLDL + LDL by 13%. Both the apoB-containing cholesterol-rich and the triglyceride-rich subclasses decreased significantly. With the exception of ApoC-III,all plasma lipids apolipoproteins and lipoprotein subclasses were reduced by treatment down to similar levels as the baseline levels of a healthy group of reference subjects. This study suggests that by improving insulin sensitivity a dual PPAR α / γ agonist has the potential to normalise most of the lipoprotein abnormalities in patients with CKD.

Long-term treatment with the dipeptidyl peptidase-4 inhibitor saxagliptin in patients with type 2 diabetes mellitus and renal impairment: a randomised controlled 52-week efficacy and safety study.

OBJECTIVE: Therapeutic options are limited for diabetes patients with renal disease. This report presents 52-week results from a study assessing the dipeptidyl peptidase-4 inhibitor saxagliptin in patients with type 2 diabetes mellitus (T2DM) and renal impairment. DESIGN: Double-blind study in patients stratified by baseline renal impairment (moderate, severe or end-stage renal disease [ESRD] on haemodialysis) randomised to saxagliptin 2.5 mg once daily or placebo added to other antidiabetic drugs in use at baseline, including insulin. PATIENTS: A total of 170 adults with glycated haemoglobin (HbA(1c) ) 7-11% and creatinine clearance < 50 ml/min or ESRD were randomised and treated. MEASUREMENTS: Absolute changes in HbA(1c) and fasting plasma glucose (FPG) from baseline to week 52 were evaluated using analysis of covariance (ANCOVA) with last observation carried forward. Repeated-measures analyses were also performed. RESULTS: Adjusted mean decrease in HbA(1c) was greater with saxagliptin than placebo (difference, -0.73%, p < 0.001 [ANCOVA]). Reductions in adjusted mean HbA(1c) were numerically greater with saxagliptin than placebo in patients with renal impairment rated as moderate (-0.94% vs. 0.19% respectively) or severe (-0.81% vs. -0.49%), but similar to placebo for those with ESRD (-1.13% vs. -0.99%). Reductions in adjusted mean FPG were numerically greater with saxagliptin in patients with moderate or severe renal impairment. Saxagliptin was generally well tolerated; similar proportions of patients in the saxagliptin and placebo groups reported hypoglycaemic events (28% and 29% respectively). CONCLUSIONS: Saxagliptin 2.5 mg once daily offers sustained efficacy and good tolerability for patients with T2DM and renal impairment.

Saxagliptin improves glycaemic control and is well tolerated in patients with type 2 diabetes mellitus and renal impairment.

AIM: To evaluate the efficacy and safety of saxagliptin vs. placebo in patients with type 2 diabetes mellitus (T2DM) and renal impairment. METHODS: In this multicentre, randomized, parallel-group, double-blind, placebo-controlled study, patients with glycated haemoglobin (HbA1c) 7-11% and creatinine clearance <50 ml/min were stratified by baseline renal impairment (moderate, severe or end-stage on haemodialysis), and randomized (1 : 1) to saxagliptin 2.5 mg once daily or placebo for 12 weeks. Oral antihyperglycaemic drugs and insulin therapy present at enrolment were continued throughout the study. The absolute change in HbA1c from baseline to week 12 (primary efficacy end-point) was analysed using an analysis of covariance model with last observation carried forward methodology. RESULTS: A total of 170 patients were randomized and treated. The adjusted mean decrease from baseline to week 12 in HbA1c was statistically significantly greater in the saxagliptin group than in the placebo group; the difference between treatments was -0.42% (95% confidence interval: -0.71 to -0.12%, p = 0.007). Adjusted mean HbA1c decreases from baseline to week 12 were numerically greater with saxagliptin than with placebo in the subgroups of patients with moderate (-0.64 vs. -0.05%) and severe (-0.95 vs. -0.50%) renal impairment. HbA1c reductions were similar between saxagliptin and placebo in the subgroup with end-stage renal disease on haemodialysis (-0.84 vs. -0.87%). Saxagliptin was generally well tolerated; incidences of adverse events and hypoglycaemic events were similar to placebo. CONCLUSIONS: Saxagliptin 2.5 mg once daily is a well-tolerated treatment option for patients with inadequately controlled T2DM and renal impairment.

