Relationship between frailty, nutrition, body composition, quality of life, and gender in institutionalized older people.

Our aim was to explore the relationship between frailty, nutrition, body composition, and how gender modifies this relationship among long-term care facility residents. We further investigated how body composition correlates with health-related quality of life (HRQoL) in both genders. In all, 549 residents (> 65 years of age) were recruited from 17 long-term care facilities for this cross-sectional study. Demographic information, diagnoses, use of medications, and nutritional supplements were retrieved from medical records. Participants' frailty status, cognition, nutritional status, HRQoL, and body composition were determined. Energy, protein, and fat intakes were retrieved from 1- to 2-day food diaries. The final sample consisted of 300 residents (77% women, mean age 83 years). The majority of participants, 62% of women and 63% of men, were identified as frail. Frail participants in both genders showed lower body mass index (p = 0.0013), muscle mass (MM) (p < 0.001), poorer nutritional status (p = 0.0012), cognition (p = 0.0021), and lower HRQoL (p < 0.001) than did prefrail participants. Women had higher fat mass, whereas men exhibited higher MM. The HRQoL correlated with the MM in both women, r = 0.48 [95% CI 0.38, 0.57] and men r = 0.49 [95% CI 0.38, 0.58]. Interventions aimed at strengthening and retaining MM of long-term residents may also support their HRQoL.

Health locus of control and mortality: a population-based prospective cohort study.

OBJECTIVES: The objective of the study was to estimate associations between health locus of control (HLC) and mortality. STUDY DESIGN & METHODS: The public health survey in Scania 2008 was linked to the Swedish cause of death register. In this study of 10,757 men and 12,322 women aged 18-80 years, 421 men and 235 women died during the 5.3-year follow-up. Survival analyses were conducted. RESULTS: Respondents with only some or no internal HLC had significantly higher hazard rate ratios (HRRs) compared with respondents with high HLC. For women, the HRRs of those with low HLC did not significantly differ from the reference group after final adjustments for health-related behaviours. CONCLUSIONS: HLC is a predictor of mortality, and this association is to an important extent mediated by health-related behaviours.

Sexual identity and low leisure-time physical activity: a population-based study.

OBJECTIVES: To investigate associations between sexual identity and low leisure-time physical activity (LTPA). STUDY DESIGN: Cross-sectional study. METHODS: The 2012 public health survey was conducted with a postal questionnaire in southern Sweden with 28,029 respondents, aged 18-80 years. Analyses were conducted with logistic regressions. RESULTS: The prevalence of low LTPA among men and women were as follows: 13.9% and 12.3% among heterosexuals, 26.1% and 18.5% among bisexuals, 19.5% and 15.6% among homosexuals, 26.6% and 18.5% among others. Bisexual men and women and other men had higher odds ratio of low LTPA than heterosexuals in the final models, whereas gay and lesbian participants did not differ. CONCLUSIONS: The results should guide health promotion and prevention.

Sexual orientation and poor psychological health: a population-based study.

OBJECTIVES: The purpose of this study was to analyse associations between sexual orientation and poor psychological health. STUDY DESIGN: This was a cross-sectional study. METHODS: The 2012 public health survey in Scania, Southern Sweden, is a cross-sectional population-based study with 28,029 participants aged 18-80 years. Logistic regression analyses were performed. RESULTS: The prevalence of poor psychological health (measured using the General Health Questionnaire [GHQ]-12) was 16.3% among men and 22.4% among women. Bisexual men and women had significantly higher odds ratios of poor psychological health throughout the multiple analyses than heterosexual individuals. In contrast, the odds ratios of poor psychological health among gay men and lesbian women were not significantly higher. CONCLUSIONS: Respondents with bisexual orientation have increased risk of poor psychological health.

Marital status and 5-year mortality: A population-based prospective cohort study.

OBJECTIVES: The aim was to investigate the association between baseline marital status and mortality using survival (Cox-regression) analysis. STUDY DESIGN: This is a prospective cohort study. METHODS: The public health survey by Scania in 2008 was linked to the Swedish cause of death register. This prospective cohort study includes 12,245 men and 14,969 women aged 18-80 years, and 538 men and 362 women of them died during the 5.3-year follow-up. RESULTS: Unmarried, divorced, and widowed men had significantly higher hazard rate ratios (HRRs) of all-cause mortality than married/cohabitating men. For women, the HRRs of these groups did not significantly differ from those of the married/cohabitating reference group. CONCLUSIONS: The results are in accordance with a previous study that only compared those living alone with those cohabitating.

