Alcohol consumption and its relation to lipid-based cardiovascular risk factors among middle-aged women: the role of HDL(3) cholesterol.

To study the association of alcohol consumption and lipid-based cardiovascular risk factors among middle-age women, cross-sectional analysis among 274 middle-aged healthy women with different drinking habits and a follow-up analysis of alcoholic women during abstinence was performed. Serum total cholesterol, low and high-density lipoprotein cholesterol (LDL and HDL cholesterol), triglycerides (TG), apolipoproteins A1 (Apo A1) and B (Apo B), and HDL-cholesterol subfractions 2 (HDL(2)) and 3 (HDL(3)) were measured. All lipid values except LDL cholesterol positively correlated with self-reported alcohol consumption. When alcoholics were excluded the correlation was significant only for HDL cholesterol, HDL(3), and Apo A1. The increasing trend of HDL cholesterol, HDL(3) and Apo A1 were clearly seen first in women consuming >20-40 g/day of absolute alcohol. Alcohol consumption >40 g/day increased all lipid values except LDL cholesterol. Abstinence for 2 weeks caused a significant decrease in HDL(3) cholesterol, and an increase in LDL cholesterol and Apo B. The results indicate that among middle-aged women the Apo A1 and HDL cholesterol via its HDL(3) but not HDL(2) subfraction might play a role in the beneficial coronary consequences associated with moderate alcohol consumption. However, the increasing beneficial trend first appears when daily drinking exceeds 20 g/day.

Cost-effectiveness of an innovative four-year post-discharge programme for elderly patients--prospective follow-up of hospital and nursing home use in project elderly and randomized controls.

The cost-effectiveness of a post-discharge programme on the use of hospital care and the continuity of care was assessed in an elderly cohort (n = 204) discharged from the city hospital. The participation rate was 97.6%, and the patients were aged 75 years or over and lived alone. The randomized controls (n = 204) received standard aftercare. During the follow-up the costs of university hospital care decreased by 52% in the intervention group and by 24% in the control group per patient year, compared with the costs in the year preceding the project. This happened despite the higher morbidity in the intervention group in terms of fractures and the use of university hospital care in the year preceding the project. There was also a tendency in the intervention group for the previous non-users of university hospital care to remain non-users during the follow-up. The costs of city hospital care increased by 16% and 5%, and of all hospital care by 1.3% and 0.2%, respectively. There were no differences in admissions to permanent care in the nursing homes. The intervention group did not make their first contact with the hospitals or permanent care in nursing homes earlier than the control group during the follow-up. The co-operation between hospital and domiciliary care and voluntary workers was well-suited to the innovative care of the elderly people.

The injury mechanisms of osteoporotic upper extremity fractures among older adults: a controlled study of 287 consecutive patients and their 108 controls.

