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Amphotericin B revisited: reassessment of toxicity.

PURPOSE: Although amphotericin B remains the mainstay of therapy for serious fungal infections, numerous acute and chronic toxicities make clinical usage difficult. Nevertheless, utilization of amphotericin B has increased dramatically in recent years. Accordingly, a study to reassess toxicity associated with the use of amphotericin in the modern era and to determine the aggregate impact toxicities have on the overall therapeutic course of patients was undertaken. PATIENTS AND METHODS: The charts of 50 patients at our institution who had received amphotericin B were retrospectively reviewed for the occurrence of drug-related acute and chronic toxicities and their impact on therapy. Patients evaluated were at least 21 years of age, had received at least 100 mg of amphotericin B, and were treated for at least 3 days. An analysis to investigate associations between drug administration variables and toxicities was also undertaken. RESULTS: The mean age of study subjects were 54 years, the average duration of therapy was 19 days, and the mean cumulative dose of amphotericin B was 582 mg. Acute toxicities accompanying infusion occurred in 66% of all patients. Fever was experienced by 34% of study subjects and chills by 56%, with rates of 2.6 and 3.5 mean episodes per patient per treatment course, respectively. Other acute toxicities including hypotension were rare, and no patients exhibited bronchospasm or anaphylaxis. Nephrotoxicity occurred in 30 patients (60%). Baseline creatinine values in these patients rose by a mean of 1.55 mg/dL (137 mumol/L), with increases in creatinine ranging from 0.2 to 5.2 mg/dL (18 to 460 mumol/L). Analysis of six drug administration parameters by stepwise multiple linear regression failed to reveal any significant associations with nephrotoxicity. The mean nadir potassium value was 3.1 mEq/L (3.1 mmol/L) (range: 2.3 to 4.8 mEq/L [2.3 mmol/L]), with 45 of 50 patients (90%) receiving potassium supplementation (average daily supplement = 69 mEq). Only increasing amphotericin B concentration was correlated with an increased requirement for potassium supplementation (p less than 0.01, stepwise multiple linear regression). CONCLUSION: Although clinically important toxicities continue to occur with usage of amphotericin B despite current methods of infusion and premedication, these are usually manageable and rarely limit the course of therapy.

Adult↗

Comparison of quantitative ultrasound parameters with dual energy X-ray absorptiometry in pre- and postmenopausal women.

BACKGROUND: Quantitative ultrasound (QUS) has been claimed as an alternative technique for risk assessment of hip fractures associated with osteoporosis. However, reports concerning modest correlations between QUS parameters and dual energy X-ray absorptiometry (DXA) in women raise questions about the reliability of QUS technology to predict bone mineral density (BMD). Partially, the lack of stronger correlations may be due to heterogeneity in bone architecture deterioration which may be more pronounced in older than in younger women. Therefore, it was thought important to study QUS/DXA interrelationships in subgroups of pre- and postmenopausal women. METHODS: We studied 217 pre- and postmenopausal women between the ages of 25 and 75 years, who were referred for a BMD measurement because of osteoporosis in at least one family member either in the first or in the second degree. All women had a calcaneal QUS and a DXA measurement at the lumbar spine, total hip and femoral neck. RESULTS: The linear regression coefficients between the QUS parameters broadband ultrasound attenuation (BUA) and speed of sound (SOS) and DXA at the various sites in the group as a whole were 0.53 to 0.54 (P<0.0001). Significantly lower regression coefficients between BUA and DXA at the total hip and the femoral neck were found in premenopausal women (r=0.31 and 0.38, P<0.0001) compared to postmenopausal women (r=0.56 and 0.53, P<0.0001). For SOS there was no significant difference between the regression coefficients in the pre- and postmenopausal group. The overall prevalence of osteoporosis as assessed by DXA in the total group was 25% (6% in the pre- and 36% in the postmenopausal group). BUA failed to detect osteoporosis in all five premenopausal women but also in 20 out of 50 postmenopausal women with osteoporosis according to DXA measurements. SOS measurements were even worse in this respect. CONCLUSIONS: Linear regression coefficients between calcaneal QUS parameters and DXA are only modest considering a group of 25--75-year-old Dutch women. In the subgroup of premenopausal women correlations between BUA and BMD at the hip and femoral neck are worse compared to those in postmenopausal women. The predictive value of QUS parameters for BMD is limited, therefore it is not appropriate to use QUS as a surrogate for DXA.

