The effect of visual and hearing impairments on functional status.

OBJECTIVES: To describe the prevalence of visual and auditory impairment in frail older persons and to evaluate the association between sensory impairment and overall functional status. DESIGN: Prospective patient evaluation and retrospective analysis of data. SETTING: The outpatient geriatric assessment clinic of a university medical center. PARTICIPANTS: Consecutive patients seen in the University of Nebraska Medical Center Outpatient Geriatric Assessment Clinic from 1986 to 1992 for whom both vision and hearing information were available (n = 576). MEASUREMENTS: Visual acuity was measured by the Lighthouse Near Visual Acuity Test, and auditory acuity was evaluated with the whisper test. Functional status was determined by Lawton-Brody activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Comorbid illness was classified by the Cumulative Illness Rating Scale, and mental status was assessed by the Folstein Mini-Mental State Exam. RESULTS: Eighteen percent of patients had visual impairment of 20/70 or worse. Hearing impairment was found in 64%. The mean ADL and IADL scores were 20/24 and 12/23, respectively, for patients with visual acuity better than 20/70, compared with 18/24 and 8/23 for visually impaired patients (P < .001 for both comparisons). ADL and IADL scores were also higher in hearing intact patients compared with those with hearing impairment: respectively, 21/24 vs 19/24 (P < .001) and 13/23 vs 11/23 (P < .001). The effects of visual acuity and hearing acuity on IADL score are independent of mental status and comorbid illness (P < .001). The effect of visual acuity on ADL score is independent of mental status and comorbid illness (P < .001), whereas the effect of hearing on ADL score is not. Subjects with both hearing and vision impairment had mean IADL (P < = .05) and ADL (P < = .05) scores significantly lower than those with no impairment CONCLUSIONS: Impairments of vision and hearing are common in this frail older outpatient population. Functional status, as measured by IADL and ADL scores, is diminished for sensory impaired subjects. Combined vision and hearing impairments have a greater effect on function than single sensory impairments and influence functional status independent of mental status and comorbid illness. Overall, these results suggest that interventions to improve sensory function may improve functional independence.

Performance of alcoholism screening questionnaires in elderly veterans.

PURPOSE: To validate three alcoholism screening questionnaires in elderly male veterans. PATIENTS: Participants were 120 male veterans aged 65 years or older. METHODS: In this cross-sectional study, consecutive patients in the outpatient general medical practice at the Omaha VA Medical Center were interviewed with the alcohol module of the Revised Diagnostic Interview Schedule (DIS-III-R) and three alcoholism screening questionnaires, the Michigan Alcoholism Screening Test-Geriatric Version (MAST-G), the CAGE, and the Alcohol Use Disorders Identification Test (AUDIT). Performance characteristics (sensitivity, specificity, predictive values, likelihood ratios, and areas under the receiver operating curve [ROC]) of the screening questionnaires were determined in comparison with the DIS-III-R. RESULTS: Forty-three participants (36%) met DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders) criteria for alcohol abuse or dependence; 23% were active drinkers and 13% were inactive. Fifty of the 120 (42%) reported abstinence from drinking during the preceding year. A MAST-G score > or = 5 had a sensitivity and specificity of 70% and 81%, respectively. A CAGE score > or = 2 had a sensitivity and specificity of 63% and 82%. Using active drinkers only, an AUDIT score of > or = 8 had a sensitivity and specificity of 33% and 91%. The positive predictive values (PPV) for the MAST-G, CAGE, and AUDIT were 67%, 66%, and 69%, respectively; the negative predictive values were 83%, 80%, and 68%, respectively. Areas under the receiver operating curves for the MAST-G, CAGE, and AUDIT were 0.84 +/- 0.04, 0.77 +/- 0.05, and 0.56 +/- 0.08, respectively. CONCLUSION: The MAST-G and the CAGE outperformed the AUDIT for detecting alcohol abuse and dependence in an elderly male veteran population. The CAGE, requiring only four easily memorized questions to achieve similar accuracy, appears to offer an advantage over the 24-item MAST-G.

