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Since the excess mortality rate associated with an ankle-brachial blood-pressure index (ABPI) less than 0 9 was only partly explained by an excess cardiovascular mortality, we believe that leg artery disease should not only be regarded as a marker of generalised arteriosclerosis but also as a sign associated with an increased risk of premature death. 439 men who were part of a prospective population study in Malmö, Sweden, were, at 68 years of age, invited to a health examination including, ABPI, carotid-artery ultrasonography, and 24 h ambulatory electrocardiographic monitoring. Cause- specific mortality and incidence of myocardial infarction (MI) during 8 years of follow-up was compared in men with and without signs of arteriosclerotic disease. Of 60 men with an ABPI <0·9, 20 (33%) had angina pectoris or previous Ml. Another 11 (18%) had silent ST-segment depression (≽1 mm); 3 (5%) had a history of stroke; and 17 (28%) had symptom-free carotid stenosis (>30% reduction of the cross-sectional diameter). Total mortality rate in men with no signs of arteriosclerotic disease was 19·6 per 1000 person-years and cardiac event rate (fatal and non-fatal Ml and death from chronic ischaemic heart disease was 8·6 per 1000 person-years). Leg artery disease, carotid stenosis, and ischaemic heart disease were in a univariate analysis all associated with an increased cardiac event rate and an increased total mortality rate. In a multivariate analysis an ABPI less than 0·9 was associated with a 2·4 times higher total mortality (95% Cl 1·5-3·9) and a 2·0 times higher cardiac event rate (1·1-3·9). Carotid stenosis and ischaemic heart disease contributed to the risk for Ml (RR 2 1; 95% Cl 1·2-3·8; and 2·1; 1 2-3·9, respectively), whereas no independent association with total mortality was found.

Bilateral arthrotomography was performed in 50 consecutive patients with unilateral symptoms of disc displacement to evaluate the frequency of temporomandibular joint disc displacement in asymptomatic joints. Using well-defined clinical criteria, there were no false-positive findings of either reducing or non-reducing discs. On the other hand, a risk of false-negative diagnosis of non-reducing disc was apparent. Sixty per cent of the patients had a non-reducing displaced disc in the asymptomatic joint. Most of these patients could recall a previous spell of discomfort from this joint. Severe or moderate deformation had taken place in non-reducing discs, while reducing discs were normal in shape or had, at most, a thickening of the posterior band. The duration of symptoms was significantly correlated with the degree of deformation in the symptomatic joints (P less than 0.01). Perforation was statistically, significantly correlated with disc deformation and, in symptomatic joints, hard tissue changes. Fifty-seven per cent of the asymptomatic joints with displaced discs developed pain following the onset of symptoms from the contralateral side, most within 2 years. Less than half of them were free of pain at the end of the 5 year follow-up period. In view of this tendency for an asymptomatic joint with a displaced disc to subsequently develop pain refractory to treatment, such a joint must be considered a weakened link in the craniomandibular system, vulnerable to changes in mandibular function such as, for instance, displacement of the disc on the contralateral side.

The Skaraborg Hypertension Project is a 5-year trial testing the impact of structured hypertension care implemented in half of the country, the other half serving as control. Population investigations revealed improved blood pressure control in all treated hypertensives in the study area, blood pressure reduction averaging 2-5 mmHg. The primary trial hypothesis of a possible impact on stroke incidence in the community was tested in this study. Cases of fatal and non-fatal stroke were identified from local and national mortality and morbidity registers, and diagnoses were validated against medical records. Of an initial 1169 reported cases, 1097 proved to be true stroke after validation. A statistically significant difference in stroke incidence trends (fatal and non-fatal) between the study and control populations was identified (ρ 0.0251). Improved hypertension control in the study area seems the most plausible explanation for the relative decline in stroke incidence in the study area.

