AbstractThis article presents the relevance of norm values to a battery of Quality of Life questionnaires for use in upper gastrointestinal disorders. The derivation of reference values offers an important contribution by confirming the ability of the questionnaires to differentiate patients from healthy controls. Two self-administered questionnaires, the Psychological General Well-being (PGWB) index and the Gastrointestinal Symptom Rating Scale (GSRS) were used. The norm values were derived in a randomly selected sample from a Swedish population consisting of 4624 individuals (reference group). The patients comprised more than 900 patients with gastroesophageal reflux disease (GORD) included in clinical trials. In the reference group, males reported significantly higher values on well-being as compared with women, whereas women reported more pronounced gastrointestinal symptoms than men. Generally, the younger persons and the group aged 60–70 years reported the highest well-being. Among gastrointestinal patients women scored lower and reported more symptoms than men. With increasing age, well-being improved and symptoms declined. Even though the well-being and symptoms scores differed between patient and the reference group similar patterns in terms of age and gender were observed. In summary, the results show that there are differences with respect to gender and age among normal controls as well as in GORD patients. These aspects have to be considered in clinical studies. The results also support the discriminative ability of the Quality of Life instruments.Key Words: Quality of Lifemethodologygastrointestinal symptomspsychometric documentationreference values
The prevalence of disability pensions was investigated among 5 birthyear cohorts (1926–30) of male residents in Malmö, Sweden (N=7,697). They were invited to a screening programme in the mid-1970s. Disability pension and mortality data were identified from national computerized databases. At the end of follow-up (the calendar year of their 58th birthday), 1,391 (18%) had been granted a disability pension and 655 (9%) had died. The most frequent causes for disability pension, accounting for 74% of the cases, were musculoskeletal diseases, mental disorders (including alcohol dependence) and diseases of the circulatory system. Alcohol dependence was more common among those who refrained from participating in the screening programme, while musculoskeletal and neurological diseases were more common among those who did participate. Mental disorders (including alcohol dependence) predominated in younger and musculoskeletal diseases in older age groups. Both alcohol dependence and non-participation in health screening were related to the risk of a disability pension. To be used for identifying subjects at risk for disability pension, health screenings should be designed to reach as many of the usual non-participants as possible and should be targeted at men in younger ages.
Background The study was designed to determine whether a 1-year hospital-based secondary prevention programme would have any long-term effects on serum lipid levels and the use of lipid-lowering drugs in patients with coronary artery disease 4 years after referral to primary care facilities for follow-up. Design/methods After acute myocardial infarction or coronary bypass surgery, 241 consecutive patients were randomly assigned to conventional care (CC) by the primary health care facilities or to a 1-year hospital-based secondary prevention programme (SPP) with target levels for serum cholesterol (< 5.2 mmol/l) and triglycerides (< 1.5 mmol/l). After 1 year all patients were referred to the primary care sector for a further 4-year follow-up. Results At the 1-year follow-up there was a significant decrease in serum cholesterol, LDL-cholesterol and triglyceride levels in the SPP group but no change in the CC group, and lipid-lowering drugs were used more frequently in the SPP group. These changes were maintained after 5 years. The proportion of patients achieving target serum cholesterol and triglyceride levels were larger in the SPP group. Conclusions Initiatives regarding cholesterol lowering and drug treatment taken by specialists within a structured hospital-based SPP have long-term impact. Accordingly, drug treatment should be initiated and adjusted to adequate doses before patients are referred to primary care for follow-up.
To evaluate ultrasonographically determined intima-media thickness as a measure of early atherosclerosis, three studies were performed. Ultrasound measurements of intima-media thickness in the carotid artery were directly validated by comparing the same thickness measured by light microscopy. The values were closely correlated (r = .82, P < .001). Intima-media thickness determined by light microscopy was consistently smaller than that determined by ultrasound, probably due to shrinkage during histological preparation. As an indirect validation, mean intima-media thickness was calculated in three large groups of patients with no plaque (n = 224), one plaque (n = 105), and one circumferential or two or more plaques (n = 54) in the carotid bifurcation. Intima-media thickness increased significantly with increasing plaque score, indicating that diffuse intima-media thickening is more pronounced with more severe atherosclerosis. The intima-media thickness also increased with increasing multifactorial cardiovascular risk, reflecting a positive relation between signs of early atherosclerosis and the burden of known risk factors for the disease. Our studies support earlier findings that have found that ultrasonographically determined intima-media thickness is a valid way to study early atherosclerosis.
