15-Lipoxygenase-2 is expressed in macrophages in human carotid plaques and regulated by hypoxia-inducible factor-1alpha.

BACKGROUND: Macrophages are prominent in hypoxic areas of atherosclerotic lesions and their secreted cytokines, growth factors and activity of enzymes are involved in atherogenesis. Previously, we showed that 15-lipoxygenase (LOX)-2 is expressed in human monocyte-derived macrophages and that hypoxia increases 15-LOX-2 expression and secretion of pro-inflammatory molecules. Here we investigated whether human carotid plaque macrophages express 15-LOX-2 and whether its expression in macrophages is regulated by hypoxia through hypoxia-inducible factor 1alpha (HIF-1alpha). MATERIALS AND METHODS: Carotid plaques from 47 patients with high-grade symptomatic carotid artery stenosis were analysed using immunohistochemistry, and stained areas were quantified by digital image analysis. Carotid plaque macrophages were isolated with anti-CD14 immunobeads using an immunomagnetic bead technique. Primary macrophages were transfected with HIF-1alpha siRNA or control siRNA before extraction of RNA and medium analysis. RESULTS: In paired tissue sections, the extent of staining for CD68 correlated with staining for 15-LOX-2 but not for 15-LOX-1. In carotid plaque macrophages isolated with anti-CD14 immunobeads, 15-LOX-2 mRNA was expressed at high levels. In primary macrophages, 15-LOX-2 expression was significantly increased by incubation with the HIF-1alpha stabilizer dimethyloxalylglycine. Knockdown of HIF-1alpha significantly decreased production of the 15-LOX-2 enzyme products 12- and 15-hydroxyeicosatetraenoic acid. In carotid plaques, HIF-1alpha staining correlated with staining for 15-LOX-2. CONCLUSIONS: These results demonstrate that 15-LOX-2 is highly expressed in human plaques and is correlated with the presence of macrophages and HIF-1alpha. 15-LOX-2 enzyme activity can be modulated by HIF-1alpha. Thus, increased expression of 15-LOX-2 in macrophages in hypoxic atherosclerotic plaque may enhance inflammation and the recruitment of inflammatory cells.

Nocturia in relation to body mass index, smoking and some other life-style factors in women.

OBJECTIVE: To analyze the relationship of nocturnal micturition to body mass index (BMI), smoking, regular exercise, coffee and tea drinking, parity, and menopausal transition in women. METHODS: A questionnaire study was carried out in 3669 respondents among 6000 women, i.e. 1200 randomly selected from each 5-year age group between 40 and 64 years in the County of Jämtland, Sweden. The questions concerned number of nocturnal voiding episodes, health, childbirths, occurrence of somatic diseases and symptoms, habits and medication. RESULTS: In univariate analyses, body mass index (BMI) > or =30, smoking, lack of regular exercise and menopausal status, but not parity, were associated with an increased number of nocturnal micturition episodes. Nocturia was twice as common in women who drank no evening coffee or tea as in those who drank either of these beverages. In a multiple logistic regression analysis, independent correlates for two or more nocturnal micturition episodes vs. no more than one episode were: smoking 1-15 cigarettes daily vs. no smoking (odds ratio (OR), 1.4; confidence interval (CI), 1.1-1.8), 16 or more cigarettes per day vs. no smoking (OR, 1.8; CI, 1.1-2.8), <5 years after menopause vs. before (OR, 2.0; CI, 1.4-2.7), 5-9 years after vs. before (OR, 2.3; CI, 1.6-3.2) and > or =10 years after vs. before (OR, 3.5; CI, 2.6-4.7), BMI > or =30 vs. <20 (OR, 3.5; CI, 2.6-4.7). BMI in the ranges 20-24.9 and 25-29.9 showed no independent influence on nocturia. CONCLUSIONS: Nocturnal micturition was increased by smoking and raised BMI and decreased by regular exercise, but was not influenced by childbirth.

Nightmares, cardiac symptoms and the menopause.

