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Biomedical subjects

N Hammar

Publications and source records attributed to N Hammar.

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

ECG-abnormalities in Japanese and Swedish patients with sarcoidosis. A comparison.

BACKGROUND AND AIM OF THE WORK: ECG abnormalities are more common in patients with sarcoidosis than in controls. The incidence of cardiac sarcoid granulomas in the Japanese population has been found to be higher than that seen in Caucasians. We compared the prevalence of ECG abnormalities in Japanese and Swedish patients with sarcoidosis. METHODS: Twelve-lead routine ECG's were compared between consecutive patients (134 Japanese and 149 Swedish) of similar age with histologically verified sarcoidosis or a high clinical probability of the disease and a history of no more than 12 months before the ECG. RESULTS: There was no statistically significant difference in the prevalence of first degree AV block, ST-T-segment abnormalities, right bundle branch block (RBBB) and left anterior block (LAH) in Japanese and Swedish patients. Among the Swedes, the results were compared with those of a smaller group (n = 29) of older patients with a longer disease course. In these few patients LAH and RBBB occurred more frequently than in patients with a recent diagnosis. CONCLUSIONS: ECG abnormalities in patients with sarcoidosis seem to be of similar frequency in Japan and Sweden. ST-T changes and first degree AV block would appear early in the course of the disease, whereas more pronounced conduction defects may appear later.

Cardiomyopathies↗
PubMed2000

[Obesity doesn't increase the risks of coronary surgery. Results from a study of 7,248 patients who underwent the surgery].

Out of 7,248 patients who underwent coronary artery bypass surgery from 1970-1995, 17% of females and 13% of males were severely obese, defined as body mass index (BMI) 30 kg/m2. Risk of death within 30 days of operation was 2.1% in patients with BMI < 25 kg/m2, 2.1% if BMI was 25-30 kg/m2 and 1.3% in patients with BMI 30 kg/m2 (P = 0.20). The low risk in obese patients persisted after multivariate correction for year of surgery, age, sex, hypertension, diabetes, unstable angina and number of diseased vessels. The risk of reoperation for bleeding decreased (P < 0.001) whereas the risk of wound infection and sternal dehiscence increased (P = 0.09 and P = 0.05, respectively) with increasing BMI. We conclude that coronary artery bypass surgery can be performed safely in obese patients.

Adult↗
PubMed2000

Incidence of acute myocardial infarction and cause-specific mortality after transurethral treatments of prostatic hypertrophy.

OBJECTIVES: Transurethral resection of the prostate (TURP) is associated with a higher long-term mortality than open prostatectomy which has been ascribed to a higher incidence of acute myocardial infarction (AMI). To assess the possible excess risk associated with TURP, we studied the incidence of AMI and the cause-specific mortality in patients treated with TURP and transurethral microwave thermotherapy (TUMT). METHODS: Patients treated for benign prostatic hypertrophy at a university hospital (888 patients with TURP and 478 with TUMT) were monitored during an average follow-up period of 3.9 years. The incidence of AMI and the causes of death were compared with those in the general population. RESULTS: Both treatments were followed by a higher incidence of AMI than in the general population, in particular from 2 years or more after treatment (standardized morbidity ratio 1.50, 95% confidence interval [CI] 1.14 to 1.93). The long-term mortality from all causes was increased in patients younger than 75 years of age when undergoing any of the treatments (standardized mortality ratio [SMR] 1.16, 95% CI 0.97 to 1.39), in particular, death from cardiovascular diseases (SMR 1.25, 95% CI 0.95 to 1.60) and tumors (SMR 1.54, 95% CI 1.14 to 2.03). CONCLUSIONS: The similarity of the results for TURP and TUMT suggests that the prostatic enlargement rather than the treatment is associated with cardiovascular disease.

Adult↗
PubMed2000

Recent time trends in acute myocardial infarction in Stockholm, Sweden.

