bluuebunny/crossref_metadata_2025 huggingface dataset:
Autonomy and intellectual disability: the case of prevention of obesity in Prader–Willi syndrome
Authors: Hooren R. H. van , Widdershoven G. A. M. , Borne H. W. van den , Curfs L. M. G.
Published: March 2003

Background

The policy concerning care for people with intellectual disability (ID) has developed from segregation via normalization towards integration and autonomy. Today, people with ID are seen as citizens who need to be supported to achieve a normal role in society. The aim of care is to optimize quality of life and promote self‐determination. The promotion of autonomy for people with ID is not easy and gives rise to ethical dilemmas. Caregivers are regularly confronted with situations in which there is a conflict between providing good care and respecting the client's autonomy. This becomes evident in the case of prevention of obesity in people with Prader–Willi syndrome (PWS).

Method

As part of a study about the ethical aspects of the prevention of obesity, in‐depth qualitative interviews were conducted with the parents and professional caregivers of people with PWS.

Results

In analysing interviews with parents and formal caregivers, the present authors found that the dichotomy between respecting autonomy and securing freedom of choice on the one hand, and paternalism on the other, is too crude to do justice to the process of care. The stories indicated that caregivers see other options and act in other ways than to intervene without taking into account the wishes of the individual with PWS. The present authors elaborated these options, taking models of the physician–patient relationship as a heuristic starting point. They extended the logic of these models by focusing on the character of the process of interaction between caregiver and care receiver, and on the emotional aspects of the interactions.

Conclusion

This approach results in more attention to processes of interpretation, deliberation and joint learning.
Maladaptive behaviour in children and adolescents with Down's syndrome
Authors: Dykens E. M. , Shah B. , Sagun J. , Beck T. , King B. H.
Published: March 2003

Background

Although children with Down's syndrome (DS) are at lower risk for psychopathology than others with intellectual disability, they do show more problems than typically developing children. However, age‐related trends in these problems remain unclear.

Methods

The present authors examined age‐related changes in the maladaptive behaviours of 211 children and adolescents with DS aged between 4 and 19 years (mean = 9.74 years). Most participants (n = 180) were recruited from families residing in the greater Los Angeles area, California, USA, while a minority (n = 31) were patients from a clinic specializing in the psychiatric management of people with DS. The participants were divided into four age groups: (1) 4–6 years, (2) 7–9 years, (3) 10–13 years and (4) 14–19 years.

Results

Externalizing behaviours were lower across both the community and clinic samples, while internalizing behaviours were significantly higher in older adolescents aged between 14 and 19 years. Increases were found in withdrawal, seen in 63% of community‐based adolescents, and 75% of clinic adolescents.

Conclusions

Older adolescents with DS may show decreased externalizing symptoms and subtle increases in withdrawal. Possible relationships are discussed between these shifts and increased risks of later‐onset depression and Alzheimer's disease in adults with DS.
A pilot study of the reliability and validity of the Caregiver Activity Survey – Intellectual Disability (CAS‐ID)
Authors: McCarron M. , Gill M. , Lawlor B. , Beagly C.
Published: March 2003

Background People with Down's syndrome (DS) are at increased risk of Alzheimer‐type dementia (AD) when compared to the general population. Despite AD being a serious progressive disorder, little attention has been paid to the impact of the illness on formal caregivers. In the general population, the Caregiver Activity Survey (CAS) is used to measure time spent by family caregivers assisting people with AD in their day‐to‐day activities of living. In order to plan appropriate models of health and social care effectively for people with AD and DS, it is imperative that the care requirements of individuals at different stages of dementia are realized. An amended version of this survey, the Caregiver Activity Survey – Intellectual Disability (CAS‐ID), was developed and tested for use by professional caregivers in the present study.

Methods The CAS‐ID was administered to 30 people with DS and their caregivers. Convergent validity was tested by comparing the results of the CAS‐ID to other validated tests for cognitive and functional impairment in individuals with DS. Test–retest and inter‐rater reliability were investigated.

Results The final version of the CAS‐ID consists of eight items: dressing, bathing/showering, grooming, toileting, eating and drinking, housekeeping, nursing care‐related activities, and supervision/ behaviour management. The scale had excellent test–retest reliability, and correlated strongly with the Down Syndrome Mental Status Examination (DSMSE; r = −0.770), the Test for Severe Impairment (TSI; r = −0.881) and the Daily Living Skills Questionnaire (DLSQ; r = −0.855).

Conclusions The present authors provide preliminary evidence for the validity and reliability of the CAS‐ID. This instrument offers a means of identifying and measuring care and resources requirements as this population experiences symptoms of dementia. Such information may help assist healthcare professionals in planning supports and services to address the care challenges evidenced at different stages of the disease process.
A comparative study of mastery motivation in young children with Down's syndrome: similar outcomes, different processes?
Authors: Gilmore L. , Cuskelly M. , Hayes A.
Published: March 2003

Background  Findings from previous research into motivation in young children with Down's syndrome (DS) have been mixed. Some studies have suggested that development is merely delayed, while others have proposed that there are inherent differences or deficits. Using the mastery motivation paradigm, studies of young children have often found that those with DS are just as persistent and goal‐directed as typically developing children of the same mental age (MA). However, research involving children with DS with MAs above 2 years is very limited. The major aim of the present study was to extend previous research by focusing on children with MAs between 24 and 36 months. A secondary aim was to investigate issues which would advance conceptual knowledge about the construct of mastery motivation.

