Heavy-resistance training in older Scandinavian men and women: short- and long-term effects on arm and leg muscles.

The short- and long-term effects of heavy-resistance training (85% of one-repetition maximum (RM)) on elbow flexion and knee extension dynamic and isokinetic strength and on morphology in the biceps brachii and vastus lateralis muscles were evaluated during 1 year in 35 Scandinavian men and women, aged 70-77 years, 12 of whom formed a control group. After the first 11 weeks of training (n = 23; 3 times/week) elbow flexion and knee extension dynamic strength (1 RM) had increased [mean +/- SD] 49% +/- 16 and 163% +/- 75, respectively, with no significant difference between men and women. For the following 27 weeks, strength was maintained with one training session per week (n = 12) but dropped without training (n = 11). After the final 11 weeks of training (n = 11; 3 times/week), strength had further increased 32% +/- 16 in both the arm and the leg. Isokinetic strength measurements (Cybex II; 30 degrees/s) revealed similar but smaller gains than for dynamic strength. Muscle biopsies (n = 20) taken at the start and after the first 11 weeks of training showed a significant increase in the area of both type 1 and type 2 fibers in the biceps brachii muscle and a positive significant correlation between the percentage increase in the proportional area of type 2 fibers in the vastus lateralis muscle and the percentage increase in knee extension dynamic muscle strength. In conclusion, older Scandinavian men and women have a high capacity both to improve and to maintain muscle strength, some of which is mediated through an adaptation in the muscle fiber type population.

Well-being and treatment satisfaction in adults with diabetes: a Swedish population-based study.

In order to implement the St Vincent Declaration programme, instruments for quality assurance of medical outcomes as well as measures of psychological outcomes of diabetes care had to be developed. This paper presents baseline values for three questionnaires measuring psychological Well-being, Treatment Satisfaction and General Health among a representative sample of adult people with diabetes in Sweden consisting of 423 individuals of which 153 were insulin treated and 270 were diet/tablet-treated. Cronbach's alpha indicated that each of the Well-being and Treatment Satisfaction subscales was internally reliable, alphas ranging from 0.66-0.88. Factor analysis resulted in identification of five subscales (depression, anxiety, positive well-being, treatment satisfaction and metabolic control). There was no relation between any of the quality of life subscales with HbA1c, BMI, duration of diabetes, frequency of blood glucose tests per day, insulin regimens or diabetic complications. Females reported a more negative impact of diabetes on daily life compared with males (p < 0.001). In conclusion, the Well-being and Treatment Satisfaction scales are reliable for quality assurance purposes in diabetes while the briefer general health instrument provides a useful assessment of the global impact of a chronic disease.

Administration of vitamin K to newborn infants and childhood cancer.

OBJECTIVES: To investigate whether childhood cancer is associated with intramuscular administration of vitamin K to newborn infants. DESIGN: Routines for administration of vitamin K to infants born after normal deliveries during 1973-89 were obtained from maternity hospitals. Occurrence of cancer up to the end of 1991 was identified by comparing these records with the national cancer registry. Adherence to the routine method of administering vitamin K was checked with the medical records of a sample of 396 infants (196 who had developed childhood cancer and 200 controls). SETTING: All maternity hospitals in Sweden. SUBJECTS: 1,384,424 full term infants born after non-instrumental deliveries, 1,085,654 of whom were born in units where vitamin K was routinely given by intramuscular injection and 272,080 of whom were born where it was given orally. MAIN OUTCOME MEASURES: Odds ratios for cancer after intramuscular administration of vitamin K versus oral administration after stratification for year of birth. RESULTS: Adherence to routine method of administering vitamin K was 92% in the 235 cases where individual information could be found. The risk of cancer after intramuscular administration of vitamin K was not elevated compared with that after oral administration: odds ratios of 1.01 (95% confidence interval 0.88 to 1.17) for all childhood cancers and 0.90 (0.70 to 1.16) for childhood leukaemia. CONCLUSIONS: The alleged association between intramuscular vitamin K prophylaxis to newborn infants and childhood cancer could not be verified in the present study of full term infants born after non-instrumental delivery.

Childhood mortality in relation to nutritional status and water supply--a prospective study from rural Malawi.

In connection with the introduction of an improved method of water supply in rural Malawi, the nutritional status, morbidity, and mortality among 1,178 children under five were studied during three rainy and three dry seasons. Data were collected at fortnightly home interviews. Nutritional assessment was made twice a year. One hundred and thirty-seven of the children died during the study period, and the probability of dying before the age of five was estimated to 270 per 1,000 children. The mortality risk was related to weight for height (p less than 0.001) and height for age (p less than 0.01) as well as to upper arm circumference (p less than 0.001) and triceps skinfold (p less than 0.05). Mortality among children living in households using the new, piped-water supply tended to be lower than mortality for those using traditional water sources, although the difference was not statistically significant (relative risk 0.4, 95% confidence interval 0.1-1.3).