AIMS: The purpose of this study was to analyse time trends in first acute myocardial infarction (AMI) incidence in Stockholm County during 1984-1996. METHODS AND RESULTS: The study base consisted of the population of Stockholm County 30-89 years old 1984-1996. New cases of first AMI in the study base were identified by combining information regarding hospital discharges and deaths. The diagnostic quality was evaluated for 2403 First-AMI cases 45-70 years old that occurred during 1992-1994. The evaluation indicated a very high agreement with diagnostic criteria of AMI among hospital treated cases. Among fatal cases outside hospital, the autopsy rate was nearly 70%. The incidence of first AMI declined during the study period for both men and women. In men, the age-adjusted incidence of first AMI was 18% lower in 1994-1996 than in 1984-1987 and in women it was 13% lower. The average yearly decline was 2% for men and 1.4% for women. CONCLUSION: The results of this study suggest a continued decline in AMI incidence in Stockholm. A reduction in the proportion of regular smokers has probably contributed to this decline. Future trends in AMI incidence are difficult to predict in view of diverging trends in risk factors.

Adult↗
PubMed2000

Reduced risk of coronary artery bypass surgery for unstable angina during a 6-year period.

OBJECTIVE: To assess the risk of early death or acute myocardial infarction in patients undergoing isolated coronary artery bypass surgery for unstable coronary artery disease. METHODS: Retrospective observational study of 853 patients operated on because of unstable coronary artery disease during 1990-1995. RESULTS: There were 5.9% deaths and 13.0% nonfatal infarctions < or =30 days. These figures declined during the observation period and were 2.6% and 6.2%, respectively, in 1995. The relative risk of early death or myocardial infarction was 50% less during 1994-1995 than during 1990-1991, after multivariate adjustment for several patient risk factors. The risk of death or infarction was almost twice as high in patients > or =50 years than in those < 50 years of age. Multivariate analysis showed that aortic-cross-clamp time > or =60 min, previous bypass surgery, pre-operative heart failure, emergency surgery, worse Braunwald class and non-use of an internal mammary artery graft were associated with an increased risk of death or infarction. Early mortality was 3.4% (24/702) in unstable patients without symptoms of congestive heart failure, who were not operated on emergently after failed percutaneous coronary intervention and had not had previous cardiac surgery. CONCLUSIONS: We observed a marked reduction of the risk of early death or myocardial infarction after surgery for unstable angina during the 6-year period 1990-1995. The risk reduction was not explained from operations performed on patients with less risk and indicates improved peri-operative patient management.

Adult↗
PubMed2000

Attack rate, mortality and case fatality for acute myocardial infarction in Sweden during 1987-95. Results from the national AMI register in Sweden.

OBJECTIVE: To assess trends in attack rate, mortality and case-fatality of acute myocardial infarction (AMI) in Sweden. SETTING: All 303 324 Swedes discharged from hospitals, or deceased, with a diagnosis of AMI between 1987 and 1995. DESIGN: Analysis based on the National AMI Register in Sweden. The National AMI Register was assembled by linking the records of the National Hospital Discharge Register and the National Cause of Death Register in Sweden. MAIN OUTCOME MEASURES: Age-standardized attack rate, mortality and case fatality rates for AMI. RESULTS: Between 1987 and 1995, the age-standardized attack rate of AMI declined by 11% for men and 10% for women, whilst mortality from AMI decreased by 14% for both sexes. The decrease was most pronounced for men below the age of 64, with a reduction of 22% in attack rate and nearly 30% in mortality. There was no change over time in the case fatality rates on the date of attack, including also deaths outside hospital, whilst case fatality within 28 days decreased from 49 to 45% amongst men, and 45 to 42% amongst women. This reduction persisted over 1 year of follow-up. CONCLUSIONS: The decrease in attack rate of AMI in Sweden may be attributed both to changes in risk factors amongst the population and to improved medical intervention. The decline in case fatality rates indicates that improved treatment of patients with AMI has contributed to the reduction in mortality. However, the high, and essentially unchanged, proportion of deaths outside hospital stresses the importance of disease prevention.

