Quantification of shape of flow-volume loop of healthy preschool children and preschool children with wheezing disorders.

BACKGROUND: The earliest change associated with airflow obstruction in small airways is reflected in a concave shape on the maximum expiratory flow-volume loop (MEFVL). The shape of the MEFL changes with age but reference values for curvilinearity indices (CI) for preschool children have not been published. We aimed to describe the normal curvilinearity of healthy preschool MEFVL by CI (the ß angle and the ratio of maximum expiratory flow when 50% of forced vital capacity remains to be expired/peak expiratory flow (MEF(50%) /PEF)) and to test their capacity in detecting concavity in preschool children with wheezing disorders. METHODS: Spirometric data were obtained from 132 healthy preschool children and 171 3-to-5-year-old preschool children with wheezing disorders and reference values for CI calculated. RESULTS: Mean (SD) ß angle of healthy children was 203° (16°) and mean MEF(50%) /PEF of healthy children was 0.71 (0.12) indicating convexity of MEFVL, both decreased with increasing age (P = 10(-4) ). Children with wheezing disorders had lower z-score values of CI (P ≤ 10(-6) ) indicating more concave MEFVL. Among the two CI, MEF(50%) /PEF allowed for the best discrimination between healthy children and children with wheezing disorders (Wilks' lambda = 0.898, P = 10(-7) ). CONCLUSION: These CI can detect and quantify the concavity of the descending limb of the MEFVL in preschool children with wheezing disorders, MEF(50%) /PEF having the highest sensitivity in detecting the concavity.

Job stress and major coronary events: results from the Job Stress, Absenteeism and Coronary Heart Disease in Europe study.

AIMS: The intention of this study is to investigate the relationship of the demands/control/strain model with hard coronary events in an epidemiological, prospective, multicenter, European study. METHODS AND RESULTS: Six cohorts (Brussels, Ghent, Lille, Barcelona, Göteborg and Malmö) from four European countries (Belgium, France, Spain and Sweden) consisting of 21 111 middle-aged male subjects participated between 1993 and 1996 in the baseline survey of the Job Stress, Absenteeism and Coronary Heart Disease in Europe (JACE) study. The Karasek strain model of psychological demands (five items)/control (nine items) was used. During a mean follow-up of 40 months 185 acute coronary events or coronary deaths were observed. Age-adjusted hazard ratios (HRs) for developing an acute coronary event were 1.46 [CI 95% confidence interval (1.08-1.97)] for high against low psychological demands and 1.53 (95% CI 1.0-2.35) for strained (high demands plus low control) against relaxed (low demands plus high control) groups. After adjustment for standard cardiovascular risk factors the HR for developing a coronary event for those above or equal to the median against those below the median of psychological demands was 1.46 (95% CI 1.08-1.97) whereas the HR for strained against relaxed groups is 1.46 (95% CI 0.96-2.25). Sensitivity analyses confirmed the robustness of the results. CONCLUSION: In this European, multicenter, prospective, epidemiological study the Karasek job strain model was an independent predictor of acute coronary events, with the psychological demands scale emerging as the important component.

Longitudinal follow-up study of smoker's lung with thin-section CT in correlation with pulmonary function tests.

PURPOSE: To evaluate thin-section computed tomography (CT) in depicting longitudinal changes in the lung parenchyma. MATERIALS AND METHODS: One hundred eleven volunteers underwent sequential examination with thin-section CT and pulmonary function tests over a mean period of 5.5 years. According to their smoking habits between initial evaluation (T0) and follow-up (T1), the subjects were classified as persistent current smokers (n = 57), persistent nonsmokers (n = 31), persistent ex-smokers (n = 13), or quitters (n = 10). RESULTS: Significant differences in CT findings between T0 and T1 were seen in only the group of persistent current smokers, who showed a higher frequency of emphysema (40% vs 26%; P =.005) and ground-glass attenuation (42% vs 28%; P =.02). Individual analysis of follow-up CT scans in the 19 persistent current smokers with micronodules at T0 demonstrated (a) no changes in seven cases, (b) a higher profusion of micronodules in seven cases, and (c) replacement of micronodules with emphysema in five cases. Subjects with emphysema and/or areas of ground-glass attenuation at T0 had a significantly more rapid decline in lung function than did those with a normal CT scan. CONCLUSION: Emphysema and/or ground-glass attenuation are linked with impairment of ventilatory lung function over time in persistent current smokers.