Biomedical subjects

B Gullberg

Publications and source records attributed to B Gullberg.

At least 55 records · Page 3Linked to original sources

PubMed1993

Life-style and different fracture prevalence: a cross-sectional comparative population-based study.

In order to explain the higher prevalence of fractures in urban compared with rural areas, 782 residents in the city of Malmö, Sweden and 486 inhabitants from the nearby rural municipality of Sjöbo were invited to participate in a sex- and age-matched cross-sectional study on life-style differences; 73 and 80% respectively responded. Responders answered a questionnaire on medical and social background and were interviewed on past and present physical activity. The men and women of the rural area were found to be significantly more active physically at work and during spare time. Housing was larger in the rural area. For women, these differences are decreasing in the younger age groups. Bone mass was found to be correlated to heavier work load for men. Other life-style variable such as dairy calcium intake, coffee drinking, estrogen medication, and morbidity, could not explain this difference. Higher prevalence of fractures in the city could therefore be explained by physically less active life-style.

Activities of Daily Living↗

PubMed1993

Serum concentrations of total sialic acid and sialoglycoproteins in relation to coronary heart disease risk markers.

This study investigated the relationship between serum sialic acid concentration and cardiovascular mortality. Correlations were determined between lifestyle-related coronary heart disease risk markers (cigarette consumption, alcohol consumption, and leisure time physical activity), biological risk markers (apolipoprotein A1, apolipoprotein B, lipoprotein(a), and diastolic blood pressure) on the one hand and the concentration of sialic acid as well as sialic acid-rich acute phase proteins (orosomucoid, haptoglobin, and alpha 1-antitrypsin) on the other. A total of 145 men aged 21-46 years and with a C-reactive protein concentration below 5 mg/l were included. Total sialic acid concentration correlated significantly with apolipoprotein B (r = 0.48), number of cigarettes smoked daily (r = 0.32), and leisure time physical activity (r = -0.23) after adjustment for age and other cardiovascular risk markers. No significant partial correlations were found between serum total sialic acid concentration on the one hand and alcohol consumption, apolipoprotein A1, lipoprotein(a), and diastolic blood pressure on the other. Of the sialic acid-rich glycoproteins, orosomucoid correlated with apolipoprotein B (r = 0.38), haptoglobin with cigarette consumption (r = 0.35) and leisure time physical activity (r = -0.26) and alpha 1-antitrypsin with cigarette consumption (r = 0.18), leisure time physical activity (r = 0.17), alcohol consumption (r = -0.18), and apolipoprotein B (r = 0.21) after adjustment for age and other cardiovascular risk markers.

Acute-Phase Proteins↗

PubMed1993

Subarachnoid hemorrhage, cerebral hemorrhage, and serum cholesterol concentration in men and women.

The role of serum cholesterol in predicting the risk of stroke is unclear and may depend on the subtype of the disease. In 1964 to 1965, 54,385 Swedish men and women participated in a health survey with serum cholesterol and diastolic blood pressure determinations. The Swedish mortality register was used to identify causes of death in this cohort during 20.5 years of follow-up (1964 to 1985). A person-year-based Poisson model was used for multivariate analysis. Relative risk increased with decreasing serum cholesterol level for subarachnoid hemorrhage in men and for cerebral hemorrhage in women but not for subarachnoid hemorrhage in women. For cerebral hemorrhage in men, the risk function was U-shaped. Adjustment for diastolic blood pressure did not significantly change the relation between the risk for any of the different stroke types and the cholesterol level. A low cholesterol level predicts death from intracranial bleeding, but the data suggest that there is differing risk pattern for men and women.

Adult↗

PubMed1993

Hip fracture in Malmö over three decades.

The incidence of hip fracture in the city of Malmö, Sweden, has increased from the 1950s to the 1980s, a trend also seen in other industrialised cities. The population of Malmö was studied during the 1980s and compared with that during the 1950s, as described by Alffram (1964). Marked changes were seen in the social structure and the percentage of elderly in the city of Malmö, and there was evidence that a more sedentary life-style is led today. The degree of trauma is less today than it was 30 years ago, and there is a higher proportion of displaced cervical hip fractures. The mean age of men and women with both cervical and trochanteric fractures in Malmö increased during the 30-year period, and today more patients are seen who have had a previous fragility fracture and the rates of co-morbidity are higher.

Aged↗

PubMed1993

Incidence of hip fractures in Malmö, Sweden (1950-1991).

