[Good continuing education is more important than disadvantages of industrial sponsorship].
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Drug Industry↗
Biomedical subjects
G Tibblin
Publications and source records attributed to G Tibblin.
The pituitary-gonadal axis and health in elderly men: a study of men born in 1913.
The results of recent studies suggest that a relative hypogonadism in men is associated with several established risk factors for prevalent diseases. Therefore, we determined total and free testosterone, luteinizing hormone (LH), and sex-hormone binding globulin (SHBG) in a cohort of randomly selected men (n = 659) at 67 years of age. These data were analyzed cross-sectionally in relation to blood glucose and serum insulin, which were measured while fasting and after an oral glucose tolerance test, in addition to plasma lipids and blood pressure. The data were also analyzed in relation to impaired glucose tolerance (IGT) and diabetes, which were discovered at examination or earlier diagnosis. Risk factors for the development of diabetes up to 80 years of age were analyzed with univariate and multivariate statistics. Total and free testosterone and SHBG concentrations correlated negatively with glucose and insulin values; total testosterone and SHBG, with triglycerides; and SHBG, with blood pressure (from P < 0.05 to P < 0.01). Men with IGT or newly diagnosed diabetes had higher BMI values (26.2 +/- 0.31 and 27.0 +/- 0.59 [mean +/- SE], respectively) and waist circumference (99.0 +/- 1.03 and 100.5 +/- 1.57) than nondiabetic men (BMI, 25.1 +/- 0.14; waist circumference, 95.4 +/- 0.47; P < 0.05), indicating abdominal obesity. Such men and men with previously diagnosed diabetes had, in general, lower total and free testosterone and SHBG levels, while those for LH were not different. In multivariate analyses that included BMI, waist-to-hip ratio, total and free testosterone, and SHBG, the remaining independent predictors for the development of diabetes were low total testosterone (P = 0.015) and, on the borderline, low SHBG (P = 0.053). In relation to nondiabetic men, the risk ratio for mortality, myocardial infarction, and stroke increased gradually and significantly from 1.18 to 1.68, from 1.51 to 1.78, and from 1.72 to 2.46 in men with IGT, newly diagnosed diabetes, and previously known diabetes, respectively. It was concluded that low testosterone and SHBG concentrations in elderly men are associated with established risk factors for diabetes and in established diabetes. Moreover, low testosterone levels independently predict the risk of developing diabetes. In different degrees of expression, the diabetic state predicts strongly (and gradually mortality from) myocardial infarction and stroke. It has been suggested that a relative hypogonadism might be a primary event, because other studies have shown that testosterone deficiency is followed by insulin resistance, which is ameliorated by testosterone substitution. The data suggest that the relative hypogonadism involved might be of both central and peripheral origin.
Aged↗
Quality of life in hypertensive patients treated with either carvedilol or enalapril.
UNLABELLED: An important aspect of antihypertensive drug treatment is quality of life (QL) which should at least not be negatively affected. In this study, the QL during treatment with carvedilol (C), a beta-blocker with vasodilating properties due to alpha-1-receptor blockade, was compared to that of enalapril (E) in patients who had responded to the treatment. PATIENTS AND METHODS: Patients with mild to moderate hypertension (diastolic blood pressure 95-115 mmHg) were randomised to receive either E(n = 119) of C(n = 129) in a double-blind multicenter study. The starting doses were 12.5 (C) and 10 (E) mg with doubling of the dose if necessary at 3-week intervals. If insufficient blood pressure (BP) control was found at 50 mg C or 40 mg E, 12.5 mg of hydrochlorothiazide was added. After having reached the goal BP the patients entered a 5-months maintenance period. General well-being was evaluated by the "Göteborg Quality of Life Questionnaire". RESULTS: Equally many patients in the respective treatment groups responded at the different dose levels. Diastolic BP after 5 months in the maintenance period was similar on C and E, respectively. For most items, QL was not affected by the treatments. An increased incidence of cough was perceived in the E group (p < 0.001). None of the C treated patients reported frequent cough at the end of the study compared with 12% of E treated patients. CONCLUSION: C and E had similar BP lowering effects. Neither treatment seemed to affect the patients QL adversely. Cough, although seldom leading to withdrawal from the therapy, may be more common than is commonly recognised during treatment with ACE-inhibitors.
Adult↗
Is hypertension changing? Blood pressure development in cohorts of 50-year-old men between 1963 and 1993.
