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Objectives Investigate trends in the prevalence of obesity and malnutrition among very old adults (age ≥ 85 years) between 2000 and 2017. Design, Setting, Participants, Measurements A study with data from the Umeå 85+/Gerontological regional database population-based cohort study of very old adults in northern Sweden. Every 5 years from 2000–2002 to 2015–2017, comprehensive assessments of participants were performed during home visits (N=1602). Body mass index (BMI) classified participants as underweight (2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30.0 kg/m2). Mini Nutritional Assessment (MNA) scores classified participants as malnourished (0 to Results Between 2000–2002 and 2015–2017, the mean BMI increased from 24.8± 4.7 to 26.0± 4.7 kg/m2. The prevalence of obesity and underweight were 13.4% and 7.6%, respectively, in 2000–2002 and 18.3% and 3.0%, respectively, in 2015–2017. The mean MNA score increased between 2000–2002 and 2010–2012 (from 23.2± 4.7 to 24.2± 3.6), and had decreased (to 23.3± 4.2) by 2015–2017. The prevalence of malnutrition was 12.2%, 5.1%, and 8.7% in 2000–2002, 2010–2012, and 2015–2017, respectively. Subgroup analyses revealed similar BMI and MNA score patterns among nursing home residents. Conclusions Among very old adults, the mean BMI and prevalence of obesity seemed to increase between 2000–2002 and 2015–2017. Meanwhile, the nutritional status (according to MNA scores) seemed to improve between 2000–2002 and 2010–2012, it declined by 2015–2017.

STROBE Statement—checklist of items that should be included in reports of observational studies. (DOC 93 kb)

The purpose of the present parent-offspring study was to investigate the influence of heredity and environment on bone density in young men. Another aim was to discover whether the same genetic factors influence bone mass, lean mass and muscle strength. Fifty families including a father, mother and one son were investigated. The mothers (aged 44.5 +/- 4.4 years) and fathers (aged 47.1 +/- 4.4 years) generally had a sedentary lifestyle with little physical activity. As a contrast, all but three of the sons (aged 17.0 +/- 0.4 years) were active in ice hockey training. Bone mineral density (BMD, g/cm2) of the total body, head, lumbar spine and femoral neck was measured using dual-energy X-ray absorptiometry. Muscle strength of the hamstrings and quadriceps muscles was also measured in the boys. BMD values of different sites in the fathers, mothers and sons were adjusted for weight, height, age, and any significant influence of environment. Heritability estimates were obtained as regression coefficients with the boys' adjusted BMD as dependent variable and the adjusted midparent bone density (father BMD + mother BMD/2) as independent variable. Accordingly, heritability explained 34-54% of the variation in the sons' BMD. Midparent BMD of several sites also predicted the boys' lean mass and quadriceps strength, and midparent-offspring differences in lean mass predicted midparent-offspring differences in BMD of the total body, head and spine (beta = 0.30-0.51, p < 0.05). The sons were found to have almost 30% higher femoral neck BMD than their fathers, and physical activity (hours/week) predicted BMD at several sites among the sons beta = 0.26-0.34, p < 0.05). In conclusion, heritability is a main determinant of the variance in BMD in young men. Based on the results we suggest that the same genetic factors may influence bone mass, lean mass and muscle strength by affecting body size. The present study also emphasizes the importance of physical activity for the development and maintenance of BMD in men.

