<p>This study examined relationships between 24-hour ambulatory BP and components of the insulin resistance syndrome, and investigated the prognostic significance of 24-hour BP for cardiovascular morbidity in a longitudinal population-based study of 70-year-old men. The findings indicated, that a reduced nocturnal BP fall, nondipping, was a marker of increased risk primarily in subjects with diabetes. A low body mass index and a more favourable serum fatty acid composition at age 50 predicted the development of white-coat as opposed to sustained hypertension over 20 years. Furthermore, cross-sectionally determined hypertensive organ damage at age 70 was detected in sustained hypertensive but not in white-coat hypertensive subjects. In a prospective analysis, 24-hour ambulatory pulse pressure and systolic BP variability at age 70 were strong predictors of subsequent cardiovascular morbidity, independently of office BP and other established risk factors. Isolated ambulatory hypertension, defined as having a normal office BP but increased daytime ambulatory BP, was associated with a significantly increased incidence of cardiovascular events during follow-up. </p><p>Hypertension constitutes part of the insulin resistance syndrome, and is a common and powerful risk factor for cardiovascular disease in elderly. Blood pressure (BP) measured with 24-hour ambulatory monitoring gives however more detailed information and may be a better estimate of the true BP than conventional office BP. </p><p>In summary, these data provide further knowledge of 24-hour ambulatory BP and associated metabolic risk profile, and suggest that the prognostic value of 24-hour ambulatory BP is superior to conventional BP in an elderly population.</p>

This study examined relationships between 24-hour ambulatory BP and components of the insulin resistance syndrome, and investigated the prognostic significance of 24-hour BP for cardiovascular morbidity in a longitudinal population-based study of 70-year-old men. The findings indicated, that a reduced nocturnal BP fall, nondipping, was a marker of increased risk primarily in subjects with diabetes. A low body mass index and a more favourable serum fatty acid composition at age 50 predicted the development of white-coat as opposed to sustained hypertension over 20 years. Furthermore, cross-sectionally determined hypertensive organ damage at age 70 was detected in sustained hypertensive but not in white-coat hypertensive subjects. In a prospective analysis, 24-hour ambulatory pulse pressure and systolic BP variability at age 70 were strong predictors of subsequent cardiovascular morbidity, independently of office BP and other established risk factors. Isolated ambulatory hypertension, defined as having a normal office BP but increased daytime ambulatory BP, was associated with a significantly increased incidence of cardiovascular events during follow-up. Hypertension constitutes part of the insulin resistance syndrome, and is a common and powerful risk factor for cardiovascular disease in elderly. Blood pressure (BP) measured with 24-hour ambulatory monitoring gives however more detailed information and may be a better estimate of the true BP than conventional office BP. In summary, these data provide further knowledge of 24-hour ambulatory BP and associated metabolic risk profile, and suggest that the prognostic value of 24-hour ambulatory BP is superior to conventional BP in an elderly population.

Peritoneal carcinomatosis (PC) is traditionally regarded as a terminal stage of disease with a poor prognosis and systemic chemotherapy is regarded as palliative treatment. In order to improve survival and even to achieve cure for selected patients with PC, cytoreductive surgery and intraperitoneal che-motherapy have been advocated. Despite complete macroscopic removal of tumour, residual microscopic malignant cells might result in recurrence. Intraperitoneal chemotherapy aims to kill residual malignant cells and thereby needs to be distributed in the entire peritoneal cavity. This aggres-sive combined loco-regional treatment has a high risk of morbidity and mor-tality. Whether the increased risks are acceptable to improve survival re-quires investigation and the impact of loco-regional treatment of PC on health-related quality of life (HRQL) needs to bee explored The overall aim of this thesis was to analyse the impact of cytoreductive surgery and intraperitoneal chemotherapy on patients with peritoneal carci-nomatosis. A significant survival improvement (median 32 months) was seen in 18 patients with PC of colorectal origin subjected to loco-regional treatment, in comparison to matched controls treated with systemic chemotherapy (me-dian survival 14 months, Paper I). The results of single-photon emission computer-tomography (SPECT) in 51 patients were correlated to the number of intraperitoneal chemotherapy courses that could be performed without further surgery (Paper II). Postoperative 30-days morbidity and 90-days mortality was investigated in 123 PC-patients after loco-regional treatment. Severe adverse events occurred in 51 (41%) patients. Five patients (4%) had treatment-related mortality. Stoma formation, duration of surgery, periopera-tive blood loss, and extent of PC was associated with morbidity (Paper III). HRQL was investigated in 64 patients. HRQL was negatively affected at 3 months but a partial recovery was seen at 8 months. 30-day morbidity did not have any impact on HRQL at 8 months (Paper IV). This treatment there fore appears justified despite considerable toxicity in view of possible life prolongation.