Changes in plasma beta-cell tropin concentrations during pregnancy in rats.

The mechanisms which initiate and maintain the energy partitioning into maternal tissues during pregnancy are unknown. The present study shows that in each of the weeks prior to pregnancy in the rat, plasma beta-cell tropin (beta CT) concentrations (nmol/l) were 0.68 +/- 0.10, 0.61 +/- 0.14 and 0.73 +/- 0.11 (n = 11, mean +/- S.E.M.). During early (1-3 days) pregnancy the concentration rose to 1.32 +/- 0.26 and by early-mid (7-10 days) pregnancy they had increased to 1.96 +/- 0.41. By mid-late (14-17 days) pregnancy plasma beta CT concentration had declined to the prepregnancy concentrations (0.67 +/- 0.16). This mid-term increase in the circulating concentration of the lipogenic hormone beta CT may contribute to the deposition of lipid associated with the early period of gestation. The increased circulating beta CT could be derived from the pituitary gland neurointermediate lobe or by secretion from the placenta. It should be emphasised that the measurements in the present study represent a 'snap-shot' at discrete intervals and do not provide information about the dynamic hormonal interplay which occurs physiologically.

Beta-cell tropin- and glucose-induced hypersecretion of insulin and amylin from perfused fatty rat pancreas.

The neurointermediate pituitary peptide beta-cell tropin (BCT) has potent insulin-releasing and lipogenic properties and is elevated in obesity and type-2 diabetes. The effects of BCT and glucose on the release of insulin and amylin from the perfused pancreas of obese 'fatty' (fa/fa) rats and lean (Fa/?) controls were measured. Pancreata were perfused, sequentially, with buffer containing: 5.6 mmol glucose/l (basal); basal glucose +/- 0.5 nmol BCT/l; 16.7 mmol glucose/l (high). Insulin and amylin release during basal glucose treatment was eight to nine times greater from pancreata from fatty than from lean rats. BCT induced a fivefold greater monophasic insulin and amylin release from fatty compared with lean pancreata. When not preceded by BCT there was a twofold greater high glucose-induced amylin release from fatty pancreata but no difference in insulin secretion. When preceded by BCT stimulation, high glucose induced twofold greater insulin and fourfold larger amylin release from fatty compared with lean pancreata. Molar secretion ratios of insulin:amylin varied between 30:1 and 50:1. In view of the elevated levels of BCT found in the fatty rat and in the light of the above findings, it is concluded that the peptide may have a role in the development of hyperinsulinaemia, hyperamylinaemia and insulin resistance in this animal model of obesity and diabetes.

Elevated plasma concentrations of beta-cell tropin (ACTH22-39) in diet-treated type II diabetic patients.

beta-Cell tropin, the pituitary peptide ACTH22-39, is a potent insulin secretagogue and stimulates lipogenesis in adipose tissue in rodents. Plasma beta-cell tropin was measured fasting and after glucose infusion (5 mg.kg glucose ideal body weight-1.min0-1 for 90 min) in 10 mild diet-treated non-insulin-dependent (type II) diabetic subjects and 10 control subjects (body mass index) (BMI): 26.4 +/- 3.2 and 24.1 +/- 2.0 kg/m-2, NS, fasting plasma glucose 7.8 +/- 2.7 mM and 4.7 +/- 0.3 mM, respectively). The diabetic subjects had raised fasting plasma beta-cell tropin compared with the normal subjects (geometric mean (1 SD range): 0.49 (0.25-0.96) nM and 0.17 (0.10-0.28) nM, respectively, P = 0.007). In response to the glucose infusion, plasma glucose rose higher in the diabetic subjects (mean +/- 1 SD: 13.7 +/- 3.1 and 9.6 +/- 0.9 mM, P = 0.007) and plasma insulin was impaired in the diabetic compared with the nondiabetic subjects (geometric mean (1 SD range): 14 (8-26) and 34 (18-63), P less than 0.01). beta-Cell tropin concentrations in the diabetic subjects rose to 1.31 (0.74-2.30) nM (P = 0.007), whereas beta-cell tropin did not change in the normal subjects at 0.19 (0.11-0.91) nM. There was no overlap between glucose-stimulated plasma beta-cell tropin in the two groups (P = 0.0002). Pituitary-adrenal function, as assessed by plasma cortisol, did not differ between the two groups when fasting and did not change after the glucose infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlation between plasma beta-cell tropin concentrations and body weight in obese rhesus monkeys.