Saxagliptin is non-inferior to glipizide in patients with type 2 diabetes mellitus inadequately controlled on metformin alone: a 52-week randomised controlled trial.

AIM: To assess the efficacy and safety of saxagliptin vs. glipizide as add-on therapy to metformin in patients with type 2 diabetes mellitus and inadequate glycaemic control on metformin alone. METHODS AND PATIENTS: A total of 858 patients [age ≥ 18 years; glycated haemoglobin (HbA(1c) ) > 6.5 - 10.0%; on stable metformin doses ≥ 1500 mg/day] were randomised 1 : 1 to saxagliptin 5 mg/day or glipizide up-titrated as needed from 5 to 20 mg/day for 52 weeks. The primary objective was to assess if the change from baseline HbA(1c) achieved with saxagliptin plus metformin was non-inferior to glipizide plus metformin. RESULTS: The per-protocol analysis demonstrated non-inferiority of saxagliptin vs. glipizide; adjusted mean changes from baseline HbA(1c) were -0.74% vs. -0.80%, respectively; the between-group difference was 0.06% (95% CI, -0.05% to 0.16%). Treatment with saxagliptin vs. glipizide was associated with a significantly smaller proportion of patients with hypoglycaemic events (3.0% vs. 36.3%; p < 0.0001) and a divergent impact on body weight (adjusted mean change from baseline -1.1 kg with saxagliptin vs. 1.1 kg with glipizide; p < 0.0001). There was a significantly smaller rise in HbA(1c) (%/week) from week 24 to 52 with saxagliptin vs. glipizide (0.001% vs. 0.004%; p = 0.04) indicating a sustained glycaemic effect beyond week 24. Excluding hypoglycaemic events, the proportion of patients experiencing adverse events (AEs) was similar (60.0% saxagliptin vs. 56.7% glipizide); treatment-related AEs were less common with saxagliptin vs. glipizide (9.8% vs. 31.2%), attributable to the higher frequency of hypoglycaemia in glipizide patients. Discontinuation rates resulting from AEs were similar (∼4%). CONCLUSION: Saxagliptin plus metformin was well tolerated, provided a sustained HbA(1c) reduction over 52 weeks, and was non-inferior to glipizide plus metformin, with reduced body weight and a significantly lower risk of hypoglycaemia.

Prevalence of metabolic syndrome in an elderly Swedish population.

The prevalence of the metabolic syndrome in different elderly European populations has not been well studied. The aim of this study was to measure the prevalence of metabolic syndrome, as well as its individual components, in an elderly Swedish cohort. A random sample of 778 individuals (372 men and 406 women) was selected from a 70-year-old cohort in the H70 study, a gerontological and geriatric population study carried out in Gothenburg, Sweden. The study included medical and treatment history assessments, laboratory procedures and physical examinations to determine the presence of each of the five components of the metabolic syndrome as defined by the National Cholesterol Education Program Adult Treatment Panel III. Of the 508 adults (243 men and 265 women) included in the study, 22.6% had metabolic syndrome. The prevalence was higher in men (26.3%) than in women (19.2%). One third of the total sample had at least one of the five risk factors for metabolic syndrome. High blood pressure (> or =130/85 mmHg or use of antihypertensive/diuretic medication) was the most prevalent risk factor in both men (68.3%) and women (50.2%), while abdominal obesity was the overall second most common risk factor (27.2% of men and 42.7% of women). The prevalence of high fasting plasma glucose (> or =110 mg/dl or use of antidiabetic medication) was 29.0% in men and 19.1% in women. Metabolic syndrome was prevalent in a significant proportion of this elderly Swedish population, highlighting the underdiagnosis of a condition that is important to treat.

Tesaglitazar, a novel dual peroxisome proliferator-activated receptor alpha/gamma agonist, dose-dependently improves the metabolic abnormalities associated with insulin resistance in a non-diabetic population.

