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Objectives: This study assessed associations of three theoretically different occupational class schemes with all-cause and cardiovascular mortality in Norwegian men and women., Study Design: Pooled survey and register data from four Norwegian cohort studies., Methods: We pooled survey data from four general population cohorts (N = 97,469) linked to national mortality registries with follow-up over 45 years. Survival was modelled using accelerated failure time models stratified by sex for three class schemes: The European Socio-Economic Classification (ESeC), The Oslo Register Data Class scheme (ORDC) and The International Socio-Economic Index (ISEI). Main analyses were adjusted for age, birth cohort, and study. Secondary analyses included smoking behaviour as a mediator., Results: During median 27.6 years of observation, 37,488 participants had died (13,243 from cardiovascular disease). Hazard ratios for male all-cause mortality were lowest in the highest occupational class categories ORDC 2: 0.68 (0.65-0.72), ESeC 1: 0.76 (0.73-0.79) and ISEI 5th quintile: 0.80 (0.77-0.82) compared to working class reference categories. Female mortality risks were lowest for Cultural Lower Middle class ORDC 7: 0.84 (0.72-0.98), Small Employers and Self-employed ESeC4: 0.70 (0.50-0.97) and ISEI 5th quintile: 0.79 (0.70-0.90). Patterns for cardiovascular mortality were similar to all-cause mortality. Including smoking behaviour as a mediator attenuated associations, but overall mortality patterns according to occupational class remained unchanged., Conclusion: The results underline that mortality inequalities do not simply consist of higher risks in the most disadvantaged groups. The association of occupational class with mortality is found across different categories of occupational class schemes, illustrating their continued relevance for studying social determinants of health., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Preserved ratio impaired spirometry (PRISm) and restrictive spirometric pattern (RSP) are often considered interchangeable in identifying restrictive impairment in spirometry., Research Question: Do PRISm and RSP have different individual associations with risk factors, morbidity, and mortality?, Study Design and Methods: In a cross-sectional and longitudinal study, including 26,091 Norwegian general population men (30 to 46 years of age), we explored the association of PRISm and RSP with smoking habits, BMI, education, respiratory symptoms, self-reported cardiopulmonary disease, and mortality after 26 years of follow-up. PRISm was defined as FEV 1 /FVC ≥ lower limit of normal (LLN) and FEV 1  < LLN, and RSP was defined as FEV 1 /FVC ≥ LLN and FVC < LLN. We compared the associations of PRISm and RSP to airflow obstruction and normal spirometry, both as mutually (PRISm alone, RSP alone) and nonmutually exclusive (PRISm, RSP) categories, adjusting for age, BMI, smoking, and education. We also conducted sensitivity analyses using Global Initiative for Chronic Obstructive Lung Disease criteria to define spirometric abnormalities., Results: The prevalence of the mutually exclusive spirometric patterns was as follows: normal 82.4%, obstruction 11.0%, PRISm alone 1.4%, RSP alone 1.7%, and PRISm + RSP 3.5%. PRISm alone patients were frequently obese (11.2%), had active or previous tobacco use, commonly reporting cough, phlegm, wheeze, asthma, and bronchitis. RSP alone patients were both obese (14.6%) and underweight (2.9%), with increased breathlessness, but similar smoking habits to patients with normal spirometry. The prevalence of heart disease was 4.6% in PRISm alone, 2.7% in RSP alone, and 1.6% in obstruction. With normal spirometry as a reference, RSP alone had increased all-cause (hazard ratio [HR], 1.57; 95% CI, 1.21-2.04), cardiovascular (HR, 1.48; 95% CI, 0.88-2.48), diabetes (HR, 6.43; 95% CI, 1.88-21.97), and cancer (excluding lung) mortality (HR, 1.51; 95% CI, 0.95-2.42). PRISm alone had increased respiratory disease mortality (HR, 4.00; 95% CI, 1.22-13.16). Patients with PRISm + RSP had intermediate characteristics and the worst prognosis. Findings were overall confirmed with nonmutually exclusive categories and Global Initiative for Chronic Obstructive Lung Disease criteria., Interpretation: PRISm and RSP are spirometric patterns with distinct risk factors, morbidity, and mortality, which should be differentiated in future studies., Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: L. C. and R. N. report funding from AstraZeneca, outside the submitted work. K. S. reports fees from UCB Pharma and MSD, outside the submitted work. None declared (A. J., A. G.)., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background