Aerobic fitness predicted by demographics, anthropometrics, health behaviour, physical activity and muscle fitness in male and female recruits entering military service.

INTRODUCTION: The physical and mental training load can be high during military service. Therefore, tailored preconditioning programmes based on assessment of physical fitness could increase readiness for military service, especially among those ones with lower baseline fitness level. The purpose of present study was to investigate how self-assessed health behaviour, physical activity and muscle fitness can predict physical fitness in young male and female military cohorts. METHODS: Demographics, health behaviour and daily physical activity preceding military service were surveyed by a questionnaire. Thereafter, physical fitness was assessed during the military service by the tests of 12 min running, 1 min push-ups and sit-ups. Explosive power of the lower extremities was studied by maximal standing long jump. Measurements of body anthropometry consisted of body mass, height, and waist circumference. RESULTS: The two strongest individual predictors of objectively measured running distance in 12 min were self-reported physical activity and physical readiness in both men and women. Self-reported physical activity, readiness for military service, sitting time, education, smoking and body anthropometrics together explained 52% of the variance in the 12 min running test result (R2=0.52, mean absolute percentage error (MAPE) 8.8%, mean absolute error (MAE) 207 m) in men, while for women the predictive values were weaker. Addition of muscle fitness results to the adjusted regression model further improved the model, which explained 59% of the variance in the 12 min running tests result of male conscripts (R2=0.59, MAPE 7.8%, MAE 181 m). CONCLUSION: In the present study, self-reported physical activity, muscle fitness, physical readiness for military service, sitting time, education, smoking and body anthropometrics predicted inadequately the measured endurance capacity among recruits. The present questionnaire-based variables do not accurately predict physical fitness of recruits and thus, they are not either suitable for practical use for preconditioning programmes or preselection before entering the military service.

Long-term skeletal consequences of childhood acute lymphoblastic leukemia in adult males: a cohort study.

OBJECTIVE: Long-term health sequelae of childhood-onset acute lymphoblastic leukemia (ALL) remain largely unknown. Low bone mineral content (BMC) and bone mineral density (BMD) are recognized complications, but it is unknown whether these persist until adulthood. We evaluated skeletal characteristics and their association with ALL therapy in long-term male ALL survivors. DESIGN: This cross-sectional cohort study included 49 long-term male ALL survivors and 55 age-matched healthy males. METHODS: BMD and compression fractures were assessed by dual-energy X-ray absorptiometry; blood biochemistry was obtained for parameters of calcium homeostasis. RESULTS: The ALL survivors (median age 29 years, range 25-38 years), assessed 10-38 years after ALL diagnosis, had lower lumbar spine (P<0.001), femoral neck (P<0.001), and whole-body (P=0.017) BMD than expected based on normative values. When compared with the controls (median age 30 years, range 24-36 years), the ALL survivors had lower lumbar spine BMC (P=0.014), lower whole-body BMC (P<0.001), and lower whole-body BMD (P<0.001), but the differences were partly explained by differences in height. Altogether, 20% of the ALL survivors had spinal compression fractures, but these were equally prevalent in the controls. Males diagnosed with ALL before age 5 years had significantly lower BMD values. Other recognized risk factors included untreated hypogonadism, vitamin D deficiency, hypophosphatemia, low IGF-binding protein-3, and low physical activity. CONCLUSIONS: At young adulthood, long-term male ALL survivors have significantly reduced BMC and BMD and a high prevalence of spinal compression fractures. Careful follow-up and active treatment of the recognized risk factors are warranted.

Predictors of perceived togetherness in very old men and women: a 5-year follow-up study.

Although a considerable amount of research has been carried out on older adults' social ties, most of it has focused on quantitative aspects and on cross-sectional samples. In this study, the subjective aspect of social interaction is described by the concept of perceived togetherness. The aim of this study was to examine the extent to which different factors predict perceived togetherness in men and women over a 5-year period. It also addresses the question of whether it is possible to identify different subgroups in perceived togetherness. The data were collected with structured interviews and laboratory tests from 225 elderly people at ages 80 and 85. The results showed that the predictors of perceived togetherness partly differed between sexes as well as within the groups of males and females. Predictors common to both genders were contacts with friends, less depressive symptoms, higher education level and better coping with instrumental activities of daily living (IADLs). The findings indicated the importance of friends. Widowhood and self-rated health were predictors in women but not in men. Moreover, there appeared to be two subgroups of women and men in perceived togetherness; these were labeled "socially embedded", "socially isolated", "socially active" and "solitary". The results indicate diversity in perceived togetherness and its predictors. More attention should be paid to individual differences in order to prevent loneliness and to promote older adults' well-being.