OBJECTIVE: To study secular trends in the prevalence and treatment of hypertension in the general population, and the disease course. DESIGN: Health examinations of cohorts of 50-year-old men in 1963, 1973, 1983 and 1993. SETTING: The city of Göteborg, Sweden (about 400,000 inhabitants). PARTICIPANTS: Random population samples of 50-year-old men. MAIN OUTCOME MEASURE: Mean blood pressure (BP) levels in the populations and among treated hypertensives, proportions of hypertensives, and frequency of high BP values (> or = 160/and or 95, and > or = 175/115 mmHg, respectively). RESULTS: The mean population BP decreased from 138.4/89.0 mm to 128.7/84.4 mmHg during the 30-year period (p < 0.0001). Mean BP levels among treated hypertensives decreased from 170/113 to 142/94 mmHg (p < 0.0001), and the proportion of men with high BP values diminished from 3.9 to 0.1%. Also BP levels among normotensives decreased significantly (p < 0.0001). CONCLUSION: The findings could partly be seen as a result of successful case-finding and treatment of hypertension in the region, but alteration of the natural course of hypertension cannot be excluded.
Blood Pressure↗
The impact of health care advice given in primary care on cardiovascular risk. CELL Study Group.
OBJECTIVE: To evaluate the additional benefit of "intensive" health care advice through six group sessions, compared with the advice usually offered to subjects with multiple risk factors for cardiovascular disease. DESIGN: Prospective, randomised controlled clinical study lasting 18 months. SETTING: 681 subjects aged 30-59 years, with at least two cardiovascular risk factors in addition to moderately high lipid concentrations: total cholesterol > or = 6.5 mmol/l on three occasions, triglycerides < 4.0 mmol/l, and ratio of low density lipoprotein cholesterol to high density lipoprotein cholesterol > 4.0. Most (577) of the subjects were men. MAIN OUTCOME MEASURE: Percentage reduction in total cholesterol concentration (target 15%); quantification of the differences between the two types of health care advice (intensive v usual) for the Framingham cardiovascular risk and for individual risk factors. RESULTS: In the group receiving intensive health care advice total cholesterol concentration decreased by 0.15 mmol/l more (95% confidence interval 0.04 to 0.26) than in the group receiving usual advice. The overall Framingham risk dropped by 0.068 more (0.014 to 0.095) in the group receiving intensive advice, and most of the risk factors showed a greater change in a favourable direction in this group than in the group receiving usual advice, but the differences were seldom significant. The results from questionnaires completed at the group sessions showed that the subjects improved their lifestyle and diet. CONCLUSION: Limited additional benefit was gained from being in the group receiving the intensive health care advice. It is difficult to make an important impact on cardiovascular risk in primary care by using only the practice staff. Better methods of communicating the messages need to be devised.
Adult↗
Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time.
BACKGROUND & AIMS: It has been suggested that irritable bowel syndrome (IBS) and functional dyspepsia represent the same disease entity, the irritable gut. The aim of this study was to test the stability, consistency, and relevance of the current classification in the entire, unselected population of persons with gastrointestinal and/or abdominal symptoms, including those who had not consulted physicians. METHODS: Sequential postal questionnaires were sent to 1290 representative persons (age range, 20-79 years) sampled from the population. Questions were asked about the prevalence of 24 gastrointestinal and/or abdominal symptoms and the site and type of abdominal pain, if any. RESULTS: The prevalence of dyspepsia was 14% (32% if predominant reflux symptoms and concomitant IBS symptoms were included), and the prevalence of IBS was 12.5%. The 3-month incidence rates of reflux, dyspepsia, and IBS among previously symptomless persons were 0.5, 8, and 2 per 1000, respectively. Of persons with IBS, 87% also fulfilled the dyspepsia criteria, and the overlap between dyspepsia subgroups was more than 50%. The use of stricter criteria did not eliminate this overlap. Over a 1-year period, approximately 50% changed their symptom profile. Principal component analysis did not show any natural clustering of the symptoms. CONCLUSIONS: The separation of functional gastrointestinal symptoms into dyspepsia, its subgroups, and IBS may be inappropriate.
Adult↗
High birthweight as a predictor of prostate cancer risk.
In a follow-up study of a cohort of 50-year-old men who were born in 1913 and were living in Gothenburg, Sweden, we found an association between birthweight and prostate cancer. Of 366 men with known birthweight, there were 21 patients with prostate cancer. The incidence is about five times higher in the highest quartile of birthweight than in other birthweight groups. The findings indicate that aspects of the pre- and perinatal period may affect the risk of subsequent prostate cancer.
Birth Weight↗
Helicobacter pylori seropositivity among Swedish adults with and without abdominal symptoms. A population-based epidemiologic study.