Absorptiometry, Photon↗

Evaluation of data produced by optode arrays under flow injection analysis (FIA) conditions using a partial least squares method (PLS2).

Transient diffuse reflectance spectra in the visible wavelength region from an enzyme optode were evaluated to determine artificial mixtures consisting of penicillin and ampicillin simultaneously. In order to achieve a discrimination of the samples the optode operated at two different working pH values. Using an appropriate FIA modus a linear range in the increase and decrease of the time-dependent signal was registered which could be easily fitted by means of ordinary linear regression. In this way characteristic static and dynamic features of the enzyme catalyzed reaction could be extracted for the evaluation by partial least-squares (PLS). The pre-processed raw data were differently weighted and the optimal number of primary factors was each selected by full cross validation. The interpretation of the spectral loadings and the correlation matrix identifies redundant variables resulting in a model with an optimal number of variables. The results obtained with this model show that the straightforward linear regression can be a sufficient approach to avoid the introduction of systematic errors in on-line pre-processing of data.

Ampicillin↗

The feasibility of using histologic placental sections to predict newborn nucleated red blood cell counts.

OBJECTIVE: To determine the feasibility of using calculated nucleated red blood cell (RBC) counts from histologic placental slides to predict newborn nucleated RBC counts. METHODS: This retrospective study compared absolute nucleated RBC counts from 24 newborns, diagnosed with fetal distress in labor, with counts calculated from their histologic placental slides. A simple linear regression model was tested with newborn nucleated RBC counts as the dependent variable and calculated placental nucleated RBC counts as the independent variable. RESULTS: The mean +/- standard deviation newborn nucleated RBC count was 4.81 x 10(9) +/- 5.46 x 10(9)/L compared with 1.37 x 10(9) +/- 1.78 x 10(9)/L calculated from placental sections. These data were normalized by logarithmic transformation. A significant linear regression was obtained, r(2) = 0.74, P <.001. The prediction equation obtained was natural logarithm (newborn nucleated RBC count) is equal to 1.002 x natural logarithm (placental nucleated RBC count) + 1.173. CONCLUSION: It is feasible to calculate nucleated RBC counts from histologic slides of the placenta that are predictive of newborn nucleated RBC counts. Further work on more homogeneous groups of subjects is necessary to increase the precision of the method. The placenta could serve as a surrogate source for newborn whole blood nucleated RBC counts around the time of birth.

Erythroblasts↗

Thyroid neoplasia in Marshall Islanders exposed to nuclear fallout.

We studied the risk of thyroid neoplasia in Marshall Islanders exposed to radioiodines in nuclear fallout from the 1954 BRAVO thermonuclear test. We screened 7266 Marshall Islanders for thyroid nodules; the islanders were from 14 atolls, including several southern atolls, which were the source of the best available unexposed comparison group. Using a retrospective cohort design, we determined the prevalence of thyroid nodularity in a subgroup of 2273 persons who were alive in 1954 and who therefore were potentially exposed to fallout from the BRAVO test. For those 12 atolls previously thought to be unexposed to fallout, the prevalence of thyroid nodules ranged from 0.9% to 10.6%. Using the distance of each atoll from the test site as a proxy for the radiation dose to the thyroid gland, a weighted linear regression showed an inverse linear relationship between distance and the age-adjusted prevalence of thyroid nodules. Distance was the strongest single predictor in logistic regression analysis. A new absolute risk estimate was calculated to be 1100 excess cases/Gy/y/1 X 10(6) persons (11.0 excess cases/rad/y/1 million persons), 33% higher than previous estimates. We conclude that an excess of thyroid nodules was not limited only to the two northern atolls but extended throughout the northern atolls; this suggests a linear dose-response relationship.

Adolescent↗

The effect of preparation taper on the retention of cemented cast crowns under lateral fatigue loading.