The aim of this study was to describe housing standards, physical environmental barriers in the homes and housing accessibility in relation to elderly people's subjective general apprehension of their housing situation. By means of a novel instrument for home assessments, the Enabler, a rural population sample of individuals aged 75-84 years was surveyed. The results demonstrated that the respondents lived in houses with high housing standards. However, in every home assessed, physical environmental barriers were found. The environmental barrier that was predicted to cause the heaviest environmental demand of all, in relation to the prevalence of functional limitations and dependence on assistive devices for mobility in the sample investigated, was "Lack of handrails at WC/bath-tub/shower". The respondents' subjective general apprehension of their housing was very positive, and not correlated to housing accessibility. In conclusion, inaccessible housing represents a potential public health problem, since it threatens the activity level of older persons. However, other aspects of housing seem to be more important to the elderly people themselves. Housing accessibility problems are currently overlooked but are important to future public planning concerning housing for the elderly.

To support planning in habilitation/rehabilitation interventions with the mentally retarded, the IDA (Irena Daily Activity Model - the working model for day activities centre) assessment was developed as a method for a general occupational functioning assessment. This study was designed to examine the reliability and construct validity of the IDA assessment, which were evaluated in terms of interrater reliability and convergent validity. The IDA was applied in two random samples consisting of 6 patients each: 5 men and 7 women, a total of 12 attendees at two different day activity centres for people with developmental disabilities and mental retardation. Interrater reliability was measured by comparing the IDA measurements obtained by 6 raters at each unit (n = 12), who rated each subject independently on the IDA scale. Kappa as value of agreement was calculated and gave a value of k = 0.71 in the assessment of the performance areas of mobility-sensory motor components. This corresponds to a good agreement. The remaining performance domains of the IDA scale gave values of k = 0.85-0.93, which shows a very good agreement. The convergent validity of IDA assessments was tested by correlating data generated by the different approaches. The IDA occupational performance test score was correlated with Raven's Progressive Matrices Standard general cognitive ability test score, using Spearman Rho correlation coefficient calculations p = 0.86, which demonstrates a significant correlation between the two measurements. The present study demonstrated that IDA gave an overall profile of functional status and was sufficiently sensitive to detect the occupational limitations in the performance domains comprising the sensory capacity, mobility, body scheme, ADL, communication, readiness to act, and vocational skills imposed by mental retardation.

A computerized medical record system was introduced in Greek primary health care (PHC) in the village of Spili in Crete. The present study was carried out to study similarities and differences in the pattern of PHC use in Dalby Health Centre, Sweden (DHC), and Spili Health Centre, Greece (SHC).In both Dalby and Spili more than half the population contacted their respective health centre during 1989. Patients contacted DHC more often than SHC, 3.33 vs 2.30 times. Relatively more females than males used the health services in Dalby (64% vs 50%), but not in Spili (57% vs 55%). More visits were made by appointment at DHC than SHC (36.0% vs 12.6%).There were great similarities in the two areas in the ten most common diagnoses, analysed in four age-groups. In both areas, acute upper respiratory infections dominated in the youngest age-groups, and hypertension and diabetes in those aged 45 years and above.

The cross-sectional study entitled Health Profile of Skaraborg County, 1977 (HPS 77), forms part of an evaluation of a care programme for persons suffering from high blood pressure. Concurrently with the implementation of the study, epidemiological data were collected concerning the health profile of an entire county, with the aim of facilitating comparisons between the municipalities in the county. This paper describes how the study was implemented and gives an analysis of non-participation and validity.A comparison is made betwen participants and non-participants with regard to record data obtained from the National Health Insurance Fund, hospital records and the register of the Temperance Board. The non-participants differ in most respects from the participants, who have a more marked pattern of disorders in their case histories.In a longitudinal non-participants analysis, participants are compared with non-participants with respect to mortality during the following four-year period. In this study the non-participants differed, in having a higher mortality rate.The validity of the questionnaire is discussed on the basis of three different analyses. The validity varied considerably, depending on the questions studied. For example, 53% of those with myocardial infarction in the questionnaire were confirmed in hospital records. This was also true for 62 % of those with stroke and 49 % of those with angina pectoris in a follow-up interview. Medication for hypertension was confirmed in '94%. Ten of twelve participants who reported three or more symptoms of mental disorders were confirmed at interview with a physician.Studies like HPS 77 could be useful when planning preventive as well as curative measures. Thus it is important to describe not only the implementation of the study, but also its validity and the importance of non-participation for the results presented.