The risk factors for falls in older adults are well known but knowledge on the direct injury mechanisms that result in various osteoporotic fractures has been very sparse. The purpose of this study was therefore to clarify the injury mechanisms of osteoporotic upper extremity fractures of older adults and to compare these mechanisms with those of the control fallers, and in this way to obtain reliable insight into the etiology and pathogenesis of upper extremity fractures and thus to enable fracture prevention. One hundred and twelve patients with a fresh fracture of the proximal humerus, 65 patients with an elbow fracture, 110 patients with a wrist fracture and 108 controls (no fracture, or a fracture other than the case fracture) were interviewed and examined between September 1995 and December 1997. The inclusion criteria of the subjects were that the patient was 50 years of age or older at the time of the accident, and that the fracture/injury had occurred as a result of low-energy trauma (typically a fall from standing height or less) within a week before the interview and examination. In 97% of patients with a proximal humerus or elbow fracture, and in all patients (100%) with a wrist fracture, the fracture was a result of a fall. In the control group this figure was 93%. In a polychotomous logistic regression analysis the intergroup differences in the fall directions (adjusted by gender, age and functional capacity) were statistically highly significant (chi 2 = 43.6, d.f. = 15, p < 0.001). Most of the patients with a proximal humerus fracture or elbow fracture reported that they had fallen 'obliquely forward' (43% and 38%) or 'to the side' (29% and 26%), whereas in the wrist fracture group the main fall direction was also 'obliquely forward' (34%) but the other fall directions (i.e., 'forward', 'to the side', 'obliquely backward' and 'backward') were quite equally represented (13-19%). The odds ratio (OR) for an obliquely forward fall resulting in a proximal humerus fracture was 3.5 [95% confidence interval (CI) 1.4-9.2), as compared with the fall directions of the controls and the 'obliquely backward' fall direction. In a logistic regression analysis the patients with a wrist fracture managed to break their fall (e.g., with an outstretched arm) more frequently than the patients in the other groups (OR 3.9; 95% CI 2.0-7.3). The patients with a proximal humerus fracture, in turn, managed to break their fall less frequently than the controls (OR 0.33; 95% CI 0.14-0.80). The same was true of the patients with an elbow fracture, although the difference was not significant (OR 0.49%; 95% CI 0.19-1.3). As objective evidence for a direct fall-induced impact on the fracture site, 68% of patients with a proximal humerus fracture revealed a fresh subcutaneous hematoma on the shoulder/upper arm, while such a hematoma was rare in the controls (2%) (p < 0.001). Correspondingly, 62% of patients with an elbow fracture showed a similar hematoma on the elbow area, while this was seen in none of the controls (p < 0.001). In patients with a wrist fracture a hand/wrist hematoma was seen in 58% of the victims, as compared with 18% of the controls (p < 0.001). The study shows that the most typical osteoporotic upper extremity fractures of older adults have their specific injury mechanisms. A great majority of these fractures occur as a result of a fall and a subsequent direct impact of the fractured site. Effective fracture prevention could be achieved by minimizing the obvious risk factors of falling and reducing the fall-induced impact force with injury site protection.

Alcohol consumption profile by time in middle-aged men: a longitudinal study based on three different diagnostic instruments.

This longitudinal study aimed at comparing aggregate measures of heavy or problem drinking and their variations across time among the same subjects. We examined middle-aged men participating in a health survey over a 5-year interval. Of the 133 consecutive men in the whole age group interviewed as 40-year-olds in 1989, 114 were reached and re-interviewed in 1994. Alcohol consumption was measured by self-report, Malmo-modified Michigan Alcoholism Screening Test (Mm-MAST), and serum carbohydrate-deficient transferrin (CDT). Self-reported alcohol consumption decreased with years (142 vs 105 g/week, P = 0.01), as did CDT (16.9 vs 14.4 U/l, P = 0.02), but there was no change in the Mm-MAST results. There was no significant difference in the number of heavy drinkers (either Mm-MAST score > or = 3, or by self-reported alcohol consumption > or = 280 g/week, or by CDT > or = 20 U/l) at 40 and 45 years of age (37 and 47% respectively). At the individual level, alcohol consumption both increased and decreased with age. At 45 years of age 5/114 (4%) of the men reported that they had increased their alcohol consumption by more than 80 g/week and 25/114 (22%) said that they had reduced their drinking by the same amount. The remaining 84 (74%) reported drinking the same amount as 5 years earlier (+/- 80 g/week). This indicates that alcohol drinking habits are not stable in middle age. Most heavy drinkers in both age groups were detected by Mm-MAST and this proportion increased with age while the proportion of positive self-reports and CDTs decreased. Thus, the social consequences, measured here by the Mm-MAST, may be more readily experienced with years even at smaller consumption levels.

Hyperinsulinaemia in hypertensive subjects: validity of a test for the detection of insulin resistance in clinical practice.