Economic stress in childhood and suicide thoughts and suicide attempts: a population-based study among adults.

OBJECTIVES: To investigate associations between economic stress in childhood and suicide thoughts and attempts. STUDY DESIGN: The 2012 public health survey in Scania, Sweden, is a cross-sectional postal questionnaire study including 28,029 participants, aged 18-80 years. METHODS: Associations were analyzed in logistic regressions. RESULTS: A 12.1% prevalence of men and 15.5% of women had ever experienced suicide thoughts, while 3.2% of men and 5.3% of women had experienced suicide attempt. Roughly 24% had experienced less severe and 8% severe economic problems in childhood. Significant associations between economic stress in childhood and suicide thoughts and attempts remained throughout the age-adjusted and multiple adjusted analyses. CONCLUSIONS: Economic stress in childhood is associated with self-reported suicide thoughts and suicide attempts in an adult general population.

Addictive behaviors, social and psychosocial factors, and electronic cigarette use among adolescents: a population-based study.

OBJECTIVES: The aim was to investigate associations between e-cigarette use and social and psychosocial factors and cigarette smoking, alcohol consumption, and narcotics use among adolescents attending 9th grade in primary school and 2nd grade in secondary school. STUDY DESIGN: Cross-sectional study. METHODS: The public health survey among adolescents in Scania in 2016 includes pupils in grades 9 and 2. The associations between e-cigarette use and lifestyle, social and psychosocial factors, and trust were investigated with logistic regressions. RESULTS: In 9th grade, 32% of male pupils and 27% of female pupils had ever used e-cigarettes, and in 2nd grade, 43% of males and 31% of females had ever used e-cigarettes. E-cigarette use was significantly associated with current smoking, snus (a moist powder tobacco product originating in Sweden) use, water pipe use, intensive alcohol consumption, and narcotics and also with psychosocial conditions related to home and parents, peers, and school. CONCLUSIONS: The prevalence of ever e-cigarette use was high among adolescents attending both grades. E-cigarette use was most strongly associated with health-related lifestyles. It was also associated with psychosocial factors such as study difficulties, school stress, problems talking with parents, and generalized trust.

Socioeconomic status, social capital and self-reported unmet health care needs: A population-based study.

AIMS: The aim of this study was to investigate the associations between socioeconomic status (SES) and self-reported unmet health care needs, taking economic stress, generalized trust in other people and trust in the health care system into account. METHODS: The 2012 public health survey in Scania was conducted using a postal questionnaire and included 28,029 participants aged 18-80 years. The study was cross-sectional. Associations between SES and unmet health care needs were investigated, adjusting for economic stress and trust in logistic regressions. RESULTS: SES was significantly associated with unmet health care needs. The SES categories of unemployed, on long-term sick leave and unskilled manual workers reported particularly high levels of unmet health care needs. SES differences in unmet needs were attenuated when economic stress and the two dimensions of trust and self-rated health were introduced in multiple analyses. The working population gave a lack of time as the reason for unmet health care needs, whereas those on sick leave or unemployed reported a lack of money. CONCLUSIONS: SES differences in self-reported unmet health care needs were observed and these associations were attenuated when economic stress during the past year, generalized trust in other people, trust in the health care system and self-rated health were introduced into the multiple models.

Induction of the 5S RNP-Mdm2-p53 ribosomal stress pathway delays the initiation but fails to eradicate established murine acute myeloid leukemia.

