Search PubMed⌕ Search

Biomedical subjects

L Janzon

Publications and source records attributed to L Janzon.

At least 127 records · Page 7Linked to original sources
PubMed1994

Low pulse-wave amplitude during reactive leg hyperaemia: an independent, early marker for ischaemic heart disease and death. Results from the 21-year follow-up of the prospective cohort study 'Men born in 1914', Malmö, Sweden.

OBJECTIVE: To study the incidence of myocardial infarction, all-cause mortality and mortality from ischaemic heart disease in relation to arterial leg blood flow determined by venous occlusion plethysmography of the calf. DESIGN: A prospective cohort study 'Men born in 1914'. SETTING: Malmö, a city in southern Sweden with 256,000 inhabitants, and a single referral hospital. SUBJECTS: Six-hundred and thirty-six 55-year-old men, randomly selected from the general population. None of them had signs or symptoms of leg artery disease. MAIN OUTCOME MEASURES: All-cause mortality, morbidity and mortality from ischaemic heart disease during 21 years of follow-up following the initial examination in 1968. RESULTS: A low pulse-wave amplitude (i.e. < 5 mm) during reactive hyperaemia was, independently of other known arteriosclerotic risk factors, associated with a higher cardiac event rate of 37.1% (relative risk: 2.2; 95% CI: 1.3-3.6) and a higher all-cause mortality rate of 62.9% (relative risk: 1.7; 95% CI: 1.2-2.4) during 21 years of follow-up. No other plethysmographically recorded variable was associated with an increased mortality and cardiac event rate. CONCLUSIONS: The plethysmographically recorded pulse-wave amplitude during reactive hyperaemia can be used as an early independent marker to identify individuals at risk of developing ischaemic heart disease and death at an early age.

Aged↗
PubMed1994

Pathological significance and molecular characterization of the vacuolating toxin gene of Helicobacter pylori.

Some strains of Helicobacter pylori are known to produce an extracellular cytotoxin that causes vacuolization in various mammalian cells. In this study, we found that concentrated culture supernatants from four Helicobacter strains isolated from patients infected with the bacterium, but having normal gastric mucosa, lacked cytotoxic activity. We also show that a higher percentage of strains isolated from patients with polymorphonuclear leukocyte infiltration of gastric mucosa are toxin positive (78%) versus those isolated from patients lacking such infiltration (33%). In addition to examining the relationship between pathology and cytotoxic activity, we used the previously published N-terminal sequence of the protein to clone and characterize vacA, the structural gene encoding the cytotoxin. Briefly, three oligonucleotides capable of encoding the first nine amino acids corresponding to the sense strand and four oligonucleotides corresponding to the noncoding strand of the last seven known amino acids of the cytotoxin protein were made. They were used in all 12 possible combinations in 12 different PCR reactions, with DNA from a cytotoxin-positive strain as template. In four combinations, the expected 69-bp fragment was seen. The sequence of this 69-bp fragment confirmed that it encoded the known N-terminal sequence of the cytotoxin. This gene is capable of encoding a 136-kDa protein with a 33-amino-acid signal peptide, whereas the purified cytotoxin is only 87 kDa, suggesting processing in the C-terminal region of the protein. A single copy of the vacA gene encodes the cytotoxin in H. pylori. Consequently, the insertion of a kanamycin resistance marker in the vacA gene produced an isogenic mutant lacking the cytotoxic activity. This mutant provides genetic evidence that vacA encodes the cytotoxin. Sequence analysis of the DNA adjacent to the vacA gene demonstrated that this gene is next to a putative cysteinyl tRNA synthetase gene. From the sequence arrangement, we predict that there are no other genes transcribed together with vacA. We also show that five of seven cytotoxin-negative strains examined still carry the sequences encoding it whereas the other two have suffered a deletion of the vacA gene. We further show that in at least one cytotoxin-negative but vacA-positive strain (MO19), there are variations in the length of the vacA gene that could explain the cytotoxin-negative phenotype in this strain.

Amino Acid Sequence↗
PubMed1994

Hypertension and silent myocardial ischemia: their influence on cardiovascular mortality and morbidity.

