IGH::NSD2 Fusion Gene Transcript as Measurable Residual Disease Marker in Multiple Myeloma

Multiple myeloma (MM) is the second most common hematological malignancy. Approximately 15% of MM patients are affected by the t(4;14) translocation resulting in the IGH::NSD2 fusion transcript. Breakage occurs in three major breakpoint regions within the NSD2 gene (MB4-1, MB4-2, and MB4-3), where MB4-1 leads to the production of full-length protein, while truncated proteins are expressed in the other two cases. Measurable residual disease (MRD) has been conclusively established as a crucial prognostic factor in MM. The IGH::NSD2 fusion transcript can serve as a sensitive MRD marker. Using bone marrow (BM) and peripheral blood (PB) samples from 111 patients, we developed a highly sensitive quantitative real-time PCR (qPCR) and digital PCR (dPCR) system capable of detecting fusion mRNAs with a sensitivity of up to 1:100,000. PB samples exhibited sensitivity three orders of magnitude lower compared to BM samples. Patients with an MB4-2 breakpoint demonstrated significantly reduced overall survival (p = 0.003). Our novel method offers a simple and sensitive means for detecting MRD in a substantial proportion of MM patients. Monitoring may be carried out even from PB samples. The literature lacks consensus regarding survival outcomes among patients with different NSD2 breakpoints. Our data align with previous findings indicating that patients with the MB4-2 breakpoint type tend to exhibit unfavorable overall survival.

Effective venetoclax-based treatment in relapsed/refractory multiple myeloma patients with translocation t(6;14)

Introduction: The selective Bcl-2 inhibitor venetoclax has shown promising therapeutic potential in multiple myeloma, particularly in cases associated with t(11;14) IGH::CCND1 translocation. However, the efficacy of venetoclax in myeloma patients with the t(6;14) IGH::CCND3 translocation remains less investigated. Methods: In this study, we conducted a retrospective analysis to investigate the efficacy of venetoclax-based therapy in relapsed/refractory myeloma patients with t(6;14) translocation. The treatment courses of three patients, that included previous therapies and responses to venetoclax, were assessed. Clinical data, laboratory results, and adverse events were analyzed to evaluate treatment outcomes. Results: Our findings demonstrated remarkable therapeutic responses in three consecutive patients with t(6;14) translocation-associated myeloma who received venetoclax-based therapy. Patient 1, a lenalidomide-bortezomib-daratumumab and alkylator treatment refractory patient, achieved sustained stringent complete remission (sCR) after combining carfilzomib-dexamethasone with venetoclax, which was his best response ever. Similarly, Patient 2, refractory to frontline bortezomib-thalidomide-dexamethasone therapy, attained CR following a transition to bortezomib-dexamethason-venetoclax treatment. Patient 3, who was immunomodulatory (IMID)-intolerant, showed a highly favorable response to venetoclax-dexamethasone therapy after his first relapse following autologous stem cell transplantation. No significant adverse effects were observed in any of the patients. Discussion: Our study provides compelling preliminary evidence for the efficacy of venetoclax in t(6;14) translocation-associated myeloma. The outcomes observed in our patients suggest that venetoclax-based therapy holds substantial promise as an effective treatment option for this specific genetic subgroup. Furthermore, the similarities in treatment response between t(11;14) and t(6;14) translocation subgroups highlight the importance of personalized approaches targeting specific genetic abnormalities to optimize therapeutic outcomes.