Method  The participants were 25 children with DS and 43 typically developing children, matched for MA (24–36 months). The main measures of mastery motivation were persistence with structured mastery tasks (i.e. puzzles and shape‐sorters) and maternal reports.

Results  With the challenging tasks, children with DS were just as persistent as the typically developing children. Correlations of persistence measures in the group with DS suggested that persistence for these children represented a more generalized approach rather than a task‐specific response. Maternal ratings of persistence were lower in the group with DS.

Conclusions  The main conclusion was that children with DS in the MA range of 24–36 months do not differ in their persistence with challenging tasks when compared with typically developing children of the same MA. The implication is that motivational development is delayed for children with DS, rather than deficient. However, there were some indications of possible differences in the processes underlying mastery behaviour in the two groups. The study addresses a number of conceptual and methodological issues associated with mastery motivation research, and stresses the important contribution that future longitudinal studies could make.
Salbutamol inhalation has no effect on myocardial ischaemia, arrhythmias and heart‐rate variability in patients with coronary artery disease plus asthma or chronic obstructive pulmonary disease
Authors: Rossinen  , Partanen  , Stenius‐Aarniala  , Nieminen
Published: March 2003

Rossinen J, Partanen J, Stenius‐Aarniala B, Nieminen MS (Helsinki University Central Hospital, Helsinki, Finland). Salbutamol inhalation has no effect on myocardial ischaemia, arrhythmias and heart‐rate variability in patients with coronary artery disease plus asthma or chronic obstructive pulmonary disease. J Intern Med 1998; 243: 361–66.

Objectives

Inhaled beta‐2 agonists raise heart rate, systolic blood pressure and contractility, all of which cause an increase in oxygen consumption of the heart. We performed a study on the influ‐ ence of inhaled salbutamol on myocardial ischa‐emia, rhythm, and heart rate variability as assessed by Holter monitoring of 24 patients with coronary artery disease (CAD) and clinically stable asthma or chronic obstructive pulmonary disease (COPD).

Design

In hospital the patients received 0.2 mg (hour 1), 0.4 mg (hour 6), 0.8 mg (hour 13) of salbutamol with a metered‐dose inhaler and a spacer, and 5 mg (hour 25) with a nebulizer; symptoms, peak expiratory flow (PEF), 30‐h Holter monitoring, and blood pressure (BP) were recorded. The study parameters were compared for the hour preceding and following each dose of salbutamol.

Results

No cardiac symptoms were associated with salbutamol inhalation. PEF increased after all doses (P < 0.005). A dose of 0.2 mg salbutamol induced no changes in heart rate, whereas dose of 0.4 mg increased heart rate from a mean of 75 ± 13 to 79 ± 14 beats min−1 (P < 0.005), and a dose of 0.8 mg from 76 ± 14 to 78 ± 15 beats min−1 (P < 0.05). No changes in systolic BP appeared after any dose of salbutamol. The diastolic BP was lowered after 0.8 mg of salbutamol from 86 ± 12 to 82 ± 10 mmHg (P < 0.05). The 5 mg of nebulized drug provoked no significant changes in heart rate or BP. Myocardial ischaemia, heart rate variability and ventricular arrhythmias remained unaltered with all doses.

Conclusions

The commonly used doses of inhaled or nebulized salbutamol induced no acute myocardial ischaemia, arrhythmias or changes in heart rate variability in patients with CAD and clinically stable asthma or COPD.
Factors associated with pre‐hospital and in‐hospital delay time in acute myocardial infarction: a 6‐year experience
Authors: Berglin Blohm  , Hartford  , Karlsson  , Herlitz
Published: March 2003

Berglin Blohm M, Hartford M, Karlsson T, Herlitz J (Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden). Factors associated with pre‐hospital and in‐hospital delay time in acute myocardial infarction: a 6‐year experience. J Intern Med 1998; 243: 243–50.

Objectives

To explore factors associated with delay time prior to hospital admission and in hospital amongst acute myocardial infarction (AMI) patients with particular emphasis on the delay time to the administration of thrombolytic therapy.

Methods

During a 6‐year period we prospectively computerized pre‐hospital and in‐hospital time intervals for AMI patients admitted to the coronary care unit (CCU) direct from the emergency department (ED) or via paramedics, at Sahlgrenska Hospital, Göteborg, Sweden.

Results

Pre‐hospital delay: independent predictors of a prolonged delay were increased age (P<> = 0.0007), female sex (P<> = 0.02) and a history of hypertension (P<> = 0.03). For AMI patients who received thrombolytic treatment and the only independent predictor of a prolonged delay was increased age (P<> = 0.005).

In‐hospital delay: for all AMI patients independent predictors of a prolonged delay were prolonged pre‐hospital delay (P < 0.0001), increased age (P= 0.03) and a history of angina (P= 0.002), hypertension (P= 0.01) and diabetes (P= 0.01). For thrombolytic treated AMI patients independent predictors of a prolonged delay were prolonged pre‐hospital delay (P < 0.0001), female sex (P= 0.02) and a history of diabetes (P= 0.02).

Conclusion

Risk factors for both pre‐hospital and hospital delay time could in AMI be defined although slightly different. Two factors appeared for both, i.e. increasing age and a history of hypertension.
Diabetes and impaired glucose tolerance in Jordan: prevalence and associated risk factors
Authors: Ajlouni K. , Jaddou H. , Batieha A.
Published: March 2003

Ajlouni K, Jaddou H, Batieha A (National Centre for Diabetes, Endocrine and Genetic Diseases, Amman, Jordan and the University of Science and Technology, Irbid, Jordan). Diabetes and impaired glucose tolerance in Jordan: prevalence and associated risk factors. J Intern Med 1998; 244: 317–323.

