The effect of elicitation task on discourse coherence and cohesion in adolescents with brain injury.

Six adolescents with traumatic brain injury and six adolescents who had been hospitalized for an illness or injury not affecting the brain were administered two narrative tasks designed to vary in their demand for spontaneous organization of information and minimize the requirement for new learning. The discourse topics--a description of each subject's injury and hospitalization, and a re-telling of a current event--were chosen to be representative of discourse in adolescent daily living. Narratives produced by subjects in each group were compared between the two tasks on measures of coherence and cohesion. Subjects in both groups produced significantly more coherent and cohesive narratives in the personal event task than in the current event task, and there was no significant difference between groups. The results are discussed in relation to face validity of language tasks for adolescents, and the multiple factors contributing to adolescent social discourse.

[Trends in cancer incidence and cancer mortality in Netherlands: good and bad news]. / Trends in kankerincidentie en sterfte door kanker in Nederland: goed en slecht nieuws.

Since 1990 age-standardized cancer mortality in men has decreased by about 1% per year. This decrease is due to a decrease in the mortality from lung cancer, stomach cancer, pancreatic cancer and bladder cancer. The mortality from melanoma, prostate cancer and oesophageal cancer in men has increased. After a slight increase in age-standardized cancer mortality in women, the rate has remained constant since 1990 in spite of the rapid increase in lung cancer mortality. Mortality due to cancers of the stomach, pancreas, cervix and ovary has decreased. Total cancer incidence in both men and women didn't change much during 1989-1994. In men the incidence of prostate cancer strongly increased. For women both the incidence of lung cancer and breast cancer increased. In the south-east of the Netherlands cancer incidence has been registered since 1973. In this area, the incidence increased before 1989. Therefore, it is likely that the national cancer incidence rates have also increased. Despite this increase, the age-standardized overall cancer mortality in the Netherlands did not increase during recent years.

Waist circumference as a screening tool for cardiovascular risk factors: evaluation of receiver operating characteristics (ROC).

UNLABELLED: To evaluate the receiver operating characteristics (ROC) to determine the cutoffs of waist circumference as a potential population directed screening tool for hypercholesterolaemia (> or = 6.5 mmol/L), low high density lipoprotein cholesterol (< 0.9 mmol/L), and hypertension (treated and/or systolic > or = 160 and/or diastolic blood pressure > or = 95 mmHg), in 2183 men and 2698 women aged 20 to 59 years selected at random from Dutch civil registries. MAIN OUTCOME MEASURES: Height, weight, body mass index (BMI), waist circumference, total plasma cholesterol and high density lipoprotein cholesterol concentrations, and blood pressure. RESULTS: ROC curves showed that sensitivity equalled specificity at waist circumferences between 93-95 cm in men and 81-84 cm in women for identifying individual risk factors, and 92 cm in men and 81 cm in women for identifying those with at least one risk factor. Sensitivity and specificity were equal at levels between 61% to 69% for identifying individual risk factors, with positive predictions (56.8% in men and 37.8% in women) within 2% of those using previously defined 'Action Level 1' of waist circumference 94 cm in men and 80 cm in women (58.8% in men and 37.4% in women). Risk prediction by anthropometric methods was relatively low: ROC areas for identifying each risk factor by waist varied from 55% to 60%, and reached about 65% for identifying at least one risk factor. Height accounted for less than 0.3% of variance in waist circumference. Using BMI at 25 kg/m2 gave similar prediction to waist, but its combination with waist did not improve predictive values. CONCLUSIONS: Measurement of waist circumference 'Action Level 1' at 94 cm (37 inches) in men and 80 cm (32 inches) in women could be adopted as a simpler valid alternative to BMI for health promotion, to alert those at risk of cardiovascular disease, and as a guide to risk avoidance by self-weight management.

Overweight, underweight, and mortality. A prospective study of 48,287 men and women.