In a 24-year sub-sample taken from a 42-year period of study (1950-1991), hip fracture incidence was analysed from a defined catchment area within one hospital. During this time, 8,256 hip fractures occurred in a generated risk population of 1,915,571 person-years. Crude incidence increased three-fold in women and five-fold in men. In men, the age-specific increase was twice as large as the age drift. In women, the two components were of equal size. The more marked increase in men caused the female:male ratio to decrease from 4.2 in 1950 to 2.4 in 1991. In men, all age classes experienced a significant yearly increase (1.6% in the 50-59 age group, 3.9% over the age of 80). In women, only the 70-79 and 80+ age groups showed a significant increase (1.4%, 2.3%). In the age-standardised curve, a levelling off occurred during the mid-80s. In women, this was attributable to changes in climate during wintertime. In men, no significant association was found with temperature. The age-standardised curve followed an approximate linear trend with an increase of 6.4/100,000/year in women and 4.9/100,000/year in men. The cumulative rate for the age group 50-79 years doubled in men but increased only by one-third in women. The impact of increasing incidence in men compared with women is discussed using an osteoporosis model consisting of base risk, senile risk, and post-menopausal risk.

Aged↗

PubMed1993

Methodology of MEDOS multicentre study of hip fracture incidence: validity and relevance considerations.

The Mediterranean osteoporosis (MEDOS) study was carried out in 14 centres from six countries in Southern Europe to determine the incidence rates and risk factors associated with hip fracture over the age of 50 years. This paper discusses both the validity and relevance of the data, that is, whether the number of collected cases of hip fracture and the size and age distribution of the population are representative of the population as a whole, and whether the incidence measures used in the study are suitable for comparing the risk of hip fracture between populations and for predicting future risk within populations. Five measures of risk were assessed at each centre: crude incidence over the age of 50 years; age-standardised incidence; risk increase/fracture doubling time by age; computed incidence at 50 years; and excess morbidity. Three standardised populations were used for comparison: the MEDOS population (incidences standardised to the overall age and sex distribution of all the participating centres); the weighted MEDOS population (only including the age range 60 to 84 years); and the Swedish population at the start of the study. The MEDOS study showed that the incidence of hip fracture increased exponentially with age in both sexes at all centres. The regression slope of incidence against age was affected by the age distribution of the population, but not by the absolute size of the population. Methods used to define the population of the catchment areas did not introduce errors of a greater magnitude than would the occasional addition or removal of single fracture cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed1993

Therapeutic strategies in the prevention of hip fracture with drugs affecting bone metabolism.

This is increasing evidence that interventions with drugs affecting bone metabolism decrease the risk of hip fracture. The use of such agents is increasing in Europe, and there is a need to develop the strategies for optimum means of intervention. This paper assesses the impact of the increasing use of such agents on hip fracture outcome using several sets of assumptions. Since hip fractures occur largely after the age of 70 years, intervention directed at this age has a significant impact on hip fractures prevented. Indeed, the gains are greater if the effects of a 5-year treatment wear off once treatment has stopped. The targeting of intervention to those with the lowest values of bone mineral density increases the efficiency of intervention on hip fracture outcome by 70-140%, depending on the gradient of risk associated with decreasing bone mineral density.

Aged↗

PubMed1993

Tumours of the central nervous system and serum sialic acid concentration in men and women.

In a population-based study serum sialic acid level was examined in relation to subsequent development of central nervous system (CNS) tumours (229 cases). Significantly increased sialic acid concentration was found in men with a malignant CNS tumour diagnosed within 8 years of analysis, compared with corresponding matched controls. These findings suggest that the tumour existed at the time of examination which is supported by a negative linear association between sialic acid level and the time from screening to tumour diagnosis.

Adult↗

PubMed1993

The clinical outcome of acute myocardial infarction is related to the circadian rhythm of myocardial infarction onset.

In order to study whether the circadian rhythm of acute myocardial infarction (AMI) onset has any impact on the clinical outcome, in terms of enzymatically estimated infarct size, circulatory arrest from ventricular tachyarrhythmias, and in-hospital mortality, the authors studied a representative population of 10,791 AMIs treated in the same center between 1973 and 1987. In 6,763 cases (63%) the time of symptom onset was known. In these cases a major peak in AMI incidence was observed between 7:01 AM and 10:00 AM, and minor peaks at 12:01 noon, 3:01 PM-4:00 PM, and 8:01 PM-9:00 PM. In a set of multivariate analyses including several clinical characteristics, symptom onset between 6:00 AM and 12:00 noon significantly predicted a greater infarct size, and symptom onset between 12:00 AM and 6:00 AM was associated with a significantly lower risk of circulatory arrests from ventricular tachyarrhythmias. The time of symptom onset was not significantly associated with in-hospital mortality after adjustment for other clinical characteristics, including infarct size. The authors suggest that the time of day has an impact, not only on the incidence, but also on the severity of AMI and that the ability of beta blockers to blunt the morning increase in AMI incidence may possibly contribute to the beneficial secondary preventive effects of such drugs after AMI.