Két myeloproliferativ betegség egy betegben – klónok együttélése és vetélkedése

A myeloproliferativ betegségeket genetikai hátterük alapján Philadelphia-kromoszóma-pozitív krónikus myeloid leukaemia, illetve Philadelphia-kromoszóma-negatív klasszikus myeloproliferativ neoplasia csoportokra bonthatjuk. Az utóbbiak hátterében a Janus-kináz-2 vagy a calreticulin gének mutációi állnak. Egy betegben a Philadelphia-kromoszóma-negatív és -pozitív myeloproliferativ neoplasiák együttes előfordulása irodalmi ritkaságnak számít. Munkánk során az elmúlt 20 év alatt mintegy 120, krónikus myeloid leukaemiás beteg hosszú távú követése kapcsán azon betegek klinikumát vizsgáltuk, akikben Philadelphia-kromoszóma-negatív myeloproliferativ neoplasiát is igazoltunk. A Philadelphia-kromoszóma jelenlétét klasszikus citogenetikai és/vagy fluoreszcens in situ hibridizációval mutattuk ki, majd a képződött BCR–ABL1 fúziós RNS mennyiségét kvantitatív, valós idejű polimeráz-láncreakcióval követtük. A Janus-kináz-2 és a kalretikulin gének mutációit szintén molekuláris genetikai módszerekkel, mennyiségi allélspecifikus polimeráz-láncreakcióval, illetve fragmensanalízissel mutattuk ki. A mutáns klónok mennyiségének időbeli változásának, valamint a klinikai adatoknak a segítségével következtettünk a betegségek kialakulásának dinamikájára. Munkánk során négy, Philadelphia-kromoszómát és a Janus-kináz-2/calreticulin gén mutációját is hordozó esetet azonosítottunk. Egyes esetekben a klónok vetélkedése, más esetben közös klónban együttes előfordulásuk volt megfigyelhető. Az izolált thrombocytosis a diagnóziskor, valamint a célzott kezelés hatására javuló genetikai eltérés mellett a perzisztáló vagy a fokozódó thrombocytosis hívhatja fel a figyelmet a két ritka hematológiai betegség társulásának lehetőségére. Eseteink felhívják a figyelmet arra, hogy a myeloproliferativ neoplasiák társulása kevésbé ritka, mint ahogy az irodalmi adatok sugallják. Ha a betegség szokatlan megjelenésű, vagy viselkedése ezt indokolttá teszi, felmerülhet a Philadelphia-kromoszóma-pozitív és -negatív myeloproliferativ neoplasiák társulásának gyanúja. Orv Hetil. 2022; 163(28): 1123–1129.

[Calreticulin: Pathophysiology of an unusual gain-of-function and its clinical consequences]

One characteristic type of the common somatic mutations causing myeloproliferative neoplasias is the frameshift mutation of the calreticulin gene that leads to proteins of abnormal structure. The pathologic protein induces novel cell biological processes that are fundamental to the onset and maintenance of myeloproliferative diseases. In this review, an insight is provided into these processes, aiding better understanding of the underlining pathobiological processes and eventually to more effective therapy in the future.

Targeted Venetoclax Therapy in t(11;14) Multiple Myeloma: Real World Data From Seven Hungarian Centers

Despite the introduction of novel agents, multiple myeloma remains incurable for most patients, necessitating further therapeutic options. Venetoclax, a selective BCL-2 inhibitor, had shown promising results in patients with translocation t(11;14), but questions remain open about its optimal use. We have contacted all Hungarian haematology centers for their experience treating t(11;14) myeloma patients with venetoclax. 58 patients were reported. 37 received venetoclax in the relapsed/refractory setting with few or no other therapeutic options available. 21 patients started venetoclax as salvage after failing to achieve satisfactory response to first line therapy. In the relapsed/refractory setting objective response rate (ORR) was 94%, median progression-free survival (PFS) 10.0 months and median overall survival (OS) 14.6 months. In reinduction patients, ORR was 100%, median PFS and OS were not reached. Importantly, we found no adverse effect of high risk features such as deletion 17p or renal failure, in fact renal failure ameliorated in 42% of the cases, including three patients who became dialysis independent. Our study also reports the highest number of plasma cell leukemia cases successfully treated with venetoclax published in literature, with refractory plasma cell leukemia patients achieving a median PFS of 10.0 and a median OS of 12.2 months.

Sexual behavior of Roma women in Romania

Background

Roma women are considered a vulnerable population with regard to reproductive health. Early pregnancy and childbirth is common among Roma women. Roma women use less preventive services prenatal care, cancer screening and family planning.

Methods

The present study aims to analyze the sexual behavior of Roma women based on the secondary analysis of a subsample of 343 Roma women aged 15-44, as a part of the Romanian Reproductive Health Survey 2016.

Results

The main sexual events of the Roma women start in adolescence: 63.9% of Roma women had their first sexual intercourse at age of 15-19and 26.7% at age of 15 and 9.4% between 20-24 years. Roma with a low educational level start earlier sexual life, 28,8% of Roma women with no education had their sexual intercourse before age 15 and 64.8% between 15-19 years. Roma women are living in couples as adolescents with a higher prevalence of teenager couples in rural area 19.4% of Roma women in rural areas and 13.4% in urban areas are in a couple before the age of 15, (p < o,o5) and 60.5% in rural areas and 58.9% in urban areas between 15-19 years. 2/3 of Roma women had their first pregnancy in adolescence, 66.9% between 15-19 and 8.4% under 15 years of age. Concerning the first delivery 65.4% Roma adolescent girls had their first child at 15-19 years, and 2.8% at ages under 15 years.

Conclusions

The Roma female minorities had in adolescence their main sexual events, the first sexual intercourse, the start of a life in couple, the first pregnancy and the first delivery; Roma women from rural areas and women with a low level of education had all these experiences earlier; In order to prevent unwanted pregnancies, public reproductive health policies in Romania should include measures addressed to the need and specific educational and cultural characteristic of Roma women and their partners.