Mutations resulting in constitutive activation of signaling pathways that regulate ribosome biogenesis are among the most common genetic events in acute myeloid leukemia (AML). However, whether ribosome biogenesis presents as a therapeutic target to treat AML remains unexplored. Perturbations in ribosome biogenesis trigger the 5S ribonucleoprotein particle (RNP)-Mdm2-p53 ribosomal stress pathway, and induction of this pathway has been shown to have therapeutic efficacy in Myc-driven lymphoma. In the current study we address the physiological and therapeutic role of the 5S RNP-Mdm2-p53 pathway in AML. By utilizing mice that have defective ribosome biogenesis due to downregulation of ribosomal protein S19 (Rps19), we demonstrate that induction of the 5S RNP-Mdm2-p53 pathway significantly delays the initiation of AML. However, even a severe Rps19 deficiency that normally results in acute bone marrow failure has no consistent efficacy on already established disease. Finally, by using mice that harbor a mutation in the Mdm2 gene disrupting its binding to 5S RNP, we show that loss of the 5S RNP-Mdm2-p53 pathway is dispensable for development of AML. Our study suggests that induction of the 5S RNP-Mdm2-p53 ribosomal stress pathway holds limited potential as a single-agent therapy in the treatment of AML.

Disruption of the 5S RNP-Mdm2 interaction significantly improves the erythroid defect in a mouse model for Diamond-Blackfan anemia.

Diamond-Blackfan anemia (DBA) is a congenital erythroid hypoplasia caused by haploinsufficiency of genes encoding ribosomal proteins (RPs). Perturbed ribosome biogenesis in DBA has been shown to induce a p53-mediated ribosomal stress response. However, the mechanisms of p53 activation and its relevance for the erythroid defect remain elusive. Previous studies have indicated that activation of p53 is caused by the inhibition of mouse double minute 2 (Mdm2), the main negative regulator of p53, by the 5S ribonucleoprotein particle (RNP). Meanwhile, it is not clear whether this mechanism solely mediates the p53-dependent component found in DBA. To approach this question, we crossed our mouse model for RPS19-deficient DBA with Mdm2(C305F) knock-in mice that have a disrupted 5S RNP-Mdm2 interaction. Upon induction of the Rps19 deficiency, Mdm2(C305F) reversed the p53 response and improved expansion of hematopoietic progenitors in vitro, and ameliorated the anemia in vivo. Unexpectedly, disruption of the 5S RNP-Mdm2 interaction also led to selective defect in erythropoiesis. Our findings highlight the sensitivity of erythroid progenitor cells to aberrations in p53 homeostasis mediated by the 5S RNP-Mdm2 interaction. Finally, we provide evidence indicating that physiological activation of the 5S RNP-Mdm2-p53 pathway may contribute to functional decline of the hematopoietic system in a cell-autonomous manner over time.

Randomization to a low-carbohydrate diet advice improves health related quality of life compared with a low-fat diet at similar weight-loss in Type 2 diabetes mellitus.

AIMS: To compare the effects on health-related quality of life (HRQoL) of a 2-year intervention with a low-fat diet (LFD) or a low-carbohydrate diet (LCD) based on four group-meetings to achieve compliance. To describe different aspects of taking part in the intervention following the LFD or LCD. METHODS: Prospective, randomized trial of 61 adults with Type 2 diabetes mellitus. The SF-36 questionnaire was used at baseline, 6, 12 and 24 months. Patients on LFD aimed for 55-60 energy percent (E%) and those on LCD for 20 E% from carbohydrates. The patients were interviewed about their experiences of the intervention. RESULTS: Mean body-mass-index was 32.7 ± 5.4 kg/m(2) at baseline. Weight-loss did not differ between groups and was maximal at 6 months, LFD: -3.99 ± 4.1 kg, LCD: -4.31 ± 3.6 kg (p<0.001 within groups). There was an increase in the physical component score of SF-36 from 44.1 (10.0) to 46.7 (10.5) at 12 months in the LCD group (p < 0.009) while no change occurred in the LFD group (p < 0.03 between groups). At 12 months the physical function, bodily pain and general health scores improved within the LCD group (p values 0.042-0.009) while there was no change within the LFD group. CONCLUSIONS: Weight-changes did not differ between the diet groups while improvements in HRQoL only occurred after one year during treatment with LCD. No changes of HRQoL occurred in the LFD group in spite of a similar reduction in body weight.

Infant botulism with prolonged faecal excretion of botulinum neurotoxin and Clostridium botulinum for 7 months.

In Finland in April 2010, a 3-month old baby was diagnosed with type A infant botulism. He excreted botulinum neurotoxin and/or Clostridium botulinum in his faeces until November 2010. Five months of excretion was after clinical recovery and discharge from hospital. C. botulinum isolates recovered from the household dust in the patient's home were genetically identical to those found in the infant's stool samples. Long-term faecal excretion of C. botulinum may pose a possible health risk for the parents and others in close contact with the infant.

