Pharmacokinetic aspects of retinal drug delivery

Drug delivery to the posterior eye segment is an important challenge in ophthalmology, because many diseases affect the retina and choroid leading to impaired vision or blindness. Currently, intravitreal injections are the method of choice to administer drugs to the retina, but this approach is applicable only in selected cases (e.g. anti-VEGF antibodies and soluble receptors). There are two basic approaches that can be adopted to improve retinal drug delivery: prolonged and/or retina targeted delivery of intravitreal drugs and use of other routes of drug administration, such as periocular, suprachoroidal, sub-retinal, systemic, or topical. Properties of the administration route, drug and delivery system determine the efficacy and safety of these approaches. Pharmacokinetic and pharmacodynamic factors determine the required dosing rates and doses that are needed for drug action. In addition, tolerability factors limit the use of many materials in ocular drug delivery. This review article provides a critical discussion of retinal drug delivery, particularly from the pharmacokinetic point of view. This article does not include an extensive review of drug delivery technologies, because they have already been reviewed several times recently. Instead, we aim to provide a systematic and quantitative view on the pharmacokinetic factors in drug delivery to the posterior eye segment. This review is based on the literature and unpublished data from the authors' laboratory.

Survival and its predictors from age 75 to 85 in men and women belonging to cohorts with marked survival differences to age 75: a comparative study in three Nordic populations

BACKGROUND AND AIMS

While predictors of survival in older people have been examined in depth in a large number of studies, a literature search revealed no cross-national comparative prospective cohort studies on this issue. This study investigated survival and its predictors from age 75 to 85 among three local Nordic populations using survival data on national cohorts as background information.

METHODS

The data were derived from national registers and from samples of 75-year old living in Denmark, Sweden, and Finland. The subjects were invited to take part in interviews and examinations focusing on different domains of health, functional capacity, and physical and social activities.

RESULTS

The proportion of survivors to age 75 was markedly smaller among the Finnish men and women than Danish or Swedish subjects. In the local population no marked differences in survival from age 75 to 85 were observed between the groups of men, while women survived longer than men and longer in Göteborg than in Glostrup or Jyväskylä. Univariate models revealed 12 predictors of survival. In the multivariate models, the significant predictors among men related to physical fitness, whereas among women they pertained to social activities and morbidity.

CONCLUSIONS

Despite great differences in the proportions of survivors to age 75, and excepting the survival advantage of women, only minor differences were present in the subjects' further survival to age 85. In the univariate analyses, many of the factors predictive of survival from age 75 to 85 were the same in the examined populations, whereas in the multivariate analyses differences between the sexes emerged.

Factors affecting the increased risk of physical inactivity among older people with depressive symptoms

The purpose of this study was to investigate the association between depressive symptoms and physical inactivity, and whether motives for and barriers to exercise explain the potential association between depressive symptoms and physical inactivity in older people. The design of the study was cross-sectional. The study population comprised 645 people born between 1922 and 1928 who were residents in a city-center area of Jyväskylä in central Finland. Depressive symptoms were assessed using Center for the Epidemiologic Studies Depression Scale, physical activity using Grimby's (1986) validated scale, and motives for and barriers to exercise using a questionnaire and mobility limitation with a test of walking time over 10 m. The results demonstrated that the risk of physical inactivity was more than twofold among persons with depressive symptoms compared with non-depressed people. A higher prevalence of perceived barriers to physical activity, such as poor health, fear and negative experiences, together with lack of knowledge, explained part of the increased risk of physical inactivity among those with depressive symptoms while differences in motives for physical activity did not have a material effect. Adjustment for walking time over 10 m attenuated the increased risk of inactivity further. When planning exercise promotion programs, finding ways to overcome fear and negative experiences and providing information may help to increase physical activity among people with depressive symptoms. Additionally, difficulties caused by poor mobility should not be ignored.

Genetic basis of reduced eyes in the hybrids of Drosophila virilis phylad species

Structural anomalies were detected in F1 and backcross hybrids of Drosophila virilis and three of its sibling species Drosophila novamexicana, Drosophila americana texana and Drosophila americana americana. Similar but not identical anomalies have been described in D. virilis x D. lummei hybrids. F1 (D. virilis x D. novamexicana) hybrids had only slight disorders in the abdominal cuticula, but 5.3% of the first backcross generation hybrids had reduced eyes. Eye defects in the second generation were due to interaction of the heterozygous fourth chromosome of D. novamexicana with the homozygous D. virilis chromosomes 2 and 3. Reciprocal F1 hybrids between D. virilis and D. a. americana and between D. virilis and D. a. texana had normal eyes, but in the second hybrid generation 4.9% of D. virilis x D. a. americana and 1.6% of D. virilis x D. a. texana hybrids had anomalous eyes. In D. virilis x D. a. texana hybrids, the heterozygous fourth chromosome of D. a. texana was incompatible with homozygous D. virilis chromosomes 2 and 3. Of the D. virilis x D. a. americana hybrids homozygous for D. virilis chromosomes 2 and 3, 10.2% had the eye defect. The incompatibility system of non-conspecific chromosomes causing the eye anomalies in the hybrids of these three species pairs was different from those in D. virilis x D. lummei hybrids and has evolved independently after the diverging of the American lineage from D. lummei.

Genetic effects in common on maximal walking speed and muscle performance in older women

The purpose was to examine whether maximal walking speed, maximal isometric knee extensor strength, and leg extensor power share genetic or environmental effects in common. The data was collected from 103 monozygotic and 114 dizygotic female twin pairs aged 63-76 years. Maximal walking speed over 10 m was measured in the laboratory corridor using photocells for timing. Isometric knee extensor strength and leg extensor power were measured using an adjustable dynamometer. The genetic models showed that strength, power, and walking speed had a genetic effect in common which accounted for 52% of the variance in strength, 36% in power, and 34% in walking speed. Strength and power had a non-shared environmental effect in common explaining 13% of variation in strength and 14% in power. The remaining variance was accounted for by trait-specific effects. Some people may be more prone to functional limitation in old age due to their genetic disposition, but this does not rule out that changes in the lifestyle of predisposed subjects may also have a major effect. Approximately half of the variation in each trait was explained by environmental effects, which suggests the importance of the physical activity to improve performance and prevent functional limitation.