BACKGROUND: The relative contributions of a low and high body mass index (BMI [weight in kilograms divided by height in meters squared]) to all-cause and cause-specific mortality are still controversial. OBJECTIVE: To examine mortality rates in relation to BMI in a prospective cohort study of 48,287 Dutch men and women aged 30 to 54 years at baseline from 1974 to 1980. METHODS: During an average 12-year follow-up, 1319 deaths occurred. Relative risks (RRs) were calculated from the Cox proportional hazard model by using a BMI between 18.5 and 24.9 kg/m2 as the reference category. RESULTS: All-cause mortality was significantly increased in obese men (BMI, > or = 30 kg/m2; RR, 1.5; 95% confidence interval [CI], 1.1-2.0) and in underweight men (BMI, < 18.5 kg/m2; RR, 2.6; 95% CI, 1.8-3.9) but not in women. The increased risk in underweight men could be attributed to deaths within the first 5 years of follow-up and to lung cancer mortality among smokers. Coronary heart disease (CHD) mortality was about 3-fold higher among obese men and women. About 21% and 28% of CHD mortality in men and women, respectively, could be attributed to being overweight (BMI, > or = 25 kg/m2). The RR (but not the absolute risk) for CHD among obese men was still significant after adjustment for the presence of smoking, hypertension, hypercholesterolemia, and diabetes mellitus at baseline, and it was more pronounced for CHD among nonsmokers than among smokers (RR, 7.1; 95% CI, 2.3-21.7; and RR, 2.7; 95% CI, 1.5-4.7, respectively). CONCLUSIONS: Total mortality was increased in obese and underweight men but not in women. The increased mortality in overweight men was mainly attributable to CHD and, in underweight men, to early mortality and especially lung cancer mortality among smokers.

Intracutaneous versus intramuscular hepatitis B vaccination in primary non-responding haemodialysis patients.

OBJECTIVE: To determine whether hepatitis B vaccination given intracutaneously (i.c.) is more effective than intramuscularly (i.m.) in primary non-responding haemodialysis patients. DESIGN: A prospective, randomized study of antibody responses to hepatitis B vaccine given i.c. or i.m., in 25 haemodialysis patients. Outcome measures were rates of seroconversion, mean and geometric mean levels of antibody achieved, and antibody levels 1 year after vaccination. RESULTS: With a dosing schedule of 10 micrograms vaccine once a week i.c. in the skin overlying the deltoideus muscle of the non-dominant arm during 12 consecutive weeks, antibody levels to hepatitis B surface antigen (anti-HBsAg) of 10 IU/1 or more were achieved in nine of 10 evaluable patients, with a geometric mean of 70 IU/1. Nine months after the end of the vaccination anti-HBsAg levels had dropped to 9 +/- 4 IU/1 (M +/- SE), with a geometric mean of 5 IU/1, in the nine remaining evaluable patients. With a dosing schedule of 40 micrograms vaccine i.m. in the deltoideus muscle of the non-dominant arm at 0, 1, and 3 months, anti-HBsAg levels of at least 10 IU/1 were achieved in eight of 14 evaluable patients, with a geometric mean of 94 IU/1. Nine months after the end of the vaccination anti-HBsAG levels had dropped to 16 +/- 7 IU/1, with a geometric mean of 9 IU/1, in the nine remaining evaluable patients. Anti-HBsAg levels at 8 and 12 weeks were higher in the i.c. than in the group receiving vaccine i.m. (at 8 weeks 134 +/- 76 vs 39 +/- 20 IU/1, P < 0.05, and at 12 weeks 188 +/- 98 vs 47 +/- 18 IU/1 P < 0.01). The half-time of anti-HBsAg is about 13 weeks, both when the averaged absolute and when the geometric mean levels are used for the estimate. CONCLUSION: intracutaneous route is a less practical but effective method of vaccination against hepatitis B in primary non-responding haemodialysis patients. The weekly 10 micrograms vaccine i.c. scheme resulted in the fastest development of protective antibody levels, within 8 weeks, which may be useful in previously non-immune persons who may be infected with hepatitis B virus (e.g. needle-stick accidents).

