Reduced visfatin levels in aortic stenosis increase after aortic valve replacement and may contribute to reverse left ventricular remodelling.

AIM: Visfatin may play a part in reverse left ventricular remodelling. Using a mouse model of reversible left ventricle pressure overload, we examined if visfatin was altered in the myocardium. Furthermore, we addressed this issue in patients with aortic stenosis (AS) and examined whether visfatin levels are related to reverse remodelling following aortic valve replacement (AVR). METHODS: Myocardial visfatin was analysed after aortic banding (AB) and debanding (DB) in mice and compared to sham operated animals. Myocardial visfatin was measured in biopsies from patients undergoing AVR and compared to controls. Serum visfatin was measured before and after AVR in patients with AS and correlated with echocardiographic measurments of cardiac morphology and function. RESULTS: Four weeks after AB, myocardial visfatin protein was reduced by 50% compared to sham. Three days after DB, myocardial protein levels increased significantly. Myocardial visfatin and serum visfatin levels were reduced by 23% and 64%, respectively, in patients with AS compared to controls. Twelve months after AVR, serum visfatin levels increased compared to preoperative values and correlated negatively with degree of left ventricular hypertrophy. CONCLUSION: Myocardial visfatin and serum visfatin levels are reduced by cardiac pressure overload. Visfatin levels increase after correction of pressure overload and may play a part in postoperative reverse remodelling.

The cardiokine secreted Frizzled-related protein 3, a modulator of Wnt signalling, in clinical and experimental heart failure.

OBJECTIVES: Experimental studies have shown involvement of Wnt signalling in heart failure (HF). We hypothesized that secreted frizzled-related protein 3 (sFRP3), a modulator of Wnt signalling, is related to the progression of HF. DESIGN: Circulating sFRP3 was measured in 153 HF patients and compared with 25 healthy controls. The association of sFRP3 with mortality was evaluated in 1202 patients (GISSI-HF trial). sFRP3 mRNA expression was assessed in failing human and murine left ventricles (LV), and cellular localization was determined after fractioning of myocardial tissue. In vitro studies were carried out in cardiac fibroblasts subjected to cyclic mechanical stretch. RESULTS: (i) Heart failure patients had significantly raised serum sFRP3 levels compared with controls, (ii) during a median follow-up of 47 months, 315 patients died in the GISSI-HF substudy. In univariable Cox regression, tertiles of baseline sFRP3 concentration were significantly associated with all-cause and cardiovascular mortality. After adjustment for demographic and clinical variables, but not for CRP and NT-proBNP, the associations with mortality remained significant for the third tertile (all-cause, HR 1.45, P = 0.011; cardiovascular, HR 1.66, P = 0.003), (iii) sFRP3 mRNA expression was increased in failing human LV, with a decline following LV assist device therapy. LV from post-MI mice showed an increased sFRP3 mRNA level, particularly in cardiac fibroblasts, and (iv) mechanical stretch enhanced sFRP3 expression and release in myocardial fibroblasts. CONCLUSION: There is an association between increased sFRP3 expression and adverse outcome in HF, suggesting that the failing myocardium itself contributes to an increase in circulating sFRP3.

[The health project Ebeltoft: health check ups and discussions in general practice. Basic data from a 5-year, prospective, randomized, controlled population study]. / Sundhedsprojekt Ebeltoft: Helbredsundersøgelser og helbredssamtaler i almen praksis. Basisdata fra en fem¿rig, prospektiv, randomiseret, kontrolleret befolkningsunders|gelse.

A study was carried out to investigate people's interest in participating in health check-up and in discussions about health with their own general practitioner, participants' health status, the proportion who received health advice following health check-up, and the lifestyle goals they set following discussion with their general practitioner. This study reports the baseline data from a five-year randomized, controlled, prospective, population-based study in general practices in Ebeltoft, Denmark. All general practitioners from the four practices in Ebeltoft and a random sample of 2,000 people aged between 30 and 50 years were invited to participate. Participants were randomly divided into three groups-one control group and two intervention groups. One intervention group was given a health check-up which included a range og tests (Table 2 and 3); this group received written feedback from the general practitioner. The other intervention group was also given a health check-up and written feedback, in addition, they were given the opportunity to attend their general practitioner to discuss health-promoting measures. A total of 1370 people participated in the study (69% response rate). Health advice was given to 76% of 905 participants following health check-up. Almost all of the 456 participants (96%) who were offered the opportunity of discussing their health with their general practitioner took up the offer: 64% of the 456 participants reported that they had decided to undertake lifestyle changes. Eleven of those who discussed their health with the doctor were referred to a specialist (2%). There was considerable interest in participating in health promotion. Three out of four of those who had a health check-up were given health advice. Two out of three of those who were offered a health talk with the general practitioner appeared willing to make relevant lifestyle changes. Longterm follow up is needed to determine effects and side effects of health check-up and health talks.