Objectives

To study the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) and their risk factors in Jordan.

Design

A cross‐sectional study in four Jordanian communities was conducted: Sarih in the north, Sikhra in the middle of the country, Mazar in the south and Subha‐Subheih in the east. Within each community, a systematic sample of households was selected. All subjects ≥25 years of age within the selected households were invited to participate in the study. A total of 2836 subjects were actually included in the study with an overall response rate of 70.5% (45% in males and 86% in females). World Health Organization criteria were adopted for the diagnosis of DM (fasting plasma glucose ≥7.8 mmol L−1 or plasma glucose of ≥11.1 mmol L−1, 2 h after an oral anhydrous glucose load of 75 g) and IGT (fasting plasma glucose <7.8 mmol L−1 and plasma glucose between 7.8 mmol L−1 and 11.1 mmol L−1, 2 h after an oral glucose load of 75 g).

Results

The overall prevalence of DM was 13.4%: 14.9% in males and 12.5% in females. IGT was found in 9.8% of the study population: 9.0% in males and 10.3% in females. Factors independently related to DM using stepwise logistic regression analysis were sex, age, family history of DM, hypertension, hypercholesterolaemia (HC), and hypertriglyceridaemia (HTG).

Conclusion

Diabetes mellitus and IGT are common among adult Jordanians. Considering the high prevalence of this sickness makes it imperative to formulate a national plan to face this disease and its complications.
Hypocalcaemia in HIV infection and AIDS
Authors: Kuehn E. W. , Anders H. J. , Bogner J. R. , Obermaier J. , Goebel F. D. , Schlöndorff D.
Published: March 2003

Objectives.  To study the prevalence and possible mechanisms of hypocalcaemia in HIV infection and AIDS.

Subjects. 828 patients with HIV infection or AIDS and 549 controls.

Interventions.  Measurements of total serum calcium and albumin levels. Parameters of calcium homeostatsis were determined in a subgroup of 21 hypocalcaemic AIDS patients.

Results. Mean serum calcium was 2.34 ± 0.13 mmol L−1 in the HIV group vs. 2.46 ± 0.10 mmol L−1 in controls (P < 0.0001). After adjusting for serum albumin, hypocalcaemia was present in 6.5% of the HIV group vs. 1.1% of controls. Mean serum calcium was declining according to CDC groups, and differed significantly from controls in each group. Regression coefficients of cacium vs. albumin were 0.147 amongst HIV‐infected patients and 0.106 for controls. In the subgroup of hypocalcaemic patients with AIDS, 10/21 had vitamin D deficiency, six of these with low ionized calcium levels. Low serum PTH was found in 2/21 patients, Magnesium deficiency in 1/21. Of the remaining eight patients, only one had secondary hyperparathyroidism, while the other seven lacked an adequate PTH response, despite low ionized calcium levels in four subjects.

Conclusions. Mean serum calcium concentrations were lower through all CDC stages, irrespective of albumin, resulting in a higher prevalence of hypocalcaemia in HIV‐positive patients compared with controls. In a considerable number, this seems to be caused by vitamin D deficiency and potentially a lack of adequate PTH secretion, but further studies are needed to confirm this.
Relationship between serum ferritin and risk factors for ischaemic heart disease in 2235 Danes aged 30–60 years
Authors: Milman N. , Kirchhoff M.
Published: March 2003

Abstract.  Milman N, Kirchhoff M (Glostrup Hospital, University of Copenhagen and Næstved Hospital, Denmark). Relationship between serum ferritin and risk factors for ischaemic heart disease in 2235 Danes aged 30–60 years. J Intern Med 1999; 245: 423–433.

Objectives.  The aim was to examine the relationships between serum ferritin and risk factors for ischaemic heart disease (physical activity, body mass index, tobacco smoking, alcohol consumption, serum total cholesterol, serum triglycerides, serum high‐density lipoprotein (HDL) cholesterol, systolic and diastolic blood pressures).

Design.  Epidemiological population survey performed at the Copenhagen County Centre for Prevention of Disease in 1982–84.

Subjects.  The participants were selected at random from the census register and comprised 2235 healthy Caucasian Danes, all non‐blood‐donors (1044 men and 1191 women), in cohorts of 30, 40, 50 and 60 years of age. The participants gave a detailed medical history and had a clinical examination including blood samples.

Main outcome measures.  In both men and women, all risk factors displayed a significant increase with age. In men aged 40–60 years, significant positive associations were found between serum ferritin and the following risk factors: body mass index, alcohol intake, serum triglycerides, and systolic and diastolic blood pressures. There was a significant negative association between serum ferritin and tobacco smoking. There was no association between serum ferritin and physical activity, serum total cholesterol or serum HDL cholesterol. In women aged 40–60 years, significant positive associations were found between serum ferritin and the following risk factors: body mass index, alcohol intake and serum triglycerides. There was no association between serum ferritin and physical activity, tobacco smoking, serum total cholesterol, serum HDL cholesterol or blood pressure.