Dietary calcium, potassium, magnesium and blood pressure in the Netherlands.

BACKGROUND: The quantitative contribution of dietary calcium, potassium and magnesium to blood pressure levels remains unknown as does the combined effect of dietary calcium, potassium and magnesium. METHODS: The relation between blood pressure and dietary calcium, potassium and magnesium and the combined effect of these minerals on blood pressure was studied in 20,921 Dutch men and women aged 20-59 years. Food intake was measured by a food frequency questionnaire. The data were adjusted for age, body mass index, heart rate, alcohol and energy intake. RESULTS: An inverse association was observed between blood pressure and dietary potassium and magnesium in both men and women. Dietary calcium was inversely related to systolic blood pressure (SBP) in women and with diastolic blood pressure (DBP) in men. The relation between magnesium intake and blood pressure was stronger than those between blood pressure and intakes of potassium and calcium. Men and women who consumed a diet with intakes in the upper tertiles of all three minerals had a lower SBP and DBP compared to those who had intakes in the lower tertiles (men: SBP = -1.3 (95% CI: -2.6, -0.1), DBP = -1.9 (95% CI: -2.7, -1.0), women: SBP = -1.8 (95% CI: -3.1, -0.5), DBP = -1.5 (95% CI: -2.4, -0.7). CONCLUSION: These results suggest that diets rich in calcium, potassium and magnesium are associated with lower blood pressure.

Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample.

OBJECTIVE: To determine the frequency of cardiovascular risk factors in people categorised by previously defined "action levels" of waist circumference. DESIGN: Prevalence study in a random population sample. SETTING: Netherlands. SUBJECTS: 2183 men and 2698 women aged 20-59 years selected at random from the civil registry of Amsterdam and Maastricht. MAIN OUTCOME MEASURES: Waist circumference, waist to hip ratio, body mass index (weight (kg)/height (m2)), total plasma cholesterol concentration, high density lipoprotein cholesterol concentration, blood pressure, age, and lifestyle. RESULTS: A waist circumference exceeding 94 cm in men and 80 cm in women correctly identified subjects with body mass index of > or = 25 and waist to hip ratios > or = 0.95 in men and > or = 0.80 in women with a sensitivity and specificity of > or = 96%. Men and women with at least one cardiovascular risk factor (total cholesterol > or = 6.5 mmol/l, high density lipoprotein cholesterol < or = 0.9 mmol/l, systolic blood pressure > or = 160 mm Hg, diastolic blood pressure > or = 95 mm Hg) were identified with sensitivities of 57% and 67% and specificities of 72% and 62% respectively. Compared with those with waist measurements below action levels, age and lifestyle adjusted odds ratios for having at least one risk factor were 2.2 (95% confidence interval 1.8 to 2.8) in men with a waist measurement of 94-102 cm and 1.6 (1.3 to 2.1) in women with a waist measurement of 80-88 cm. In men and women with larger waist measurements these age and lifestyle adjusted odds ratios were 4.6 (3.5 to 6.0) and 2.6 (2.0 to 3.2) respectively. CONCLUSIONS: Larger waist circumference identifies people at increased cardiovascular risks.

Differences in the association between alcohol consumption and blood pressure by age, gender, and smoking.

The positive association between alcohol consumption and blood pressure is well known. Little is known, however, about effect modification by age, gender, and smoking on the alcohol-blood pressure association. We used data of a cross-sectional study conducted in the Netherlands to investigate the association between alcohol consumption and blood pressure. Between 1987 and 1990, we examined about 30,000 men and women age 20-59 years. After adjustment for age, body mass index, and smoking, we found that in men systolic and diastolic blood pressure increased by 0.9 and 0.6 mmHg per daily drink, respectively. In women, systolic and diastolic blood pressure were 2 and 1 mmHg higher in those who consumed 2 or more glasses per day compared with nondrinkers, respectively. We observed a stronger association between alcohol and blood pressure in older men compared with younger men and in male and female smokers compared with nonsmokers. These data show that gender, age, and smoking all are important effect modifiers of the alcohol-blood pressure relation.