Key messages

Main sexual events of Roma women begin in adolescence. The reproductive health policies should be adressed with special emphasis to Roma adolescent women.

PERSISTENT ASYMPTOMATIC SEVERE HYPOGLYCAEMIA DUE TO TYPE 0A GLYCOGENOSIS - GENERAL AND ORO-DENTAL ASPECTS

Background

Type 0 glycogenosis is a genetic metabolic disorder characterized by the absence of glycogen synthesis of hepatic synthase and hence of liver glycogen stores in normal amounts. It is an extremely rare condition.

Case study

This case is a 5-year and 11-month-old female child with asymptomatic severe hypoglycemia in the last two years. During the admission and afterwards, an extensive panel of paraclinical and imaging investigations was carried out to diagnose and document the case, which led to the specific genetic test. The result was positive for 2 heterozygous mutations in the GYS2 gene (hepatic glycogen synthase), the p.547C> T mutation was pathogenic (class 1) and c.465del, frameshift likely pathogenic (class 2). In order to integrate the clinical picture of patients with this condition and to establish potential correlations regarding the specific aspects with the general development and the phenotype, the oro-dental status was investigated.

Conclusion

The investigations showed a positive correlation with literature data in several respects: low stature, hypoglycemia with hyperketonemia but normal plasma lactate, postprandial and contradictory hyperglycemia, delayed bone development, etc. Oro-buco-maxillary aspects showed a slight delay in the dental eruption. Dietary therapy and stricter dental care and additional prophylaxis are required.

STATINS TREATMENT AND ORO-DENTAL ASPECTS IN A CASE OF HEREDITARY HYPERCHOLESTEROLEMIA IN A CHILD UNDER 6 YEARS

Familial hypercholesterolemia (FH) is a genetic disease with autosomal dominant transmission, characterised by high blood cholesterol levels. The evolution of this disease leads to primary atherosclerosis and cardiovascular disease. Patients with HF develop atherosclerosis by the age of 20 and usually do not survive past the age of 30. We present the case and oro-dental aspects of a preschooler that was diagnosed at the age of 4 with FH, compound heterozygote (mutation/genotype1 LDLR: C20IX, exon 4; mutation/genotype2 LDLR: G571E, exon 12) and the experience of our clinic in the management of this patient that received off-label treatment with statins. When diagnosed, his cholesterol level was 932 mg/dL and his LDL-cholesterol level was 792 mg/dL. Treatment with rosuvastatin and ezetimibe was prescribed. Both substances (rosuvastatin and ezetimibe) are not approved for children under the age of 6 in Europe. Taking into considerations the diagnosis and prognosis for unfavorable evolution, treatment with statins was started at the age of 5 years.

[Importance of next generation sequencing in precision oncology approach of acute myeloid leukemia]

In contrast to solid tumours, the genetic background of acute myeloid leukemia (AML) is characterized by a relatively low number of alterations per sample (average 3-5 mutations similarly to paediatric malignancies). Although the mutational background is rather heterogeneous, the detection of genetic alterations has diagnostic, prognostic and therapeutic relevance. We investigated cytogenetic and most commonly occurring molecular genetic alterations, and their co-occurrence in 830 AML patients diagnosed and treated in our institute between 2001 and 2019. Results from the recently introduced next generation sequencing for seven AML patients are also presented. Both methods (previously performed standard PCR-based tests and NGS) achieved the same results for commonly occurring mutations, but NGS technique was capable to identify further, rarely occurring mutations which bear diagnostic and prognostic importance according to the recent European LeukemiaNet recommendations. The introduction of NGS techniques to routine laboratory diagnostic applications is a required step following international expertise.

Dissection of subclonal evolution by temporal mutation profiling in chronic lymphocytic leukemia patients treated with ibrutinib

The Bruton's tyrosine kinase (BTK) inhibitor ibrutinib is inducing durable responses in chronic lymphocytic leukemia (CLL) patients with refractory/relapsed disease or with TP53 defect, with BTK and phospholipase C gamma 2 (PLCG2) mutations representing the predominant mechanisms conferring secondary ibrutinib resistance. To understand the landscape of genomic changes and the dynamics of subclonal architecture associated with ibrutinib treatment, an ultra-deep next-generation sequencing analysis of 30 recurrently mutated genes was performed on sequential samples of 20 patients, collected before and during single-agent ibrutinib treatment. Mutations in the SF3B1, MGAand BIRC3 genes were enriched during ibrutinib treatment, while aberrations in the BTK, PLCG2, RIPK1, NFKBIE and XPO1 genes were exclusively detected in posttreatment samples. Besides the canonical mutations, four novel BTK mutations and three previously unreported PLCG2 variants were identified. BTK and PLCG2 mutations were backtracked in five patients using digital droplet PCR and were detectable on average 10.5 months before clinical relapse. With a median follow-up time of 36.5 months, 7/9 patients harboring BTK mutations showed disease progression based on clinical and/or laboratory features. In conclusion, subclonal heterogeneity, dynamic clonal selection and various patterns of clonal variegation were identified with novel resistance-associated BTK mutations in individual patients treated with ibrutinib.