The presence of ST-segment depression during ambulatory electrocardiographic monitoring, in relation to blood pressure treatment and control, was monitored in a non-randomized study in 167 men (49%) from the 'Men born in 1914' Malmö study, who were considered to have hypertension (diastolic blood pressure [DBP], > or = 95 mm Hg or receiving antihypertensive therapy). Men were excluded if they had a history of ischemic heart disease. A high frequency of ST-segment depression (41%) and associated high cardiac event rate (14%) were found in hypertensive elderly men who had inadequately controlled blood pressure (i.e. DBP > or = 95 mm Hg). This was associated with a relative risk of a cardiac event of 9.8 (95% confidence interval: 2.6-36.9), even after adjustment for smoking, blood lipids and alcohol consumption. The lower frequency of ST-segment depression (21%) and lower cardiac event rate (5%) in hypertensive men with adequate blood pressure control suggests that effective antihypertensive treatment leads to a reduced event rate. In conclusion, the occurrence of ST-segment depression during ambulatory electrocardiographic monitoring in this group of subjects may be an expression of silent myocardial ischemia, with or without left ventricular hypertrophy. The incidence of asymptomatic ST-segment depression and the rate of cardiac events in hypertensive patients may be, in part, related to the level of blood pressure control attained.

Aged↗
PubMed1994

Positive correlation between H,K-adenosine triphosphatase autoantibodies and Helicobacter pylori antibodies in patients with pernicious anemia.

BACKGROUND: Helicobacter pylori is a major cause of gastritis, and the parietal cell H,K-adenosine triphosphatase (ATPase) is a major autoantigen in autoimmune atrophic corpus gastritis, which may eventually lead to pernicious anemia and/or neuropathy. Whether the bacterium induces the autoimmune response is unknown. METHODS: By means of enzyme-linked immunosorbent assay the occurrence of antibodies against porcine H,K-ATPase and H. pylori was determined in sera from 30 patients with pernicious anemia. RESULTS: All sera scored positive against H,K-ATPase, and 25 (83%) scored positive against H. pylori. The titers of antibodies against both antigen preparations inversely correlated with the duration of disease. A possible common epitope in the antigen preparations was tested with a competition assay. There was no indication of a common epitope in either human or porcine H,K-ATPase and H. pylori. CONCLUSIONS: There was a positive correlation and a high incidence of antibodies against H,K-ATPase and H. pylori in sera from patients with pernicious anemia. These antibodies recognized different epitopes.

Aged↗
PubMed1993

Non-invasively detected carotid stenosis and ischaemic heart disease in men with leg arteriosclerosis.

Since the excess mortality rate associated with an ankle-brachial blood-pressure index (ABPI) less than 0.9 was only partly explained by an excess cardiovascular mortality, we believe that leg artery disease should not only be regarded as a marker of generalised arteriosclerosis but also as a sign associated with an increased risk of premature death. 439 men who were part of a prospective population study in Malmö, Sweden, were, at 68 years of age, invited to a health examination including, ABPI, carotid-artery ultrasonography, and 24 h ambulatory electrocardiographic monitoring. Cause-specific mortality and incidence of myocardial infarction (MI) during 8 years of follow-up was compared in men with and without signs of arteriosclerotic disease. Of 60 men with an ABPI < 0.9, 20 (33%) had angina pectoris or previous MI. Another 11 (18%) had silent ST-segment depression (> or = 1 mm); 3 (5%) had a history of stroke; and 17 (28%) had symptom-free carotid stenosis (> 30% reduction of the cross-sectional diameter). Total mortality rate in men with no signs of arteriosclerotic disease was 19.6 per 1000 person-years and cardiac event rate (fatal and non-fatal MI and death from chronic ischaemic heart disease was 8.6 per 1000 person-years). Leg artery disease, carotid stenosis, and ischaemic heart disease were in a univariate analysis all associated with an increased cardiac event rate and an increased total mortality rate. In a multivariate analysis an ABPI less than 0.9 was associated with a 2.4 times higher total mortality (95% CI 1.5-3.9) and a 2.0 times higher cardiac event rate (1.1-3.9). Carotid stenosis and ischaemic heart disease contributed to the risk for MI (RR 2.1; 95% CI 1.2-3.8; and 2.1; 1.2-3.9, respectively), whereas no independent association with total mortality was found.