Background Pain is an important manifestation of rheumatoid arthritis (RA) and it is imperative to find complementary options for patients experiencing pain despite antirheumatic treatment. Kaltenborn9s manual mobilization is a complementary and alternative medicine (CAM) method based on gentle traction and passive motion. It has been tested extensively in osteoarthritic joints and found to provide pain relief, but there are no published studies to date on the use of this method in RA hand joints under ultrasound (Doppler) surveillance. Objectives The aim of this pilot study was to preliminarily assess the effectiveness of the Kaltenborn manual mobilization method in reducing tenderness, pain, and Doppler activity in patients with RA. Methods A total of 110 hand joints (1 wrist, 5 MCPs & PIPs bilaterally) in 5 female patients with RA who did not respond to antirheumatic treatment were clinically examined with patient-reported outcomes (PROs) for joint swelling, tenderness, and pain (VAS). Using Kaltenborn9s technique, the MCP2-5 joints in 1 randomized hand (4/5 patients, n=20) were manually mobilized. Synovitis, tenosynovitis and disease activity were evaluated using the ultrasound Doppler quantification method. Three treatment sessions, each with two segments, were carried out every 2nd day for 1 week. Results Out of the 20 MCP joints treated in the test-hand, 75% (15/20) were self-reported as tender. Of these, 67% (10/15) were non-tender after the 3rd treatment session (1 week). In the control-hand, 60% (12/20) were self-reported as tender. Of these, 50% (6/12) were non-tender after 1 week. Both hands combined yielded highly significant reductions in self-reported tenderness (27/40 vs. 11/40, OR 5.48 [2.10, 14.28], p There was a 14.2% overall reduction in quantitative Doppler activity from the treated joints at baseline (51.5±35.7) vs. all treatment segments within the 1st and 3rd treatment sessions over 1 week (37.3±31.6) (p Conclusions An overall pattern of tenderness and pain reduction from baseline to post treatment and even among the control hand was observed, suggesting symmetry behind pain perception in RA. A strong patient-reported effect is present with pain outcomes and quantitative ultrasound helps with identifying changes in inflammation. A highly significant decrease in Doppler activity was observed. The remarkable ultrasound findings may indicate possible physiological microcirculatory changes as a result of joint mobilization therapy. These results support further studies of Kaltenborn9s manual mobilization as a relatively safe, complementary treatment option for RA patients with tender hand joints despite antirheumatic therapy. Disclosure of Interest A. Levitsky: None declared, Y. Kisten: None declared, P. Nordstrom: None declared, S. Lind: None declared, N. Vivar: None declared, R. van Vollenhoven Grant/research support from: AbbVie, BMS, GSK, Pfizer, Roche, UCB, Consultant for: AbbVie, Biotest, BMS, Crescendo, GSK, Janssen, Lilly, Merck, Pfizer, Roche, UCB, Vertex

Vitamin D receptor (VDR) polymorphism has been associated with bone mineral density (BMD), but recent data indicate association to parameters of body constitution and growth. We investigated VDR gene polymorphism, defined by BsmI and TaqI, in 90 healthy Caucasian males and any relation with parameters of body constitution at birth, and to parameters of body constitution, BMD and bone area, at age 16.9 +/- 0.3 yr (mean +/- SD) and at age 19.2 +/- 0.7. Using PCR and the restriction enzyme BsmI and TaqI, the allelic variants BB, Bb, and bb, and TT, Tt, and tt were identified. Height (cm) and weight (kg) were measured using standardized equipment, and BMD of the total body, lumbar spine, and femoral neck, and bone area (cm2) of the total body, humerus, femur was measured using dual-energy x-ray absorptiometry. BsmI and TaqI genotypes were related in 89 of the 90 cases; hence, the same associations were found for both genotypes. Boys with the BB genotype were shorter at birth (P = 0.01) and grew less from birth to age 16.9 +/- 0.3 (P = 0.01) than their Bb and bb counterparts. Both during puberty (age 16.9 +/- 0.3) and after puberty (age 19.3 +/- 0.7), the BB boys were shorter (P = 0.005-0.008) and had lower bone area of the humerus, femur, and total body (P0.05) than the Bb and bb boys. The allelic variants were not related to BMD at any site. A prediction model including parental height, birth height, birth weight, and VDR alleles could predict up to 39% of the total variation in adult height in our population. The VDR allelic variants alone contributed to 8% of the total variation.

The purpose of the present study was to investigate the influence of estrogen receptor alpha gene polymorphism and estradiol on height and bone density during and after puberty in males. Using the restriction enzymes XbaI and PvuII, the allelic variants XX, Xx, xx, PP, Pp, and pp were identified in 90 Caucasian boys 16.9+/-0.3 yr of age (mean +/- SD). Bone mineral density (BMD; g/cm2) of the total body, head, femoral neck, and lumbar spine was measured using dual-energy x-ray absorptiometry. Volumetric BMD (vBMD; mg/cm3) was estimated for the spine. The XbaI or PvuII genotypes were not related to the levels of estradiol, and the levels of estradiol were not related to BMD (P0.05). The xx allelic variant was associated with a higher spine vBMD than the Xx allelic variant (361 vs. 340 mg/cm3, P = 0.04). In a multivariate analysis including pubertal development, physical activity, and body weight, the XbaI genotype independently predicted total body BMD, head BMD, and spine vBMD (P0.05). The PvuII genotype independently predicted spine vBMD (ppPP, P = 0.01). The 20 boys with the PP allelic variant were found to have a greater body height than the other 70 boys (182 cm vs. 179 cm, P = 0.03). At a 2-yr follow-up the XbaI genotype was still independently related to total body BMD, head BMD, and spine vBMD. In conclusion, estrogen receptor gene polymorphism is related to bone density and height during late puberty and at attainment of peak bone density in young men.