Peritoneal carcinomatosis (PC) is a common manifestation of both gastrointestinal and gynecologic malignancies. Until recently, this condition was considered beyond curative intent treatment. Since the 1980s, new treatment strategies combining cytoreductive surgery (CRS) with perioperative intraperitoneal and intravenous chemotherapy have emerged. The underlying hypothesis considers CRS responsible for the removal of the macroscopic disease and that perioperative chemotherapy should address the residual microscopic disease. These new treatment regimens have presented encouraging clinical results that contrast with prior failure. The parameters for perioperative chemotherapy are mainly extrapolated from literature on peritoneal dialysis and data from systemic chemotherapy. The overall aim of this thesis was to provide a pharmacokinetic and pharmacodynamic rationale for perioperative intraperitoneal (IP) and intravenous (IV) chemotherapy in PC patients and, to assess its toxicity. After intraoperative IV administration of 5-fluorouracil or ifosfamide, substantial levels of these drugs were found inside the peritoneal fluid and tumor nodules (Papers I and II). This created a pharmacologically advantageous situation whereby a normothermic administered IV drug was subject to the effect of the local hyperthermia in the peritoneal fluid and tumor nodule. High levels of 5-fluouracil, ifosfamide and doxorubicin were observed inside the tumor nodules (Papers I, II and III) and, the identical pharmacokinetic advantage (expressed as Area Under the Curve (AUC) IP/IV ratios)) resulted in different drug levels of doxorubicin according to the density of the tumor nodules (Paper III). These data stressed the importance of pharmacodynamic variables such as tumor nodule density, size, and, vascularity. Therefore, the tumor nodule is proposed as a more appropriate pharmacological endpoint than AUC ratios. After IP Mitomycin C administration in PC patients with a contracted abdomen, mitomycin clearance from the abdomen decreased (Paper IV), which indicated  these patients at risk of under-treatment. Consequently, these pharmacologic data indicate a change in dosimetry for these treatment protocols might be warranted according to the diffusion area. Although diffusional vectors are viewed the main driving force for these treatment protocols, only pharmacokinetic variables such as dose, volume and duration are considered. As pharmacodynamic variables are equally important in the pharmacological assessment of cytotoxic effect, the tumor nodule was proposed as the center of a new conceptual model (Paper I). Mitomycin C data on non-metabolizers ( Paper IV) indicated the cytotoxicity of these cancer chemotherapy protocols is at the level of the individual tumor nodules. The morbidity and mortality of a new bidirectional intraoperative chemotherapy regimen in PC patients was analyzed (Paper V) which provided a means for identifying subsets of patients at risk for increased toxicity. This thesis provides pharmacokinetic and pharmacodynamic guidance for improving perioperative chemotherapy treatment strategies in PC patients and reports its toxicity.

Syftet med studien var att undersöka hur anställda inom en polismyndighet i Sverige skattade sina levnadsvanor och hälsa samt om det finns någon skillnad mellan grupperna; poliser med yttre tjänstgöring, poliser med inre tjänstgöring och civilanställda. Ytterligare ett syfte var att studera sambandet mellan levnadsvanor och hälsa. Studien hade en kvantitativ ansats med en beskrivande, korrelativ och jämförande design. De medverkande var 153 personer. Stratifierat urval och randomiseringstabell har använts. Två instrument/enkäter har använts från folkhälsoinstitutet och livsmedelsverket. Resultatet visade att deltagarna bedömer sig stressade men skattar sitt hälsotillstånd som relativt gott. Över 50 procent av deltagarna hade besvär av värk i axlar och över 43 procent besväras av värk i ryggen. Deltagarna bedömde sig ha ringa besvär från sjukdomar som högt blodtryck, diabetes och astma. Användandet av tobak varierade mellan deltagargrupperna. Poliserna rökte minst, detta även jämfört med befolkningen i övrigt men snusade mest. Sambandsanalyser visade att deltagare med värk var tröttare, hade svårare att sova och kände sig mer stressade.

Introduction: Domestic research studies focused on the interrelationships between political ideology characteristics inherent in policy decisions and the contributions these political determinants exert over health indicators and outcomes are limited. Given the paucity of research that focuses on political and policy support of health at the county-level, this study sets out to utilize the University of Wisconsin Population Health Institute’s (UWPHI) annual County Health Rankings data and examine them within the context of county-based majority political partisanship and economic measures. Methods: This exploratory ecological study examined differences between independent variables: partisan voting behavior (trichotomized as conservative, moderate, and liberal) and median per capita household income in U.S. dollars (by quartile) on dependent variables related to mortality (years of productive life lost) and morbidity (number of poor mental and physical health days) at the county-level to compare differences in political and ideological underpinnings that may act as influencers on health outcomes. Multiple data sources were combined and matched to all 3,140 counties located in the U.S. Two-way between-subjects ANOVA statistical tests were conducted to determine if there is an effect of partisan voter index category on the three aforementioned dependent variables related to health outcomes, and median per capita income by quartile. Results: There was a statistically significant main interaction between median per capita household income by quartile and partisan voter index category on years of productive life lost, F(6,2789) = 19.3, p < .000, partial η2 = .040. While there were also statistically significant interactions between the independent and dependent variables of poor mental and physical health days, results of those analyses should be interpreted with caution. Pertaining to years of productive life lost, post hoc analyses of significant interactions revealed significant differences at the lower income quartile, but not in the expected direction. The conservative category had statistically significant lower years of productive life lost in comparison to the liberal category (M = -8.21, SE = 1.47, p = .000). Also, there were significant differences detected in the upper quartile suggesting that the liberal category has lower years of productive life lost in comparison to the conservative category (M = 7.06, SE = 1.06, p = .000). Conclusion: Results should be interpreted with caution and suggest more research and methodological refinements are needed, particularly related to categorizing county-level political dynamics.