BACKGROUND: The role of Helicobacter pylori in functional dyspepsia is unclear. The aim of this population-based study was to determine whether the prevalence of H. pylori infection is higher among people with dyspepsia or irritable bowel syndrome (IBS) than among symptomless persons after control for age, sex, and socioeconomic status. METHODS: In a postal questionnaire we asked a representative sample (20-79 years; n = 1260) from a Swedish municipality about abdominal symptoms in the preceding 3 months. A randomly selected subsample, 50 with dyspepsia, 50 with IBS, and 50 symptomless, matched with regard to age, sex, and education, were tested for the presence of IgG antibodies to H. pylori, using the HM-CAP immunoassay. RESULTS: Fifty-five persons (38%) were H. pylori-seropositive. The seroprevalence among dyspeptics (33%) did not exceed that in healthy people (48%) or in those reporting IBS (33%). The prevalence increased with age and with lower social class, but the latter association disappeared when age was taken into account. Neither sex nor symptom intensity predicted Helicobacter seropositivity. CONCLUSION: Our data are incompatible with an important aetiologic role for H. pylori in functional dyspepsia.
Age Distribution↗
The value of prostate specific antigen in early diagnosis of prostate cancer: the study of men born in 1913.
PURPOSE: We attempt to elucidate the performance of serum prostate specific antigen (PSA) as a screening test for prostate cancer. MATERIALS AND METHODS: We analyzed sera stored since 1980 in a nested case-control study. RESULTS: The 36 patients with prostate cancer had a markedly greater mean serum PSA level than did 68 subjects without cancer (22.71 versus 2.67, respectively, p < 0.0001). Among the controls 24% had a serum PSA of greater than 4.0 micrograms/l. A serum PSA value exceeding 4.0 micrograms/l. in 1980 was associated with a 20-fold excess risk of cancer between 1981 and 1986, and an 8-fold risk between 1987 and 1991. CONCLUSIONS: Diagnosis of clinically significant prostate cancer can be advanced substantially by serum PSA testing. However, the large number of high serum PSA values in men who remained free of clinical disease emphasizes the need for a more specific screening test.
Aged↗
[The child is the father of the man also among men born in 1913. New discoveries on fetal factors and adult diseases].
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Adult↗
Low birthweight and ischaemic heart disease.
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Humans↗
A randomized study of manual therapy with steroid injections in low-back pain. Telephone interview follow-up of pain, disability, recovery and drug consumption.
A total of 101 outpatients with acute or sub-acute low-back pain was randomly allocated to one of two treatment groups. One group was given standardised conventional and optimised activating treatment by primary health care teams. The other group received, according to a pragmatic approach, another treatment programme including manipulation, specific mobilisation, muscle stretching, autotraction and cortisone injections. The treatment effect was evaluated by standardised telephone interviews 3, 7, 14, 21 and 90 days after the start of treatment. The two groups were similar in most of the pretrial variables, including age, sex, occupation, education, previous low-back pain problems, previous treatment, sick-leave, findings at the physical examination, quality-of-life score, presence of common symptoms, disability rating and pain score. In the early phase as well as at the 90 days' follow-up, the group receiving manual therapy had significantly less pain, less disability, faster rate of recovery and lower drug consumption, indicating that this type of treatment is superior to conventional treatment.
Adult↗
Factors related to perceived health among elderly people: the Albertina Project.
The Albertina Project is an epidemiological study of the medical, social and economic situation among people aged 75 years or older in Uppsala, Sweden. In this report, health conditions, quality-of-life measures and housing problems affecting it are presented. A postal questionnaire was sent to an 11% random sample (n = 959) of the eligible population out of which 706 (74%) persons responded. Nearly one-third of the elderly people could not read a newspaper with or without glasses, more than one-third had impaired hearing, 47% had some sort of mobility problem and 66% reported some form of sleeping problem. Forty-two per cent felt lonely sometimes or often and 65% were worried, in most cases about the risk of falling. In spite of this, 87% rated their health as good and 79% were content or rather content with their situation. Even though eyesight and hearing problems were common in this study, they did not affect perceived health to any large extent. Mobility problems and sleeping problems had a greater impact. The most important factors related to perceived health were activity score, contentment and mobility problems. Contentment was affected by activity score and loneliness and the latter was in turn affected by age and type of dwelling. The practical implication of these findings is that perhaps more attention should be focused on efforts to improve old people's satisfaction with their life situation rather than on marginal improvements of their medical situation.
Activities of Daily Living↗
Social mobility and health in a prospective study of middle-aged men.