and Aim: Reduced lung function is associated with increased mortality, but it is unclear how different spirometric patterns are related to specific deaths. Aim of this study was to investigate these associations in a large general population cohort., Methods: The study population consisted of 26,091 men aged 30-46 years from the Pneumoconiosis Survey of Western Norway conducted in 1988-1990 with follow-up on date and cause of death for 26 years. Cox proportional hazard models were used to estimate the association between baseline FEV 1 , FVC, obstructive (OSP) and restrictive spirometric pattern (RSP) (z-scores calculated according to GLI-2012 equations) and mortality (European 2012 shortlist classification (E-2012)), after adjustment for age, body mass index, smoking habits, and education., Results: In total, 2462 (9%) subjects died. A predominant reduction of FEV 1 (and OSP) were associated with respiratory non-cancer (E-8) (HR for one unit FEV 1 z-score decrease 2.29 (95% CI 1.90, 2.77) and lung cancer mortality (E-2.1.8) (1.27(1.12, 1.44)). A similar reduction of FEV 1 and FVC (and RSP) were associated with diabetes (E-4.1) (FEV 1 2.21(1.67, 2.92), FVC 2.41(1.75, 3.32)), cerebrovascular (E-7.3) (1.52(1.21, 1.91), 1.54(1.19, 1.98)), ischemic heart disease (E-7.1) (1.22(1.10, 1.35), 1.21(1.08, 1.36)), neurological (E-6.3) (1.56(1.21, 2.01), 1.61(1.22, 2.13)), suicide (E-17.2) (1.37(1.13, 1.65), 1.29(1.04, 1.59)) and hematological cancer mortality (E-2.1.19-21) (1.29(1.05, 1.58), (1.26(1.00, 1.58)). No association was found between reduced lung function and mortality due to accidents, alcohol abuse, digestive and genitourinary cancer., Conclusions: Spirometric obstruction was mainly related to pulmonary mortality. Spirometric restriction was mainly related to extra-pulmonary mortality., Competing Interests: Declaration of competing interest Lucia Cestelli has nothing to disclose. Amund Gulsvik has nothing to disclose. Ane Johannessen has nothing to disclose. Knut Stavem reports fees from UCB Pharma and MSD, outside the submitted work. Rune Nielsen reports funding from AstraZeneca, outside the submitted work., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Persistent dyspnea, functional limitations, and reduced quality of life (QoL) are common following pulmonary embolism (PE). Rehabilitation is a potential treatment option, but the scientific evidence is limited., Research Question: Does an exercise-based rehabilitation program improve exercise capacity in PE survivors with persistent dyspnea?, Study Design and Methods: This randomized controlled trial was conducted at two hospitals. Patients with persistent dyspnea following PE diagnosed 6 to 72 months earlier, without cardiopulmonary comorbidities, were randomized 1:1 to either the rehabilitation or the control group. The rehabilitation program consisted of two weekly sessions of physical exercise for 8 weeks and one educational session. The control group received usual care. The primary end point was the difference in Incremental Shuttle Walk Test between groups at follow-up. Secondary end points included differences in the Endurance Shuttle Walk Test (ESWT), QoL (EQ-5D and Pulmonary Embolism-QoL questionnaires) and dyspnea (Shortness of Breath questionnaire)., Results: A total of 211 subjects were included: 108 (51%) were randomized to the rehabilitation group and 103 (49%) to the control group. At follow-up, participants allocated to the rehabilitation group performed better on the ISWT compared with the control group (mean difference, 53.0 m; 95% CI, 17.7-88.3; P = .0035). The rehabilitation group reported better scores on the Pulmonary Embolism-QoL questionnaire (mean difference, -4%; 95% CI, -0.09 to 0.00; P = .041) at follow-up, but there were no differences in generic QoL, dyspnea scores, or the ESWT. No adverse events occurred during the intervention., Interpretation: In patients with persistent dyspnea following PE, those who underwent rehabilitation had better exercise capacity at follow-up than those who received usual care. Rehabilitation should be considered in patients with persistent dyspnea following PE. Further research is needed, however, to assess the optimal patient selection, timing, mode, and duration of rehabilitation., Clinical Trial Registration: ClinicalTrials.gov; No.: NCT03405480; URL: www., Clinicaltrials: gov., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: This study assessed the association between respiratory symptoms and mortality in four cohorts of the general population in Norway aged 15-75 years and in selected subgroups in the pooled sample., Methods: The study comprised 158,702 persons, who were drawn randomly from the Norwegian population register. All subjects