ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00867.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Corticosteroid therapy results in osteoporosis. There is a doubling in the risk of fracture in patients taking more than the equivalent of 7.5 mg day−1. The bone loss is most rapid from the axial skeleton, particularly during the 1st year of therapy. The most important mechanism for the bone loss is a decrease in osteoblastic activity. Preventative strategies should be targeted to patients with low bone‐mineral density, especially if the dose of corticosteroids is likely to be high. Treatment strategies agreed on by the Consensus Panel included hormone replacement therapy and bisphosphonates, with monitoring of efficacy by bone densitome

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00868.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objectives.Smokers have recently been shown to be insulin resistant and to exhibit several characteristics of the insulin resistance syndrome (IRS). In this study, we assessed fasting and postprandial lipid levels in healthy, normolipidaemic, chronic smokers and a matched group of non‐smoking individuals.Design.A standardized mixed meal (containing 3.78 MJ and 51 g of fat) was given in the morning after an overnight fast. The smokers were either abstinent from tobacco for 48 h or were allowed to smoke freely, including being allowed to smoke six cigarettes during the study.Subjects.Twenty‐two middle‐aged, healthy male subjects, nine habitual smokers and 13 non‐smoking control subjects, were recruited to the study. The smokers had all been smoking at least 10 cigarettes per day for at least 10 years.Results.The smokers exhibited a lipid intolerance in that their postprandial increase in triglyceride levels was more than 50% higher than in the non‐smokers' group. This lipid intolerance could not be discerned in the postabsorptive state because the fasting triglyceride levels were the same in both groups, whilst the smokers had significantly lower high‐density lipoprotein (HDL) cholesterol. The peak postprandial triglyceride level correlated closely and negatively with fasting HDL cholesterol, indicating an impaired lipolytic removal capacity in smokers.Conclusions.Healthy, normotriglyceridaemic smokers exhibit an abnormal postprandial lipid metabolism consistent with lipid intolerance. It is suggested that postprandial hyperlipidaemia is a characteristic trait of the insulin resistance syndrome and that the defect in lipid removal is related to the low HDL cholesterol in this syndrome. The insulin resistance syndrome is likely to be an important reason for the increased propensity for cardiovascular disease

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00869.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objectives.The main purpose was to study associations between different risk factors for coronary heart disease in order to find out whether such associations already exist during the fourth decade of life.Setting.A study carried out by the primary healthcare staff in the community of Habo in Skaraborg County in south‐western Sweden.Subjects.All men living in Habo aged 33–42 years who were willing to participate in the study ‐ in total 652 men (participation rate 86%).Main outcome measures.Risk factors for coronary heart disease considered as markers of lifestyle: body‐mass index as a measure of general obesity, waist‐to‐hip circumference ratio as a measure of central obesity, arterial blood pressure, serum cholesterol concentration and serum triglyceride concentration.Results.There were statistically significant correlations between all the factors analysed including anthropometric data, blood pressure and serum lipids.Conclusions.The results indicate associations between different risk factors at an early age and emphasises the need for a multifactorial view on risk as early as at the ages which were the focus of

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00870.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objectives.The purpose of the study was to establish plasma levels of insulin, ovarian sex hormones and dehydroepiandrosterone sulfate (DHEA‐S) and to evaluate their correlations with lipids in premenopausal women with angiographically demonstrated coronary stenosis.Design.Differences in plasma levels of insulin, ovarian sex hormones, DHEA‐S and lipids between groups were compared by analysis of variance.Setting.From January 1993 until December 1993 patients were diagnosed in the Outpatient Clinic of the Department of Endocrinology Medical Centre for Postgraduate Education, Warsaw.Subjects.Premenopausal women with normal oral glucose tolerance test (OGTT) results, with and without coronary stenosis were studied: 21 women after acute myocardial infarction with angiographically demonstrated coronary stenosis (women with CHD), and 14 women with chest pain, a positive exercise test without significant changes of coronary arteries on coronarography (women with normal coronarography, NC). The control group consisted of nine, healthy women with no risk factors for CHD.Main outcome measures.In premenopausal women with CHD, the decreased plasma level of DHEA‐S and hyperinsulinaemia were anticipated.Results.In women with CHD, the plasma levels of DHEA‐S (926.5 ± 83 ng mL−1) were significantly lower than those in women with NC (1375.7 ± 181 ng mL−1) and in healthy controls (1984 ± 127 ng mL−1),P<0.02 andP<0.001, respectively. The fasting insulin and insulin response to an OGTT in women with CHD and with NC was higher than in healthy subjects. A significant decrease of high‐density lipoprotein (HDL) cholesterol, HDL‐2 cholesterol and apolipoprotein A‐I, and an increase of total cholesterol, low‐density lipoprotein cholesterol C and apolipoprotein B levels in women with CHD compared to healthy controls were observed. A negative correlation between fasting insulin and the plasma levels of DHEA‐S was established.Conclusion.In premenopausal women, hyperinsulinaemia and decreased DHEA‐S levels may contribute to the development

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00871.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objectives.To study clinical practice and attitudes in hypertension care amongst general practitioners (GPs) and hospital internal medicine specialists.Design.Mailed case report questionnaires.Subjects.Ninety GPs and 69 internal medicine specialists at randomly selected primary health care centres and hospital outpatient departments.Main outcome measures.Case‐bound treatment preferences, treatment goals and return visit planning, and views on factors influencing practice.Results.The participation rate was 84% and 70%, for GPs and internal medicine specialists, respectively. GPs more often proposed nonpharmacological therapy (P<0.05), solely and as a complementary treatment, and prescribed more calcium antagonists (P<0.001), whilst internal medicine specialists prescribed more ACE inhibitors (P<0.001). Personal experience guides practice more than national consensus and economy, more so with increasing time since specialization.Conclusions.GPs and internal medicine specialists in Sweden report a hypertension practice closely related to each others' and to the intentions of national guideline