Adult↗
PubMed2000

Alcohol consumption, Type 2 diabetes mellitus and impaired glucose tolerance in middle-aged Swedish men.

AIMS: To investigate the association between alcohol consumption and impaired glucose tolerance and Type 2 diabetes mellitus. METHODS: A population-based cross-sectional study consisting of 3,128 Swedish men, aged 35-56 years. Oral glucose tolerance testing identified 55 cases of Type 2 diabetes and 172 cases of impaired glucose tolerance. Information on alcohol consumption, family history of diabetes, smoking and physical activity was obtained by questionnaire. RESULTS: After adjustment for family history, smoking, physical activity and body mass index, the odds ratio of diabetes was 2.1 (95% confidence interval (CI) 1.0-4.5) in men with high consumption of alcohol (corresponding to over 12 drinks per week) and 0.7 (0.3-1.8) in moderate consumers (7-12 drinks), compared to occasional drinkers. For impaired glucose tolerance, the corresponding odds ratios were 0.7 (0.5-1.1) and 0.6 (0.4-1.0), respectively. Separate analyses for type of beverage indicated that high consumers of beer, spirits and wine had an odds ratio for diabetes of 2.9 (1.2-6.9), 3.3 (1.4-7.8) and 1.2 (0.5-2.7), respectively. CONCLUSIONS: The results indicated that high consumption of alcohol increases the occurrence of Type 2 diabetes and that this may primarily concern consumption of beer and spirits. For impaired glucose tolerance, regular alcohol consumption was associated with a reduced prevalence, particularly at moderate levels.

Adult↗
PubMed1998

Myocardial infarction among women with early-stage breast cancer treated with conservative surgery and breast irradiation.

PURPOSE: To assess the possible impact of the irradiation on the risk of acute myocardial infarction among breast cancer patients treated with conservative surgery and postoperative radiation therapy. METHODS AND MATERIALS: The incidence of and mortality from acute myocardial infarction was assessed in a group of 684 women with early-stage breast cancer diagnosed during 1976-1987 who had been treated with breast conserving surgery plus postoperative radiation therapy given with tangential photon fields. In 94% of the patients the total dose was between 48-52 Gy given with 2 Gy daily fractions 5 days per week for a total treatment period of about 4 1/2-5 1/2 weeks. In 88% of the patients the target volume included the breast parenchyma alone. In the remaining patients regional nodal areas were also irradiated. A concurrent group of 4,996 breast cancer patients treated with mastectomy without postoperative radiation therapy was used as a reference. RESULTS: After a median follow-up of 9 years (range: 5-16 years) 12 conservatively treated patients (1.8%) had developed an acute myocardial infarction and 5 (0.7%) had died due to this disease. The age-adjusted relative hazard of acute myocardial infarction for the conservative group vs. the mastectomy group was 0.6 (95% C.I.: 0.4-1.2) and for death due to this disease 0.4 (0.2-1.1). The incidence of acute myocardial infarction among the conservatively treated women was similar irrespective of tumor laterality. CONCLUSIONS: There was no indication of an increased risk of acute myocardial infarction with the radiation therapy among the women treated with conservative surgery. However, due to the small number of events the study could not exclude the possibility that cardiac problems may arise in some patients with left-sided cancers who have their heart located anteriorly in the mediastinum. Individual, three-dimensional dose planning represents one method to identify such patients and is basic to technical changes aimed at decreasing the cardiac radiation dose volume.

Adult↗
PubMed1998

High effort, low reward, and cardiovascular risk factors in employed Swedish men and women: baseline results from the WOLF Study.