OBJECTIVE: To analyze the relationship between nightmares, some cardiac symptoms and the menopause in 40-64-year-old women. METHODS: A general health questionnaire study was carried out in 3669 randomly selected women (out of 6000 invited) in the County of Jämtland, Sweden. Questions were asked about the state of health, cardiac symptoms (irregular heart beat and spasmodic chest pain), sleep, nightmares, menstrual status and medication. RESULTS: Eighty-one per cent of the women reported a good night's sleep. Nightmares at least once weekly occurred in 10.4%. The prevalence of spasmodic chest pain and irregular heart beat increased with increasing number of nights a week disturbed by nightmares. The prevalence of spasmodic chest pain and irregular heart beat was increased after the menopause. In a multiple logistic regression analysis, independent correlates for spasmodic chest pain were: nightmares at least once a week versus more seldom or never (odds ratio (OR) 2.3; 95% confidence interval (CI) 1.2-4.5), sleep, poor versus good (OR 1.8; 95% CI 1.0-3.3) and postmenopausal state (OR 6.6; 95% CI 2.8-15.4). Independent correlates for irregular heart beat were: nightmares (OR 2.0; 95% CI 1.4-2.8) and poor sleep (OR 2.5; 95% CI 1.9-3.2), but not menopause. CONCLUSION: The occurrence of perceived spasmodic chest pain and of irregular heart beat is increased in 40-64-year-old women with frequent nightmares and poor sleep. The occurrence of spasmodic chest pain is further increased after the menopause.

Sleep complaints in women of ages 40-64 years in relation to sleep in their parents.

Objective: To study the occurrence of sleep complaints in women in relation to such complaints in their parents.Background: Sleep complaints are common and may be affected by many somatic, mental, and life-style and environmental factors.Methods: A cross-sectional questionnaire survey was undertaken among 3669 randomly selected women of ages 40-64 years. The women were asked about their own health and sleep and their recollection of the sleep of their parents.Results: The frequency of poor sleep was low among women reporting that neither parent had sleep disturbances. Sleep disturbances in the father, mother and both parents implied a 2.5 (95% confidence interval, 2.0-3.2), 2.5 (2.1-3.0) and 4.8-fold (3.4-6.8) increase in sleep complaints in the investigated women, respectively. The frequencies of numerous awakenings, difficulty in falling asleep again and too little sleep increased similarly. A series of logistic regression analyses revealed that all sleep characteristics were evaluated more negatively in women who reported sleep disturbances in their parents and also reported themselves to be in poor health. All sleep variables deteriorated with age. Because data regarding parent sleep was based on subjects' recall of that sleep, the results should be interpreted with some caution.Conclusions: The frequency of sleep complaints in women aged from 40 to 64 years was increased if sleep disturbances were reported in their parents.

Who stops smoking during pregnancy?

BACKGROUND: The proportion of women who stop smoking during pregnancy has varied between 17 and 40% percent in Sweden with a tendency of lower prevalence in recent years. The aim of the present study was to examine the factors that might influence the ability to stop smoking during pregnancy. METHOD: One hundred and two women were interviewed shortly after their first visit to the antenatal clinic and a second time approximately one month after delivery. Two women who had late spontaneous abortions were excluded. The women were asked about background factors, smoking habits of their parents, smoking history and current smoking habits. The carbon monoxide in expiratory air was measured to verify reported smoking habits. RESULTS: Fifty-six of the 100 participating women had stopped smoking before the second interview. Having started smoking at an older age, having no previous children, smoking few cigarettes, a higher level of education, positive support from the partner and having lived with non-smoking parents were all associated with stopping smoking when tested as single factors. Reported smoking habits could be verified. Age, smoking habits of the partner, passive smoking at work, quality of sleep, general perceived health, length of sick-leave or amount of nausea were not correlated to stopping smoking. CONCLUSION: The presence of several factors found to influence stopping smoking during pregnancy, and the tendency for smoking habits to be passed over to the new generation, are reasons for comprehensive and individualized, anti-smoking support.

Quality of life in primary care asthma.

