Dyspnoea in a cross-sectional and a longitudinal study of middle-aged men: The Study of Men Born in 1913 and 1923

In a longitudinal population study, 855 men, born in 1913 andinitially examined when 50 years old, were followed for 17 yearswith measurements of dyspnoea and other variables performedat ages 50, 54, and 67 years. In addition a sample of 226 menborn in 1923 was followed from 50 to 57 years of age. At thelatest examination, four different methods for measuring dyspnoeawere used, one based on questionnaire, one on interview, andtwo on visual analogue scales. The estimates from these methodswere highly intercorrelated, and correlated with measures ofcardiopulmonary function as well. The prevalence of dyspnoeagrade 2 (shortness of breath when walking with someone of thesame age on the level) or more, not counting the mildest formof dyspnoea in these populations, was 2.8%, 3.0%, 5.2% and 10.3%at 50, 54, 57 and 67 years of age, respectively. Dyspnoea gradel (shortness of breath when walking quickly on the level oruphill) was less well related to age. A scoring system to differentiatevarious possible causes of dyspnoea was applied. About one thirdof the dyspnoeic men had signs and symptoms of cardiac disease,one quarter had pulmonary disease, and a quarter had a combinationof both causes. The remaining 20% had no signs or symptoms indicatingcardiopulmonary disease but in the majority of the cases otherplausible causes were found.     

Recurrent myocardial infarction. 1. Natural History of fatal and non-fatal events

1306 men below 68 years of age who survived a first myocardialinfarction (MI) during 1968–1977 were followed up between2 and 12 years after discharge from hospital. The mean follow-uptime was 6.5 years. The patients were unselected and paid regularvisits to a Post-MI Clinic where treatment was standardized. The diagnosis of a non-fatal reinfarction was based on conventionalclinical criteria, and the diagnosis of fatal reinfarction onautopsy findings of a recent myocardial injury and/or a freshcoronary thrombus. The autopsy rate was high and the follow-upof endpoints was complete. The total cumulative rate of endpoint free patients was 64%at 5 years and 50% at 10 years follow-up. The total mortalityrate was 19% at 5 years and 33% at 10 years follow-up. The totalcumulative rate of a first reinfarction was 28% at 5 years and37% at 10 years follow-up (80% non-fatal and 20% fatal). 63patients suffered more than one reinfarction. The mortalityrate was strongly associated with age. In contrast the rateof non-fatal reinfarctions was independent of age.     

Megaloblastic Anaemia among Indians in Britain

A high incidence of megaloblastic anaemia, approximately threetimes that in white persons, has been found in Indian immigrantsin Britain. The clinical, haematological, and biochemical featuresof 25 patients are described. All but one of these were livingin the Southall area of Middlesex. In 15 cases the presentinghaemoglobin was less than 7 g/100 ml and three of these wereteenage girls. The majority (17 cases) were nutritional anaemias;the type of deficiency was variable and this group includedsome patients with vitamin B₁₈ deficiency, some with folic aciddeficiency, and some with deficiency of both vitamins. Amongthe remaining eight patients there were cases of perniciousanaemia, tropical sprue, gluten enteropathy, post-gastrectomyanaemia, and unexplained vitamin Bla malabsorption. Some ofthese conditions have previously been considered uncommon inAsiatic Indians.     

Atrial Arrhythmias in Long-QT Syndrome under Daily Life Conditions: A Nested Case Control Study

Background: The long-QT syndromes (LQTS) are inherited electrical cardiomyopathies characterized by prolonged ventricular repolarization and ventricular arrhythmias. Several genetic reports have associated defects in LQTS-causing genes with atrial fibrillation (AF). We therefore studied whether atrial arrhythmias occur in patients with LQTS under daily-life conditions.
Methods: We systematically assessed atrial arrhythmias in LQTS patients and matched controls using implanted defibrillators or pacemakers as monitors of atrial rhythm in a nested case-control study. Twenty-one LQTS patients (3 male; 39 ± 18 years old; 18 on β blocker, ICD therapy duration 6.3 ± 2.7 years; 4 LQT1, 6 LQT2, 2 LQT3) were matched to 21 control subjects (13 male; 50 ± 19 years old; 3 on β blocker; pacemaker therapy duration 8.5 ± 5.5 years; 19 higher-degree AV block, 2 others). LQTS patients were identified by a systematic search of the LQTS patient databases in Münster and Munich.
Results: One-third (7 of 21) of the LQTS patients developed self-terminating atrial arrhythmias (atrial cycle lengths <250 ms). Only one control patient developed a single episode of postoperative AF (P < 0.05 vs LQTS).
Conclusions: LQTS patients at high risk for ventricular arrhythmias may develop short-lasting atrial arrhythmias under daily-life conditions, suggesting that prolonged atrial repolarization may contribute to the initiation of AF.     

