Keith Meredith

The relationship between muscle mass and muscle strength in the elderly.

To determine the extent that muscle mass is predictive of muscle strength in the elderly, anthropomorphic estimates of muscle area and impedance measurements of muscle mass and peak isometric muscle strength were obtained in a relatively healthy older population over 65 years of age (mean age = 71.7; n = 218). Midarm muscle area correlated strongly with upper arm strength (r = 0.68, P < 0.0001) while midthigh muscle area had a much lower correlation with thigh muscle strength (r = 0.29, P < 0.0001). These muscle area calculations also include bone area. Lean body mass calculated by bioelectric impedance correlated highly with cumulative muscle strength measured by summing all muscle groups (r = 0.79, P < 0.0001). To determine whether aging alters muscle strength per unit of muscle mass, additional middle‐aged subjects were included, and three groups, middle‐aged (55–64) (n = 78), young‐old (65–74) (n = 161), and old‐old (75+) (n = 57), were compared. A significant age‐related trend of decreasing muscle strength per unit of lean body mass was noted. It is concluded that although muscle mass correlates with muscle strength in a healthy older population, use of simple age‐independent clinical measurements of body mass should not be used to predict muscle strength.

Nature and vocational significance of neuropsychological impairment associated with HIV infection

Abstract Research is described that addresses the nature and consequences of neuropsychological (NP) impairment associated with HIV infection. Results suggest increasing rates of NP impairment at each successive stage of infection (asymptomatic, mildly symptomatic, AIDS). NP deficits are related to independent evidence of abnormal brain structure and function, and are not explained by medical or psychiatric confounds. The NP impairment is “spotty” across infected persons, but is most frequently observed on tests of attention/speed of information processing and learning efficiency. Clinical and research assessments of HIV infected persons should especially focus on putative “subcortical” abilities, but maximum sensitivity requires coverage of multiple ability domains. NP impairment in this population also is associated with increased unemployment, complaints of job performance difficulties, and worse performance on standardized work samples. Interference with vocational functioning and general life quality...

Serum Levels of Tumor Necrosis Factor and IL-1α and IL-1β in Diabetic Patients

Objective To determine whether chronic hyperglycemia causes increased levels of serum tumor necrosis factor (TNF) and interleukin 1 α (IL-1 α) and IL-1 β. Research Design and Methods Sera were obtained from 59 diabetic patients, 44 chronically ill nondiabetic patients, and 34 age-matched healthy control subjects. Mononuclear cells were isolated from a subgroup of diabetic patients and healthy control subjects. Results Except for a modest increase in the prevalence of detectable serum TNF levels in diabetic patients, the serum cytokines measured in this study did not appear to be altered in diabetes. In vitro TNF production by mononuclear cells was not altered in diabetic patients. However, in vitro IL-1 β secretion, in response to lipopolysaccharides, was reduced. Conclusions Diabetes mellitus is not associated with significant changes in serum levels of TNF, IL-1 α, or IL-1 β. In vitro secretion of IL-1 β in response to lipopolysaccharides may be reduced in diabetes.

Family dynamics and emotional expression among patients with chronic pain and depression

&NA; Exploration of the relative roles of family dynamics and release of constrained, negative emotion in changing pain and depressive symptoms. Eighteen patients presenting mild to moderate depression and diagnoses of psychogenic pain disorder were randomly assigned to 1 of 2 treatment groups. One group was designed to facilitate the release of constrained and overcontrolled negative affect while the other was designed to provide information about pain and depression. Findings suggest that initial incongruity between patients and significant others ratings of family relationships retard changes in pain status and depressive symptoms. No significant differences were noted between patients who were taught to express negative feelings and those who were taught simply to understand those feelings. Results are discussed in terms of theories about family dynamics in the initiation and maintenance of pain conditions and in terms of the role of constrained affect as a precursor to both psychogenic pain and depression.

Diabetes-related changes in the protein composition of rat cerebral microvessels

To determine the effect of diabetes mellitus on cerebral microvessel protein composition, post translational modification of proteins with glucose and malondialdehyde (MDA) was determined and the abundant protein species found in cerebral microvessels isolated from control and streptozotocin-induced diabetic rats were studied. Two dimensional gel electrophoresis and computer assisted densitometry revealed that only one out of 25 quantitated proteins was significantly altered in diabetic rats after 5 weeks of uncontrolled hyperglycemia. The level of glycosylation of cerebral microvessel protein mixture was significantly increased in diabetic rats compared to control rats (168.8±25 vs 109.5±4.8 nmol/mg) (p<0.05). Western blot analysis of cerebral microvessel proteins from diabetic rats using a specific antibody against MDA-modified proteins revealed three protein spots with molecular weights of approximately 60,000 Kd. These were shown not to be contaminants from cerebral tissue or plasma proteins modified with MDA. It is concluded that short duration of streptozotocin-induced diabetes mellitus in rats is associated with some qualitative changes in protein composition of cerebral microvessels. These changes may contribute to the diabetes-related alterations in the blood-brain barrier.