GESTATIONAL DIABETES MELLITUS AND THE DEVELOPMENT OF CLEFT LIP / PALATE IN NEWBORNS

Background

Several studies observed metabolic disorders in pregnancy as risk factors for birth defects, including orofacial clefts. Diabetes is associated with approx. 10% of the pregnancies, but in Romania, less than 5%. An obese and diabetic woman has 3 times more risk for an offspring with a craniofacial defect than healthy women suggesting that diabetes mellitus contributes to their pathogenesis with complex mechanisms.

Case report

We present the case of a newborn 4 days old, male with neonatal hypoglycemia, cleft lip and proportionate (symmetric) macrosomia. His mother is a 35 years old Caucasian woman with no important personal risk factors and no known history of diabetes mellitus. The glucose tolerance test performed to the mother at about 10 weeks during pregnancy led to the diagnosis of gestational diabetes.

Discussion

The gestational diabetes mellitus diagnosed since the 10^th week of pregnancy, the hyperglycemia status during pregnancy and the fetal overgrowth (macrosomia at birth) indicate the possible factors that lead to the Orofacial cleft (OFC).

Conclusion

With the increased prevalence of obesity, diabetes, and the evidence of association of these syndromes with OFCs, it is recommended that mothers planning to become pregnant to follow healthy habits, maintain healthy weight, and be screened for possible diabetes prior to conception and early in pregnancy.

NEONATAL SCREENING FOR CONGENITAL HYPOTHYROIDISM IN ROMANIA: DATA FROM MEDILOG MEDICAL INFORMATION REGISTRY

Objective

Congenital hypothyroidism (CH) is one of the common preventable causes of intellectual disability in neonates, by early detection through neonatal screening. We present the 8-year experience of the National Institute for Mother and Child Health (INSMC) in using MEDILOG national registry for the neonatal screening of CH.

Methods

Neonatal screening for CH, done by TSH measurement in dried blood spot, is organized in 5 regional centers, each with a reference laboratory.

Results

In 2018 80% of all the newborns, from 80% of the maternity hospitals, were registered in MEDILOG. After re-testing of TSH and T4/FT4 from venous blood in positive cases, the incidence of confirmed CH in 2018 was 1/3576 - 1/ 4746. In INSMC center (which includes 26 counties and Bucharest, out of 41 counties), in 2018 the incidence of positive CH cases at screening was 1/2094 (TSH cut-off ≥17 mIU/L) and of confirmed CH cases 1/3576 newborns. For positive screening cases, the median duration from birth to the INSMC laboratory result was 19 days: median of 9 days between screening and laboratory registration and 6 days between registration and test result.

Conclusion

MEDILOG registry is a practical instrument for monitoring the steps of neonatal CH screening, the incidence of CH, the evolution of the diagnosed cases, for evaluation of iodine deficiency (by neonatal TSH), and also for research, with the aim of improving early disease detection and treatment.

Lipoprotein Lipase as a Prognostic Marker in Chronic Lymphocytic Leukemia

The marked clinical heterogeneity of CLL makes early prognosis assessment important. Lipoprotein lipase (LPL) has been shown to confer adverse prognosis in CLL, recent data indicating it might also contribute to CLL cell survival and metabolism. We determined LPL mRNA expression in unselected peripheral blood of 84 CLL patients by RT PCR. Results were correlated with other prognostic markers and outcome. 30/84 (40 %) of cases were LPL positive based on the cutoff established by ROC analysis. In LPL positive patients significantly shorter median survival (136 vs 258 months, p < 0.0001) and time to first treatment intervals (36 vs 144 months, p < 0.002) were documented. LPL values correlated with male gender, higher stages, more treatment requirement, CD38 positivity and unmutated IgVH genes. Among cases with 13q deletion, LPL positivity identified a subcohort with poor outcome (median survival 108 months vs NR, p < 0.0001). In multivariate analysis, cytogenetic aberrations and LPL had significant impact on survival. Our results confirm that LPL is a strong predictor of outcome in CLL, able to improve prognostic accuracy in good risk cytogenetic subgroups. The relationship between its prognostic and functional role in CLL needs to be explored further.

