Ankle-foot orthosis has limited effect on walking test parameters among patients with peripheral ankle dorsiflexor paresis.

The aim of this study was to determine the relationship between ankle dorsiflexor strength and performances on several walking tests and to determine the effect of ankle-foot orthosis (AFO) use on walking tests. The following tests were used: 10-metre walking test (with and without three stairs), a complex walking task (6-minute walk with cognitive loading) and a subjective evaluation (SIP68 mobility scale and questionnaire). Isometric strength of the ankle dorsiflexors was measured. All walking tests were performed with and without AFO in random order. When relating torque values to walking performances, the highest correlation was found with the "10 metre" and "10 metre with stairs" test (r = -0.51, i.e. an inverse relationship). No threshold in the degree of paresis was found below which walking disability suddenly increased. No significant improvement could be demonstrated from AFO use on the 10-metre tests. Improvement on the 6-minute test was nearly significant (p = 0.06), the questionnaire revealed a positive opinion on AFO use related to overall walking function and effort. Thus, we have to conclude that these walking tests do not aid the clinician in estimating the severity of (progression of) the paresis nor to detect differences in degree of paresis between subjects.

Evaluation of effect of ankle-foot orthosis use on strength restoration of paretic dorsiflexors.

OBJECTIVE: To assess whether a difference exists in restoration of strength between patients with a recent paresis of the dorsiflexors of the ankle using an ankle-foot orthosis (AFO) and patients without an AFO. DESIGN: Prospective case-control study. SETTING: Patients from regional hospitals, tested in a rehabilitation research center. PARTICIPANTS: Twenty-nine patients with a recent (6wk-1yr) peripheral paresis, alternately assigned to a group using an AFO or a control group. There was no significant difference in duration of the paresis and in torque at entering the study (T0) between the 2 groups. INTERVENTIONS: The use of an ankle-foot orthosis. MAIN OUTCOME MEASURES: Isometric torque production of ankle dorsiflexors, expressed as ratio of paretic and healthy side, in 2 measurement sessions, over a period of 6 weeks (T0-T6) with the ankle in 0 degrees and 30 degrees plantarflexion. RESULTS: Both groups had significant restoration of strength +/- standard deviation between T0 and T6 in 30 degrees flexion: non-AFO group 17% +/- 15%, AFO group 9% +/- 12%. No significant difference existed between the 2 groups (30 degrees p = .56). No significant shift in strength ratio 0 degrees :30 degrees occurred (AFO group p = .82). CONCLUSION: The use of an orthosis does not influence restoration of strength in patients with a recent peripheral paresis of the ankle dorsiflexors.

Effect of immobilization on ankle dorsiflexion strength.

This study was performed in order to determine the loss of strength of the dorsiflexors in healthy persons after immobilization of the ankle, and the ability of these muscles to regain strength. First, isometric ankle dorsiflexion strength was measured in 33 healthy male and 39 female subjects in age categories 20-40 and 40-80 years, in order to obtain reference data and to determine the reproducibility of the measurement protocol. Gender, age and ankle position had a significant influence on the ankle dorsiflexion torque. Secondly, torque was measured in 15 patients after 4-6 weeks' immobilization of the ankle due to a fracture. A 28% decrease in dorsiflexion torque was seen. Strength reduction in neutral position and in 30 degrees plantar flexion was not significantly different. Without specific therapy restoration of torque was almost complete 6 weeks after cast removal.

On the within-population relationship between nutrition and serum lipids: the B.I.R.N.H. study.

A randomized study was performed in Belgium concerning the relationship between diet and serum lipids in 5485 men and 4856 women with a mean age of 49 years. In men 17.3% of total energy was provided by saturated fat, 15.2% by monounsaturated fat and 7.5% by polyunsaturated fat. The fat intake in women was very similar. The P/S ratio was 0.51 in men and 0.52 in women. The alcohol intake was significantly higher in men (5.2% of total energy) than in women (2% of total energy). In men and women total serum cholesterol increased with saturated fat intake (p less than 0.001) and decreased with polyunsaturated fat intake (p less than 0.01). Saturated fat intake raised the HDL-cholesterol level in men and women (p less than 0.001) and monounsaturated fat raised it in men only (p less than 0.01). Dietary cholesterol increased the HDL-cholesterol level in women only (p less than 0.01). HDL-cholesterol increased with alcohol consumption (p less than 0.001) and decreased with cigarette smoking (p less than 0.001). All these changes were adjusted for differences in age, height and weight. The study confirms the existence, within a population, of a significant relationship between fat intake and serum lipid levels.

Nutrition and cardiovascular mortality in Belgium. For the B.I.R.N.H. Study Group.

Significant differences in nutrition exist between the northern and the southern regions of Belgium. The most important differences are a lower saturated fat intake, a higher polyunsaturated fat intake and a higher P/S ratio in the north. Total protein, animal and vegetal protein, salt from processed foods and fiber intake are also higher in the north. The intake of butter is higher in the south and the intake of total and dietetic margarine and of fish are higher in the north. All causes, total cardiovascular, IHD (only in men), stroke and residual cardiovascular mortality are higher in the south, consistent with the regional distribution of fat intake. However, within each region there is no correlation between these mortality patterns and fat intake. This phenomenon can be explained by the presence of confounding factors: salt intake from processed foods, fish, alcohol intake and smoking habits, all of them having a different and sometimes inverse distribution among the counties. The geographical association of fat intake and cardiovascular mortality is strengthened by a similar association between trends in fat intake and trends in cardiovascular mortality. From 1968 onwards until about 1975 a decrease in saturated fat and a marked increase in polyunsaturated fat occurred together with a decreasing dietary cholesterol and salt intake. An important decrease in IHD occurred in Belgium, particularly between 1972 and 1979, and is still the highest in Europe (1968-1984). Belgium is ranked among the five top countries of Europe where stroke mortality (age 45-74 years) is declining most. The nutritional situation of Belgium and the level of mortality, though improving, are still far from ideal. The total fat, saturated fat and salt intake are much higher than recommended by W.H.O. Continued vigorous action will be necessary in order to achieve the W.H.O. goals. A comparison of what occurred in Belgium and in other countries with regard to cardiovascular mortality and nutrition underlines the role of nutrition as a key factor in public health.

Cardiovascular risk factor distribution above the age of 75 years in a Belgian community.

An elderly Belgian population group anno 1986 consisting of 53 men and 110 women above the age of 75 years with a mean age of 80 and 81 years, respectively, is characterized by relative obesity and low diastolic blood pressure, both in men and women. The SBP/DBP ratio is 1.91 in men and 1.88 in women. HDL-cholesterol levels are relatively high in men. Women still have slightly higher HDL-cholesterol levels than men, the difference between women and men being 3.4 mg/dl. In both sexes HDL-cholesterol correlates negatively with body weight. The 24-hour urinary sodium/potassium ratio is 2.9 in men and 2.5 in women. Factors significantly related to diastolic blood pressure in a multiple regression analysis included being on a low-salt diet, the level of 24-hour urinary potassium excretion and of 24-hour urinary creatinine excretion in men, and body weight, heart rate and the level of 24-hour urinary calcium excretion in women. It may be concluded that significant differences exist between the distribution of cardiovascular risk factors in older compared to middle-aged subjects.

Coffee consumption and serum cholesterol: an epidemiological study in Belgium.

In a Belgian population group of 15,954 male and 2116 female soldiers and their spouses the relationship between coffee drinking and serum cholesterol has been studied. A moderate but highly significant monotonic positive relationship between coffee drinking and both serum total and non-high density lipoprotein (HDL)-cholesterol was observed in men (p less than 0.001) even when adjusted for the confounding effects of age, body mass index, smoking, alcohol, and dietary fat and cholesterol intake. Men drinking at least three cups of coffee daily had a mean level of serum total cholesterol about 4 mg/dl and of non-HDL-cholesterol about 3 mg/dl higher than those who did not drink coffee. No significant effect of coffee drinking on HDL-cholesterol was observed in men. In women coffee-drinking did not influence any of the measured serum lipids.

Tissue-type plasminogen activator antigen and plasminogen activator inhibitor in diabetes mellitus.