Effects of therapeutically induced affect arousal on depressive symptoms, pain and beta-endorphins among rheumatoid arthritis patients

&NA; The relationship among therapeutically induced affective arousal, depressive symptoms, pain and &bgr;‐endorphin levels were explored on 6 patients with chronic, active rheumatoid arthritis. An ABA, n of 1 study methodology was utilized, replicated 5 times. This procedure allowed the analysis of individualized changes across time in response to the therapeutic regimen. The results indicated that the treatment regimen activated the &bgr;‐endorphin system, particularly during the early and late phases of treatment. However, &bgr;‐endorphin response had little effect on reports of subjective pain. Depressive symptoms were affected positively by the treatment but were not strongly correlated to the &bgr;‐endorphin response. The results suggest that pain and depression represent independent systems and that &bgr;‐endorphin levels serve more as stress markers than analgesics in chronic, organic pain.

HEALTH‐PEERS: A DELIVERY MODEL FOR HEALTH PROMOTION AMONG THE ELDERLY

A health promotion delivery system using a peer leadership and social networking model was pilot tested in an elderly population. Participants were recruited from a volunteer organization and from a health promotion project. Lessons on fiber intake, dietary change, and peer leadership were presented in a small group setting. Those who qualified as peer leaders recruited a second generation of participants and taught them in the same manner. The pilot study determined that this model was feasible, showing an average increase in specific nutrition knowledge of 52.3%, and that peer leaders could be recruited and trained effectively. Recommendations for recruitment and training of peer leaders and for design of program content are discussed.

The interrelationship between physical exercise, muscle strength and body adiposity in a healthy elderly population.

Objective: To determine the relationship between habitual physical exercise and body adiposity in a healthy elderly population.

Pressure-Equalization (PE) Tubes in Treatment of Otitis Media: National Survey of Otolaryngologists

This study was designed to describe those indicators for the insertion of pressure-equalization (PE) tubes given highest priority by board-certified otolaryngologists. An original questionnaire was mailed to 1000 board-certified otolaryngologists practicing in the United States. The respondents rated the relative importance of 22 indicators on a 6-point scale. These indicators were grouped into four categories: Medical History, Physical Examination, Audiologic Evaluation, and Related Indicators. With a return rate of 52.7%, approximately 1 of every 9 board-certified, practicing otolaryngologists in the United States was represented in the study. The five indicators with the highest ratings were: “persistence of fluid for 3 or more months per episode,” “presence of speech-language delay,” “presence of bilateral conductive hearing loss of 20 dB or more,” “total number of episodes of otitis media,” and “lack of response to suppressive antibiotic therapy.” Additional analyses of the data yielded information regarding characteristics of the responding physicians and the self-generated indicators.

PENICILLAMINE TREATMENT IN HEMATHROSIS-INDUCED CHRONIC ARTHRITIS

Current medical management for established hemophilic arthritis is unsatisfactory and does not modify the eventual outcome. D-Penicillamine (PEN), an anti-inflammatory drug effective in rheumatoid arthritis, has not been evaluated in hemarthroses-induced joint disease. 83 NZ white rabbits had weekly intra-articular injections of citrated autologous blood (right knee) and citrated saline (left knee) for 6 months. PEN 15 mg or 50 mg/kg/da, IM, was begun early (day 1) or late (at 8 wks). Controls were saline treated rabbits. The animals were killed at 6 mo. Analysis included joint fluid WBC counts, gross and histologic examination of the synovia (acute and chronic inflammatory cells, synovial hyperplasia, and iron deposition). The saline-injected knees showed no inflammatory change and the blood-injected knees had iron deposition in all animal groups. The early high and low dose, and late low dose PEN treated groups showed no difference from untreated animals. Late high dose PEN treatment showed marked suppression of the synovitis. Four hemophiliacs with synovitis were given PEN, 5-10 mg/kg/da, p.o. for>2 months. All have had significant reduction in the synovial thickening with concurrent increased range-of-motion and decreased number of bleeds into the affected joint. These studies suggest that PEN is beneficial in the chronic arthritis induced by hemarthroses. Its anti-inflammatory mechanism is not known but may be inhibiting free radical formation, not by removing iron by its chelating ability.