Empirical research elucidating the relationships between aspects of functional competence and environmental factors is lacking. This study aimed to analyse how functional limitations in the individual and housing accessibility problems influence ADL dependence in the elderly population, and to test Lawton's docility hypothesis. Data were collected from 133 Swedish subjects aged 75–84, who were living in the community. The main finding was that dependence in ADL correlated highly significantly with housing accessibility problems. The results also revealed significantly more ADL disability in the group of respondents in whom the heaviest environmental demands were identified, supporting the docility hypothesis. Although the study had limitations because the data required the use of non‐parametric statistics, so restricting possible interpretations of the effects of geriatric comorbidity, the results indicated that interventions such as housing adaptations ought to be most effective with frail individuals. To promote independence in the general population, society has to work towards more accessible housing. More research is needed considering more environmental dimensions and elderly people's subjective apprehension of their housing environment. Copyright © 1998 Whurr Publishers Ltd.

The objective of this study was to determine whether there is an association of all-cause mortality with different aspects of social network, social support, and social influence. The study sample (n = 621) was a random half of all male residents of Malmö, Sweden, born in 1914, of whom 500 (80.5%) were interviewed and examined in 1982-1983. On the basis of a model with carefully defined and well-differentiated concepts integrated in a theoretic framework of social resources, an instrument was developed to measure different aspects of social network, social support, and social influence. During the follow-up period from September 1982 to November 1987, 67 (13.4%) of the 500 participants died. In univariate analysis, a higher mortality risk was found among men with low availability of emotional support and low adequacy of social participation and among men living alone (crude relative risk = 2.3, 2.3, and 1.7, respectively). These relative mortality risks changed little after adjustments for social class, health status at baseline, cardiovascular risk factors, alcohol intake, physical activity, and body mass index in the multivariate analysis (adjusted relative mortality risk = 2.5, 2.2, and 2.0 for men with low availability of social support and low adequacy of social participation and for men living alone, respectively). These findings are consistent with the existence of a general effect of social network and social support on mortality among elderly men.

Rheological properties of styrene-butadiene-styrene polymer (SBS) modified bitumens were studied using conventional test methods (penetration, softening point, kinematic viscosity and Fraass breaking point) and dynamic mechanical analysis (DMA). The study indicated that SBS modification improved the viscoelastic properties of bitumens, which can be demonstrated using DMA but not conventional methods. Significantly improved properties of binders included increased dynamic mechanical moduli and decreased phase angle at high temperatures, as well as reduced complex modulus and increased phase angle at low temperatures. SBS modification also caused reductions in glass transition temperature, Fraass breaking point, and temperature susceptibility. The degree of improvement was observed to be influenced by bitumen source/grade and polymer content/structure. Comparison showed that certain relationships exist between parameters obtained using conventional methods and DMA, such as between penetration and complex modulus, kinematic viscosity and complex viscosity, and Fraass breaking point and glass transition temperature. However, the main conclusion of the study is that conventional test parameters such as penetration and softening point are not suitable for characterization of rheological properties of SBS modified bitumens.

The ADL Staircase is a hierarchical instrument for assessment of independence/dependence in personal and instrumental activities of daily living (P-ADL and I-ADL). Its development was based on Katz's ADL-Index, applying the same assessment principles. The cumulativity among the items has previously been confirmed in Swedish urban elderly population samples. The purpose of this study was to test the instrument in a rural setting. Due to local environmental conditions, the authors developed alternative definitions for the “transportation” item. Data collected using 133 respondents suggested a different cumulative order among the I-ADL items from that identified in urban samples, and significant gender differences were found. The scale's cumulativity was analysed in-depth, and it revealed different results depending on which scaling analyses were used. Environmental factors highlighted the methodological difficulties inherent in I-ADL assessments, and the results revealed a higher prevalence of disability compared to previous gerontological studies. In clinical practice, awareness of the consequences of I-ADL assessments' limited generalizability between settings is strongly recommended. The study also has theoretical implications for further understanding of the complexity of disablement.