received a standardized, self-administered questionnaire on 11 respiratory symptoms between 1972 and 1998, with follow-up of death until December 31, 2017. Analyses were performed on 114,380 respondents., Results: The hazard of death was closely associated with sex, age, and education. The hazard ratios (HR) for death and the 95% confidence intervals (CI) by risk factors were similar in the four cohorts. After adjustment for demographic and environmental, modifiable factors, the HR for death was 1.90 (95% CI 1.80-2.00) for breathlessness score 3, 1.28 (1.21-1.37) for cough/phlegm score 5 and 1.09 (1.05-1.14) for attack of breathlessness/wheeze score 2 compared to the referent (no symptom), respectively. The cough/phlegm score was associated with death in current smokers but not in never smokers or ex-smokers. Breathlessness score was associated with death in men and women., Conclusion: Among persons aged 45-75 years, respiratory symptoms were significant predictors of all cause mortality. Education and smoking habits influenced only the associations between coughing and mortality. The associations were independent of study sites., (Copyright © 2020. Published by Elsevier Ltd.)

Aims: To evaluate the associations of timing of surgery with postoperative length of stay (LOS), complications, and functional outcomes 3-6 years after open reduction and internal fixation (ORIF) in closed ankle fractures., Patients and Methods: Historical cohort study by chart review of 1011 patients for postoperative LOS and complications; 959 individuals were invited to participate in a postal survey with functional outcomes questionnaires. Complications were classified as perioperative, early, or late. The associations with time from trauma to surgery (<8h, 8h to 6days, >6days) were assessed with (1) postoperative LOS using multivariable random-effects negative binomial regression, (2) complications using multivariable binary and multinomial logistic regression, and (3) three different functional outcomes using multivariable linear regression., Results: The mean patient age was 51.4 (range 18-94) years, 556 (55%) were female, and 567 individuals (59%) responded to the questionnaire. There were no statistically significant associations between time to surgery and either postoperative LOS or complications after adjusting for several patient and fracture characteristics. Patients operated on >6days after the trauma had significantly worse scores on the Olerud and Molander Ankle Score (OMAS) (p=0.039) and somewhat worse, but non-significant, scores on the Lower Extremity Functional Scale (LEFS; p=0.573) and the Self-Reported Foot and Ankle Score (SEFAS) scale (p=0.161) than those operated on <8h after trauma., Conclusion: In ankle-fracture surgery, there was no apparent association between timing of surgery and postoperative LOS or complications. A delay of surgery for 8h to 6days resulted in similar functional outcomes after 3-6 years suggesting there may be a safe window of time for surgery of up to 6days after trauma that can be used to plan and perform the final ORIF., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Implant removal in ankle fractures treated by open reduction and fixation is often based on diffuse complaints. This study determined the incidence of implant removal and identified risk factors for two principal causes for removal: complaints and surgical site infection (SSI)., Methods: Retrospective cohort study involving 997 patients operated on 2009-2011 with follow-up through to 2013. The incidence of implant removal was analysed using competing risk analysis. Risk factors for implant removal were assessed using cause-specific hazard ratios (HRs) from a Cox regression analysis., Results: The mean age at surgery was 51.6 years, 550 (55%) of the patients were female, and 170 patients (17%) had implant removal: 144 due to complaints and 26 due to infection. Multivariable HRs for implant removal due to complaints were 0.70 for male sex (p=0.047), 0.79 for each 10-year increase in age (p<0.001), 0.70 for treatment with a syndesmosis screw (p=0.038), and 1.09 for each 15-min increase in operation duration (p=0.007). HRs for hardware removal due to infection were 1.42 for each 10-year increase in age (p=0.006) and 3.15 for current smoking (p=0.005)., Conclusion: In total 17% of patients had implant removal after open reduction and fixation; the majority because of subjective complaints. The risk factors for implant removal were different for removal due to complaints than for those removed due to infection. This information may be used to inform patients about the risk and risk factors for future implant removal., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Microvascular function