Customer-oriented counseling for physical activity in older people: study protocol and selected baseline results of a randomized-controlled trial (ISRCTN 07330512)

The objective of this study is to describe the rationale, design and selected baseline results of a 2-year randomized-controlled trial (RCT) on the effects of physical activity counseling in community-living older people. After a four-phase screening and data-collection process targeting all independently living people in the city center of Jyväskylä, Finland, six hundred and thirty-two 75-81-year-old cognitively intact, sedentary persons who were able to move independently outdoors at least minimally and willing to take part in the RCT were randomized into intervention and control groups. At baseline, over half of the subjects exercised less than two to three times a month and two-thirds were willing to increase their physical activity level. The desire to increase physical activity was more common (86%) among subjects with mobility limitation compared with those without (60%, P=0.004). The intervention group received an individualized face-to-face counseling session, followed by phone contacts every 3 months throughout the intervention. The study outcomes include physical activity level, mobility limitation, functional impairments, disability, mood, quality of life, use of services, institutionalization and mortality. The screening and recruitment process was feasible and succeeded well, and showed that unmet physical activity needs are common in older people.

Physical activity compensates for increased mortality risk among older people with poor muscle strength

The aim of the study was to determine whether habitual physical activity can compensate for the increased mortality risk among older people with poor muscle strength. Mortality was followed up for 10 years after laboratory examination in 558 community dwelling 75- and 80-year-old men and women. Maximal isometric strength of five muscle groups was measured and tertile cut-off points were used to categorize participants. Participants, who reported moderate physical activity for at least 4 h a week, were categorized as physically active and the others as sedentary. High muscle strength and physical activity both protected from mortality, but their effect was not additive. Within each muscle strength tertile, physically active people had a lower mortality risk than sedentary people, the effect being most pronounced among those with lower strength in all muscle groups. A high level of physical activity may thus compensate for the increased mortality associated with low muscle strength.

Low-field MR imaging of meningiomas including dynamic contrast enhancement study: evaluation of surgical and histopathologic characteristics

BACKGROUND AND PURPOSE

Risks associated with surgery of meningiomas, especially those located in the skull base, are influenced by tumor consistency and vascularity. The purpose of this study was to find out if vascularity, consistency, and histologic characteristics of meningioma can be predicted preoperatively by using low-field MR imaging, including dynamic imaging of contrast enhancement.

MATERIALS AND METHODS

Twenty-one patients (mean age, 56; range, 34-73 years; 16 women, 5 men) with meningioma requiring first surgery were imaged by a 0.23T scanner. Time to maximum enhancement, maximum enhancement, and maximum intensity increase were noted from the enhancement curve of dynamic imaging. Relative intensity of tumor in fluid-attenuated inversion recovery (FLAIR) and T2-weighted images was calculated. The neurosurgeon evaluated surgical bleeding and hardness of tumor on a visual analog scale. Histopathologic analysis included subtype, World Health Organization grade, mitotic activity, grades of progesterone receptor expression and collagen content, proliferation activity by Ki-67 (MIB-1), and microvessel density by CD34. Correlations were studied with Kendall tau statistics.

RESULTS

The most powerful association was found between time to maximum enhancement and microvessel density (tau = -0.60, P < .001). Surgical bleeding (tau = 0.49, P = .002), blood loss during surgery (tau = 0.49, P = .002), progesterone receptor expression (tau = 0.59, P < .001), and collagen content (tau = -0.54, P < .001) were statistically best correlated with the relative intensity of meningioma on FLAIR images. Tissue hardness correlated best with relative intensity on T2-weighted images (tau = 0.40, P = .012).

CONCLUSION

Assessment of microvessel density, collagen content, and progesterone receptor expression of meningioma may be clinically feasible by using low-field MR imaging.

Activity as a predictor of mental well-being among older adults

This eight-year follow-up study examines the roles of physical and leisure activity as predictors of mental well-being among older adults born in 1904-1923. As part of the Evergreen project, 1224 (80%) persons aged 65-84 years were interviewed at baseline (1988), and 663 (90%) persons in the follow-up (1996). Mental well-being factors including depressive symptoms, anxiety, loneliness, self-rated mental vigour and meaning in life were constructed using factor analysis. The predictors of mental well-being included physical and leisure activity, mobility status and number of chronic illnesses. We used a path analysis model to examine the predictors of mental well-being. At baseline, low number of chronic illnesses, better mobility status and leisure activity were associated with mental well-being. Baseline mental well-being, better mobility status and younger age predicted mental well-being in the follow-up. Explanatory power of the path analysis model for the mental well-being factor at baseline was 19% and 35% in the follow-up. These findings suggest that mental well-being in later life is associated with activity, better health and mobility status, which should become targets for preventive measures.

The predictive value of exercise testing for survival among 75-year-old men and women

All 75-year-olds born in 1914 and living in the city of Jyväskylä, central Finland (n=388) were invited to study the predictive value of exercise test for mortality. Subjects who entered the laboratory (n=295) were to have a standard pre-test evaluation and perform a cycle ergometer exercise test. Subjects with complete background, exercise-test status and mortality data (n=282) were divided into three groups according to exercise-test status: a non-exercise test group (n=79), an exercise-test termination group (n=95), and an exercise-test completion group (n=108). Mortality was followed up for 9 years. The multivariate hazard ratio (HR) for death among the non-exercise test group compared with exercise-test completion group was 1.87 (CI 1.19-2.94). The multivariate HR for death among the exercise-test termination group compared with the exercise-test completion group was 0.95 (CI 0.58-1.54). High cycling power (W/kg body weight) in the exercise-test completion group was associated with a decreased risk for death with a multivariate HR 0.14 (CI 0.05-0.38). Performing an exercise test serves information on the risk of death that is incremental to clinical data and traditional risk factors of death in elderly people.

Recommendations for and warnings against physical activity given to older people by health care professionals

BACKGROUND

Little is known about how health care professionals advice older people with chronic conditions about physical exercise. This study investigated exercise counseling in the context of health care as perceived by older people, and factors associated with perceived advice.

DESIGN AND METHODS

Participants were 580 non-institutional 73- to 92-year-old people who reported at least one contact with health care during the previous 12 months.