STATEMENT OF PROBLEM: Clinicians have used resistance form as a basis for determining guidelines for preparation design to ensure clinical success of cemented cast restorations. Disagreement on whether clinical success follows the on-off or linear nature of resistance form continues. PURPOSE: The purpose of this study was to evaluate the number of cycles required to dislodge a cemented complete crown casting under a cyclic lateral load as a function of taper and to compare this relationship for the resistive and nonresistive ranges of taper. MATERIAL AND METHODS: Three dies were milled from stainless steel at each of the following tapers: 4, 8, 12, 16, 20, 24, 28, and 32 degrees. A gold-palladium metal-ceramic alloy crown was fabricated for each die, cemented, and subjected to lateral cyclic loading until failure or 1,000,000 cycles. The limiting taper for the dies with their given height and base was 26.6 degrees. Dies with taper less than 26.6 degrees had resistance form, whereas dies with taper larger than 26.6 degrees did not. A linear regression (alpha=.05) was used to evaluate the relation of cycles at dislodgement to taper. RESULTS: The average number of cycles to crown dislodgement or completion for each taper (SD), in units of 10,000, was as follows: 4 degrees, 100 (0); 8 degrees, 100 (0); 12 degrees, 93.54 (16.56); 16 degrees, 61.33 (38.47); 20 degrees, 25.73 (34.67); 24 degrees, 4.33 (7.36); 28 degrees, 0.06 (0.08); and 32 degrees, 0.05 (0.09). The crowns in the resistive area less than 26.6 degrees that demonstrated failure showed a linear regression with a correlation coefficient of -0.995 between the average number of cycles to dislodge the crown and the taper. The slope was significantly different from zero (P=.0048), with a value of -7.58 and a standard error of 0.53. CONCLUSION: The number of cycles required to cause crown dislodgement was linear after 12 degrees in the resistive area and nearly zero for preparations in the nonresistive area. The limiting taper concept closely predicted the transition point where the slope of the graph of cycles to dislodgement as a function of taper abruptly changed.

Cementation↗

Complete dentures and oral health-related quality of life -- do coping styles matter?

UNLABELLED: Oral health-related quality of life (OHRQOL) in edentulous patients with complete dentures is often impaired. This paper investigates the effect of different coping styles on OHRQOL. PURPOSE: (a) To assess OHRQOL of edentulous patients with conventional complete dentures, and (b) to investigate if individual differences in these patients' styles of coping with stress affect their OHRQOL. MATERIALS AND METHODS: Data were collected from 249 fully edentulous patients with complete dentures (mean age: 66.0 years) who responded to a mailed survey (adjusted response rate: 48.8%). OHRQOL was measured with the 14-item short form of the oral health impact profile (OHIP). Ratings of coping strategies were obtained using the 28-item Brief COPE, an instrument measuring various styles of coping with stress. Linear regression analyses were used to explore the relationships between coping styles, background variables such as age, gender, income, and age of prosthesis, and the patients' OHRQOL. RESULTS: About 35% of the respondents reported impacts from their oral conditions on their overall OHRQOL (OHIP-14 total score) occasionally, fairly often, or often. Physical pain was even more prevalent, with 53.3% of the respondents reporting pain impacts. The linear regression model (P < 0.0001) explained 31.1% of the variation in the OHIP-14 total score. The coping variables instrumental support, behavioral disengagement, substance abuse, denial, and religion were significant negative predictors of OHRQOL. Only emotional support was a significant positive predictor of OHRQOL. CONCLUSION: Wearing conventional complete dentures has a significant impact on OHRQOL. This impact is moderated by the styles a patient uses to cope with stress. Using emotional support has a positive effect on OHRQOL, while other coping styles, namely instrumental support, behavioral disengagement, substance abuse, denial, and religion are significant negative predictors of OHRQOL.

Adaptation, Psychological↗

Mean arterial pressure, O2-uptake, and muscle force time during dynamic and rhythmic-static exercise in men with high percentages of fast- and slow-twitch fibers.