AIMS/HYPOTHESIS: Insulin resistance is associated with abnormalities in lipid and glucose metabolism, which are major components of metabolic syndrome and risk factors for vascular disease. This study examined the effect of tesaglitazar (Galida), a novel, dual-acting peroxisome proliferator-activated receptor alpha/gamma agonist, on lipid and glucose metabolism in patients with evidence of insulin resistance. METHODS: A 12-week, multicentre, randomised, double-blind, placebo-controlled, dose-finding study compared the efficacy and safety of oral tesaglitazar (0.1, 0.25, 0.5 and 1.0 mg/day) and placebo in 390 non-diabetic patients with hypertriglyceridaemia (plasma triglyceride concentration >1.7 mmol/l) and abdominal obesity (waist-to-hip ratio >0.90 for men and >0.85 for women). RESULTS: A 1.0-mg dose of tesaglitazar reduced fasting triglycerides (the primary endpoint) by 37% (95% CI: -43% to -30%; p<0.0001), non-HDL-cholesterol by 15% (95% CI: -20% to -10%; p<0.0001) and NEFA by 40% (95% CI: -51% to -27%; p<0.0001), and increased HDL-cholesterol by 16% (95% CI: 8 to -24%; p<0.0001). At the end of treatment there was a dose-dependent increase in patients with pattern A LDL particle diameter (40% at baseline vs 87% at 12 weeks for tesaglitazar 1.0 mg). Tesaglitazar produced significant reductions in fasting insulin concentration (-35%; p<0.0001) and plasma glucose concentration (-0.47 mmol/l; p<0.0001). Respiratory infection and gastrointestinal symptoms were the most common adverse events and were similarly frequent in all groups. CONCLUSIONS/INTERPRETATION: Tesaglitazar was well tolerated and produced significant, dose-dependent improvements in lipid and glucose metabolism and insulin sensitivity. Tesaglitazar may have the potential to prevent vascular complications and delay progression to diabetes in these patients.

Percent body fat estimation from skin fold thickness in the elderly. Development of a population-based prediction equation and comparison with published equations in 75-year-olds.

OBJECTIVE: To develop a prediction equation for percent body fat (BF%) from skin fold thickness in a random sample of free-living 75-year-olds and to compare with published equations for the elderly. SETTING: Goteborg part of the Nordic Research on Aging (NORA) study in 1991/92. SUBJECTS & METHODS: Anthropometric measurements were performed in 286 participants (125 males,161 females) and body composition was estimated by four compartment model (4C) from total body water (TBW) and total body potassium (TBK) in every alternative subjects. BF % predicted from skin fold thickness (BFSF) was validated against BF % estimated from 4C model (BF4C) and was compared with BFSF and BF % predicted from equations by Durnin and Womersley, 1974 (BFDW), Deurenberg et al.,1989 (BFPD) and, Visseretal.,1994(BFMV), respectively. RESULTS: The BFSF correlated well with BF4C (r = 0.86, SEE = 4.05). Compared to BF4C, both BFPD and BFMV over estimated BF % by 3.26 and 3.63 in males and 9.56 and 9.23 in females, respectively. BFDW underestimated BF % in females by 1.06 and overestimated by 3.12 in males. BFSF showed best agreement with BF4C, where the 95 % of differences lie between +/- 7.4 in males and +/- 8.7 in females, respectively. CONCLUSION: BF % predicted from skin fold thickness correlated well with estimated BF % in 75-year-olds. Different prediction equations gave different values for BF % and population-specific prediction equations seem preferable in the elderly population.

[The best way to learn consultation skills is through tutoring in clinical situations. Experiences from a course in Gothenburg]. / Konsultationen lärs bäst genom handledning i ett kliniskt sammanhang. Erfarenheter från en kurs i Göteborg.

In 1993, a ten-week course called 'Consultation knowledge' started in undergraduate medical education in Göteborg. At the beginning of clinical clerkships students learn communication skills, clinical examination skills and documentation in a clinical context. Tutors were educated and supervised and also participated in the practical examination. Feedback from students was obtained from written evaluations and analysed. Reports from teachers' follow-up meetings were also used. Feedback data functioned as an instrument in evaluation and for development of the course. Learning objectives and core content were made clear by refining the examination and by structured support to tutors. The advantages of repeated consultation skills training in the clinical curriculum are discussed.

Seroprevalence of antibodies to Chlamydia pneumoniae in elderly people: a two-decade longitudinal and cohort difference study.

