Magnetic resonance therapy in the treatment of osteoarthritis: A scoping review

OBJECTIVES

To primarily assess the existing literature about Magnetic Resonance Therapy (MRT) or Molecular Biophysical Stimulation Therapy (MBST) in the treatment of patients with osteoarthritis (OA). The scoping review question was: What has been reported about MRT or MBST concerning treatment of patients with OA?

KEY FINDINGS

The applied treatment program consisted of one hour daily treatment for patients in all the included studies. In terms of duration of treatment, four studies suggested treatment for nine consecutive days, two for five days and one study reported treatment on weekdays for two weeks. Six of the studies investigated the effect of MRT on the knee and one study for finger, ankle, and hip, respectively. Consensus across studies was that MRT had a positive, almost always significant, effect. Six out of the seven studies had subjective outcome measurements such as pain, quality of life and joint function, which were measured through self-reported questionnaires. One study combined ultrasonography with Magnetic Resonance Imaging (MRI) to evaluate structural joint changes. This evaluation was performed by a radiologist. One study used objective measurement of cartilage thickness through a minimal distance algorithm. All tests used MBST-systems.

CONCLUSION

This scoping review showed that there seems to be a beneficial effect of MRT in the treatment of patients with OA in relation to improvement in pain, joint function, and quality of life. However, more robust research and further evaluation of MRT are needed.

IMPLICATIONS FOR PRACTICE

Treating patients diagnosed with OA with MRT for one hour for five to ten days seemed to improve pain, joint function, quality of life as well as regeneration of cartilage. However, limitations of the included studies in this scoping review, such as a general lack of control groups, low sample sizes, lack of control for confounding factors such as medication, calls for more robust research with stronger study designs.

Traumatic experiences, ICD-11 PTSD, ICD-11 complex PTSD, and the overlap with ICD-10 diagnoses

OBJECTIVES

This study investigated the frequency of traumatic experiences, prevalence rates of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD), and overlap with ICD-10 classified disorders in outpatient psychiatry.

METHOD

Overall, 165 Danish psychiatric outpatients answered the International Trauma Questionnaire, the Life Event Checklist, and the World Health Organization Well-being Index. ICD-10 diagnoses were extracted from the hospital record. Chi-square analysis, t-tests, and conditional probability analysis were used for statistical analysis.

RESULTS

Nearly, all patients (94%) had experienced at least one traumatic event. CPTSD (36%) was more common than PTSD (8%) and had considerable overlap with ICD-10 affective, anxiety, PTSD, personality, adjustment and stress-reaction disorders, and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. ICD-11 PTSD overlapped with ICD-10 anxiety, PTSD, adjustment and stress-reaction disorders, and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. A subgroup of patients with ICD-10 PTSD (23%) did not meet criteria for ICD-11 PTSD or CPTSD.

CONCLUSION

Traumatic experiences are common. ICD-11 CPTSD is a highly prevalent disorder in psychiatric outpatients. One quarter with ICD-10 PTSD did not meet criteria for either ICD-11 PTSD or CPTSD. PTSD and CPTSD had considerable overlap with ICD-10 disorders.

The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis

INTRODUCTION

More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance.

OBJECTIVES

To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison.

METHODS

We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology.

RESULTS

The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up.

CONCLUSIONS

The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population.

KEY WORDS

Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.

Insulin resistance after a 72-h fast is associated with impaired AS160 phosphorylation and accumulation of lipid and glycogen in human skeletal muscle

