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PubMed1983

Vasectomy and nonfatal myocardial infarction: continued observation indicates no elevation of risk.

The incidence of nonfatal myocardial infarction among 4,733 vasectomized men followed for 33,969 man-years was 1.3 cases per 1,000 man-years. This incidence was nearly identical in a 5-fold larger series of comparable nonvasectomized men. These data represent a substantially increased long-term followup over that reported previously for these groups and provide continued assurance of the lack of an association between vasectomy and myocardial infarction, particularly 10 or more years after vasectomy.

Adult↗
PubMed2006

The relationship between prospectively assessed body weight and physical activity and prevalence of radiological knee osteoarthritis in postmenopausal women.

OBJECTIVE: To determine the effect of weight and physical activity on the prevalence of radiological knee osteoarthritis (OA) in a cohort of middle-aged women. METHODS: The longitudinal phase of the Melbourne Women's Mid-life Health Project is a population-based prospective study of 438 Australian-born women who have been followed annually over 11 years. Of these women, 257 (59%) remained in longitudinal assessment at eleventh year of followup, and 224 of these women agreed to undergo radiographs of their knees. Radiographs were scored for features of OA [osteophytes and joint space narrowing (JSN)] using a validated scale, by 2 investigators who were blinded to questionnaire results. Data were obtained by both self-administered and face-to-face interview questionnaires. RESULTS: The average weight increase over the study period of 11 years was 4 kg (range -14 to 25 kg). Of the 224 women evaluated, 65 (29%) had knee joint osteophytes and 95 (42%) had evidence of knee JSN. Current weight and weight at baseline were independent factors associated with a higher prevalence of both osteophytes and JSN in all compartments of the knee. The average amount of physical activity over the 11 years of followup was a significant factor independently associated with an increased prevalence of patellofemoral JSN and approached significance for tibiofemoral osteophytes and total knee JSN. CONCLUSION: Our study supports a longterm detrimental effect of weight on the knee joint and suggests the importance of longterm weight maintenance programs in preventing knee OA. The average amount of physical activity was associated with an increased prevalence of some features of knee OA.

Australia↗
PubMed1976

Menopausal estrogens and breast cancer.

1891 women given conjugated estrogens for the menopause were followed for 12 years (mean) for incidence of breast cancer. Overall, 49 cases were observed; 39.1 were expected on the basis of rates in the general population (relative risk = 1.3, P = 0.06). The relative risk increased with follow-up duration, progressing to 2.0 after 15 years (13/6.6, P = 0.01). The excess risk after 10 years was not due simply to prolonged estrogen use, since there was no clear dose-response relation to accumulated years of use. However, higher risk accrued to women using higher-dose tablets and those taking the medication on an other than daily basis. In addition, after 10 years of follow-up observation, two factors related to low risk of breast cancer, multiparity and oophorectomy, were no longer so related. Finally, estrogen use was related to an especially high risk of breast cancer among women in whom benign disease developed after they had started the drug.

Aged↗
PubMed1989

Oral contraceptive use and premenopausal breast cancer in Sweden and Norway: possible effects of different pattern of use.

Different use of oral contraceptives (OCs) in relation to reproductive histories and age might explain the conflicting results found in studies from different countries of OC use and premenopausal breast cancer. A population-based case-control study in Sweden and Norway has been analysed separately for the two countries. The study consists of 317 Swedish and 105 Norwegian cases diagnosed 1984-1985 with 317 Swedish and 210 Norwegian controls. The results for each country separately are consistent with the joint analysis showing increased risk for breast cancer with increased duration of OC use with the exception of that for women with more than 15 years since first use. The relative risk of breast cancer for more than four years of use among Norwegian women was 0.6 (95% confidence internal (Cl), 0.2-1.8). In both countries there was a non-significant higher risk associated with increasing duration of use before first full-term pregnancy. Analyses for surveillance bias show no evidence of bias as explanation for the association between total duration of OC use and breast cancer.

Adult↗
PubMed1985

SCH23390 causes persistent antidopaminergic effects in vivo: evidence for longterm occupation of receptors.