The effect of oxide thickness on osteoblast attachment and survival on NiTi alloy.

NiTi alloy is used in various medical applications and the surface titanium oxide layer produced naturally or enhanced artificially has been thought to offer a protecting film against allergic and toxic effects of nickel (Ni). In this study, we investigated the effect of different oxide layer thicknesses on the survival and attachment of osteoblastic cells (ROS-17/2.8). AFM, X-ray diffraction and electrical resistance measurements were used to analyze the surface properties of oxidized NiTi samples and the effect of oxidation on material properties. The results clearly showed that straight correlation between oxide thickness and cellular well-being cannot be maid. However, the different thicknesses of oxide layer on NiTi had surprising impacts on cellular responses and also to the properties of the metal alloy.

Activity as a predictor of mental well-being among older adults.

This eight-year follow-up study examines the roles of physical and leisure activity as predictors of mental well-being among older adults born in 1904-1923. As part of the Evergreen project, 1224 (80%) persons aged 65-84 years were interviewed at baseline (1988), and 663 (90%) persons in the follow-up (1996). Mental well-being factors including depressive symptoms, anxiety, loneliness, self-rated mental vigour and meaning in life were constructed using factor analysis. The predictors of mental well-being included physical and leisure activity, mobility status and number of chronic illnesses. We used a path analysis model to examine the predictors of mental well-being. At baseline, low number of chronic illnesses, better mobility status and leisure activity were associated with mental well-being. Baseline mental well-being, better mobility status and younger age predicted mental well-being in the follow-up. Explanatory power of the path analysis model for the mental well-being factor at baseline was 19% and 35% in the follow-up. These findings suggest that mental well-being in later life is associated with activity, better health and mobility status, which should become targets for preventive measures.

Associations between loneliness, depressive symptoms and perceived togetherness in older people.

This study explores the associations of loneliness with depressive symptoms in a five-year follow-up and describes how the six dimensions of perceived togetherness explain loneliness and depressive symptoms at baseline. The data were collected on 207 residents of Jyväskylä, central Finland, who at baseline in 1990 were aged 80; and 133 residents who at follow-up in 1995 were aged 85. Loneliness was assessed using a questionnaire item with four preset response options, perceived togetherness using the Social Provisions Scale, and depressive symptoms using the CES-D scale. A recursive structural equation model showed that in women but not in men, depressive symptoms predicted more experiences of loneliness. Those who were lonely were more depressed (CES-D score 16 or over) and experienced less togetherness than those who were not. Loneliness was explained by reliable alliance, social integration and attachment; and depressive symptoms were explained by guidance, reassurance of worth, reliable alliance and attachment. A common feature in both loneliness and depressive symptoms was a lower level of perceived emotional togetherness in social interaction.

The phase state of NiTi implant material affects osteoclastic attachment.

In the present work, the responses of mature osteoclasts cultured on austenite and martensite phases of NiTi shape memory implant material were studied. We used the sensitivity of osteoclasts to the underlying substrate and actin ring formation as an indicator of the adequacy of the implant surface. The results showed osteoclasts with actin ring on both NiTi phases. However, significantly more osteoclasts were present on the austenitic NiTi than on the martensitic NiTi. We also analyzed the surface free energy of the samples but found no significant difference between austenite and martensite phases. The results revealed that osteoclasts tolerated well the austenite phase of NiTi. The chemically identical martensitic NiTi was not as well tolerated by osteoclasts (e.g., indicated by diminished actin ring formation). This leads to the conclusion that certain physical properties specific to the martensitic NiTi have an adverse effect to the surviving of osteoclasts on this NiTi phase. These results confirm that mature, authentic osteoclasts can act as cell probes in experiments concerning aspects of biocompatibility of bone implant materials.

The association of socio-economic factors with physical and mental capacity in elderly men and women.

The association of socio-economic factors with functional capacity has received less research attention than their association with diseases and mortality. However, functional capacity is an important measure of health and independence in the elderly. This study explores the associations of socio-economic factors with physical and mental capacity as measured in laboratory tests and on the basis of self-report. The data were drawn from the Evergreen project, comprising all persons aged 75 (N=388) and 80 (N=291) in Jyväskylä, central Finland. Women with a higher level of education showed better functional capacity on all indicators, among men higher education was only associated with better vital capacity and cognitive capacity. Better perceived financial situation was associated with better functional capacity in both men and women. The association between socio-economic factors and functional capacity remained even when the number of chronic diseases was controlled for. The results lend support to the assumption that socio-economic factors are associated with physical and mental capacity in elderly people.

Changes in intensity of physical exercise as predictors of depressive symptoms among older adults: an eight-year follow-up.

