Cognitive function and risk of stroke in elderly men.

OBJECTIVE: Vascular risk factors are associated with ischemic changes in the cerebral white matter. We studied the predictive value of cognitive test performance especially related to subcortico-frontal pathways, together with a cognitive screening test, for later incidence of fatal or nonfatal stroke or TIAs and stroke subtypes. METHODS: A sample of 930 70-year-old men without previous stroke/TIA from the community-based Uppsala Longitudinal Study of Adult Men was investigated at baseline using Trail Making Tests (TMT) A and B and the Mini-Mental State Examination (MMSE). RESULTS: During up to 13 years of follow-up, 166 men developed a stroke or TIA; 105 participants had a brain infarction. In Cox proportional hazards analyses adjusting for education, social group, and traditional cardiovascular risk factors, a 1-SD increase in TMT-B time was associated with a higher risk for brain infarction (hazard ratio 1.48, 95% confidence interval 1.11-1.97). The risk of brain infarction was more than threefold higher in the highest (TMT-B = 146-240 s) compared to the lowest (TMT-B = 43-84 s) TMT-B quartile. TMT-A and MMSE results were not consistently related to stroke outcomes. CONCLUSION: Impaired performance in elderly men measured by Trail Making Test B, a cognitive test especially reflecting subcortico-frontal activities, was an independent predictor of subsequent brain infarction in this community-based sample of elderly men. Our results extend previous findings of cognitive decline as an independent predictor of stroke and indicate that the risk of brain infarction is increased already in the subclinical phase of cognitive deficit.

Insulin sensitivity measured by the euglycaemic insulin clamp and proinsulin levels as predictors of stroke in elderly men.

AIMS/HYPOTHESIS: Our aim was to investigate the predictive power of a panel of variables in glucose and insulin metabolism for the incidence of stroke or transient ischaemic attacks (TIA). We hypothesised that proinsulin and insulin resistance contributes to an increase of risk for fatal and non-fatal stroke/TIA, independently of diabetes and established risk factors. METHODS: The study is based on the Uppsala Longitudinal Study of Adult Men cohort. The examinations were performed at age 70 years. RESULTS: In 1,151 men free from stroke at baseline, 150 developed stroke or TIA during a median follow-up of 8.8 years. In unadjusted Cox proportional hazards analyses, a 1 SD increase of a predictor variable was associated with an increased risk for stroke/TIA, e.g. plasma insulin (HR 1.19, 95% CI 1.01-1.40), fasting intact proinsulin (HR 1.28, 95% CI 1.09-1.49); whereas a 1 SD increase in insulin sensitivity measured by the euglycaemic insulin clamp method decreased the risk for stroke/TIA (HR 0.81, 95% CI 0.68-0.96). The predictive values of fasting intact proinsulin and insulin sensitivity endured but not that of plasma insulin when adjusting for diabetes. In models adjusting for diabetes, hypertension, atrial fibrillation, electrocardiographic left ventricular hypertrophy, serum cholesterol and smoking, proinsulin remained as a significant predictor of later stroke/TIA (HR 1.22, 95% CI 1.00-1.48) whereas clamp insulin sensitivity did not (HR 0.87, 95% CI 0.71-1.07). CONCLUSIONS/INTERPRETATION: Fasting intact proinsulin level and insulin sensitivity at clamp predicted subsequent fatal and non-fatal stroke/TIA, independently of diabetes in elderly men whereas fasting insulin did not.

Signs of osteoarthrosis of the temporomandibular joints in young patients: a clinical and radiographic study.

OBJECTIVE: The aims of this study were to investigate the occurrence of osteoarthrosis of the temporomandibular joints among young patients referred for consultation and treatment because of pain and dysfunction of the jaws and to study the relationship between signs and symptoms of temporomandibular disorders and osteoarthrosis in these patients. STUDY DESIGN: This was a retrospective study based on case histories, clinical examinations, and temporomandibular joint tomography. A total of 131 patients ranging in age from 12 to 30 years were included in the study. The null-hypothesis tested was that no significant differences in signs and symptoms of temporomandibular disorders would be found between joints with and joints without signs of osteoarthrosis. RESULTS: Osteoarthrosis of the temporomandibular joints was found in 87 patients (66%) and 151 joints (58%). The null-hypothesis was not rejected. CONCLUSION: A high prevalence of temporomandibular joint osteoarthrosis among the studied sample was found. The study did not allow us to draw any conclusions about the cause of temporomandibular joint osteoarthrosis in these patients. The result provided a basis for a subsequent follow-up study.

Bottle-blowing in hospital-treated patients with community-acquired pneumonia.