Additional chromosome abnormalities, BCR-ABL tyrosine kinase domain mutations and clinical outcome in Hungarian tyrosine kinase inhibitor-resistant chronic myelogenous leukemia patients

BACKGROUND

Additional chromosome abnormalities (ACAs), mutations of the BCR-ABL tyrosine kinase domain (TKD) and BCR-ABL splice variants may cause resistance to first- and second-generation tyrosine kinase inhibitors (TKIs) in chronic myelogenous leukemia (CML) and Philadelphia-positive (Ph+) acute lymphoid leukemia (ALL).

METHODS

Karyotyping and BCR-ABL TKD mutation screening were performed in 71 imatinib-resistant CML patients and 6 Ph+ ALL patients. A total of 56 out of these 77 patients received second-generation TKI.

RESULTS

ACAs were present in 30 of 65 imatinib-resistant patients (46%). In 27 of 74 imatinib-resistant patients (36%), 15 different BCR-ABL TKD mutations were detected. Mutations were found in 25% of chronic-phase patients (12/47), 33% of accelerated-phase patients (5/15), 71% of blast crisis CML patients (5/7) and 100% of ALL patients. In nilotinib-resistant patients, Y253H, T315I and F359I/V mutations were detected; in dasatinib-resistant patients, L248M, E279K and T315I mutations were detected. T315I was found more frequently in patients on dasatinib than on imatinib therapy. The presence of ACAs predicted shorter survival during first- and second-generation TKI therapy, while TKD mutations only influenced survival during second-generation TKI therapy.

CONCLUSION

For patients with TKI resistance, mutation and ACA screening may play a role in identifying patients with poorer prognosis.

Reduction of Bcr-Abl function leads to erythroid differentiation of K562 cells via downregulation of ERK

The chimeric bcr-abl gene encodes a constitutively active tyrosine kinase that leads to abnormal transduction of growth and survival signals leading to chronic myeloid leukemia (CML). According to our previous observations, in vitro differentiation of several erythroid cell lines is accompanied by the downregulation of extracellular signal-regulated kinases (ERK)1/2 mitogen-activated protein kinase (MAPK) activities. In this work we investigated whether ERKs have a decisive role in either the erythroid differentiation process or apoptosis of bcr-abl+ K562 cells by means of direct (MEK1/2 inhibitor UO126) and indirect (reduced Bcr-Abl function) inhibition of their activities. We found that both Gleevec and UO126 induced hemoglobin expression. Gleevec treatment reduced the phosphorylation of Bcr-Abl, ERK and STAT-5 for up to 24 h, decreased Bcl-XL levels, and induced caspase-3-dependent apoptosis. In contrast, UO126 treatment resulted in only a transient decrease of ERK activity and did not induce cell death. For studying the effect of reduced Bcr-Abl function on erythroid differentiation at the level of the bcr-abl transcript, we applied the siRNA approach. Stable degradation of bcr-abl mRNA was achieved by using a retroviral vector with enhanced green fluorescent protein (EGFP) reporter. Despite a high (>90%) transduction efficiency we detected only a transient decrease in Bcr-Abl protein and in phosphorylated ERK1/2 levels. This transient change in Bcr-Abl signaling was sufficient to induce hemoglobin expression without significant cell death. These results suggest that by transiently reducing Bcr-Abl function it is possible to overcome the differentiation blockade without evoking apoptosis in CML cells and that reduced ERK activity may have a crucial role in this process.

First and second line imatinib treatment in chronic myelogenous leukemia patients expressing rare e1a2 or e19a2 BCR–ABL transcripts

During the formation of the Philadelphia (Ph) chromosome, in the majority of chronic myelogenous leukemia (CML) patients, the chromosome 22 breakpoint is located in the major breakpoint cluster region of the BCR gene (M-bcr). Minor and micro breakpoint cluster regions (m-bcr with e1a2 transcript and micro-bcr with e19a2 transcript) are rarely affected and have been suggested to be associated with peculiar CML phenotypes. Despite the different clinical characteristics, it is currently not established, whether different therapeutic options are preferably recommended for the treatment of e1a2 or e19a2 CML. Here we report two patients with e1a2 and one patient with e19a2 translocations, treated with different approaches including imatinib. First and second line imatinib treatments induced haematologic response in all of the three patients, and major cytogenetic response in one patient with e1a2, as well as in the patient with e19a2 CML. However, relapse occurred in the patient with e19a2 CML, possibly caused by the presence of additional chromosomal abnormalities such as an extra Ph chromosome, and loss of chromosome Y. Stem cell transplantation (SCT) therapy caused complete haematologic response with molecular remission; however, the patient died of infectious complication. We conclude that in patients with rare BCR-ABL variants, the effectiveness of imatininb treatment may be influenced by the CML stage besides the actual molecular type of the rare transcript. However, this conclusion cannot be generalized to larger patient groups with rare BCR-ABL variants for which further studies may be needed.