RESULTS

Of all the participants, 23% recalled solely recommendations to exercise, and 9% solely warnings against exercise. Additionally, 34% recalled receiving both recommendations for and warnings against physical activity, and 34% did not recall exercise-related advice at all. Recalling solely recommendations to exercise was associated with having musculoskeletal diseases and impaired mobility. Reporting solely warnings against physical activity was more common among those having heart conditions. Recalling both recommendations for and warnings against exercise was associated with being physically active despite of having heart conditions, musculoskeletal diseases, and impaired mobility. Recalling no exercise-related advice was most common among people who were sedentary and older, had fewer chronic conditions and reported no mobility limitation.

CONCLUSIONS

A substantial proportion of older people recalled negative, no, or contradicting advice about exercise. As warnings against physical activity may outweigh recommendations to exercise, special attention should be paid to the content of advice in order to avoid discouraging older people from being active.

The effect of advice by health care professionals on increasing physical activity of older people

The aim of this study was to investigate whether advice by health care professionals is associated with increased exercise activity in older people. As part of the Evergreen follow-up study, self-report data on exercise related advice were collected in 1996 and physical activity in 1988 and 1996 among 611 non-institutional people initially aged 65-84 years. Logistic regression analyses were used to study the association of recollection of having received exercise counseling with increased activity. Of all the subjects, 92% reported having been in contact with health care professionals during the follow-up period, and 58% of them recalled having been advised to exercise. Those men and women who recalled having received advice, started to participate in supervised exercise classes 5-6 times more often than those who did not recall being advised. The odds ratio (95% confidence interval) in men was 6.27 (1.19-32.9), and in women 5.27 (1.97-14.1). For calisthenics at home, the corresponding figure was 12.5 (3.52-44.4) in men. We concluded that initiating new physical activities in old age is strongly connected to encouragement to exercise by health care professionals. Health care professionals should be supported to promote exercise among older patients.

Muscle strength before and mortality after a bone fracture in older people

We studied whether muscle strength measured before a bone fracture predicts mortality following the fracture. The participants were a sub-cohort of 82 people of a total of 493 Evergreen project participants initially aged 75- and 80 years, who had participated in knee extension strength tests as part of the baseline examinations, and who subsequently suffered at least one bone fracture. Maximal isometric knee extension strength was measured at baseline using an adjustable dynamometer chair. Fracture surveillance was carried out from patient records for 5 years, and mortality surveillance from population register for 10 years after baseline examinations. Average time till a fracture occurred after the baseline was 878 days (SD 576). Subsequent to the fracture, 32 deaths occurred. Using gender-specific cut-offs, three equal distribution-based groups were formed. A gradient risk of mortality was found according to baseline strength. The crude mortality rate per 1000 person-months was 15.2 in the lowest 4.9 in the middle and 1.7 in the highest third of baseline knee extension strength. The adjusted relative risk (RR) of death was 4.40 (95% confidence interval, CI 1.40-13.80) in the lowest and 2.39 (95% CI 0.68-8.4) in the middle tertile vs the highest tertile of muscle strength. Poor muscle strength measured before a fracture occurred was a powerful predictor of increased mortality after the fracture. Poor muscle strength may be a good indicator of overall vulnerability and frailty in old age, and strength testing could be helpful in targeting older people for preventive interventions.

A pattern of long-term predictors of health ratings among older people

The aim of our study was to examine the predictors of health ratings by applying a path analysis model to a set of data from 75-year-old men and women in a 5-year follow-up study. The study was part of the Evergreen project with the study group comprising all the eligible inhabitants of Jyväskylä, central Finland (N=382). The data were based on an interview and study center examinations focusing on different domains of health and functional capacity. Among the women, better health ratings at baseline, better functional ability and maximal working capacity, and a higher number of social contacts were important direct predictors of better health ratings at follow-up. Among the men, better health ratings at baseline, and depending on the model, higher physical activity or a lower number of chronic conditions and better functional ability were the most important direct predictors. The explanatory power of the path analysis models was 31-39% for men and 32% for women. In conclusion, health ratings reflect multiple dimensions of health and functioning. In addition to significant direct effects on health ratings, the predictors also have sequential effects running from life-style through functional performance and the activities of daily living to health ratings. The factors associated with health ratings differ to some extent by gender.

Coping with activities of daily living in different care settings

OBJECTIVE

To measure the functional capacity of elderly people cared for in different health and welfare care settings, with functional capacity defined in terms of activities of daily living.

SUBJECTS AND METHODS

We assessed all people aged > or =65 in health-centre hospitals or nursing homes or receiving home nursing and home help services in Central Finland (n=5652) using the Evergreen activities of daily living index, which comprises nine physical and nine instrumental activities of daily living.

RESULTS

Assessments of functional capacity were obtained for nearly all subjects: only 33 forms (0.6%) were returned with incomplete data. The mean activities of daily living sum score (range 0-54) was lowest for women receiving home nursing (17.3), and highest for women in long-term care at health-centre hospitals (48.4). Low scores described good and high scores poor functional capacity. Age showed no association with the mean activities of daily living sum score in any of the care settings.

CONCLUSION

The Evergreen activities of daily living index was easy to use and successfully distinguishes between people in different care settings. Policies of assigning older people to different settings appear to be sound and sensible as the main defining criterion is level of functional capacity rather than age.

The association of socio-economic factors with physical and mental capacity in elderly men and women

The association of socio-economic factors with functional capacity has received less research attention than their association with diseases and mortality. However, functional capacity is an important measure of health and independence in the elderly. This study explores the associations of socio-economic factors with physical and mental capacity as measured in laboratory tests and on the basis of self-report. The data were drawn from the Evergreen project, comprising all persons aged 75 (N=388) and 80 (N=291) in Jyväskylä, central Finland. Women with a higher level of education showed better functional capacity on all indicators, among men higher education was only associated with better vital capacity and cognitive capacity. Better perceived financial situation was associated with better functional capacity in both men and women. The association between socio-economic factors and functional capacity remained even when the number of chronic diseases was controlled for. The results lend support to the assumption that socio-economic factors are associated with physical and mental capacity in elderly people.

