Serum cholesterol and high density lipoprotein cholesterol distributions in patients with acute myocardial infarction and in the general population of Kuopio Province,Eastern Finland

Abstract. As part of the FINMONICA project, serum total cholesterol (TC) and high density lipoprotein cholesterol (HDLC) concentrations were determined in 1216 AMI patients (937 men. 279 women) aged 35–64 years in the province of Kuopio in eastern Finland during the 5-year period 1983–87. The distributions were compared with the corresponding distributions in a representative sample of the general population of the same area (1026 men, 1021 women). The mean serum TC levels did not differ between the AMI patients and the normal population. Only the prevalence of a very high serum TC level (> 8.0 mmol l^?1) among women was significantly higher in the AMI group than in the population sample. On the other hand, in both sexes the age-adjusted mean HDLC was significantly lower in the AMI group than in the population sample. Our findings emphasize the importance of HDLC measurement as a part of the assessment of the lipid risk factor profile in patients with AMI.     

Sequential Bilateral Bundle Branch Block During Dofetilide, A New Class III Antiarrhythmic Agent, In a Patient with Atrial Fibrillation

Sequential Bilateral BBB During Dofetilide. Introduction: I in mechanism of wide QRS complex tachycardias during dofetilide infusion was studied in a patient with atrial fibrillation.
Methods and Results: Endocardial recording from the intraventricular conduction system showed that dofetilide caused "classic" aberrant conduction (Ashman phenomenon, typical QKS morphology) at high prematurity ratios (preceding interval = 1.78 X coupling interval 290), thus mimicking ventricular ectopy. In addition, there was frequent sequential bilateral bundle branch block, caused by a significant difference in preceding bundle-to-bundle intervals (mean difference ± 1 SD: 74 ± 26 msec).
Conclusion: The present findings may prove helpful in the clinical assessment of wide QKS complex rhythms after dofetilide and possibly other "pure" Class III antiarrhythmics.     

Diagnostic features of acute myocardial infarction – changes over time from 1983 to 1990: results from the FINMONICA AMI register study

Abstract. Objectives . To examine, whether the acute myocardial infarctions (AMIs) are becoming smaller. Design . Analysis of electrocardiogram (ECG) and enzyme findings of community-based AMI registers in three geographical areas of Finland during the 8-year period 1983–90. Setting . In the FINMONICA AMI Register, all suspected coronary events in persons aged 25–64 years have been registered since 1983 according to the protocol of the WHO MONICA project in the provinces of North Karelia and Kuopio in eastern Finland and Turku/Loimaa area in south-western Finland. Subjects . Each consecutive case of suspected AMI originating from the monitored populations. During the study period, 11487 definite or possible AMIs were registered. Main outcome measures . Trends in ECG findings classified as definite or probable, and trends in enzyme findings classified as abnormal or equivocal. Results . Of the registered AMIs, 8439 (73.5%) reached the hospital alive and survived ≥ 24 h from the beginning of the symptoms. They were included in the analyses of this report and divided further, to first ever AMIs (n = 5392) and to recurrent AMIs (3047). During the study period, the proportion of ECG findings classified as definite on the basis of the serial Minnesota coding declined in men 3.1% year^?1 (P < 0.0001) on average for first AMIs and 1.9% year^?1 (P = 0.004) for recurrent AMIs. In women, the corresponding declines were 1.9% year^?1 (P = 0.007) and 1.6% year^?1 (P = 0.02), respectively. Also, the proportion of enzymes classified as abnormal declined amongst men 2.2% year (P < 0.0001) for first AMIs and 2.8% year^?1 (P < 0.0001) for recurrent AMIs. In women, the corresponding declines for abnormal enzymes was 1.3% year^?1 (P = 0.13) and 3.0% year^?1 (P = 0.02). These findings were consistent in all three areas with different registration teams and different laboratories. The proportion of definite ECG findings amongst patients hospitalized for AMI declined almost by half and the proportion of abnormal enzyme findings declined almost by one-third during the study period. Conclusions . Our findings are compatible with the clinical observation that the hospitalized AMIs are becoming smaller. The timing and magnitude of the changes suggest that they are mainly caused by decreased risk-factor levels in the population. Improved treatment of coronary heart disease and changed hospital admission policy are likely to be contributing factors.     

Victimization from workplace bullying after a traumatic event: time-lagged relationships with symptoms of posttraumatic stress

Objective

This study examined relationships between victimization from bullying and symptoms of posttraumatic stress (PTSS) after exposure to a terror attack at the workplace. It was hypothesized that (1) victims of bullying report higher and more stable levels of PTSS over time compared to their non-bullied colleagues and (2) that PTSS provides an increased risk of subsequent victimization from bullying.

Methods

The hypotheses were tested in a two-wave prospective sample comprising 2337 employees from Norwegian governmental ministries who were exposed to the 2011 Oslo terror attack. The two waves of data collection were conducted 10 and 22 months after the terror attack.

