Helicobacter pylori infection in non-ulcer dyspeptic and ulcer patients. Determinants and consequences in 'real life'.

BACKGROUND: Infection rates are high in patients with ulcer disease, but even non-ulcer dyspepsia (NUD) patients have Helicobacter pylori infection. The Notodden Helicobacter study is an 'outcome study' of clinical practice in a local hospital. The study may identify factors associated with infection and evaluate whether H. pylori infection predicts symptoms in both ulcer disease and NUD. METHODS: Base-line results on infection, symptoms, endoscopy, and treatment were registered in 587 ulcer and NUD patients. H. pylori status was assessed with a rapid urease test. Questionnaire data (5-43 months after treatment) give information about symptoms. Regression models to identify H. pylori status were developed. RESULTS: Ulcer patients (H. pylori +/-) were similar to infected NUD patients. In contrast, uninfected NUD patients were younger, had less severe symptoms, and used less medication than other patients. In NUD, infection rate increased with epigastric pain, male sex, and age. CONCLUSION: From a local hospital's point of view, H. pylori-infected NUD patients are like ulcer patients with regard to symptoms and demographics. The results suggest that H. pylori infection may give dyspeptic symptoms through other mechanisms than ulcer. We propose a division of the NUD group into HINUD (Helicobacter-infected NUD) and NINUD (non-infected NUD).

[Is blood pressure treatment as effective in a population setting as in controlled studies?]. / Er blodtrykksbehandling like effektivt i befolkningen som i kontrollerte forsøk?

Baseline (1974-76) and repeat (1977-81) cardiovascular screenings of 21,314 men aged 35-49 years brought to light 840 men who had started treatment between screenings. These were compared with men who had remained untreated. The effects of treatment on blood pressure were small, and normal target blood pressures rare. At pretreatment blood pressure up to systolic 184 mm Hg, and in most risk strata, both total mortality and cardiovascular mortality were higher among the men on treatment. This study shows an adverse effect of treatment in a population setting, particularly at low pretreatment blood pressure, and if blood pressure increases upon treatment.

Is blood pressure treatment as effective in a population setting as in controlled trials? Results from a prospective study.

OBJECTIVE: To evaluate the effectiveness of treatment in situations in which general practitioners and patients use medication according to their own judgement, and where selection, compliance and follow-up varies. This prospective population study differs from the efficacy of treatment studied in randomized trials. DESIGN: Baseline (1974-1976) and repeat (1977-1981) cardiovascular screenings of all males aged 35-49 years in three counties in Norway, with mortality follow-up from the second screening until 1990. SETTING: A nationwide ambulatory screening service reporting community results and referring high-risk subjects to their local general practitioners. PARTICIPANTS: A total of 21,314 males (86%) attended both screenings, of whom 840 took blood pressure medication at the second screening. Males with cardiovascular disease, diabetes or blood pressure treatment at baseline were excluded. MAIN OUTCOME MEASURES: Changes in coronary risk factors, mortality from all causes, coronary heart disease and non-cardiovascular causes. RESULTS: The effect of treatment on blood pressure was small, and the attainment of reasonable target blood pressures was rare. The cholesterol level decreased and the level of triglycerides increased more in the treatment group than in the untreated group. Blood pressure treatment was associated with increased mortality in most risk strata, and at pretreatment systolic blood pressures up to 184 mmHg. A particularly high mortality rate was found when blood pressure increased despite treatment and at low pretreatment blood pressures. According to Cox proportional hazards analyses controlling for pretreatment blood pressure, cholesterol, age, smoking and body mass index, the relative risk of coronary heart disease death in the treatment group was 1.8 (95% confidence interval 1.3-2.6). CONCLUSION: The benefit experienced from the trials turned into an adverse effect of treatment in the population setting, particularly at low pretreatment blood pressure, and when blood pressure increased during treatment.

High-density lipoprotein cholesterol and coronary, cardiovascular and all cause mortality among middle-aged Norwegian men and women.