Aged↗

PubMed1993

Elevation of the larynx on normal and abnormal cineradiogram.

The relationship between bolus volume (2.5, 5, 10 and 20 ml) and larynx elevation during swallowing was assessed in 10 non-dysphagic and 10 dysphagic individuals without pharyngeal dysfunction. Laryngeal elevation in different types of pharyngeal dysfunction was assessed in 60 non-dysphagic and 75 dysphagic patients. All subjects were examined with liquid barium and cineradiography at 50 frames/s. The laryngeal elevation was measured at the moment when the bolus reached the level of the valleculae and at maximum elevation. Elevation of the larynx, both the initial and maximal, was not influenced by sex, age or presence of dysphagia. Elevation of the larynx at the moment when the bolus reached the valleculae, when expressed in per cent of maximum elevation, was lower with 10 and 20 ml bolus volumes compared with 2.5 ml bolus volume (p < 0.05) in the 10 dysphagic individuals. Pharyngeal dysfunction was associated with significantly lower initial elevation of the larynx, at the moment when the bolus reached the level of the valleculae, although the maximal laryngeal elevation was normal. Initial elevation was 30% lower (p = 0.03) in patients with aspiration of bolus material into the trachea, 22% lower (p = 0.007) in those with defective closure of the laryngeal vestibule without aspiration and 16% lower (p = 0.06) in those with incoordination of the cricopharyngeal muscle compared with patients without dysfunction.

Adolescent↗

PubMed1992

Evidence for efficacy of drugs affecting bone metabolism in preventing hip fracture.

OBJECTIVE: To examine the effects of taking drugs affecting bone metabolism on the risk of hip fracture in women aged over 50 years. DESIGN: Retrospective, population based, case-control study by questionnaire. SETTING: 14 centres in six countries in southern Europe. SUBJECTS: 2086 women with hip fracture and 3532 control women matched for age. MAIN OUTCOME MEASURES: Number of drugs affecting bone metabolism taken and length taken for. RESULTS: Women taking drugs affecting bone metabolism had a significantly decreased risk of hip fracture. After adjustment for differences in other risk factors, the relative risk of hip fractures was 0.55 (95% confidence interval 0.31 to 0.85) in women taking oestrogens, 0.75 (0.60 to 0.94) in those taking calcium, and 0.69 (0.51 to 0.92) in those taking calcitonin. The fall in risk was not significant for anabolic steroids (0.6 (0.29 to 1.22)). Neither vitamin D nor fluorides were associated with a significant decrease in the risk of hip fracture. The effect on hip fracture risk increased significantly with increasing duration of exposure (risk ratio 0.8 (0.61 to 1.05) for less than median exposure v 0.66 (0.5 to 0.88) for greater than median exposure). Drugs were equally effective in older and younger women, with the exception of oestrogen. CONCLUSIONS: Oestrogen, calcium, and calcitonins significantly decrease the risk of hip fracture. Short term intervention late in the natural course of osteoporosis may have significant effects on the incidence of hip fracture.

Aged↗

PubMed1992

Low serum cholesterol concentration and short term mortality from injuries in men and women.

OBJECTIVE: To determine whether total serum cholesterol concentration predicts mortality from injuries including suicide. DESIGN: Cohort study of men and women who had their serum cholesterol concentration measured as part of a general health survey in Värmland, Sweden in 1964 or 1965 and were followed up for an average of 20.5 years. SUBJECTS: Adults participating in health screening in 1964-5 (26,693 men and 27,692 women). The study sample was restricted to subjects aged 45-74 years during any of the 20.5 years of follow-up. MAIN OUTCOME MEASURES: Serum cholesterol concentration. Deaths from all injuries and suicides during three periods of follow up (0-6 years, 7-13 years, and 14-21 years) according to the Swedish mortality register in subjects aged 45-74. Adjustment was made for prevalent cancer (identified from the Swedish cancer register) at the time of a suicide. RESULTS: A strong negative relation between cholesterol concentration and mortality from injuries was found in men during the first seven years of follow up. The relative risk in the lowest 25% of the cholesterol distribution was 2.8 (95% confidence interval 1.52 to 4.96) compared with the top 25%. Most of the excess risk was caused by suicide with a corresponding relative risk of 4.2 (p for trend = 0.001). Correction for prevalent cancer did not change the results. Events occurring during the latter two thirds of the 20.5 years of follow up were not predicted. In women no relation between cholesterol concentration and mortality from injuries was found. CONCLUSIONS: Together with observations from intervention trials the findings support the existence of a relation between serum cholesterol concentration and suicide. The causality of such a relation is, however, not resolved.

