Sarcopenic obesity and associations with mortality in older women and men - a prospective observational study.

BACKGROUND: The combined effect of sarcopenia and obesity, i.e., sarcopenic obesity, has been associated with disability and worse outcomes in older adults, but results are conflicting. The objectives of this study were to describe the prevalence of sarcopenic obesity (SO) in older adults, and to examine how the risk of mortality is associated with SO and its various components. METHODS: Data were obtained from two Swedish population studies, the Gothenburg H70 Birth Cohort Studies of 521 women and men at the age of 75, and the Uppsala Longitudinal Study of Adult Men (ULSAM), which included 288 men aged 87 years. Sarcopenia was defined using the recently updated EWGSOP2 definition. Obesity was defined by any of three established definitions: body mass index ≥30 kg/m2, fat mass > 30%/ > 42% or waist circumference ≥ 88 cm/≥102 cm for women and men, respectively. The Kaplan-Meier survival curve and the Cox proportional hazard model were used for 10-year and 4-year survival analyses in the H70 and ULSAM cohorts, respectively. RESULTS: SO was observed in 4% of the women and 11% of the men in the H70 cohort, and in 10% of the ULSAM male cohort. The 75-year-old women with SO had a higher risk (HR 3.25, 95% confidence interval (1.2-8.9)) of dying within 10 years compared to those with a "normal" phenotype. A potential similar association with mortality among the 75-year-old men was not statistically significant. In the older men aged 87 years, obesity was associated with increased survival. CONCLUSIONS: SO was observed in 4-11% of community-dwelling older adults. In 75-year-old women SO appeared to associate with an increased risk of dying within 10 years. In 87-year-old men, the results indicated that obesity without sarcopenia was related to a survival benefit over a four-year period.

Rapid analysis of inositol phosphates.

Fast and simple analytical methods for the determination of inositol bis- to hexakisphosphates or only inositol hexakisphosphate in foods and feces are presented. The methods are both faster and simpler with regard to analytical detection and sample pretreatment as compared to previously reported methods. The samples are pretreated using extraction and centrifugal ultrafiltration and analyzed using high-performance ion chromatography (HPIC) with gradient or isocratic elution. The analytes are detected using ultraviolet detection after postcolumn reaction. The methods are efficient, highly selective, and appropriate for analyzing inositol phosphates in food and feces samples. The between- and within-day variances were generally below 8 and 5% (relative standard deviation), respectively, for the presented HPIC method with gradient elution.

[The manpower market for physicians in the Nordic countries 1980-2000]. / Legemarkedet i Norden 1980-2000.

The ratio between population and active physicians in the Nordic countries has improved from 488 inhabitants per physician in 1980 to 315 in 2000. There is a large mobility of physicians between the countries, contributing to levelling out swings in demand and supply of manpower. Language and culture being similar, physicians can easily adjust to working in a neighbouring country. Iceland is special in this respect, as a surplus of Icelandic physicians has always found work in the other Nordic countries. Of course, their numbers are small relative to the total number of active physicians in the Nordic countries, now approximately 76,000. The number of students admitted to Nordic medical faculties has changed in line with swings in estimated future demand for manpower. Today, numbers are increasing again; this year, approximately 2,900 students will be admitted. Norway stands apart from the other Nordic countries in terms of medical manpower needs. During the last 20 years there has been a continuous shortage of physicians while all the other countries have been through periods of surplus and unemployment among physicians. Manpower forecasts in the early 1980s underestimated the growth in the health care system and hence the demand for medical manpower.

[Continuing education in the Nordic countries]. / Spesialistutdanningen i Norden.

The Nordic Labour Market Agreement gives Nordic medical specialist the right to be certified in the other Nordic countries. The agreement also provides for cooperation on specialist training between the five countries. This article is mainly based on published statements from the joint working group for medical manpower forecasts and specialist training in the Nordic countries. There are great differences between the countries in the way specialist training is organised. An underlying assumption in the Nordic agreement is that the level and quality of specialist training is the same in all five countries; however, there does not seem to be a corresponding coordination between the training systems adopted.

Inositol phosphates influence iron uptake in Caco-2 cells.

Phytate, inositol hexaphosphate (InsP(6)), may be hydrolyzed to inositol phosphates with lower degree of phosphorylation, i.e., inositol penta- to monophosphates (InsP(5)-InsP(1)), during food processing. Each of these lower inositol phosphates exists in different isomeric forms. The objective of this study was to determine if different isomers of InsP(3)-InsP(5) (Ins(1,2,4)P(3), Ins(1,2,3)P(3), Ins(1,2,6)P(3), Ins(1,3,4)P(3), Ins(1,2,3,4)P(4), Ins(1,2,5,6)P(4), Ins(1,2,4,5,6)P(5), and Ins(1,3,4,5,6)P(5)) and InsP(6) affect the uptake of iron. We studied the iron absorption in vitro using the human intestinal epithelial cell line, Caco-2. Addition of a 2-fold molar excess of InsP(6) or InsP(5) in proportion to Fe (1 h incubation at 37 degrees C) reduced iron uptake by 46-52% (p < 0.001). Neither InsP(4) isomers nor InsP(3) isomers affected iron uptake significantly at 1 h incubation with a molar InsP:Fe level of 2:1. Iron uptake was shown to not be a function of the isomeric form of inositol phosphates. The inositol phosphate isomers did not seem likely to interact with each other through iron to form more stable iron complexes. At a molar InsP:Fe level of 20:1 an inhibitory effect of InsP(4) was found, while InsP(3) did not affect the iron absorption even at a 20-fold molar excess.