During fasting, human skeletal muscle depends on lipid oxidation for its energy substrate metabolism. This is associated with the development of insulin resistance and a subsequent reduction of insulin-stimulated glucose uptake. The underlying mechanisms controlling insulin action on skeletal muscle under these conditions are unresolved. In a randomized design, we investigated eight healthy subjects after a 72-h fast compared with a 10-h overnight fast. Insulin action on skeletal muscle was assessed by a hyperinsulinemic euglycemic clamp and by determining insulin signaling to glucose transport. In addition, substrate oxidation, skeletal muscle lipid content, regulation of glycogen synthesis, and AMPK signaling were assessed. Skeletal muscle insulin sensitivity was reduced profoundly in response to a 72-h fast and substrate oxidation shifted to predominantly lipid oxidation. This was associated with accumulation of both lipid and glycogen in skeletal muscle. Intracellular insulin signaling to glucose transport was impaired by regulation of phosphorylation at specific sites on AS160 but not TBC1D1, both key regulators of glucose uptake. In contrast, fasting did not impact phosphorylation of AMPK or insulin regulation of Akt, both of which are established upstream kinases of AS160. These findings show that insulin resistance in muscles from healthy individuals is associated with suppression of site-specific phosphorylation of AS160, without Akt or AMPK being affected. This impairment of AS160 phosphorylation, in combination with glycogen accumulation and increased intramuscular lipid content, may provide the underlying mechanisms for resistance to insulin in skeletal muscle after a prolonged fast.

Standards for health promotion in hospitals: development and pilot test in nine European countries

PURPOSE

To describe the process of development of standards for health promotion in hospitals, including pilot study, method and results.

DESIGN/METHODOLOGY/APPROACH

A set of standards for health promotion in hospitals was developed by a task force of the International Network of Health Promoting Hospitals, following the recommendations of the ALPHA programme. The standards were pilot tested and assessed qualitatively and quantitatively in 36 hospitals in nine European countries. Subsequently, standards were reviewed by representatives from the piloting hospitals. A self-assessment tool was produced to evaluate whether hospital managers and professionals perceive the standards to be relevant and applicable and whether they are currently met. Participants provided comments from their national health system perspective and rated the standards.

FINDINGS

General comments and specific comments were provided for each standard regarding its relevance, applicability and current level of compliance. A total of 35 standards' criteria were assessed and 86 per cent (30/35) were rated > 80 per cent relevant and applicable, while 14 per cent (5/35) were rated > 60 per cent relevant. The degree of current fulfilment of the criteria, however, was low.

RESEARCH LIMITATIONS/IMPLICATIONS

While the standards should be applicable to other regions (South America, Africa, Asia) additional testing may be required to adapt them to prevailing health care challenges.

PRACTICAL IMPLICATIONS

The pilot test revealed that the standards are applicable and were considered relevant, and showed that current compliance is low. It also showed that there is a clear need to facilitate continuous monitoring and improvement of compliance. The standards are regarded as being public domain, are applicable to other organisations and can be incorporated into existing quality systems.

ORIGINALITY/VALUE

Standards are a common tool for quality assurance in health care, but so far have considered health promotion activities only partly, if at all. The standards for health promotion in hospitals developed by WHO fill this important gap.

Inflammation, thrombosis and atherosclerosis: results of the Glostrup study

Inflammation and thrombosis are important mechanisms in cardiovascular disease, as illustrated by the consistent association between inflammatory and hemostatic variables and the risk of cardiovascular events in epidemiological studies. However, the relationship between plasma concentrations of inflammatory and hemostatic markers and the severity of atherosclerosis is not yet well studied. We have evaluated 325 men and 370 women of 60 years, participating in the Danish Glostrup study. We diagnosed atherosclerosis by ultrasonographic measurement of intima-media thickness (IMT) of the right carotid artery and the assessment of plaque occurrence. Plasma samples were analyzed for the concentration of C-reactive protein (CRP), fibrinogen, d-dimer, plasminogen activator inhibitor type-1 (PAI-1) antigen and activity, tissue-type plasminogen activator (t-PA) antigen and activity, factor VII (FVII) antigen, FVII coagulant activity (FVII:C) and activated FVII (FVIIa). DNA variations were determined for fibrinogen, PAI-1, t-PA, FVII, factor XIII and methylene tetrahydrofolate reductase (MTHFR). Subjects with high IMT (upper 10% of distribution, n = 63) had higher CRP levels [2.2 mg L-1 (SE 0.3)] than subjects with IMT in the lowest tertile (n = 217) [1.7 mg L-1 (SE 0.1), P = 0.04], whereas there was no association between the hemostatic variables and IMT. There was an association between fibrinogen and d-dimer concentrations and number of plaques (P < 0.01), whereas there were no associations between CRP and the other hemostatic variables and the number of plaques. Genetic variation in the t-PA and MTHFR gene was associated with IMT. In conclusion, in the Glostrup population study, thrombosis and inflammation are associated with the severity of atherosclerosis, as reflected by IMT and plaque occurrence.

