Relationship between lung function impairment and incidence or recurrence of cardiovascular events in a middle-aged cohort.

INTRODUCTION: Lung function impairment may be a risk factor for cardiovascular disease (CVD) events. OBJECTIVE: To determine the relationship between the severity of airflow obstruction based on modified Global Initiative on Obstructive Lung Disease (GOLD) criteria and the prevalence and incidence or recurrence of CVD in a cohort of US adults, aged 45-64 years, from 1987 to 2001. METHODS: We analysed data from 14 681 adults using logistic regression to determine the cross sectional association between lung function impairment and prevalent CVD at baseline and Cox regression to examine the prospective association of lung function impairment at baseline with CVD over 15 years of follow-up. Models were adjusted for age, sex, race, smoking, comorbid hypertension and diabetes, cholesterol levels and fibrinogen level. RESULTS: At baseline, the crude prevalence of CVD was higher among subjects with GOLD 2 (OR 2.9, 95% CI 2.4 to 3.6) and GOLD 3 or 4 chronic obstructive pulmonary disease (COPD) (OR 3.0, 95% CI 2.0 to 4.5), compared with normal subjects. These relative risks were greatly reduced after adjusting for covariates (OR 1.4, 95% CI 1.1 to 1.8 for GOLD 2 and OR 1.3, 95% CI 0.8 to 2.1 for GOLD 3 or 4). Similarly, the association between COPD and risk of incident or recurrent CVD was much stronger in the unadjusted models (hazard ratio (HR) 2.4, 95% CI 2.1 to 2.7 for GOLD 2 and 2.9, 95% CI 2.2 to 3.9 for GOLD 3 or 4) than in the adjusted ones (HR 1.2, 95% CI 1.03 to 1.4 for GOLD 2 and 1.5, 95% CI 1.1 to 2.0 for GOLD 3 or 4). CONCLUSION: We observed a crude association between lung function impairment and prevalent and incident or recurrent CVD that was greatly reduced after adjusting for covariates, including age, sex, race, smoking, comorbid hypertension and diabetes, cholesterol levels and fibrinogen level. These data suggest that this association may be, in part, mediated through established CVD risk factors included in our adjusted models.

Comparison of surgical vs chemical sphincterotomy using botulinum toxin for the treatment of chronic anal fissure: a meta-analysis.

OBJECTIVE: To analyse systematically prospective randomized controlled trials dealing with the effectiveness of surgical sphincterotomy (SS) vs chemical sphincterotomy (CS) using botulinum toxin for the management of chronic anal fissure (CAF). METHOD: A systematic review of the literature was undertaken. Prospective randomized controlled trials on the effectiveness of SS vs CS using botulinum toxin were selected and analysed to generate the summative outcome. RESULTS: Four prospective randomized controlled trials dealing with SS vs CS using botulinum injection, which included 279 CAF patients, were analysed. Based on the random effects model, there was a higher complication rate [Risk ratio (RR) 14.54 (-9.84, -38.9) 95% CI, df = 2, P < 0.0163] and a higher risk of transient faecal incontinence [RR 6.39 (-2.37, -15.1) 95% CI, df = 3, P < 0.0001] in the SS group than in the CS group. However, there was significant heterogeneity among the trials (Q = 8 408 891, P < 0.0001), indicating a wide confidence interval range; thus, the inferiority of SS could not be shown. SS had a significantly higher healing rate [RR 1.63, (1.34-1.91) 95% CI, df = 3, P < 0.0110] and a significantly lower recurrence rate [RR 0.35 (0.33-0.38) 95% CI, df = 3, P < 0.0221] than CS. CONCLUSION: Both CS and SS are comparable in the management of CAF. There are no differences in the complication rates and incontinence rates between the two procedures. SS has a higher healing rate and a lower recurrence rate than CS. As long as the patient is willing to accept a negligible risk of transient faecal incontinence, SS should be the first-line treatment for CAF.

Increasing prevalence of asthma in UK primary care during the 1990s.

OBJECTIVE: To estimate recent prevalence trends of physician-diagnosed asthma in primary care in the UK, and to test the hypothesis that the asthma epidemic in the UK peaked in the mid-1990s and is currently declining. METHODS: A retrospective cohort of asthma patients was obtained from the General Practice Research Database (GPRD). From January 1990 to February 1999, asthmatics were followed up to death, censoring or mention of chronic obstructive pulmonary disease (COPD) in their clinical record. Prevalence rates of ever and managed asthma were obtained by sex, age and calendar year. RESULTS AND CONCLUSION: From 1990 to 1998, annual prevalence rates of managed physician-diagnosed asthma in women rose from 3.01% (95%CI 2.99-3.03) to 5.14% (95%CI 5.10-5.18), and in men from 3.44% (95%CI 3.41-3.46) to 5.06% (95 %CI 5.02-5.10) (P for trend <0.01 in both). In 1998, prevalence rates of managed asthma in children aged 5-14 affected 7.86% (95%CI 7.71-8.00) of girls and 10.30% (95%CI 10.15-10.47) of boys. Increasing prevalence rates in adult asthma (maximum 4.11% in 1998, 95%CI 4.03-4.19) and elderly asthma (maximum 3.37% in 1998, 95%CI 3.29-3.46) were observed as well in 1998. The study shows that the burden of asthma in UK primary care during the 1990s was still increasing.

Talocalcaneal coalition. Diagnosis with the C-sign on lateral radiographs of the ankle.

We analysed 42 weight-bearing lateral radiographs of the ankle, 20 of which were from patients with a clinical and plain radiological diagnosis of talocalcaneal coalition (TCC) who subsequently had CT. The remainder were from 22 healthy volunteers with no clinical findings suggestive of hindfoot pathology. Four observers, blinded to the CT findings, independently evaluated the radiographs on two separate occasions. With the 95% confidence interval and using the CT findings as the comparison we calculated the sensitivity, specificity, accuracy, and positive and negative predictive values for the C-sign, and for other signs known to be associated with TCC. Similarly, we also calculated the interobserver and intraobserver reliability for these signs using the kappa statistic. Our results suggest that the C-sign is highly sensitive and specific for TCC. It is an accurate indicator and significantly more reliable than other previously recognised radiological signs of TCC. Features of the C-sign, however, cannot be relied upon to indicate whether the TCC is fibrous or bony.

Life expectancy in England: variations and trends by gender, health authority, and level of deprivation.

STUDY OBJECTIVES: To investigate variations and trends in life expectancy in English district health authorities in relation to gender and Jarman deprivation level. DESIGN: Mortality data for English health authorities from 1984-94, compiled by the Office for National Statistics, were assessed conventionally and using life table techniques. SETTING: District health authorities in England. MAIN OUTCOME MEASURES: Life expectancies in the 105 DHAs in relation to rank, to gender, and to deprivation category based on the census based Jarman score. CONCLUSIONS: Differences in life expectancy had widened over the decade and prosperous areas with greatest longevity had seen the largest gains. In most deprived areas improvements in life expectancy were negligible. The greatest gender differences in life expectancy were also seen in deprived areas.

Using the proportional hazards model to study heart valve replacement data.

The proportional hazards model is used to study the effect of various concomitant variables on the time to valve failure, mortality, or other complications, for patients who have had artificial heart valves inserted. The data are from a database, which is still being assembled as more information is acquired, at Killingbeck Hospital. A suite of computer programs, not specifically developed with this application in mind, has been used to carry out the exploratory data analysis, the estimation of parameters and the validation of the model. These three elements of the analysis are all illustrated. The present report is seen as a preliminary study to assess the usefulness of the proportional hazards model in this area. Follow-up work as more data are accumulated is intended.