Levels and trends in blood pressure and prevalence and treatment of hypertension in The Netherlands, 1987-1991.

Levels and trends in blood pressure (BP), as well as prevalence and treatment of hypertension, were studied in The Netherlands between 1987 and 1991. BP was measured continuously using a standardized method in 36,273 men and women 20-59 years of age. The data were weighted for the age distribution of the general Dutch population in 1990 and adjusted for each technician who measured BP. In summer in both men and women, systolic blood pressure (SBP) was about 1.5-2.0 mm Hg lower than in the other seasons, and diastolic blood pressure (DBP) was 0.5-1.0 mm Hg lower. In 1987 SBP was 124 mm Hg in men and 117 mm Hg in women. DBP was 78 mm Hg in men and 75 mm Hg in women. The prevalence of hypertension was 8% in both men and women. Between 1987 and 1991, SBP decreased slightly while DBP increased slightly. The prevalence of hypertension did not change in this period. The percentage of treated hypertensive men decreased significantly from 44% in 1987 to 34% in 1991 and from 60% to 49%, in women. We conclude that the prevalence of hypertension did not change between 1987 and 1991, yet the treatment of hypertension decreased, possibly because of a change in the pattern of treatment by Dutch physicians.

Trends in blood pressure and the prevalence and treatment of hypertension in young adults in The Netherlands, 1974-1986.

To investigate trends in blood pressure and the prevalence and treatment of hypertension in the Netherlands between 1974 and 1986, data from two screening projects on cardiovascular risk factors were used. Between 1974 and 1980 about 30,000 men and women aged 37-43 were screened. Between 1981-1986 about 80,000 men aged 33-37 were examined. An increase in average systolic blood pressure by 2 mmHg in men in the period 1974-1980 was followed by an insignificant change during the period 1981-1986. Average diastolic blood pressure increased by 4 mmHg between 1974 and 1980 but decreased by the same amount between 1981 and 1986. The prevalence of hypertension in 40-year-old men increased from 12.7% in 1974 to 17.8% in 1980. The prevalence of hypertension in 35-year-old men did not change between 1981 and 1986 and amounted to 9.6%. Treatment of 40-year-old hypertensive men increased from 8% in 1974 to 21% in 1980 and from 9% in 1981 to 13% in 1986 among 35-year-old men. Average systolic blood pressure did not change in 40-year-old women between 1974-1980 but average diastolic blood pressure increased by 2 mmHg during that period. The percentage of hypertensive women was 8.5% and did not change between 1974 and 1980. Also, the percentage of treated hypertensive women did not change and amounted to 28%.(ABSTRACT TRUNCATED AT 250 WORDS)

Synergistic effects of anti-gp330 and anti-dipeptidyl peptidase type IV antibodies in the induction of glomerular damage.

