Nutrition and health at retirement age in the United Kingdom

A total of 113 subjects participated in a detailed nutritional and health surveys shortly before their retirement from work. Data were collected using: 7-day weighed dietary intakes; interview questionnaires including topics such as smoking, activity, stress-related factors, health history of subject and family, detailed consumption of alcohol; frequency of consumption of specific foods and drinks. Health screening included routine biochemical and haematological analyses and assessment of nutritional status. Mean nutrient intakes met the United Kingdom RDA although ranges were wide. Mean energy intakes for women (1730 kcal +/- 400 s.d.) were below the RDA of 1900 kcal; men met the RDA of 2400 kcal. Energy consumption was highest in the third period of the day (after 14.30 hours). The distribution of energy from protein, fat, carbohydrate and alcohol was 16, 42, 39 and 3 per cent respectively. The main food sources of nutrients are reported. A mean Quetelet index of 24.7 +/- 3.4 was found in women and 25.7 +/- 3.2 in men. Blood analysis indicated that a small proportion of the sample were outside expected ranges; this was most marked for aspartate aminotransferase (AST) and gamma glutamyltransferase (gamma GT) where skewed distributions distorted the standard deviations. Prescribed medication was taken by 50 per cent of the sample; 33 per cent of the sample were cigarette smokers, 40 per cent had given up smoking, 27 per cent had never smoked cigarettes. Duplicate resting blood pressure readings showed a prevalence of hypertension. The data indicate areas of concern which should be dealt with at or before this stage of retirement from work.

Nerve repair and behavioral recovery following brain transplantation in Notoplana acticola, a polyclad flatworm

Although Notoplana acticola, a marine polyclad, cannot regenerate brain tissue, neuronal repair is rapid. Brains were transplanted into decerebrate flatworms to determine the anatomical patterns and functionality of neural connections established between a new brain and the peripheral nerve network of the recipient animal. Sixty-nine transplants were performed. Four brain transplant orientations were used: normal, reversed, inverted, and reversed inverted. The functionality of the transplanted brains was tested and measured using both behavioral and electrophysiological criteria. Within 23 days, 56% of the transplants that survived and retained the transplants recovered the four behaviors tested: righting behavior, avoidance turning, ditaxic locomotion, and feeding. Nerves exiting the brain tended to join with the peripheral nerves closest to them. Anatomical connections were made within 24 hr of surgery. Some normal behavior was seen within the first 36 hrs after surgery. Control decerebrate worms did not recover behavior. Preliminary intracellular recordings from three types of identified brain sensory interneurons, in transplants, revealed normal electrophysiological properties and this implied that appropriate connections with peripheral sensory cells had been reestablished. Intracellular dye-marking of these neurons in reverse-oriented brains revealed that, although individual nerve processes apparently leave the brain and associate with inappropriate nerve cords, some of the processes turn 180 degrees to reinervate nerve cords, which they normally occupy in unoperated animals. Thus, although anatomical and functional neural connections apparently were made rapidly following brain transplantation, the specificity of the reconnections remains to be shown.

An economic study of the Western Division of N.S.W

The Hassall Report was based on an economic survey of 150 landholders throughout the Western Division of New South Wales for the financial years 197711978, 197811979 and 1979/1980. The survey used taxation records, however. some attitudinal informa- tion was collected from face to face interviews with landholders. The survey examined the financial performance in relation to the carrying capacity of the property and in relation to five land- scape categories. The survey found that the financial performance of the landscape categorized as "tall dense woodlands with scrub" was significantly poorer than for other landscape categories. The report has been used as a major reference for the recently completed Joint Parliamentary Committee Enquiry into the Western Division of New South Wales and has influenced a number of the economic recommendations in this report. This paper gives a brief summary of the financial results, a comparison of these results to those of other agricultural areas and the major policy recom- mendations made in the report.

A survey of patients selected by general practitioners for home care of suspected myocardial infarction: arrhythmia detection using Holter monitoring

From the Lancaster district (pop. 50 000) 101 patients were selected for home care of suspected acute myocardial infarction (AMI) by their general practitioners (GPs) and 78% were seen within 6 h (44% within 2 h). Infarction was confirmed in 54 cases compared with 203 in the coronary case unit over the same period. Reasons given for home management were stable condition (48%), diagnostic doubt (34%), patient preference (18%), good home (15%), age (14%). Holter ECGs from 97 patients were analysed to see if arrhythmias were undetected clinically and recordings of at least 20 h were obtained in 88 (91%). Symptoms drew attention to atrial arrhythmias in 5 patients. Ventricular premature beats were recorded in 96% of the AMI group (84% of the non-MI), ventricular tachycardia in 21% of the AMI patients (5% non-MI), atrial fibrillation in 25% of AMI (7% non-MI) and complex ventricular ectopic activity (Lown 3-5) was found in 81% of the AMI (58% of the non-MI). We conclude that the GPs in the Lancaster district select patients for home care of AMI on clinical and social grounds rather than time after onset. Holter ECG recordings reveal major arrhythmias which are usually undetected clinically and are at least as common as those found in CCU treated patients. Further studies involving larger numbers of home treated patients monitored early are required to identify criteria for home care.