BACKGROUND: Epidemiological research suggests that regular physical activity may be associated with reduced depressive symptoms. The present study examines the predictive value of physical exercise in relation to depressive symptoms among samples of adults aged 65+ during an 8-year period. METHODS: The subjects (N = 663) who participated both at the baseline (1988) and the follow-up (1996) interviews were selected for the analyses. The dependent variable depressive symptoms was assessed by the Finnish modified version of Beck's 13-item depression scale. The independent variable was the intensity of physical exercise. RESULTS: The intensity of physical exercise decreased among the older men and women. Those who had reduced their intensity of physical exercise during the 8 years reported more depressive symptoms at the follow-up than those who had remained active or increased their physical activity. Depressive symptoms were predicted by the intensity of baseline physical exercise, earlier depressive symptoms, older age, gender, having three or more chronic somatic conditions, and difficulties in performing ADL activities. CONCLUSIONS: Age-related decrease in the intensity of physical exercise increases the risk of depressive symptoms among older adults. This calls for effective measures in maintaining and supporting an adequate level of physical exercise among the aging population.

Improved laboratory test selection and enhanced perception of test results as tools for cost-effective medicine.

Inconsistencies in the way physicians perceive and handle identical laboratory results have untoward effects on morbidity, mortality and cost of medical care. In this context, the selection of suitable tests to answer definite clinical questions, and the manner in which laboratory results are presented have great impact on the action taken by the clinician. This review addresses preferred methods to improve laboratory test selection, and examines methods that more effectively convey laboratory results to clinicians. It is anticipated that refined selection of tests, and presentation of the test results in a configuration that is easily perceived by the clinician, will facilitate interpretation of laboratory reports. Furthermore, any measures that promote the application of laboratory information in medical practice improve economics at the laboratory-clinical interface. The presently described methods to optimize test selection and interpretation are: likelihood ratios to provide estimates of the ability of a test to identify a clinical condition; consensus- and discriminant function-analysis to estimate the performance of tests in diagnosing a particular disease or condition; receiver operating characteristic (ROC) curves to assess discrimination capabilities. The methods which improve test result perception are expression of results as multiples of the upper normal limit, utilizing signal strength to provide prognostic probabilities, and presentation of results in graphic forms that display mutually interrelated functions, with a specific cluster of results being highly suggestive of a given condition. In addition, we discuss application of expert systems to provide rules based on knowledge and experience to analyze results of tests and suggest diagnosis and action, including additional tests when required. It is anticipated that judicious utilization of laboratory services by application of the reviewed methodologies will help to achieve medically justified responses at a lower cost and help to achieve a proper balance between cost of tests and their clinical usefulness.

Depressed mood among the elderly in Jyväskylä. A five-year follow-up.

The aim of this article is to describe the changes that occurred in depressive symptomatology over a five-year period among 75- and 80-year old residents of Jyväskylä. It also addresses the question of whether the mood disturbance detected is a permanent phenomenon or whether it has a more episodic nature. In both follow-up cohorts, depressed people were interviewed to find out how the elderly themselves experienced depression and to assess the validity of the CES-D self-rating scale in measuring depressive symptomatology. The purpose of the study was also to find out if depression was predictive for survival. During the five-year follow-up the mean score describing depressed mood (CES-D total scale) did not significantly change in any age group or gender, nor did the mean score of those who died during the follow up differ significantly from the core of the survivors. The mean score of the CES-D subscale Lack of well-being increased among 80-year old women over a five-year follow-up period and those who died had a significantly lower well-being score than those who survived. More than half of the interviewees were classified depressed in both age-cohorts in both examination times. Almost all those elderly people whose score indicated depressiveness in the second examination confirmed that the diagnoses of depressed mood based on the CES-D scale was correct. The higher the CES-D score, the more frequent and/or the more difficult were the problems mentioned in their narratives of depression. Compared with the situation at baseline, the proportion of men and women aged 80 who reported loneliness increased significantly during the follow-up.

Laboratory cost management.

Laboratory cost management deals with the economical use of laboratory resources such as capital, equipment and manpower. Cost analysis is a tool for cost management, by means of which the laboratory manager can properly set priorities, choose appropriate test procedures, set personnel policies and make better investments of his resources. This article sets out some important aspects of cost analysis, such as the construction of cost curves, the factors that enter into cost analysis, the context in which cost analysis is used, and the limitations of this type of analysis.

Depressive symptoms in late life : Results from a study in three Nordic urban localities.