in transplanted hearts can be evaluated by methods used in routine left heart catheterization follow-up after heart transplantation (HTx). This sub-study of a randomized study compared the effects of everolimus (EVR) and calcineurin inhibitor (CNI) treatment on microvascular function as expressed by the index of microvascular resistance (IMR) at 1 year after HTx. A secondary objective was to compare the change in IMR from 7-11 weeks to 1 year after HTx between randomized groups., Methods: There were 70 HTx recipients included and randomly assigned to combination therapy (EVR and CNI with early CNI withdrawal) vs conventional CNI treatment. Coronary physiologic assessment was performed 7-11 weeks and 1 year after HTx. A linear mixed model was used to assess the group difference at 1 year and the difference in IMR change between 7-11 weeks and 1 year after HTx., Results: At 1 year, there was no significant difference in IMR between the EVR group (17.5 mm Hg∙sec ± 8.9) (mean ± SD) and the CNI group (14.9 mm Hg∙sec ± 6.6, p = 0.17). The difference in IMR change between the 2 treatment arms was 1.6 mm Hg∙sec (95% confidence interval, -2.8 to 5.9; p = 0.49). Spearman's rank correlation coefficient at 1 year after HTx between IMR and maximal intimal thickness as assessed with intravascular ultrasound in the left anterior descending artery was -0.13 (p = 0.28)., Conclusions: In this prospective, open, randomized study comparing early CNI withdrawal with mammalian target of rapamycin inhibitors immunosuppression during the first year after HTx, early transition from CNI-based immunosuppression to EVR-based treatment did not result in differences in microvascular function as assessed by the IMR., (Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Objectives: In EuroQol five-dimensional questionnaire valuation studies, each participant typically assesses more than 10 hypothetical health states by using the time trade-off (TTO) method. We wanted to explore potential learning effects when using the TTO method, that is, whether the valuations were affected by the number of previously rated health states (the sequence number)., Methods: We included 3773 respondents from the US EQ-5D valuation study, each of whom valued 12 health states (plus unconscious) in random order. With linear regression, we used sequence number to predict mean and standard deviations across all health states. We repeated the analysis separately for TTO responses indicating a state better than death and a state worse than death. Each TTO value requires a specific number of choice iterations. To test whether respondents used fewer iterations with experience, we used linear regression with sequence number as the independent variable and number of iterations as the dependent variable., Results: Mean TTO values were fairly stable across the sequence number, but analyzing state better than death and state worse than death values separately revealed a tendency toward more extreme values: state better than death values increased by 0.02, while state worse than death values decreased by 0.21 (P < 0.0001) over the full sequence. The standard deviations increased slightly, while the number of choice iterations was the same over the sequence number. The findings were stable across the levels of health state severity, age, and sex., Conclusions: TTO values become more extreme with increasing experience. Because of the randomized valuation order, these effects do not bias specific health states; however, they reduce the overall validity and reliability of TTO values., (Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Reports on quality of life of kidney donors include small populations with variable response rates. The aim was to evaluate quality of life in kidney donors in a large cross-sectional study. Through the Norwegian Renal Registry we contacted all 1984 kidney donors in the period 1963-2007 with a response rate of 76%. All received the Short-Form-36 (SF-36) survey form and a questionnaire specifically designed for kidney donors. SF-36 scores for a subgroup (n = 1414) of kidney donors were not inferior to a general population sample, adjusted for age, gender and education. When asked to reconsider, a majority stated that they still would have consented to donate. Risk factors for having doubts were graft loss in the recipient (OR 3.1, p < 0.001), medical problems after donation (OR 3.7, p < 0.001), unrelated donor (OR 2.2, p = 0.01) and less than 12 years since donation (OR 1.8, p = 0.04). Older age at donation was associated with lower risk (OR 0.98, p = 0.03). Compared with other donors, those expressing doubts had inferior SF-36 scores. Norwegian kidney donors are mostly first-degree relatives. They are fully