Rapid induction of meningeal collagen synthesis in the cerebral cisternal and ventricular compartments after subarachnoid hemorrhage

Procollagen propeptides in the lumbar CSF increase after subarachnoid hemorrhage (SAH), and elevated concentrations have been detected as early as on day 8. We studied here the timing and localization of the induction of meningeal collagen synthesis during the first week after SAH by analysing cisternal and ventricular CSF samples. We obtained 29 cisternal and 10 ventricular CSF samples at operation from patients with SAH between days 1 and 9 after onset. The carboxyterminal propeptide of type I procollagen (PICP) and the aminoterminal propeptide of type III procollagen (PIIINP) were measured using radio-immunoassays. The concentrations of PICP and PIIINP in the cisternal CSF were elevated as early as on day 2 after SAH. PICP increased in a sigmoidal fashion (R2 = 0.39, p < 0.001), while PIIINP increased linearly (R2 = 0.28, p = 0.003) and was approximately 3-fold higher on day 9 than initially. PICP was twice as high (p = 0.02) in the cisternal than in the ventricular CSF after SAH and PIIINP was 4-times higher (p = 0.007). Interestingly, the concentrations were similar in a patient with intraventricular bleeding. The cisternal compartment contributed to the propeptides in the CSF more than did the ventricular compartment, but the latter also appeared to have a definite potential for fibroproliferative reaction. Meningeal collagen synthesis was induced rapidly within the first few days after SAH suggesting that therapeutic attempts to inhibit the fibroproliferative reaction should be started as early as possible.

Predictors of decline in self-assessments of health among older people--a 5-year longitudinal study

Within the framework of the Evergreen project we examined how changes in several indicators of health and functioning and physical activity predicted a decline in self-assessments of health evaluated over a 5-year period in older people by two different measurements: self-rated health (SRH) and self-assessed change in health (SACH). The study group comprised all 75-year-old persons born in 1914 (N = 382) and living in Jyväskylä, a town in central Finland. At baseline in 1989, 91.6%, and at follow-up 5 years later in 1994, 87.3% of those eligible participated in the interview and 77.2 and 71.3%, respectively, in the examinations in the study centre, focusing on different domains of health and functional capacity. One-fifth of the subjects reported a deterioration in and one-fifth an improvement in SRH over the 5 years. The rest gave identical self-assessments of their health at baseline and at follow-up in response to the same question. Decline in SRH was associated with a decrease in physical activity and cognitive capacity. When asked directly about changes in their health (SACH), however, half the subjects said their health had declined. Negative SACH over the 5-year period was related to an increased number of chronic conditions, deterioration in functional performance and physical activity, and to the number of chronic conditions at baseline. We suggest that ageing people adapt to changes in their objective health and functional performance: the majority tend to assess their health as similar to or even better with increasing age despite an increase in chronic diseases and decline in functional performance. However, a negative SACH indicates that older people are realistic about these negative changes. These results support the assumption that the two subjective measurements of change in health are based on different criteria: assessment of current general health status tends to be based on inter-individual comparison, whereas assessment of change in health over a given time period may be based on intra-individual comparison. Physical activity seems to be an important factor when older people assess their health.

Linkage disequilibria and the site frequency spectra in the su(s) and su(w(a)) regions of the Drosophila melanogaster X chromosome

Over the last decade, surveys of DNA sequence variation in natural populations of several Drosophila species and other taxa have established that polymorphism is reduced in genomic regions characterized by low rates of crossing over per physical length. Parallel studies have also established that divergence between species is not reduced in these same genomic regions, thus eliminating explanations that rely on a correlation between the rates of mutation and crossing over. Several theoretical models (directional hitchhiking, background selection, and random environment) have been proposed as population genetic explanations. In this study samples from an African population (n = 50) and a European population (n = 51) were surveyed at the su(s) (1955 bp) and su(w(a)) (3213 bp) loci for DNA sequence polymorphism, utilizing a stratified SSCP/DNA sequencing protocol. These loci are located near the telomere of the X chromosome, in a region of reduced crossing over per physical length, and exhibit a significant reduction in DNA sequence polymorphism. Unlike most previously surveyed, these loci reveal substantial skews toward rare site frequencies, consistent with the predictions of directional hitchhiking and random environment models and inconsistent with the general predictions of the background selection model (or neutral theory). No evidence for excess geographic differentiation at these loci is observed. Although linkage disequilibrium is observed between closely linked sites within these loci, many recombination events in the genealogy of the sampled alleles can be inferred and the genomic scale of linkage disequilibrium, measured in base pairs between sites, is the same as that observed for loci in regions of normal crossing over. We conclude that gene conversion must be high in these regions of low crossing over.

A paradigm shift: from disease to health orientation

The history of science has been described as 'paradigm shifts' of sequential overthrow, each new paradigm replacing the previous one. A paradigm is an overarching view-point which guides the articulation of theories and other activities in a particular field. In the exploration of health, two different types of approach can be identified. The pathogenic view, which has dominated the orientation of medicine over the last hundred years, focuses on disease states and underlying factors that modify the chances of entering into one of those states. The competing salutogenic view appears to be undergoing a renaissance in the new strategies of public health and health promotion, and producing theories of health based on more holistic approaches and diverse methods. The two paradigms exist side by side, and both are in a constant state of flux. The advocates of the health-oriented paradigm say it is difficult to reach a true, in-depth understanding of human health on the basis of a disease-oriented approach or from the traditional vantage-point of risk-factor epidemiology, whereas opponents point out that health does not lend itself to exact measurements or experimentation in keeping with the Galilean natural science ideal. The importance and utility of health orientation need to be explored and ascertained in further research. The approach seems, however, to have a number of crucial assets that might help avoid the limitations of the established disease and risk-factor epidemiology approaches and promote new directions of pursuit, including a better understanding of the complex relationships between aging and health, and other current challenges in creating healthy public policy.

Transient increase in procollagen propeptides in the CSF after subarachnoid hemorrhage

BACKGROUND

Meningeal fibrosis following subarachnoid hemorrhage (SAH) has been verified histologically in experimental animals and in human autopsy samples, but the clinical course of the intrathecal fibroproliferative reaction is unknown. The authors therefore studied time-related changes in the CSF concentrations of type I (PICP) and type III (PIIINP) procollagen propeptides in patients with recent SAH.

METHOD

Fifty-two CSF samples were obtained from 39 patients with SAH treated surgically and eight samples from eight patients with SAH who were not surgically treated. The samples were analyzed for PICP and PIIINP by using radioimmunoassays.