Salivary calculi are a common disorder in the submandibular gland duct system, but the etiology and pathogenesis of the concrements remain unclear. Ten submandibular gland calculi were examined in a scanning electron microscope after critical-point drying, fracturing, and gold coating. The surface of the calculi was built up of numerous knobs covered by a smooth and occasionally filamentous substance, probably of mucinous origin. Microorganisms were commonly found at the surface. The nuclei of the calculi, which were rather homogeneous, were surrounded by lamellated structures. Between the lamellae spheroid bodies, 20-100 μm in diameter, were present. These spheroid bodies are probably of mucinous origin, which together with an amorphous granulated substance builds up the matrix. Microorganism-like structures occasionally appeared at the interface between lamellae. Microorganisms can be an important factor by providing an organic matrix in the later phase of the pathogenesis of salivary calculi. However, the nuclei did not show morphological evidence of any particular factor explaining the etiology of salivary calculus.

With the aid of scanning electron microscopy and microradiography, 45 teeth including 20 contralateral tooth pairs were studied to assess the effect on human dentine of (1) a 1 minute treatment with 3% NaF, (2) a dressing of Ca(OH)2 and (3) a dressing of Ca(OH)2 and CaPO3 F after follow-up periods of 2-8 weeks. After NaF treatment the SEM revealed no sign of obliteration of the dentinal tubules, and on microradiograms no indication of increased density could be registered compared to an untreated control area. Under the calcium dressing the SEM revealed in 13 cases out of 20 (5 cases of 11 intrapair comparisons) a varying degree of constriction of the dentinal tubules. Constrictions varied from one tubule to another and ceased approximately 0.1 mm in the dentine. On the microradiograms no significant difference could be registered between untreated dentine and dentine treated with the calcium dressings. Dressings of Ca(OH)2, a combination of Ca(OH). and CaPO3F for 2 months, or a 1 minute treatment with a cavity cleaner containing 3% NaF can thus not be considered to result in a reliable obliteration of the dentinal tubules.

OBJECTIVE--To identify factors that affect physicians' choice of specific antidepressant drugs in order to evaluate the validity of epidemiological studies of the risks (particularly suicide) and benefits of different compounds. DESIGN--Questionnaire survey of 264 psychiatrists and general practitioners in an urban area and a rural area of Sweden with validation of data by independent prescription surveys. SETTING--Urban area of greater Stockholm and rural county of Jämtland, Sweden. SUBJECTS--228 physicians (86%) who answered the questionnaire. MAIN OUTCOME MEASURES--The drugs used as first line drugs of choice, as drugs of choice in particularly severe depression, and as drugs of choice for disorders other than depression. RESULTS--Amitriptyline was the most common first line drug of choice among both psychiatrists and general practitioners. The patterns of choice of antidepressants in the two areas accorded with prescribing patterns in two independent prescription surveys. Amitriptyline was chosen even more frequently for severe depression and depression with severe insomnia. Clomipramine was chosen comparatively more often for depression with severe anxiety. Low toxicity compounds (mainly lofepramine, mianserin, and moclobemide) were more often the drug of choice in depression associated with overt risk of suicide. Amitriptyline and clomipramine were used extensively for disorders other than depression (40% and 54% of prescriptions, compared with 13-19% for some other major antidepressants). CONCLUSION--Patient groups treated with different antidepressant compounds may not be comparable with respect to diagnoses and severity of disease. In particular, lofepramine, mianserin, and moclobemide, and possibly amitriptyline, seem to be chosen more often for patients prone to suicide.

Female back pain is a clinical problem-especially low back pain with symptoms from the pelvic posterior region-that is often aggravated in connection with pregnancy and childbirth. Hormones have been suggested as an aetiologic factor. This study is aimed to determine whether additional hormone preparations, i.e. oral contraceptives (OC), may contribute to the increased frequency of such pain.