Passive Heymann nephritis (PHN) in the rat is induced by the administration of heterologous antibodies to renal tubular epithelium (RTE). The nephritogenic capacity of anti-RTE resides primarily in the antibody fraction directed against a 330-kD glycoprotein (gp330). However, monospecific anti-gp330 antibodies are less nephritogenic than anti-RTE antibodies. This discrepancy led us to study a possible synergizing role for different antibody specificities present within anti-RTE. The enzyme dipeptidyl peptidase type IV (DPP IV) is, like gp330, present in RTE as well as in the glomerulus. Anti-DPP IV antibodies have been shown to induce an acute, transient proteinuria. In this study, we investigated the nephritogenic effect of separate or simultaneous administration of heterologous anti-DPP IV and anti-gp330 antibodies. Injection of anti-DPP IV antibodies resulted in a short-lived glomerular binding, and in a dose-dependent polyuria, albuminuria or proteinuria. Binding of anti-gp330 antibodies was slower, but much more stable. Albuminuria could only be observed in the heterologous phase. Combined injection did not alter antibody-binding kinetics of either antibody nor the albuminuria induced by anti-gp330. However, in the presence of anti-gp330 antibodies, a lower dose of anti-DPP IV was capable to induce transient albuminuria as compared to anti-DPP IV alone. In conclusion, anti-DPP IV and anti-gp330 antibodies bind to different sites in the glomerulus with different kinetics. The presence of anti-gp330 deposits facilitated anti-DPP-IV-induced renal injury.

Redistribution of glomerular dipeptidyl peptidase type IV in experimental lupus nephritis. Demonstration of decreased enzyme activity at the ultrastructural level.

BACKGROUND: In murine chronic graft-versus-host disease, an experimental model for lupus nephritis, autoantibodies against renal tubular epithelium can be found. Part of these antibodies are directed against a constituent of renal tubular epithelium, the enzyme Dipeptidyl peptidase IV (DPP IV). DPP IV is present on the cell membrane of glomerular epithelial and endothelial cells, and plays an important role in cell-extracellular matrix interactions. In mice and rats, administration of heterologous anti-DPP IV antibodies can induce proteinuria and podocyte effacement. EXPERIMENTAL DESIGN: In this study, the glomerular DPP IV enzyme activity was investigated in the course of graft-versus-host disease in (C57BL/10 x DBA/2) F1 hybrids both by light- and electron microscopy using a DPP IV-specific substratum. RESULTS: Light microscopical examination revealed an overall reduction of DPP IV activity and an altered distribution pattern in glomeruli as early as 4 weeks after induction of graft-versus-host disease. Immunofluorescence studies using anti-DPP IV antibodies showed actual redistribution, excluding antibody-mediated enzyme inactivation. Enzyme electron microscopy revealed an irregular deposition of reaction product characterized by a patchy, "moth eaten" appearance of the endothelial and epithelial membranes. This process occurred simultaneously with the development of albuminuria and preceded the effacement of epithelial foot processes. In control mice, DPP IV showed a continuous distribution along endothelial and podocyte membranes. CONCLUSIONS: In view of these findings we postulate that impairment of the function of DPP IV as a non integrin adhesion molecule may be one of the causative factors underlying the structural and functional lesions observed in this model for lupus nephritis.

Epitope specificity of anti-gp330 autoantibodies determines the development of proteinuria in active Heymann nephritis.

In active Heymann nephritis, an experimental autoimmune disease in the rat, gp330 is regarded as the main antigenic target. Immunization with detergent-solubilized renal tubular epithelium (RTE-DOC) has been shown to be less nephritogenic than immunization with crude RTE. In this study immunization with either crude RTE or affinity-purified gp330 did, but immunization with RTE-DOC did not induce proteinuria. Both a possible aberrant subclass distribution of anti-gp330 autoantibodies and the involvement of additional nephritogenic autoantigens such as DPP IV (gp90) or laminin could be excluded. Circulating anti-gp330 autoantibody titers were significantly higher in RTE-DOC-immunized rats than in RTE-immunized animals. In contrast, significantly more antibodies were shown to bind in the glomeruli in the latter group. The time of onset of abnormal proteinuria was shown to be related to the recognition of a particular V8 protease-induced 250 kD fragment of gp330 in Western blots. This study shows that a particular fragment-specific subset of autoantibodies against gp330 is involved in the glomerular damage in Heymann nephritis.

Components of adult height and height loss. Secular trend and effects of aging in women in the DOM project.