Results

Hypothesis 1 was partially supported: victims of bullying reported significantly higher levels of PTSS than non-bullied employees at both measurement points, but bullying was not related to the stability in PTSS over time. In support of hypothesis 2, PTSS at 10 months was significantly associated with an increased risk of feeling victimized by bullying 1 year later.

Conclusions

The results indicate that victimization from bullying is associated with elevated levels of PTSS in the aftermath of a workplace terror attack, but that bullying does not have any impact on the long-term development of PTSS. PTSS may be a potential antecedent of bullying. These findings suggest that organizations must give high priority to the psychosocial work environment of traumatized employees to prevent further detrimental health consequences.

     

Client and information: a literature review

Summary

• ? This paper gives a brief review of existing research studies concerning patient information.
• ? The paper outlines two relevant perspectives on information giving and on the meaning of information to the individual patient: ideological and practical.
• ? From these two perspectives the knowledge structures of four patient groups: surgical patients, cancer patients, dialysis patients and psychiatric patients are looked at more closely.

     

Decreasing incidence of pharmacologically and non-pharmacologically treated type 2 diabetes in Norway: a nationwide study

Aims/hypothesis

This study aimed to examine recent time trends in the incidence and prevalence of type 2 diabetes in Norway.

Methods

In this Norwegian nationwide cohort study, we linked data from national registries with prospectively collected data on diabetes medication and diabetes diagnoses for all residents in Norway aged 30 to 89 years (>3.2 million people). We analysed trends in incidence and prevalence of type 2 diabetes from 2009 to 2014 by type of treatment, sex, age, education level and place of birth.

Results

During 15,463,691 person-years of follow-up from 2009 to 2014, we identified 75,496 individuals with new-onset type 2 diabetes. Of these, 36,334 (48%) were treated with blood-glucose-lowering drugs within 6 months of diagnosis. A low education level and being born in Asia, Africa or South America were significant risk factors for incident type 2 diabetes. While the prevalence of type 2 diabetes increased from 4.9% to 6.1% during the study period, the incidence decreased significantly from 609 cases per 100,000 person-years in 2009 to 398 cases per 100,000 in 2014, an annual reduction of 10.1% (95% CI ?10.5, ?9.6). A declining incidence was seen for both pharmacologically and non-pharmacologically treated type 2 diabetes, and in all subgroups defined by sex, age group, education level and place of birth.

Conclusions/interpretations

This nationwide study shows that, despite a decreasing incidence of type 2 diabetes in Norway, the prevalence continues to rise, probably due to diagnosis at a younger age and increased longevity.

     

Subcellular localization of hydrogen peroxide production in human polymorphonuclear leukocytes stimulated with lectins, phorbol myristate acetate, and digitonin: an electron microscopic study using CeCl3

The ultrastructural H2O2-producing site in human polymorphonuclear leukocytes (PMN) stimulated with soluble stimuli was studied using a CeCl3-technique. CeLlular aggregation and formation of small vacuoles were observed when PMN were stimulated with 100 microgram/ml concanavalin-A, 1 mg/ml phytohemagglutinin, or 100 microgram/ml wheat germ agglutinin for 10 min at 37 degrees C. Electron-dense deposits formed from the reaction of H2O2 and CeCl3 were observed on the contact surface of the plasma membrane of aggregated PMN stimulated with lectins. Treatment with 5 microgram/ml cytochalasin-B before lectin- stimulation induced an enhanced formation of vacuoles, degranuLation, rounding of the contour, cellular aggregation, and enhancement of the deposits. Phorbol myristate acetate (PMA; 100 ng/ml) induced strong leukocyte aggregation, the formation of multiple huge vacuoles, degranulation, and H2O2 production at almost all of the contact surface between adjoining PMN and between PMN and erythrocytes, mononuclear cells, or thrombocytes. In PMN stimulated with digitonin (B microgram/ml), vacuolar formation, degranulation, multiple projections on the surface, and H2O2 production on the whole surface membrane were demonstrated. It is shown that cellular aggregation and cell-to-cell contact have an important role in the induction of O2- production induced by lectins or PMA and that O2- production induced by the detergent is not dependent on leukocyte aggregation.     

The site of the breakpoint within the bcr is a prognostic factor in Philadelphia-positive CML patients [see comments]

The Philadelphia (Ph1) chromosome, characteristic of chronic myelogenous leukemia (CML), arises from a reciprocal translocation between chromosomes 9 and 22. The site of the breakpoint on chromosome 22 is within a small region called the breakpoint cluster region (bcr). We have mapped the breakpoint within the bcr in peripheral blood leukocyte DNA from 22 Ph1-positive CML patients. No correlation between the site of the breakpoint and the clinical phase of the disease was found. However, a striking correlation between the site of the breakpoint and the length of time between presentation and onset of acute phase was observed: on average, patients with a 5' break-point had a fourfold longer chronic phase (median, 203 weeks) than those with a 3' breakpoint (median, 52 weeks).