reimbursed and offered life-long follow-up. All inhabitants are provided universal healthcare. This should be considered when extrapolating these results to other countries., (©2011 The Authors Journal compilation©2011 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Background: The role of sex differences in health-related quality of life (HRQoL) after myocardial infarction (MI) remains controversial., Methods: In total 408 Norwegian patients completed the Short Form 36 (SF-36) questionnaire 2.5 years after MI. We compared HRQoL between sexes and with national norms. Multiple linear regression analysis was used to explore the association of scores on the Physical (PCS) and Mental (MCS) component summary scales with clinical and sociodemographic variables., Results: Women scored lower than norms on the Physical functioning, Role functioning-physical, General health, and Role functioning-emotional scales. Men scored higher on Bodily pain, and lower on the other 7 scales compared to norms. Women <70 years scored lower than men on 3 out of 8 scales and on PCS. Women >/=70 scored lower than men on 5 out of 8 scales and on PCS. Relative to sex- and age-specific norms, there were no sex-differences in SF-36 scores. Age, time since the index MI, chronic obstructive pulmonary disease (COPD), previous MI, and stroke predicted PCS scores in women. Education, COPD, infarct localization, number of indications for cardiovascular medication at discharge, medication for heart failure, and subsequent MI predicted PCS scores in men. Smoking status, education, and Q-wave MI were determinants for MCS scores in men., Conclusion: Patients had impaired HRQoL compared to sex- and age-specific norms 2.5 years after MI. Women had lower HRQoL scores than men, but relative to norms HRQoL was equally affected in both sexes. Men and women had different determinants of HRQoL.

In a cross-sectional postal survey, we compared patient-reported outcomes in patients undergoing breast reconstruction with the deep inferior epigastric perforator (DIEP) flap or an expandable breast implant (EBI). We included 34 consecutive patients who had breast reconstruction with DIEP flap and 30 patients with EBI. Outcomes were assessed using the Short Form 36 (SF-36) quality of life questionnaire, two study-specific patient satisfaction questionnaires and a visual analogue scale (VAS) on cosmetic result. There were no significant differences in SF-36 subscale scores between the two groups. On the study-specific questionnaire, more patients in the DIEP group were satisfied with the appearance of their breast (P<0.0005) and reported an improved social relationship (P=0.02), and fewer patients were sad about their body image (P=0.01) after reconstruction than in the EBI group. On the other study-specific items, satisfaction was similar in the two groups. On all five VAS items, DIEP patients reported better cosmetic results than EBI patients. We conclude that patient satisfaction and cosmetic outcome were better after breast reconstruction with the DIEP flap compared with EBI, while there was no difference in health-related quality of life.

Background: EQ-5D is a generic preference-based measure of health that can help to understand the impact of asthma and chronic obstructive pulmonary disease (COPD). The purpose of this paper was to synthesize literature on the validity and reliability of EQ-5D use in studies of asthma and COPD, and estimate EQ-5D utility scores associated with stage of disease., Methods: A structured search was conducted in EMBASE and MEDLINE (1988-2007) using keywords relevant to respiratory disease and EQ-5D. Original research studies in asthma or COPD that reported EQ-5D results and/or psychometric properties were included., Results: Studies that reported psychometric properties supported the construct validity, test-retest reliability, and responsiveness of EQ-5D in asthma (seven studies) and COPD (nine studies), although some evidence of ceiling effects were observed in asthma studies. In asthma studies that reported summary scores (n=11), EQ-5D index-based scores ranged from 0.42 (SD 0.30) to 0.93 (SD not reported). In COPD studies (n=8), scores ranged from 0.52 (SD 0.16) to 0.84 (SD 0.15). While few asthma studies reported scores by severity level, sufficient studies in COPD were available to calculate pooled mean utility scores according to GOLD stage: stage I=0.74 (0.62-0.87), stage II=0.74 (0.66-0.83), stage III=0.69 (0.60-0.78) and stage IV=0.61 (0.44-0.77) (most severe)., Conclusions: Evidence generally supported the validity and reliability of EQ-5D in asthma and COPD. Utility scores associated with COPD stage may be useful for modeling health outcomes in economic evaluations of treatments for COPD.