Conclusions.  Associations were found between serum ferritin and some risk factors for ischaemic heart disease in men and women. The clinical significance of these findings remains to be clarified. One may hypothesize that the ‘missing link’ between serum ferritin and ischaemic heart disease in men is the relationship between serum ferritin, serum triglycerides and blood pressure.
Relationships between bone mineral density, serum vitamin D metabolites and calcium:phosphorus intake in healthy perimenopausal women
Authors: Brot C. , Jørgensen N. , Madsen O. R. , Jensen L. B. , Sørensen O. H.
Published: March 2003

Abstract. Brot C, Jørgensen N, Madsen OR, Jensen LB, Sørensen OH (Copenhagen Municipal Hospital, Copenhagen, Denmark). Relationships between bone mineral density, serum vitamin D metabolites and calcium:phosphorus intake in healthy perimenopausal women. J Intern Med 1999; 245: 509–516.

Objectives. To determine the relationships between serum vitamin D metabolites, bone mass, and dietary calcium and phosphorus in a cohort of 510 healthy Danish perimenopausal women.

Design. A population‐based cross‐sectional study.

Subjects. A total of 510 healthy women aged 45–58 years, with amenorrhoea for 3–24 months. None of the women was using hormone replacement therapy.

Measurements. Measurements of total bone mineral content and regional bone mineral density were performed by dual‐energy X‐ray absorptiometry. Analyses of serum levels of 25‐OHD and 1,25‐(OH)2D, intact PTH, ionized calcium and phosphate, as well as biochemical markers of bone turnover in blood and urine. Assessment of calcium and phosphorus intake using dietary records.

Results. A consistent inverse relationship between serum 1,25‐(OH)2D and bone mineral content/density was found in whole‐body mineral content (P = 0.001), spine (P = 0.005) and femoral neck (P < 0.05). There was a positive relationship between levels of 1,25‐(OH)2D and biochemical bone markers, indicating that high levels of 1,25‐(OH)2D are accompanied by increased bone turnover. The dietary calcium:phosphorus ratio was inversely related to serum 1,25‐(OH)2D (P = 0.04) and positively related to bone mineral density (P < 0.0005). No relationships could be detected between levels of PTH, serum ionized calcium and phosphate, and serum vitamin D metabolites.

Conclusion. Within normal physiological range, elevated levels of 1,25‐(OH)2D were associated with decreased bone mineral density and content, reduced calcium:phosphorus ratio in the diet and increased bone turnover.
Reduced transcapillary fluid absorption from skeletal muscle and skin during hypovolaemia in insulin‐dependent diabetes mellitus
Authors: Olsen H. , Hulthén U. L. , Länne T.
Published: March 2003

Abstract. Olsen H, Hulthén UL, Länne T (Malmö University Hospital, Malmö, Sweden). Reduced transcapillary fluid absorption from skeletal muscle and skin during hypovolaemia in insulin‐dependent diabetes mellitus. J Intern Med 1999; 246: 477–488.

Objectives. Diabetes mellitus is associated with a high cardiovascular morbidity which has been linked to disturbances in microvascular function. This study was designed to examine the transcapillary fluid absorption during experimental hypovolaemia in type 1 diabetes.

Subjects. Twelve males with type 1 diabetes (age 25 ± 3 years, duration 8 ± 1 years) with no clinical microangiopathy and 12 healthy males (22 ± 2 years).

Interventions. As a model for hypovolaemic circulatory stress, lower body negative pressure (LBNP: 15, 30 and 60 cmH2O) was used. Transcapillary fluid absorption from tissue to blood in the upper arm, as well as forearm blood flow, was measured by volumetric technique.

Results. Resting forearm blood flow, heart rate and blood pressure were similar in diabetic patients and controls. Basal plasma noradrenaline was reduced in the diabetics compared with controls (0.75 ± 0.06 vs. 1.09 ± 0.10 pmol L–1, P < 0.05), but the increase in plasma noradrenaline in response to LBNP
was similar in the two groups. The haemodynamic responses to LBNP in the two groups were equal, showing a reduction of pulse pressure, an increase in heart rate and in peripheral resistance with a concomitant blood flow reduction. The transcapillary fluid absorption (mL 100 mL–1 min–1) was significantly reduced in the diabetic patients: LBNP 15 cmH2O, 0.024 ± 0.004 vs. 0.036 ± 0.002; 30 cmH2O, 0.041 ± 0.003 vs. 0.056 ± 0.005; and 60 cmH2O, 0.057 ± 0.007 vs. 0.091 ± 0.008 (diabetic patients vs. controls, P < 0.001).

Conclusions. The transcapillary fluid absorption from tissue to blood during hypovolaemic circulatory stress in type 1 diabetic patients is reduced by one‐third compared with controls, which indicates impaired plasma volume regulation. This basic mechanism for plasma volume control is affected before clinical microcirculatory complications are found and could be one of the causes of the increased cardiovascular morbidity and mortality in IDDM.
Higher relative, but lower absolute risks of myocardial infarction in women than in men: analysis of some major risk factors in the S heep study
Authors: Reuterwall C. , Hallqvist J. , Ahlbom A. , De Faire U. , Diderichsen F. , Hogstedt C. , Pershagen G. , Theorell T. , Wiman B. , Wolk A. ,   the SHEEP Study Group
Published: March 2003

Abstract. Reuterwall C, Hallqvist J, Ahlbom A, de Faire U, Diderichsen F, Hogstedt C, Pershagen G, Theorell T, Wiman B, Wolk A, the S
heep Study Group (National Institute for Working Life; Karolinska Institute; Karolinska Hospital; and National Institute for Psychosocial Factors and Health, Solna; and the Stockholm County Council, Stockholm, Sweden). Higher relative, but lower absolute risks of myocardial infarction in women than in men: analysis of some major risk factors in the S
heep study. J Intern Med 1999; 246: 161–174.