In vitro expansion of long-term repopulating hematopoietic stem cells in the presence of immobilized Jagged-1 and early acting cytokines

There is an increasing body of evidence that suggests that genes involved in cell fate decisions and pattern formation during development also play a key role in the continuous cell fate decisions made by adult tissue stem cells. Here we show that prolonged in vitro culture (14 days) of murine bone marrow lineage negative cells in medium supplemented with three early acting cytokines (stem cell factor, Flk-2/Flt-3 ligand, thrombopoietin) and with immobilized Notch ligand, Jagged-1, resulted in robust expansion of serially transplantable hematopoietic stem cells with long-term repopulating ability. We found that the absolute number of marrow cells was increased approximately 8 to 14-fold in all cultures containing recombinant growth factors. However, the frequency of high quality stem cells was markedly reduced at the same time, except in cultures containing growth factors and Jagged-1-coated Sepharose-4B beads. The absolute number of hematopoietic cells with long-term repopulating ability was increased approximately 10 to 20-fold in the presence of multivalent Notch ligand. These results support a role for combinatorial effects by Notch and cytokine-induced signaling pathways in regulating hematopoietic stem cell fate and to a potential role for Notch ligand in increasing cell numbers in clinical stem cell transplantation.

Using focus groups to evaluate an education program

Two evaluation studies were carried out in 1995 and 1997. The first evaluation assessed tile effectiveness of the Psychiatric Nurse Practitioner's education program and its impact on mental health and psychiatry in Belize. The second study was done to determine if the mental health services were sustained in the country. Interviews and focus groups were used for data collection. In this paper the focus is on the findings from the focus groups. The findings show that the PNP's role performance was adequate, they have made an impact on the mental health services and the services are sustained.

Age, activity, and physical performance: an evaluation of performance models

Two performance models relating age, physical activity, and physical performance were evaluated on 5 age cohorts involving more than 6,000 persons ranging in age from 20 to 69 years. Significant age and activity main effects, without 1 Age X Activity interaction, were obtained on 5 fitness measures and 2 activity indexes. These results are inconsistent with predictions from the moderation model, but they fit predictions from a recently formulated tonic and overpractice model of physical performance.

Age, activity, and physical performance: An evaluation of performance models

Two performance models relating age, physical activity, and physical performance were evaluated on 5 age cohorts involving more than 6,000 persons ranging in age from 20 to 69 years. Significant age and activity main effects, without 1 Age X Activity interaction, were obtained on 5 fitness measures and 2 activity indexes. These results are inconsistent with predictions from the moderation model, but they fit predictions from a recently formulated tonic and overpractice model of physical performance.

Age, exercise, and coding performance

We investigated the effects of exercise on the coding performance of young and older subjects. Hypotheses were tested that exercise either facilitates spatial localization or reduces susceptibility to distraction in older subjects. In a balanced design, we administered Digit Symbol and Symbol Digit coding tasks to exercisers and nonexercisers at two age levels under conditions of low or high within-task interference. The findings showed higher performance by the exercisers than by the nonexercisers only at the older age level and only with the Symbol Digit task. These findings support the hypothesis that exercise compensates for a loss of spatial localization skills with age. We found no evidence that susceptibility to distraction either increased with age or was affected by chronic exercise.

Effects on mood of a life-styles program for the rehabilitation of injured workers

This study reports an examination into the effects on daily mood of participation in a life-styles program by injured workers. In the current prospective study, 14 participants completed the Memorial University Mood Scale (MUMS) prior to starting the program, at 1 month, 2 months, and at 3 months. They also completed the Memorial University Scale of Happiness (MUNSH) prior to entry and after three months. There were significant improvements on the MUMS subscales of positive mood and vigor as well as overall mood. There were no changes in negative mood. Neither the positive nor the negative dispositional subscales of the MUNSH revealed any change. The results were interpreted as indicating strong psychologic benefits of the life-styles program for injured workers and are also consistent with a recently proposed two-factor state/trait model of well-being.

The prediction of mortality in elderly institution residents

The relationship between activity and mortality has been examined mainly in middle-aged and elderly community residents. This study investigated the prediction of five-year mortality in 156 institution residents, including a subsample (n = 121) retested one year after the initial assessment. The measures included demographic variables, three health indexes, happiness, quality of life ratings, personality and life stress indexes, cognitive function, and activity level. The strongest predictors of survival beyond five years from initial testing were a younger age and a high activity level. The relationships of age and activity to survival were mutually independent and were not secondary to the effects of any other variable. Health was not related to activity level and did not emerge as a strong predictor of survival. After a consideration of methodological issues, the findings were interpreted as providing support for an activity theory formulation of mortality prediction.