Altered chemokine Th1/Th2 balance in Addison's disease: relationship with hydrocortisone dosing and quality of life.

The adrenalitis found in autoimmune Addison's disease (AAD) is considered having a Th1-driven pathogenesis. Circulating Th1- and Th2-associated chemokines responsible for the trafficking of leukocytes to inflammatory sites are markers for the Th1/Th2 balance. The aim of the study was to assess if the same daily hydrocortisone dose of 30 mg given in either 2 or 4 doses to patients with AAD could affect the Th1/Th2 balance of circulating chemokines.Fifteen patients (6 women) with AAD were included in this randomised, placebo controlled, double blind cross-over study. Samples for chemokines, Th1-associated (CXCL10, CXCL11) and Th2-associated (CCL17, CCL22), were drawn 5 times during a 24-h period at the end of each treatment period and analysed with Luminex. Seven control subjects did the same diurnal blood sampling once. Subjects with AAD had higher median diurnal levels of the Th1-associated chemokines than controls, CXCL10 [43 (33-56) pg/ml vs. 22 (19-34) pg/ml, p<0.01] and CXCL11 [37 (29-48) pg/ml vs. 16 (9-24) pg/ml, p<0.001], whereas no significant difference was found regarding the Th2-related chemokines. Similar chemokine levels were found when the same hydrocortisone dose of 30 mg was divided in 2 or 4 doses. Levels of CXCL11 correlated negatively with scores of SF-36 domains (high score indicate better health) of General Health (GH) and total score for Physical Component Summary (PCS), and these negative correlations were most pronounced at 04:00 h on the 2-dose regimen. Patients with AAD have a dominant Th1 chemokine profile that partially correlates to reduced quality of life.

Functional and muscle morphometric effects of ACL reconstruction. A prospective CT study with 1 year follow-up.

Computed tomography (CT) was used to explore if changes in muscle cross-sectional area and quality after anterior cruciate ligament (ACL) injury and reconstruction would be related to knee function. Fourteen females and 23 males (16-54 years) underwent clinical tests, subjective questionnaires, and CT 1 week before and 1 year after ACL surgery with semitendinosus-gracilis (STG) graft and rehabilitation. Postoperatively, knee laxity was decreased and functional knee measures and subjective patient scores improved. The most obvious remaining deficit was the quadriceps atrophy, which was significantly larger if the right leg was injured. Right-leg injury also tended to cause larger compensatory hypertrophy of the combined knee flexor and tibial internal rotator muscles (preoperatively). The quadriceps atrophy was significantly correlated with the scores and functional tests, the latter also being related to the remaining size of the gracilis muscle. Biceps femoris hypertrophy and, in males only, semimembranosus hypertrophy was observed following the ACL reconstruction. The lack of semimembranosus hypertrophy in the women could, via tibial internal rotation torque deficit, contribute to the less favorable functional and subjective outcome recorded for the women. The results indicate that the quadriceps, the combined knee flexor/tibial internal rotator muscles, side of ACL injury, and sex are important to consider in rehabilitation after STG graft.

Marital status, social capital and health locus of control: a population-based study.

OBJECTIVES: To investigate the association between marital status and lack of internal health locus of control (HLC), taking economic stress and trust into account. STUDY DESIGN: Cross-sectional study. METHODS: The public health survey Skåne 2008 is a postal questionnaire study (55% participation rate). A random sample was invited to participate, and 28,198 individuals aged 18-80 years agreed. Logistic regression models were used to discern associations between marital status and lack of internal HLC. The multiple regression analyses included age, country of birth, education, economic stress and 'horizontal' trust. RESULTS: In total, 33.7% of the men and 31.8% of the women lacked internal HLC. After age-adjustments, the unmarried and divorced men and the widowed women displayed significantly higher odds ratios of lack of internal HLC. The significantly higher odds ratios only remained for unmarried men throughout the multiple analyses. In contrast, divorced women had significantly lower odds ratios of lack of internal HLC than married women after adjustments for economic stress. CONCLUSIONS: Health promotion regarding HLC and related behaviours should consider men and women who are not cohabiting. Health promotion should particularly consider unmarried men due to their higher propensity to lack internal HLC. The economic conditions and exposure to economic stress among widowed and divorced women should also be highlighted.