STUDY OBJECTIVE: To examine associations between measures of work stress (that is, the combination of high effort and low reward) and cardiovascular risk factors. DESIGN: Cross sectional first screening of a prospective cohort study. SETTING AND PARTICIPANTS: The study was conducted among 5720 healthy employed men and women living in the greater Stockholm area aged 19-70 years. All analyses were restricted to subjects with complete data (n = 4958). The investigation of associations between indicators of effort-reward imbalance and cardiovascular risk factors was restricted to the age group 30-55 years (n = 3427). MAIN RESULTS: Subjects reporting high effort and low reward at work had a higher prevalence of well known risk factors for coronary heart disease. After adjustment for relevant confounders, associations between a measure of extrinsic effort and reward (the effort-reward ratio) and hypertension (multivariate prevalence odds ratio (POR) 1.62-1.68), increased total cholesterol (upper tertile 220 mg/dl)(POR = 1.24) and the total cholesterol/high density lipoprotein(HDL)-cholesterol ratio (upper tertile 4.61)(POR 1.26-1.30) were found among men. Among women a measure of high intrinsic effort (immersion) was related to increased low density lipoprotein (LDL)-cholesterol (upper tertile 130 mg/dl)(POR 1.37-1.39). Analyses of variance showed increasing mean values of LDL cholesterol with an increasing degree of the effort-reward ratio among men and increased LDL-cholesterol among women with high levels of intrinsic effort (upper tertile of immersion). CONCLUSIONS: Findings lend support to the hypothesis that effort-reward imbalance represents a specific constellation of stressful experience at work related to cardiovascular risk. The relation was not explained by relevant confounders (for example, lack of physical exercise, body weight, cigarette smoking).

Adult↗
PubMed1998

Job strain, social support at work, and incidence of myocardial infarction.

OBJECTIVES: The combination of high psychological job demands and low decision latitude (high job strain) has been associated with an increased risk of coronary heart disease. It has been proposed that this may also be the case for low social support at work. The aim of this study was to analyse the relations between these psychosocial factors and incidence of myocardial infarction. METHODS: Associations between psychosocial work characteristics and incidence of myocardial infarction was investigated through a population based case-control study. The study base comprised employed men and women in five Swedish counties during the years 1976-84. Cases of first myocardial infarction were identified from hospital discharge registers and death records from outside hospital, controls were selected through a random sample, and psychosocial work environment was assessed through a job exposure matrix on the basis of the occupation in the 1970 and 1975 censuses. RESULTS: An increased incidence of myocardial infarction was found for men and women in occupations characterised by low decision latitude. For men this increase was seen primarily in combination with high psychological demands (high job strain) and low social support at work. Younger men (30-54 years of age) in occupations with both high job strain and low social support at work had a relative risk of 1.79 (95% confidence interval (95% CI) 1.22 to 2.65) compared with subjects in low strain and high social support jobs after controlling for age, county of residence, and socioeconomic group. CONCLUSIONS: Our results indicate that jobs characterised by low decision latitude, high job strain, or low social support at work may be associated with an increased risk of acute myocardial infarction. If these associations are causal they may be of substantial importance from the point of view of workers' health.

Adult↗
PubMed1998

Myocardial infarction in male and female dominated occupations.

The aim of the study was to investigate whether workers in jobs dominated by the opposite sex have an increased risk of myocardial infarction (MI). A case-referent study was carried out to estimate the relative risk of first MI in different occupational groups. The study base comprised all men and women in five counties in the middle of Sweden during 1976-84. Cases of MI were identified from both hospital discharge records and death records. Information on occupation was obtained from two consecutive censuses. Primary health related selection was analysed for men with data from the physical examination of conscripts to compulsory military service in 1969-70 combined with data from the censuses of 1970-90 and data on early retirement in 1971-92. Increased risk of MI was found among both women (relative risk (RR) 1.41, 95% confidence interval (95% CI) 1.15 to 1.73) and men (1.21, 1.10 to 1.32) in blue collar jobs where men predominate, and among men with white collar jobs (1.26, 1.09 to 1.45) where women predominate. However, the increased risk among men in white collar jobs was probably due to negative health selection into these occupations. These results do not support the notion that being of the sexual minority in an occupation is in itself an important risk factor for MI.

Adult↗
PubMed1997

Comparison of early and late mortality in men and women after isolated coronary artery bypass graft surgery in Stockholm, Sweden, 1980 to 1989.