Job stress, absenteeism and coronary heart disease European cooperative study (the JACE study): Design of a multicentre prospective study

Background: The motives, objectives and design of a multicentreprospective study on job stress, absenteeism and coronary heartdisease in Europe (the JACE study) is presented in this paper.Some specific gaps in the reviewed literature are explicitlytapped into by the JACE study. Its objectives are i) to comparethe distributions of the Karasek job stress scales for the samebroad categories of occupations in different European countries(in males and females), ii) to study the predictive power ofthe job stress scales and the job strain model for one yearof sickness absence (in males and females) and iii) to studythe predictive power of the job stress scales and the job strainmodel for a three year incidence of coronary heart disease (Inmales only). Methods: In answering these questions, relationsare studied controlling for gender, age, level of education,company size, physical work risks and shift work, as well astraditional risk factors for CHD (i.e serum cholesterol, serumHDL cholesterol, smoking habits and blood pressure). The JACEstudy is a Biomed 1 concerted action. The JACE group consistsof eight participating centres from six countries, i.e. fromBelgium and Sweden (two centres), France, Italy, Spain, Swedenand The Netherlands (each one centre). The coordination of thegroup is in Brussels. The participating centres brought in over15, 000 European workers to test the hypotheses.     

Body Temperature in General Population Samples

ABSTRACT Oral body temperature was measured in 816 men, 57 and 67 years old, sampled from the general population of Göteborg, Sweden, and 22 physically highly active men, sampled on clinical grounds. The measurements were taken in the morning for 14 months. After adding 0.3°C to the readings to make them comparable with rectal readings, the mean body temperature was 36.8±0.4°C. There was a seasonal variation with a peak during the winter and a trough during the summer. Body temperature was inversely correlated with height and positively correlated with weight and body fat but not with lean body mass. High physical activity and sensitivity to heat were associated with a higher than average body temperature. Sensitivity to cold was associated with a lower than average body temperature. Smoking prior to the measurements did not appear to affect body temperature.     

The multifactor primary prevention trial in Goteborg, Sweden

The effect of a multifactorial intervention programme on coronaryheart disease (CHD), stroke incidence and total mortality wasdetermined in a random sample of men, 47–55 years oldat entry. The intervention group comprised 10004 men, and thetwo control groups were of similar size. The intervention consistedof antihypertensive treatment in subjects with screening bloodpressure above 175 mmHg systolic or 115 mmHg diastolic, dietaryadvice to men with serum cholesterol levels above 260 mg per100 ml ( = 6.8 mMol l^–1), advice to stop smoking to subjectswho smoked more than 15 cigarettes per day. The interventionwas applied for 10 years during which time CHD and stroke incidenceand mortality were followed by means of special registers. Participationrate at first screening examination was 75%.     

The Effect of the Calcium Antagonist Nimodipine on the Detoxification of Soman in Anaesthetized Rabbits

The effect of nimodipine, a vasoactive calcium antagonist, on the disappearance of soman from blood was studied in anaesthetized rabbits intoxicated with soman (10.8 μg kg^?1 i.v.). Blood samples from the left heart ventricle and femoral artery were used to investigate soman detoxification. The concentrations of the soman isomers C + P - and C - P - in blood samples were determined by gas chromatography coupled with high-resolution mass spectrometry. During the sampling, 15–300 s after soman injection, the soman concentration in control animals decreased from 50 to 0.029 ng mL^?1; in animals pre-treated with nimodipine (10 mg kg^?1) it decreased from 15 to 0.033 ng mL^?1. In animals pre-treated with nimodipine the soman concentration was significantly reduced during the first minute of sampling. No differences were detected between soman concentrations in samples from the heart and femoral artery. Acetylcholinesterase inhibition was also used as an indicator of soman activity; there was no difference between the activity of this enzyme in different peripheral organs of control and nimodipine-treated animals. Nimodipine reduces the initial concentration of soman in the blood, which might be of significance in the treatment of soman intoxication.     

What should the public be told about primary prevention of CHD?

There is an increasing demand from the general public for medicalinformation. In his analysis of ongoing and prospective tendenciesin Megatrends, Naisbit[¹] foresees a change from an industrialera to a society based on the creation and distribution of information,and ‘from a society run by short-term considerations andrewards in favour of dealing with things in much longer-termframes’. And with regard to medical care: ’The newemphasis on the human angle shows up in three major trends behindthe move from institution help to self-help’. These aspectsinclude among others our responsibility for health, self-careand preventive medicine. The medical profession has to meet this demand for informationwith appropriate answers. So far we have failed in several respects.One source of confusion is the rapid distribution to the generalpublic of research results which have not had time to be putinto an overall health prospective. Some of the issues which seem to be confusing with respect tocoronary heart disease (CHD) prevention are: what risk factorsare really of importance, what can be achieved by screeningexaminations versus more general health measures, and whetherour diet really matters.