The aim was to extend recent findings of suggested temperamental features in attempted suicide and to explore possible domains of vulnerability to suicide risk after attempted suicide. Fifty-four psychiatric inpatients hospitalized after a suicide attempt underwent lumbar puncture for analysis of CSF 5-HIAA concentration and also completed the Karolinska Scales of Personality (KSP) before discharge from the hospital. Suicide attempters scored high on Somatic Anxiety, Psychic Anxiety, and Muscular Tension, and low on Socialization, findings that support recent findings in suicide attempters followed up after an emergency room visit. Five patients committed early suicide, i.e., within 3 years, and the overall long-term suicide mortality after attempted suicide was 13%. There were significant correlations between survival time among early suicides and CSF 5-HIAA (r = .87; p = .054), and the following KSP scale t scores: Somatic Anxiety (r = -.96; p.05), Impulsivity ( r = -.88; p.05), and Socialization (r = 90; p.05). KSP Socialization showed correlations with CSF 5-HIAA (r = .89; p = .046) among the early suicides. Features of temperamental vulnerability to suicide risk after attempted suicide might involve anxiety proneness, impulsivity, low socialization, and low CSF 5-HIAA.

Suicide risk after attempted suicide, as predicted by cerebrospinal fluid (CSF) monoamine metabolite concentrations, was studied in a sample of 92 psychiatric mood disorder inpatients admitted shortly after attempting suicide. The potential of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the CSF to predict suicide risk within the first year after attempted suicide was studied by means of survival analysis after after median split subgrouping. Eleven patients (12%) committed suicide within 1 year after attempted suicide. Eight of these belonged to the below-the-median (87 nM) CSF 5-HIAA subgroup, that is, the suicide risk was 17% as compared with 7% among those with above-the-median CSF 5-HIAA. The cumulative number of survived patient-months during the first year after attempted suicide was significantly lower in the low CSF 5-HIAA subgroup. It was concluded that low CSF 5-HIAA predicts short-range suicide risk after attempted suicide in mood disorder psychiatric inpatients. These findings lend further support to the serotonin hypothesis of suicide risk.

Aspects of problem solving were measured in nine male psychiatric patients, hospitalized after attempted suicide. Testing took place within 3 weeks (except for one patient) of the suicide attempt. Controls were patients with chronic idiopathic pain and healthy volunteers. Suicidal patients had significantly lower scores on general intellectual tests and in verbal and design fluency. No differences in problem solving (the Perceptual Maze Test and the Wisconsin Card-Sorting Test) and flexibility (the Uses of Objects Test and the Stroop Test) were found. The results are interpreted as indicating a decreased ability of suicidal patients to generate new ideas, when no alternatives are provided.

There has been a shift of focus in suicide research toward a psychobiological approach during the last 2 decades. The reason for this is the recent emergence of two clusters of biological factors which tend to correlate with suicidal behavior. These are associated with serotonergic neurotransmission and with certain neuroendocrine functions, particularly the release of cortisol.

Suicide is a major public health problem. Birth cohort analyses in Canada (Solomon and Hellon 1980), the United States (Murphy and Wetzel 1980), Australia (Goldney and Katsikitis 1983), Austria (Vutuc and Gredler 1984), Sweden (Nordstrom and Âsgârd 1986), the Federal Republic of Germany (Hafner and Schmidtke 1985), and England and Wales (Murphy et al. 1986) have demonstrated an increase in the risk of suicide for young people, particularly for young adult males. The reasons for this shift in the age distribution of suicide mortality remain to be explored.