A gerontological population of 178 men and 249 women was investigated regarding the prevalence of antibodies specific to Chlamydia pneumoniae. A longitudinal substudy was carried out on 22 men and 44 women, age range 70-90 y. Antibodies specific to C. pneumoniae were common. Men had higher prevalences and higher antibody levels than women. More than half of the individuals in the longitudinal study had significant IgG and/or IgA titre changes (> or = 4-fold) between the ages of 70 and 90 y, suggesting that C. pneumoniae infections are common in the elderly population. This is of importance for the treatment of respiratory infections in elderly people.

Body composition, smoking and physical activity in 75-year-old men and women in three Nordic localities with special reference to diagnosed diseases.

PURPOSE: To describe and compare anthropometric characteristics among populations of 75-year-olds in three Nordic localities and to investigate possible relationships with chronic heart disease (CHD), chronic lung disease (CLD), diabetes mellitus, arthrosis and life-style factors such as smoking and physical activity. MATERIAL AND METHODS: Anthropometric data were measured in 104 men and 191 women in Jyvaskyla (Finland), 196 men and 209 women in Glostrup (Denmark) and in 127 men and 167 women in Goteborg (Sweden). Variables assessed were body height, body weight, BMI, waist/hip ratio, skinfolds from several sites and percent body fat by bioelectrical impedance. The diagnosis of diseases were made by a physician based on the individual's medical history, drugs and medical examination. Physical activity was recorded by self-rating. RESULTS: Men in Goteborg were taller and had a higher body weight while there was no difference in BMI among the men. Among women, those in Goteborg were tallest, while those in Jyvaskyla had the highest body weight, BMI, percent of body fat and waist/hip ratio. Biceps and triceps skinfolds were highest in men from Goteborg, while in women triceps and subscapular skinfolds were highest in those from Jyvaskyla. CHD was most common in those from Jyvaskyla, and women with CHD had a higher body weight, BMI and lean body mass in all three localities. Lean body mass was lower in men and women with CLD and women with CLD were also shorter, with a lower body weight, BMI, and percent body fat. Diabetes mellitus was associated with a higher body weight, BMI, percent body fat and lean body mass in women, but not in men. Both men and women with arthrosis had a higher BMI, while smoking was only associated with CHD in those from Jyvhskyla. In men with CHD the proportion of persons with low physical activity was higher in all three localities. The physical activity was also lower among men with CLD and diabetes mellitus in Goteborg and Glostrup. CONCLUSION: There were anthropometric differences among 75-year-olds in the three Nordic localities. CHD and CLD were associated with various anthropometric variables. These findings may reflect either cause and effect relationships between diseases and anthropometric characteristics or differences in life-style factors influencing morbidity.

Auditory function in 70- and 75-year-olds of four age cohorts. A cross-sectional and time-lag study of presbyacusis.

Within the framework of the gerontological and geriatric population studies in Göteborg, Sweden, 473 elderly persons were examined using pure-tone audiometry in two recent cohorts. The aim of this study was to present cross-sectionally acquired hearing data in these contemporary groups aged 70 and 75. Another objective was to compare hearing function at the same age over the last two decades (time-lag study) in three 70-year-old cohorts and three 75-year-old cohorts. The largest time-lags were 14 years (75-year-olds) and 21 years (70-year-olds). The most recently tested cohort of 70-year-olds, studied in 1992, demonstrated median pure-tone averages (PTA: 0.5, 1 and 2 kHz) of 20.2 dB HL in the left ear of men and 18.2 dB HL in women. The left median pure-tone thresholds at 4 kHz were 56.0 dB HL in men and 34.7 dB HL in women. Hearing acuity in 70-year-olds was not demonstrated to have changed in any consistent fashion over a 21-year time-lag. For the most recently evaluated 75-year-olds, the median PTA in the left ear was 27.3 dB HL in men and 21.6 dB in women. The left median 4 kHz threshold was 67.3 in the male group and 45.5 dB HL in the female group. Hearing in 75-year-olds over a time-lag of 14 years demonstrated somewhat better pure-tone thresholds predominantly in the men's better ear in the earliest cohort when compared to the cohort tested in 1990-91. However, there were no consistent differences of pure-tone thresholds between these age cohorts, except for the intermediate cohort 2, in which the men had generally worse hearing. Thus, there was no apparent evidence of changes of the auditory function in elderly of the same age over the last two decades. Gender-specific dissimilarities in annual pure-tone threshold deterioration between the ages of 70 and 75 were found and are discussed.