The fasting plasma concentration of the pituitary peptide beta-cell tropin [beta-CT, adrenocorticotropic hormone-(22-39)] was measured in 17 rhesus monkeys from a colony known to develop spontaneous obesity. The weight of the animals was 9.4-23.9 kg (12-46% body fat). Plasma beta-CT concentrations were 0.03-0.84 nmol/l and were strongly correlated with body weight (P = 0.014, r = 0.584). Plasma beta-CT was also correlated with plasma insulin concentration as a power function (P = 0.011, r = 0.600) and with percent body fat up to 40% (P = 0.003, r = 0.0804). Plasma insulin is also correlated with body weight (P = 0.015, r = 0.578) but does not decline when body fat is in excess of 40%, supporting the hypothesis that beta-CT may be involved in a feed-back control mechanism, perhaps mediated by insulin. Because beta-CT has been shown in rodent studies to be a potent insulin secretagogue and lipogenic agent, it is possible that beta-CT is causally involved in the development of obesity and that there may be central determinants of obesity mediated through pituitary secretion of beta-CT.

Nicotine and cotinine in the cervical mucus of smokers, passive smokers, and nonsmokers.

Although epidemiological studies suggest that cigarette smoking is a risk factor for cervical cancer, further evidence is required to document the biological plausibility of this relationship. This study obtained cervical mucus, using a cervical flush technique, from 50 patients in a neoplasia clinic. Nicotine was detected in the cervical mucus of all 25 smokers and cotinine in the mucus of 84% of the smokers; nicotine and cotinine levels were correlated (P < or = 0.10) with both the number of cigarettes usually smoked and the number smoked in the last 24 h. Nicotine and cotinine levels for passive smokers and nonexposed women were much lower than for women who currently smoked, with little difference found between the nonsmoking women who did and did not report passive smoke exposure. In the one woman who reported smokeless tobacco use, both nicotine and cotinine were detected at much higher levels than for other nonsmoking women. These results indicate that tobacco constituents do indeed reach the uterine cervix, suggesting that they could play a causal role in the development of cervical cancer.

The effects of insulin and the pituitary peptide beta-cell tropin on the incorporation of D-3-3H-glucose into lipid in brown adipocytes from lactating and non-lactating rats.

Lactating and non-lactating rat brown adipocytes were used to study the dose-dependent stimulation of lipogenesis by Beta-cell tropin (BCT) and insulin. In non-lactating animals BCT increased lipogenesis approximately 2-fold compared to a 3-fold stimulation with insulin; however BCT was effective at a substantially lower molar concentration than insulin. In lactating animals resistance was observed to both BCT and insulin action.

Plasma B-cell tropin (ACTH22-39) concentration in lean and obese (ob/ob) mice and lean and obese (fa/fa) Zucker rats.

A method has been developed for the measurement of plasma concentrations of Beta-cell tropin (BCT), which is a potent insulinotropic and lipogenic peptide secreted by the pituitary. The method was employed to compare plasma Beta-cell tropin concentrations between lean and genetically obese (ob/ob) mice and between lean and genetically obese (fa/fa) Zucker rats. The plasma concentration in lean mice was 0.17 +/- 0.02 (5)nmole/l (mean +/- SEM, n = 5), while that in obese (ob/ob) mice was significantly higher, being 2.88 +/- 1.13 (5)nmole/l. The plasma BCT concentration in Zucker rats was 0.14 +/- 0.02 (15)nmole/l, while that in obese Zucker (fa/fa) rats was significantly higher, being 1.69 +/- 0.72 (16)nmole/l. These results explain previously observed differences in the Beta-cell tropin-like biological activity in plasma from lean and obese animals, and support the hypothesis that the peptide has a role in the development of hyperinsulinaemia and obesity.