In primary care, asthma is usually assessed by means of the patients' history regarding symptoms and simple lung-function testing. These outcomes may, however, not be related to other estimates of asthma control such as quality of life. In the present study quality of life was studied in relation to symptoms (visual analogue scale, VAS) and lung function in adult patients with asthma in a primary-care setting. In a healthcare centre in Stockholm, 405 individuals diagnosed as having asthma were identified. Out of this number, 120 patients completed the study. Patients were categorized into four groups according to lung function and their response to a question regarding asthma symptoms on the VAS. Quality of life was evaluated with the Asthma Quality of Life Questionnaire (AQLQ) and current treatment was recorded. Quality of life differed significantly between the groups with regard to all domains and overall score; overall score was 6.0 (0.12)--(mean SEM) in group A (VAS < or = 2, normal FEV1), 5.4 (0.24) in group B (VAS < or = 2, low FEV1), 4.8 (0.25) in group C (VAS > 2, normal FEV1) and 4.6 (0.24) in group D (VAS > 2, low FEV1) (P < 0.0001). In general a gradient, with group A having the highest and group D the lowest score, was detected. Experience of symptoms (VAS > 2) was highly related to lower scores in the environmental domain (P < 0.0001). The correlation between FEV1 and quality of life was generally low whereas there was a fairly good correlation between VAS and quality of life (P < 0.0001 for all domains). Patients without steroid treatment had higher quality of life scores than patients treated with steroids. The majority of asthma patients in primary care have high quality of life scores, indicating a low prevalence of symptoms and only slight activity limitations. Evaluation of quality of life enables a more careful grading of asthma status. Furthermore, this measure provides information concerning asthma control that is not revealed by spirometry and simple questions regarding symptoms.

[Quality assurance of drug prescription in primary health care. A new database software makes the drug therapy surveillance easier]. / Kvalitetsarbete kring läkemedelsförskrivning i primärvården. Nytt databasprogram underlättar uppföljning av läkemedelsbehandling.

Quality assurance of drug prescription is a pre-requisite for rational drug use. From 22 health-care centres in the south-western area of the Stockholm County Council region, drug-prescription data were obtained from the patients' computerised medical recordings. This could be done with the aid of a specially designed database program. The drug-prescription data from the 22 health-care centres were collected and compiled in a central unit. Thereafter the results were brought back to the health-care centres, in which the quality assurance of drug prescription could be started.

Evaluation of changes in public interest concerning lipids and other cardiovascular risk factors between 1990 and 1995.

OBJECTIVE: To assess changes between 1990 and 1995 in the knowledge of cardiovascular risk factors, attitudes to lifestyle changes and to the role of primary health care in preventive work in an urban population. DESIGN: Postal questionnaire. SETTING: South-western Stockholm. SUBJECTS: 1000 randomly selected men and women aged 40 to 64 years. MAIN OUTCOME MEASURES: Knowledge of and attitudes toward cardiovascular risk factors and contacts with primary health care. RESULTS: Response rate was 67%. In 1995 69% thought it important to know one's own lipid values (75% in 1990; 95% CI for change -11, -2). Forty-two per cent thought hyperlipidaemia was a definite cause of coronary heart disease (CHD) (50% in 1990; 95% CI for change -13, -2). Sixty-one per cent thought that a reduction in hyperlipidaemia would reduce cardiovascular risk (70% in 1990; CI for change -14, -4), and 53% thought that a reduction in hypertension would do so (65% in 1990, CI for change -17, -7). Fewer people believed in the negative consequences of eating habits. A majority expected doctors to know about patients' smoking (88%) or drinking (87%) habits. CONCLUSION: Interest in hyperlipidaemia declined between 1990 and 1995, but people expected doctors to take an interest in patients' lifestyles and in prevention. This knowledge is an important working tool for physicians.

Nocturia and health in women aged 40-64 years.