[The need for humanistic research in medicine]. / Om behovet for humanistisk forskning i sundhedsvidenskab.

The need for humanities in medicine is often discussed these years. Results from qualitative studies are now published in many medical journals. This article describes some characteristics of qualitative research and presents its theoretical basis. To give a better understanding of the qualitative research process, it is here compared with the clinical process. This analogy is reasonable because the qualitative researcher just as the clinician performs data collection and data analysis during the same process. The most important aspect of qualitative research is not "to measure" but "to understand" something. And understanding is created through concepts that makes phenomena and events "conceivable". The conceptual work in qualitative research is of great importance. The relation between traditional medical research and medical humanities is such that we need both, because the one cannot solve the others' tasks, and vice versa. It is worth while remembering that an engagement in the one research area does not exclude respect for the other research areas' potential and value.

Ebeltoft project: baseline data from a five-year randomized, controlled, prospective health promotion study in a Danish population.

BACKGROUND: There is increasing political pressure on the medical profession to approach welfare diseases, such as coronary heart disease and diabetes, through prevention. General practitioners are required to offer regular health checks to healthy people, in spite of the lack of scientific evidence for the universal need, usefulness and side effects of such an intervention. Randomized controlled trials are needed. AIM: A study was carried out to investigate people's interest in participating in health checks and in discussions about health with their own general practitioner, participants' health status, the proportion who received health advice following health checks, and the lifestyle goals they set following discussion with their general practitioner. This study reports the baseline data from a five-year randomized, controlled, prospective, population-based study in general practices in Ebeltoft, Denmark. METHOD: All general practitioners from the four practices in Ebeltoft and a random sample of 2000 people aged between 30 and 50 years were invited to participate. Participants were randomly divided into three groups--one control group and two intervention groups. One intervention group were given a health check which included being screened for cardiovascular risk factors, lung and liver function, fitness, sight and hearing and an optional test for the human immunodeficiency virus (HIV); this group received written feedback from the general practitioner. The other intervention group were also given a health check and written feedback; in addition, they were given the opportunity to attend their general practitioner to discuss preventive health. RESULTS: A total of 1370 people participated in the study (69% response rate). Health advice was given to 76% of 905 participants following health checks. Almost all of the 456 participants (96%) who were offered the opportunity of discussing their health with their general practitioner took up the offer; 64% of the 456 participants reported that they had decided to undertake lifestyle changes. Eleven of those who discussed their health with the doctor were referred to a specialist (2%). CONCLUSION: There was considerable interest in participating in health promotion. Three out of four of those having a health check were given health advice. Two out of three of those offered a health talk with the general practitioner appeared willing to make relevant lifestyle changes. Long-term follow up is needed to determine effects and side effects of health checks and health talks.

[Focus group interview as a qualitative research method]. / Fokusgruppeinterview som kvalitativ forskningsmetode.

Focus group research is a qualitative method with interesting properties. It is performed by planned discussion and interview with a small group of people conducted by a moderator. The participants are sampled from the study population. The aim is to obtain knowledge of the participant's considerations and ideas on a specific topic. The method is feasible in illuminating the variation of viewpoints held in a population. It is used as a single source of data or in combination with other methods. As the method provides data in a social context it is used as an alternative to individual interviews, when appropriate, or in the initial development of a questionnaire. The focused interviews is feasible in methodological triangulation or when other methods are suboptimal. Focus group interviews is considered to be of value in health research.

Patients' perceptions--a shift in medical perspective.

Based on an empirical study in general practice, patients' perceptions and a fundamental shift in medical perspective are described. The research material was collected in a prospective interview-study that included 13 general practitioners and 35 patients (24 female and 11 male). Patients and doctors were interviewed before and after the consultation. A semistructured schedule was followed, and all 175 interviews were performed by the investigator, and taped. A patient-perception-model of health, based on the analysis of the interviewdata, became the framework for describing the complexities of illness experiences. The coupling of viewpoints revealed that patients and doctors live in different conceptual worlds. Often they did not know the extent to which their perceptions were different, nor why. The aspects of disease that lie outside the biomedical field have not hitherto been of great interest in medical research. However, our ability to act on the humanistic dimensions in everyday clinical settings depends on knowledge about these as well. Medical human science research may give us new conceptions and theories in this complex territory.

[Integration of the patient's viewpoint in quality assessment--a new method]. / Integrering af patientperspektiv i kvalitetsvurdering--en ny metode.

Attempts at evaluating the health services are characterised by the multiplicity of methods used to assess diagnosis, treatment and care--e.g., compliance investigations, consensus and audit methods, and methods that include evaluation by patients. By means of triangulation methods both medical and consumer perspectives can be included in the evaluation.

[Medical humanistic research, fields and methods]. / Medicinsk-humanistisk forskning, genstandsfelt og metoder.