OBJECTIVES: To determine the prevalence of hyperinsulinaemia in non-diabetic hypertensive subjects and to investigate the validity of a simple test for the detection of insulin resistance/hyperinsulinaemia. The test consisted of five markers: (1) obesity (body-mass index, BMI > or =30 kg/m2); (2) central adiposity (waist-to-hip ratio, WHR > or =1.00 in men and > or =0.88 in women); (3) hypertriglyceridaemia (> or =1.70 mmol/l); (4) low high-density lipoprotein (HDL) cholesterol (<1.00 mmol/l in men and <1.20 mmol/l in women); and (5) impaired glucose tolerance according to the WHO criteria. The test was defined to be positive for subjects who had simultaneously at least two of the five markers. DESIGN AND SETTING: A community-based screening programme for hypertension carried out at Pieksämäki District Health Centre, and the Community Health Centre of the City of Tampere, Finland. SUBJECTS: The 161 hypertensives who were detected by screening all subjects aged 36, 41, 46 and 51 years (n = 1148) in Pieksämäki town, and a randomly selected normotensive control group of 177 men and women aged 40 and 45 years in the City of Tampere. MAIN OUTCOME MEASURES: Hyperinsulinaemia defined by using two different cut-off points of the fasting plasma insulin (> or =13.0 mU/l and > or =18.0 mU/l). RESULTS: Hyperinsulinaemia > or =13.0 mU/l was present in 45% of hypertensive men and in 25% of hypertensive women. The sex difference was statistically significant (P < 0.01). The corresponding rates of hyperinsulinaemia > or =18.0 mU/l were 18% and 16%. The sensitivity of the test for hyperinsulinaemia > or =13.0 mU/l was 77% and specificity 73% in men, and 100% and 70% in women. The corresponding figures for hyperinsulinaemia > or =18.0 mU/l were 94% and 60% in men, and 100% and 63% in women. CONCLUSION: Our results suggest that hyperinsulinaemia/insulin resistance in hypertensives becomes identifiable by using simple measurements of BMI, WHR, serum triglycerides and HDL cholesterol as well as the oral glucose tolerance test as means.

Obesity type and clustering of insulin resistance-associated cardiovascular risk factors in middle-aged men and women.

OBJECTIVE: To examine different clusterings of the insulin resistance-associated cardiovascular risk factors with respect to different types of obesity. DESIGN: A screening programme for obesity (body mass index; BMI> or =30 kg/m2) and abdominal adiposity (waist-to-hip ratio; WHR > or = 1.00 in men and > or = 0.88 in women). SETTINGS: Pieksämäki District Health Centre and the Community Health Centre of the City of Tampere, Finland. SUBJECTS: All volunteers were either aged 36, 41, 46 or 51 y (n=1148) and living in the town of Pieksämäki, with a control population of 162 subjects in the City of Tampere. MAIN OUTCOME MEASURES: Different clusterings of: 1) hypertension (a systolic blood pressure > or = 160 mmHg and/or a diastolic blood pressure > or = 95 mmHg or concurrent drug treatment for hypertension); 2) hypertriglyceridaemia > or = 1.70 mmol/l; 3) a low level of high-density-lipoprotein (HDL) cholesterol; < 1.00 mmol/l in men, < 1.20 mmol/l in women; 4) abnormal glucose metabolism (impaired glucose tolerance or non-insulin-dependent diabetes) and 5) hyperinsulinaemia with a fasting plasma insulin > or = 13.0 mU/l. RESULTS: The prevalence of a cluster consisting of dyslipidaemia (hypertriglyceridaemia and/or low HDL-cholesterol) and insulin resistance (abnormal glucose metabolism and/or hyperinsulinaemia) was found to be 4% in the control subjects, 18% in the abdominal adipose subjects (WHR > or = 1.00 in men and > or = 0.88 in women with a BMI < 30 kg/m2), 28% in the 'pure' obese subjects (BMI> or = 30 kg/m2 with WHR < 1.00 in men and < 0.88 in women), and 46% in the central obese subjects (subjects showing both 'pure' obesity and abdominal adiposity). The prevalence rates of the other clusterings of abnormalities varied similarly according to the type of obesity. CONCLUSION: Clusterings of insulin resistance-associated abnormalities were related to the type of obesity in both middle-aged men and middle-aged women.

Metabolic syndrome' in a middle-aged Finnish population.