Parameters of fibrinolysis, including euglobulin fibrinolytic activity, tissue-type plasminogen activator (t-PA) antigen, plasminogen activator inhibitor (PA-inhibitor) activity, and plasmin-alpha 2-antiplasmin complex (PAP) were studied in 62 patients (35 women and 27 men; ages 53 +/- 16 years) with either insulin-dependent (IDDM) or noninsulin-dependent (NIDDM) diabetes mellitus. Compared to a control group of similar age (n = 57), the diabetic patients had a significantly lower mean euglobulin fibrinolytic activity (1.2 +/- 0.7 vs. 1.7 +/- 1.1 ng/ml, p less than 0.01) but significantly higher mean t-PA antigen (15.7 +/- 8.4 vs. 6.6 +/- 2.9 ng/ml, p less than 0.001) and PA-inhibitor activity (2.6 +/- 1.3 vs. 1.5 +/- 0.7 IU/ml, p less than 0.001) levels. Significant univariate correlations were observed between PA-inhibitor activity and age (r = 0.32, p less than 0.05), diastolic blood pressure (r = 0.42, p less than 0.01) and euglobulin fibrinolytic activity (r = -0.40, p less than 0.01). In multivariate analysis, only body mass index (positively) and euglobulin fibrinolytic activity (negatively) remained significantly related to PA-inhibitor activity in the total diabetic population as well as in the NIDDM group. The only parameter in the IDDM group significantly related to PA-inhibitor activity was diastolic blood pressure. These results suggest that PA-inhibitor plays a role in the regulation of fibrinolysis in diabetes patients and that factors like obesity and hypertension may be related to reduced fibrinolysis via PA-inhibitor levels.

Trends in stroke mortality and in antihypertensive treatment in Finland from 1972 to 1984 with special reference to North Karelia.

Trends in antihypertensive treatment and stroke mortality were analysed in the province of North Karelia where the first systematic hypertension control programme in Finland was started in 1972. Surveys carried out in random samples of the middle-aged population of North Karelia showed that the control of hypertension was better than in the reference area, especially from 1972 to 1977. From 1972 to 1984, mortality from stroke fell on average 6.3% and 7.6% per annum, in North Karelian men and women aged 35-64 years. These declines were steeper than those observed in the rest of Finland. In the age group of 65-74 years the decline in stroke mortality was also steeper in North Karelia. From 1978 to 1984 the self-reported awareness of hypertension and the proportion of people receiving antihypertensive drug treatment decreased in the middle-aged population in Finland, suggesting lesser efforts at detection and treatment. During the same period, the steep national decline in stroke mortality levelled off, but the mortality rate remained higher than in the USA and in other Western European countries. Prevention of stroke through hypertension control in the community still remains a major challenge for health care.

On the within-population relationship between dietary habits and serum lipid levels in Belgium.

In a Belgian population group of 15,954 male and 2116 female subjects, an epidemiological survey has been conducted to investigate the relationship between dietary fat intake and serum total and HDL-cholesterol. The study has established, both in men and in women, a significant positive relationship between serum total cholesterol and the dietary intake of saturated fat and a significant negative one between serum total cholesterol and the intake of polyunsaturated fat and the P/S-ratio of the diet. At equal levels of consumption, polyunsaturated fat has a decreasing effect on serum total cholesterol which is about half the increasing effect due to saturated fat. Polyunsaturated fat and the P/S-ratio decrease the HDL-cholesterol value but only with borderline significance. The present study demonstrates the importance of dietary fat as a determinant of the serum lipid level within a population.

The relationship between cations and blood pressure in the People's Republic of China.

Blood pressure was measured in the north and in the south of the People's Republic of China in 1002 men and 1006 women. The 24-hour urinary excretion of sodium, potassium, calcium, magnesium, and creatinine was measured, and the relationship between urinary cations and blood pressure was studied. Blood pressure and 24-hour sodium excretion were higher in northern China than in southern China. With some exceptions, a positive correlation was found between urinary sodium and blood pressure and a negative one between 24-hour urinary potassium excretion and blood pressure. Urinary calcium correlated negatively and urinary magnesium did not correlate significantly with blood pressure. The sodium/potassium ratio correlated positively with blood pressure, and the calcium/magnesium ratio, negatively. This study confirms the positive within-population relationship between sodium intake and blood pressure in Oriental populations.

[Epidemiology of rectal cancer: current findings]. / Epidémiologie du cancer du rectum: données récentes.

The exact incidence of rectal cancer in Belgium is not known, due to the absence of an operational national cancer registry. Mortality data however are well documented by death certificates. Annual rectal cancer death rates reach 20 and 13 per 100,000 for men and women respectively in the age category from 45 to 74 years (data from 1981). When similar data obtained for the years 1968 to 1983 are being compared, a significant decrease of rectal cancer mortality can be observed, at a rate of 2.6% annually. Such a decrease is not seen for colon cancer, of which the respective annual death rates are 41 and 33 per 100,000. Absolute figures for the whole Belgian population in 1984 were 3204 deaths due to colorectal cancer, with 2307 cases for colon and 897 cases for rectal cancer. In regions where incidence data are available, it is found that the cumulative risk of colorectal cancer between birth and the age of 75 can reach more than 5% in industrialized countries. Recent incidence data confirm the significant decrease in rectal cancer occurrence.

