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Biomedical subjects

E Prescott

Publications and source records attributed to E Prescott.

At least 37 records · Page 2Linked to original sources
PubMed2001

Changes in smoking habits and risk of asthma: a longitudinal population based study.

A common statement from exsmokers is that symptoms of asthma develop shortly after smoking cessation. This study, therefore, investigated the relationship between smoking cessation and development of asthma in a large cohort from the Copenhagen City Heart Study (CCHS). The CCHS is a longitudinal, epidemiological study of the general population from the capital of Denmark, conducted between 1976 and 1994. The study population involved the 10,200 subjects who provided information on self-reported asthma and smoking habits from the first two examinations (baseline and 5-yr follow-up), and the 6,814 subjects who also attended the third and last examination (10-yr follow-up). The point-prevalence of smoking cessation as well as the asthma incidence between examinations was estimated, and a multivariate logistic regression model was used to examine the relationship between changes in smoking habits and development of asthma. During the study period, asthma incidence increased from 1.2-4.2%. Between examinations 1,316 subjects quit smoking. Smoking cessation between examinations was significantly related to reported asthma at follow-up. With never-smokers as the reference group and following adjustment for sex, age, chronic bronchitis, level of forced expiratory volume in one second and pack-yrs of smoking, the odds ratio (OR) for developing asthma when quitting smoking between examinations was 3.9 (95% confidence interval (CI) 1.8-8.2) from baseline to first follow-up and 3.1 (95% CI 1.9-5.1) from first to second follow-up. Continuing smoking also increased the risk of asthma significantly (OR 2.6 and 2.0, respectively). The results indicate that exsmokers have a higher incidence of self-reported asthma than never-smokers. It is likely that subjects perceive chronic obstructive pulmonary disease as asthma, hence the relationship between smoking cessation and asthma might be due to misclassification rather than causality.

Aged↗
PubMed2000

Tobacco smoking and risk of hip fracture in men and women.

BACKGROUND: Previous findings suggest that tobacco smoking increases the risk of hip fracture in women. A similar adverse effect of smoking is suspected to be present in men, but bone mineral density studies have raised the concern that men may be more sensitive to the deleterious effect of smoking on bone than women. In this study we prospectively determined the influence of current, previous, and cumulative smoking history on risk of hip fracture in men and women and addressed the issue of possible gender difference in the susceptibility to tobacco smoking. METHODS: Pooled data from three population studies conducted in Copenhagen with detailed information on smoking habit. A total of 13,393 women and 17,379 men, initially examined between 1964 and 1992, were followed until 1997 for first admission due to hip fracture. The relative risks (RR) of hip fracture associated with smoking were estimated by means of multiplicative Poisson regression models. RESULTS: During follow-up, 722 hip fractures were identified in women, and 447 in men. After adjustment for potential confounders, including body mass index, female current smokers had an RR of hip fracture of 1.36 (95% CI: 1.12-1.65) and male smokers 1.59 (95% CI: 1.04-2.43) relative to never smokers. In both sexes, the RR of hip fracture gradually increased by current and accumulated tobacco consumption. The RR were consistently higher in men than in women, but the test for interaction between sex and tobacco smoking was insignificant. After 5 years, male ex-smokers had an adjusted RR of 0.73 (95% CI: 0.55-0.98) relative to current smokers, while no significant decrease in risk was observed in female ex-smokers (RR = 0.91; 95% CI: 0.72-1.17)). Approximately 19% of all hip fractures in the present study population were attributable to tobacco smoking. CONCLUSION: Tobacco smoking is an independent risk factor for hip fracture in men and women, and there appears to be no gender differences in smoking related risk. Smoking cessation reduces the risk of hip fracture in men after 5 years, while the deleterious effect of smoking seems to be more long-lasting in female ex-smokers.

Adult↗
PubMed1999

Alcohol intake and the risk of lung cancer: influence of type of alcoholic beverage.