Studies on insulin secretion and the pituitary insulin secretagogue beta-cell-tropin in the sand-rat (Psammomys obesus).

The sand-rat (Psammomys obesus) is an animal model for the study of human maturity onset diabetes which appears to be controlled by caloric intake. In the present investigations, these animals have been studied in relation to the influence of low- and high-energy diets on body weight, plasma insulin and blood glucose levels, and on insulin secretion from the perfused pancreas and the secretion of corticotropin-like intermediate lobe peptide (CLIP, ACTH18-39) and the insulin secretagogue beta-cell-tropin (beta-CT, ACTH22-39) from the pituitary neurointermediate lobe. The sand-rats maintained on the high-energy diet all became obese. Insulin secretion from the perfused pancreas of the obese sand-rat in the presence of 5.6 mM glucose was significantly higher than in the lean controls maintained on low-energy diets. Increasing the glucose concentration to 16.7 mM only produced a small stimulation of insulin secretion in the obese animals, and the difference between the two groups was not significant. Stimulation of insulin secretion by beta-CT was variable, but the obese animals appeared to be more responsive. Pituitary neurointermediate lobes were incubated for 4 h to measure the secretion of the ACTH related peptide. These were separated by gel filtration and the concentrations measured by radioimmunoassay with a CLIP antiserum and a CLIP standard. In all experiments beta-CT was 4-6 per cent of the total CLIP immunoreactive material. In these experiments the obese animals maintained on a high-energy diet were divided into two groups, those with plasma insulin levels less than 500 mu u/ml and those with insulin levels greater than 500 mu u/ml. The latter group had a significantly higher blood glucose level, presumably due to the insulin resistance resulting from the severe hyperinsulinaemia. It was also observed that CLIP-IRM and beta-CT secretion was lower in this group than in the animals maintained on low-energy diets or those on high-energy diets with moderate hyperinsulinaemia. This suggests a possible feedback inhibition by insulin on the secretion of beta-CT.

Petroleum associated with polymetallic sulfide in sediment from gorda ridge.

A sediment sample, impregnated with asphaltic petroleum and polymetallic sulfide, was dredged from the southern end of Gorda Ridge (the Escanaba Trough) off northern California, within the offshore Exclusive Economic Zone of the United States. The molecular distributions of hydrocarbons in this petroleum show that it was probably derived from terrestrial organic matter in turbidite sediment filling the Escanaba Trough. Hydrothermal activity at the Gorda Ridge spreading center provided the heat for petroleum formation and was the source of fluids for sulfide mineralization.

Evidence for the presence of the pituitary insulin secretagogue beta-cell trophin in human plasma.

It has been demonstrated that the insulin secretagogue beta-cell-trophin, ACTH(22-39), is present in human plasma. The hormone, separated from plasma by affinity chromatography on a corticotrophin-like intermediate-lobe peptide antibody column, behaves similarly to synthetic beta-cell-trophin on a gel filtration column and on reverse-phase high-performance liquid chromatography. Sufficient amounts of the hormone were isolated from the plasma of two patients with Nelson's syndrome to demonstrate its biological activity on the perfused rat pancreas.

Use of inhaled beclomethasone dipropionate and optimized theophylline doses in asthmatic children at Camp Bronco Junction, 1977-1978.

During both the 1977 and 1978 eight-week summer sessions at Bronco Junction the effect of oral inhalation of beclomethasone dipropionate and optimum dose theophylline therapy in 56 chronically severe, corticosteroid dependent asthmatic children was evaluated. By the end of the two summer camp sessions 10 of the 56 were able to discontinue the beclomethasone dipropionate therapy, and 33 others were able to reduce their dosage. All but one child were able to discontinue oral prednisone therapy.