Trends in stroke and stomach cancer in Austria compared to selected Eastern and Western European countries.

The age-adjusted rates of stomach cancer in men and women aged 45-74 years tended to decrease in different countries in Europe between 3.0% and 5.3% per year over the last 10-15 years. East European countries had generally higher stomach cancer death rates than West European countries, and of these Austria and Finland had the highest rates. Stroke mortality decreased in West European countries in a similar way; the underlying factor might be salt intake. Between and also within West European countries a positive association has been found between changes in salt intake and trends in both stomach cancer and stroke mortality. In most East European countries, stroke mortality has increased. The greatest annual increases were in Poland and Czechoslovakia ranging between 2.9% and 4.8%. Thus, although the decline in stomach cancer mortality in Europe suggests a general reduction of salt intake, this alone was not sufficient to result in a decline in stroke mortality in East European countries. The stroke-salt intake association in East European countries might have been modified by other factors such as increased fat intake and obesity causing high blood pressure. Further studies are therefore needed to clarify the role of salt intake as a linking factor of stomach cancer and stroke.

Comparison of health status between Portuguese and Finnish elderly people.

This study compares the living situation, morbidity and mortality and related factors between two different communities, one in eastern Finland (with high mortality in cardiovascular diseases) and another in Lisbon, Portugal (representing the Mediterranean area with low ischaemic heart disease but nigh cerebrovascular mortality). The representative samples of 65-74 year old population were examined using the same study protocol, and official mortality statistics were analyzed from these countries. The results show that elderly Finns have more facilities at home than elderly Portuguese. Self reported diabetes mellitus, stroke and chronic bronchitis as well as obstipation, urinary problems, leg pain and chest pain, and cough in the morning were more prevalent in Portugal but cardiac failure was more common in Finland. Reported hypertension and antihypertensive drug treatment were equally prevalent in both countries, but diastolic blood pressure level was clearly higher in Portugal. Total CVD mortality in this age group is higher in Finland among men but lower among women, stroke mortality is higher but ischaemic heart disease lower among both genders in Portugal.

Decline in cardiovascular mortality in North Karelia and other parts of Finland.

The trends in mortality from ischaemic heart disease, cerebrovascular stroke, and all cardiovascular diseases were analysed for the province of North Karelia and for the rest of Finland. Linear trends in mortality were computed for the population aged 35 to 64 for the period from 1969 to 1982, and changes in mortality between the three year means of 1969-71 and 1980-2 were calculated. In North Karelia, where a community based preventive programme has been carried out since 1972, the annual decline in mortality from ischaemic heart disease in men was on average 2.9%, whereas in the rest of Finland it was 2.0%. For women the respective average annual declines in mortality were 4.9% and 3.0%. The net decline from 1969-71 to 1980-2 in North Karelia was 100 deaths/100,000 men. The annual mortality from all cardiovascular disease in men decreased by 2.9% in North Karelia and by 2.6% in the rest of Finland; in women the decreases were 6.0% and 5.0% a year, respectively. The net decline in North Karelia was 71 deaths/100,000 men. The decline in mortality from all causes was also appreciable in both sexes in North Karelia, but it did not differ significantly from national trends.

A multi-centre study on within-person variability in the urinary excretion of sodium, potassium, calcium, magnesium and creatinine in 8 European centres.

We have studied the within-person variability in the excretion of sodium, potassium, calcium, magnesium and creatinine in 20-60-year old men and women from 8 European centres. Only the data from people who reported that their collections were complete were entered in the analysis. The within-person coefficients of variation for the electrolytes ranged from 28 to 38 and that for creatinine from 21 to 24. The corresponding number of days required to estimate the excretion of electrolytes and creatinine to within 20 per cent of the habitual excretion (95 per cent confidence interval) varied between 4 for creatinine in men to 14 for magnesium in both men and women. The results of this study demonstrate once more that creatinine is unsuitable as a marker of completeness of urine collection for the individual.

The mechanism of disappearance of the physiologic third heart sound with age.

