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Biomedical subjects

A Bingham

Publications and source records attributed to A Bingham.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Coronary disease in France: data from the MONICA registers (1985-1991)].

The MONICA Project is an international project co-ordinated by the World Health Organisation. The objective of this study is to assess fluctuations in coronary heart disease (CHD) mortality and morbidity. From 1985 to 1991 a continuous and exhaustive registration of acute coronary events (15,775 cases among which 12,789 men and 2,986 women) was carried out in the 3 French MONICA Centres Lille, Strasbourg and Toulouse. During this period, the average rate of CHD mortality according to the death certificates was higher for men in Lille (93/100,000 inh) and Strasbourg (84/100,000 inh) than in Toulouse (57/100,000 inh). The official rates are close to those found by the MONICA Registers if documented myocardial infarctions only are taken into account. If sudden deaths are included, these rates must be multiplied by 1.6. In terms of evolution, official statistics showed an improvement with a mortality decrease of 33%. For the MONICA Registers which include sudden deaths, the decrease was only 20%. Official statistics underestimate coronary death rate and overestimate the decrease tendency. Morbidity rates between the South and the North of France are close, and when compared to Northern Europe countries, France is in an area of moderate incidence. The favourable evolution of coronary disease frequency hides in fact a contrasted evolution: improvement in myocardial infarction recurrence and worsening of incidence. The example of CHD proves that registers provide relevant information for a prevention policy.

Adult↗
PubMed1996

[Therapeutic management of myocardial infarction: trends observed in the MONICA-France project between 1985 and 1991].

This paper describes the trends observed in the treatment of myocardial infarction within the three French MONICA registers between 1985 and 1991. Data, collected according to the WHO-MONICA Protocol, relate to the initial care of patients and the treatment they were prescribed. In this study 2974 cases are included. The time delays before hospitalization do not change in spite of an increasing use of mobile emergency care units. In all three centers there is a strong progression of thrombolysis, increasing from 12% to 41% in Strasbourg, from 21% to 47% in Toulouse and from 31% to 35% in Lille. Antiplatelet drugs rise from 11% to 76% in Strasbourg, from 39% to 85% in Toulouse and from 33% to 76% in Lille. Beta-blockers also progress in the three centers. Prescription of anticoagulants, nitrates and antiarrythmics is constant. In contrast calcium blockers are less prescribed. Duration of hospital stay is much longer in Strasbourg. In Toulouse the resort to coronary angiography (96%) and to angioplasty (51%) is much more frequent than in the two other centers. Similar trends in the three regions reflect the results of the secondary prevention trials conducted in the last years. Differences concern mainly treatments and procedures that were less studied before 1991. It will be interesting to study the trends in the following years in order to estimate the influence of the trials on the homogeneity of practice in the three centers.

Adult↗
PubMed1995

Cardiovascular risk factors and alcohol consumption in France and Northern Ireland.

The levels of different lipid, lipoprotein and haemostatic variables were assessed in 615 control subjects of the ECTIM Study, defined by five groups of alcohol consumption: non-drinkers, 0 < or = 15 g/day, 15 < . < or = 36 g/day, 36 < . < or = 66 g/day and > 66 g/day. After adjustment for age, body mass index, cigarette consumption and country, alcohol consumption was associated with an increase in HDL-cholesterol (0.47 +/- 0.02 to 0.59 +/- 0.01 g/l in non-drinkers and > 66 g/day consumers, mean +/- S.E.M., P < 0.0001), apolipoproteins A-I and A-II (1.37 +/- 0.03 to 1.60 +/- 0.03 g/l and 0.32 +/- 0.01 to 0.41 +/- 0.01 g/l, respectively, P < 0.0001), LpA-I, LpA-I:A-II (0.46 +/- 0.01 to 0.50 +/- 0.01 g/l and 0.75 +/- 0.02 to 0.91 +/- 0.02 g/l, respectively, P < 0.001) and PAi-1 activity (134 +/- 11 to 177 +/- 11 U/ml, P < 0.001). Conversely, no increases were found for total and LDL-cholesterol, triglycerides, apolipoproteins B and C-III, LpE:B, LpC-III:B, fibrinogen and factor VII. Hence, among the lipid and haemostatic variables studied, only HDL parameters and PAi-1 activity were increased by alcohol consumption.