Objectives. Middle‐aged men have often been the subjects of multifactorial studies of myocardial infarction (MI) risk factors. One major objective of the S
heep study was to compare the effects of different MI risk factors in women and men.

Design. S
heep (Stockholm Heart Epidemiology Program) is a population‐based case‐referent study of causes of MI (first event) in Swedish women and men aged 45–70 years. During the period 1992–94, 2246 cases of MI were identified; 34% of the cases were women and 27% of the cases were fatal. One referent per case was chosen randomly from the Stockholm County population after stratification for the case’s sex and age. Logistic regression was used to estimate the relative risks associated with risk factors of primary interest (diabetes, hypercholesterolaemia, hypertriglyceridaemia , hypertension, overweight, physical inactivity, smoking and job strain).

Results. The relative risk estimates ranged from 1.5 to 4.4 in women and from 1.3 to 2.9 in men (results for nonfatal cases and their referents). None of the 95% confidence intervals included 1.0. The relative risks were higher in the women than in the men (101–180%). The absolute risks, however, were all lower in the women than in the men. Estimates of Rothman’s synergy index for gender ranged from 1.0 (hypertension) to 1.8 (current smoking).

Conclusions. The indications of some effect modification due to sex (stronger risks in men for certain exposures) invoke the question of possible mechanisms.
Intensive rehabilitation of emotionally distressed patients after coronary by‐pass grafting
Authors: Perski A. , Osuchowski K. , Andersson L. , Sanden Å. , Feleke E. , Anderson G.
Published: March 2003

Abstract. Perski A, Osuchowski K, Andersson L, Sanden Å, Feleke E, Anderson G (Karolinska Institute and Hospital of the National Social Insurance Board, Nynäshamn, Sweden). Intensive rehabilitation of emotionally distressed patients after coronary by‐pass grafting. J Intern Med 1999; 246: 253–263.

Objectives. To evaluate whether the status of emotionally distressed post coronary by‐pass surgery patients can be improved by a comprehensive, in‐patient rehabilitation programme.

Design. Cross‐sectional.

Setting. Rehabilitation hospital.

Subjects. One hundred and fifty‐two post coronary by‐pass surgery patients referred to an intensive rehabilitation programme. The study group was divided into two subgroups, according to the level of emotional distress. Forty‐three (30%) out of 142 patients who completed the Nottingham Health Profile were considered to be distressed.

Interventions. The comprehensive 4‐week inpatient rehabilitation programme consisted of daily physical exercise, lectures about coronary disease and risk factors, psychological support and nutrition counselling.

Main outcome measures. Physical fitness, blood lipids and quality of life questionnaires.

Results. The two‐way analysis of variance showed that emotionally distressed patients achieved equally good results as those obtained by nondistressed patients in performance regarding the maximal exercise stress test, maximum rate pressure product achieved, or the level of resting heart rate. Significant improvement in psychological well‐being as assessed by a seven‐point rating scale was observed in both groups. Both groups of patients were also equally successful in weight reduction and lowering of total cholesterol and triglycerides. Of all the patients who were employed at admission, twice the number of patients in the distressed group were in receipt of a permanent disability pension and half the number of patients was employed, compared to the initially nondistressed group, at 1‐year follow‐up.

Conclusions. Distressed patients were very successful in improving their functional status and reducing risk factors when offered an intensive rehabilitation programme but they were much less successful in returning to work. Secondly, patients who were emotionally distressed after surgery did not differ in regard to disease status or physical capacity from nondistressed patients. They did, however, experience more angina pectoris both in daily life and when exposed to a maximal exercise stress test. Finally, the presence of emotional distress was easily detected by any measure of psychological status.
Leptin is associated with increased risk of myocardial infarction
Authors: Söderberg S. , Ahrén B. , Jansson J.‐H. , Johnson O. , Hallmans G. , Asplund K. , Olsson T.
Published: March 2003

Abstract. Söderberg S, Ahrén B, Jansson J‐H, Johnson O, Hallmans G, Asplund K, Olsson T (Umeå University, Umeå; and Lund University, Malmö, Sweden). Leptin is associated with increased risk of myocardial infarction. J Intern Med 1999; 246: 409–418.

Objectives and design. Leptin is involved in the regulation of bodyweight and metabolism in man and might also be involved in the pathophysiology of the insulin resistance syndrome, which is associated with the development of cardiovascular diseases. We tested whether leptin is a risk factor for acute myocardial infarction (AMI) in a nested case‐referent study.

Subjects and methods. Sixty‐two men with first‐ever AMI were identified who, prior to AMI, had participated in population‐based health surveys in Northern Sweden. Referents were matched for sex, age, date and type of health survey, and geographical region. Blood pressure, body mass index (BMI) and the presence of smoking, diabetes and hypertension were recorded. Total cholesterol, apolipoprotein A‐1 (apo A‐1), apolipoprotein B (apo B), plasminogen activator inhibitor (PAI‐1), insulin, and leptin were analysed in stored samples. Their influences on first‐ever AMI were analysed by conditional logistic regression analysis.