Objective: In various diseases, resting respiratory rate (RR) is associated with mortality. We hypothesized that RR could be an early marker of low-grade disease and hence be associated with mortality also in healthy individuals. The objective of the study was to assess if resting RR was associated with long-term mortality in healthy males., Study Design and Setting: In a cohort of healthy men aged 40-59, we studied the relation of RR in 1972-1975 with all-cause and respiratory mortality until 2000. We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs)., Results: Among 1,623 men, 615 died during follow-up, 96 from respiratory causes. Men in the upper RR quartile (>16 breaths/min) had higher all-cause mortality than in the lowest quartile (<13 breaths/min), HR 1.29 (95% CI 1.04-1.60, P=0.02), though this was not statistically significant in multivariable models. Resting RR was not associated with respiratory mortality., Conclusion: RR at rest was not independently associated with long-term all-cause or respiratory mortality in this cohort of healthy men.

Background: A randomised study was conducted to determine if short-term exercise training in patients with chronic atrial fibrillation (AF) might improve symptoms and health-related quality of life (HRQoL)., Methods: AF patients (64+/-7 years) were randomised to exercise training (n=15) or a 2-month control period (n=15) followed by an exercise training program (ETP). The ETP consisted of 24 training sessions with aerobic exercise and muscle strengthening. A cycle ergometer test, with recording of perceived exertion on the Borg scale, was performed. The participants completed HRQoL questionnaires, the Short-Form 36 (SF-36) and Symptom and Severity Checklist (SSCL), before and after training. Because there were no changes after two months in the control group, pooled data for all patients are presented before and after training., Results: Four of the eight SF-36 scales improved significantly (p<0.05) following training: physical functioning (82+/-14 pre-ETP, 86+/-10 post-ETP), bodily pain (82+/-17 pre-ETP, 92+/-14 post-ETP), vitality (61+/-14 pre-ETP, 68+/-13 post-ETP) and role-emotional (85+/-28 pre-ETP, 94+/-20 post-ETP). The SF-36 physical component summary scale also increased from 49+/-6 pre-ETP to 52+/-6 post-ETP (p<0.05). Significant improvements were also observed for summary and specific symptom scores of the SSCL. Exercise capacity improved by 41+/-20% and perceived exertion during testing by 1.4 points after training (p<0.05 for both)., Conclusions: The study demonstrates a significant improvement in HRQoL, symptoms during exercise testing and exercise capacity after a short-term exercise training program in patients with chronic AF.

Study Objectives: To determine if the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0 (subjects at risk for COPD) provides information about long-term mortality risk., Design, Setting, and Participants: From 1972 to 1975, clinical, physiologic, and biochemical parameters including respiratory symptoms, spirometry, and physical fitness were measured in 1,999 healthy men aged 40 to 59 years in an occupational cohort, of whom 1,623 had acceptable spirometry findings. In a proportional hazards model with follow-up until 2000, we assessed all-cause mortality according to GOLD stage 0, I, II, and III compared with "normal" subjects, after adjusting for known risk factors and potential confounders., Results: After 26 years (range, 25 to 27 years), 615 men (38%) had died. In multivariate proportional hazards models, GOLD stage 0 subjects had a nonsignificantly increased hazard of death (hazard ratio [HR], 1.19; p = 0.21) after adjustment for age, smoking, physical fitness, body mass index, systolic BP, and serum cholesterol. Similarly, subjects in GOLD stage I (HR, 1.30; p = 0.05) and stage II (HR, 1.77; p < 0.0001) had increased all-cause mortality. When expanding GOLD stage 0 to comprise patients with any respiratory symptom in a sensitivity analysis, the HR for all-cause mortality increased (HR, 1.35; p = 0.03)., Conclusion: There probably is an excess mortality among GOLD stage 0 subjects compared to symptom-free subjects; however, this should be interpreted cautiously and the results vary with the definition of the GOLD stage 0. Subjects in GOLD stage I or stage II had higher mortality than symptom-free subjects.