Impact of a 10-year nation-wide alcohol campaign on knowledge of sensible drinking limits in Denmark

In Great Britain and in Denmark, strong efforts have been made to influence knowledge on upper threshold for hazardous drinking. In Denmark, a campaign has been repeated every week 40 from 1990 to 2000 with information on the sensible drinking limits of 21 drinks per week for men and 14 drinks per week for women. The aim of this study was to examine the effect of this ongoing campaign on the level of knowledge of sensible drinking limits for men and women. Random representative samples of 1030 adult Danes were telephone interviewed each year during 1994-1999. Our main finding was that the level of knowledge of sensible drinking limits for own sex increased in all subsets of the population throughout the period. However, at the end of the study period (1999) a total of 80% of highly educated young (18-25 years) men knew sensible drinking limits for own sex, while only 35% of uneducated older (more than 65 years) men had knowledge on sensible drinking limits. The proportions were similar among women. Subjects admitting an intake higher than sensible for own sex, i.e. 21 and 14 drinks per week, respectively, had the highest knowledge of these drinking limits. We conclude that public health campaigns, such as the sensible drinking limit campaign, certainly has an impact on level of awareness in the general population. Furthermore, those drinking more than 21 and 14 drinks per week, respectively, are reached by these campaigns.

Tissue-type plasminogen activator and C-reactive protein in acute coronary heart disease. A nested case-control study

OBJECTIVES

To study the importance of inflammation and fibrinolysis for evolution of ischaemic heart disease in a cohort of initially healthy subjects.

DESIGN

Nested case-control study. Follow-up periods 7-15 years.

SUBJECTS

Included in the study were 133 cases with coronary heart disease and 258 controls.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Subjects with ischaemic heart disease identified in 1991 by the Danish National Hospital Register. Protein concentration of C-reactive protein (CRP) and tissue-type plasminogen activator (t-PA) were measured with ELISA methods in stored serum samples.

RESULTS

CRP and t-PA concentrations were both significantly higher in cases than in controls (P < 0.001 and P < 0. 001). This difference between cases and controls for CRP and t-PA was present in both men (CRP: P = 0.022; t-PA: P = 0.001) and women (CRP: P = 0.013; t-PA: P = 0.005) and it was present in both the 7-9 years follow-up cohort (CRP: P = 0.014; t-PA: P = 0.001) and the 15 years follow-up cohort (CRP: P = 0.027; t-PA: P = 0.012). The best predictor of CRP was t-PA, whilst the best predictor of t-PA was triglycerides. In a logistic regression analysis model, t-PA still came out as independent predictor of coronary heart disease, whilst such a significance disappeared for CRP. With the use of ROC curves we determined that AUC for t-PA was 0.62, and for CRP 0.59, indicating that none of these two analytes has a high prognostic power in predicting future coronary events in an initially healthy population.

CONCLUSION

We conclude that moderate increases in serum concentrations of CRP and t-PA are present for up to 15 years before the presence of clinical overt coronary heart disease; that a low-grade inflammation is determined by other risk factors and that t-PA is an independent risk factor for evolution of coronary heart disease.

Relation between job strain and myocardial infarction: a case-control study

OBJECTIVES

To study the influence of different job related and socioeconomic factors for development of myocardial infarction (MI).

METHOD

The study was a case-control study of 76 male wage earners who had been admitted to hospital with MI. As a control group 176 male wage earners not admitted to hospital who were residents of the same county were used. Both groups were interviewed with an extensive questionnaire on job related conditions. Several indices on job related psychosocial factors were established in accordance with Karasek's job strain model as well as the extension of the model, the isostrain model.