SCH23390 has neurochemical properties characteristic of a specific D1 dopamine receptor antagonist. However, it is a potent inhibitor of dopamine-mediated behaviors which previously had been thought to be linked to D2 receptors. The metabolism of SCH23390 following parenteral administration to rats was much more rapid in the periphery than in brain, and SCH23390 had behavioral effects long after its circulating concentration had declined below detectable levels. Furthermore, the stimulation of adenylate cyclase by dopamine was attenuated in striatal homogenates taken from rats treated with SCH23390 as much as twelve hours before sacrifice. Pretreatment with cis-flupenthixol, a compound with equivalent D1 potency in vitro, failed to inhibit dopamine-stimulated adenylate cyclase activity one or four hours following injection, despite the fact that this dose produced significant behavioral effects. These data indicate that SCH23390 may act with unusual tenacity at certain sites in the central nervous system.

Adenylyl Cyclases↗
PubMed1991

Bone density in women receiving depot medroxyprogesterone acetate for contraception.

OBJECTIVE: To determine if the use of the injectable contraceptive depot medroxyprogesterone (DMPA), which reduces ovarian oestrogen production, is associated with changes in bone density. DESIGN: Population study. DMPA users were compared with two control groups selected from larger population studies and individually matched for several putative determinants of bone density (age, race, body mass index, and years of oestrogen deficiency). Controls and DMPA users were matched without prior knowledge of their bone density measurements. SETTING: Teaching hospital and community family planning clinics. SUBJECTS: 30 current users of DMPA with a minimum five years' previous use, 30 premenopausal controls, and 30 postmenopausal controls. MAIN OUTCOME MEASURE: Lumbar spine and femoral neck bone mineral density assessed by dual energy x ray absorptiometry. RESULTS: Compared with premenopausal controls matched for age, race, and body mass index, DMPA users had significantly reduced bone density in the lumbar spine (mean difference 7.5% (95% confidence interval 1.9% to 13.1%), p = 0.002) and in the femoral neck (6.6%, (0.8% to 12.3%), p = 0.007). Compared with postmenopausal controls matched for body mass index and duration of oestrogen deficiency, DMPA users had greater bone density in the lumbar spine (8.9% (4.3% to 13.5%), p = 0.001), but in the femoral neck the difference in bone density was less (4.0% (-0.4% to 8.5%), p = 0.04). CONCLUSIONS: Women using DMPA have bone density values intermediate between those of normal premenopausal and postmenopausal controls; thus, the degree of oestrogen deficiency induced by DMPA may have an adverse effect on bone density.

Absorptiometry, Photon↗
PubMed1998

Maternal exposure to influenza in pregnancy and electrodermal activity in offspring: a further study from Mauritius.

This study examined the effect of mothers' exposure to the 1957 A2/Singapore influenza virus in the first, second, and third trimesters of pregnancy on the electrodermal activity of their 15-year-old offspring. The epidemic occurred during cold months of the year. The results show that maternal viral (and cold) exposure during all trimesters of pregnancy produced a lower frequency of nonspecific electrodermal responses and diminished responsivity to 75-db and 90-db tones as compared with the offspring of mothers who were not exposed. However, there was a critical effect of second trimester exposure as indicated by an increase in frequency of nonresponses to orienting tones. The findings are compared with those from an earlier study from Mauritius involving 3-year-old children in which the effects of exposure to the 1968 A2/Hong Kong virus were examined and in which the effect of could exposure could be examined separately because viral exposure occurred during the hot months.

Adolescent↗
PubMed1998

Changes in premature deaths in Finland: successful long-term prevention of cardiovascular diseases.