RESULTS

The authors found a time-dependent increase in PICP and PIIINP in the CSF of the patients with SAH. Two weeks after the hemorrhage, concentrations were four times higher in patients with SAH than the concentrations in the control subjects. Concentrations in patients with SAH then declined steadily, but remained slightly but significantly elevated even at 10 weeks. PICP and PIIINP did not correlate with the age or sex of the patient or the amount of blood in the initial CT scan. Four patients developed late posthemorrhagic hydrocephalus; their PICP and PIIINP levels were higher than in matched patients with SAH without hydrocephalus.

CONCLUSIONS

Time-dependent changes in CSF concentrations of PICP and PIIINP suggest a transient fibroproliferative reaction in the meninges after SAH. The considerable magnitude and extended time course of the changes make the measurement of PICP and PIIINP practicable for the diagnosis of a fibroproliferative state in patients with recent meningeal disease. Furthermore, the results suggest a role for meningeal fibrosis in the development of late posthemorrhagic hydrocephalus.

Cardiac adverse effects and acute exercise in elderly subjects

Cardiac arrhythmias, ST segment depressions and other cardiac adverse effects are occasionally seen in relation to physical exercise in elderly people. However, the magnitude, quality, and time-dependence of these events need to be clarified. During voluntary maximal cycle ergometer exercise (CEE), immediate cardiac disturbances as a reason for exercise termination were registered in a sample of 75-year-old men and women (N=203) (population group, PG). Any referrals to hospital following cardiac incidents within 24 hours post-CEE were obtained from patient records. Ambulatory ECG was recorded 24 hours before and after CEE in 23 elderly subjects (12 men, 11 women) capable of maximal effort (Holter group, HG). In the PG, 23.4% of the men and 6.4% of the women had to terminate CEE because of cardiac disturbances. One subject was referred to hospital because of exercise-induced atrial fibrillation. In the HG, no long-lasting effect of exercise on the occurrence of cardiac disturbances was found in elderly subjects capable of maximal effort.

Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population

OBJECTIVE

In older people, mobility impairments and physical inactivity are risk factors for further disability and death. We studied the interaction of physical activity and mobility impairment as a predictor of dependence and mortality.

DESIGN

A population-based, prospective study. The data were collected in structured interviews in the year 1988 and 8 years later in the year 1996 as part of the Evergreen Project.

PARTICIPANTS

Subjects were 1109 independently living, at baseline 65- to 84-year-old people in the city of Jyvaskyla, in central Finland.

METHODS

Participants were ranked into four groups: (1) Intact mobility and physically active (Mobile-Active), (2) Intact mobility and sedentary (Mobile-Sedentary), (3) Impaired mobility and physically active (Impaired-Active), and (4) Impaired mobility and sedentary (Impaired-Sedentary). The confounders adjusted for in the models included age, marital status, education, chronic conditions, smoking, and physical exercise earlier in life.

RESULTS

In men and women, the relative risk of death was two times greater in Impaired-Active and three times greater in Impaired-Sedentary groups than the risk of death in Mobile-Active groups. However, the risk of death did not differ between Mobile-Active and Mobile-Sedentary groups. The odds ratio for dependency (95% confidence interval) in Impaired-Sedentary men was 5.21 (1.44-18.70) and in Impaired-Sedentary women was 2.92 (1.52-5.60) compared to Mobile-Active groups. The risk of dependence did not differ significantly between Mobile-Active, Mobile-Sedentary, and Impaired-Active groups.

CONCLUSIONS

Mobility impairments predicted mortality and dependence. However, among people with impaired mobility, physical activity was associated with lower risks, whereas the risk did not differ according to activity level among those with intact mobility. Despite of their overall greater risk, mobility-impaired people may be able to prevent further disability and mortality by physical exercise.

Health and functional capacity as predictors of community dwelling among elderly people

The aim of this study was to identify factors that predict community dwelling (i.e., nonuse of institutional bed-days) among elderly people. This was a longitudinal study of institution use including both short-term and long-term use of hospitals and nursing homes. The impact of health, functional performance, and carrying out the activities of daily living on community dwelling was studied using the method of path analysis. The participants were all the 75-year-old (N = 388) and 80-year-old (N = 291) men and women resident in the City of Jyväskylä, Finland. Predictor variables included disease severity, symptoms of illness, cognitive capacity, walking speed, muscle strength, hearing, and ability to carry out the activities of daily living. The outcome variable was community dwelling. Over 70% of the elderly people had received institutional care during the 5-year follow-up. The path analysis models showed that disease severity and symptoms of illness had an effect on community dwelling: those with a more severe disease or more symptoms needed more institutional care. The effect was also mediated through limitations in physical performance and cognitive capacity and need for assistance in activities of daily living. The explanatory power of these models varied from 23% to 36%. The results of this study suggest that prevention, treatment, and rehabilitation programs aimed at the promotion of community dwelling in elderly people should focus on the severity of diseases, functional performance, and the ability to carry out the activities of daily living.

Increase of collagen synthesis and deposition in the arachnoid and the dura following subarachnoid hemorrhage in the rat

Arachnoidal fibrosis following subarachnoid hemorrhage (SAH) has been suggested to play a pathogenic role in the development of late post-hemorrhagic hydrocephalus in humans. The purpose of this study was to investigate the rate of collagen synthesis in the arachnoid and the dura in the rat under normal conditions and to study the time schedule and the localization of the increased collagen synthesis following an experimental SAH. We found that the activity of prolyl 4-hydroxylase, a key enzyme in collagen synthesis, was 3-fold higher in the dura than that in the arachnoid and was similar to the activity in the skin. We then induced SAH in rats by injecting autologous arterial blood into cisterna magna. After SAH, we observed an increase in prolyl 4-hydroxylase activity of the arachnoid and the dura at 1 week. At this time point the enzyme activity in both tissues was 1.7-1.8-fold compared to that in the controls and after this time point the activities declined but remained slightly elevated at least till week 4. The rate of collagen synthesis was measured in vitro by labeling the tissues with [(3)H]proline. The rate increased to be 1.7-fold at 1 to 2 weeks after the SAH in both of the tissues. Immunohistochemically we observed a deposition of type I collagen in the meninges at 3 weeks after the SAH. SAH is followed by a transient increase in the rate of collagen synthesis in the arachnoid and, surprisingly, also the dura. Increased synthesis also resulted in an accumulation of type I collagen in the meningeal tissue, suggesting that the meninges are a potential site for fibrosis. The time schedule of these biochemical and histological events suggest that meningeal fibrosis may be involved in the pathogenesis of late post-hemorrhagic hydrocephalus.