RESULTS

The most significant findings were consistent with Karasek's job strain model in that mean with a high degree of demand combined with a low degree of control at work had a significantly increased odds ratio (OR) 95% confidence interval (95% CI) of 2.1 (1.2 to 3.8) for MI after adjustment for age compared with men with a low degree of demand and a high degree of control at work. Further adjustment for smoking, socioeconomic status, employment sector, job category, and social network did not affect the OR substantially (OR 2.3 (1.2 to 4.4)). Other factors significantly associated to MI were job category (blue collar workers v white collar workers, OR 2.8 (1.6 to 5.8)), and employment sector (private v public, OR 3.1 (1.8 to 6.1)).

CONCLUSIONS

Thus, the study confirmed the job strain model as well as the well known association between socioeconomic status and risk of MI, whereas the finding of an increased risk among employees in the private sector has not previously been described.

The primary structure of caprine PP3: amino acid sequence, phosphorylation, and glycosylation of component PP3 from the proteose-peptone fraction of caprine milk

Proteose-peptone component 3 is a phosphorylated glycoprotein that was isolated from the proteose-peptone fraction of caprine milk. By mass spectrometric analysis, amino acid sequencing, and polymerase chain reaction analysis, the primary structure has been determined and has been shown to contain 136 amino acids. Phosphorylations were identified at Ser30 and Ser41. A partial glycosylation was present at Thr16, and a N-linked glycosylation was present at Asn78. Galactosamine was the amino sugar detected at Thr16. Glucosamine and galactosamine were the amino sugars found in the carbohydrate group linked to Asn78. The caprine amino acid sequence exhibits 88% identity with the bovine proteose-peptone component 3 sequence. However, when compared with the bovine sequence, the caprine sequence contains an insertion of a serine residue at position 25.

Association of factor VII protein concentration with lifestyle factors

Several studies have demonstrated that changes in fasting levels of factor VII coagulant activity (FVII:C), a thrombotic risk marker, are due to changes in FVII protein concentrations (FVII:Ag). Consequently, studies on FVII now often include measurements of FVII:Ag. The present cross-sectional study examined the association between several behavioural variables (body mass index, physical activity, tobacco or alcohol consumption) or physiological variables (total cholesterol, HDL-cholesterol, triglycerides, glucose, insulin, fibrinogen, resting pulse, systolic blood pressure, bleeding time) and FVII:Ag in 439 51-y-old Danish men. In the multivariate analyses, body mass index (BMI), low physical activity, total cholesterol, short bleeding time, and insulin showed an independent positive association with FVII:Ag. The strongest independent association with FVII:Ag was found for total cholesterol. These results suggest that blood lipids are major determinants of FVII:Ag, but that other lifestyle factors such as insulin, BMI and physical activity can also influence FVII:Ag. Furthermore, the association between FVII:Ag and bleeding time suggests an effect of FVII or the FVII pathway on primary haemostasis.

The localization and multimeric nature of component PP3 in bovine milk: purification and characterization of PP3 from caprine and ovine milks

The distribution of proteose-peptone component PP3 in bovine whey, milk fat globule membrane, and casein has been investigated with antibodies raised against highly purified PP3. Using Western blot analysis, we show that PP3 is present in the milk fat globule membrane and in whey but is absent in the casein fraction. The proposed multimeric structure of bovine PP3 was analyzed by mass spectrometry and gel filtration. Calibrated gel filtration of acidic whey showed that PP3 eluted at a volume corresponding to 190 kDa, indicating that PP3 exists as a multimeric aggregate in bovine milk. Western blot analysis with anti-bovine PP3 immunoglobulins was used to analyze caprine, ovine, and human milks, and immunoreactive proteins were detected in caprine and ovine milks. Finally, the immunoreactive proteins from caprine and ovine milks were purified and characterized as PP3 analogues by amino acid analysis and N-terminal sequence analysis.

