Self-reported vs state-recorded motor vehicle collisions among older community dwelling individuals.

INTRODUCTION: Motor vehicle collisions (MVCs) continue to place an increased burden on both individuals and health care systems. Self-reported and state-recorded police reports are the most common methods for MVC evaluation in epidemiologic studies, with varying degrees of agreement of information when compared in previous studies. The objective of the current study is to address the differences in MVC reporting and provide a more robust measure of the agreement between self-reported and state-recorded MVCs in a community dwelling population of older adults. METHODS: A three-year prospective study was conducted in a population-based sample of 2000 licensed drivers aged 70 and older. At annual visits, participants were asked to self-report information on any MVC that occurred over the prior year where police were called to the scene. Information on police-reported MVCs was also ascertained from Alabama official state-recorded databases. The kappa coefficient was calculated to determine overall agreement between any self-reported and state-recorded crashes, as well as the raw number of crashes reported. In addition, agreement was stratified by demographics, health status, medication use, functional status (i.e. vision, cognition), and driving habits. RESULTS: 1747 participants who completed three years of follow up were involved in 225 state-recorded MVCs and 208 self-reported MVCs yielding overall substantial agreement between any self-report and state-recorded MVC (kappa=0.64). Cumulative number of self-reported and state-recorded MVCs was also compared, with agreement slightly reduced (kappa=0.55). The clinical characteristic resulting in the greatest variation in agreement with drivers was impaired contrast sensitivity showing better agreement between self-reported and state-recorded MVCs (kappa=0.9) than those with non-impaired contrast sensitivity (kappa=0.6). CONCLUSION: Study results showed substantial agreement between self-reported and state-recorded MVCs for any MVC involvement among the study population. When examining the reporting of the total number of MVCs over the three year period, agreement was reduced to a moderate level. There was consistency in agreement across MVC risk factors except among individuals with contrast sensitivity. These findings have implications for the design and analytic planning of epidemiologic and clinical research focused on MVCs.

Lexical factors and cerebral regions influencing verbal fluency performance in MCI.

OBJECTIVE: To evaluate assumptions regarding semantic (noun), verb, and letter fluency in mild cognitive impairment (MCI) and Alzheimer disease (AD) using novel techniques for measuring word similarity in fluency lists and a region of interest (ROI) analysis of gray matter correlates. METHOD: Fifty-eight individuals with normal cognition (NC, n=25), MCI (n=23), or AD (n=10) underwent neuropsychological tests, including 10 verbal fluency tasks (three letter tasks [F, A, S], six noun categories [animals, water creatures, fruits and vegetables, tools, vehicles, boats], and verbs). All pairs of words generated by each participant on each task were compared in terms of semantic (meaning), orthographic (spelling), and phonemic (pronunciation) similarity. We used mixed-effects logistic regression to determine which lexical factors were predictive of word adjacency within the lists. Associations between each fluency raw score and gray matter volumes in sixteen ROIs were identified by means of multiple linear regression. We evaluated causal models for both types of analyses to specify the contributions of diagnosis and various mediator variables to the outcomes of word adjacency and fluency raw score. RESULTS: Semantic similarity between words emerged as the strongest predictor of word adjacency for all fluency tasks, including the letter fluency tasks. Semantic similarity mediated the effect of cognitive impairment on word adjacency only for three fluency tasks employing a biological cue. Orthographic similarity was predictive of word adjacency for the A and S tasks, while phonemic similarity was predictive only for the S task and one semantic task (vehicles). The ROI analysis revealed different patterns of correlations among the various fluency tasks, with the most common associations in the right lower temporal and bilateral dorsal frontal regions. Following correction with gray matter volumes from the opposite hemisphere, significant associations persisted for animals, vehicles, and a composite nouns score in the left inferior frontal gyrus, but for letter A, letter S, and a composite FAS score in the right inferior frontal gyrus. These regressions also revealed a lateralized association of the left subcortical nuclei with all letter fluency scores and fruits and vegetables fluency, and an association of the right lower temporal ROI with letter A, FAS, and verb fluency. Gray matter volume in several bihemispheric ROIs (left dorsal frontal, right lower temporal, right occipital, and bilateral mesial temporal) mediated the relationship between cognitive impairment and fluency for fruits and vegetables. Gray matter volume in the right lower temporal ROI mediated the relationship between cognitive impairment and five fluency raw scores (animals, fruits and vegetables, tools, verbs, and the composite nouns score). CONCLUSION: Semantic memory exerts the strongest influence on word adjacency in letter fluency as well as semantic verbal fluency tasks. Orthography is a stronger influence than pronunciation. All types of fluency task raw scores (letter, noun, and verb) correlate with cerebral regions known to support verbal or nonverbal semantic memory. The findings emphasize the contribution of right hemisphere regions to fluency task performance, particularly for verb and letter fluency. The relationship between diagnosis and semantic fluency performance is mediated by semantic similarity of words and by gray matter volume in the right lower temporal region.

Estrogen and progesterone receptors in human gallbladder.

Gallbladder disease is more prevalent in women than men. Estrogen therapy has been associated with an increased incidence of gallbladder disease in both sexes. Further, increased progesterone levels have been implicated in impairment of gallbladder motility in pregnancy. Because sex hormones often exert their action through specific receptors, we investigated whether human gallbladder contains receptors for estrogen and progesterone. Binding of radiolabeled hormones in cytosol and nuclei prepared from human gallbladder of both sexes is indicative of the presence of receptors for both estrogen and progesterone. The binding is saturable, of high affinity and highly specific for its particular type of hormone but not other steroids. Fractionation of sodium molybdate-stabilized gallbladder cytosol on Sephadex G-100 demonstrates that the labeled hormones are not bound to defined proteins such as sex steroid binding globulin or albumin. These studies indicate that human gallbladder contains both estrogen and progesterone receptors, that the presence of these receptors may explain the sensitivity of gallbladder tissue to these hormones and that certain aspects of gallbladder function may be mediated by the interaction of steroid hormones with these receptors.

Estrogen binding proteins in male rat liver and other tissues.

Previous work in our laboratory has defined two estrogen binders in male rat liver cytosol, one a putative estrogen receptor found in both sexes, and the other a species unique to the male. We tested other tissues of male rats by gel filtration chromatography and estrogen binding studies to detect whether similar protein speus work in our laboratory has defined two estrogen binders in male rat liver cytosol, one a putative estrogen receptor found in both sexes, and the other a species unique to the male. We tested other tissues of male rats by gel filtration chromatography and estrogen binding studies to detect whether similar protein speus work in our laboratory has defined two estrogen binders in male rat liver cytosol, one a putative estrogen receptor found in both sexes, and the other a species unique to the male. We tested other tissues of male rats by gel filtration chromatography and estrogen binding studies to detect whether similar protein species were present. Several of the tissues assayed contained a high affinity receptor-like molecule: pancreas greater than liver greater than kidney greater than lung greater than testes greater than scrotal skin. This species could not be detected in spleen, jejunum, and epididymis. The same tissues were also assayed to detect the male-specific estrogen binding protein. This protein was undetectable in any other tissues examined and appears to be specific for liver tissue. Because of this tissue specificity, we have postulated a role for it as a mechanism for binding and possibly eliminating excess estrogen in the male.