This article describes the long-term consequences of successful cardiovascular disease (CVD) prevention and its influence on premature mortality in Finland, with special reference to North Karelia. Active community-based CVD prevention began in 1972 in the province of North Karelia (population, 180,000). Since 1977, active preventive work has been carried out nationwide, taking advantage of the experience from North Karelia, which continued as a demonstration area for integrated prevention of noncommunicable diseases. Comprehensive community-based interventions as part of WHO interhealth and CINDI programmes in North Karelia and nationwide aimed at changing the target risk factors and health behaviours (serum cholesterol, blood pressure, smoking, diet) at the population level. Age-adjusted mortality rates for CVD, coronary heart disease (CHD), cerebrovascular disease, all cancers, lung cancer, accidents and violence, and all causes in the population aged 35-64 years from the pre-programme period (1969-71) to 1995 were the main measures of the outcome. Among men there was a great reduction in deaths from CHD, CVD, cancer, and all causes in the whole country. From 1969-71 to 1995 the age-standardized CHD mortality (per 100,000) decreased in North Karelia by 73% (from 672 to 185) and nationwide by 65% (from 465 to 165). The reduction in CVD mortality was of the same magnitude. Among men, CHD mortality decreased in the 1970s, as did lung cancer mortality in the 1980s and 1990s, significantly more in North Karelia than in all of Finland. Among women there was a great reduction in CVD (including CHD and stroke) mortality and all-causes mortality, but only a small reduction in cancer mortality. These results show that a major reduction in CVD mortality among the working-age population can take place in association with active reduction of major risk factors, with a favourable impact on cancer and all-causes mortality.

Adult↗
PubMed2003

Guideline for the management of late-life depression in primary care.

OBJECTIVE: To develop a guideline for the primary care management of depression in later life based on best practice. METHOD: Source material included relevant guidelines, literature reviews and consensus documents coupled with an updated literature review covering 1998-October, 2001. This material was summarised as a series of evidence-based statements and recommendations agreed by consensus. RESULTS: Good quality evidence exists for the pharmacological and psychological treatment of depressive episode (major depression), although not specifically in primary care. There is some evidence of efficacy of antidepressants in late-life dysthymia and minor depression associated with poor functional status. In depressive episode, current evidence suggests acute treatment for at least six weeks and a continuation period of at least 12 months. Both tricyclic antidepressants and Selective Serotonin Re-uptake Inhibitors are effective in longterm prevention. There is less data on how to manage patients who do not respond in the acute treatment phase. More data is needed on sub-groups of patients with specific co-morbid medical conditions and those who are frail. Collaborative care is effective in older depressed primary care patients. CONCLUSIONS: There are effective treatments for depression in primary care. More research is needed to address the optimum treatment of depression with medical co-morbidity and to elucidate the role of newer psychological interventions. Collaborative care between primary care and specialist services is a promising new avenue for management.

Aged↗
PubMed2005

Pimecrolimus 1% cream for the treatment of atopic dermatitis.

Atopic dermatitis is a highly pruritic inflammatory disorder of the skin characterized by onset in infancy or childhood and a chronically relapsing course. Mainstay treatments are emollients and topical corticosteroids, but the latter are limited by side-effects from longterm use. Pimecrolimus is an ascomycin macrolactam derivative and a calcineurin inhibitor that targets T-cell activation but does not inhibit antigen-presenting cells in the skin. In multiple clinical trials comprising more than 19,000 patients, pimecrolimus cream has been shown to be very effective in suppressing atopic dermatitis and to have an excellent safety profile. This has also been shown in long-term studies (>2 years) and by postmarketing experience.

Clinical Trials as Topic↗
PubMed1990

Does vasectomy have long-term effects on somatic and psychological health status?

All the major international articles on the somatic and psychological consequences of vasectomy published over the last 10 years have been reviewed and analysed. Although some experiments on animals have revealed harmful effects, none of the large-scale epidemiological studies has pointed to any increase in health risks (cardiovascular, hypertensive, psychiatric) in vasectomized men. The contradictions which arise between the clinical and large-scale epidemiological studies may be the result of methodological or experimental conditions. As our knowledge stands at present it can therefore be considered that vasectomy has no major effects on the physical or mental health of men.

Animals↗
PubMed1991

[Can breast cancer be prevented?].