Home blood glucose monitoring in diabetic children and adolescents. A 3-year feasibility study.

In order to elucidate the question whether blood glucose monitoring should replace glucosuria testing in childhood diabetes 160 diabetic children and adolescents were invited to participate in a feasibility study on home blood glucose testing. Seventeen girls and 15 boys with an age of 4-21 years and duration of diabetes for 0.3-18.7 years accepted, thus a selection of motivated patients. They performed 20-22 diurnal blood glucose profiles, each consisting of 7 blood samples, during a 3 month period. Thereafter, all patients were encouraged to continue blood glucose self-control and the actual performance of the 32 patients was evaluated 3 years later. Daily glucosuria tests were also made and HbA1 was analysed. Patients' attitudes were evaluated through 2 questionnaires. The study shows that blood glucose monitoring is feasible in the actual age groups. Most patients were positive towards blood tests, particularly because it gave an immediate answer to an actual problem, but its introduction did not change the metabolic control. However, pain restricted its daily use and only 6.4% of the patients preferred blood testing to urinalysis for long term use. Furthermore, the correlation between home glucosuria and HbA1 was as good as between home blood glucose and HbA1. It is concluded, that blood glucose self-monitoring is a valuable tool in the management of childhood diabetes, but that it should be regarded as a complement to and not a substitute for daily home urinalysis.

The epidemiology of diabetes in Swedish children 0-14 years--a six-year prospective study.

Since 1 July 1977, all newly diagnosed diabetic children in Sweden aged 0-14 years have been reported to a central register. During the first 6 years, 2300 newly diagnosed diabetic children out of a population of 1.6 million children were registered. The degree of certainty was close to 100%. The mean of the yearly incidence rate for the whole 6 year period was 23.6 per 100000. The prevalence of insulin dependent diabetes mellitus on 1 July 1980 was 1.48 per 1000 and 1.52 on 1 July 1983. Comparing the first and second 3-year periods, an increase was found (22.7-25.1 per 100000). This increase was consistent when analyzing incidence rates by age, sex, and geographical distribution. Cumulative incidence rates revealed a risk of developing diabetes by the age of 15 years of 3.6 per thousand for boys and 3.2 per thousand for girls. The higher incidence for boys was consistent throughout the study period. Seasonal variations in the incidence rate were also consistent, showing yearly incidence peaks in the autumn and winter months. Incidence peaks were noted for both sexes in the pubertal ages. Age- and sex-standardized morbidity ratios varied significantly within the country. 12.8% of the probands had a first degree relative with Type 1 diabetes, and it was twice as common that this relative was a father as a mother. The high and rapidly increasing incidence of Type 1 diabetes in a genetically stable population such as Sweden calls for case-control studies directed towards the identification of environmental pathogens.

Urinary tract infection in children with type I diabetes.

The prevalence and incidence of bacteriuria in 304 girls and 337 boys with type I diabetes was studied by screening for bacteriuria at their regular outpatient controls. In 90 girls and 108 boys a urine specimen was sampled every third month during a year. The prevalence of bacteriuria was 3/304 in girls and 0/337 in boys. During the one year follow-up one of the 90 girls had pyelonephritis and two cystitis while none of the boys had bacteriuria. It is concluded that the rate of urinary tract infection in young diabetic persons does not differ from that present in healthy young people.

Total care for juvenile diabetics--a Swedish experiment.

A Swedish Study Group for Childhood Diabetes has recently prepared a national treatment and care programme for diabetes in children and adolescents, which is briefly presented in this paper. The programme is based on the working hypothesis that long-term vascular and neurological complications - still the most serious threats to the well-being and survival of juvenile diabetics - may be prevented by continuously maintaining a normal or near-normal blood glucose level. Four levels (I--IV) of metabolic control are being defined, of which level I is the optimal goal and level II acceptable, while levels III and IV are regarded as inadequate. To achieve a satisfactory therapeutic result great efforts are required by both patients and the diabetic health teams at the pediatric clinics. In addition to insulin, diet and exercise, great emphasis should be laid on home-monitoring of blood glucose and glycosuria, on patient education and on psychological support both to the children and to their families. The therapeutic team should understand the psychological problems which frequently occur in diabetic families and be able to guide them through the different stages of the disease until the patients reach psychosocial maturity. The programme thus aims at providing a total - biological, functional, emotional and social - care for diabetic children and adolescents, and at thereby improving their quality of life on a long-term basis.