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Biomedical subjects

J Vestbo

Publications and source records attributed to J Vestbo.

At least 109 records · Page 6Linked to original sources
PubMed1995

Isolated systolic hypertension as a major risk factor for stroke and myocardial infarction and an unexploited source of cardiovascular prevention: a prospective population-based study.

The purpose of this study was to determine the prevalence of isolated systolic hypertension (ISH) and associated risk of major cardiovascular events. The Copenhagen City Heart Study is a prospective population survey with cardiovascular examinations at 5-year intervals. Blood pressure measurement was carried out as office blood pressure. ISH was defined as SBP > or = 160 mmHg and DBP < 90 mm Hg. The risk of stroke and myocardial infarction (MI) in association with ISH was assessed using a multivariate Cox regression model. Follow-up was carried out by means of the National Patients Register and Death Register. The 19,698 subjects were randomly selected after age stratification from an area of central Copenhagen. Subjects (n = 6621) were included if > or = 50 years, not on anti-hypertensive or cardiac medicine, and had no history of a previous stroke or MI. Initial cases of verified stroke or MI were recorded from 1976 to 1988. The prevalence of ISH showed an age-related increase from 3% in the 55-year olds to 13% in the 72-year olds. No sex difference was found. Relative risk of stroke corrected for other risk factors was 3.0 (95% CI 1.6-5.3) for women and 2.7 (1.8-4.3) for men. This was the highest relative risk among all hypertensive groups. Relative risk of MI corrected for other risk factors was 0.8 (0.3-2.0) for women and 1.6 (1.0-2.5) for men. Population attributable risk for stroke associated with ISH is up to 30%.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1994

[Pneumocystis carinii pneumonia in HIV-infected patients examined by bronchoscopy during the period 1989-1991].

We analyzed prospectively collected data from 211 HIV-infected patients who underwent bronchoscopy because of pulmonary symptoms during the period 1989-1991. We found an improvement in survival for patients diagnosed with Pneumocystis carinii pneumonia (PCP) in 1991 as compared to 1989 and 1990 (log rank test: p = 0.07). A significant decline in PO2 and CD4 cell count was observed in patients with PCP in the same period (p < 0.05 and 0.005 respectively). We suggest that the decline in CD4 cell count and in PO2 may reflect a change in Pneumocystis carinii transmission, and that the improved survival may be a result of altered treatment strategy of PCP.

AIDS-Related Opportunistic Infections↗
PubMed1994

Respiratory symptoms at presentation and long-term vital prognosis in patients with pulmonary sarcoidosis.

A follow-up of 254 patients with pulmonary sarcoidosis has been carried out after a median of 27 years from the diagnostic admission. Information on respiratory symptoms at entry was available in 80% of the patients. Cough and chronic bronchitis was present in 39% and 37%, respectively, whereas 41% reported breathlessness when walking and 25% reported breathlessness when undressing. In total, 51% had at least one respiratory symptom. All patients could be traced; eighty patients (31.5%) died during follow-up. A total of 17 died of sarcoidosis and a further 16 died of sarcoidosis-related diseases. All deaths from sarcoidosis were seen among patients with respiratory symptoms at presentation. For sarcoidosis and sarcoidosis-related deaths (N = 33), presence of one or more of the respiratory symptoms increased the risk significantly. For overall mortality, respiratory symptoms were also significant predictors; this was the case even after adjusting for age, sex, x-ray stage and lung function (FEV1 & TLC) at presentation. In conclusion, respiratory symptoms at the time of diagnosis are independently related to vital prognosis in pulmonary sarcoidosis.

Adult↗
PubMed1994

The prognosis of extrapulmonary sarcoidosis.

The frequency and functional prognosis of some major extrapulmonary manifestations (EPM) are reviewed using the literature and our own data. The influence of EPM on the vital prognosis is studied. Our knowledge of functional and vital prognosis in EPM is scanty.

Eye Diseases↗
PubMed1993

[Expectoration--an underestimated symptom?].

The prognostic value of pulmonary mucus hypersecretion is reviewed and is found to be considerable as regards COPD-mortality, -morbidity, and respiratory cancer. In contrast to previous belief, mucus hypersecretion cannot be considered a "harmless" respiratory symptom. The most efficacious intervention seems to be cessation of smoking, whereas little evidence is available supporting the benefit of long-term medical treatment or treatment involving chest physiotherapy.