Apolipoprotein(a) isoforms and coronary heart disease in men: a nested case-control study

The objective of the present study was to examine the possible associations between low molecular weight (LMW) apolipoprotein(a) (apo(a)) isoforms (F,B,S1,S2) and coronary heart disease (CHD). We conducted a nested case-control (prospective) study of five cohorts of white men: The 1936 cohort (baseline 1976, n = 548) and four cohorts from MONICA I born in 1923 (n = 463), 1933 (n = 491), 1943 (n = 504) and 1953 (n = 448) studied at baseline in 1983. At follow up in 1991, 52 subjects had developed a first myocardial infarction and 22 had been hospitalized with angina pectoris. Plasma samples obtained at baseline were stored frozen until 1993-94, when case samples (n = 74) were analyzed together with samples from matched (disease free) controls (n = 190). In a statistical model (conditional logistic regression) including all age groups, cholesterol (or apo B) level (P < 0.01), systolic blood pressure (P = 0.05) and smoking (P = 0.02) predicted CHD. In the statistical model Lp(a) interacted significantly with age (OR = 5.7; 95% CI: 1.4-23.6; P = 0.016), and high Lp(a) (over 45 mg/dl) was associated with significantly increased risk in subjects under 60 years (OR = 3.82; 95% CI: 1.47-9.96), but not in older men (OR = 0.67; 95% CI: 0.235-1.89). Therefore, we studied the impact of Lp(a)/apo(a) and other variables in subjects who had been under 60 years when they became cases. Among the younger subjects the presence of LMW apo(a) isoforms significantly predicted the development of CHD (OR = 3.83; 95% CI: 1.18-12.4). The increased risk pertained to high Lp(a) (above versus below 45 mg/dl: OR = 3.68; 95% CI: 1.03-13.10), and to Lp(a) concentrations when entered into the model as a continuous variable (P = 0.04). Cholesterol or apo B (P < 0.01), smoking (P = 0.02), systolic blood pressure (P = 0.05) and low alcohol consumption (under nine drinks/week) (P = 0.04) were also significant predictors of CHD. We conclude that LMW apo(a) isoforms are significantly associated with increased risk of CHD in men under 60 years.

Self rated health as a predictor of coronary heart disease in Copenhagen, Denmark

STUDY OBJECTIVE

To analyse the association between self rated health and the incidence of fatal and non-fatal coronary heart disease (CHD) in a Danish cohort followed up over 16 years.

DESIGN

This was a prospective epidemiological follow up study.

SETTING

A cohort from the County of Copenhagen, Denmark.

PARTICIPANTS

The study included 1052 men and women born in 1936. During the 16 years' follow up 50 cases of CHD were registered in either the Danish register of deaths or the register of hospital admissions.

MAIN RESULTS

Univariate analysis showed the following relative risks of CHD in the four self rated health groups: 'extremely good': 1.0, 'good': 4.0, 'poor': 5.8, 'miserable': 12.1 (p = 0.02). After control for the conventional CHD risk factors and a substantial number of other potential confounders the relative risks were: 1.0, 4.2, 6.5, and 18.6 (p = 0.02) respectively.

CONCLUSIONS

Self rated health was an independent predictor of CHD in the present cohort. If confirmed, the association between self rated health and CHD may lead to new insight into psychosocial processes leading to this disease.

Adverse effects of psychosocial stress on gonadal function and insulin levels in middle-aged males

OBJECTIVES

To investigate the relationship between gonadal function, insulin and psychosocial stress in middle-aged men.

DESIGN

A population-based, cross-sectional, observational study.

SETTING

Glostrup Hospital, Copenhagen, Denmark.

SUBJECTS

Four hundred and thirty-nine males, all aged 51 years.

MAIN VARIABLES

Body-mass index (BMI), waist-to-hip ratio (WHR), insulin, C-peptide, free testosterone, luteinizing hormone (LH), lipids, fibrinogen, lung function tests (FVC, FEV1, PEF), blood pressure, a self-administered questionnaire with questions on psychosocial variables, lifestyle and self-rated health.

RESULTS

Free testosterone correlated inversely (P < 0.05) with weight, BMI, WHR, and fibrinogen, and positively with FEV1. An independent correlation between free testosterone and insulin (P < or = 0.03), but not with C-peptide, was seen after controlling for BMI and WHR. Subjects with low levels of free testosterone, or those in the lowest quintile of the distribution of the hypogonadal index (HI: free testosterone/LH), showed a cluster of negative psychosocial variables, and psychological as well as health-related problems. Furthermore, hypogonadal men had lower (P < 0.05) levels of FEV1, peak flow and FVC, but higher (P < 0.01) levels of fibrinogen and higher pulse pressure than men with normal gonadal function. This gradient of variables, relative to HI, was not seen for possible confounders like BMI, WHR, and tobacco or alcohol consumption.

