Validation of Clinical COPD Phenotypes for Prognosis of Long-Term Mortality in Swedish and Dutch Cohorts.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with variable mortality risk. The aim of our investigation was to validate a simple clinical algorithm for long-term mortality previously proposed by Burgel et al. in 2017. Subjects with COPD from two cohorts, the Swedish PRAXIS study (n = 784, mean age (standard deviation (SD)) 64.0 years (7.5), 42% males) and the Rotterdam Study (n = 735, mean age (SD) 72 years (9.2), 57% males), were included. Five clinical clusters were derived from baseline data on age, body mass index, dyspnoea grade, pulmonary function and comorbidity (cardiovascular disease/diabetes). Cox models were used to study associations with 9-year mortality. The distribution of clinical clusters (1-5) was 29%/45%/8%/6%/12% in the PRAXIS study and 23%/26%/36%/0%/15% in the Rotterdam Study. The cumulative proportion of deaths at the 9-year follow-up was highest in clusters 1 (65%) and 4 (72%), and lowest in cluster 5 (10%) in the PRAXIS study. In the Rotterdam Study, cluster 1 (44%) had the highest cumulative mortality and cluster 5 (5%) the lowest. Compared with cluster 5, the meta-analysed age- and sex-adjusted hazard ratio (95% confidence interval) for cluster 1 was 6.37 (3.94-10.32) and those for clusters 2 and 3 were 2.61 (1.58-4.32) and 3.06 (1.82-5.13), respectively. Burgel's clinical clusters can be used to predict long-term mortality risk. Clusters 1 and 4 are associated with the poorest prognosis, cluster 5 with the best prognosis and clusters 2 and 3 with intermediate prognosis in two independent cohorts from Sweden and the Netherlands.

Validation of a parental questionnaire to identify atopic dermatitis in a population-based sample of children up to 2 years of age.

BACKGROUND: Validated eczema questionnaires have been available for schoolchildren only, but the incidence of atopic dermatitis (AD) is highest during infancy. OBJECTIVE: To validate a parental questionnaire to identify AD in children up to 2 years of age. METHODS: Parents of 476 children answered a written questionnaire prior to an examination by a physician. Sensitivity, specificity, predictive values and test-retest reliability of the questionnaire were assessed. RESULTS: A total of 245 (51%) girls and 231 (49%) boys, aged 1-24 months, with and without physician-diagnosed AD participated. Seventy-one children (15%) had physician-diagnosed AD. Validation of the questionnaire by comparisons with physicians' diagnoses showed a sensitivity of 0.87 (95% confidence interval, CI, 0.77-0.94) and a specificity of 0.98 (95% CI, 0.96-0.99). The positive predictive value was 0.90 (95% CI, 0.80-0.96) and the negative predictive value was 0.98 (95% CI, 0.96-0.99). CONCLUSION: The questionnaire identified AD in children aged 0-2 years with high accuracy.

Management, asthma control and quality of life in Swedish adolescents with asthma.

AIM: In Sweden, paediatricians or general practitioners treat most adolescents with asthma. This study compares management, treatment goals and quality of life for adolescents aged 15-18 y in paediatric or primary care. MATERIAL AND METHODS: A random sample of patients answered a disease-specific and a quality-of-life (MiniAQLQ) questionnaire. RESULTS: The 146 adolescents in paediatric care had more years with asthma, better continuity of annual surveillance, higher use of inhaled steroids and a stated better knowledge of their asthma than the 174 patients in primary care. No difference could be detected in asthma control or quality of life. Of all 320 adolescents, approximately 20% had woken at night due to asthma symptoms during the last week. About 15% had made unscheduled, urgent care visits and a third had used short-acting beta-agonist relievers more than twice a week. Quality-of-life scores were high and similar in both settings. CONCLUSIONS: Swedish adolescents with asthma are managed and treated somewhat differently in paediatric and primary care but with equal and, for the most part, satisfying results. The difference between the two settings probably reflects both differences in severity of asthma and different treatment traditions. For all adolescents, better fulfilment of goals regarding symptoms and exacerbations would be desirable, whereas a good quality of life including normal physical activity seems to have been achieved.