Helicobacter pylori serology in elderly people: a 21-year cohort comparison in 70-year-olds and a 20-year longitudinal population study in 70-90-year-olds.

AIMS: (i) to compare Helicobacter pylori serology in two 70-year-old cohorts in Gothenburg, Sweden, born 21 years apart, (ii) to study H. pylori serology in a 70-year-old cohort over 20 years. POPULATION AND METHOD: H. pylori serology at the age of 70 was investigated in 98 men and 132 women born in 1901/02 and in 77 men and 113 women born in 1922. In 21 men and 40 women Helicobacter serology was monitored longitudinally with examinations at 70, 81, and 90 years of age. The analyses were performed on frozen samples by use of an in-house enzyme immunoassay with a sensitivity of 0.99, specificity of 1.00 and positive and negative predictive values of 0.96 and 1.00, respectively. Absorbance values <0.500 were interpreted as negative; values of > or = 0.700 were interpreted as positive, and values in between as inconclusive. RESULTS: The 70-year-old cohort, born in 1922, showed a significantly lower proportion of subjects with positive H. pylori serology in both men (57.1% vs 80.6%) and women (48.7% vs 75.8%) compared with 70-year-olds born in 1901/02. There were no significant sex differences in either cohort. No longitudinal increase or decrease could be demonstrated in those who were examined at 70, 81 and 90 years of age. CONCLUSIONS: The difference in H. pylori prevalence between the two cohorts may reflect a rapid change in socio-economic conditions in Sweden during this 20-year period.

Postural balance and self-reported functional ability in 75-year-old men and women: a cross-national comparative study.

OBJECTIVE: To study postural balance in relation to self-reported functional ability (mobility and ADL) and general physical activity in elderly men and women living in three different Nordic environments. PARTICIPANTS: A random sample of 448 men and 556 women from among the 75-year-old residents in Glostrup, Denmark, and Göteborg, Sweden, and all the residents of relevant age (127 men and 261 women) in Jyväskylä, Finland. MEASUREMENTS: Assessment of postural balance with eyes open and closed using a piezoelectric force platform. A structured interview on self-reported functional ability and physical activity. An in-laboratory medical examination. RESULTS: In spite of some differences in balance between the groups studied (better results in women compared with men and, to some extent, better results in the participants from Denmark and Finland than in those from Sweden), the performance in the balance tests was similarly associated with functional ability within all groups. The subjects reporting no need of help in performing the ADL and mobility functions performed significantly better in the balance tests. These differences were seen more clearly in the control of anteroposterior movement of center of forces than in the mediolateral direction. The performance in the balance tests was also significantly better among the subjects reporting a higher level of general physical activity than in their less active counterparts. Physical activity and than in their less active counterparts. Physical activity and certain long standing illnesses modified significantly the relationship between postural balance and ADL-performance. When these factors were analyzed simultaneously, the role of balance as a predictor of ADL-performance largely disappeared. CONCLUSIONS: The results suggest that good balance is one of the prerequisites of performance without difficulty in mobility and ADL functions. Physical exercise may help to maintain balancing abilities in old age; good balance, in turn, may also enable a physically active way of life. The associations of balance with functional ability and physical activity were independent of sex and locality. The results also support the validity of static stabilometry as a tool for evaluating threats to functional limitations in older subjects.

Item bias in self-reported functional ability among 75-year-old men and women in three Nordic localities.

The purpose of this article is to analyse item bias in a measure of self-reported functional ability among 75-year-old people in three Nordic localities. The present item bias analysis examines whether the construction of a functional ability index from several variables results in bias in relation to geographical locality and gender. Information about self-reported functional ability was gathered from surveys on 75-year-old men and women in Glostrup (Denmark), Göteborg (Sweden) and Jyväskylä (Finland). The data were collected by structured home interviews about mobility and Physical activities of daily living (PADL) in relation to tiredness, reduced speed and dependency and combined into three tiredness-scales, three reduced speed-scales and two dependency-scales. The analysis revealed item bias regarding geographical locality in seven out of eight of the functional ability scales, but nearly no bias in relation to gender in the combined data. The conclusion is that only one tiredness-scale (Lower Limb-T), one reduced speed-scale (Lower Limb-S) and the two dependency-scales (PADL-H and Mob-H) can be proposed for use in comparisons between the three localities (with removal of one or more items).