A method is described by which the acid secretion of the stomach is maintained at a high level for 11 hours by repeated large doses of histalog subcutaneously injected. In this investigation, two groups of cases, with one untreated, the other treated, with a perorally administered anti-cholinergic, it was possible to study the duration of the drug. The anticholinergic investigated was oxyphencyclimine HCl (Daricol®). The mean duration of 10 mg (1 tablet) was in 8 duodenal ulcer patients at least 6 hours, and of 20 mg (2 tablets) given to 5 duodenal ulcer patients at least 11 hours. The long duration of both 10 mg and 20 mg of oxyphencyclimine should facilitate the adjustment of the optimal effective dose (OED), which might be important in the treatment of hypersecretion in cases of duodenal ulcer.

Observations in the course of music therapy as well as informal reports by relatives and other caregivers indicate that music constitutes a significant category of experience for people with Rett syndrome, despite the severe cognitive, communicative and social disability produced by this neurological developmental disorder. Since there is a lack of systematic information about the role of music in the lives of persons with Rett syndrome, we have conducted a questionnaire survey of primary caregivers of people with Rett syndrome in Sweden. The results reported here confirm that music appears to hold significance for people with Rett syndrome, as revealed by their responsiveness to music and their possession of musical favourites reported by primary caregivers. Music, a cognitively complex product of human culture, may thus provide a window on the cognitive capacities of these severely afflicted persons, and should be featured in all efforts to enrich the quality of their lives.

Aim. The aim of the study was to examine the dosimetric effect of rectal retraction, using a rectal retractor, by performing a comparative treatment planning study. Material and Methods. Treatment plans using volumetric arc therapy (VMAT) were produced for ten patients both with and without rectal retraction. A hypofractionation scheme of 42.7 Gy in seven fractions was used. The dose to the rectal wall was evaluated for both methods (with and without retraction) using four dose-volume criteria: V40.1 Gy, V38.3 Gy, V36.5 Gy, and V32.6 Gy. Results. The retraction of the rectal wall increased the distance between the rectal wall and the prostate. The rectal wall volume was reduced to zero for all dose-volume values except for V32.6 Gy, which was 0.2 cm3 in average when the rectal retractor was used. Conclusion. There was a significant decrease of V40.1 Gy, V38.3 Gy, V36.5 Gy, and V32.6 Gy when the rectal retractor was used without compromising the dose coverage of planning target volume (PTV).

A research project in primary health care has been in progress since 1988 in an agricultural area of Crete, with the aim of surveying the cardiovascular risk profile and following the incidence of cardiovascular disease in the population over time. In the present paper we have investigated the mortality rates and the causes of death in 1989 and 1990 of the population of the Agios Vassilios county (n = 7758). Furthermore, whenever possible, we have checked the accuracy of the certified causes of death against the case record system introduced in 1988 in the health centre. During 1989 and 1990, 267 subjects died in the research area, 234 of whom were >65 years old. Diseases of the circulatory system (mostly congestive heart failure) accounted for 46% of all deaths. The corresponding figure for neoplasms was 18%. The standardized mortality from ischaemic heart disease was found to be very low in both men and women, 37.9 and 41.9 per 100 000 per year, respectively, in comparison with that of Greece as a whole in 1989, 140.0 and 59.5, respectively. These figures were considerably lower than those reported in 1988 from for example Sweden, 303.6 and 153.3, respectively. The standardized mortality from cerebrovascular disease in Agios Vassilios county was found to be somewhat lower than the national figures in 1989, 118.1 and 107.0 in males and females versus 135.7 and 142.1, respectively. In our analyses we did not find any under- representation of deaths in circulatory diseases when the death certificates were checked against the available information in the case record system at the health centre, in those patients where this type of in formation was available (n = 128, 48%). In conclusion, the mortality from ischaemic heart disease still seems to be low in Cretans, as previous reports have shown. An upward trend may, however, be expected in the future, maybe as a result of the change in lifestyle now taking place in Crete. The longitudinal observation of the mortality of the Agios Vassilios population is expected to elucidate this further in the future.