Results. Men with first‐ever AMI had higher BMI, plasma insulin and leptin, and diastolic blood pressure than the referents. Furthermore, they had lower plasma apo A‐1 and were more often smokers. Smoking, high leptin, PAI‐1 and cholesterol, and low apo A‐1 levels were significant risk factors for first‐ever AMI in univariate analysis. High leptin (OR 8.97; 95% CI: 1.73–46.5) and cholesterol (OR 5.18; 95% CI: 1.34–20.0) levels remained significant risk factors for AMI in a multivariate model. High apo A‐1 was protective (OR = 0.13; 95% CI: 0.03–0.55). The combination of high leptin and low apo A‐1 was associated with a particularly pronounced increased risk for AMI.

Conclusion. Plasma leptin strongly predicts first‐ever AMI. Our data support the hypothesis that leptin is an important link in the development of cardiovascular disease in obesity.
The effect of various hormonal preparations and calcium supplementation on bone mass in early menopause. Is there a predictive value for the initial bone density and body weight?
Authors: Pines A. , Katchman H. , Villa Y. , Mijatovic V. , Dotan I. , Levo Y. , Ayalon D.
Published: March 2003

Abstract. Pines A, Katchman H, Villa Y, Mijatovic V, Dotan I, Levo Y,. Ayalon D (Ichilov Hospital, Tel‐Aviv; Ramat Marpe Hospital, Ramat‐Gan, Tel‐Aviv, Israel. VU Ziekenhuis, Amsterdam, The Netherlands). The effect of various hormonal preparations and calcium supplementation on bone mass in early menopause. Is there a predictive value for the initial bone density and body weight? J Intern Med 1999; 246: 357–361.

Objectives. To compare the effect of various oestrogen and oestrogen/progestin preparations on bone density over a 2‐year follow‐up period in early postmenopausal women.

Setting. A retrospective study on 315 women followed in a menopause clinic.

Design. Antero‐posterior lumbar spine bone densitometry was performed at baseline and between 18 and 24 months (mean 22 months) after initiation of hormone therapy. Participants were divided into six groups: women taking conjugated equine oestrogen (CEE) (n = 30); CEE plus sequential monthly medroxyprogesterone acetate (MPA) (n = 52); CEE plus sequential bimonthly MPA (n = 51); oral estradiol plus sequential monthly norethisterone acetate (n = 52); transdermal estradiol plus sequential monthly MPA (n = 30). A control group (n = 100) was composed of nonusers of hormones.

Results. Hormone users, as a whole (n = 215), increased their bone mineral density (BMD) by 2.9% (4.8) as compared to the controls who lost 3.5% (3.4; P < 0.001). There were similar gains in BMD amongst the five study groups. Calcium supplementation was associated with better results in all women: users of hormones and calcium had a gain in BMD of 4.5% (4.8) compared to only 1.5% (4.5) in those on hormones but without calcium (P < 0.001); amongst the controls, women using calcium lost 1.4% (2.4), whilst nonusers of calcium lost 3.7% (2.4; P < 0.001). A dose–response curve was found between basal BMD and the effect of hormone therapy: women with osteoporosis (T‐score <75%) demonstrated the largest increase in BMD – 6.3% (4.6), osteopenia (T‐score 75–85%) was associated with a gain of 3.2% (5.6), low‐borderline values (T‐score 86–100%) gave a modest increase of 1.3% (4.3), and those with more than average BMD values (T‐score >100%) actually lost bone despite hormone treatment [–2.1% (4.1)].

Conclusions. All hormone regimens had a similar bone conserving effect. Basal BMD value may serve as a predictor for the success of treatment. Calcium supplementation should be recommended in all postmenopausal women.
Musculo–skeletal pathology in patients with angina pectoris and normal coronary angiograms
Authors: Frøbert O. , Fossgreen J. , Søndergaard‐Petersen J. , Hede J. , Bagger J. P.
Published: March 2003

Abstract. Frøbert O, Fossgreen J, Søndergaard‐Petersen J, Hede J, Bagger JP (University Hospital Aarhus, and Aarhus County Hospital, Denmark and Royal Postgraduate School, Hammersmith Hospital, London, UK). Musculo–skeletal pathology in patients with angina pectoris and normal coronary angiograms. J Intern Med 1999; 245: 237–46.

Purpose. To evaluate the role of the musculo–skeletal apparatus in patients with angina pectoris despite normal coronary angiograms.

Design. A survey of patients and controls investigated by blinded observers.

Setting. A tertiary cardiologic referral centre.

Subjects. Thirty women and 18 men (mean age 52.9 years) with chest pain of an average duration of 3 years and 11 months were investigated. All had normal resting electrocardiograms. No patients showed evidence of left ventricular hypertrophy or valvular heart disease on echocardiography and all had a normal coronary angiogram. All had left ventricular ejection fraction >50%, and none had signs of coronary vasospasm. Eighteen healthy persons (10 women and eight men, mean age 51.2 years) served as controls.

Main outcome measures. The group frequency of chest wall complaints, spinal radiograph and physical examination findings; pressure pain thresholds.

Results. The patients had significantly more complaints of pain from the neck, chest, and thoracic spine, and sensations and pain radiating to the arms than the controls. The patients had more degenerative findings on radiograph than the controls, mainly at levels C4–C7. Physical examination showed that abnormal findings were significantly more frequent in patients than in the control group in the anterior and posterior chest wall, in the spine at levels Th1–Th6 and in the muscles of the neck and shoulder girdle. There were no statistically significant differences in pain thresholds or in neurological examination.