Alcohol consumption has been associated with an increased risk of lung cancer, but the antioxidants in wine may, in theory, provide protection. This association was studied in 28,160 men and women subjects from three prospective studies conducted in 1964-1992 in Copenhagen, Denmark. After adjustment for age, smoking, and education, a low to moderate alcohol intake (1-20 drinks per week) was not associated with an increased risk of lung cancer. Men who consumed 21-41 and more than 41 drinks per week had relative risks of 1.23 (95% confidence interval (CI) 0.88-1.74) and 1.57 (95% CI 1.06-2.33), respectively. The risk of lung cancer differed according to the type of alcohol consumed: After abstainers were excluded, drinkers of 1-13 and more than 13 glasses of wine per week had relative risks of 0.78 (95% CI 0.63-0.97) and 0.44 (95% CI 0.22-0.86), respectively, as compared with nondrinkers of wine (p for trend = 0.002). Corresponding relative risks for beer intake were 1.09 (95% CI 0.83-1.43) and 1.36 (95% CI 1.02-1.82), respectively (p for trend = 0.01); for spirits, they were 1.21 (95% CI 0.97-1.50) and 1.46 (95% CI 0.99-2.14), respectively (p for trend = 0.02). In women, the ability to detect associations with high alcohol intake and type of beverage was limited because of a limited range of alcohol intake. The authors concluded that in men, a high consumption of beer and spirits is associated with an increased risk of lung cancer, whereas wine intake may protect against the development of lung cancer.

Adult↗
PubMed1999

Gender and determinants of smoking cessation: a longitudinal study.

BACKGROUND: The less favorable trend in smoking prevalence in women compared to men may be due to lower cessation rates. We analyzed determinants of spontaneous smoking cessation with particular reference to gender differences. METHODS: Data on smoking were collected by questionnaire in three samples of the adult population, examined for the first time at intervals between 1976 and 1984. In total 11,802 (59%) subjects were smokers, and 9085 of them attended a reexamination after 5 years. Ten to 16 years later 6053 were examined once again. Logistic regression was performed to study the relation of determinants to having quit after 5 and 10-16 years. RESULTS: The prevalence of quitting was 12 and 22% at first and second follow-up, respectively. At both reexaminations, quitting smoking was positively associated with male sex and cigar smoking and negatively associated with the amount of tobacco smoked, inhalation, and alcohol consumption. Furthermore, in women, smoking cessation was positively associated with level of education and body mass index (BMI). Smoking cessation was not affected by cohabitation status, leisure activity, or bronchitis symptoms. CONCLUSIONS: Smoking cessation initiatives should be targeted at heavy cigarette smokers, and at women, in particular the lean and poorly educated.

Adult↗
PubMed1999

Socioeconomic status, lung function and admission to hospital for COPD: results from the Copenhagen City Heart Study.

This study analysed the effect of education and income on development of chronic obstructive pulmonary disease (COPD) assessing lung function and hospital admission. The study population consisted of 14,223 subjects, aged 20-90 yrs, randomly sampled from the population of Copenhagen in 1976. Association between socioeconomic factors and forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) at study entry was analysed by linear regression. The relation between socioeconomic factors and risk of admission to hospital for COPD from study entry until 1993 was assessed by register linkage. Education and income were independently associated with FEV1 and FVC. The age- and height-adjusted difference in FEV1 (mean+/-SEM) between the highest and lowest level of education and income was 259+/-31 mL in females and 400+/-39 mL in males. After additional adjustment for quantity and duration of smoking and inhalation, the difference was 220+/-31 mL and 363+/-39 mL in females and males, respectively. Results for FVC were of the same magnitude. Using a socioeconomic index which combined information on education and household income the association with lung function did not differ by age. A total of 219 females and 265 males were admitted to hospital for COPD during follow-up. Education and income were significantly associated with admission to hospital. After detailed adjustment for smoking the relative risks (95% confidence intervals) for medium and high versus low socioeconomic index in females were 0.74 (0.55-1.02) and 0.27 (0.10-0.73), respectively. Corresponding relative risks in males were 0.47 (0.36-0.63) and 0.35 (0.17-0.70). The results indicate that socioeconomic factors operating from early in life affect the adult risk of developing chronic obstructive pulmonary disease independently of smoking in both females and males.

Denmark↗
PubMed1999

Prognostic value of nutritional status in chronic obstructive pulmonary disease.

The association between low body mass index (BMI) and poor prognosis in patients with chronic obstructive pulmonary disease (COPD) is a common clinical observation. We prospectively examined whether BMI is an independent predictor of mortality in subjects with COPD from the Copenhagen City Heart Study. In total, 1,218 men and 914 women, aged 21 to 89 yr, with airway obstruction defined as an FEV(1)-to-FVC ratio of less than 0.7, were included in the analyses. Spirometric values, BMI, smoking habits, and respiratory symptoms were assessed at the time of study enrollment, and mortality from COPD and from all causes during 17 yr of follow-up was analyzed with multivariate Cox regression models. After adjustment for age, ventilatory function, and smoking habits, low BMI was predictive of a poor prognosis (i.e., higher mortality), with relative risks (RRs) in underweight subjects as compared with that in subjects of normal weight of 1.64 (95% confidence interval [CI]: 1.20 to 2.23) in men and 1.42 (95% CI: 1.07 to 1.89) in women. However, the association between BMI and survival differed significantly with stage of COPD. In mild and moderate COPD there was a nonsignificant U-shaped relationship, with the lowest risk occurring in normal-weight to overweight subjects, whereas in severe COPD, mortality continued to decrease with increasing BMI (test for trend: p < 0.001). Similar results were found for COPD-related deaths, with the strongest associations found in severe COPD (RR for low versus high BMI: 7.11 [95% CI: 2.97 to 17.05]). We conclude that low BMI is an independent risk factor for mortality in subjects with COPD, and that the association is strongest in subjects with severe COPD.

Adult↗
PubMed1999

A sensitivity analysis of secular trends in risk factors and mortality based on cohort studies.

Because of a "healthy responder effect," secular trends in mortality based on cohort studies may be biased if based on responders only. Because responders are selected on the basis of their health at study entry, subjects just entering a study are not comparable with subjects who have been in the study for several years. The result may be an artificial increase in mortality, which impedes analyzing the effect of secular trends in risk factors on mortality. The objective of this paper is to suggest a solution by using data on nonresponders and applying a sensitivity analysis. We illustrate this solution with data on trends in smoking prevalence and all-cause mortality based on a large Danish cohort study with 19 years of complete follow-up on responders and nonresponders. Secular trends in mortality based on the whole sample vs responders only illustrated that results based on responders were biased. In a sensitivity analysis, the observed person-years of nonresponders were distributed among six categories of persons with respect to smoking behavior (never-smokers; ex-smokers; noninhaling current smokers; and current smokers of 1-14, 15-24, and > or =25 gm tobacco per day) according to preset assumptions regarding smoking habits. The observed deaths among nonresponders were then distributed on the six smoking categories according to relative risks derived from a Poisson regression analysis among responders. This procedure allowed us to study the effect of adjustment for smoking on the unbiased secular trend in mortality. By applying different assumptions regarding smoking habits among nonresponders, we explored the effect of the assumptions on the adjusted secular trend in mortality. We conclude that secular trends in mortality based on responders in a cohort study are likely to be biased. If complete follow-up on nonresponders is available, this method could prove useful in other cohort studies.

Aged↗
PubMed1998

Role of biotin-containing membranes and nuclear distribution in differentiating human endometrial cells.

Human Ishikawa endometrial cells form domes when confluent monolayers are stimulated with fresh fetal bovine serum. Extensive structural and biochemical changes have been detected during the approximately 30 h differentiation period. The earliest detectable change involves the formation of multinucleated structures and the appearance of "granules" that stain for biotin within those structures. Nuclei become associated with each other and are ultimately enclosed within a biotin-containing membrane. Aggregated membrane-sheathed nuclei and the cells containing them begin to elevate from the dish as biotin staining becomes apparent in apical membranes. The elevated structures are called predomes and consist of one or more very large cells containing the sheathed nuclei. Apical membranes of these unusual cells extend far out into the medium in structures that resemble endometrial pinopods. A lumen under the elevated cells fills with transcytosed fluid. As differentiation proceeds, highly concentrated chromatin material that was flattened against apical and lateral membranes of the predome cells begins to disperse. Small mononuclear cells evolve from larger predome cells. Apical membranes of predome and dome cells continue to stain for biotin. Gel electrophoresis of SDS-solubilized biotin-containing membranes, followed by Western blot analysis using avidin-linked peroxidase, resulted in three stained bands with molecular weights similar to those of the mitochondrial carboxylases: propionyl carboxylase, methylmalonyl carboxylase, and pyruvate carboxylase.

Biotin↗
PubMed1998

Smoking and risk of myocardial infarction in women and men: longitudinal population study.

OBJECTIVE: To compare risk of myocardial infarction associated with smoking in men and women, taking into consideration differences in smoking behaviour and a number of potential confounding variables. DESIGN: Prospective cohort study with follow up of myocardial infarction. SETTING: Pooled data from three population studies conducted in Copenhagen. SUBJECTS: 11,472 women and 13,191 men followed for a mean of 12.3 years. MAIN OUTCOME MEASURES: First admission to hospital or death caused by myocardial infarction. RESULTS: 1251 men and 512 women had a myocardial infarction during follow up. Compared with non-smokers, female current smokers had a relative risk of myocardial infarction of 2.24 (range 1.85-2.71) and male smokers 1.43 (1.26-1.62); ratio 1.57 (1.25-1.97). Relative risk of myocardial infarction increased with tobacco consumption in both men and women and was higher in inhalers than in non-inhalers. The risks associated with smoking, measured by both current and accumulated tobacco exposure, were consistently higher in women than in men and did not depend on age. This sex difference was not affected by adjustment for arterial blood pressure, total and high density lipoprotein cholesterol concentrations, triglyceride concentrations, diabetes, body mass index, height, alcohol intake, physical activity, and level of education. CONCLUSION: Women may be more sensitive than men to some of the harmful effects of smoking. Interactions between components of smoke and hormonal factors that may be involved in development of ischaemic heart disease should be examined further.

Aged↗
PubMed1998

Long-term trial of deferiprone in 51 transfusion-dependent iron overloaded patients.

Fifty-one transfusion-dependent iron-loaded adult patients (38 with thalassemia major) were treated with the orally active iron chelator deferiprone (1,2 dimethyl-3-hydroxypyrid-4-one, L1) at a dose of 75 mg/kg/d (range, 50 to 79). Twenty patients discontinued the drug and five died after a mean of 18.7 months (range, 4 to 35). Of the 20, 5 had arthropathy, 5 had gastrointestinal symptoms, 4 had a rising serum ferritin, 3 had agranulocytosis or neutropenia, 1 had tachycardia, 1 had renal failure, and 1 went abroad. Twenty-six patients continued deferiprone for a mean of 39.4 months (range, 12 to 49). Among these patients, there was no overall significant change in serum ferritin (initial mean, 2,937 microg/L; range, 980 to 5,970; final mean, 2,323 microg/L; range, 825 to 5,970) or in urine iron excretion (initial mean, 31.2 mg/24 h; range, 16.3 to 58. 2; final mean, 32.1 mg/24 h; range, 9.4 to 75.8), implying no overall change in iron stores. When the patients who had received deferiprone for longer than 3 years were considered separately, there was also no significant change in serum ferritin or urinary iron excretion. The initial serum ferritin levels in the 26 patients who continued deferiprone treatment were significantly lower than in those who discontinued the drug (P < .01). The liver iron content in 17 patients who had received deferiprone for 24 to 48 months ranged from 5.9 to 41.2 mg/g dry weight, 50% having levels above 15.0 mg, a level associated with a high risk of cardiac disease due to iron overload. In this study the drug caused fewer side effects and was more effective at maintaining iron status among patients previously well chelated and with lower initial serum ferritin levels.

Adult↗
PubMed1998

Vital prognosis after hospitalization for COPD: a study of a random population sample.

STUDY AIM: To examine survival after admission due to chronic obstructive pulmonary disease (COPD) in a population sample over a time span of 15 years. DESIGN: Linkage between a prospective population cohort and register information on hospitalization and mortality. SETTING: The Copenhagen City Heart Study (CCHS). PARTICIPANTS: A total of 267 men and 220 women who had participated in the CCHS and who were hospitalized with a discharge diagnosis of COPD (ICD-8 491-2). MAIN RESULTS: The crude 5-yr survival rate after a COPD admission was 45% (37% for men and 52% for women). Mortality risk increased with age and with decreasing forced expiratory volume in 1 s (FEV1)% predicted; for subjects with an FEV1 < or = 40% at the CCHS survey, 5-yr survival after subsequent hospitalization was only 28%. Smoking and presence of chronic mucus hypersecretion at the examination in CCHS were not strongly associated with prognosis. Survival after admission due to COPD did not change significantly over time. CONCLUSION: Compared to previous studies of COPD patients, the present study indicates that prognosis after hospital admission remains virtually unchanged over the last decades. FEV1 is still the strongest predictor of survival in this patient group.

Adult↗
PubMed1998

High prevalence of low bone mass in thalassaemia major.

Cooley's original description of beta-thalassaemia major included marked bone deformities as a characteristic feature. These were thought to be due to expansion of haemopoiesis attempting to compensate for the congenital anaemia. Regular blood transfusions from infancy prevents these skeletal problems. Nevertheless, symptoms due to bone disease frequently occur in adult patients. Osteoporosis has not previously been reported as a cause of severe morbidity in thalassaemia major. The present study shows a high prevalence of low bone mass among thalassaemia major patients and analyses the predisposing causes. Bone density scans were performed in 82 patients with transfusion-dependent beta thalassaemia. Factors known to be associated with low bone mass such as gender, endocrine disorders and lifestyle activities, together with factors specific to the thalassaemia and its management, were included in a series of univariate analyses to ascertain any significant associations. 42 (51%) of the patients had severely low bone mass and a further 37 (45%) had low bone mass. The three factors showing a statistically significant association with severely low bone mass were male sex, 24/38 (63%) males had severely low bone mass, compared with 18/44 (41%) females, the lack of spontaneous puberty, 22/32 (69%) who required therapeutic induction of pubertal development had severely low bone mass, compared with 19/47 (40%) with spontaneous puberty and diabetes, 8/10 (80%) diabetic patients had severely low bone mass, compared with 23/56 (41%) with normal glucose tolerance. There was no association between the bone mineral density measurements and the haematological characteristics or treatment details of these patients. Severely low and low bone mass are common findings in patients with beta-thalassaemia major despite optimal transfusion and iron chelation. The associated features suggest that the severely low bone mass is due to endocrine abnormalities, in contrast to the haematological causes of bone disease characteristically seen in untreated thalassaemics.

Adult↗
PubMed1998

Mortality in women and men in relation to smoking.

BACKGROUND: Mortality from smoking-related diseases in women is increasing worldwide. Studies comparing hazards associated with smoking in women and men based on a sufficient number of heavy smokers of both genders are lacking. METHODS: We used pooled data from three prospective population studies conducted in Copenhagen to compare total and cause-specific mortality in relation to smoking habits. A total of 30917 subjects, 44% women, with initial examinations between 1964 and 1992 were followed until 1994 for date and cause of death. RESULTS: During follow up, 2900 women and 5744 men died. Smoking characteristics differed considerably with gender, particularly in the older subjects. Overall mortality rates in smokers were approximately twice those in people who never smoked. Positive associations with smoking in both men and women were confirmed for all-cause mortality as well as mortality from respiratory disease, vascular disease, lung cancer, and other tobacco-related cancers. Despite large gender differences in age at smoking debut, total and cause-specific relative mortality in smokers was similar in men and women. After excluding non-inhalers, relative risks associated with smoking for respiratory and vascular disease were higher for women than men whereas there were no gender differences in smoking related risk of cancers. CONCLUSIONS: The relative risks suggest that women may be more sensitive than men to some of the deleterious effects of smoking. However, because of lower baseline mortality rates in women, rate differences may be similar and results should be interpreted with caution.

Adolescent↗
PubMed1998

Psychosocial, behavioural, and health determinants of successful smoking cessation: a longitudinal study of Danish adults.

OBJECTIVE: To examine the factors that determine whether or not smokers become long-term quitters, and to study whether determinants of successful cessation differ with levels of motivation to stop. DESIGN: In a cohort of men and women, aged 30-60 years at first examination in 1982/1984, smoking behaviour was evaluated from questionnaires at baseline and at follow up 10 years later. SETTING: County of Copenhagen, Denmark. PARTICIPANTS: 2554 subjects from the original sample of 4581 were successfully followed. This study deals with the 1365 subjects who were smokers at the first examination. MAIN OUTCOME MEASURE: Smoking status (abstinent for one year or more) at follow up. RESULTS: At follow up 15% of the baseline smokers had been abstinent for one year or more. In multivariate analysis, successful smoking cessation was associated with older age, high social status, low prior tobacco consumption, baseline motivation to stop smoking, and having a non-smoking spouse/cohabitant. The same result was obtained when the analyses were repeated separately for smokers with and without motivation to stop. CONCLUSIONS: Smokers motivated to stop are more likely to quit and remain abstinent than smokers with no such motivation. Age, social status, spouse/cohabitant's smoking behaviour, and the daily consumption of tobacco predict success in smoking cessation, irrespective of smokers' former motivation to stop.

Adult↗
PubMed1998

Update on the "Dutch hypothesis" for chronic respiratory disease.

BACKGROUND: Many patients with chronic obstructive lung disease show increased airways responsiveness to histamine. We investigated the hypothesis that increased airways responsiveness predicts the development and remission of chronic respiratory symptoms. METHODS: We used data from 24-year follow-up (1965-90) of 2684 participants in a cohort study in Vlagtwedde and Vlaardingen, Netherlands. Increased airways responsiveness was defined as a PC10 value (concentration of histamine for which challenge led to a 10% fall in forced expiratory volume in 1 s) of less than 8 mg/ml. Information on respiratory symptoms was collected by means of a standard questionnaire every 3 years. Logistic regression was used to control for age, area of residence, cigarette smoking status, and sex. FINDINGS: Participants with increased airways responsiveness (1281 observations) were more likely than those without increased airways responsiveness (5801 observations) to develop the following symptoms during any 3-year follow-up interval: chronic cough (odds ratio 1.9 [95% CI 1.2-2.9]), chronic phlegm (2.0 [1.3-3.0]), dyspnoea (2.3[1.5-3.5]), asthmatic attacks (3.7[2.2-6.1]), and persistent wheeze (2.7[1.7-4.4]). The estimate of the odds ratio for the development of any of the six symptoms was 1.7 (1.2-2.3). Participants with increased airways responsiveness were less likely than those without this characteristic to show remission of these respiratory symptoms. The estimate of the odds ratio for the remission of any of the six symptoms was 0.42 (0.28-0.61). INTERPRETATION: These prospective analyses show that increased airways responsiveness is positively associated with the development of chronic respiratory symptoms and negatively associated with the remission of these symptoms in adults.

Bronchial Hyperreactivity↗