To study the mechanism of disappearance of the physiologic third heart sound (S3) with advancing age, combined phonoechocardiographic and phonomechanocardiographic recordings from 165 normal subjects between 6 and 62 years old were quantitatively analyzed. Nearly all individuals under 40 years old had a recordable S3. Although recordable in 38.6% of the 44 subjects over 40 years old, the physiologic S3 found in adults was less intense and occurred later in diastole when compared with that in children and adolescents. Marked changes in left ventricular filling hemodynamics were observed with aging, including an increase in left ventricular wall thickness and mass, a prolongation of the left ventricular isovolumetric relaxation period, a decrease in left ventricular early diastolic filling and wall thinning rates, and a reduction in the height and steepness of the rapid filling wave measured on the calibrated left apexcardiogram (linear correlation with age significant at p less than .001 for all parameters). Although less pronounced, these changes were very similar to the diastolic abnormalities found in patients with pressure overload left ventricular hypertrophy. Therefore, the higher pressure load imposed on the left ventricular wall due to the well-known gradual increase in blood pressure that occurs during normal growth and adulthood appears to be the most likely explanation for the observed changes in diastolic filling. It is concluded that the later occurrence, the diminishing amplitude, and the eventual complete disappearance of the physiologic S3 with age results from a decrease in early diastolic left ventricular filling and subsequent deceleration of inflow caused by the development of relative left ventricular hypertrophy in adulthood as compared with childhood.

Nifedipine as an adjunct to St. Thomas' Hospital cardioplegia. A double-blind, placebo-controlled, randomized clinical trial.

The cardioprotective effect of the addition of the slow calcium-channel blocker nifedipine to cardioplegic solution was tested in two double-blind placebo controlled randomized studies. The first study included 24 patients undergoing aortic-coronary bypass grafting, and the second included 24 patients undergoing aortic valve replacement. Nifedipine at a dose of 200 micrograms/L or placebo was added to St. Thomas' Hospital cardioplegic solution. The following markers of ischemia were used: adenosine triphosphate and its catabolites, creatine phosphate and inorganic phosphate, determined in transmural left ventricular biopsy specimens taken before, at the end of, and after aortic cross-clamping; hemodynamic recovery 15 minutes after cessation of cardiopulmonary bypass; clinical outcome in terms of the incidence of arrhythmias, low cardiac output, positive inotropic support immediately after operation, and follow-up at 15 months. The main difference between the two studies was that myocardial temperature during cross-clamping remained constant at 14 degrees C in coronary bypass grafting but increased to 25 degrees C in valve operations despite the application of the same amounts of cardioplegic solutions. This lower temperature resulted in better preservation of high-energy phosphates in coronary bypass operations as compared to the placebo group having valve replacement operations. According to analysis of variance, a drug effect could be demonstrated only in the aortic valve replacement study: Accumulation of breakdown products of the adenine nucleotide pool was less in the nifedipine group than in the placebo group (p less than 0.05). Adenosine triphosphate decreased only to 84% in the nifedipine group and to 72% in the placebo group. Despite this adenosine triphosphate-sparing effect, weaning from cardiopulmonary bypass was more difficult in the nifedipine group. Left ventricular stroke work index 15 minutes after bypass was decreased to 72% of the prebypass value in the nifedipine group (t test, p less than 0.01) and only to 86% in the placebo group (p = NS). In contrast, after the patients were admitted to the intensive care unit, the incidence of low cardiac output tended to be lower in the nifedipine group than in the placebo group: 33% versus 58% (p = NS). In conclusion, ischemia-induced degradation of nucleotides as it occurs when myocardial cooling is inadequate can be prevented by the addition of nifedipine to the St. Thomas' Hospital cardioplegic solution. This effect, however, is not associated with an improved clinical outcome.

A multi-centre study on completeness of urine collection in 11 European centres. I. Some problems with the use of creatinine and 4-aminobenzoic acid as markers of the completeness of collection.

We have studied the completeness of urine collections in 11 European centres. The completeness of collection was examined by questioning the participants, by calculating the ratio of observed to expected creatinine, and by measuring the recovery of p-aminobenzoic acid (PABA) in the urine after administration of a 240 mg dose. The ratio of observed to expected creatinine is a fairly insensitive measure of undercollection. People who report that their collection is incomplete are likely to have collected incompletely to a considerable degree. It was concluded that the use of PABA in epidemiological studies is still questionable; overcollection cannot be detected by using PABA, and it appeared that people sometimes forget or refuse to take the capsules. It is also suggested that differences in the meal-time patterns between countries may interfere with the PABA recovery test.