A study was carried out to determine whether bottle-blowing has any positive effects in patients with pneumonia. In a prospective open study 145 adults with untreated community-acquired pneumonia requiring hospitalization were randomized to early mobilization (group A), to sit up and take 20 deep breaths on 10 occasions daily (group B), or to sit up and to blow bubbles in a bottle containing 10 cm water through a plastic tube 20 times on 10 occasions daily (group C). Peak expiratory flow (PEF), vital capacity (VC), forced expiratory volume in 1 sec (FEV1) and serum concentration of C-reactive protein (CRP) were determined on admission, and on days 4 and 42. Fever duration and hospital stay were recorded. In a subset of 16 patients, single breath diffusion capacity of carbon monoxide was measured on 3 occasions. The patients in group A were hospitalized for a mean of 5.3 days, group B for 4.6 days and group C for 3.9 days. Treatment was a significant factor (p = 0.037) in a Cox regression model, with group C significantly better than group A (p = 0.01). The number of days with fever was 2.3, 1.7 and 1.6 in groups A, B and C respectively. These differences were not significant (p = 0.28). No significant differences were found between the groups regarding CRP, PEF, VC, FEV1, or diffusion capacity. Intensive bottle-blowing shortens the hospital stay in patients with pneumonia. The underlying mechanism is not clear.

Long-term effect on mother-infant behaviour of extra contact during the first hour post partum. V. Follow-up at three years.

Primiparous mothers and their infants who had had an extra 15-20 minutes skin-to-skin and suckling contact (P+) during the first hour after delivery behaved differently, had a longer duration of breast-feeding, and expressed different opinions on child rearing practices at follow-ups 36 hours, 3 and 12 months after delivery as compared with a control group (P) of primiparous mothers and their infants, who were given routine care immediately after birth. The present report is based on parts of the results of the follow-up at 3 years. Asked in retrospect more P mothers found the time together with their infants immediately after delivery to have been insufficient. More P+ children were reported to have been earlier continent during the day and also earlier stubborn than the children in the P group. The Denver Developmental Screening Test showed similar results in both groups. Catecholamine levels in the urine of extra contact mothers and their boys were found to be slightly higher than those of routine care mothers and boys. Two separate analyses of video-tapes of free play showed that mothers and children in the P+ group were smiling/laughing more often than P mothers and children. The P+ mothers were more encouraging and instructing towards their children than the P mothers. Articulated conflicts were more common in the P+ group. Regardless of the type of conflict, more conflicts in the P+ group were solved. As in earlier parts of this longitudinal study differences related to type of neonatal care were more pronounced for boy-mother than for girl-mother pairs.

Long-term effect on mother-infant behaviour of extra contact during the first hour post partum. III. Follow-up at one year.

The present prospective study examined, one year after delivery, the possible effects of early extra contact during the first hour following delivery. An extra skin-to-skin contact and suckling contact was allowed 22 primiparous mothers and their infants (P + group). One control group of 20 primiparous mothers and their infants were given routine care immediately after birth (P group). During observation of a physical examination of the infant, 'extra contact mothers' held and touched their infants more frequently and more often talked positively to their infants than did mothers given routine care. 'Extra contact mothers' had returned to their professional employment outside the home to a lesser extent than had routine care mothers. A greater proportion of 'extra contact' infants slept in a room of their own. In the P+ group, mothers who had returned to gainful employment were also able to have their babies sleep in a room of their own--no such correspondence was found in the P group. The Gesell Developmental Schedules revealed that, in four parts out of five, infants with extra contact immediately after birth, were ahead of those in the control group. On the other hand, the Vineland Social Maturity Scale and the Cesarec Marke Personality Scheme did not reveal any major differences between the two groups. Mothers with early extra skin-to-skin contact and suckling contact breast-fed their infants on an average for 2 1/2 months longer than did routine care mothers. No other differences in feeding habits were found. The influence of extra contact was more pronounced in boy-mother than in girl-mother pairs.

Long-term effect on mother-infant behaviour of extra contact during the first hour post partum. I. First observations at 36 hours.

The immediate post partum period may be particularly important for the developing relationship between mother and infant; little is as yet known, however, of the long-term effects of hospital practice during this period. This study examines the effect of extra contact during the first hour following delivery. An extra skin to skin contact and suckling contact was given to 22 primiparous mothers and their infants. One control group of 20 primiparous mothers and infants and a second one of 20 multiparous mothers and infants was given routine care immediately after birth. All mothers and infants were healthy with normal pregnancies and deliveries. At 36 hours a first observation was made of maternal and infant behaviour during breast feeding in all three groups. At this stage primiparae with extra contact showed behaviour much more like the behaviour of multiparae with routine care. Infants of primiparae with routine care cried most frequently. The behaviour of mothers of boys differed more from group to group than did that of mothers of girls.

Long-term effect on mother-infant behaviour of extra contact during the first hour post partum. II. A follow-up at three months.

Primiparous mothers and their infants who had an extra 15-20 minutes' suckling and skin to skin contact during the first hour after delivery, behaved differently at 36 hours post partum compared with a control group without this extra contact. The present study is a 3-month follow-up of these mothers and infants by means of direct observation of mother-infant free play and a personal interview with the mothers. Mothers in the extra contact group spent more time kissing and looking en face at their infants; these infants smiled more often and cried less frequently. A greater proportion of the mothers with extra contact were still breast feeding at 3 months. The influence of extra contact on behaviour was more pronounced in boy-mother than in girl-mother pairs.