Background: The objective in lung transplantation is to prolong life, but the survival effect in patients with chronic obstructive pulmonary disease (COPD) or alpha1-anti-trypsin deficiency emphysema is still unresolved. This study assesses the impact of diagnosis, single-lung transplantation (SLT) vs bilateral lung transplantation (BLT) and timing of transplantation on survival in a national cohort., Methods: In 219 consecutive patients accepted onto the lung transplantation waiting list in Norway, 1990 to 2003, we assessed predictors of death: (1) on the waiting list; (2) 90 days after transplantation. For each period we used Cox regression, including age, gender, diagnosis, baseline pulmonary function tests, cardiac catheterization data, exercise capacity and transplant type, as potential predictors. Survival benefit was assessed graphically by combining adjusted survival curves after transplantation with the curve for those waiting, modeling transplantation after 6, 12 or 24 months., Results: Mean patient age was 49 years (SD 10), with 55% women. High forced expiratory volume in 1 second (FEV(1)) percentage predicted death on the waiting list. Diagnoses other than COPD/emphysema and receiving SLT were associated with death 90 days after transplantation. In COPD/emphysema, there was no clear survival benefit from BLT or SLT. For patients in the "Other" group, the data suggest a survival benefit from BLT., Conclusions: In COPD/emphysema, there was no obvious survival benefit from lung transplantation, which questions prolongation of life as the primary motivation for the procedure.

Objectives: To compare traditional Chinese acupuncture, minimal acupuncture at non-acupoints and conventional treatment for chronic sinusitis., Design: A three-armed single blind randomised controlled study., Setting: In an outpatient specialist clinic, we recruited 65 patients with symptoms of sinusitis >3 months and signs of sinusitis on computed tomography (CT)., Interventions: We randomised patients to one of three study arms: (1) 2-4 weeks of medication with antibiotics, corticosteroids, 0.9% sodium chloride solution, and local decongestants (n=21), (2) 10 treatments with traditional Chinese acupuncture (n=25), or (3) 10 treatments with minimal acupuncture at non-acupoints (n=19)., Outcome Measures: Change in sinus soft tissue swelling on CT, symptoms of sinusitis, and health-related quality of life (HRQoL), using the two component summary scales of the Short Form 36 and a rating scale., Results: In the conventional treatment group, sinus soft tissue swelling was reduced over 4 weeks (p=0.04), and HRQoL improved over 12 weeks (p=0.01-0.05). Pairwise comparisons of changes in total symptom score between the groups showed signs of a difference between conventional medication and sham over 4 weeks (p=0.06)., Conclusion: Sinus soft tissue swelling was reduced in the conventional treatment group over 4 weeks, and HRQoL improved over 12 weeks. Only a non-significant difference in symptom score change over 4 and 12 weeks was shown between conventional medication and traditional Chinese acupuncture.

The objective of this study was to assess the effect on health-related quality of life of acupuncture and sham acupuncture as adjunctive treatment in intractable epilepsy. We performed a randomized controlled trail with two parallel treatment arms at The National Center for Epilepsy in Norway, a comprehensive epilepsy center. Thirty-four patients with long-standing drug resistant epilepsy completed the study. The intervention consisted of 20 acupuncture treatments (bilateral needling of three acupoints plus one or two individually chosen points) or sham acupuncture (bilateral needling with smaller needles of three points outside the traditional meridians) over 8 weeks. The main outcome measures were changes in mean health-related quality of life scores for the two groups after 8 weeks, using the 89-item Quality of Life in Epilepsy (QOLIE-89) questionnaire. We found no difference between the acupuncture and sham acupuncture groups in score changes in any dimension of the QOLIE-89 questionnaire, despite testing a large number of dimensions. We also found no change in QOLIE-89 scores between baseline and 8 weeks in either groups. In conclusion, we could not demonstrate a significant effect of traditional acupuncture or sham acupuncture on the health-related quality of life of patients with intractable epilepsy., (Copyright 2000 BEA Trading Ltd.)