Aged↗
PubMed1993

The choice of strategy in the treatment of intermittent claudication--a decision tree approach.

OBJECTIVES: to compare possible outcomes of the non-operative treatment for intermittent claudication with that of surgery. DESIGN: decision tree approach using published and vascular registry data. The valuation of clinical outcomes was estimated by index weights using the Rosser index and the Quality of Well-Being scale. SETTING: routine health care in Sweden. MATERIALS: published data on 224 non-operatively treated claudicants and data from 805 claudicants treated with surgery or angioplasty from the Swedvasc registry. No diabetics were included. Chief outcome measure: expected utility value at one year after decision on treatment given the clinical data and the estimated health status valuations. MAIN RESULTS: it was possible to identify a success rate for surgery above which it was the better alternative. However, depending on which of two health indices that was used, and if reconstruction was supra- or infrainguinal, this threshold value varied from 0-81%. CONCLUSIONS: reliable measures of the value of outcomes have to be developed and, in addition, long-term data on outcome and costs in routine care have to be collected before a comprehensive economic assessment based on the decision tree approach can be made to support decisions on treatment for intermittent claudication.

Aged↗
PubMed1993

Low ankle-brachial pressure index in 68-year-old men: prevalence, risk factors and prognosis. Results from prospective population study "Men born in 1914", Malmö, Sweden.

The objectives were to study the distribution of ankle-brachial pressure indices (ABPI) in elderly men in relation to arteriosclerotic risk factors, cardiovascular morbidity and total mortality. The data are taken from the prospective cohort study "Men born in 1914" in Malmö, a city in southern Sweden with 220,000 inhabitants and a single referral hospital. Prevalence of low ABPI (< 0.90) at 68 years of age, total mortality, mortality from ischaemic heart disease (IHD) International Classification of Diseases (ICD) code 410.0-412.9) and cardiac event rate [fatal and non-fatal myocardial infarction (MI) and mortality from chronic ischaemic heart disease] during 8 years of follow-up was measured. Sixty-seven of 477 randomly selected men (14.0%) had an ABPI < 0.90 in one or both legs, 18/477 (3.8%) had intermittent claudication according to the Rose questionnaire, which had a sensitivity of 14.9% and a specificity of 98% when using ABPI as a reference method. Ninety-two per cent of the men with an ABPI < 0.90 were or had been smokers, compared with 80% of the men with an ABPI > or = 0.90. Mean systolic blood pressure and median plasma triglyceride levels were significantly higher in the group with low ABPI. Thirty (45%) of the men with low ABPI and 87 (21%) of the men with pressure indices above 0.90 died during follow-up (p < 0.001). Cardiac event rate was 25% (17/67) in the group with low ABPI and 10% (41/410) in the other group (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Chronic pain and the sociodemographic environment: results from the Pain Clinic at Malmö General Hospital in Sweden.

OBJECTIVE: To study the occurrence of chronic pain in relation to different sociodemographic factors. DESIGN AND PATIENTS: The study cohort included all 1,360 new patients who, between July 1, 1988, and June 30, 1991, were referred to the multidisciplinary Pain Clinic at Malmö General Hospital, Malmö, Sweden, because of chronic, nonmalignant pain. The patients were characterized by age, sex, type of pain (nociceptive, neurogenic, psychogenic), place of residence, and ethnic background. SETTING: The referred sample was from the municipality of Malmö, a city with 240,000 inhabitants in an industrialized area served by one hospital. RESULTS: The age and sex standardized number of patients referred per 10,000 inhabitants and year varied among the different city areas from 0.35 to 1.63. High-rate areas had, in comparison to the city average, a higher migration rate, a higher proportion of single households with children, a higher percentage of people in need of social security benefits, a higher unemployment rate, and a greater percentage of people with foreign background. The age and sex distribution differed greatly among the three pain categories. Nociceptive pain was the most common category, with a striking overrepresentation of young women. CONCLUSION: Our results support the view that the occurrence of pain in an urban population is related to a number of sociodemographic factors. Further studies should be performed to evaluate how these factors influence incidence, medical-seeking behavior, clinical course, and rules for referral.