Age, exercise, and coding performance

We investigated the effects of exercise on the coding performance of young and older subjects. Hypotheses were tested that exercise either facilitates spatial localization or reduces susceptibility to distraction in older subjects. In a balanced design, we administered Digit Symbol and Symbol Digit coding tasks to exercisers and nonexercisers at two age levels under conditions of low or high within-task interference. The findings showed higher performance by the exercisers than by the nonexercisers only at the older age level and only with the Symbol Digit task. These findings support the hypothesis that exercise compensates for a loss of spatial localization skills with age. We found no evidence that susceptibility to distraction either increased with age or was affected by chronic exercise.

Balance and age in the sighted and blind

This study evaluated the usefulness of a balance test with eyes open and closed to index postural control capability. Experiment 1 was a one-year longitudinal study of 225 subjects aged 50 to 82 years. Comparing the two conditions, balance with eyes open had higher reliability, had greater sensitivity to aging effects, correlated stronger with functional age indices (vital capacity and forced expiratory volume), and showed greater sensitivity to the effects of physical fitness training. Experiment 2 included 22 visually impaired subjects aged 19 to 84 years. Minimally sighted subjects balanced for longer than fully blind subjects, but no differences in balance were found between subjects blind from birth versus those with acquired vision loss. The findings demonstrate the importance of vision to balance and indicate that balance with eyes open is a valid and sensitive test for clinical and research purposes.

Social desirability in measures of subjective well-being: a systematic evaluation

The present investigation addressed the problem of a social desirability response bias in measures of psychological well-being. Data on 150 people, between the ages of 50 and 82, yielded high correlations between three measures of well-being (the MUNSH, the LSI-Z, and the PGC) and the Edwards Social Desirability Scale, but only moderate ones between well-being scales and the Marlowe-Crowne Social Desirability Scale. Part correlations between well-being measures and an external criterion of happiness, controlling for social desirability, failed to improve on the zero-order criterion/well-being relationship. Controlling for social desirability, therefore, does not enhance the construct validity of well-being scales. These and related results suggest that the high zero-order correlations between measures of well-being and the Edwards scale are more readily attributed to content similarity between the Edwards scale and measures of well-being than to a social desirability response bias in well-being measures.

Age by distance effects in running and swimming records: a note on methodology

Running and swimming records by Masters athletes provide useful data for appraising age trends in physical performance; however, different forms of analysis have yielded conflicting conclusions about whether the deterioration with age is greater on sprint events or longer events. Aspects of analytic procedure that have contributed to the conflict include the use of time or velocity as the dependent variable, and the expression of age trend as relative or absolute change. An evaluation of underlying issues showed that meaningful inferences can be derived either where relative age change is compared across events, or the dependent variable is transformed to a logarithmic scale for purposes of comparing absolute change across events. Confounding of variables is introduced if absolute change in velocity is analyzed with respect to both age and event. The conclusion from every analysis in the literature that permits meaningful inference is that deterioration with age is greater on events of beyond sprint distance.

Age trends in maximal physical performance: comparison and evaluation of models

Versions of five paradigmatic models of age change in maximal physical performance were compared with respect to internal and validational data. The models were termed power output, power supply, energy output-supply, motivation, and sampling. The power output models tended to be more stringent in terms of internal criteria. The model that best predicted the validational data (i.e., from studies of reaction time, strength assessment, and athletic records) was from the energy output-supply category. This model, the power output relative to power available (POrPA) model, postulates that deterioration with age in physical performance varies with the ratio of peak power output to available power: the numerator generally varies with the strength demands of the task, and the denominator varies with task duration at high power output. The implications of this model were discussed with respect to habitual physical performances in later life.

"Happy are they who are happy . . ." a test between two causal models of relationships between happiness and its correlates

The intention of the study was to test between two causal models of relationships between happiness and five of its correlates (i.e., housing satisfaction, financial satisfaction, perceived health, locus of control, and activity level). In Model 1, happiness was identified as a propensity variable that is a source of influence on the lower order correlates. Model 2 is a traditional formulation whereby levels of happiness are determined by its correlates. The models were tested by causal modeling procedures, using 18-month longitudinal data from 408 elderly subjects. The findings support Model 1 over Model 2 for 17/18 predictions that differentiated the models. The status of happiness as a trait was discussed with reference to: the type of items included in the happiness scale; and relationships with variables not included in the research.

