OBJECTIVES: Previous studies have suggested that abnormal levels of cortisol and testosterone might increase the risk of serious somatic diseases. To test this hypothesis, we conducted a 5-year follow-up study in middle-aged men. METHODS: A population-based cohort study conducted in 1995 amongst 141 Swedish men born in 1944, in whom a clinical examination supplemented by medical history aimed to disclose the presence of cardiovascular disease (CVD) (myocardial infarction, angina pectoris, stroke), type 2 diabetes and hypertension were performed at baseline and at follow-up in the year 2000. In addition, salivary cortisol levels were measured repeatedly over the day. Serum testosterone concentrations were also determined. Using the baseline data, an algorithm was constructed, which classified the secretion pattern of cortisol and testosterone from each individual as being normal or abnormal. RESULTS: By the end of follow-up, men with an abnormal hormone secretion pattern (n = 73) had elevated mean arterial pressure (P = 0.003), fasting insulin (P = 0.009) and insulin : glucose ratio (P = 0.005) compared with men with a normal secretion pattern (n = 68). Body mass index, waist circumference, and waist : hip ratio were significantly elevated in both groups. However, the 5-year incidence of CVD, type 2 diabetes, and hypertension were significantly higher (P
Endogenous adenosine might cause or perpetuate bradyasystole. Our aim was to determine whether aminophylline, an adenosine antagonist, increases the rate of return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest.
In a double-blind trial, we randomly assigned 971 patients older than 16 years with asystole or pulseless electrical activity at fewer than 60 beats per minute, and who were unresponsive to initial treatment with epinephrine and atropine, to receive intravenous aminophylline (250 mg, and an additional 250 mg if necessary) (n=486) or placebo (n=485). The patients were enrolled between January, 2001 and September, 2003, from 1886 people who had had cardiac arrests. Standard resuscitation measures were used for at least 10 mins after the study drug was administered. Analysis was by intention-to-treat. This trial is registered with the ClinicalTrials.gov registry with the number NCT00312273.
Baseline characteristics and survival predictors were similar in both groups. The median time from the arrival of the advanced life-support paramedic team to study drug administration was 13 min. The proportion of patients who had an ROSC was 24.5% in the aminophylline group and 23.7% in the placebo group (difference 0.8%; 95% CI -4.6% to 6.2%; p=0.778). The proportion of patients with non-sinus tachyarrhythmias after study drug administration was 34.6% in the aminophylline group and 26.2% in the placebo group (p=0.004). Survival to hospital admission and survival to hospital discharge were not significantly different between the groups. A multivariate logistic regression analysis showed no evidence of a significant subgroup or interactive effect from aminophylline.
Although aminophylline increases non-sinus tachyarrhythmias, we noted no evidence that it significantly increases the proportion of patients who achieve ROSC after bradyasystolic cardiac arrest.
A simple photographic method for detection and measurement of refractive errors in children, using a specially designed camera and electronic flash unit and 'instant' (Polaroid) film, was tested on 64 children, aged 3 to 8 years, and compared with the results from retinoscopy. The refractive errors ranged from -6.5 to +6.5 D. A light reflex in the pupil was observed on the photos of all children with hyperopia greater than = 0.5 and myopia greater than = 2.0 D. A curvilinear relationship was observed (in the range -2 to -4 and +0.5 to +3 D) between the width of the light reflex in the pupil, easily measured on the photos and the degree of refractive error, determined by retinoscopy. The degree of ametropia could be estimated with reasonable accuracy (+/- 0.5 D) in the interval from -2 to -4 D and +0.5 to +3 D. The method can demonstrate the type and, to a limited extent, also the degree of refraction anomaly and may be of value in screening for refractive errors in children.
To evaluate the feasibility of computerized decision support in the management of patients with open angle glaucoma or ocular hypertension.
Based on a Swedish consensus document a computer program was developed, which provided one of 25 different recommendations for appropriate action. In 373 patient visits to seven different eye clinics, the program's recommendations were compared to the actual decisions made by the responsible ophthalmologists.
Notable differences were observed between the clinics' management strategies, especially regarding follow-up frequency and start or increase of anti-glaucoma treatment. The program's recommendations conformed with the clinical decisions in 23 to 92% of the cases when a standard management strategy was simulated. The concordance increased to 93 to 100%, when policy differences between the clinics were taken into account.
Clinical decision-making in the management of patients with ocular hypertension or open angle glaucoma can be implemented in a computer program. The optimum management protocol remains to be defined.