The influence of different percentages of slow-twitch (ST) and fast-twitch (FT) fibers in vastus lateralis on the relationship between mean arterial pressure (MAP) and O2-uptake (VO2) with muscle force time (MIpm, 60 integral of 0 p X t) exerted on the pedal during upright cycling, or during rhythmic isometric contraction (RIC) (only one subjects) was studied in three high percent STUDIED IN THREE HIGH PERCENT ST men (average 78% ST) (ST group), and in three high percent FT men (average 75% FT) FT group). MAP, or MIpm, was higher and had a steeper linear regression in the FT group than in the ST group at or against the same absolute VO2 during cycling at 60 rpm, or 100 rpm. The relationship between MAP and MIpm, however, was almost the same between both in the FT and ST group, or between both at 60 and 100 rpm. During RIC the slope (delta y/delta x) of the linear regression line between MAP and MIpm was close to that during cycling, whereas the slope of VO2 vs. MIpm was much lower. In conclusion, the variations in fiber population in working muscle do not seem to have any effect on MAP. MAP increases with MIpm independent of fiber population and/or fitness (VO2 max).

Adult↗

Body uneasiness in overweight and obese Italian women seeking weight-loss treatment.

OBJECTIVE: It is known that the psychopathology of eating disorders is associated with body image disturbances, but little is known concerning the body image of obese subjects. The aim of this study was to assess body uneasiness in overweight and obese women in relation to their age, degree of obesity, the percentage and distribution of body fat mass, and eating disordered behaviours. METHOD: The study population consisted of 99 overweight and obese women with a mean age of 34.3 +/- 10.1 years and a mean body mass index (BMI) of 31.3 +/- 5.4 kg/m2, who completed two self-report questionnaires: the Bulimic Investigation Test Edinburgh (BITE) to assess disordered eating behaviours and the Body Uneasiness Test (BUT) to assess body image uneasiness. Pearson correlations were used to determine the associations between the BUT scores and age, anthropometric measures (BMI, waist and hip circumferences, waist/hip ratio, percentage of body fat mass) and the BITE scores. The most significant determinants of the BUT scores were also determined using a multiple linear regression model. RESULTS: Disordered eating behaviours were found in 7.1% of the patients. Neither BUT nor BITE scores correlated with age, but BITE scores correlated with BMI and hip circumference (p < 0.05). The overall BUT score increased with increasing BITE scores and higher indices of all of the anthropometric measures (p < 0.001) except for the percentage of body fat mass. Multiple linear regression analyses showed that, among the considered parameters, the only significant determinants of body uneasiness were disordered eating behaviours. CONCLUSIONS: Our results confirm that body uneasiness in an obese clinical population is closely associated with disordered eating behaviours, and suggest that it is not dependent on age, the degree of obesity, or the percentage or distribution of body fat mass.

Adult↗

Gut bacteria associated with an atherogenic TMAO-dietary pattern and choline-rich foods among aging women.

BACKGROUND AND AIMS: Choline can be metabolized by gut bacteria with a choline utilization gene, CutC, as identified through genome sequencing studies. This metabolism produces trimethylamine, the precursor to the atherosclerotic metabolite trimethylamine N-oxide (TMAO). Bacterial species involved in trimethylamine production in free-living humans have been under-investigated. We previously developed the TMAO dietary pattern (TMAO-DP), which is predictive of plasma TMAO and choline. We evaluated associations between the TMAO-DP, dietary choline, and choline-rich foods (fish, red meat, eggs) with the abundance of species with CutC. We also explored associations between the TMAO-DP and microbiome diversity. METHODS AND RESULTS: This cross-sectional analysis included 287 women (mean age&#xa0;=&#xa0;79.6 years) from the Women's Health Initiative. Diet was assessed using a food frequency questionnaire. Stool samples were collected and the V3-V4 regions of the 16S ribosomal RNA were sequenced. Adjusted linear regression models evaluated associations between the TMAO-DP with the CLR-transformed abundance of species with CutC and with alpha-diversity indices. For beta-diversity, PERMANOVA examined measures of Aitchison distance within and between quartiles of the TMAO-DP. Associations between dietary choline and choline-rich foods with the abundance of species were evaluated using linear regression. The TMAO-DP was associated with Acidaminococcus intestini [Beta (SE): 0.23 (0.09), p-value&#xa0;=&#xa0;0.035] and Desulfovibrio desulfuricans [Beta (SE): 0.16 (0.6), p&#xa0;=&#xa0;0.035]. The TMAO-DP was not associated with alpha- or beta-diversity. CONCLUSION: This study provides evidence that Desulfovibrio desulfuricans and Acidaminococcus intestini, two species identified as having CutC by gene sequencing, may produce trimethylamine from diet in free-living women.