Estimated prevalences of respiratory symptoms, asthma and chronic obstructive pulmonary disease related to detection rate in primary health care.

OBJECTIVE: To assess the prevalence of respiratory symptoms, asthma and chronic obstructive pulmonary disease (COPD), and to relate it to an estimated detection rate in primary health care. DESIGN: A two-staged study with a cross-sectional survey and a clinical validation. SETTING: The adult population of Värmland, a county in Sweden. SUBJECTS: 4814 persons completed the survey and 206 the confirmative validation study. MAIN OUTCOME MEASURES: Prevalence of respiratory symptoms, of asthma and COPD. RESULTS: More than 40% reported respiratory symptoms. Wheeze was reported by 8.0%, shortness of breath by 11.4% and sputum production by 14.1%. Smoking was more common among women than among men. The prevalence of asthma was 8.2% and COPD 2.1%. Of persons with asthma, 33% were estimated to be undiagnosed, 67% used medication and nearly 60% attended primary health care services. CONCLUSION: Respiratory symptoms as well as asthma were common in this study and equivalent to earlier findings. The difference between the epidemiologically estimated prevalence of asthma and the lower detection rate in primary health care can be explained by at least three factors: persons who did not seek any care, were underdiagnosed or attended other health care providers.

Mammographic screening for breast cancer. What cancers do we find?

The aim of this study was to compare lymph node involvement of breast cancer cases detected at mammography screening with clinically-detected cases. During a 3-year period, 273 primary breast cancers were detected in a population-based screening programme, and 149 primary breast cancers were diagnosed clinically. Lymph node involvement was evaluated in univariate and multivariate logistic regression models correcting for tumour size, histological grade, steroid receptor status and DNA-ploidy. Patients with screen-detected cancers had a low relative risk of having lymph node metastases (univariate, OR = 0.31; 95% confidence interval = 0.19-0.52). In the multivariate logistic regression model, the relative risk was halved (OR = 0.47; 0.28-0.78). The reduced risk was more pronounced for women younger than 50 years of age compared to older women. The risk for screen-detected cases of having lymph node metastases at diagnosis was statistically significantly lower than for clinically-detected cases. The marked reduction, even when correcting for tumour size, makes it less likely that factors such as detection of clinically innocent tumours, length bias sampling or clinical symptoms related to axillary metastases can explain the whole difference. The results indicate at least part of the effect may be explained by tumour progression in the late preclinical detectable phase.

In vitro cultivation of rabbit aortic media and the development of the cultures in relation to cellular heterogeneity.

Explants of rabbit aortic media were transferred to tissue culture and the development of the characteristic regions of the cultures was followed. With a new technique the explants were instantly immobilized in the culture flasks, by which the temporal development was strictly defined. The culture developed along the following four major lines: (1) cells migrated from the explant and some cells formed a network of large, attenuated cells, while other, smaller and poorly flattened cells formed clusters attached to the plastic or the network; (2) with continuing growth the network of larger and attenuated cells expanded, grew denser and formed the monolayered component of the culture; (3) multilayered thickenings formed at sites where poorly flattened small cells were numerous either within or at the outer margin of the monolayer or (4) at the margin of the explant where profuse emigration of cells had occurred. Thus, the development of the culture was dependent upon the growth behaviour and expansion of two subpopulation of cells. In the electron microscope the smaller, poorly flattened type of cell with multilayered growth pattern had features of a highly metabolically active cell and had numerous attachment sites of fibronexus type. The attenuated larger cell type growing as monolayers had very abundant microfilaments. The differences may reflect a functional segregation among different cell subpopulations in arterial smooth muscle tissue.