Adult↗
PubMed1995

Medical treatment of myocardial infarction in France and Northern Ireland. Results from the ECTIM study. Enquête cas-Témoins de l'Infarctus du Myocarde.

As part of the ECTIM Study, the medical treatment given to male patients (25-64 years) 3 to 9 months after myocardial infarction (MI) were analysed in France and Northern Ireland. On univariate analysis, hypolipidaemic drugs, angiotensin-converting enzyme inhibitors and antiarrhythmic drugs were found to be prescribed more frequently in France, while beta-blockers were more common in Northern Ireland. No differences were found for diuretics, calcium channel blockers, antithrombotic and anti-anginal drugs, although the Northern Irish patients were mainly on antiplatelet drugs and nitrates, while the French patients received nitrates and non-nitrates, as well as oral anticoagulants and antiplatelet drugs in similar amounts. These differences remained after adjustment for personal history of diabetes, hyperlipidaemia, hypertension, and previous myocardial infarction, but the beta-blocker prescription was no longer significant. When the French centres were analysed, patients from Strasbourg were more frequently on oral anticoagulants and diuretics and less frequently on antiplatelet drugs, while patients from Toulouse had fewer anti-anginal drugs. Hence, although the current guidelines for secondary prevention of myocardial infarction are generally well applied in France and Northern Ireland, significant differences exist regarding the choice of the active drug.

Adult↗
PubMed1995

Autres pays, autres coeurs? Dietary patterns, risk factors and ischaemic heart disease in Belfast and Toulouse.

The WHO MONICA project monitors trends and determinants in cardiovascular disease to relate classical risk factor changes to trends in incidence rates. The Belfast and Toulouse MONICA centres have also collaborated in dietary studies. Both centres have validated incidence and attack rates for ischaemic heart disease using coronary event registration. These data confirm that the disease in middle-aged men is between three and four times as common in Belfast as in Toulouse. Risk factor surveys show some differences between the centres, but the overall risks assessed by two multiple logistic function scoring systems were identical. A weighed dietary survey revealed no important difference in macronutrient intake, although carbohydrate and saturated fat intake in Belfast was significantly higher. Protein, dietary cholesterol and polyunsaturated fat, particularly linoleic acid intake, was significantly higher in Toulouse, as was consumption of wine, cheese, fruit and vegetables, but not potatoes. The Northern Irish diet is typically Northern European, but although the diet in Toulouse has some features of the Mediterranean diet, it is not appreciably different from that in Belfast in terms of total fat intake. Major differences are present for several food items, and in general these differences add support to the antioxidant hypothesis.

Antioxidants↗
PubMed1995

[Treatments of ischemic cardiopathies (IC) and modalities of prescription of aspirin in the three French MONICA centers in 1990].

In 1990, the three French MONICA centres recorded comparable frequencies of myocardial infarction admitted and not admitted to hospital. However, the mortality on the 28th day revealed an excess hospital mortality in Lille compared to Strasbourg and Toulouse (p < 0.001). Toulouse infarct patients were younger. The emergency management of coronary patients subsequently admitted to hospital also differed (16.7% patients in Lille vs 40% in Strasbourg and 24.3% in Toulouse) (p < 0.01). In Lille, 41.6% of patients had known coronary heart disease vs 30.4% in Toulouse and 38.4% in Strasbourg (p < 0.05). These three characteristics influenced the mortality. During admission, considerable differences were observed in the therapeutic strategies in the 3 centres: in Toulouse, angioplasty was predominant (51.4%) together with prescription of calcium channel blockers (65.5%) and aspirin (82.5%). In Lille, there were a high prescription (20.3%) of antiplatelets other than aspirin during the acute phase compared to Toulouse (0.6%) and Strasbourg (7.3%). In Strasbourg, the cardiologists of the department rarely used angioplasty during the acute phase, but were the leading prescribers of beta-blockers. Fibrinolysis was performed in 4 out of 10 patients in the three centres. Aspirin was used in more than 7 out of 10 patients during the acute phase in all MONICA centres, but at a variable dosage: doses greater than or equal to 250 mg per day were prescribed in Toulouse (97.6%) and Strasbourg 82.8%), while, in Lille, only one out of 2 patients received this dosage (50.6%).