Humans↗

Dialysis adequacy and health related quality of life in hemodialysis patients.

Patients with end-stage renal disease have significant impairments in health related quality of life (HRQOL). The determinants of HRQOL, including the effect of dialysis adequacy, have not been well studied. This study was designed to investigate whether dialysis adequacy is associated with HRQOL in hemodialysis patients. A cross-sectional survey of 128 patients who had been on hemodialysis for more than 6 months was conducted. Baseline information on demographic factors and detailed clinical information was collected. Average Kt/V levels (for the 3 months preceding HRQOL assessment) were determined. HRQOL was assessed with the Kidney Disease Quality of Life Short Form, the Short Form-36 (SF-36), and the EuroQol EQ-5D. Multiple linear regression was performed to control for differences in important baseline covariates. Patients with average Kt/V levels greater than or equal to 1.3 had better HRQOL as measured by significantly higher scores (p < 0.05) in 4 of 11 kidney disease targeted domains, 6 of 8 SF-36 domains, and on the EQ-5D visual analog scale and index score. Using multiple linear regression to control for important covariates, the adjusted EQ-5D index score was higher by 0.036 (95% confidence intervals 0.015, 0.057) for each 0.1 increment in Kt/V, which is both statistically and clinically significant. Dialysis adequacy was significantly associated with HRQOL in hemodialysis patients. Controlled studies that examine the effect of increasing Kt/V on HRQOL are needed.

Aged↗

Protease inhibitor-based therapy is associated with decreased HIV-related health care costs in men treated at a Veterans Administration hospital.

BACKGROUND: Protease inhibitor (PI) therapy for HIV infection is associated with decreased rates of opportunistic infections and death. Statistical models predict that decreased complications will be associated with decreased hospitalization costs. A recent report suggested that the decrease in the HIV hospitalization costs were offset by increases in demand for outpatient services. We performed a study of hospital use and HIV-associated health care costs in our center to determine the following: whether PI therapy is associated with decreased inpatient use; whether PI therapy is associated with decreased outpatient use and costs; whether decreased HIV health care costs are associated with increased use of nucleoside analogues. METHODS: The Dallas Veteran Affairs Medical Center provides comprehensive inpatient and outpatient HIV care and thus can evaluate the relation between inpatient and outpatient costs. The mean monthly number of hospital days, Infectious Diseases clinic visits, emergency department visits, other outpatient clinic visits, inpatient costs, outpatient costs, and PI costs were determined from January 1, 1995 through July 31, 1997. This time period was then divided into three intervals. Comparisons of PI use and HIV-related health care costs were during the three intervals was performed using analysis of variance (ANOVA). Significant differences between the baseline characteristics were further analyzed through multiple linear regression. RESULTS: A decrease in hospital days, and all outpatient visits including emergency visits, and HIV clinic visits was determined. No difference was found in the rate of use of other outpatient services. The per patient costs of HIV care decreased from a monthly average of $1905 U.S. in the first interval to $1122 U.S. in the last interval (p < .01). Linear regression demonstrated an inverse relation between PI use and total HIV costs (B=-0.67, p=.00, adjusted R2=0.52) but no relation between nucleoside use, stage of disease or financial class. CONCLUSIONS: PI therapy is associated with decreased hospital days and use of outpatient services. Total patient costs decreased, but a concomitant rise in outpatient costs took place. This increase was primarily a result of increased costs of acquiring PI. Increases in the number of nucleoside agents prescribed were not associated with decreased costs.

Adult↗

Influence of metabolic state and diabetes on the outcome at the end of first year after gastric banding.