OBJECTIVE: To investigate methods for the detection of different clusterings of the insulin-resistant abnormalities consistent with the concept of the 'metabolic syndrome' in clinical practice, and to research the occurrence of these clusters in a middle-aged Finnish population. METHODS: We studied a random sample of 207 middle-aged subjects in the city of Tampere, and all 1148 subjects of four middle-aged age groups in Pieksamaki town, in central Finland. Clusterings of the following eight markers of insulin resistance were recorded as the main outcome measures: 1) at least one first-degree relative with non-insulin-dependent diabetes (NIDDM); 2) obesity: body mass index (BMI) > or = 30 kg/m2; 3) central adiposity: waist-to-hip ratio (WHR) > or = 1.00 in men and > or = 0.88 in women; 4) hypertension: systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg, or receiving drug treatment for hypertension; 5) hypertriglyceridaemia > or = 1.70 mmol/l; 6) low high-density lipoprotein (HDL) cholesterol: < 1.0 mmol/l in men and < 1.20 mmol/l in women; 7) abnormal glucose metabolism according to WHO criteria and 8) hyperinsulinaemia: fasting plasma insulin > or = 13.0 mU/l. RESULTS: The metabolic syndrome, defined as a clustering of dyslipidaemia (hypertriglyceridaemia, low HDL cholesterol, or both) and insulin resistance (abnormal glucose tolerance, hyperinsulinaemia, or both) was present in 17% of men and in 8% of women; this sex difference was statistically significant (P< .001). The syndrome was detectable with a sensitivity of 96% and a specificity of 55% by the combined four markers of insulin resistance (NIDDM in a close relative, obesity, central adiposity and hypertension). CONCLUSION: In clinical practice, the metabolic syndrome can be detected during normal clinical examination. The occurrence of the syndrome is already high by middle age.

Hyperinsulinemia and clustering of cardiovascular risk factors in middle-aged hypertensive Finnish men and women.

OBJECTIVE: To examine the relationship between hyperinsulinemia and clusters of cardiovascular risk factors in middle-aged hypertensive patients. DESIGN: A population-based study. SETTING: Pieksämäki District Health Center, and the Community health Center of the city of Tampere, in central Finland. SUBJECTS: Hypertensive men and women aged 36, 41, 46, and 51 years (n = 18) in the town of Pieksämäki, and a normotensive control population of 177 subjects aged 40 and 45 years in the city of Tampere. MAIN OUTCOME MEASURES: Clusters of obesity (body mass index > 30.0 kg/m2), abdominal adiposity (waist:hip ratio > 1.00 for men and > 0.88 for women), hypertriglyceridemia (> 1.70 mmol/l), a low level of high-density lipoprotein cholesterol (< 1.0 mmol/l in men and < 1.20 mmol/l in women) and abnormal glucose metabolism (impaired glucose tolerance or noninsulin-dependent diabetes as defined by World Health Organization criteria) according to statistical quartiles of the fasting plasma insulin concentration. RESULTS: Among the hypertensives, there was a 2.0- to 3.6-fold higher risk of having a clustering of the insulin-resistance associated cardiovascular risk factors compared with that of the normotensives. Among the hypertensive subjects in the highest quartile of fasting plasma insulin there was a six- to 12-fold increase in risk associated with having two or more insulin resistance-associated cardiovascular risk factors compared with the subjects in the lowest quartile. There was a positive correlation between a high number of ascertained risk factors and high levels of fasting plasma insulin. CONCLUSION: In clinical practice, knowledge of the close relationship between risk-factor cluster status and fasting plasma insulin levels offers a tool to evaluate the occurrence of hyperinsulinemia in middle-aged hypertensive men and women.

Comparison of manual Amplicor PCR, Cobas Amplicor PCR, and LCx assays for detection of Chlamydia trachomatis infection in women by using urine specimens.

We compared the Roche Amplicor PCR, Roche Cobas Amplicor PCR, and Abbott LCx assays by using urine specimens for the detection of Chlamydia trachomatis infections in a female population. First-catch urine and endocervical swab specimens were collected from a total of 442 patients. Urine specimens were tested by the manual Roche Amplicor PCR, the automatic Roche Cobas Amplicor PCR, and the Abbott LCx assays as instructed by the manufacturers. For the Cobas Amplicor PCR, the internal control protocol was used for every specimen to reveal the presence of polymerase inhibitors. Cell culture of cervical specimens was used as a reference method. Of 442 patients, 50 (11.3%) were confirmed to have chlamydial infection. The diagnostic sensitivity and specificity of cell culture with cervical swab specimens were 88 and 100%, respectively. With urine specimens the sensitivity and specificity for the manual Amplicor PCR assay were 100 and 99.7%, respectively; those for the automatic Cobas Amplicor PCR assay were 94 and 99.2%, respectively; and those for the LCx assay were 94 and 100%, respectively. Thus, all amplification methods with urine specimens proved to be highly sensitive and specific for the detection of C. trachomatis infection in women. No statistically significant differences in the test performances could be demonstrated for specimens from this population. All three amplification techniques with urine specimens proved to be superior to cell culture with cervical swab specimens in diagnosing C. trachomatis infections in women.