OBJECTIVES: We sought to analyze early and late mortality after coronary artery bypass graft surgery (CABG) in relation to gender. BACKGROUND: Early mortality after CABG is generally higher in women than in men, but the causes are controversial. Few studies have investigated long-term mortality after CABG in relation to gender. METHODS: In all, 3,326 men and 607 women underwent isolated CABG in Stockholm from 1980 to 1989. Mortality for these patients was followed by means of the National Cause of Death Register, from the time of operation until the end of 1990. Survival was evaluated by life-table methods and by proportional hazards regression. RESULTS: Early mortality (within 30 days) was 3% in women and 1.7% in men, corresponding to a relative risk of 1.8 (95% confidence interval [CI] 1.0 to 3.0) in women compared with men. When age and body surface area were taken into account, the relative risk was 1.0 (95% CI 0.5 to 2.0), which was not markedly different but multivariate analyses that included hypertension, diabetes mellitus, previous myocardial infarction, left ventricular function and number of diseased vessels. Only small gender differences in mortality were observed for 5 years after the operation among those who survived for 30 days. CONCLUSIONS: The results suggest that men and women run similar risks of early and late mortality after CABG when patient characteristics are taken into account.

Adult↗
PubMed1997

Alcohol consumption, drinking pattern and acute myocardial infarction. A case referent study based on the Swedish Twin Register.

OBJECTIVES: Little is known about the possible influence of different kinds of alcohol drinking pattern on the risk of acute myocardial infarction. In this study the association between average daily alcohol consumption, as well as large intakes of alcohol on single occasions, and myocardial infarction incidence was investigated. DESIGN: A case referent analysis nested within a prospective cohort study. SETTING: Incident cases of myocardial infarction were identified by using hospital discharge data and deaths. Referents were selected from the study population through a stratified random sample. SUBJECTS: Individuals of the Swedish Twin Register below 75 years of age living in a region of 10 Swedish counties in 1972-1981 or in Stockholm County in 1972-1987. MAIN OUTCOME MEASURE: Incidence of acute myocardial infarction. RESULTS: No difference in myocardial infarction incidence was found between former alcohol drinkers and lifelong abstainers. For men, drinkers had a 40% lower incidence than non-drinkers, as did those with a drinking pattern involving a large intake on single occasions. Women had on average a very low level of alcohol consumption and there were only small differences in incidence of myocardial infarction between drinkers and non-drinkers. An increased incidence was indicated for women reporting some-times drinking comparatively large amounts of alcohol on single occasions. CONCLUSIONS: The results support the suggestion that low and moderate alcohol consumption is protective for myocardial infarction. A drinking pattern involving a large intake of alcohol on single occasions did not seem to substantially influence myocardial infarction incidence except possibly for women with an overall very low level of consumption.

Aged↗
PubMed1996

Cancer incidence among male railway engine-drivers and conductors in Sweden, 1976-90.

During recent years, the relationship between exposure to magnetic fields and cancer has attracted increasing interest. In Sweden, train personnel are exposed to comparatively strong magnetic fields in their work. The aim of the present study was to investigate cancer incidence, particularly leukemia and brain tumors, among male railway engine drivers and conductors, respectively, and to compare their cancer incidence with that of the general male population. The study population comprised all male railway engine drivers (n = 7,466) and conductors (n = 2,272) who were ever employed at the Swedish State Railways during the period 1976-90. The study population was observed with regard to cancer incidence by means of the National Cancer Register for the period 1976-90. The total cancer incidence (all tumors included) among railway engine drivers was lower than in the general Swedish population. An increased incidence of lymphocytic leukemia was observed among railway engine drivers and conductors combined (relative risk = 2.3; 95 percent confidence interval = 1.3-3.2), with the same point estimate for both occupational groups. For brain tumor (astrocytoma), the observed relative risk was close to one. The study provides evidence of an excess risk of lymphocytic leukemia in railway engine drivers and conductors, workers with known occupational exposure to magnetic fields.

Adult↗