Acute Disease↗
PubMed1994

Myocardial infarction case-fatality gradient in three French regions: the influence of acute coronary care.

The objective of this study was to evaluate the influence of acute coronary care on the myocardial infarction (MI) case-fatality gradient observed in three French regions. In 1989, a total of 813 hospitalized events of premature MI, occurring in men and women aged 25-64, were registered in three WHO-MONICA sites established in Lille (North of France), Strasbourg (East of France) and Toulouse (South of France). The case-fatality rates observed 28 days after the onset of the MI, were 30.6% in Lille, 17.5% in Strasbourg and 9.9% in Toulouse (P < 0.0001). We compared the management of events and the use of cardiovascular therapies in these centres before admission to hospital, during the stay and on discharge from hospital. Differences were observed between the three centres in the use of medical treatments: in Strasbourg, aspirin and antiplatelet agents were prescribed 15% less frequently, (P < 0.0001) while diuretics were prescribed twice as often as in Toulouse (P < 0.0001). Thrombolytic agents (P < 0.01) and invasive techniques (coronary angiography, coronary angioplasty and coronary bypass surgery) (P < 0.0001) were more widely used in Toulouse compared with the two other centres. Lille might have a higher rate of coronary case fatality than Strasbourg and Toulouse because of a series of cumulative characteristics. The disease presented in a more serious form: more frequent electrocardiographic changes in anterior leads (P < 0.02), higher percentage of use of inotropic drugs in association with diuretic agents (P < 0.04), and longer duration of stay in intensive care units (P < 0.0001). However, when case-fatality rates were adjusted for all these variables in a multivariate model, the rate remained significantly higher in Lille than in the two other centres (P < 0.0001), as suggested by the odds ratio (3.27, 95% confidence interval: 1.69-6.32). In conclusion, the influence of acute coronary care on the MI case-fatality gradient observed between the North and South of France is very weak.

Acute Disease↗
PubMed1994

Impact of apolipoprotein E polymorphism on lipoproteins and risk of myocardial infarction. The ECTIM Study.

Human apolipoprotein (apo) E, a polymorphic protein with three common alleles, epsilon 2, epsilon 3, and epsilon 4, plays an important role in lipoprotein metabolism. This article describes the association of this polymorphism with lipids, apolipoproteins, and lipoproteins with a particular regard to lipoprotein particles, as defined by their apolipoprotein content, as well as the risk of myocardial infarction in a multicenter population-based case-control study (ECTIM study). In the ECTIM study, 574 male patients aged 25 to 64 were examined 3 to 9 months after myocardial infarction in four regions participating in the World Health Organization MONICA project: Belfast (Northern Ireland) and Lille, Strasbourg, and Toulouse (France). Control subjects (n = 722) were randomly selected from the regional populations. The distribution of apoE phenotypes was significantly different across the four control samples (P = .04), with a higher frequency of the epsilon 4 allele in Belfast (14.3%) than in Toulouse (8.2%). The association of apoE polymorphism with biological measurements was studied in the control groups (n = 640) after men with coronary heart disease or those taking hypolipidemic drugs were omitted, with the apoE3/3 phenotype as a reference after adjustment for concomitant factors. Individuals carrying the epsilon 2 allele had lower levels of plasma cholesterol, low-density lipoprotein cholesterol (LDL-C), and apoB and higher levels of triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), apoC-III, apoE, lipoprotein (Lp) C-III:B, and Lp E:B. However, the effect of the epsilon 2 allele on triglyceride, VLDL-C, apoE, and Lp E:B parameters was heterogeneous across the populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Chronic bullous disease of childhood and ulcerative colitis.