Many social factors and social phenomena and their influence on health are now of interest for epidemiological research and also for health policy. On social phenomenon of interest is mobility in the social structure of society. In this prospective study of a sample of 50-year-old men born in 1913 in Gothenburg, Sweden, it was possible to study intergenerational social mobility and different measures of ill-health, like health complaints, incidence of myocardial infarction and mortality. The results of the study indicate that individuals who find themselves in a lower social group than that of their father at the age of 50 exhibit a somewhat poorer subjective state of health and report more complaints and symptoms at the age of 60. They also tended to be slightly more at risk with regard to myocardial infarction, but there were no mortality differences in a long-term follow-up.
Absenteeism↗
The epidemiology of abdominal symptoms: prevalence and demographic characteristics in a Swedish adult population. A report from the Abdominal Symptom Study.
The prevalence of abdominal symptoms was studied by means of a postal questionnaire sent to a representative sample (n = 1290) of the adult population of a Swedish municipality. The subjects were asked about the occurrence of 35 abdominal symptoms during the preceding 3 months. The participation rate was 89.6%, and 54.3% of the responders reported at least one discomforting abdominal symptom. The overall prevalence rate was significantly higher in women than in men, and the highest rate (75%) was found among young women. The average number of symptoms per individual was also significantly higher in women. The overall prevalence rate in women decreased significantly with age, irrespective of menopause. The prevalence of most individual symptoms decreased with age and/or was higher in women. However, the prevalence of symptoms indicative of gastro-oesophageal reflux disease did not vary with age or sex. The prevalence of symptoms usually regarded as ominous did not increase with age; in some instances it even decreased. With the exception of reflux symptoms and night pain, the apparent disappearance with increasing age implies that most of the complaints are of functional origin.
Abdominal Pain↗
Housing conditions of elderly people in a city. The Albertina Project.
OBJECTIVE: To study housing conditions of elderly people in Uppsala, Sweden. DESIGN: The Albertina Project is an epidemiological study. A postal questionnaire was sent to a random sample. SETTING AND SUBJECTS: The general population 75 years or older in the community of Uppsala, 1985. MAIN OUTCOME MEASURES: Information on marital status, housing conditions, housing standard, problems with the apartment/house, desires for modifications to the apartment, wishes to stay or to move related to the possibility to prevent institutionalization because of bad housing standard. RESULTS: About half of those who participated in the study were single (never married, divorced or widowed). 85% lived in their own homes, 10% in so-called service apartments, and only 5% in institutions. More than 90% had a good housing standard. 45% reported some form of housing problem, but only 14% wanted modifications to their dwelling, and only 8% wanted to move from their present dwelling, in most cases due to problems with stairs or need for more help. CONCLUSION: Most people lived in their own home and wanted to stay there. The housing standard appeared to be satisfactory in the majority of cases but minor modifications might prevent "unnecessary" moves to institutions.
Age Factors↗
Low systolic blood pressure and self perceived wellbeing in middle aged men.
OBJECTIVE: To examine the relation between systolic blood pressure and self perceived wellbeing in 50 year old men. DESIGN: Cross sectional population study of data derived from questionnaires and physical examination as a part of a cardiovascular risk factor survey. SETTING: City of Gothenburg, Sweden. STUDY POPULATION: 776 men from a random population sample of 1016 men aged 50. METHODS: Self perceived wellbeing according to the Gothenburg quality of life questionnaire, which is an assessment of social, physical, and mental wellbeing in 15 different areas. MAIN RESULTS: Low systolic blood pressure was significantly (p < 0.05) related to impaired social wellbeing in four areas: work, home and family, financial situation, and housing. Of the items dealing with physical wellbeing, health, memory, and appetite were significantly related to blood pressure. As regards mental wellbeing, energy and self confidence were significantly related to systolic blood pressure. Diastolic blood pressure was significantly related to housing, memory, energy, patience, and self confidence. In multiple regression analyses that controlled for smoking, stress, physical activity, social activity, and emotional support, poor social, physical, and mental wellbeing were all significantly related to low systolic blood pressure independently of other factors. Low diastolic blood pressure was independently associated with poor physical and mental, but not social, wellbeing. CONCLUSION: Low systolic blood pressure was associated with poor perception of wellbeing in several areas. The cause is unclear.
Attitude to Health↗
Risk factors for coronary heart disease during 25 years of follow-up. The study of men born in 1913.
We followed 845 50-year-old men initially free of coronary heart disease (CHD) for 25 years. Blood pressure, serum cholesterol and smoking habits were significant and independent risk factors for CHD during the first 15 years of follow-up and for the whole follow-up period. CHD during the last 10 years of follow-up could be predicted by blood pressure, serum cholesterol and triglycerides and also by body mass index, but not by smoking habits in univariate analyses. Only blood pressure was an independent risk factor for CHD during the last 10 years of follow-up in multivariate analysis.
Aged↗