Effects of lisinopril or lisinopril/hydrochlorothiazide compared with adjusting of previous medication and intensifying non-pharmacological treatment in patients with mild to moderate hypertension.

The objective of this study was to compare the effectiveness of three treatment methods available for treatment of previously medicated patients with mild to moderate hypertension. The comparison was made between adjusting or increasing previous medication and switching the previous drug treatment to lisinopril (CAS 76547-98-3) or lisinopril hydrochlorothiazide (CAS 58-93-5) therapy and in both of these treatment groups the effect of additional intensified health education was tested. An open, randomised, controlled multi-centre study lasting 36 weeks involving 189 doctors and 69 nurses was carried out in 155 centres of primary health care and occupational health care system in Finland. The study population consisted of 1156 patients, age 30-70 years, (mean DBP 95-115 mmHg in the last three to five measurements during follow-up). The number of patients achieving target pressure (DBP < 90 mmHg) at the end of the study, defined daily doses (DDD) of antihypertensive drugs and side-effects in different treatment groups were regarded as the main outcome measures of the study. After exclusions and drop-outs the final analysis was carried out with 900 patients, 419 women (46.6%) and 481 men (53.4%). Patients receiving lisinopril treatment achieved target pressure significantly more often (p < 0.001) than those continuing their previous or adjusted medication at 36 weeks (59.2 and 55.5% vs 40.3 and 42.7%). Only a small additional but statistically non-significant blood pressure lowering effect was achieved with intensified non-pharmacological treatment at weeks 12 and 24, but this difference had disappeared at week 36. The mean DDDs of different antihypertensive drugs did not differ between groups except for female patients on previous or adjusted medication not receiving health education, the mean DDD being significantly (p < 0.05) higher at weeks 24 and 36 in this group. The profile of adverse effects at the end of the study clearly favoured patients on lisinopril treatment except for cough which was reported in 18% of patients vs 10% in the control groups. 81 patients on lisinopril treatment were withdrawn from the study because of cough. The results showed that hypertensive patients with poor treatment control benefit from all three approaches. A greater proportion of patients on lisinopril treatment achieved target pressure and also experienced fewer side effects than those continuing on adjusted previous medication. Intensified personal health education given once a month during six months had only a small additional beneficial effect on reaching the target pressure and this effect was lost in three months after the health education period.

Detection of Chlamydia trachomatis infections in women by Amplicor PCR: comparison of diagnostic performance with urine and cervical specimens.

We used the Roche Amplicor PCR assay to compare urine and cervical swabs as sample material in the detection of Chlamydia trachomatis causing genital infections. The diagnostic performance of Amplicor PCR was compared with that of cell culture and the Gen-Probe PACE 2 assay with cervical specimens. If discrepant from other results, the specimens negative by PCR were diluted and reanalyzed to reveal PCR inhibitors. Of 666 patients, 39 (5.9%) were confirmed to have chlamydial infection. The respective sensitivity and specificity of Amplicor PCR were as follows: urine specimens, 82.0 and 99.7%; cervical specimens, 82.0 and 99.8%. Those for cell culture with cervical specimens were 84.6 and 100%. For the Gen-Probe PACE 2 assay, the sensitivity and specificity with cervical specimens were 79.5 and 100%, respectively. Without the effect of PCR inhibitors, the sensitivity of PCR with urine would have been 97.4%. Provided that the problems currently caused by inhibitors will be solved, the Amplicor PCR assay with urine specimens offers a tempting alternative for the diagnosis of C. trachomatis infection in women.

Norfloxacin and Salmonella excretion in acute gastroenteritis--a 6-month follow-up study.