Abstract. Objectives. Hyperhomocysteinaemia is an independent risk factor for cardiovascular disease. We explored possible determinants of plasma homocysteine and cysteine concentrations amongst middle‐aged and elderly subjects. Design and subjects. Of 501 35–95‐year‐old randomly selected residents of Lund and Malmö, Sweden, 244 (49%; 131 men, 113 women) were investigated. Results. Total plasma homocysteine concentrations were higher in men than in women (mean ± SD: 13.9 ± 4.1 and 12.3 ± 4.1 μmol L −1 ; P < 0.001), increased markedly with age (Spearman's p = 0.488; P < 0.001), and were correlated ( P < 0.001) to concentrations of blood folate, serum vitamin B 12 , and serum creatine (p = −0.366, −0.338, and 0.463). Users of multivitamins had lower homocysteine levels than nonusers [10.5 ± 3.3 μmol L −1 (n = 31) and 13.5 ± 4.2 μmol L −1 (n = 213), respectively; P < 0.001]. Total plasma cysteine concentrations also increased significantly with age and increasing serum creatinine, but were unrelated to gender, blood folate, serum vitamin B 12 and use of multivitamins. Conclusions. Age, gender, folate, serum vitamin B 12 , serum creatinine and multivitamin usage are all important determinants of the plasma homocysteine concentration, whereas only age and serum creatinine are determinants of the plasma cysteine concentration. The age‐related increase in homocysteine and cysteine may be linked to the age‐related impairment of renal function, whereas the sex difference in plasma homocysteine may be because of the fact that more homocysteine is formed in men than in women in conjunction with creatine‐creatinine synthesis.
With an improved highly reproducible method, we measured total plasma homocysteine (free plus protein-bound) and related amino acids in the fasting state in healthy subjects, before and after treatment with co-factors for homocysteine metabolism: 1 mg cyanocobalamin (n=14), 5 mg folic acid (n=13) or 40 mg pyridoxine hydrochloride (n=15) daily for 14 days. Cyanocobalamin and pyridoxine hydrochloride had no effects on plasma levels of amino acids, but folic acid had a considerable homocysteine-lowering effect. Total plasma homocysteine was reduced in all but two subjects, from 19.9±4.4 (mean±SEM) to 9.5±1.0 μmol/l (-52%, p<0.01). We propose that folic acid in excess acts by enhancing the remethylation of homocysteine to methionine. The finding confirms a previous report by us. Since homocysteine is considered to be an atherogenic amino acid and recent reports suggest that mild to moderate homocysteinaemia is also associated with premature vascular disease, treatment with folic acid might be of use as prophylaxis.
Sleep disordered breathing (SDB) including obstructive and central sleep apnoea/hypopnoea as well as periodic breathing (PB) is common and is believed to increase risk for mortality in patients with congestive heart failure (CHF). Mandibular advancement device (MAD) has widely been recommended for treatment of obstructive sleep apnoea but the method has never been investigated for treatment of SDB in the patients with CHF. The aim with the present study was to examine the effect of MAD intervention on SDB in patients with CHF. The study included 17 male patients, aged 68.4+/-5.7 (mean+/-SD) with stable, mild to moderate CHF due to left ventricular systolic dysfunction and with SDB, expressed as apnoea/hypopnoea index (AHI) > or = 10. The SDB was examined during a single night using an unattended, portable polysomnographic device in the patients home, prior to and following intervention with a individually adjusted MAD. The SDB was evaluated by calculating AHI, PB expressed as the percentage of the total registration time, oxygen desaturation index (ODI) and snoring time. The AHI was reduced by MAD intervention from 25.1+/-9.4 to 14.7+/-9.7 (p=0.003). ODI reduced from 21.1+/-9.0 to 10.5+/-7.8 (p=0.007) and snoring time decreased from 53+/-111 to 18+/-47 seconds (p=0.02). PB was reduced from 55.7+/-25.6 to 40.4+/-26.4 per cent without statistical significance. In conclusion, the MAD intervention may be a feasible method for reducing SDB in patients with stable, mild to moderate CHF and left ventricular systolic dysfunction.