A and B blood group antigen expression on mixed colony cells and erythroid precursors: relevance for human allogeneic bone marrow transplantation

Using anti-A and anti-B blood group monoclonal antibodies and fluorescent activated cell sorting of human bone marrow, A (or B) blood group antigen was shown to be on 5.2 +/- 5.9 (mean +/- SD) % of CFU-GEMM and 12.5 +/- 19.6% of the erythroid burst forming cells (designated BFU-GEMM) as defined by the mixed colony assay, and 49.5 +/- 20% of the BFU-E and 83.5 +/- 9.9% of the CFU-E as defined by the erythroid colony assay. This antigen expression on the BFU-GEMM is consistent with the concept that erythroid bursts stimulated by leucocyte conditioned medium are less mature, and are closer in development to the pluripotent stem cell than the BFU-E. These results help to explain the delayed erythropoiesis, and perhaps impaired engraftment of all cell lineages, that may occur in some recipients of ABO incompatible bone marrow transplants with persistent and high anti-A titres.

Nutrition and the elderly: identifying those at risk

At present our interpretation of dietary, biochemical and clinical findings is still inadequate to diagnose marginal or subclinical malnutrition in the elderly. There are two main types of nutritional risk; the first is long-standing, against which early-warning signs and early preventive action are needed. The second type of nutritional risk may be sudden, following medical or social stress. This calls for prompt action at that critical stage. Given the means to implement research findings, practical action can be taken by the Health and Social Services, relations, friends and the elderly themselves. It is necessary to take practical action against nutritional risks at an early stage. For this reason, our current longitudinal study is concentrated on men and women at the age of retirement from work.

Simultaneous use of four methods of estimating food consumption

As part of a four-year longitudinal study examining changes in nutrient intakes, eating patterns, lifestyle and health on individuals before and after retirement from work, accurate assessments of customary food and beverage intakes were essential. This paper shows that by using four techniques simultaneously, a number of discrepancies were exposed, even though the subjects had filled in their records meticulously. Together they provide data more truly representative of what each individual eats. The techniques included: a week's weighed dietary record; a recall of customary food and beverages consumed throughout a typical day; key questions relating to foods and drinks (including alcohol) within a general questionnaire; and lists giving the frequency of consumption of specific foods and drinks.

Factors contributing to vitamin D status near retirement age

As part of a larger survey assessing health and wellbeing in men and women at retirement age, vitamin D status was examined. The sample of 110 men and women participated in a week's weighed dietary survey, with extensive interviews including socio-economic background and the collection of medical information and blood samples. Estimations of plasma 25-hydroxyvitamin D (25-OHD) were included among the analyses, and were related to dietary intakes and sunlight exposure, including recent holidays in the sun. The results emphasize the major importance of ultraviolet light on the skin. Fortified and unfortified foods, as well as other variables possibly affecting vitamin D status, were investigated. It was found that a weekly consumption of fatty fish maintained adequate plasma 25-OHD levels in those whose exposure to sunlight was poor. It is concluded that positive action taken at a time of change, ie, retirement from work, may sustain the adequate vitamin D status shown in this sample.

Three-year follow-up of couples evaluated for sexual dysfunction

The present status of 49 couples who three years previously had been evaluated but not treated at a clinic for sexual dysfunction was determined by a self-report assessment battery. The battery consisted of the Sexual Interaction Inventory, the Locke-Wallace Marriage Inventory and the Sexual History Form completed at initial evaluation and follow-up. An additional Follow-up Questionnaire was completed at post only. Approximately 52% of the men and 54% of the women reported receiving therapy during the period between initial intake and follow-up. Analysis of male data revealed that with the exceptions of estimates of mate satisfaction and marital happiness, all other variables measuring sexual behaviors and attitudes did not show significant changes over time. Men who received subsequent therapy reported significantly more erectile difficulty at both intake and follow-up than their nontreated counterparts. In contrast, women showed significant improvement over time in sexual satisfaction, acceptance of mate, and ability to achieve orgasm through a wider variety of means. These improvements were reported by women who had therapy during the interim period as well as women who had not had therapy. Repeated measured ANOVAs and t-test analyses were performed examining the effects of male dysfunction on female functioning. Interpretations of the differences in change noted over time between women and men are offered as well as suggestions for future research.