From 1977 to 1982 screening for cardiovascular disease was performed in three Norwegian counties. All those aged between 40 and 54 years were invited, of whom 23,690 men and 23,425 women (90%) attended. Smoking habits and previous cardiovascular disease were recorded; total cholesterol, high-density lipoprotein cholesterol (HDL cholesterol), triglycerides and blood pressure were measured. During subsequent follow-up (mean 6.8 years) 422 men and 54 women died from coronary heart disease, 514 and 114 from all cardiovascular diseases and 983 and 404 from all causes, men and women respectively. For men, mortality decreased with increasing HDL cholesterol, to a minimum of around 1.5 mmol.l-1 (58 mg.dl-1), whereafter mortality increased. This applies to coronary, cardiovascular and all causes of death, as well as to men with and without a history of disease. The association between mortality and HDL cholesterol in healthy men disappeared when total cholesterol was below 6.5 mmol.l-1 (251 mg.dl-1). The inverse association between mortality and HDL cholesterol in women was somewhat stronger than in men, both for coronary and cardiovascular diseases. The relative risks of coronary death, associated with an increase in HDL cholesterol of 0.5 mmol.l-1 (19 mg.dl-1), from the Cox proportional hazards regression, with other major cardiovascular risk factors as covariates, were 0.8 (95% confidence interval: 0.6, 1.0) and 0.8 (0.7, 1.0) for men with and without history of disease, respectively. Corresponding figures for women were 0.5 (0.3, 0.9) and 0.7 (0.4, 1.3).

[Why do women still smoke while men quit?]. / Hvorfor røyker kvinner, når menn slutter?

Norwegian men have reduced their rates of daily smoking, while the overall rate of smoking among women has remained unchanged for the last 15 years. The prevalence of smoking among adolescent girls has declined. Highly educated women are less likely to smoke, compared with women with lower education. Some groups of Norwegian women, however, are maintaining their smoking habits. We discuss possible explanations of the remaining high rates of smoking among women, and suggest strategies to improve the smoking cessation rate among women.

Treatment of hypertension as a risk factor in a prospective study.

The association between blood pressure treatment, blood pressure level and mortality, taking other cardiovascular risk factors into account was studied. A 12-year follow-up of a cardiovascular risk factor screening performed by the Oslo study group in Oslo and by ambulatory teams from the National Health Screening Survey in three counties in Norway was done. All men in Oslo and all men and women in the three counties, (age 40-49) participated, of these 33154 men and 16407 women have complete data on blood pressure and treatment, including subjects reporting previous myocardial infarction or stroke. Mortality from coronary heart disease, stroke and all causes by blood pressure treatment and blood pressure level were studied. At the initial screening 1058 men and 817 women reported taking blood pressure medication, of which 201 and 41 died during follow-up. Total number of deaths were 2341 in men and 421 in women, of these 131 deaths in men and 47 in women reporting previous infarction or stroke. Those reporting blood pressure treatment had a marked excess mortality from cardiovascular disease and all causes of death. A J-shaped association between blood pressure and mortality was marked in the treated group, but weak in those not on treatment. It is concluded that blood pressure treatment is associated with excess mortality from all causes. This may indicate that "real life" treatment outcomes are inferior to those reported from controlled clinical trials. There is a J-shaped association between all cause mortality and blood pressure in men on treatment.

[Adequate measurement of artificial mineral fibers and evaluation of the biological effect]. / Adäquate Messung von künstlichen Mineralfasern und Bewertung der biologischen Wirkung.

Epidemiological and clinical medical examinations of exposed workers to man-made mineral fibers (MMF) to fix threshold limit values are presupposed by adequate measurements of MMF-dust. As yet are used technics which are unsatisfying. In consideration of the biological conditions in the breathing system a draft to measure MMF dust is introduced and proved. This draft based on the use of two-step-gravimetrical measurements together with membranous filter devices and evaluation by an electronic microscope.