Insensitive lung-specific questionnaires may explain the poor association between arterial P(O2) and reported health-related quality of life. Conceivably, modern lung specific or generic quality of life measures might show a better association with arterial P(O2). Fifty-nine outpatients (34 men) with chronic obstructive pulmonary disease (COPD) who fulfilled the following criteria were studied: age 18-67 years, FEV1 < or = 70%, < or = 15% reversibility after beta2-agonist inhalation, and no other disabling disorders. All completed the Respiratory Quality of Life Questionnaire (RQLQ) and Short Form 36 (SF-36), and were tested with spirometry and arterial blood gases. In accordance with available COPD staging systems, patients were divided into those with an FEV1 of < 50% and 50-70% of predicted. Patients' characteristics were, [mean (SD)]: age: 57.0 years (9.0); FEV1: 1.46 (0.6). Spearman's rank correlations between arterial P(O2) and dimensions of the RQLQ ranged from 0.25-0.52, and were greater than for the SF-36 (0.14-0.36) in patients with moderate to severe COPD. The association between arterial P(O2) and quality of life scores in moderately to severely affected COPD patients was moderate, but higher than previously reported. The associations were higher with a lung-specific questionnaire than with a general health measure, indicating a higher sensitivity of the lung-specific measure in this patient group.

The aim of our study was to identify predictors for recurrence of epileptic seizures in a large county hospital population. We identified 956 patients (18-67 years) with ICD 9 code 345 as primary diagnosis, seen at the Central Hospital of Akershus over 7 years (1987-1994). The diagnosis of epilepsy was confirmed for 696 of the patients. These were divided into two groups: (1) no seizures during the previous year (n = 485) and (2) seizures during the previous year (n = 184). To identify predictors for recurrence of seizures, we used neurologic deficit, number of AEDs used, CT-scan findings, EEG findings, aetiology, gender, age below and above 50 years and comorbidity as independent variables in a logistic regression model. In a univariate analysis, the strongest predictors for recurrence of seizures were: age above 50 years (OR = 5.2;P < 0.0001), known aetiology (OR = 1.4;P = 0.04) and use of two or more AEDs (OR = 5. 7;P < 0.0001). In the multivariate analysis age, more than 50 years (OR = 1.7;P = 0.0216) and use of two or more AEDs (OR = 5.6;P < 0.0001) were the only predictors for recurrence of epileptic seizures., (Copyright 1999 BEA Trading Ltd.)

The objective of this study was to assess the performance of a lung-specific health status measure in patients with chronic obstructive pulmonary disease (COPD). We used the Respiratory Quality of Life Questionnaire (RQLQ), a modification of an Australian questionnaire intended for asthma patients and adapted in this study to fit patients with COPD also. For comparison we chose the general health profile measure Short Form 36 (SF-36). We assessed the five RQLQ scales and eight SF-36 scales for reliability, validity and responsiveness in 59 outpatients attending a Norwegian hospital for COPD. Statistical analysis included internal consistency, test-retest reliability and convergent validity between the two questionnaires. Responsiveness was assessed in patients reporting global change in health status over 1 year. All scales of the RQLQ showed good internal consistency (Cronbach's a = 0.85-0.94) and test-retest reliability (intraclass correlation coefficient = 0.86-0.94), as did the SF-36 scales (a = 0.66-0.90) and intraclass correlation coefficient = 0.60-0.86). Pearson correlations between scales with similar items ranged from 0.54 to 0.76, supporting the construct validity of both questionnaires. The RQLQ had responsive scales, showing significant changes in the expected direction over 1 year. We conclude that the RQLQ showed an acceptable reliability, construct validity and responsiveness in COPD patients, encouraging further use of this questionnaire.

Contingent valuation using willingness to pay (WTP) is one of the methods available for assessing the value of a new technology or treatment for a disease in monetary terms. Experience with this method is lacking in epilepsy. The objectives of this study were to assess the acceptability of the WTP method in epilepsy, the level of the responses, and to investigate its validity by comparison with other non-monetary preference measures. Among 397 patients with epilepsy responding to a comprehensive questionnaire, 82 were randomly selected for an interview. They were asked about their WTP for an imaginary new technology which could permanently cure their epilepsy. Fifty-nine patients participated and 57 completed the interview (32 women; mean age 44 years), the majority with well-controlled epilepsy. The patients indicated a median WTP of Norwegian Kroner (NOK) 150,000 (USD 20,000; GBP 11,800), interquartile range NOK 50,000-350,000 (USD 6, 667-46, 667; GBP 3,937-27,559) for this cure. Non-response was low, indicating high acceptability of this method. There was little association between WTP and other preference measures; the Spearman rank correlation coefficient was -0.09 and -0.12 with time trade-off and standard gamble respectively, questioning the validity of this method.