Longitudinal study on elderly recipients of meals-on-wheels

A second nutrition study was undertaken on sever survivors who had originally participated in a survey in 1970 of 100 people in receipt of meals-on wheels because of nutritional and/or social risk. The original and follow-up studies included a seven-day weighed dietary intake, socio-economic questionnaires and detailed case records. In 1980 these very elderly subjects were maintaining their original energy and nutrient intakes, in spite of deteriorating health and physical capabilities. They had retained an interest in food and continued a similar style of eating. Even when intakes were low, there were no long gaps in the day without food or drink.

Changing food habits among 100 elderly men and women in the United Kingdom

One hundred elderly men and women were interviewed, using a specially designed questionnaire to uncover possible alterations in food habits with regard to specific food items, and the reasons for these changes. Over half the sample had changed the type of bread used; the main reasons for change to brown or wholemeal were health and taste. Health was also the main reason given by the 26 per cent who had changed to a higher-fibre breakfast cereal. Thirty-eight had altered the type of milk consumed; 12 subjects were now using dried milk for reasons of health, including weight reduction. Forty-three percent had altered their usage of butter or margarine; butter was mainly selected for its taste, margarine mainly for health, but also taste and price. Other important reasons for change were the ease of obtaining convenience foods, the availability of familiar foods in one or two portion sizes, changes in family circumstances, and a desire for variety and ease of use, even if it involved an alteration in traditional cooking methods. Although it is often thought that the elderly are resistant to dietary change, there was no individual who had not made some alteration of food habits.

Menstrual respiratory changes and symptoms

The duration of standardised overbreathing required to produce slow wave activity in the EEG during different phases of the menstrual cycle has been studied, and changes in carbon dioxide sensitivity of the respiratory system. Normal subjects developed slow waves more quickly and had more sensitive CO2 responses during the premenstrual/menstrual phases. This may be a factor contributing to premenstrual tension.

An at-risk concept used in homes for the elderly in the United Kingdom

In Great Britain, the matrons, often without training in catering or nutrition, are usually confronted with the responsibility of planning menus in homes for the elderly. They face the problems of budgeting restrictions, increases in food prices, staff shortages, and low wages for staff. Previous nutrition surveys of the elderly have isolated special concerns with intakes of ascorbic acid, potassium, energy, protein, vitamin D, and iron. This pilot study explores the next step: The practical applications of these findings to residential homes. Questionnaires were devised to obtain information from the matron, cooks, and residents and from the investigators' general observations. Specific at-risk factors were isolated, taking into account administrative, psychologic, and social conditions, as well as food. By a system of grading (with comments) into low, moderate, or high nutritional risk to residents, the strengths of each home could be used as positive examples to improve other homes; appropriate advice could then be given to each home.

A technique for assessing nutritional 'at-risk' factors in residential homes for the elderly

A technique for assessing the degree of nutritional risk to residents in old people's homes is outlined. Administrative, psychological and social factors are considered as well as food. Twenty-six risk factors are identified. In one short visit, using questionnaires to the matron, cook and the residents and a check-list of general observations, the degree of risk, high, moderate or low, can be assessed. The technique has been used in a pilot study for comparisons between homes, and for advice to individual homes.

Typographic decision making: the layout of indexes

The authors have previously published work on typography and the design of instructional materials. This paper reports the application of their approach to the design and layout of a textbook index.

Increased glucuronidation of bilirubin in man and rat by administration of antipyrine (phenazone)

1. Antipyrine in a dose of 3·2 mmol (600 mg) daily for 6 weeks produced a significant fall in both total and unconjugated serum bilirubin concentrations in six patients with Gilbert's syndrome. The maximum reduction in serum bilirubin concentration was seen after 2 weeks of treatment.

2. In the rat, administration of antipyrine in doses of 0·42 and 1·27 mmol 24 h−1 kg−1 (80 and 240 mg 24 h−1 kg−1) for 84 h caused a significant increase in the apparent maximal velocity (Vmax.) for the glucuronidation of bilirubin by liver microsomal preparations when the concentration of either uridine diphosphate glucuronic acid (UDPGA) or bilirubin was altered. There was no significant difference between the apparent Vmax. values attained with the two doses of antipyrine in either set of experiments. Neither the microsomal protein content nor the apparent affinity constant (Km) was altered in these studies.

3. In contrast, administration of phenobarbitone in doses of 0·34 mmol 24 h−1 kg−1 (80 mg 24 h−1 kg−1) caused a significant increase in the microsomal protein content but there was no significant change in the values for the apparent Vmax. or apparent Km for the glucuronidation of bilirubin with various concentrations of both UDPGA and bilirubin.

Problem of the old and the cold

A pilot winter study of body temperatures using new measuring techniques was tested on 72 volunteers aged 65 or more living in Portsmouth. The body temperatures were related to their environmental temperature and living conditions. No case of serious hypothermia was found, but the study confirms that elderly people have lower body temperatures and suggests that the coldest individuals tended to be the least aware of discomfort from the cold; this may well place them "at risk" for developing hypothermia.