Bronchoalveolar Lavage Fluid↗
PubMed1993

[How much is lung function affected by smoking and occupation? Dichotomy of continuous variables can change the results].

Data from a cross-sectional study of 1045 men comprising a random population sample (768 men) and a sample of cement workers (277 men) were analyzed in order to examine the effects of smoking and occupation on forced expiratory volume in one second (FEV1). The continuous FEV1 variable and five dichotomous FEV1 variables based on % of predicted were analyzed. Differences between the "relative importance" of smoking and occupation were found to depend on the choice of the FEV1 variable. The effects of occupation compared with the effects of smoking varied considerably with different FEV1 variables, continuous or dichotomized at different cut-off levels. We conclude that comparison of surveys utilizing different FEV1 variables must be made with caution.

Adult↗
PubMed1993

Amount of Pneumocystis carinii and degree of acute lung inflammation in HIV-associated P carinii pneumonia.

Correlations between semiquantitative amounts of Pneumocystis carinii (PC), the degree of inflammation, and the severity of pneumonia were analyzed in 58 patients with PC pneumonia (PCP). Material from both transbronchial biopsies (TBBs; n = 39) and bronchoalveolar lavage fluid (BALF; n = 57) was examined. In the TBB the amount of PC correlated strongly with overall inflammation in the interstitium (Kendall correlation coefficient [Kcc] = 0.59; p < 0.0001), type 2 pneumocyte proliferation, and edema formation. The amount of PC in the TBB also correlated with interstitial accumulation of neutrophils (Kcc = 0.54; p = 0.0001), lymphocytes, and macrophages. In BALF the amount of PC correlated with edema formation and type 2 pneumocyte proliferation in the TBB but not with the percentage of neutrophils, lymphocytes, or macrophages in BALF. The amount of PC in the BALF and the percentage of neutrophils in the BALF correlated significantly with Po2 and the serum lactate dehydrogenase (LDH) level. Neither short-term nor long-term survival was affected by the amount of PC, inflammatory markers in the TBB, inflammatory cells in BALF, Po2, or the serum LDH levels. In conclusion, the amount of PC is associated with the extent of the acute inflammatory reaction in the lung in PCP associated with human immunodeficiency virus (HIV).

Adult↗
PubMed1993

Genetic markers for chronic bronchitis and peak expiratory flow in the Copenhagen Male Study.

The associations between four major blood groups, ABH secretor status, and complement C3, and chronic bronchitis and peak expiratory flow were examined in 3387 men, aged 55-74 years. Presence of chronic bronchitis was assessed using the British Medical Research Council (BMRC) questionnaire. Men with NS- in the MNS system had significantly less chronic bronchitis than others, i.e. 11.4% versus 16.0% (p < 0.0005). In heavy smokers, both men with NS- and NS+ had significantly less chronic bronchitis than others. Also, Rhesus positive men had less chronic bronchitis than Rhesus negative men, 28.0% versus 38.3% (p < 0.05). Absence of the complement C3 allele C3F was associated with a higher prevalence of chronic bronchitis. No association with chronic bronchitis was found for the AB0 system or the ABH secretor system. No convincing associations were found between genetic markers and mean peak flow. In conclusion, this study has suggested new genetic markers for respiratory disease indicating a partly genetic aetiology of chronic respiratory disease. The MNS, and to some extent the Rhesus blood groups, were associated with chronic bronchitis in middle-aged men. However, this study demonstrates once again that no single blood type can act as a risk indicator of chronic respiratory disease.

ABO Blood-Group System↗
PubMed1993

Vital prognosis in intrathoracic sarcoidosis with special reference to pulmonary function and radiological stage.

A follow-up of 254 patients with intrathoracic sarcoidosis has been carried out after a median of 27 yrs from the diagnostic admission. All patients could be traced. At the end of follow-up there was no excess mortality (80 deaths observed versus 65.5 expected). However, during the first 20 yrs of follow-up a slight excess mortality was seen. Thirty three out of the 80 deaths were related to sarcoidosis. No excess number of deaths from lung cancer or lymphoma was observed. Erythema nodosum was of no prognostic significance concerning survival. X-ray stage was related to survival with a significant excess mortality for stage 3. Early clearing of X-ray changes gave a favourable vital prognosis. Survival was related to lung function, and for forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC) index and total lung capacity (TLC) this relationship reached levels of statistical significance. In multivariate Cox regression models, with age and sex entered as covariates, the same parameters were found to be significant predictors of mortality. Patients with FEV1 < or = 50% predicted had an increased mortality risk of 4.2 (95% confidence interval 1.8-9.6) when compared to patients with FEV1 > 80% predicted. Likewise, patients with TLC < or = 80% predicted had a mortality risk of 2.6 (1.5-4.5) when compared to patients with TLC > 80% predicted. In conclusion, a modest excess mortality was observed during the first 20 yrs of follow-up. Furthermore, both X-ray staging and lung function at the time of diagnosis influenced long-term mortality in patients with intrathoracic sarcoidosis.