The prevalence and correlates of depressive symptoms among 75-year-olds were examined in three Nordic urban localities: Gothenburg, Sweden (n=446), Jyväskylä, Finland (n=382) and Glostrup, Denmark (n=541). Depressive symptomatology was assessed with the Center for Epidemiologic Studies Depression Scale (CES-D). Prevalence figures for depressiveness seemed to be somewhat higher in Jyväskylä than in the two other localities. Women had more depressive symptoms than men in all three areas. The lowest mean score was recorded for Danish men and the highest level of symptoms in Finnish women. The associations discovered in this Nordic comparative study between demographic characteristics and depressive symptoms are very similar to the findings of earlier studies: male sex, being married, a high level of education, and a good financial situation seemed to afford 'protection' against depressiveness. Morbidity and poor self-rated health showed a clear correlation with frequent depressive symptoms, as did loneliness variables describing the quality or the lack of human relations.

Factors related to carrying out everyday activities among elderly people aged 80.

The study was based on an epidemiological model in which performing activities of daily living (ADL) was the dependent variable. Variation in performing was explained by physical and mental health, and by physical performance. The population consisted of all 80-year-old residents (N = 291) of the city of Jyväskylä in central Finland; 90% of them agreed to take part in the interviews at home, while 72% took part in the laboratory examinations to determine health status and functional capacity. Difficulties in at least some PADL (Physical Activities of Daily Living) tasks were reported by 86.5% of the men, and 87.2% of the women; none said they could perform all IADL (Instrumental Activities of Daily Living) tasks without difficulty. Physical performance (grip strength and stair mounting test in men, and stair mounting test, balance, and upper extremity function test in women) and visual acuity showed a significant association with ADL performance both in men and in women. In addition, depressive symptoms in women, and cognitive capacity in men were associated with both PADL and IADL, and ADL performance, respectively. In the search for pathways to reduced ADL performance, it is important to look not only at chronic diseases but also at the aging processes as well as the disabilities caused by inactivity. Tests of cognitive capacity, psychological well-being and physical performance provide valuable information on the factors that underlie the aged individual's reduced functional capacity.

Two approaches to the study of experiences of health and old age: the thematic interview and the narrative method.

This paper discusses two methods of data collection for the study of experienced health and old age: the thematic interview and the narrative method, both of which represent the interpretive research paradigm. Two applications of the method are described: the thematic interview was used in a study of patient experiences of health and nursing, and the narrative method in a study of experiences of ageing. The role and utility of the methods are discussed from the point of view of nursing research.

Patterns of experienced aging with a Finnish cohort.

A cohort study of eighty-year old residents in Jyväskylä (pop. 66,000), central Finland, was carried out in 1990 as part of the EVERGREEN-project. A total of 262 persons born in 1910 were interviewed in the cohort study. The survey data produced a fairly accurate picture of the respondents' objective situation. In order to shed further light on how the respondents felt about growing old, tape recorded narrative stories were collected from a subsample of twenty persons (10 women and 10 men). The stories revealed the subjective meanings and evaluations attached by the individuals concerned to their own aging. Being members of the same culture and the same age cohort, they also shared the same way of perceiving themselves and the surrounding world. It became obvious that there existed some kind of boundary conditions for the experience of aging. The model of boundary conditions for the experience of aging was developed on the basis of the narratives.

Serum markers for breast cancer.

A considerable number of tumour markers and other laboratory tests are used for follow up and evaluation of breast cancer patients. No marker presently available is sensitive enough for early diagnosis and screening, but markers can be used to evaluate response to therapy and for early detection of a relapse. Of the markers presently available, CA 15-3 and CEA are mostly used. CA 15-3 appears to be somewhat more sensitive than CEA. When a cut-off level giving 97.5% specificity is used, the sensitivity of these assays is only about 5-25% in local disease and 50-70% in advanced disease. The combined use of these markers increase the sensitivity by 5-10%. The CA 15-3 assay measures a family of molecules called breast mucins, and several newer assays including MCA, MSA, CA 549, CA M26, CA M29 and BCM appear to measure members of the same family. The results obtained by these assays and with CA 15-3 correlate fairly well. So far none of the new assays has proven superior to CA 15-3. Of patients with advanced cancer, 20-30% are negative for the above mentioned markers. For these patients it may be worthwhile to try other markers not related with the above mentioned.

Identification of the isoflavonic phytoestrogen daidzein in human urine.

The identification by gas chromatography-mass spectrometry of the isoflavonic phytoestrogen daidzein [7-hydroxy-3-(4-hydroxyphenyl)-4H-1-benzopyran-4-one] for the first time in human urine is described. The metabolism and effect on reproduction of isoflavones in animals and the possible significance of phytoestrogens in man is discussed. Preliminary results on the quantitative excretion of daidzein in female subjects consuming different diets are also reported.