Background. General population data were used to study co-morbidities between lifetime social phobia and mood disorders. Methods. Data come from the US National Comorbidity Survey (NCS). Results. Strong associations exist between lifetime social phobia and major depressive disorder (odds ratio 2·9), dysthymia (2·7) and bipolar disorder (5·9). Odds ratios increase in magnitude with number of social fears. Reported age of onset is earlier for social phobia than mood disorders in the vast majority of co-morbid cases. Temporally-primary social phobia predicts subsequent onset of mood disorders, with population attributable risk proportions of 10–15%. Social phobia is also associated with severity and persistence of co-morbid mood disorders. Conclusions. Social phobia is a commonly occurring, chronic and seriously impairing disorder that is seldom treated unless it occurs in conjunction with another co-morbid condition. The adverse consequences of social phobia include increased risk of onset, severity and course of subsequent mood disorders. Early outreach and treatment of primary social phobia might not only reduce the prevalence of this disorder itself, but also the subsequent onset of mood disorders.

Research has demonstrated that problem gambling is associated with substance and alcohol abuse (Petry, Stinson, & Grant, 2005), participation in criminal activities (McCorkle, 2002; Meyer & Stadler, 1999), and involvement in the criminal justice system (NORC, 1999). This study assessed problem gambling and its relation to crime and substance use within a population in which these risk factors are compounded: Adults mandated to participate in drug and DUI courts. Results indicate that the prevalence and severity of problem gambling may be higher within this population than any other. Furthermore, the results of qualitative and quantitative analyses converged to highlight that gambling, crime and substance use are interrelated behaviors, as each may lead to and/or reinforce the other. These findings suggest that problem gambling is a salient issue among substance-abusing offenders and that resources should be dedicated to screening those involved with the criminal justice system for problem gambling, establishing evidence based best practices in the prevention and treatment of problem gambling within this population, and that such practices may incorporate components addressing gambling, crime, and substance use.

The migration morbidity hypothesis suggests that stress events inherent in immigration contribute to an increase in psychopathology. Assessing and investigating migration-morbidity among children of Mexican origin and Mexican American mothers living in the United States is the focus of the current study. Participants in the study were 133 students in 3rd, 4th, and 5th grades residing in the U.S. A replication of the ASEBA Teacher Report Form (TRF) Post-Traumatic Stress Problems (PTSP) scale factor structure was conducted to determine its utility for children of Mexican and Mexican American mothers. Item-level confirmatory factor analysis (CFA) was used to evaluate the adequacy of the PTSP scale model. Three models were evaluated using a CFI, RMSEA, and WRMR to determine fit. Results using dichotomous TRF responses and omitting item 8, which includes information about a child's ability to concentrate, yielded a CFI = 0.956, RMSEA = 0.071, and WRMR = 0.862. Standardized factor loadings ranged from 0.484 to 0.976. The ASEBA TRF was used to gather information about a teacher's perception of problem behaviors in the classroom. Information was gathered for two groups: children of Mexican and children of Mexican American mothers residing in south Texas. An ANOVA determined that teachers observed a statistically significant difference (p = .04, d = 0.37) in happiness between groups with children born of Mexican origin mothers and rated as less happy than their peers born to Mexican American mothers. Children did not differ in other measures of behavior. The students resided in a primarily Mexican American/Mexican community, which could have impacted the results. In addition, the sensitive nature of the study may have impacted the low return rate. Implications of the study and their impact on education and immigrant mental health are discussed.

Older patients suffer from a greater number of medical morbidities, consume a greater number of prescribed medications, and report lower levels of quality of life than their younger counterparts. The objectives of this study were to determine whether there is 1) an association between medical morbidity and symptom burden or 2) an association between medication use and symptom burden. This was a cross-sectional study of the symptoms, medical morbidities, and medications reported by 159 community-dwelling male patients 65 years of age or older. Correlations were drawn using linear regression analysis. On average, the participants in this study suffered from 2.56 +/- 1.36 medical morbidities, were prescribed 7.91+/- 2.83 medications, and reported 3.17 symptoms at any severity. The results of this study demonstrated a direct correlation between number of medical morbidities and symptom burden (R2 = 0.94). Our study did not find a significant correlation between medication use and symptom burden (R2 = 0.20). The findings of this study suggest that the number of medical morbidities has a stronger negative impact on symptom burden than the number of medications used. Thus, when attempting to improve quality of life for older patients, physicians should focus on the treatment and alleviations of symptoms associated with medical morbidity.