In a controlled, randomized, double-blind study, 100 patients (66 women, 34 men; age 18-69 years) with acute salmonellosis were treated with norfloxacin (400 mg) or placebo tablets twice daily for 10 days to compare the effects on the excretion time of salmonella bacteria. In all patients salmonellae were detected in the stools before the start of treatment. The follow-up included 6 stool cultures after the start of treatment: day 3-4, day 12-14, and 4 times during 1-6 months. At 3-4 days there were 98% non-excretors in the norfloxacin group (46/47 patients) compared to 38% (17/45) in the placebo group (p < 0.001). The cumulative 6-month elimination rate in norfloxacin patients at 3-4 days was 72%, which was significantly (p = 0.0001) greater than the 31% in the placebo patients. However, there was no significant difference in the proportion of non-excretors or the elimination rate between the 2 groups at the following visits. Only one patient had an adverse event resulting in discontinuation of the treatment. We conclude that norfloxacin treatment for 10 days decreased the excretion of salmonella bacteria during the first week, but there was no difference in excretion rates 1-6 months after treatment initiation in the treatment versus placebo group.

Women have a larger and less atherogenic low density lipoprotein particle size than men.

Some epidemiological studies have shown that serum total cholesterol increases with age. especially in women. On the other hand, the risk of coronary artery disease is smaller in women than in men. Earlier studies have shown that a small dense low density lipoprotein (LDL) is more atherogenic than a large LDL. We studied LDL size and apolipoprotein E (apo E) phenotypes in premenopausal and postmenopausal women and in men at the same age. In this study 342 subjects participating in a health screening study were examined. There were four subgroups: 40-year-old men (n = 85), 40-year-old women (n = 80), 70-year old men (n = 88) and 70-year-old women (n = 89). In the present study LDL size was larger (P < 0.01) in women (26.39 +/- 0.07 nm) than in men (25.95 +/- 0.07 nm). We found that LDL size correlated highly positively (r = 0.606; P < 0.001) with serum high density lipoprotein (HDL) concentration and inversely with serum triglyceride concentration (r = -0.627; P < 0.001). Measuring serum HDL cholesterol and triglycerides in health screening studies gives information indirectly about LDL size and its atherogenicity. Apo E phenotype was not significantly associated with serum triglycerides, but was associated with LDL size, LDL cholesterol, total cholesterol and HDL cholesterol. In our sample LDL size decreased and LDL cholesterol and total cholesterol increased according to the most prevalent apo E phenotypes in the order E2/3, E3/3, E3/4 and E4/4. Subjects with phenotype apo E4/4 had the smallest LDL size (25.70 +/- 0.19 nm), the highest total cholesterol (6.53 +/- 0.35 mmol/l) and the lowest HDL cholesterol values (1.28 +/- 0.04 mmol/l). We conclude that there was a significant interaction between sex and age in serum total cholesterol which was highest in older women. However, their LDL size was larger and their LDL is less atherogenic. Apo E phenotype had a significant influence on LDL size.

Alcohol-induced macrocytosis and blood pressure.

The effect of alcohol on blood pressure was studied prospectively in consecutive general practice patients with macrocytosis (MCV greater than or equal to 100 fl). The patients were separated into misuser and non-misuser groups on the basis of the Malmö modified Michigan Alcoholism Screening Test. There was no significant difference in the prevalence of antihypertensive medication between the misuser and non-misuser groups. When patients using antihypertensive medication were excluded and the groups were age-adjusted, male misusers (n = 95) compared to control patients (n = 22) had significantly higher diastolic (88 mmHg and 81 mmHg, respectively, P = 0.001) and systolic (146 mmHg and 137 mmHg, respectively, P less than 0.001) blood pressure values. Female misusers (n = 24), as compared to female non-misusers (n = 59) had significantly higher diastolic (83 mmHg and 82 mmHg, respectively, P = 0.04) but not systolic blood pressure values. Thus, alcohol seems to have a pressor effect predominantly among men. As 72% of men with macrocytosis were alcohol misusers and 41% of them either had elevated systolic or diastolic blood pressure, all patients with macrocytosis should be asked about their alcohol consumption and at least the males should have blood pressure measured.