To analyse the relationship between nocturnal micturition and health in 40- to 64-year-old women. A questionnaire study was carried out in 3669 randomly selected women (out of 6000 invited) in the County of Jämtland, Sweden. Questions were asked about the general health status of health, health development during the last 5 years, nocturnal micturition, parity, menstrual status, menopausal symptoms, hormone replacement therapy, cardiac diseases, diabetes and snoring. Poor health was reported by 10.4%. In 24.1% of the women health development had been unfavourable in the last 5 years. Poor health was reported by 4.7% of women without nocturnal micturition, and by 11.2, 20.1 and 39.0% (P<0.0001) of women with one, two, and three or more nocturnal voiding episodes, respectively. In a multiple logistic regression analysis significant independent correlates of health were: one versus no nocturnal micturitions (odds ratio [OR] 2.2; confidence interval [CI] 1.5-3.3), two versus none (OR 3.2; 1.9-5.3), and three or more versus none (OR 6.5; 3.5-11.9), spasmodic chest pain (OR 6.6; CI 3.0-14.5), irregular heart beats (OR 3.0; CI 2.1-4.3), diabetes (OR 5.1; CI 2.8-9.4), leg oedema> or =6 days/month versus <6 days/month (OR 23; CI 1.6-3.3), snoring: < or =3 times/week versus never (OR 1.4; CI 1.0-2.0), snoring 4-7 times/week versus never (OR 1.6; CI 1.1-2.2), being<5 years after versus being before the menopause (OR 1.6; 95% CI 1.0-2.5), 5-9 years after versus before the menopause (OR 1.7; CI 1.0-2.9), > or =10 years after versus before the menopause (OR 2.2; CI 1.3-3.7), diuretic treatment (OR 2.8; CI 1.7-4.6). The perceived state of health in 40- to 64- year-old women is profoundly affected by nocturia, independently of heart diseases, diabetes, snoring, age and menopausal status.

Collagen metabolism markers as a reflection of bone and soft tissue turnover during the menstrual cycle and oral contraceptive use.

Two different groups of women, 23 healthy young adults and 13 women with chronic posterior pelvic pain, were studied before and during use of oral contraceptives (OC). Collagen metabolism markers-here, the amino-terminal propeptide of type I procollagen, the carboxy-terminal telopeptide of type I collagen, and the amino-terminal of procollagen type III-as well as hormones and other endocrine factors indicating the balance between androgen expression/anabolism and catabolism of the subjects (testosterone, sex-hormone binding globulin, and insulin-like growth factor I were measured. Type I procollagen, the carboxy-terminal telopeptide of type I collagen, and the amino-terminal of procollagen type III were all significantly decreased during OC use. These findings implicate OC use-induced changes in collagen type I and III turnover. A shift in the anabolic/catabolic balance was also recorded indicating a less anabolic situation during OC use.

Functioning and well-being of patients with type 2 diabetes or angina pectoris, compared with the general population.

This study compares the health-related quality of life (HRQOL) of patients with type 2 diabetes mellitus or angina pectoris with that of a standard population sample (SPS). The HRQOL was assessed by the Swedish Health-Related Quality of Life Survey (SWED-QUAL), a generic HRQOL questionnaire adapted from the Medical Outcomes Study (MOS), with twelve scales tapping aspects of physical, mental, social and general health. Subjects between 45 and 84 years of age who answered the questionnaire were included, i.e. 266 patients with type 2 diabetes, 758 patients with mild angina pectoris (Canadian Classes I and II) and 908 with severe angina (Canadian Classes III and IV). As controls, we used 1126 subjects from the SPS. Patients with type 2 diabetes, mild angina and severe angina showed an increasing degree of health disturbance, compared with the SPS. Diabetic patients with no heart disease showed only a minor impact on the HRQOL, while the presence of a heart disease showed a considerable impact. In angina patients, the presence of diabetes also to some extent added to the decrease in HRQOL. On comparing the impact of the heart disease and diabetes on the HRQOL, the heart disease showed a stronger effect on most aspects of the HRQOL than diabetes. It is concluded that coronary heart disease is an important predictor of the impact on the HRQOL of type 2 diabetes patients.

Quality of life in relation to comorbidity among diabetic patients followed for three years in Swedish primary health care.