Happiness and activities as propensities

The research proceeded in two stages. The intention at the first stage was to develop a comprehensive activities inventory (i.e., the Memorial University of Newfoundland Activities Inventory, or MUNAI) that reflected recurrent content themes in interview data obtained from elderly adults. The intention at the second stage was to test a reactivity model and a propensity model of happiness-activity relationships in an 18-month longitudinal design. The reactivity model asserts that happiness, in part, is determined by activity levels. The claim of the propensity model is that both happiness and activity indices are reflections of different underlying propensities. The results supported the propensity model in that (a) activity structure retained stability over the longitudinal interval, (b) the relative standing of individuals on both happiness and the structural activity indices retained stability and, (c) the happiness-activities relationship was of a limited order.

Longitudinal trends in track and field performances

Previous investigation of aging effects in track and field performances has relied on cross-sectional data. In the present study, the shapes were examined of longitudinal performances on age curves from 81 older, elite, male athletes. The mean duration of the longitudinal span was 5.3 years, and performances were obtained from six events. The prediction made was that the performance on age curves would be curvilinear in shape: attenuated decline was predicted for the early portion of the longitudinal span, due to the effects of accumulated training. After quantification of the curves by application of a second-order polynomial model, the prediction was borne out by overall analysis of the equation coefficients. Other findings indicated discrepancies in the shape of the curves between the long jump and running events, and a failure to obtain effects owing to the ages of athletes.

Predictors of happiness

The current investigation reports findings on the temporal stability of happiness as assessed by the Memorial University of Newfoundland Scale of Happiness (MUNSH), and the stability of the predictor/happiness relationships in three subgroups of persons over 64 years of age. Respondents were interviewed twice, 18 months apart, on the MUNSH and on nine established correlates. Separate multiple regression analyses were used to assess the predictor/happiness relationship for each phase. The stability of happiness was evaluated by the inclusion of phase 1 MUNSH scores in the phase 2 predictor array. For urban and institutional persons the main independent predictors of happiness in both phases were housing satisfaction, health, activities, and changes in life events. For rural individuals only health and marital status remained consistent predictors for both phases. Happiness, greater in rural than in institutionalized persons, remained stable for all groups, with an average of 86% of the accounted MUNSH 2 variance due to MUNSH 1 scores. These results show that, although predictor effectiveness may differ across subgroups, happiness remains stable in later years.

Adult age trends in athletic performances

Aged trends in male, world record, track and field performances were examined over the 40-69 years age range. Five hypotheses were compared with respect to accuracy of prediction of differential age trends across events. The only hypothesis to yield statistically significant predictions was termed that of energy expenditure-supply ratio. This hypothesis predicts performance changes with age to exhibit steeper overall declines for events for events associated with higher maximal force transmissions, relative to the available (anaerobic or aerobic) energy supply.

Issues relating to the usage and conceptualization of mental health constructs employed by gerontologists

A major intention of the article was to delineate and clarify issues related to the usage and conceptualization of mental health constructs commonly utilized by gerontologists. Conclusions were drawn to the effect that (a) meanings of mental health constructs cluster differently depending on the type of analysis employed, (b) happiness may be considered the most apposite representative of the array of mental health constructs employed by gerontologists, (c) happiness has been conceptualized either as containing current affect and dispostional components or current affect components only, (d) contemporary models of happiness favour neither the expansionist nor contractionist positions as a means of attaining happiness and (e) questions as to the relative contributions to happiness of the affective and dispositional components represents an important problem for future research. A final intention of the article was to provide a speculative reconceptualization of the happiness construct.

The measurement of happiness: development of the Memorial University of Newfoundland Scale of Happiness (MUNSH)

Items of the Affect Balance Scale, the Life Satisfaction Index-Z and the Philadelphia Geriatric Center Scale together with 22 new items were used in the construction of a happiness scale for the elderly. Items were initially administered to 301 subjects from urban, rural, and institutional settings and correlated with ratings of happiness. A new scale consisting of 24 items was cross-validated on an additional 297 subjects. Test-retest reliability scores were obtained on 56 subjects. Results indicated that the new scale was a better predictor of "avowed happiness" in both validation and cross-validation samples than the existing scales used for comparison. Moreover, the new scale's test-rated reliability was within an acceptable range for this type of scale.

Adult age trends in record running performances

Age trends in record running performances, over distances from 100 yards to the marathon, were analyzed for males between 40-74 years. Within event distances, an exponential model most accurately related performance time to age. In terms of this model, rate of age decline in running performance was greater for middle and longer distance events than for sprints. Within age-levels, linear and power models were highly accurate in relating performance time to event distance. A general model, that proved highly accurate in accounting for variance in performance times over the full age and distance ranges, expressed performance as the product of a power function of distance and an exponential function of age. Findings are discussed in terms of anaerobic and aerobic processes that underlie running performance at different event distances.