A path analysis model of self-rated health among older people

The aim of this study was to examine the structure of self-rated health among 75-year-old men and women. The study was part of the Evergreen project, comprising all the 75-year-old residents (N = 382) of Jyväskylä, in central Finland, in 1989. The data were collected by interviews, questionnaires and laboratory examinations, focusing on different domains of health and functional capacity. Of the target group, 91.6% (119 men and 231 women) participated in the interview, and 77.2% (104 men and 191 women) took part in the clinical and laboratory examinations. Path analysis models (LISREL 8) were used to examine the structure of self-rated health. About half the participants self-rated their health as good or unusually good. In both genders, a smaller number of difficulties in performing the physical activities of daily living (PADL), fewer chronic diseases, and better maximal working capacity were associated with better self-rated health. In addition, among the women a smaller number of depressive symptoms, and among the men better cognitive capacity had a positive effect on self-rated health. Physical activity and muscle strength had a positive indirect effect on self-rated health among both men and women. The explanatory power of the path analysis model for self-rated health was 44% for the men, and 42% for the women. The ability to perform the physical activities of daily living independently is an important associate of good self-rated health among older people. The path analysis models suggest that the factors underlying the physical activities of daily living also directly modify self-ratings of health among the elderly. The models of self-rated health for the men and the women were not exactly alike.

An efficient and accurate integration of mini-Mu transposons in vitro: a general methodology for functional genetic analysis and molecular biology applications

Transposons are mobile genetic elements and have been utilized as essential tools in genetics over the years. Though highly useful, many of the current transposon-based applications suffer from various limitations, the most notable of which are: (i) transposition is performed in vivo, typically species specifically, and as a multistep process; (ii) accuracy and/or efficiency of the in vivo or in vitro transposition reaction is not optimal; (iii) a limited set of target sites is used. We describe here a genetic analysis methodology that is based on bacteriophage Mu DNA transposition and circumvents such limitations. The Mu transposon tool is composed of only a few components and utilizes a highly efficient and accurate in vitro DNA transposition reaction with a low stringency of target preference. The utility of the Mu system in functional genetic analysis is demonstrated using restriction analysis and genetic footprinting strategies. The Mu methodology is readily applicable in a variety of current and emerging transposon-based techniques and is expected to generate novel approaches to functional analysis of genes, genomes and proteins.

The Y chromosomes of Drosophila lummei and D. novamexicana differ in fertility factors

Many first-generation interspecific hybrids between the five species of the Drosophila virilis subgroup are fertile. Fertile hybrids can be utilized in the analysis of sterile hybrids, by creating new combinations of genetic elements to identify cross-incompatible chromosomes or chromosome segments. Here, crosses starting from D. lummei, D. virilis, D. novamexicana and D. americana were produced to analyse the 96.4% male sterility in the progeny of D. virilis females mated with D. novamexicana males (sterility based on sperm motility). In autosomally identical heterozygous combination, the substitution of a large segment of the D. virilis X chromosome with a double or a triple inversion from the sister taxa decreased male sterility from 96.4% (Xvirilis) to 11% (Xvirilis/novamexicana), 19% (Xvirilis/americana) and 34% (Xvirilis/lummei). This result shows that the Xvirilis interaction with D. novamexicana elements (Y and/or autosomes) is a major component in the F1 sterility observed. When males with a substituted Ylummei in otherwise pure D. novamexicana were crossed with D. virilis females, all the F1 males were fertile. We constructed combinations of intact Xvirilis, recombinant Xvirilis/novamexicana, Ynovamexicana and Ylummei chromosomes in homozygous D. virilis and heterozygous D. virilis/D. novamexicana autosomal backgrounds. In such combinations, the Y chromosome interacted strongly not only with the nonconspecific X chromosome, but with several autosomes. Autosomal hybrid sterility contributions tend to be recessive and not present in the F1. In this species group, the role of the Y chromosome is central in contributing to the phenomenon called Haldane's rule of sterility, but the Y chromosomal incompatibility factor of D. novamexicana is the most divergent one.

Absence of p53 mutations in benign and pre-malignant male genital lesions with over-expressed p53 protein

Mutations of the tumor-suppressor gene p53 are common in epithelial tumors. Clonal mutations of p53 have been found in cervical and vulvar carcinomas negative for human papillomavirus (HPV), though at least in cervical cancer HPV infection and p53 mutations are not mutually exclusive. We have previously shown that about 40% of male genital warts and bowenoid papulosis lesions exhibit immunohistochemically detectable aberrant p53 protein, irrespective of the presence of HPV DNA. We studied p53 mutations in exons 4-8 with SSCP and sequencing in 13 male patients with 1 to 3 therapy-resistant genital warts or intra-epithelial neoplasias each and in 4 patients with penile squamous cell carcinoma. Thus, 13 genital warts, 6 bowenoid papulosis, 1 Queyrat's erythroplasia and 1 carcinoma in situ were studied. p53 protein was detected immunohistochemically, and HPV status was analyzed with DNA in situ hybridization and amplification of HPV-specific DNA. There was no correlation between p53 protein expression and HPV status. No mutations in exons 5-8 of the p53 gene were found in any of the lesions, and furthermore, no exon 4 mutations were found in lesions positive in p53 immunohistochemistry. In conclusion, overexpression of p53 does not indicate a p53 mutation in male genital warts, pre-malignant lesions or malignant squamous cell carcinomas. Our study thus suggests that p53 mutations are not important, or at least not early, events in male genital carcinogenesis.