Adolescent↗
PubMed1993

The Malmo Diet and Cancer Study. Design and feasibility.

The Malmö Diet and Cancer study is a 10-year prospective case-control study in 45-64-year-old men and women (n = 53,000) living in a city with 230,000 inhabitants. One objective is to clarify whether a western diet is associated with certain forms of cancer whilst taking other life-style factors into account. Another broad question is whether oxidative stress and the activity in DNA-repairing systems influence the impact of diet on the development of all or certain forms of cancer. The study is also to act as a resource available for testing new hypotheses emanating from other studies. Initially food intake, heredity, socio-economic factors, life-style pattern, occupational situation, previous and current diseases, symptoms and medications, will be determined. Viable lymphocytes, granulocytes, erythrocytes, and plasma/serum will be stored in a biological bank together with tumour specimens gathered from cases. The incidence and mortality of all cancer forms will then be followed for 10 years by existing registries. Data from the initial examination in these cases will then be compared with those of control subjects not having developed any form of cancer. A biomarker programme, utilizing the biological bank, has been developed and is aimed at finding predictors and/or precursors of cancer. A high participation rate (> 70%) and a high quality biological bank are prerequisites for a successful project. The experience gathered so far indicates that these goals are feasible.

Adult↗
PubMed1993

The Malmö biological bank.

Currently there are no available biological markers that have been satisfactorily validated clinically as 'intermediate end-points' for evaluation of the impact of diet on cancer. Therefore, there is high scientific value in banking biological specimens for future use in the Malmö Diet and Cancer Study. The banking procedures we have developed are adequate for assessing factors that estimate dietary intake (e.g. vitamins, lipids or micronutrients) as well as non-dietary variables (e.g. immunologic and ecogenetic factors of biologically effective doses of xenobiotic exposures) that may regulate the biological expression of dietary variables. This approach is further justified by state-of-the-art technology that includes assessment of the concept of gene-environment interactions. Purified viable mononuclear leucocytes, granulocytes, erythrocytes, plasma and serum are being stored from each individual entering the study under the guidelines of a strict quality control programme. Storage of tumour/normal tissues from incident cancer cases are also being stored and quality controlled. It is hoped that these banking procedures will encourage a high activity in biomarker development in the future.

Algorithms↗
PubMed1993

The Malmö biomarker programme.

Evaluation of pro-oxidant/antioxidant dietary factors in relation to individual susceptibility to cancer and cardiovascular disease is justified based on a review of the literature. This working hypothesis is amendable to further scientific validation from biomarkers with end-point sensitivity to oxygen radicals. So far, the biomarker programme developed around this theme may be divided into three distinct classes: (1) Markers of genotoxic exposure estimate DNA damage either directly as a biologically effective dose, or indirectly by estimating aberrant cellular functions that lead to accumulation of DNA damage. The examples included are ADP-ribosylation in mononuclear leucocytes (R. Pero, A. Olsson), oxidative DNA damage (K. Frenkel), gene expression in lymphocytes (S. Garte, G. Cosma), serum alpha macroglobulin (W. Troll) and oxidized DNA damage and repair (N. Christie). (2) Markers of genetic predisposition have been shown to have genetic inheritance patterns that relate to individual susceptibility to cancer or cardiovascular disease. The examples included are glutathione transferase mu phenotyping (R. Pero, J. Seidegård) and poly (ADP-ribose) polymerase pseudogene polymorphism (M. Smulson). (3) Markers of dietary status have been validated to estimate the amount of a particular nutrient or xenobiotic in the diet that has been taken up and metabolized or distributed to body fluids or tissues. The example included here is niacin nutriture (E. Jacobson, M. Jacobson). This biomarker is presented in Section 5 (pp. 59-62) of the Malmö Diet and Cancer Programme Minisymposium reported in this issue of the journal.