Medical research, which attempts to analyse the numerous aspects of human disease which cannot be investigated scientifically, is at present in a phase of clarification. It is argued that the term "medical humanistic research" is a more adequate term for research into the aspects of human disease within a human scientific tradition than e.g. "qualitative research". The fields of research, methods of collecting data and the various theoretical bases and disciplinary roots of the methodological aspects are discussed. New methodological possibilities are mentioned and the weaknesses and sources of error are indicated. Finally, reflections concerning the future prospects of medical humanistic research in the medical profession are made. The problem is not only the current medical scientific research but, on the other hand, the extent to which the continued medical disciplinary development in scientific understanding is desired. Is possible new structured knowledge about human understanding, feelings, volition and desires which are associated intensely with every medical activity to be abandoned?

Prevalence and sequelae of sexual torture.

283 torture victims (135 examined by the Amnesty International [AI] Danish Medical Group, and 148 by the International Rehabilitation and Research Center for Torture Victims [RCT]) were questioned about methods of torture and subsequent sexual difficulties. Overall, the prevalence of sexual torture was 61% (women 80%, men 56%), but this was higher in the RCT than in the AI group. More Latin Americans than Europeans had been sexually tortured in the AI group. Prevalence of sexual difficulties was 32%, the RCT recording a significantly higher prevalence than the AI (43% vs 20%). Sexually tortured victims were more likely to have sexual difficulties (40%) than were non-sexually tortured victims (19%). Overall, there were more cases of sexual difficulties in victims from Africa and from Turkey/Middle East/Far East than in victims from Latin America and from Europe. In the RCT subsample, prevalence of sexual difficulties and anxiety was significantly higher in sexually tortured victims than in non-sexually tortured victims; the two groups were broadly similar with respect to depression and low self-esteem. Depressed victims and victims with low self-esteem were more likely to have sexual difficulties. In the RCT group, but not overall, prevalence of sexual difficulties was significantly associated with age but was independent of low self-esteem and of depression.

Guidelines of the World Health Organization for clinical trials with antimicrobial agents.

The WHO Consensus Documents Series on Clinical Investigation covers many different therapeutic drug groups including the antibacterial drugs. The documents have been produced by the WHO Regional Office for Europe in collaboration with a wide group of clinicians and other experts in order to define and promote agreement on current and emerging standards for the clinical investigation of drugs.

The teaching and organisation of clinical pharmacology in European medical schools (W.H.O. Working Group on Clinical Pharmacology).

A World Health Organisation (European Regional Office) working party has been established to review the progress of clinical pharmacology in European countries. As part of this review a questionnaire on the teaching of clinical pharmacology was sent to the Deans of all 350 medical schools in the region. Very few replies were received from U.S.S.R., Greece and Portugal and these countries' returns were not analysed further. The overall compliance rate (excluding these countries) was 82% with a figure of 84% from Western Europe and 74% from Eastern Europe. An average time of 96 h (range 0-320) was devoted to pharmacology teaching in the medical curriculum in Western Europe with 124 (0-240) h in Eastern Europe. In contrast 28 h (0-210) was devoted to clinical pharmacology teaching in Western Europe and 27 h (0-90) in Eastern Europe. On average in Western Europe each medical school had 2 individuals trained in clinical pharmacology with 1.3 posts in the subject and the figures for Eastern Europe were 2.3 and 1.1 respectively. However these figures hide a wide variance in the teaching of clinical pharmacology. Particularly in Western Europe there are a number of medical schools in Italy, Spain and the Federal Republic of Germany (FRG) where clinical pharmacology is not taught and there is a dearth of individuals trained in the subject. Every effort to encourage clinical pharmacology and its teaching should be made, particularly in these countries.

[Can prevention be hazardous to health?]. / Kan forebyggelse blive helbredsskadelig?

Health-promotion/disease-prevention may--despite the best intentions--have mischievous effects and overlooked ethical implications. This article describes some consequences of health promotion when initiated by the medical profession as medicalization of the modern human being, problems with false test-results, iatrogenic disease, and the risk of "victim blaming". The responsibility of the medical profession includes the well-being of healthy people as well as the actually or future sick. Therefore, health promotion has to be based on the values and informed consent of the healthy part of the population.

Sleep disturbances in torture survivors.

One of the main complaints in torture survivors is sleep disturbance with nightmares, too little sleep and daytime fatigue. Seven subjects, who had been exposed to torture from 6 months to seven years previously, were examined by polysomnography. All had abnormal sleep patterns compared with normal age- and sex-matched controls. The subjects woke frequently from REM sleep, had reduced REM sleep duration, absent Stage 4 sleep, short total sleep time and low sleep efficiency. This study revealed that previously healthy young persons subjected to extreme stress may develop an abnormal sleep pattern.