More than six-fold variation in incidence between countries, an increasing incidence among immigrants to high incidence areas, and a general increase in the incidence of breast cancer within countries, are factors which suggest a potential for prevention. Reproductive factors such as early menarche, late age at first full term birth, nulliparity, and late age at menopause increase risk of breast cancer, but manipulation of any one of these factors does not seem to be a realistic preventive tool. Nevertheless, the future possibility of using tamoxifen as a chemopreventive agent against breast cancer is discussed, particularly in relation to women at increased risk due to familial clustering. Alcohol consumption by young women, and overweight among postmenopausal women may also increase the incidence of breast cancer. Consequently, reduced alcohol intake by young women, and weight reduction among overweight women after menopause may reduce the risk of breast cancer.

Adolescent↗
PubMed1984

[Prevention of the development of tolerance to isosorbide dinitrate in interval therapy].

A number of carefully controlled studies in recent years have unequivocally documented evidence of tolerance development with respect to anti-ischemic effects during longterm treatment with nitrates [1, 3, 4, 5, 7, 8]. To determine to what extent tolerance development can be circumvented through an interval regimen, a study was performed in ten patients with stable angina pectoris and reproducible ST-segment depression according to a randomized, double-blind, cross-over, placebo-controlled protocol. Analysis of the anti-ischemic effect of 20 mg ISDN was carried out after acute administration and during chronic treatment on an interval regimen with the administration of 20 mg ISDN in the morning (at 8 a.m.) and at midday (1 p.m.) (Figure 1). On acute administration, 20 mg ISDN led to a reduction in ST-segment depression from 2.15 to 0.40 mm (p less than 0.01) and during longterm treatment from 2.25 to 0.40 mm (p less than 0.01) (Figure 2, Table 1). After acute administration the plasma concentration of ISDN was 9 ng/ml, 2-ISMN 34 ng/ml and 5-ISMN 149 ng/ml (Figure 5, Table 2). Of the control values during longterm treatment, a detectable level was found only for 5-ISMN with a concentration of 36 ng/ml while that of both 2-ISMN and ISDN was 0 ng/ml. On renewed administration, there was an increase of ISDN to 9 ng/ml, 2-ISMN to 37 ng/ml and 5-ISMN to 208 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1990

[Long-term arterial blockade and retrograde venous perfusion in peripheral arterial occlusive diseases].

The method of longterm artificial arterial blockade in patients with peripheral arterial occlusive disease (PAOD) opens new therapeutic possibilities. However, it is yet not clear if and how the suspected dilation of collateral arteries can be therapeutically used. The retrograde venous perfusion permits the transport of active substances in high concentrations into ischemic areas. The resulting temporary local damping or even blockade of sympathetic innervation can under certain conditions achieve therapeutic effects. A longterm arterial blockade can be performed even in case of trophic lesions. This permits treatment in stage IV of PAOD. It has been proved that antibiotics reach a lesion by retrograde venous perfusion faster and better than by systemic application, especially in badly compensated cases. However, sufficient experience on the therapeutic effect and possible side effects in stage IV is still lacking.

Arterial Occlusive Diseases↗
PubMed1983

Five years' experience of intrauterine contraception with the Nova-T and the Copper-T-200.

A randomized study was performed for the comparison of two copper-releasing intrauterine contraceptive devices (IUDs), the Nova-T and the Copper-T-200, simultaneously in Denmark, Finland, and Sweden. Five years' experience demonstrated that Nova-T users had a significantly lower pregnancy rate than Copper-T-200 users. The Pearl index over 5 years was 0.8 for Nova-T users and 2.0 for Copper-T users. The performance and tolerance of the Nova-T were less affected by parity and age than was the performance of the Copper-T. Infections were treated by removal of the device and with antibiotics. The cumulative rate of removals because of infections and suspected infections was below 5 with both devices over 5 years. The copper wire in the Nova-T has a silver core which prevents corrosion-induced fragmentation of the wire. Hence, the effective lifetime of this device is more than 5 years. The results indicate that the Nova-T, which is easy to insert and remove and is associated with a low pregnancy rate and a low medical termination rate, is a real improvement over other IUDs.

Adult↗