Animals↗
PubMed1993

Socio-demographic characteristics of women requesting induced abortion. A cross-sectional study from the municipality of Malmö, Sweden.

The aim of this study in an urban population has been to describe socio-demographic characteristics of women seeking an induced abortion. The 1,220 cases in the study correspond to an annual abortion rate of 26.0 per 1,000 women aged 15-44. There were substantial differences from 10.1 to 42.6 per 1,000 women in the 18 different urban areas. High rate areas had, in comparison with the municipal average, a higher percentage of people with low income, low education, foreign background, and people in need of social welfare. There was also a higher percentage of people living alone and a higher migration rate. Women applying for an induced abortion had similar socio-demographic characteristics. It is concluded that these associations should be considered in future family planning programs and that preventive efforts probably can be made more cost effective by concentrating on areas and individuals with these socio-demographic characteristics.

Abortion Applicants↗
PubMed1992

Adverse outcome in surgery for chronic leg ischaemia--risk factors and risk prediction when using different statistical methods.

OBJECTIVE: to compare two different statistical methods in predicting the outcome of surgery for chronic leg ischaemia. MATERIAL: the present study from the Swedvasc registry is based on an inception cohort of 1635 patients with chronic leg ischaemia (intermittent claudication in 609 and critical ischaemia in 1026 patients), who have been followed until 1 year after surgery. Outcome was classified as improved vs. not improved, amputated or dead in claudication and as the intact leg vs. amputation or death in critical ischaemia. METHODS: logistic regression analysis was compared to the inductive expert system program, Assistant Professional, in the prediction of outcome. Seventy per cent of cases in the data base were used to create a risk factor model including 17 variables registered in Swedvasc. These variables included an assessment of patients overall health status, severity of disease, the surgeon's experience and surgical procedures. This model was then evaluated using the remaining 30% of the patients in the data base. RESULTS: a risk score indicating a probability of an adverse outcome exceeding 0.5 was, in patients with intermittent claudication, associated with a sensitivity of 38% using logistic regression and 26% using Assistant Professional. The percentages of correctly predicted adverse outcomes were 29 and 50%, respectively. In patients with critical ischaemia, the sensitivities with the two methods were 68 and 38% and the predictive values 42 and 57%, respectively. CONCLUSIONS: the risk scores created with the two methods gave low sensitivities. It is concluded that risk functions could not be used to predict an adverse outcome in patients operated on for chronic leg ischaemia with the data set used.

Aged↗
PubMed1992

Influence of social support on cardiac event rate in men with ischaemic type ST segment depression during ambulatory 24-h long-term ECG recording. The prospective population study 'Men born in 1914', Malmö, Sweden.

Three-hundred and ninety-four 68-year-old men, representing 60.3% of a cohort of men born in 1914, were examined with ambulatory ECG during 24 h in 1982-83. Ninety-eight (24.8%) men had one or more episodes of ischaemic type ST segment depression (greater than or equal to 0.10 mV), 79 of whom had no history of previous ischaemic heart disease (IHD). During 63 months follow-up, 17 of the 98 suffered a cardiac event, i.e. fatal or non-fatal myocardial infarction (MI) or death due to chronic IHD. The objective of this study was to assess the influence of psychosocial factors, such as social network and social support, on cardiac event rate in men with ischaemic ST segment depression. A higher risk was found among men with little material and informational support (i.e. access to practical services and material resources and access to guidance, advice and information (crude relative risk 4.8; 95% CI; 1.6-14.8) and men with low availability of emotional support (i.e. opportunity for care, encouragement of personal value and feelings of confidence and trust) (crude relative risk 4.3; 95% CI: 1.4-13.3). This association was independent of history of IHD and other known risk factors for myocardial infarction (MI).

Aged↗
PubMed1992

Hypertension and ST segment depression during ambulatory electrocardiographic recording. Results from the prospective population study 'men born in 1914' from Malmö, Sweden.