The aim of this study was to follow health-related quality of life (HRQOL) in diabetic subjects over a three-year period in relation to their medical situation. Forty-eight subjects 42-81 years of age in 1992 were identified as those responding to the HRQOL questionnaire on both occasions from a larger study of 341 diabetic patients in 1992 and 413 in 1995 in Stockholm County. Age- and sex-matched controls were taken from randomly collected samples of the general Swedish population. HRQOL was assessed by the SWED-QUAL (the Swedish Health-Related Quality of Life Survey). Medical data were extracted from medical records at community health centres. Pearson's correlation coefficient for SWED-QUAL results over time exceeded 0.60 for seven of the ten scales (p < 0.001). A significant difference between 1992 and 1995 was found only for "Physical functioning" (p < 0.01). The general deterioration in health seen in medical records was accompanied by a decrease in the "Sleep problems" scale. In conclusion, worse outcome was noted only for "Physical functioning", while deterioration in health according to medical records was related to a worse outcome with respect to "Sleep problems". However, as the sample was small and not randomly selected, the results should be interpreted with caution and need confirmation in further studies.

[Evaluation of the new admission procedures for medical education at the Karolinska Institute: selection based on tests and interviews is best]. / Utvärdering av Karolinska institutets nya antagningsformer till läkarutbildningen: PIL-arna klarade sig bäst.

To develop an admission procedure permitting selection of highly motivated medical students with personality characteristics appropriate for a future as practising physicians, from 1992 and onwards the Karolinska Institute based admission on a written test and two interviews (PIL group, n = 135), on upper secondary school grade point average (on a 5-point scale; GPA group, n = 161), on Scholastic Aptitude Test results (SAT group, n = 80), or other criteria (mainly foreign grades), the groups being compared at evaluation of the procedures in 1996. The PIL group scored highest in all respects, including clinical suitability, motivation, relations with classmates, and realistic expectations as to their future work as physicians, and none of them left medical school. Academic results were similar in the GPA group, though the two groups differed in secondary school GPAs (PIL group 4.0, GPA group 4.8(5.0). The evaluation suggested that admission via written test and interviews is a good alternative to conventional admission based on GPA or SAT.

Excessive drinking--brief intervention by a primary health care nurse. A randomized controlled trial.

OBJECTIVE: To evaluate the effect of a nurse-conducted intervention on excessive drinkers. DESIGN: Randomized, controlled trial. SETTING: Vårby Health Centre, Stockholm. INTERVENTION: The intervention group visited a nurse three times during a 12-month period. The controls met once with a general practitioner (GP). PATIENTS: Patients were recruited at a health screening on the basis of a raised gamma-glutamyl transferase (GGT). Of 2338 subjects, aged 25-54 years, 222 had a screening GGT of > or = 0.9 mukat/l. 100 were randomized to the treatment and 122 to the control group. MAIN OUTCOME MEASURES: GGT, self-reported alcohol consumption (g/week), sickness allowance and use of health care. RESULTS: After 2 years a reduction of GGT from 1.52 to 1.21 mukat/l (p = 0.02) had occurred in the treatment group. The controls increased their mean level of GGT from 1.75 to 2.16 mukat/l. Mean weekly alcohol consumption in the intervention group was reduced from 337 to 228 g/week (p = 0.02). The controls did not quantify their alcohol consumption initially, but reported a reduced weekly consumption at follow-up. CONCLUSION: The intervention had an impact on GGT and self-reported consumption. The controls also reported decreased consumption possibly because their appointment with the GP functioned as a very brief intervention.

The seasonal interrelationship between melatonin, vasopressin, and serum osmolality in elderly subjects.

Plasma concentration of arginine vasopressin (AVP) and melatonin and serum osmolality were measured at noon and at midnight in individuals living in the northern hemisphere on March 22-23, June 13-14, September 26-27, and December 12-13 in 35 healthy volunteers (15 men and 20 women) aged 60-74 years. The nocturnal increase in melatonin was highest in the autumn and lowest in the winter in both sexes. The midnight serum osmolality level was lower in the autumn than in any other time of the year. In both the men and the women the AVP level was higher in winter than in any other season (P < 0.01 and P < 0.0001, respectively). In men, the AVP level was higher at noon than at midnight in 49% of the investigated 24 hr periods, at the same level in 15% and lower in 36% (NS). The corresponding figures for women were 55%, 25%, and 20%, respectively (P < 0.05). This study suggests a possible relationship between melatonin and serum osmolality.