In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss.

AIMS/HYPOTHESIS: The study aimed to compare the effects of a 2 year intervention with a low-fat diet (LFD) or a low-carbohydrate diet (LCD), based on four group meetings to achieve compliance. METHODS: This was a prospective randomised parallel trial involving 61 adults with type 2 diabetes consecutively recruited in primary care and randomised by drawing ballots. Patients that did not speak Swedish could not be recruited. The primary outcomes in this non-blinded study were weight and HbA(1c). Patients on the LFD aimed for 55-60 energy per cent (E%) and those on LCD for 20 E% from carbohydrate. RESULTS: The mean BMI and HbA(1c) of the participants were 32.7 ± 5.4 kg/m(2) and 57.0 ± 9.2 mmol/mol, respectively. No patients were lost to follow-up. Weight loss did not differ between groups and was maximal at 6 months: LFD -3.99 ± 4.1 kg (n=31); LCD -4.31 ± 3.6 kg (n=30); p < 0.001 within groups. At 24 months, patients on the LFD had lost -2.97 ± 4.9 kg and those on LCD -2.34 ± 5.1 kg compared with baseline (p = 0.002 and p = 0.020 within groups, respectively). HbA(1c) fell in the LCD group only (LCD at 6 months -4.8 ± 8.3 mmol/mol, p = 0.004, at 12 months -2.2 ± 7.7 mmol/mol, p = 0.12; LFD at 6 months -0.9 ± 8.8 mmol/mol, p = 0.56). At 6 months, HDL-cholesterol had increased with the LCD (from 1.13 ± 0.33 mmol/l to 1.25 ± 0.47 mmol/l, p = 0.018) while LDL-cholesterol did not differ between groups. Insulin doses were reduced in the LCD group (0 months, LCD 42 ± 65 E, LFD 39 ± 51 E; 6 months, LCD 30 ± 47 E, LFD 38 ± 48 E; p = 0.046 for between-group change). CONCLUSIONS/INTERPRETATION: Weight changes did not differ between the diet groups, while insulin doses were reduced significantly more with the LCD at 6 months, when compliance was good. Thus, aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk compared with the traditional LFD and this approach could constitute a treatment alternative. TRIAL REGISTRATION: ClinicalTrials.gov NCT01005498 FUNDING: University Hospital of Linköping Research Funds, Linköping University, the County Council of Östergötland, and the Diabetes Research Centre of Linköping University.

Two cases of food-borne botulism in Finland caused by conserved olives, October 2011.

In October 2011 in Finland, two persons fell ill with symptoms compatible with botulism after having eaten conserved olives stuffed with almonds. One of these two died. Clostridium botulinum type B and its neurotoxin were detected in the implicated olives by PCR and mouse bioassay, respectively. The olives were traced back to an Italian manufacturer and withdrawn from the market. The public and other European countries were informed through media and Europe-wide notifications.

Social capital, desire to increase physical activity and leisure-time physical activity: a population-based study.

OBJECTIVES: To investigate the associations between social capital (trust) and leisure-time physical activity. STUDY DESIGN: The 2004 Public Health Survey in Skåne is a cross-sectional study. METHODS: In total, 27,757 individuals aged 18-80 years answered a postal questionnaire (59% participation). Logistic regression models were used to investigate the associations between trust, desire to increase physical activity and leisure-time physical activity. RESULTS: The prevalence of low leisure-time physical activity was 15.3% among men and 13.2% among women. Middle-aged men and older women, respondents born abroad, those with medium/low education, those with the desire to increase physical activity but needing support, and those reporting low trust had significantly higher odds ratios of low leisure-time physical activity than their respective reference groups. The associations between low trust and desire to increase physical activity and between low trust and low leisure-time physical activity remained in the multiple models. CONCLUSIONS: The positive association between low trust and low leisure-time physical activity remained after multiple adjustments. There is a concentration of men and women with low leisure-time physical activity who report the desire to increase their physical activity but think that they need support to do so. This group also has a significantly higher prevalence of low trust.