Associations of sensory-motor functions with poor mobility in 75- and 80-year-old people

This study investigated the associations of sensory-motor functions with mobility in elderly people. All 75- and 80-year-old residents of the city of Jyväskylä, Finland, were invited to take part in the study. A total of 617 (93%) persons were interviewed, and 500 (75%) took part in laboratory examinations. Self-reported mobility was recorded during the interview. Basic mobility functions (maximal walking speed and stair-mounting ability) and sensory-motor functions (maximal isometric muscle strength, standing balance, reaction time and visual acuity) were measured in the laboratory. Multivariate analyses showed that poor sensory-motor functions were significantly associated with poor performance in basic mobility functions and that poor performance in basic mobility functions was associated with self-reported disability in mobility. The associations discovered were consistent with models of the disablement process. Muscle strength, balance, reaction time and vision all have individual significance for mobility, underlining the need for multifactorial approaches in prevention and rehabilitation.

Constant hierarchic patterns of physical functioning across seven populations in five countries

This research was aimed at identifying critical steps in the decline in physical function that often parallels aging. Six basic and nine instrumental activities of daily living (ADLs) were classified into four domains of disability characterized by specific underlying physical impairment. The hierarchical order of this classification was verified in two random samples representative of the older home-dwelling population. The concordance level of disability and results of performance-based measures of physical function were also tested. Finally, the cross-cultural reliability of the model was verified in seven population-based samples of older persons living in five European countries. In older persons the disabling process follows a general pattern of progression based on a typical sequence of impairments.

Is self-rated health comparable across cultures and genders?

Self-rated health is a frequently used health indicator, but there is little data on its comparability across cultures. We employed samples from Tampere, Finland, and Florence, Italy, of the European Longitudinal Study on Aging to examine the cultural and gender differences in self-rated health. Personal interview data was used and vital status ascertained after 7 years. After adjusting for several health-related variables, we found no substantial difference in self-rated health between genders, although women in Florence were three times and men in Florence four times more likely to report good self-rated health than men in Tampere. The correlational structure of self-rated health was similar in both areas. The significant graded association between self-rated health and mortality in both areas was mostly explained by other health indicators included in a multivariate model. Results suggest that self-rated health is a useful summary of physical health, but it may predict mortality better in men than in women and be sensitive to cultural environment. Therefore, direct gender and cultural comparisons of self-rated health should be made with caution.

'A good person does not feel envy': envy in a nursing community

The definition of envy is commonly based on psychoanalytical views of organizational culture. The purpose of this paper is to describe envy in a nursing community. The population study consisted of random sample of 120 subjects drawn from among the employees of one central hospital in Finland. The study material consisted of data collected by questionnaires (response rate 65%). The data were processed by various statistical methods. Open-ended questions were analysed by inductive content analysis. The results of this study indicated that the employee's view of his/her official position in the nursing community, his/her relationships with his/her fellow workers and the management as well as relationships with other nursing communities are all related to envy. The employee's view of his/her official position intensified his/her feelings of envy, if he/she had other negative feelings, anxiety, dissatisfaction with him/herself, and negative feelings towards fellow workers. The major object of envy was fellow workers' salaries. Envy towards other nursing communities was generated by alleged differences in the amount of labour, or by the charge nurse's greater interest in other sections. Employees coped with envy by hiding these feelings and being modest. Women coped with envy by being silent, while men denied the value of the object of envy.

Self-rated health and self-assessed change in health in elderly men and women--a five-year longitudinal study

The purpose of the present investigation was two fold: (1) to examine how men and women self-rate their health as they age from 75 to 80 yr and how they assess the change in their health over the five year period; and (2) to ascertain how self-assessed change in health over the follow-up period corresponded to the difference in self-ratings of health between the assessments performed at baseline and at follow-up. The study was part of the Evergreen-project with the study group comprising all inhabitants born in 1914 (N = 388) living in Jyväskylä, central Finland. At baseline, 93.4%, and at follow-up, 93.3%, of those who were eligible participated in the interview. Self-rated health, when asked using the same questions, did not change at follow-up compared to baseline. However, nearly half of the follow-up group reported that their health had become worse over the five year period. Gender differences in self-rated health were not found, although women reported more often than men that their health had become worse and some of the men said their health had become better. It is concluded that self-rated health seems to be age-adjusted; elderly people who say their health has become worse as they age actually self-rate their health as the same or better than before.

["A good person does not feel envy"--envy in nursing communities]

The purpose of this study was to describe the nature, manifestation, and amount of envy among the staff of a nursing community. The definition of envy is commonly based on views of essence of envy and organisational culture. The population study consisted of random sample of 120 subjects drawn from among the employees in the Kainuu Central Hospital. Frequency and percentage distributions were used to present the data. The correlations between the variables were examined using cross-tabulation. Summarized variables were formed for nature of envy, and the Cronbach alpha coefficient was used to test the internal consistency of those. Factor analysis and cross-tabulation were also used. Open-ended questions were analysed by qualitative contact analysis. These results were used to complement quantitative data. The results of this study indicated that the employee's view of his/her official position in the nursing society, his/her relations with his/her fellow workers and the management as well as the relations to other nursing societies are all related to enviousness. The employees's view of his/her official position intensified his/her feelings of envy, if he/she had other negative feelings (anxiety, dissatisfaction with him/herself, and feeling if looks could kill). If the employee was ambitious and hard-working, his/her envy manifested in a comparison of his/her own work and the work of other employees. The major object of envy was fellow workers' salary. Envy was also caused by new, proficient, and senior co-workers and possible favourites or proteges of management. Envy towards other nursing community was generated by alleged differences in the amount of labour, or by the charge nurse's greater interest in other section. Employees coped with envy by hiding these feelings and being modest. Women coped with envy by being silent.

Maintaining movement ability in old age: challenges for gerontechnology

The degree of behavioral slowing that occurs with aging is highly task specific. Compensation for age related slowing, when necessary, requires task redesign and ergonomic interventions. Walking, performing various physical chores required in carrying out ADLs and IADLs, and avoiding falls are challenges for significant numbers of old people. Interventions based on prevention and/or compensation were presented. Approaches to the maintenance of strength required to carry out such activities emphasized resistive training programs. Improvements in visibility of the physical environment were stressed as one means of reducing falls and accidents.

Physical activity and the changes in maximal isometric strength in men and women from the age of 75 to 80 years

OBJECTIVE

To research the natural changes in maximal isometric strength, over a period of 5 years, in men and women aged 75 at baseline, and to study the effect of everyday physical activity on strength alterations.

DESIGN

A 5-year longitudinal study.

SETTING

Exercise laboratory.