Aged↗

PubMed1992

Circadian distribution of onset of acute myocardial infarction in subgroups from analysis of 10,791 patients treated in a single center.

A circadian variation of symptom onset in acute myocardial infarction (AMI) with an increased frequency in the late morning and possibly also in the evening has been found in several studies. It has been suggested that different circadian rhythms may exist in various subgroups of patients. This possibility was examined in a population of 10,791 patients collected between 1973 and 1987 in a continuously operating register of patients with AMI in Malmö, Sweden. In 6,763 patients (63%) in whom a distinct symptom onset could be established, symptom onset occurred with an increased frequency between 6:01 A.M. and 12:00 noon (30.6%) and between 6:01 P.M. and 12:00 midnight (26.9%). Similar bimodal circadian rhythms were seen in patients aged greater than 70 years (n = 2,923), less than or equal to 70 years (n = 3,840), men (n = 4,528), women (n = 2,235), smokers (n = 2,458), hypertensives (n = 1,999), diabetics (n = 653), patients with (n = 1,872) and without (n = 4,891) a history of previous AMI, and in patients with recent non-Q-wave AMI (n = 333). In 455 patients receiving cardioselective beta blockers the circadian distribution did not differ from a random, whereas in patients taking nonselective beta blockers or calcium antagonists significant bimodal rhythms were found. Statistically significant interactions were found between symptom onset and age dichotomized at 70 years, and between patients with and without a history of previous AMI. In a multivariate analysis only these variables age less than or equal to/greater than 70 years; +/- history of a previous AMI) were found to modify the circadian rhythm of symptom onset in the population.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1992

The apparent incidence of hip fracture in Europe: a study of national register sources.

The objective of this study was to examine the apparent incidence of hip fracture from discharge rates in European countries. A request was sent to the Ministries of Health in all European countries, asking for the number of hip fracture patients by age and sex, between the years 1983 and 1985. Seventeen countries responded. As expected, hip fracture was most frequently found amongst the elderly, particularly women. The incidence of hip fracture rose exponentially with age in both sexes. It was higher in women than men and there was a three-fold range between countries in the female to male sex ratio. There was an eleven-fold range in apparent incidence amongst women and a seven-fold range amongst men between the various countries. The highest incidence was found in the northern part of Europe and the lowest in the Mediterranean area. There was a significant positive correlation between the age-standardized incidence rates reported in men from each country and that in women. There was a larger difference in incidence between countries than between sexes, which suggests important genetic or environmental factors in the causation of hip fracture. The extent to which this reflects imperfect capture of data is uncertain but will be important to determine in order to identify reasons for differences and to enable confident projections of the future magnitude of this disorder.

Adult↗

PubMed1992

Serum lactate dehydrogenase isoenzyme 1 and tumour volume are indicators of response to treatment and predictors of prognosis in metastatic testicular germ cell tumours.

44 patients with metastatic testicular germ cell tumours treated with cisplatin-based chemotherapy were evaluated for prognostic implications of clinical characteristics. 22 obtained complete remission by the initial chemotherapy, and 30 are disease-free. S-LDH-1 had an overall predictive value regarding the response of 80%, S-LDH of 64%, S-AFP of 62%, and S-hCG of 62%. In multivariate analysis regarding response, only tumour volume classified according to the Royal Marsden system (P = 0.0036) and S-LDH-1 (P = 0.0069) yielded information. Regarding survival, S-LDH-1 (P = 0.0141) and an estimate of total tumour mass (P = 0.0171) had most impact with additional information from S-hCG only (P = 0.0536). We conclude that S-LDH-1 may be used as a tumour marker in addition to S-hCG and S-AFP in patients with metastatic testicular germ cell tumour.

Adolescent↗

PubMed1992

Serum sialic acid concentration predicts both coronary heart disease and stroke mortality: multivariate analysis including 54,385 men and women during 20.5 years follow-up.