BACKGROUND: The influence of metabolic state and the presence of diabetes before surgery on the weight changes following non-adjustable gastric banding, were studied. METHODS: The total of 50 patients referred for gastric banding had the following parameters measured: insulinemia, glycemia, total cholesterol, triglycerides (TAG), dehydroepiandrostendione (DHEA) and its sulphate (DHEA-S), triiodothyronine, thyroxine, and thyroxine-stimulating hormone. We evaluated 28 of these, who completed at least 6 months of follow-up. 12 of these patients had diet-treated non-insulin dependent diabetes mellitus (NIDDM) and 16 were non-diabetics, and 9 of them had a positive family history of NIDDM (FH DM). We compared the change in weight of the diabetics, non-diabetics and those with positive FH DM, at 3, 6 and 12 months after the operation. Multiple linear regression tested the influence of the measured parameters on patients' weight. RESULTS: Weight loss was greatest in the group of patients without a positive family history of diabetes, and lowest in the diabetic group. Due to the high dispersion, differences in the t-test are not significant. When individual factors and their influence on weight development were tested by multiple linear regression, weight loss was greatest in patients with high TAG and low insulin levels and lowest in patients with diabetes or positive FH DM. CONCLUSIONS: Although post-operative weight can be influenced by other factors, eg. psychological ones, it is advisable to test each patient pre-operatively for insulin and TAG levels, and to establish family history of diabetes and presence of diabetes to give an idea of the prognosis of weight change.

Adult↗

Reliability and validity of three-dimensional fetal brain volumes.

OBJECTIVE: To determine the intraobserver and interobserver variability in calculating three-dimensional fetal brain volumes and to examine the relationship between these volumes and biparietal diameter and head circumference measurements and estimated gestational age. METHODS: Eighty-five subjects between 16 and 40 completed weeks' gestation participated in the Institutional Review Board-approved study. Fetal head images were obtained axially and stored on a magnetic optical disk. The fetal brain volumes were calculated in triplicate by each of 2 observers using 8 to 10 coronal cuts. The coefficient of variation was determined for both physicians. Pearson correlations and linear regression were used to evaluate the relationship between three-dimensional head volume and standard biparietal diameter and head circumference measurements and estimated gestational age. RESULTS: The coefficients of variation were low for both investigators, at 2.04% and 2.44%. The correlations between fetal brain volumes and biparietal diameter, head circumference, and estimated gestational age were all highly significant (P < .001). The linear regression of brain volumes with estimated gestational age was also highly significant (P < .001). CONCLUSIONS: Three-dimensional fetal brain volume measurements had excellent intraobserver and interobserver reliability. The volumes correlated very well with standard biparietal diameter and head circumference measurements. These volumes can also be used to determine estimated gestational age.

Brain↗

Relationship of serum and plasma copper and ceruloplasmin concentrations of cattle and the effects of whole blood sample storage.

The present study was conducted to determine whether plasma and serum copper and ceruloplasmin concentrations in cattle are different and whether transport of samples with storage on ice before centrifugation affects the measurements. Mean copper and ceruloplasmin values were higher in plasma than in serum. Linear regressions were plasma copper (microgram/ml) = 1.200 serum copper -0.032 (r2 = 0.99), serum ceruloplasmin (mg/dl) = 14.0 serum copper + 2.34 (r2 = 0.48), and plasma ceruloplasmin (mg/dl) = 18.2 plasma copper + 2.1 (r2 = 0.43). The percentage of copper associated with ceruloplasmin was less in serum (55%) than in plasma (66%). Storage of blood samples on ice for 3 days decreased serum copper value by 3.5%. Linear regressions to correct for storage effects were corrected serum copper = 1.11 stored serum copper -0.04 (r2 = 0.94) and corrected plasma copper = 1.22 stored plasma copper -0.17 (r2 = 0.86). A cuproprotein may be involved in the blood clotting process, and some ceruloplasmin and its copper are apparently trapped in the fibrin clot, causing less copper in serum, compared with that in plasma. The difference between plasma and serum copper concentrations of calves was slightly increased by dietary copper supplementation.

Animals↗

Moderate alcohol consumption and its relation to visceral fat and plasma androgens in healthy women.