A 12-year-old girl with ulcerative colitis (UC) treated by colectomy with rectal stump preservation, salazopyrin, and systemic steroids developed persistent mouth ulcers, cutaneous targetlike lesions, papulopustules, and bullae. The clinical, histologic, and immunopathologic features were typical of chronic bullous disease of childhood (CBDC). Although resistant to combined immunosuppressive therapy with low-dose prednisolone, cyclosporin, and thalidomide, striking remission of the mucocutaneous symptoms resulted with surgical resection of the diseased rectal stump. An etiologic association between CBDC and UC is postulated.

Child↗
PubMed1993

Allergic contact dermatitis from para-tertiary-butylphenol-formaldehyde resin (PTBP-F-R) in Northern Ireland.

Over the past 5 years, 2270 patients with suspected allergic contact dermatitis were patch tested in our clinic to the European standard series of allergens. 7 patients (0.3%) showed a positive reaction (> or = +) to PTBP-F-R. In 3 (42.9%) of these patients, the allergen was traced to adhesives but no allergen source was determined in the remainder (57.1%). On the basis of these findings, it is questionable whether PTBP-F-R alone should routinely be included in the European standard series.

Adult↗
PubMed1993

Sleeping tablet consumption, self reported quality of sleep, and working conditions. Group of Occupational Physicians of APSAT.

STUDY OBJECTIVE: The aim was to assess the frequency of sleep disorders in relation to working conditions. DESIGN: This was a cross sectional study. Data were collected prospectively, on a standardised form, by 13 occupational physicians. The quality of sleep was assessed by self perceived sleep disturbances and consumption of sleeping tablets. Working conditions were described by the worksite physician as well as by the participants. SETTING: 2769 small or medium sized firms in the Paris area. PARTICIPANTS: A random sample of 7629 wage earners was studied. Among the participants, 61% were men and 39% women; 44% were blue collar workers. MAIN RESULTS: The prevalence of sleeping tablet consumption was 6.1% and 11.3% respectively for men and women. Sixteen percent of men and 26% of women stated that they had sleep disturbances (p < 0.001). In both sexes, drug consumption and sleep disturbances increased with age and were highest among individuals aged 55 years and more. No association between working conditions (exposure to noise, assembly line working, or physical workload) and sleep disturbances or drug consumption was found. Sleeping tablet consumption was higher among subjects reporting a bad atmosphere at work; the same was true for men with little interest in their job and for women working under time pressure. For both sexes, subjects reporting any of these conditions were more likely to report sleep disturbances. CONCLUSIONS: A high prevalence of self reported sleep problems and related drug consumption was observed. Physical working conditions were not related to the quality of sleep in contrast to perceived job conditions. The results suggest that sleep quality might be a useful health indicator for the occupational physician.

Absenteeism↗
PubMed1992

A case-control study of lipoprotein particles in two populations at contrasting risk for coronary heart disease. The ECTIM Study.

The incidence of coronary heart disease (CHD) in middle-aged men is more than three times higher in Northern Ireland than in France. The ECTIM study, which is based on WHO MONICA centers in Belfast (Northern Ireland), Strasbourg (eastern France), Toulouse (southwestern France), and Lille (northern France), has been established to investigate this striking difference. Male patients aged 25-64 years with myocardial infarction (MI) and control subjects sampled from the general population were recruited in the four centers. Hypolipidemic drug treatment was much more frequent in France than in Belfast. "Hypercholesterolemia" defined by the presence of hypolipidemic drug treatment or a low density liproprotein cholesterol level greater than 200 mg/dl was more frequent in cases than in controls in both countries but was similar in both control groups. An in-depth study of lipid variables, including measurements of cholesterol fractions, triglycerides, apolipoproteins (apo), and lipoprotein particles (Lp), was performed in nonhypercholesterolemic subjects. In Northern Ireland and France, patients in comparison with controls had lower levels of high density lipoprotein cholesterol, apo A-I, apo A-II, Lp A-I, and Lp A-II:A-I and higher levels of Lp E:B and Lp(a):B. The levels of triglycerides, very low density lipoprotein cholesterol, apo B, and Lp C-III:B were higher in cases than in controls only in Belfast. In control subjects, the mean levels of cholesterol fractions and apolipoproteins were similar in Northern Ireland and France; however, the level of Lp A-I was lower and the levels of Lp E:B and Lp(a):B were higher in Northern Ireland than in France.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Primary results of the MONICA project].