Inositol phosphates with different numbers of phosphate groups influence iron absorption in humans.

BACKGROUND: Inositol hexaphosphate (IP(6)) is a well-known inhibitor of iron absorption, whereas the effects of the less-phosphorylated derivatives of IP(6) are less known. OBJECTIVES: The objective was to investigate the effects of inositol tri-, tetra-, and pentaphosphates (IP(3), IP(4), and IP(5), respectively) on iron absorption in humans. DESIGN: Iron absorption was measured in 5 experiments from single meals by extrinsic labeling with (55)Fe and (59)Fe and determination of whole-body retention and the erythrocyte uptake of isotopes. In experiments 1-3 the meals contained white-wheat rolls to which 10 mg P as IP(5), IP(4), or IP(3), respectively, was added. Inositol 1,2,6-triphosphate [Ins(1,2, 6)P(3)] and a mixture of isomers of IP(4) and IP(5) were studied. White-wheat rolls contained 10 mg P as IP(3) + IP(4) and 2 mg P as IP(5) + IP(6) in experiment 4 and 20 mg P as IP(3) + IP(4) and 3 mg P as IP(5) + IP(6) in experiment 5; inositol phosphates were obtained via fermentation of sodium phytate. Each experiment had 8-11 subjects. RESULTS: In experiment 1, iron absorption was reduced by 39%, whereas there was no significant effect on iron absorption in experiments 2 and 3. In experiments 4 and 5, iron absorption was reduced by 54% and 64%, respectively, suggesting that IP(3) and IP(4) contributed to the inhibitory effect. CONCLUSIONS: IP(5) has an inhibitory effect on iron absorption, whereas IP(3) and IP(4) in isolated form have no such effect. IP(3) and IP(4) in processed food contribute to the negative effect on iron absorption, presumably by binding iron between different inositol phosphates. To improve iron absorption from cereals and legumes, degradation of inositol phosphates needs to be to less-phosphorylated inositol phosphates than IP(3).

[Mutual evaluation of teaching hospital departments. A way to improve the quality of specialist education]. / Gjensidig evaluering av utdanningsavdelinger ved sykehus. En velegnet metode for å bedre kvaliteten på spesialistutdanningen.

In cooperation with four hospital departments, the Norwegian Medical Association piloted a method for combining internal and external evaluation of the departments' educational programmes for residents. The aim was to improve the quality of education in the departments. The ophthalmologic departments at two university hospitals and two pediatric departments at local hospitals have participated in the project. Written reports describing internal and external evaluations, based on reciprocal visits by representatives of the different departments have served as guidelines for improvement. The evaluation revealed inadequate opportunities for resident education in all the participating departments. The interesting and positive experiences were that, despite these findings, the reciprocal evaluations seemed to encourage and inspire the departments that were evaluated to develop better educational programmes for their residents. This paper shows the advantages reciprocal evaluation seems to have as a supplementary method for quality improvement in departments that educate residents.

Quality of poststressor rest influences the ulcerative process.

Gastric ulceration in rats is exacerbated by allowing a so-called recovery period after exposure to an ulcerogenic stressor. One hypothesis, which has support from pharmacological studies, argues that this effect is brought about by a rebound of parasympathetic activation. We tested this parasympathetic rebound hypothesis by presenting animals with a fear-inducing (sympathetic-activating) conditioned stimulus (CS) after 2 hr of water-restraint stress. Contrary to the hypothesis, presentation of such a CS increased severity of ulceration compared with those animals that did not receive the CS after restraint stress and control animals. These ulceration data favor instead a sustained activation hypothesis for ulceration, whereby presentation of the CS effectively prolonged the length of time during which animals were under stress, thus enhancing the degree of ulceration. Measurement of plasma corticosterone however indicated a negative correlation between adrenocortical activity and degree of gastric ulceration, contrary to that expected by a sustained activation hypothesis. It is suggested that this inconsistency may be because of the activating of a pituitary-endorphinogenic mediated stress analgesia.

Serial stressors: prior exposure to a stressor modulates its later effectiveness on gastric ulceration and corticosterone release.

Several studies have focused on the proactive effects of prior exposure to a stressor on ulcerogenic and endocrine responses to exposure to a similar final stressor. In the present study, we explored the effects of prior exposure of Møll-Wistar rats to water-restraint stress on gastric ulceration and corticosterone responses to a final stressor. The number of prior exposures to water-restraint challenge was varied from one to four, and the durations of the prior exposures varied from 30 min to 2 h. The duration of the final stress challenge was 75 min. The two indices of the stress response to the final stressor challenge yielded different results. For neither index was the duration of prior exposures a significant factor in modulating the response to the final challenge. For gastric ulceration, those animals receiving one prior exposure, but not four, exhibited less gastric ulceration than animals receiving no prior exposure. These animals also developed less ulceration than those receiving four prior exposures. For corticosterone, those animals receiving four prior exposures exhibited a lower adrenocortical response to the final stressor than did animals receiving no prior exposure, or only one prior exposure. The results indicate the complexity of proactive effects of earlier stress experience on responses to a final stressor challenge.

Regulation of animal experimentation in Sweden.

The Swedish regulations in force on animal protection matters - regulations on destination breeding, experimental animal housing and ethical pre-testing - are a solid base for controlled and adopted experimental animal use in relation to the political attitudes prevailing towards these questions in Sweden. Certain and by no means small or unsignificant groups of the population are, however, still very critical of the structure of our regulations as well as the application thereof, and of the experimental animal use on the whole. This is something that Sweden has in common with several other countries. In an international comparison, however, the situation for the experimental animals in Sweden is likely to be quite good.