Conclusion. The musculo–skeletal abnormalities observed in the patients could include reflex mechanisms. Whether the abnormal findings are mainly responsible for the angina pectoris symptoms or merely epiphenomena warrants further study.
Does immigration contribute to decreasing CHD incidence? Coronary risk factors among immigrants in Göteborg, Sweden
Authors: Dotevall A. , Rosengren A. , Lappas G. , Wilhelmsen L.
Published: March 2003

Abstract.  Dotevall A, Rosengren A, Lappas G, Wilhelmsen L (Sahlgrenska University Hospital at Ostra, Göteborg University, Göteborg, Sweden). Does immigration contribute to decreasing CHD incidence? Coronary risk factors among immigrants in Göteborg, Sweden. J Intern Med 2000; 247: 331–339.

Objectives.  To investigate if an increasing proportion of immigrants may have contributed to the decreasing trend in coronary heart disease (CHD) in Sweden during the last few decades and to analyse the cardiovascular risk factor pattern in immigrants compared to Swedish‐born subjects.

Population and methods.  CVD risk factors were investigated within the framework of the WHO MONICA project. A random sample of 1618 men and women aged 25–64  years responded to the invitation to a screening procedure including questionnaires and physical and laboratory examination. Data on myocardial infarctions (MI) were collected from the Göteborg Myocardial Infarction Register. Data from the City Council secretariat were used to estimate the number of immigrants in the total population.

Results.  In 1995, immigrants constituted 22.4% of the population between 25 and 64 years of age in Göteborg. The incidence of MI in immigrants, 21.7%, was similar to that in Swedish‐born subjects. Non‐Finnish immigrants reported more unemployment, low physical activity during leisure time and psychological stress than Swedish subjects. Immigrant men also smoked more. BMI and WHR were significantly higher in immigrant women and Finnish immigrants had higher blood pressure than Swedes. Total‐ and LDL‐cholesterol were higher in Finnish men. HDL‐cholesterol was significantly lower and s‐triglycerides significantly higher in non‐Finnish immigrants of both genders.

Conclusion.  The decreasing trend in CHD in Sweden during the last few decades is not due to an increasing number of immigrants from ‘low‐risk countries’. On the contrary, the immigrants in the present study seem to have a worse CVD risk factor profile than Swedes.
Globalization, coca‐colonization and the chronic disease epidemic: can the Doomsday scenario be averted?
Authors: Zimmet P.
Published: March 2003

Abstract. Zimmet P (International Diabetes Institute, Melbourne, Australia). Globalization, coca‐colonization and the chronic disease epidemic: can the Doomsday scenario be averted? J Intern Med 2000; 247: 301–310.

There are at present approximately 110 million people with diabetes in the world but this number will reach over 220 million by the year 2010, the majority of them with type 2 diabetes. Thus there is an urgent need for strategies to prevent the emerging global epidemic of type 2 diabetes to be implemented. Tackling diabetes must be part of an integrated program that addresses lifestyle related disorders. The prevention and control of type 2 diabetes and the other major noncommunicable diseases (NCDs) can be cost‐ and health‐effective through an integrated (i.e. horizontal) approach to noncommunicable diseases disease prevention and control. With the re‐emergence of devastating communicable diseases including AIDS, the Ebola virus and tuberculosis, the pressure is on international and regional agencies to see that the noncommunicable disease epidemic is addressed.

The international diabetes and public health communities need to adopt a more pragmatic view of the epidemic of type 2 diabetes and other noncommunicable diseases. The current situation is a symptom of globalization with respect to its social, cultural, economic and political significance. Type 2 diabetes will not be prevented by traditional medical approaches; what is required are major and dramatic changes in the socio‐economic and cultural status of people in developing countries and the disadvantaged, minority groups in developed nations. The international diabetes and public health communities must lobby and mobilize politicians, other international agencies such as UNDP, UNICEF, and the World Bank as well as other international nongovernmental agencies dealing with the noncommunicable diseases to address the socio‐economic, behavioural, nutritional and public health issues that have led to the type 2 diabetes and noncommunicable diseases epidemic. A multidisciplinary Task Force representing all parties which can contribute to a reversal of the underlying socio‐economic causes of the problem is an urgent priority.
Primary prophylaxis for individuals with severe haemophilia: how many hospital visits could treatment prevent?
Authors: Miners A. H. , Sabin C. A. , Tolley K. H. , Lee C. A.
Published: March 2003

Abstract. Miners AH, Sabin CA, Tolley KH, Lee CA (Royal Free Hospital School of Medicine, London; University of Nottingham, Nottingham; and Royal Free Hampstead NHS Trust, London, UK). Primary prophylaxis for individuals with severe haemophilia: how many hospital visits could treatment prevent? J Intern Med 2000; 247: 493–499.

Objectives. To assess how many hospital visits primary prophylaxis with clotting factor could prevent.

Design. The potential for reducing hospital visits was assessed by comparing rates of in‐patient, Out‐patient and day‐case visits per patient‐year for individuals with severe (< 1 IU dL–1) haemophilia who had never received primary prophylaxis with attendance rates for individuals with mild/moderate (1–50 IU dL–1) haemophilia. Hospital attendance data were collected retrospectively for the period 1988–97 inclusive for individuals who were aged 18 years or over.

Setting. Data were obtained on patients who were registered at the Katharine Dormandy Haemophilia Centre (KDHC), London, UK.