The aim of this study in 341 men (aged 68 years) without history of ischemic heart disease was to study the relation between hypertension and silent ischemic-type ST segment depression during ambulatory long-term electrocardiographic recording and to assess the influence between these two variables on cardiovascular morbidity and mortality rates. Seventy-nine men (23%) demonstrated one or more episodes of silent ischemic ST segment depression. One hundred and sixty-seven men (49%) were considered to have hypertension (i.e., they had a diastolic blood pressure of 95 mm Hg or greater or were treated with antihypertensive therapy). Forty-nine (72%) of the 68 treated hypertensive subjects were classified as uncontrolled (i.e., their diastolic blood pressure was 95 mm Hg or greater). The occurrence of ischemic ST depression was higher in hypertensive men (28%) than in normotensive men (19%). The highest incidence of ischemic ST depression (41%) was observed in treated hypertensive men with inadequate blood pressure control. Cardiac event rate during a 53-month follow-up was 6.6% in hypertensive men and 4.6% in normotensive men. Uncontrolled treated hypertensive men had a higher event rate (14%) than hypertensive men overall. Hypertensive men with inadequate blood pressure control and who demonstrated ST segment depression had the highest event rate (25%).

Aged↗
PubMed1992

The epidemiology of sick leave in an urban population in Malmö, Sweden.

The epidemiology of sick leave was studied in the city of Malmö, Sweden, (230,000 inhabitants). Every current and completed sick-leave episode during the year of 1985 was collected for 124,411 persons aged 16 to 65, who were registered with the National Health insurance scheme in 1985. Absence rate, absence incidence, absence prevalence and absence duration were analyzed in relation to age, sex, marital status, nationality, income and place of residence. Absence rate (mean value) in the total population was 25.5 days with a median of three days. The absence rate increased by age. High absence rates were seen for females, single people and some immigrant groups. This was even true for residential areas characterized by a higher proportion of single-person households and households on social welfare, of unemployed and people with a low income and a foreign background. The absence rate gives limited information as to the epidemiology of sick leave. Through adding absence incidence, absence prevalence and absence duration it was possible to get a more comprehensive picture of the phenomenon. Sex-differences in absence rate for instance were mainly explained by differences in absence incidence and prevalence, while differences in absence rate regarding nationality were explained by differences in absence duration. This is an important step towards a better understanding of the factors behind sick leave.

Absenteeism↗
PubMed1992

Interval carcinomas in the Malmö Mammographic Screening Trial: radiographic appearance and prognostic considerations.

OBJECTIVE: Interval carcinoma is the term used to describe malignant breast tumors that are detected in the intervals between mammographic screenings. These tumors are important because they contribute significantly to breast cancer mortality in the screened population. MATERIALS AND METHODS: Two radiologists retrospectively reviewed the mammograms of the 96 interval carcinomas (17% of all malignant neoplasms in the screened group) that were detected during the 10-year Malmö Mammographic Screening Trial in Malmö, Sweden (average time between screenings, 21 months), including one sarcoma, 75 invasive carcinomas, and 20 noninvasive carcinomas. We recorded the interval between screening and detection, and noted the tumor's appearance on the prior screening mammogram and at the time of diagnosis; these data were correlated with histologic tumor type and the patients' mortality. The doubling time for tumor volume of the invasive carcinomas was estimated. RESULTS: Excluding the sarcoma, 72 carcinomas (75%) were detected within 18 months of screening. Retrospective review of the available preceding screening mammograms (94 cases) indicated that 10 tumors were missed (observer's error), 63 studies showed no tumor (true interval carcinomas), and 21 studies showed subtle signs of malignancy, mostly nonspecific densities or asymmetries (unrecognized sign). Of 66 invasive carcinomas in which doubling times for tumor volume could be calculated, 27 (41%) had doubling times of less than 100 days. At the end of the study, 20 of the 96 patients had died of breast cancer. CONCLUSION: Interval carcinomas in this series were dominated by comedo, medullary, and mucinous carcinomas that often had a nonspecific appearance (when present) on prior screening mammograms. The interval carcinomas also contained a subset of rapidly growing tumors with a grave prognosis.

Aged↗