PARTICIPANTS

The target group in 1989 was the total 75-year-old population of Jyväskylä. One hundred one men (81%) and 186 women (75%) participated in baseline strength tests, and after 5 years, 55 men and 111 women (70% and 72% of the survivors) took part in the follow-up measurements.

METHODS

Maximal isometric hand grip, arm flexion, knee extension, trunk flexion, and trunk extension forces were measured using dynamometers. Self-rated physical activity was recorded using a scale by Grimby (1986). Strength changes were compared between groups based on the amount of everyday physical activity: (1) remained active (AA, 24 men, 24 women); (2) remained sedentary (SS, 11 men, 43 women); (3) decreased activity (AS, 11 women); and (4) increased activity (SA, 32 women). AS and SA could be formed for women only because of the small number of men. All analyses were stratified by gender.

MAIN RESULTS

The average percentage change in strength over 5 years among survivors varied from a 4% increase in knee extension strength observed in men and women to a 16% decrease in grip strength in women. The grip strength decrease was greater in women than men. The AA men maintained their trunk extension strength at a higher level than the SS men. Time by group interactions in men were not significant. In women, the rate of decline in AS was 32% in grip and 27% in elbow flexion strength, which was greater than in the other activity groups. The AA women retained their knee extension strength at a higher level than the other groups. Those who died before follow-up tests exhibited poorer strength test results at baseline. Physical activity decreased over follow-up.

CONCLUSIONS

Strength alterations with age differed between muscle groups. Undertaking everyday physical activities such as household work, walking, and gardening, which are also the most common physically demanding activities of older people, may play an important role in maintaining strength at an adequate level for independent living.

A comparative study of factors related to carrying out physical activities of daily living (PADL) among 75-year-old-men and women in two Nordic localities

The aim of this cross-sectional and cross-national study was to describe and compare the ability to carry out physical activities of daily living (PADL) and examine factors that might explain variation in this ability in two Nordic populations. Seven hundred and six men and women aged 75 from two populations (Glostrup, Denmark, and Jyväskylä, Finland) were interviewed and given a laboratory examination in 1989-90. The ability to carry out the PADL activities was studied by interview. Tests were given to determine depressive symptoms, cognitive capacity, and selected physical and sensory performance domains. Four different regression models (men and women in Jyväskylä and Glostrup) were used to analyze a number of variables describing physical and psychological health and performance related to the PADL. Knee extension strength and stair mounting height in three models (men and women in Jyväskylä and women in Glostrup), and walking speed in one model (men in Glostrup) emerged as explanatory factors on the basis of the physical performance tests done. Sight, except in the women in Glostrup, hearing in the men in Jyväskylä, and balance in the women in Glostrup also explained PADL functioning. In addition, symptoms of depression in the men in Glostrup, and symptoms of illness, except in the men in Jyväskylä, and cognitive capacity in the men in Jyväskylä emerged as explanatory factors in the regression models. There were, however, no major differences in the determinants of PADL functioning in the two Nordic populations of elderly people. Physical, psychological and sensory tests provide useful information, complementary to self-reports regarding declining PADL functional capacity.

Calcaneal bone mineral density predicts fracture occurrence: a five-year follow-up study in elderly people

A 5-year follow-up study investigated calcaneal bone mineral density (BMD) and changes in BMD in relation to fracture occurrence. The subjects comprised two cohorts born in 1914 and 1910 living in the city of Jyväskylä in central Finland. One hundred and three men (82%) and 188 women (73%), aged 75, and 57 men (74%) and 136 women (65%), aged 80, of the eligible population participated in the baseline bone measurements. The follow-up bone measurements were obtained for 59 men (68%) and 119 women (66%), aged 80 years, and for 21 men (53%) and 61 women (48%), aged 85 years. During the follow-up period, 8 men and 36 women from the younger and 11 men and 24 women from the older cohort sustained at least one fracture. When the baseline levels of BMD were related to fracture occurrence, the results clearly showed that with increased BMD values the probability of fracture decreased. Where men and women had similar BMD values, they also had a similar fracture probability. Except for one woman in the older cohort, none of those who had initial BMD values more than 1 standard deviation above the mean for their age developed a fracture during the follow-up period. The mean annual decrease in BMD was greater in the women (2.5-2.7%) than in the men (0.8-1.0%). The BMD change tended to associate with fracture occurrence only in the 75-year-old women (p = 0.075). The results suggest that calcaneus BMD can be used as a predictor of fracture occurrence in 75- to 80-year-old men and women. However, associating fractures with the change in BMD was difficult due to the limited number of survivors and initial differences in BMD values.

Postural balance and self-reported functional ability in 75-year-old men and women: a cross-national comparative study

OBJECTIVE

To study postural balance in relation to self-reported functional ability (mobility and ADL) and general physical activity in elderly men and women living in three different Nordic environments.

PARTICIPANTS

A random sample of 448 men and 556 women from among the 75-year-old residents in Glostrup, Denmark, and Göteborg, Sweden, and all the residents of relevant age (127 men and 261 women) in Jyväskylä, Finland.

MEASUREMENTS

Assessment of postural balance with eyes open and closed using a piezoelectric force platform. A structured interview on self-reported functional ability and physical activity. An in-laboratory medical examination.

RESULTS

In spite of some differences in balance between the groups studied (better results in women compared with men and, to some extent, better results in the participants from Denmark and Finland than in those from Sweden), the performance in the balance tests was similarly associated with functional ability within all groups. The subjects reporting no need of help in performing the ADL and mobility functions performed significantly better in the balance tests. These differences were seen more clearly in the control of anteroposterior movement of center of forces than in the mediolateral direction. The performance in the balance tests was also significantly better among the subjects reporting a higher level of general physical activity than in their less active counterparts. Physical activity and than in their less active counterparts. Physical activity and certain long standing illnesses modified significantly the relationship between postural balance and ADL-performance. When these factors were analyzed simultaneously, the role of balance as a predictor of ADL-performance largely disappeared.

CONCLUSIONS

The results suggest that good balance is one of the prerequisites of performance without difficulty in mobility and ADL functions. Physical exercise may help to maintain balancing abilities in old age; good balance, in turn, may also enable a physically active way of life. The associations of balance with functional ability and physical activity were independent of sex and locality. The results also support the validity of static stabilometry as a tool for evaluating threats to functional limitations in older subjects.