The MONICA project is an international study coordinated by the WHO, designed to explain the important variations of coronary mortality observed in the industrialised countries over the last 20 years. Thirty-nine centres in 27 countries are participating in the project which, over a 10 year period will, in geographically determined zones; a) record the numbers of acute myocardial infarcts and coronary deaths, b) analyse the treatment of acute cardiac events, and c) evaluate the cardiovascular risk factors and preventive measures in the general population. The MONICA-France project comprises three registers (Bas-Rhin, Haute-Garonne and the urban community of Lille), and a coordinating centre. The preliminary results confirm the wide geographic variability of coronary mortality with a prevalence slightly higher in Alsace and the North than in the South-West of France. The approximative frequency of coronary events in France is estimated at 112,000 infarcts and over 175,000 acute coronary episodes and deaths. Information is provided about the severity of the principal coronary risk factors and the conditions of their treatment in the register zones. A study of the accessibility of emergency treatment of acute infarction in the Bas-Rhin area, has demonstrated the key role of the general practitioner as the first contact but confirmed the long delay to hospital admission which nullified the potential benefits of thrombolysis in a high proportion of cases. However, the significant decrease in hospital mortality of acute infarction observed over a 3 year period in the three register zones, is probably related to the number of patients thrombolysed in that time.

Adult↗
PubMed1990

Incidence of acne vulgaris in patients with infantile acne.

A group of patients who attended dermatology clinics in Northern Ireland between 1960 and 1970 with a diagnosis of infantile acne was compared with a similar age-matched control group of 160 medical students. The severity of the acne was judged according to the form of treatment required--topical treatment, systemic antibiotics or isotretinoin. The statistical power of this study is limited but there appears to be a trend towards higher incidence and greater severity of acne vulgaris in teenage years in patients with a history of infantile acne compared to their peers.

Acne Vulgaris↗
PubMed1990

Between-register and within-register variability in event-finding and rates in the MONICA-France Project.

The 1985 and 1986 coronary event data from the three French MONICA Registers in Haute-Garonne (Toulouse), Bas-Rhin (Strasbourg) and the Urban Community of Lille (UCL) are used to compare the sources of information, the distribution of events in different diagnostic categories, and their possible effects on event rates. All three registers follow the MONICA protocol, and use the "cold pursuit" method, with data abstracted retrospectively from medical files or from the doctors establishing the causes of death. The health system and medical background are similar in the three centers. The distribution of the sources of information (in-hospital and out-of-hospital) and the distribution of events by diagnostic categories are different among centres. The possible effects of these differences on rates of definite myocardial infarction or possible coronary death are estimated between registers and within registers during a 2-year period. Cross-sectional comparisons are questionable, and possible false trends in event rates require special attention.

Adult↗
PubMed1990

Comparison of dietary patterns between population samples in the three French MONICA nutritional surveys.

A nutritional survey was carried out from 1985 to 1987 in three French areas covered by the ischaemic heart disease registers: Bas-Rhin (BR), Haute-Garonne (HG) and the Urban Community of Lille (UCL). 1,128 men aged 45-64 were included in a survey, using the 3-day record method. The results, after adjustment for age, socio-economic status, residence and prescribed diet, showed differences, sometimes significant, between the three samples. Fat represented 37% of the total energy intake in BR, 36% in UCL, and 34% in HG. The P:S ratio ranged from 0.50 in HG, to 0.47 in BR, and 0.40 in UCL. These differences were due to a higher intake of vegetable fat and a lower intake of animal fat in HG. In spite of a very important alcohol intake, with no big differences between the centres (33 to 36 g/day), we noticed that HG drank mainly wine, whereas BR and UCL drank wine and beer in about the same proportions.

Alcoholic Beverages↗