Outcome measures. In‐patient stays, Out‐patient and day‐case visits.

Results. Individuals with mild/moderate haemophilia were 45% (31–56), 36% (30–41) and 70% (68–73) less likely to have required in‐patient, Out‐patient and day‐case visits than were individuals with severe haemophilia. HIV serostatus and age were also shown to be significant and independent predictors of the rate of Out‐patient and day‐case visits, but not the rate of in‐patient stays.

Conclusion. These results suggest that primary prophylaxis for individuals with severe haemophilia could significantly reduce the demand for in‐patient stays, and Out‐patient and day‐case visits.
Carotid atherosclerosis, vascular risk profile and mortality in a population‐based sample of functionally healthy elderly subjects: the Berlin Ageing Study
Authors: Hillen T. , Nieczaj R. , Münzberg H. , Schaub R. , Borchelt M. , Steinhagen‐Thiessen E.
Published: March 2003

Abstract. Hillen T, Nieczaj R, Münzberg H, Schaub R, Borchelt M, Steinhagen‐Thiessen E (Humboldt‐University Berlin, Berlin; Department of Public Health Medicine/King’s College London, London; and Klinikum der Hansestadt Stralsund, Stralsund, Germany). Carotid atherosclerosis, vascular risk profile and mortality in a population‐based sample of functionally healthy elderly subjects: the Berlin Ageing Study. J Intern Med 2000; 247: 679–688.

Objectives. Studies on extracranial carotid atherosclerosis have predominately been undertaken on middle‐aged subjects. This study examines the prevalence of extracranial carotid atherosclerosis, its relation to vascular risk factors and its significance for survival in elderly subjects.

Design. Population‐based cross‐sectional survey. Non‐modifiable vascular risk factors examined were family history of atherosclerotic disease, sex and apolipoprotein E (apoE) genotype. Potentially modifiable risk factors assessed were smoking, fibrinogen, fasting lipids, body mass index, hypertension and diabetes.

Setting and subjects. Two hundred and twenty‐five functionally healthy volunteers of the Berlin Ageing Study, aged 70–100.

Main outcome measures. Presence of carotid stenosis and plaque ascertained by ultrasound imaging; 5‐year mortality.

Results. At least one plaque was found in 144 (64%) of the volunteers; 34 (15%) had a stenosis over 50%; and nine (4%) had a stenosis over 75%. Total cholesterol > 6.5 mmol L–1, LDL cholesterol > 4.6 mmol L–1 and total cholesterol/HDL cholesterol ratio > 5 were significantly associated with presence of plaque in 70‐ to 80‐year‐old subjects, as was diabetes in subjects over 80 years. Log‐linear analyses showed significant three‐way interactions for high LDL cholesterol and diabetes with plaques and age. Family history, sex, apoE genotype, smoking and fibrinogen were not related to presence of plaque in the study population. Cox regression analysis revealed increased 5‐year mortality rates for subjects with plaques (OR = 2.88; 95% CI = 1.30–6.35), whereas the vascular risk profile was not associated with mortality.

Conclusions. In a population‐based sample of functionally healthy elderly subjects, the significance of the vascular risk profile seemed to be diminished. It had no impact on survival and only modifiable risk factors showed an age‐dependent association with carotid disease.
Serum level of soluble tumour necrosis factor receptor II (75 kDa) indicates inflammatory activity of sarcoidosis
Authors: Ziegenhagen M. W. , Fitschen J. , Martinet N. , Schlaak M. , Müller‐Quernheim J.
Published: March 2003

Abstract. Ziegenhagen MW, Fitschen J, Martinet N, Schlaak M, Müller‐Quernheim J (Medical Hospital, Borstel, Germany and INSERM U.14, Vandoevre‐Les‐Nancy, France). Serum level of soluble tumour necrosis factor receptor II (75 kDa) indicates inflammatory activity of sarcoidosis. J Intern Med 2000; 248: 33–41.

Objectives. Tumour necrosis factor α (TNFα) is a key cytokine involved in granuloma formation of sarcoidosis. Since soluble TNF receptors (sTNF‐R) are known to inhibit TNF effects, we were interested in whether they are elevated in the serum of sarcoidosis patients.

Methods. We determined serum levels of sTNF‐R I (55 kDa) and sTNF‐R II (75 kDa) in 49 patients with sarcoidosis and 22 controls. The clinical course of the disease was re‐evaluated in a follow‐up after (mean ± SE) 6.8 ± 6.6 months.

Results. sTNF‐R I (3.1 ± 1.1 ng mL–1, P < 0.05) and sTNF‐R II (5.5 ± 2.7 ng mL–1, P < 0.0005) were significantly elevated in sarcoidosis compared with controls (2.4 ± 0.7 and 3.0 ± 1.3 ng mL–1, respectively). Interestingly, both sTNF receptors were significantly higher in the serum of patients with active compared with inactive sarcoidosis (P < 0.005 and P < 0.0005, respectively). Furthermore, serum sTNF‐R II levels were significantly higher in sarcoidosis patients with advanced radiological types II and III. In 10 patients, serum sTNF‐R levels were obtained before and after systemic corticosteroid therapy and we observed a significant decrease of sTNF‐R II (P < 0.02), whereas sTNF‐R I levels were not reduced significantly.

Conclusions. Both types of sTNF receptors are elevated in the serum of sarcoidosis patients with active disease, but only the sTNF‐R II seems to be useful for monitoring the inflammatory activity of the disease.