Moderate and heavy alcohol consumption have no favorable effect on lipid values.

Moderate alcohol consumption has been reported to provide protection against coronary heart disease. We studied serum lipid values in 380 men, including 184 controls (37 teetotalers and 147 moderate drinkers), 90 heavy drinkers, and 106 alcoholics. Total cholesterol values were significantly lower among alcoholics than controls (mean +/- SEM, 5.43 +/- 0.15 mmol/L [210 +/- 5.8 mg/dL] vs 6.01 +/- 0.08 mmol/L [232 +/- 3.1 mg/dL]), but their high-density lipoprotein (HDL) cholesterol values were higher (1.66 +/- 0.07 mmol/L [64 +/- 2.7 mg/dL] vs 1.14 +/- 0.02 mmol/L [44 +/- 0.8 mg/dL]). Accordingly, there was a highly significant difference in the HDL/total cholesterol ratio (0.32 +/- 0.13 vs 0.19 +/- 0.01). Heavy drinkers had significantly higher total cholesterol values than controls (6.30 +/- 0.13 mmol/L [244 +/- 5.0 mg/dL] vs 6.01 +/- 0.08 mmol/L [232 +/- 3.1 mg/dL]); the same was true of HDL cholesterol values (1.25 +/- 0.07 mmol/L [48 +/- 2.7 mg/dL] vs 1.14 +/- 0.02 mmol/L [44 +/- 0.8 mg/dL]). No significant difference was found in the HDL/total cholesterol ratio between controls and heavy drinkers or between teetotalers and moderate drinkers. Therefore, moderate alcohol intake apparently does not change HDL/total cholesterol ratio; if moderate drinking is protective against coronary heart disease, the mechanism is probably not via lipids.

Elevated high-density-lipoprotein cholesterol and normal triglycerides as markers of longevity.

Serum cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides of 85 year old home-living persons were compared to those of controls and of patients who had severe coronary artery disease (CAD) at an early age. Eighty-five-year-olds had higher serum HDL cholesterol than controls and patients with CAD. Patients with severe CAD had higher serum total cholesterol and serum triglycerides and lower HDL-cholesterol than other groups. When 85-year-old persons were divided into quintiles according to serum HDL cholesterol, women with highest HDL cholesterol had lowest mortality, men with lowest HDL cholesterol had highest mortality. We conclude that elevated HDL cholesterol is correlating with longevity and low HDL cholesterol with CAD at an early age.

Double-blind comparison of cefixime and cefaclor in the treatment of acute otitis media in children.

In a double-blind study cefixime, an oral cephalosporin of the third generation, was compared to cefaclor in the treatment of acute otitis media in 397 children aged 6 months to 12 years. Clinical evaluation was carried out at the beginning, at day 10-12 and day 28-35 after the start of the treatment. Specimens for bacterial culture and sensitivity testings were taken from the nasopharynx at the initial visit. Patients were randomized either to cefixime in a dose of 8 mg/kg/day or cefaclor in a dose 40 mg/kg/day in the proportion of 2 cefixime patients to 1 cefaclor patient. Two daily doses were administered for 7 days. At day 10-12, 93.5% in the cefixime group and 90.5% in the cefaclor group (p = 0.08) were clinically cured or improved. At day 28-35 the rate of cured or improved patients had decreased, mostly due to reinfections, to 90.1% in the cefixime group and to 86.6% in the cefaclor group (p = 0.12), respectively. 375 patients (69.9%) had positive bacterial culture in the nasopharynx of at least one strain of Haemophilus influenzae, Streptococcus pneumoniae, Branhamella (Moraxella) catarrhalis or combinations of these 3.73.6% of the B. catarrhalis strains were beta-lactamase producing and 11.4% of the H. influenzae strains, respectively. All isolated bacteria were sensitive to cefixime. Adverse events were reported in 17.9% in the cefixime and 10.6% in the cefaclor group. Most reactions were of moderate or mild nature and mostly affected skin or the gastrointestinal region. No serious adverse experiences occurred. In view of the good clinical results obtained cefixime seems to be at least as effective as cefaclor in the treatment of acute otitis media in children.