Between 1984 and 1987, adult height, sitting height, arm span, and iliac crest height were measured in 13,386 women of the DOM project. Combined effects of secular trends between cohorts born in 1911 to 1945 and aging between ages 40 to 74 years showed a decrease in stature of 4.9 +/- 0.3 cm (mean +/- standard error of mean) and in sitting height of 3.9 +/- 0.2 cm. Height and sitting height diminished but no effect of aging on arm span was found in 380 women measured again after 5 years. When arm span and iliac crest height did not change with age, they reflected a secular trend (1.6 +/- 0.3 cm and 0.5 +/- 0.3 cm). This implies an age-related decline in stature of -3 cm in 35 years.

Pathogenesis of trypanosomiasis-induced glomerulonephritis in mice.

We investigated the pathogenesis of glomerulonephritis in mice that had been infected with Trypanosoma brucei. Polyclonal B cell activation was evaluated, with special attention to the presence of autoantibodies, which are known to be involved in other models for glomerulonephritis. The BALB/c mice studied developed severe albuminuria. Light-microscopy of the kidneys showed increase of mesangial matrix and thickening of the glomerular capillary walls. Immunofluorescence studies showed immunoglobulins in a mixed linear-granular pattern along the glomerular capillary wall and in the mesangium. Trypanosomal antigens were not found in these aggregates. Electron-microscopy revealed mesangial, subendothelial, and subepithelial electron-dense deposits. During the course of this infection, significant levels of antibodies directed against known nephritogenic renal autoantigens, i.e. GBM, laminin, RTE, and gp330, were measured in serum and glomerular eluates. These findings led us to conclude that mice infected with T. brucei and treated with diminazene aceturate develop an autoimmune-mediated glomerulonephritis, characterized by mesangial, subendothelial, and subepithelial immune aggregates. This murine model seems to offer a useful tool for the study of immunological aspects of polyclonal B cell activation in infection-related glomerular disease.

Combination of dietary factors in relation to breast-cancer occurrence.

Combinations of dietary factors were studied in relation to breast-cancer occurrence among 133 breast cancer cases and 289 population controls in The Netherlands. Dietary factors were classified according to their possible mechanism of action, i.e., relating either to the intestinal microflora (total fat, fiber, fermented milk products) or to the anti-oxidant hypothesis (beta-carotene, selenium and polyunsaturated fatty acids). From 6 interactions evaluated, the combination of high fiber intake and high intake of fermented milk products was the only one suggesting synergistic protection (age-and-fat-adjusted OR for interaction = 0.48, 95% confidence interval (CI) = 0.21 - 1.13). In order to estimate the extent to which the above dietary factors together might be related to breast cancer, subjects with a supposedly favorable dietary pattern (low fat intake, high fiber intake, high intake of fermented milk products; high intake of beta-carotene and selenium, low intake of polyunsaturated fatty acids) were compared with subjects with an unfavorable dietary pattern. This resulted in an age-adjusted odds ratio of 0.40 (95% CI = 0.14 - 1.15), which was largely attributable to the combination of low intake of fat and high intake of fermented milk products and fiber (age-adjusted OR = 0.33, 95% CI = 0.15 - 0.73). The other factors did not appreciably affect the odds ratio. These analyses show in a quantitative way that a dietary pattern which combines low intake of fat and high intake of fiber and fermented milk products might provide substantial protection against breast cancer.

Phenprocoumon-induced hepatitis mimicking non-A, non-B hepatitis.

A 58-year-old man presented with jaundice 6 months after aortic valve replacement. Although non-A, non-B hepatitis was initially suspected, the final diagnosis of phenprocoumon (Marcoumar)-induced hepatitis progressing to cirrhosis was based on recurrence of jaundice after re-exposure to the drug, improvement after withdrawal and centrilobular necrosis with eosinophilic infiltration in the liver biopsy. Antibodies to hepatitis C virus were absent. The aortic valve was replaced by a bioprosthesis to eliminate the need for life-long anticoagulation.