Hyperlipidaemia: differences in management practices and attitudes in two regions in Europe--Sicily and the Stockholm area.

In order to compare attitudes and management concerning hyperlipidaemia and risk factors for coronary heart disease among doctors in northern and in southern Europe, a questionnaire study was undertaken among doctors in primary health care and departments of internal medicine in Sicily and Stockholm. The regions differed in culture and health-care structure. Guidelines were similar, but screening of healthy individuals was recommended in Sicily, and not in Sweden. One hundred and fifty-three general practitioners in Sicily and 120 in Stockholm, 211 internists in Sicily and 83 in Stockholm participated. Main outcome measures were management policies for investigation and treatment and also attitudes. Routine lipid checks at first visits were done by few doctors in Stockholm but by a majority in Sicily (p < 0.001); in the presence of general cardiovascular risk factors (other than heredity, diabetes, cardiovascular disease and hypertension), routine checks were carried out more often by both general practitioners (p < 0.001) and internists (p < 0.005) in Stockholm. Drug treatment was initiated at lower cholesterol levels for secondary and primary intervention, cardiovascular disease, cardiovascular risk factors and hereditary hyperlipidaemia by both groups in Sicily (p < 0.001), as was dietary treatment. Secondary prevention was considered important by all groups, but primary prevention only by Sicilian doctors. We concluded that there were differences in views and management practice between doctors in Sicily and in Stockholm on the investigation and treatment of patients with hyperlipidaemia. Doctors tested lipids at first visits in Sicily but not in Stockholm. Treatment was initiated at lower levels of cholesterol in Sicily.

Daytime sleepiness in 40-64 year-old women in relation to somatic health and medical treatment.

OBJECTIVE: To investigate daytime sleepiness and napping in relation to nocturnal sleep, health, and medication. DESIGN: An epidemiological survey using a questionnaire. SETTING: The county of Jämtland in northern Sweden. SUBJECTS: 3669 randomly selected women aged 40-64 years, with a similar number of women in each 5-year age group. MAIN OUTCOME MEASURES: Daytime sleepiness (DS), health, night sleep, somatic diseases, and medication. RESULTS: DS was more common in subjects suffering from asthma, cardiac diseases, hypertension, muscular pain, and frequent nocturnal micturition. In a logistic regression analysis with DS as the dependent variable and age, health, nocturnal sleep, frequent awakenings, inability to fall asleep again after nocturnal awakening, and hypnotic medication as explanatory variables there was an increase in DS by age in each 5-year class from 40-44 years, but a decrease in DS beyond 60 years. General health, health development during the last 5 years, and sleep characteristics were associated with increased DS. There was no increase in DS related to the use of hypnotics. CONCLUSIONS: Poor health, a poor night's sleep, and different somatic diseases, but not use of hypnotics, are associated with DS in women aged 40-64.

Drug utilization 90%--a simple method for assessing the quality of drug prescribing.