CONCLUSION

Psychosocial stress may be associated with a process of premature ageing in middle-aged males, corresponding to a hypogonadal state as well as to indirect signs of increased insulin resistance.

Social class and cardiovascular disease--an update

Cardiovascular disease is associated with a low social class position in numerous epidemiological studies. The mechanisms behind this finding are not fully known, although several factors may be of importance (e.g. lifestyle, neuroendocrine regulation, foetal deprivation). A better understanding of the biological basis for class-related disease may facilitate efforts in preventive medicine related to cardiovascular health.

Localization of transglutaminase-reactive glutamine residues in bovine osteopontin

Here we report the identification of two transglutaminase-reactive glutamines (Gln-34 and Gln-36) in bovine osteopontin (OPN). Sequence alignment revealed that these glutamines are conserved in all known OPN sequences, indicating a functional importance of this region of the protein. Furthermore, immunological analysis of bovine bone demonstrated that OPN is present in high-molecular-mass complexes in vivo. These findings support the functional aspects of a transglutaminase-catalysed cross-linking of OPN in facilitating cellular attachment and tissue calcification.

Blood lead as a cardiovascular risk factor

Many epidemiologic and experimental animal studies support the hypothesis of there being a causal association between lead exposure and increased blood pressure/cardiovascular disease. This study includes 1,052 men and women from Copenhagen County, Denmark, who were examined in 1976 and 1981; in 1987, only the men were examined. Blood lead fell by approximately 40% for the men during the 11-year period and by approximately 30% for the women during the first 5-year period. There was a univariate association between systolic blood pressure and blood lead for both sexes in 1976, but it disappeared at the following examinations. For women, there was also a significant association with diastolic blood pressure, even after confounders were controlled for at the two examinations. Moreover, the authors found a significant univariate association between changes in blood lead and changes in systolic blood pressure from 1976 to 1987 in the males. All participants taking part in the study in 1976 were followed regarding hospital admissions and deaths throughout a follow-up period lasting for 14 years. There was a significant univariate association with total mortality, coronary heart disease, and cardiovascular disease. However, with regard to coronary heart disease and cardiovascular disease, the associations disappeared when confounders were controlled for. Blood lead was a significant predictor of total mortality after control for relevant confounders. This study supports the hypothesis of there being a weak causal association between blood lead and blood pressure, total mortality, coronary heart disease, and cardiovascular disease. The importance of this association is very modest for the individual, but the population attributable risk may be considerable.

Alcohol consumption in a Danish cohort during 11 years

A cohort living in Copenhagen County, originally consisting of 1198 persons, 577 men and 621 women, 40-years of age in 1976, was reexamined in 1981, and again in 1987. Of the original cohort 1052 (88%) participated in 1976, 992 (84%) in 1981, and 965 (85%) in 1987. The purpose of this study was to describe changes in alcohol consumption in the cohort, with the view of identifying subgroups, who have changed their alcohol consumption behaviour to a certain extent. Alcohol consumption was measured by the same questionnaire all three times as to the level of consumption and frequency. Alcohol consumption peaked in 1981 (45-year olds) with 10.4 drinks on average a week. Men increased their consumption by 8% and women by 37%. There was an overall downward tendency in the consumption frequency among men, whereas the opposite was the case among women. The two groups are converging toward a weekly consumption frequency. It seems now that women are leading the change toward a greater wine consumption in relative and absolute terms. It is therefore concluded that female consumption should be considered as a target in future preventive programmes.