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00872.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objectives.To investigate the relationship between gonadal function, insulin and psychosocial stress in middle‐aged men.Design.A population‐based, cross‐sectional, observational study.Setting.Glostrup Hospital, Copenhagen, Denmark.Subjects.Four hundred and thirty‐nine males, all aged 51 years.Main variables.Body‐mass index (BMI), waist‐to‐hip ratio (WHR), insulin, C‐peptide, free testosterone, luteinizing hormone (LH), lipids, fibrinogen, lung function tests (FVC, FEV1, PEF), blood pressure; a self‐administered questionnaire with questions on psychosocial variables, lifestyle and self‐rated health.Results.Free testosterone correlated inversely (P<0.05) with weight, BMI, WHR, and fibrinogen, and positively withFEV1. An independent correlation between free testosterone and insulin (P≤ 0.03), but not with C‐peptide, was seen after controlling for BMI and WHR. Subjects with low levels of free testosterone, or those in the lowest quintile of the distribution of the hypogonadal index (HI: free testosterone/LH), showed a cluster of negative psychosocial variables, and psychological as well as health‐related problems. Furthermore, hypogonadal men had lower (P<0.05) levels ofFEV1, peak flow andFVC, but higher (P<0.01) levels of fibrinogen and higher pulse pressure than men with normal gonadal function. This gradient of variables, relative to HI, was not seen for possible confounders like BMI, WHR, and tobacco or alcohol consumption.Conclusion.Psychosocial stress may be associated with a process of premature ageing in middle‐aged males, corresponding to a hypogonadal state as well as to indirect signs of i

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00873.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objective.To investigate the influence of hierarchial position and perceived influence on ethical and technical decisions.Design.The study was conducted as a postal questionnaire survey.Subjects.A random sample of 329 Danish physicians working at departments of internal medicine and related subspecialties. Of these, 270 (82%) returned a completed questionnaire.Main outcome measure.Self‐reported perceived influence in discussions about technical and ethical issues in connection with decisions to terminate treatment for patients with terminal malignant illness.Results.The odds ratio for perceived influence between consultants and house officers is 14.9 for ethical issues, 44.9 for technical issues, and 652.3 for questions concerning departmental policy. Gender plays no role, when one controls for hierarchial position.Conclusions.Hierarchial position is the major determinant of perceived influence on technical and ethical decisions. Position seem to play a larger role in technical than in ethical decision

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00874.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objective.To investigate influence of whole‐body cooling on cyclic GMP (cGMP) in women with Raynaud's phenomenon and in healthy women.Design.The study was performed as an open, parallel‐group comparison between women with Raynaud's phenomenon and healthy women during the winter month of February.Setting.The municipality of Västerås (Sweden).Participants.The Raynaud group comprised 24 female patients. The control group consisted of 21 healthy females.Main outcome measure.The venous levels of cGMP were measured on three different occasions: just before and after 40 min of whole‐body cooling and after 20 min rest at room temperature (21°C).Results.Venous cGMP increased significantly in the control group after cold exposure (mean difference 0.43 pmol ml−1; 95% CI, 0.018–0.848;t= 2.18; df = 20;P= 0.02) and remained at a high level after 20 min rest (mean difference 0.58 pmol mL−1; 95% CI, 0.063–1.108;t= 2.34; df = 20;P= 0.015). In contrast, the levels of venous cGMP in the Raynaud group did not change significantly. The difference in increase between the two groups was significant (P<0.02). The diastolic blood pressure in the Raynaud group increased after 40 min of whole‐body cooling and was still significantly increased (P<0.001) after 20 min rest at room temperature (21 °C).Conclusion.These results indicate that women suffering from Raynaud's phenomenon lack the physiological response of cGMP to cold exposure, which may explain their increased v

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00875.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objective.To investigate the relation between severity of complaints, laboratory data and psychological parameters in patients with chronic fatigue syndrome (CFS).Subjects.Eighty‐eight patients with CFS and 77 healthy controls matched for age, sex and geographical area.Methods.Patients and controls visited our outpatient clinic for a detailed medical history, physical examination and psychological tests: Checklist Individual Strength (CIS), Beck Depression Inventory (BDI) and Sickness Impact Profile (SIP). Venous blood was drawn for a complete blood cell count, serum chemistry panel, C‐reactive protein and serological tests on a panel of infectious agents.Results.All patients fulfilled the criteria for CFS as described by Sharpeet al. (J R Soc Med1991;84: 118–21), only 18 patients (20.5%) fulfilled the CDC criteria. The outcome of serum chemistry tests and haematological tests were within the normal range. No significant differences were found in the outcome of serological tests. Compared to controls, significant differences were found in the results on the CIS, the BDI, and the SIP. These results varied with the number of complaints (CDC criteria). When the number of complaints was included as the covariate in the analysis, there were no significant differences on fatigue severity, depression, and functional impairment between patients who fulfilled the CDC criteria and patients who did not.Conclusion.It is concluded that the psychological parameters of fatigue severity, depression and functional impairment are related to the clinical severity of the illness. Because the extensive panel of laboratory tests applied in this study did not discriminate between patients and controls, it was not possible to investigate a possible relation between the outcomes of psychological and laboratory te

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00876.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY