[Nutritional deficiency an unlikely cause of death during sport training].
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Attitude to Health↗
Biomedical subjects
L Hansson
Publications and source records attributed to L Hansson.
The Nordic comparative study on sectorized psychiatry. II. Resources of the psychiatric services and treated incidence.
As a part of a Nordic comparative study on sectorized psychiatry, treated incidence was related to the resources and dynamic qualities of psychiatric services in 7 catchment areas. One-year treated incidence cohorts were used. Data was collected concerning number of beds and staff, number of long-term patients and turnover rate of patients in the services and availability of specialized services. A positive correlation was found between rates of outpatient staff and treated incidence. No statistically significant correlation was found between the dynamic qualities of the services and treated incidence. Treated incidence of dependence was the highest in a center that had a special service unit for abusers. Special services for young and old people were not clearly reflected in treated incidence in respective patient groups.
Adolescent↗
Status of current therapies for hypertension.
Specific antihypertensive therapy has been in common clinical use for about four decades. During this relatively short period of time remarkable progress has been made in many regards. The value of lowering elevated arterial pressure has been documented in a number of intervention trials. Initially, such studies comprised patients with malignant hypertension only, but later large-scale studies have comprised patients with non-malignant forms of hypertension. At the same time numerous new pharmacological principles have been taken into clinical use in the treatment of hypertension. It is the purpose of this brief review to sum up some of the important steps that have been taken in this area during previous decades and to try to evaluate the status of current therapies for hypertension. Special emphasis will be given to some of the remaining issues and questions that are currently under investigation, such as the place of novel therapies, e.g. calcium antagonists and ACE-inhibitors, and the issue of the level to which blood pressure should be lowered in order to extract the maximum benefit of antihypertensive treatment. Some of the ongoing large-scale intervention trials in hypertension, e.g. the CAPPP Study, the NORDIL Study, the HOT Study and the STOP Hypertension-2 study, will be reviewed.
Aged↗
General considerations when treating hypertension.
Numerous intervention studies have clearly demonstrated the value of antihypertensive treatment. By lowering diastolic blood pressure 5 to 6mm Hg in middle-aged hypertensive patients, a 42% reduction in stroke morbidity and a 14% reduction in coronary heart disease morbidity can be obtained. Recently published large intervention trials have shown that antihypertensive treatment provides even greater benefits in elderly hypertensive patients. Not only are cardiovascular morbidity and mortality reduced, but, in the 'old elderly', total mortality is reduced when blood pressure is lowered. It is conceivable that even better outcomes will be achieved with newer antihypertensive therapies, such as calcium antagonists and angiotensin converting enzyme inhibitors, and this possibility is being investigated in large prospective intervention trials.
Aged↗
Replication of bovine papillomavirus vectors in murine cells.
Varying capacities for autonomous replication have been obtained with bovine papillomavirus type 1 (BPV-1)-based expression vectors in mouse C127 cells. Both integration of the vector DNA into the genome of the host cell and replication as monomeric extrachromosomal elements have been observed. In this study, we have examined what features of BPV-1 vectors influence their replication potential. Transfection of the entire BPV-1 genome into C127 cells resulted in the replication of extrachromosomal monomeric BPV-1 elements. The same result was obtained when a plasmid sequence was inserted into the BPV-1 DNA. However, introduction of foreign, transcriptionally active units resulted in chromosomal integration of the expression vectors. This result was obtained with clones isolated by co-transfection followed by neomycin selection, as well as with clones isolated from neoplastic foci. Supertransfection of a BPV-1-based expression vector into cells harbouring unintegrated replicating BPV-1 genomes resulted in integration of the vector DNA, whereas replication of the resident BPV-1 genomes was unaffected. Extrachromosomal replication of such a vector was achieved when the enhancer and promoter region of the foreign gene were deleted.
Animals↗
Reduced clearance of leukocytes from lungs in septic rats.
Leukocytes have previously been shown to sequestrate in the lungs and liver in association with traumatic and septic shock. In a rat model of gram-negative sepsis of intra-abdominal origin, a previously described in vivo technique was used for dynamic studies of leukocyte sequestration in different organs using white blood cells labeled with 111-indium-oxine. One group of rats was either studied immediately after induction of sepsis or for 6 h under a scintillation camera for continuous registration of the activity distribution (i.e., presence of leukocytes). Another group was studied 12 h after induction of sepsis for 60 min. The activity increased immediately over the lungs, indicating sequestration of the leukocytes during the first 6 h, but there was no significant difference in this respect between septic and control animals. It does not seem possible to study leukocyte sequestration dynamically in this way. When the labeled leukocytes were administered 12 h after induction of sepsis, however, the activity of septic animals' lungs was seen to remain elevated over the time period studied compared with control rats, in which the activity slowly decreased. In the liver and spleen, the activity increased in both groups, but significantly more so in control animals, which may be explained by disturbed leukocyte margination and cell turnover in the septic animals. This study has indicated that leukocyte distribution in different organs is affected by sepsis and this reaction can be studied using radiolabeled leukocytes.
Animals↗
Reversal of cardiovascular structural changes when treating essential hypertension. The importance of the renin-angiotensin-aldosterone system.
Our study attempted to evaluate the importance of changes in the circulating renin-angiotensin-aldosterone system (RAAS) and in hemodynamics in relation to observed changes in cardiovascular structure. We studied previously untreated men (n = 28) with essential nonmalignant hypertension and a supine casual diastolic blood pressure > 95 mm Hg on three to four separate (> 1-week interval) occasions measured in triplicate. We used intraarterial blood pressure, dye-dilution technique, plethysmography (hands), eye-ground photos, M-mode echocardiography, radio immunoassays, and multiple regression analysis. Patients were randomized to 6 months of double-blind treatment with either enalapril or hydrochlorothiazide, following 4 to 6 weeks on placebo. We found that enalapril blocked the plasma angiotensin converting enzyme (ACE) with a secondary increment in plasma renin activity (PRA) and reductions in angiotensin II (AII) and aldosterone. Blood pressure was lowered through a reduction in total peripheral resistance (TPR). Hydrochlorothiazide increased PRA, AII, and aldosterone, and lowered blood pressure mainly through a reduction in cardiac output. Enalapril was significantly more effective than hydrochlorothiazide in reversing structural changes in the retinal and hand vasculature as well as in the heart. A reduction in cardiac hypertrophy was seen even in the occasional enalapril-treated patient, in whom little or no reduction in blood pressure occurred. In the stepwise regression analyses, the changes in retinal and hand vascular structure were most strongly related to various changes in the RAAS, explaining 15 to 34% of the variance. For the changes in cardiac structure, the type of therapy (enalapril or hydrochlorothiazide) appeared to be the most important factor, explaining between 29 and 50% of the variance. The changes in cardiac structure were even more strongly related to changes in the RAAS for the enalapril treated patients and explained up to 55% of the variance in cardiac structure. It can be concluded that the reversal of structural vascular changes during antihypertensive therapy was more dependent on the blockade of the RAAS than on lowering of the blood pressure.
Blood Pressure↗
Reversal of left ventricular hypertrophy in hypertensive patients. A metaanalysis of 109 treatment studies.
This is a metaanalysis of all available studies as of December 1990 that have evaluated the effect of antihypertensive pharmacologic therapy on left ventricular structure examined by echocardiography. We applied preset inclusion criteria to the analysis. A total of 109 studies comprising 2357 patients (28% previously untreated) with an average age of 49 years (range 30 to 71) were included. Overall left ventricular mass (LVM) was reduced by 11.9% [95% confidence interval (CI) 10.1 to 13.7] in parallel with a reduction of mean arterial pressure of 14.9% (CI 14 to 15.8). To differentiate between first-line therapies and to adjust for differences between studies, we performed ANCOVA. Angiotensin converting enzyme (ACE) inhibitors reduced LVM by 15% (CI 9.9 to 20.1), beta-blockers by 8% (CI 4.8 to 11.2), calcium antagonists by 8.5% (CI 5.1 to 11.8), and diuretics by 11.3% (CI 5.6 to 17). When we calculated LVM using the same formula for all studies the absolute reductions in grams were 44.7 g with ACE inhibitors, 22.8 g with beta-blockers, 26.9 g with calcium antagonists, and 21.4 g with diuretics. Except for diuretics, all therapies mainly affected wall thickness, while diuretics predominantly reduced ventricular diameter. In conclusion, this metaanalysis shows that ACE inhibitors, beta-blockers, and calcium antagonists all reduce LVM by reversing wall hypertrophy, and that the effect is most pronounced with ACE inhibitors. Conversely, diuretics reduce LVM mainly through a reduction of left ventricular volume. Based on these data, we hypothesize that ACE inhibitors are more effective than other first-line therapies in reducing LVM. However, this theory and its possible prognostic implications need to be evaluated in controlled prospective trials.
Adult↗
Cardiovascular risk factors and antihypertensive treatment.
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Antihypertensive Agents↗
Is blood pressure measurement with a standard cuff reliable?
This study compares blood pressures measured with a standard cuff (rubber bag 12 x 35 cm) with concomitantly measured intra-arterial pressures in 48 subjects. With the standard cuff, and using a diagnostic cut-off limit for diastolic hypertension of 90 mmHg, 15/48 patients were found to be hypertensive, whereas only 4/48 had intraarterial pressure above 90 mmHg. Thus, the specificity of the non-invasive method was only 75%. If higher diagnostic cut-off limits were used, e.g. 95 mmHg, specificity increased to 84%, and with lower cut-offs specificity was 63% for 85 mmHg and 52% for 80 mmHg. A specificity of only 75% is very poor for a method commonly used in screening examinations and may lead to considerable over-diagnosis of mild hypertension.
Adolescent↗
Regression of left ventricular hypertrophy in previously untreated essential hypertension: different effects of enalapril and hydrochlorothiazide.
OBJECTIVES: Primarily to investigate the long-term effects of antihypertensive therapy on left ventricular morphology in non-malignant essential hypertension and in particular to compare an angiotensin converting enzyme inhibitor and a diuretic in this respect. DESIGN: Previously untreated males aged 20-65 years with diastolic blood pressure > or = 95 mmHg during a 4- to 6-week placebo period were randomly assigned to double-blind treatment with enalapril or hydrochlorothiazide. METHODS: Indirect and intra-arterial blood pressure, echocardiography, apex cardiography, carotid pulse tracing and phonocardiography. RESULTS: Left ventricular mass (LVM) was significantly correlated with intra-arterial blood pressure at baseline. During long-term treatment (14-18 months) blood pressure decreased significantly in both treatment groups (indirectly and intra-arterially), at rest and during dynamic exercise. No significant differences in blood pressure response were seen between the two therapeutic alternatives. LVM decreased progressively and significantly on enalapril after 18 months of monotherapy and decreased non-significantly on hydrochlorothiazide after 14 months of monotherapy. The difference in effect between treatments was significant in a stepwise regression analysis taking change in blood pressure into account. The relationship between the reductions in LVM and blood pressure were significant for enalapril but not for hydrochlorothiazide. Neither therapy affected left ventricular diastolic or systolic diameters significantly, but enalapril reduced posterior wall thickness and interventricular septal thickness significantly, and improved left ventricular distensibility significantly. Neither therapy had any negative effects on systolic function, although hydrochlorothiazide decreased left ventricular ejection time index significantly. CONCLUSION: Enalapril was significantly more effective than hydrochlorothiazide in reversing left ventricular hypertrophy without negatively affecting left ventricular function.
Adult↗
Antihypertensive efficacy and side effects of three beta-blockers and a diuretic in elderly hypertensives: a report from the STOP-Hypertension study.
OBJECTIVE: To compare the blood pressure-lowering efficacy, the frequency of side effects and changes in laboratory values of three beta-blockers and a potassium-sparing diuretic combination in elderly hypertensive patients. DESIGN: The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was a prospective, randomized, double-blind, multicentre trial comparing active antihypertensive treatment with placebo in patients aged 70-84 years. METHODS: The study group consisted of 1627 elderly hypertensive patients (mean +/- SD age 75.7 +/- 3.7 years; 37% males, 63% females). Supine and standing blood pressure, heart rate and side effects were recorded at each visit. Blood was drawn for routine analysis. The mean length of follow-up was 25 months (range 6-65). No patient was lost to follow-up. RESULTS: After 2-months' single-drug therapy, all four active drugs were found to be equally effective in reducing diastolic blood pressure (DBP). However, there were differences in their efficacy in reducing systolic blood pressure (SBP); the diuretic was significantly more effective than the beta-receptor blockers. The results of a series of multiple linear regression analyses showed that the observed differences in effect on SBP could not be explained by the different effects of the drugs on heart rate. More than two-thirds of the patients were given supplementary treatment, most of them already by the 2-month visit, after which there was no significant difference in blood pressure among the treatment regimens. The changes in laboratory values and in the prevalence of symptoms were minor for all four regimens. CONCLUSION: Metoprolol (controlled release), atenolol, pindolol and the combination hydrochlorothiazide + amiloride were equally effective as single drugs in reducing DBP. There were differences in their efficacy in reducing SBP, the diuretic being more effective than the beta-blockers. After addition of supplementary treatment (beta-blocker to diuretic, or vice versa) there were no significant differences in blood pressure reduction among the groups. The changes in laboratory values and in the prevalence of symptoms were minor for all active treatment regimens. Thus, the satisfactory effect on cardiovascular morbidity and mortality was not impaired by low tolerability of the drugs.
Aged↗
Utilization and patterns of care in comprehensive psychiatric care organizations. A review of studies and some methodological considerations.
This article reviews and analyzes studies on the utilization of care and patterns of care in psychiatric care organizations with a defined catchment area responsibility. Eight studies fulfilled the inclusion criteria. The main results of the studies were reviewed with regard to distribution of utilization, typical patterns of care, sociodemographic characteristics, clinical characteristics and, when appropriate, organizational characteristics related to utilization. The results show that a small proportion of patients use a large proportion of resources. Sociodemographic factors such as living alone or having no occupation in some of the studies predicted a higher utilization. Only one study reported sex differences, men being more common among heavy users. In most of the studies a psychosis diagnosis predicted a higher utilization. A history of prior contacts with psychiatric care predicted a higher utilization in 2 studies. It is concluded that future studies should make efforts to develop standardized models of classification of patterns of care to enhance possibilities of comparisons. Cost, as a common unit for summarizing and comparing resource utilization, has not been used, but is viewed as a highly relevant measure. Furthermore, measures of utilization should be separated from evaluations of outcome or quality of care. However, the latter is a neglected area that should also be promoted in studies of utilization of psychiatric care to create knowledge of the relationship of utilization to outcome.
Catchment Area, Health↗
Antihypertensive drugs and plasma lipids.
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Adrenergic beta-Antagonists↗
Increased passage of bovine serum albumin over the respiratory tract after intratracheal instillation during septic shock in rats.
Sepsis may initiate acute respiratory distress syndrome which may be accompanied by an increased pulmonary epithelial-endothelial permeability. In this study, sepsis was induced by an intraperitoneal implantation of gelatine capsules containing Escherichia coli/Bacteroides fragilis/adjuvant substance. The importance of bacteria in sepsis-related lung injury was studied in rats given an intraperitoneal injection of E. coli or in rats given the adjuvant substance alone in capsules intraperitoneally. Rats with empty capsules were used as controls. The rats were intratracheally instilled with bovine serum albumin (BSA) directly after the capsule implantation or the injection of E. coli, and the passage over the lower respiratory tract was assessed as blood plasma levels of immunoreactive BSA. The plasma BSA levels in the control rats increased continuously up to 24 h after intratracheal instillation. This increase was significantly augmented already 1 h after the septic challenge, i.e. before any clinical symptoms were observed, in both the septic rats and the rats with the E. coli injected intraperitoneally. Furthermore, the time required to obtain maximal plasma BSA levels was shorter in septic, adjuvant-exposed and in E. coli-injected rats than in the controls. The plasma levels and the total BSA passage over the lower respiratory tract was significantly higher (p less than 0.001) in the septic and in the E. coli-injected rats than in the adjuvant-exposed and the control rats.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Relation of central hemodynamics to obesity and body fat distribution.
Central obesity increases the risk for cardiovascular disease, but little is known about its hemodynamic effects. The aims were to investigate the influence of obesity (as defined by body mass index) and abdominal fat accumulation (as defined by the waist/hip ratio) on hemodynamics at rest and during mental stress. Invasive hemodynamic studies were performed in 20 healthy, normotensive young men (aged 18-22 years) recruited from an unbiased population sample. Their body mass index and waist/hip ratio ranged between 18.5 and 30.2 (mean 24.1) and 0.77 and 0.98 (mean 0.87), respectively. Hemodynamics were related to the two anthropometric indexes by bivariate regression analyses. Cardiac output and stroke volume were positively correlated to body mass index (p = 0.05 and p = 0.005), but inversely to waist/hip ratio (p = 0.01 and p = 0.01). Mental stress augmented the hemodynamic patterns. Total peripheral resistance during stress correlated inversely to body mass index (p = 0.02), whereas high waist/hip ratio was associated with higher systemic vascular resistance p = 0.002). The delta CO/delta MAP ratio, i.e., relative contribution of cardiac output for the stress-induced increase in mean arterial pressure, showed a strong positive association with body mass index (p = 0.004), but was inversely related to the waist/hip ratio (p = 0.002). Serum insulin correlated significantly to the stress-induced change in total peripheral resistance (r = 0.54; p = 0.02), whereas the increase in cardiac output was inversely related to insulin (r = -0.59; p = 0.007). Thus, central obesity is associated with a specific hemodynamic pattern characterized by higher total peripheral resistance, lower cardiac output, and a vasoconstrictor response to psychosocial stress.
Adipose Tissue↗
Regional sensitivity of human airways to capsaicin-induced cough.
To examine the sensitivity of different parts of the human respiratory tract to a tussive and bronchoconstrictor stimulus, randomized, standardized single breaths of capsaicin aerosols were inhaled by nine healthy, nonsmoking subjects. A small droplet aerosol (3.2 microns MMD) was inhaled slowly (0.25 L/s), and a large droplet aerosol (5.2 microns MMD) was inhaled rapidly (1.0 L/s) to optimize differences in deposition, which were assessed after inhalation of 99mTc-DTPA aerosols with similar characteristics. Both capsaicin aerosols (zero to 256 microM) produced a concentration-dependent cough response. The geometric means (95% Cl) for the concentrations causing two coughs (cough threshold) were 2.3 microM (1.1 to 4.9) and 8.7 microM (3.1 to 24.5) (p less than 0.02), respectively, with the small and large droplet aerosols. The concentrations causing five coughs were 5.5 microM (3.0 to 10.0) with the small droplet aerosol and 29.5 microM (8.3 to 104.7) with the large droplet aerosol (p less than 0.02). In contrast, FEV1, measured 2 min after the largest concentration of capsaicin, was not significantly altered by any of the two capsaicin aerosols. In each subject, a similar dose was deposited in the larynx with both aerosols, whereas the dose deposited in intrapulmonary airways was 2.3 times larger with the small droplet aerosol. This study confirmed that slow inhalation of a small droplet aerosol produced a more peripheral airway deposition than did rapid inhalation of a large droplet aerosol. The small droplet aerosol was four times more potent, and capsaicin-sensitive sensory neurons mediating cough seem, therefore, to be present in human intrapulmonary airways.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Capsaicin-induced cough in humans.
We have evaluated the properties of capsaicin as a selective cough-inducing agent in healthy human subjects. Despite frequent coughing, the subjects could inhale repeated breaths of capsaicin aerosol during 60 s without difficulty. Cough started immediately on inhalation and was most intense during the first 30 s. Cough always disappeared promptly when the capsaicin inhalation was terminated. The cough response was well reproducible and concentration-dependent up to 10 microM; at higher concentrations there was a distinct plateau of the cough response. Specific airway conductance was not changed 3 min after 50 microM capsaicin. Capsaicin (> or = 10 microM) had a burning taste, but there were no visual signs of pharyngitis or laryngitis. Citric acid (nebulized solutions 0.125 to 32%) had a choking effect and could be administered only as single breaths. There was no correlation between the cough response to citric acid and to capsaicin. Inhaled lidocaine (20 and 80 mg from nebulized solutions) caused a dose-dependent inhibition of capsaicin-induced cough. Lidocaine suppressed citric acid-induced cough as effectively as capsaicin-induced cough. In conclusion, we have characterized capsaicin-induced cough and demonstrated that it can be a useful tool in the study of cough reactivity and for evaluation of antitussive agents in humans. Capsaicin may be complementary to citric acid and may offer experimental advantages over this traditional tussive stimulus.
Administration, Inhalation↗