Adult↗
PubMed1992

Baseline characteristics are not sufficient indicators of non-response bias follow up studies.

STUDY OBJECTIVE: The aim was to examine whether baseline characteristics from a cross sectional survey provided sufficient information regarding non-response bias in a follow up study when compared with information on hospital admissions in the intervening years. DESIGN: This was an 11 year follow up study of a cohort selected in 1974 with register information on hospital admissions during follow up. SETTING: The study was based on a sample of cement workers from a particular Portland cement factory with suitable controls from other occupations. PARTICIPANTS: A total of 1404 men participated in the first survey in 1974, including a questionnaire and lung function tests. In 1985 1070 men were alive and of these, 928 men (87%) responded to a postal questionnaire. MAIN RESULTS: Non-responders in 1985 did not differ markedly from responders when smoking habits, respiratory symptoms, and lung function were examined in 1974. During follow up, non-responders had twice as high rates of hospital admission due to respiratory diseases as responders. These differences remained present after adjusting for minor differences in age and smoking habits. CONCLUSIONS: Equal distributions of baseline characteristics among responders and non-responders in a follow up study do not preclude non-response bias.

Aged↗
PubMed1991

[Forced expiratory volume in 1 second (FEV1)--a respiratory physiological measurement of considerable prognostic value].

The epidemiologic literature concerning a relationship between a decreased FEV1 and mortality, morbidity and lung cancer was reviewed FEV1 is a very potent predictor of COPD mortality and morbidity, and of lung cancer. Furthermore, FEV1 is a hitherto largely unrecognized potent predictor of general mortality and cardiovascular mortality and morbidity. The consequence of this knowledge should be a more widespread usage of spirometry, both in epidemiologic studies and in daily clinical practice.

Cardiovascular Diseases↗
PubMed1991

Severe Rhodococcus equi pneumonia: case report and literature review.

Rhodococcus equi is an aerobic, gram-positive, non-motile pleomorphic bacillus infecting immunocompromised patients. Forty-nine cases of Rhodococcus equi infection have been reported, mainly in patients infected with the human immunodeficiency virus (HIV). A case in which Rhodococcus equi caused severe pulmonary infection, the most common presentation, is described. Clinically, patients have symptoms of pneumonia with hemoptysis as a prominent feature. X-ray will often show a cavitating upper-lobe infiltrate, resembling infection with mycobacteria. Rhodococcus equi is easily cultured from blood or sputum on standard media, but is frequently regarded as a contaminant. Mortality from Rhodococcus equi pneumonia is high (25%) and early surgical intervention has been recommended. Based on this review, the benefit of surgery seems dubious, whereas good results have been obtained using long-term antibiotic treatment with erythromycin plus rifampicin, or vancomycin in combination with either of these antibiotics.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Are respiratory symptoms and chronic airflow limitation really associated with an increased risk of respiratory cancer?

The relationship between respiratory symptoms, chronic airflow limitation and respiratory cancer was examined in a random population sample of 876 middle-aged men. All men were examined in 1974 with interview and lung function tests. Information on respiratory cancer from 1974 to June 1985 was obtained from the Danish Cancer Register. Using a multivariate Cox regression model including age as the underlying time scale and controlling for pack-years of cigarettes, cough and breathlessness were found to be significantly related to cancer--relative risks (RRs) 2.5 (95% confidence interval (CI): 1.3-5.0) and 2.2 (95% CI: 1.0-4.9), respectively. Phlegm, chronic phlegm, and chronic bronchitis were not related to respiratory cancer after controlling for age and smoking. Forced expiratory volume in one second (FEV1) was related to respiratory cancer, RR = 2.1 (95% CI: 1.3-3.4) per litre under the expected FEV1 given height. Thus, our study demonstrates some relationship between respiratory symptoms and FEV1 and respiratory cancer; however, the study at the same time questions the previously demonstrated relationship between phlegm and respiratory cancer.

Aged↗