OBJECTIVES: To describe a simple method for assessing the quality of drug prescribing. METHODS: We tested the idea that the number of drugs accounting for 90% of drug use--drug utilization 90% (DU90%)--may serve as an indicator of the quality of drug prescribing. We ranked the drugs by volume of defined daily doses (DDD) and determined how many drugs accounted for the DU90% segment. We also compared this segment with the pharmacotherapeutic guidelines issued by the Regional (local) Drug Committee to determine the adherence to its recommendations (index of adherence). The cost per DDD within the DU90% segment and for the remaining 10% was also calculated. The utilization of drugs based on prescriptions purchased during April 1995 was determined for 24 primary health care (PHC) centres in southwestern Stockholm. RESULTS: The number of different products, defined as all products marketed under a single brand name within an ATC (anatomic therapeutic chemical) category, in the DU90% segment varied twofold (81-164) between the 24 PHC centres. Differences in the number of GPs per PHC centre accounted for a third of this variation. The compliance with the Drug Committee recommendations varied between 54% and 78%. There was no relationship between the number of products accounting for the DU90% segment and the adherence to local prescription guidelines, i.e. prescribing more products did not increase the adherence. The costs for the DU90% drugs varied from 2.26 SEK/DDD in one PHC centre to 3.75 in another one, with an average cost of 2.87 SEK/DDD, while for the remaining 10% it was the double (6:54 SEK/DDD). In all, the DU90% drugs made up 80.8% of the total cost as compared with 19.2% for the remaining 10%. In the DU90% segment, there was no clear relationship between adherence to the guidelines and the cost/DDD, i.e. following the evidence-based guidelines appeared to provide a higher quality of prescribing rather than cheaper prescribing. CONCLUSIONS: The DU90% is an inexpensive, flexible, and simple method for assessing the quality of drug prescribing in routine health care. The number of products in the DU90% segment and adherence to prescription guidelines may serve as general quality indicators. The method may be adapted to provide comparative data between PHC centres, hospitals, regions etc. that may be cross-sectional and longitudinal. Other quality criteria, specific for each class of drugs, should complement these general indicators.

Sleep and cardiac symptoms amongst women aged 40-64 years.

OBJECTIVES: To determine whether the occurrence of cardiac symptoms is related to sleep disturbances. DESIGN: An epidemiological survey by means of a questionnaire. SETTING: The county of Jämtland in northern Sweden. SUBJECTS: Randomly selected women (6000) aged 40-64 years, with a similar number of women in each 5-year age group. A total of 3669 responded. MAIN OUTCOME MEASURES: Sleep disturbances and cardiac symptoms. RESULTS: In total, 81.9% of the women reported a good night's sleep. Amongst them, 0.4% stated that they were troubled by both spasmodic chest pain and a sensation of irregular heart beat, 0.8% spasmodic chest pain alone, 5.8% irregular heart beat and 93.0% neither of these conditions. The corresponding frequencies amongst the women who slept poorly were 1.5, 1.8, 15.0 and 81.7%, respectively (P < 0.0001). Amongst the subjects with reported sleep complaints, there was an increase in heart symptoms, both in those with trouble falling asleep, frequent awakenings and difficulty in getting to sleep again, and in those who awoke too early in the morning. Spasmodic chest pain was 8.8 (1.9-40.3) times and irregular heart beat 7.7 (3.3-18.1) times more common in women with nightmares almost every night than in those who never experienced nightmares. Daytime sleepiness was also associated with increased heart symptoms. CONCLUSION: Poor sleep was associated with an increase in spasmodic chest pain and irregular heart beat.

Diabetic patients in primary health care--quality of care three years apart.

OBJECTIVE: To compare registering of diabetic complications and metabolic control in diabetic subjects in primary health care in 1992 and 1995. DESIGN: Cross-sectional surveys of medical records. SETTING: Three community health centres in Stockholm County. SUBJECTS: Diabetic patients aged 18-84 years in 1992 (n = 177) and in 1995 (n = 413). MAIN OUTCOME MEASURES: Rate of noted diabetic complications and metabolic values. RESULTS: Retinopathy examination was noted in 64% in 1992 versus 65% in 1995, neuropathy examination in 44 versus 49%, and urine examination in 88% versus 73% (p < 0.001). HbA1c was examined in 52% in 1992 versus 68% (p < 0.001) in 1995, fasting blood glucose in 89 versus 90%, and cholesterol in 34 versus 42%. Acceptable HbA1c values were noted in 51% in 1992 versus 46% in 1995. Smoking habits were available in 26% in 1992 versus 53% in 1995 (p < 0.001) and BMI in 5 versus 39% (p < 0.001). Diabetic blindness was present in 2.2% in 1995, uraemia in 0.3%, and amputation due to gangrene in 1.2%. CONCLUSION: Documented examination rates of diabetic patients are unacceptably low, and the metabolic level unsatisfactory in most cases. Severe complications are, however, rare.