Postural balance and its sensory-motor correlates in 75-year-old men and women: a cross-national comparative study.

BACKGROUND: There are no earlier cross-national comparative studies analyzing the functions of the posture control mechanisms and its sensory-motor correlates in elderly subjects. We investigated whether there are differences in balance between elderly subjects living in different geographical areas, and analyzed the sensory-motor associates of balance in men and women separately. METHOD: Using a force platform method, the functioning of the posture control system under three standardized conditions (normal standing, eyes open; normal standing, eyes closed; and tandem standing, eyes open) was studied among samples of 75-year-old residents in three Nordic localities, namely Glostrup in Denmark, Göteborg in Sweden, and Jyväskylä in Finland. The associations of the variables describing performance in each test with other sensory and motor functions were studied using correlation analyses and multivariate regression models. RESULTS: Differences between the populations were observed in both tests with visual control, favoring the participants from Glostrup and Jyväskylä compared with those from Göteborg. However, only minor differences between the subjects from different localities were observed in the test performed with the eyes closed. In all localities there was a primary sex difference in favor of the women which, however, mainly disappeared when body height was taken into the analyses as a covariate. A good performance in the balance tests (body height-adjusted values) was associated with good visual acuity, low vibrotactile thresholds, and high psychomotor speed. Also, isometric muscle strength, especially hand grip and body extension, was positively associated with good performance in the balance tests. Among the women, a poorer balance was observed in women with a smaller body mass. The results of the multivariate analyses showed that among the men, the most important predictors of good performance in the balance tests were low vibrotactile threshold on the foot, high isometric hand grip strength, and low body stature. Among the women, the most important predictors were low body stature, high body mass, high isometric body extension strength, and high psychomotor speed. However, only a small proportion of the variance in balance (about 13% in the men and 11% in the women) could be explained by the help of these factors. CONCLUSIONS: As the same procedure was applied to the analysis of postural balance, some differences between the populations living in different localities could be detected in some of the tests. The better performance of the women in the balance tests may partly be explained by anthropometric factors, especially differences in body height. There may also be differences in sensory-motor associates of balance in elderly men and women. On the basis of the associations observed, it is difficult to explain the differences in balance between the sexes or subjects living in different localities. Within the sexes, only a small proportion (10-13%) of the variation in balance during normal standing with eyes open could be explained by the factors included in the study.

Dental state and functional capacity in 75-year-olds in three Nordic localities.

The aims of the study were to compare dental state in three Nordic 75-year-old populations and to evaluate dental state as a marker of functional ageing. The study is part of a Nordic comparative study of 75-year-olds in Glostrup, Göteborg and Jyväskylä. In the dental studies, 411 subjects in Denmark, 308 in Sweden and 310 in Finland participated. Odontological history was obtained from interviews. Other methods, which are described elsewhere, were used to measure various functional parameters. In Göteborg, 23% of the 75-year-olds reported they were edentulous and 27% that they had more than 20 of their own teeth. The corresponding figures in Glostrup were 45% and 15% and in Jyväskylä 58% and 9%, respectively. In all three localities, economic factors and lifestyle factors, such as tobacco smoking, low physical activity and low social activity, were significant predictors for impaired dental health. The number of teeth was significantly associated with, for example, spirometry parameters, reaction time, body extention and body flexion in males. In females, significant associations were obtained with spirometry parameters, reaction time, handgrip, body extension and body flexion. Internordic differences regarding dental state were obvious. Dental state was associated with functional capacities. We suggest that dental state is a marker of functional capacity in elderly populations.

Body composition and the aged: what needs to be measured?

Within the gerontological and geriatric population studies in Gothenburg, Sweden, body composition studies have been performed with a four-compartment model (using whole-body potassium 40 counting and dilution of isotope labelled water) for two decades, the impedance method for some years and total body nitrogen determination by in vivo neutron activation technique for the last few years. Examples are given from a longitudinal study in 70-year-olds followed at the ages of 75, 79 and 81 years, and from a recent study of 75year-olds.