OBJECTIVE: To study the inter-relationships between daily alcohol intake, fat distribution and plasma androgens in order to verify whether daily alcohol intake correlates with abdominal body fat and, if so, to what extent such a relation is mediated by plasma androgens. SUBJECTS: A random sample of 87 clinically healthy women (aged 38 y) with a light-moderate alcohol consumption and without clinical evidence suggestive of any endocrine disorder. MEASUREMENTS: Anthropometric and computed tomography (CT scans made at the level of L4-L5 in a subgroup of 18 women) measurements of body fatness and adipose tissue distribution, main behavioural factors, including daily alcohol intake and plasma androgens (i.e. total and free testosterone levels). RESULTS: After adjustment for BMI, cigarette smoking and physical activity, significant differences were found in waist circumference and waist-hip ratio as well as in plasma androgens with increasing daily alcohol intake. Waist-thigh ratio tended to parallel waist-hip ratio, but did not achieve statistical significance. In simple linear regression analysis, abdominal visceral fat area, derived from CT, correlated positively with both plasma free testosterone and alcohol intake. While the above reported difference in body fat distribution totally disappeared after controlling also for free testosterone level, the differences in plasma androgens with increasing alcohol intake remained essentially unchanged when allowance was made also for waist-hip ratio. In multiple linear regression analysis, daily alcohol intake appeared to be positively and independently correlated to both plasma total and free testosterone levels. Neither BMI nor waist-hip ratio nor fasting insulin made any significant contribution to the prediction of plasma androgens after daily alcohol intake had been taken into account. CONCLUSIONS: The results of this study show that moderate alcohol consumption correlates with abdominal distribution of body fat, likely due to enlarged visceral fat area, and increased plasma androgenicity (i.e. higher total and free testosterone levels) in adult healthy women. These data also suggest that the relation between alcohol intake and fat distribution may be, at least in part, mediated by plasma androgens.

Adipose Tissue↗

Identifying population differences in lung function: results from the Allied Dunbar national fitness survey.

In order to identify valid population differences in lung function (e.g. occupational, ethnic), it is necessary to adjust for known confounding variables (e.g. age, body size). The present paper proposes appropriate methods for analysing forced expiratory volume (FEV1), forced vital capacity (FVC) and maximum oxygen uptake (VO2 max), recorded as part of the Allied Dunbar national fitness survey (ADNFS). The ADNFS randomly selected subjects from 30 regional sites throughout England. Measurements of FEV1, FVC and complete records of other relevant information were available on 2672 subjects. Traditional analyses of co-variance (ANCOVA) were found to be inappropriate to investigate population differences in FEV1 and FVC, due to a significant increase in error variance with age. However, by fitting a multiplicative model with allometric body size components to the FEV1 and FVC measurements using weighted log-linear regression, valid and plausible associations with body size, age, smoking, and physical activity, together with 'gender specific' regional differences in lung function were identified. Further insight was obtained when FEV1 and FVC were included into the multiplicative model to predict VO2 max. The apparent advantage of being taller when predicting VO2 max, was explained more accurately by the subjects' superior FVC. In summary, by fitting the multiplicative 'allometric' model using weighted log-linear regression, valid population differences in lung function were identified. Regions containing a higher proportion of working-class, unemployed or less affluent subjects were found to be associated with below average lung function performances.

Adolescent↗

Marital satisfaction in couples with rheumatoid arthritis.

OBJECTIVE: To understand correlates of marital satisfaction in persons with rheumatoid arthritis (RA) and their spouses. METHODS: In a cross-sectional survey, 79 persons with RA and 78 spouses completed the Kansas Marital Satisfaction Scale, the revised Ways of Coping Questionnaire scales, and the Health Assessment Questionnaire. A series of linear regression analyses were then performed to investigate correlates of marital satisfaction for patients and spouses. RESULTS: Seventy-six percent of patients were women. Mean patient age was 56.5 years (+/- 12.5 years), number of years married was 30.7 (+/- 13.5), and duration of RA was 14.2 years (+/- 9.0 years). Demographic features of spouses resembled those of patients. Patients and spouses were generally satisfied with their marriages. Linear regression analyses showed that lower marital satisfaction in patients was associated with higher education level (P < 0.01), patient's greater use of escape into fantasy (P < 0.01), patient's greater use of finding blame (P < 0.05), and spouse's higher use of escape into fantasy (P < 0.001). Spouses less satisfied with their marriages were more likely to use passive acceptance (P < 0.05) and less likely to find blame (P < 0.05). Female spouses were less likely to be satisfied in their marriages (P < 0.01) than male spouses. CONCLUSIONS: This study indicates that certain passive coping styles are associated with lower marital satisfaction in persons with RA and their spouses. More highly educated patients and female spouses are also less satisfied in their marriages. These cross-sectional correlations should not be regarded as causal and should be examined further in longitudinal studies.

Adaptation, Psychological↗