To investigate the nature of the relationship between serum sialic acid concentration and cardiovascular mortality, the risks for coronary heart disease (CHD) and stroke were assessed separately in 26,693 men and 27,692 women followed during 20.5 years. Diastolic blood pressure, total cholesterol and body mass index were used as covariates in a person-year-based Poisson model. Relative risks for CHD mortality associated with the highest sialic acid quartile was 1.76 (95% confidence interval (CI): 1.58-1.96) in men and 1.94 (95% CI: 1.61-2.34) in women. Corresponding figures for stroke were 1.62 (95% CI: 1.26-2.09) and 1.68 (95% CI: 1.28-2.21) respectively. No significant patterns related to the age at entry was observed. For both genders, and both endpoints, diastolic blood pressure was associated with higher relative risk than sialic acid, and body mass index and serum total cholesterol were less predictive. Serum sialic acid concentration predicts both death from CHD and stroke in men and women independent of age. The biological foundation of this finding remains unclear.

Adult↗

PubMed1992

Longevity in patients with high degree atrioventricular block paced in the atrial synchronous or the fixed rate ventricular inhibited mode.

Survival in patients paced for high degree AV block has been demonstrated to be influenced by underlying cardiac disease in particular congestive heart failure. One previous study has suggested that dual chamber pacing may improve the vital prognosis for such patients. To investigate this, 74 patients treated with rate adaptive atrial synchronous (VDD) and 74 patients treated with VVI pacemakers for high degree AV block, were retrospectively studied for a mean of 5.4 years by life-table analysis. The two groups had an equal distribution of age, sex, date of pacemaker implantation, and concomitant cardiovascular diseases. Total mortality and estimated survival did not differ between the two groups. The estimated survival in the VDD group at 1, 3, and 5 years for patients without and with congestive heart failure was 94%, 86% and 78%, and 92%, 83% and 72%, respectively. In the VVI group the corresponding values were 95%, 90%, and 83% for patients without congestive heart failure and 82%, 64%, and 47% for those with congestive heart failure (P = 0.008). Compared to the expected survival rate of the general Swedish population, only the VVI group with congestive heart failure, had an excess mortality (P = 0.007). Patients with high degree AV block have a fairly normal vital prognosis irrespective of pacing mode. The prognosis for patients with congestive heart failure was negatively affected by VVI pacing. Thus, for patients with congestive heart failure the choice of pacing mode is of vital importance, whereas for patients without congestive heart failure, other factors such as feeling of well-being and exercise capacity should decide the final choice of pacing mode.

Aged↗

PubMed1992

Clinical outcome of acute myocardial infarction in patients on treatment with beta-blockers or calcium antagonists. A study of 7,922 hospitalized first myocardial infarctions.

To assess the effects of current treatments with beta-blockers or calcium antagonists on the clinical outcome of acute myocardial infarction (MI), enzymatically estimated infarct sizes, circulatory arrests from ventricular tachyarrhythmias, ventricular tachycardia (VT)/ventricular fibrillation (VF), and in-hospital mortality were analyzed retrospectively from 7,922 citizens of Malmö, Sweden, hospitalized due to a first MI between 1973 and 1987. Of these patients, 296 were on treatment with calcium antagonists, 393 on treatment with a beta 1-selective beta-blocker, 482 with a nonselective beta-blocker, and 95 on combined treatment with beta-blockers and calcium antagonists at the time of admission to hospital. In a set of multivariate analyses including several clinical characteristics, patients on treatment with a nonselective beta-blocker had a significantly lower peak aspartate aminotransferase (ASAT; difference -0.70 mukat/l, 95% CL: -1.24 to -0.16), whereas no significant relations between peak ASAT and treatment with cardioselective beta-blockers or calcium antagonists were found. Treatment with cardioselective beta-blockers or calcium antagonists, in contrast to treatment with a nonselective beta-blocker, were significant predictors of the occurrence of circulatory arrests from VT/VF. The relative risk of VT/VF in patients on cardioselective beta-blockers was 1.51 (95% CI: 1.12-2.03), and in patients on calcium antagonists 1.44 (95% CI: 1.03-2.02). None of the treatments were significantly associated with in-hospital mortality. In patients on beta-blockers or calcium antagonists when suffering their first MI, nonselective beta-blockade may reduce infarct size. Treatment with beta-blockers or calcium antagonists identified patients with an increased risk of circulatory arrests from VT/VF, but neither of the treatments were significantly associated with in-hospital mortality. We suggest that only minor differences exist between the effects of chronic treatment with beta-blockers and calcium antagonists on the outcome of an acute MI.

Adrenergic beta-Antagonists↗