Social class and cardiovascular risk factors in Danish men

During the last 25 years, a series of epidemiological studies in North-Western Europe and U.S.A. have demonstrated a negative association between social class and the incidence of cardiovascular disease (CVD), that is, an increasing incidence the lower the social class. In studies where possible explanations of this negative gradient have been analyzed, it was concluded that the traditional individual risk factors, such as elevated blood pressure, high serum cholesterol, and smoking, could explain about one half of the differences demonstrated. In a prospective study of a cohort of 504 men from the County of Copenhagen, the participants were examined when 40 and 51 years old. At both examinations the social class of the participants was recorded in addition to a number of cardiovascular risk factors. The latter included both the traditional risk factors and some not previously analyzed in relation to social class. At the 51-year examination we found statistically significant negative associations between social class and the following risk factors: plasma fibrinogen (p less than 0.001), short height (p less than 0.001), smoking (p less than 0.05), physical inactivity in leisure time (p less than 0.01), shift work (p less than 0.05), job strain (p less than 0.05), living alone (p less than 0.01), and having a poor social network (p less than 0.05). Two factors showed a significant opposite association with social class: Type A behaviour (p less than 0.001) and physical inactivity at work (p less than 0.001). In the last 10-15 years, a tendency has been demonstrated in many countries towards a strengthened association between social class and cardiovascular risk factors. This tendency was not found in our cohort. It has been discussed whether some of the social inequalities observed could be due to selection, so that people with a favourable cardiovascular risk profile socially were upward mobile. We found no support for such a selection hypothesis in our study.

Plasma fibrinogen and ischemic heart disease risk factors

The association between risk factors for ischemic heart disease and plasma fibrinogen level was analyzed in a cross-sectional population study. All 51-year-old men living in a certain area within the county of Copenhagen were invited; 439 of 542 (81%) participated in the study. Data were collected via questionnaire and at health examinations. The following independent variables were analyzed: social variables, which included social class, marital status, and job strain; psychological and psychosomatic variables, which included abdominal pain, personal and economic problems, self-assessed state of health, and degree of loneliness; behavioral variables, which included smoking, drug consumption, physical activity, use of sugar, and alcohol consumption; and physiological variables, which included high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, physical fitness, fasting glucose level, waist-to-hip ratio, and systolic blood pressure. In the multivariate analyses, the following variables showed an independent positive association with plasma fibrinogen level: one social variable (low social class); two psychological variables (abdominal pain index and personal/economic problems); two behavioral variables (smoking and physical inactivity during leisure time); and three physiological variables (low HDL cholesterol, low physical fitness, and high LDL cholesterol). The strongest independent associations with plasma fibrinogen level were found for smoking, social class, LDL cholesterol, and HDL cholesterol. These analyses suggest that smoking is a major risk factor for an elevated plasma fibrinogen level, but that other factors such as social class, cholesterol level, physical inactivity/physical fitness, and psychological problems also influence plasma fibrinogen level.

Cerebral ventricular size in the offspring of schizophrenic mothers. A preliminary study

Within a prospective, longitudinal study of offspring of schizophrenic mothers, computed tomographic scan-derived measurements of ventricular size were evaluated for a subsample consisting of schizophrenics, borderline schizophrenics (DSM-III schizotypal), and mentally healthy individuals. Schizophrenics exhibited larger ventricular sizes and borderline schizophrenics smaller ventricular sizes than mentally healthy individuals. Ventricular size correlated with premorbidly obtained obstetric data. These results are interpreted as being consistent with the hypothesis that neurological insult may decompensate schizotypal individuals toward florid schizophrenia.

Alcohol-induced brain damage and liver damage in young males

37 alcoholic males under the age of 35 were examined clinically, by psychometric tests, by computerised tomography (CT scans), and by liver biopsy. Factors other than alcoholism that might have caused brain damage were excluded. The prevalence of brain damage in this group was far greater than that of severe liver damage: 59% were intellectually impaired and 49% had cerebral atrophy on CT scan, whereas only 19% had cirrhosis. There was no significant correlations between the degree of liver damage and the degree of intellectual impairment (p greater than 0-05), nor between the degree of intellectual impairment and the presence of cerebral atrophy. The CT scan is an inadequate measure of functional brain damage, psychometric testing is preferable. Other neurological complications of alcoholism were not impressive. Disabling intellectual impairment may be the earliest complication of chronic alcoholism and may arise early in the alcoholic career.