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Rationale, aims and objectives Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed. Our aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well-defined, general Norwegian population without known CVD at baseline. Methods We assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD), using Cox proportional hazard models. The study population comprises 52 087 Norwegians, aged 20‐74, who participated in the Nord-Trondelag Health Study (HUNT 2, 1995‐1997) and were followed-up on cause-specific mortality for 10 years (510 297 person-years in total). Results Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89‐0.99 per 1.0 mmol L -1 increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88‐1.07). The association with IHD mortality (HR: 1.07; 95% CI: 0.92‐1.24) was not linear but seemed to follow a ‘U-shaped’ curve, with the highest mortality

Several European studies have reported sleeping problems in 20-40% of the population. We used data from the Population Study of Women in Gothenburg, based on medical examinations of three different representative cohorts of 38- and 50-year-old women in 1968-1969, 1980-1981 and 2004-2005 to study secular trends in sleep-related factors. The average reported sleep duration declined by about 15 min in the 38-year-old women during the 36 years of observation. No corresponding change in sleep duration was observed among 50-year-old women. During the same period, the proportion of women complaining of sleeping problems almost doubled in both age groups: from 17.7% in 1968 to 31.7% in 2004 in 38-year-old women, and from 21.6% to 41.8% in 50-year-old women. The prevalence of insomnia was higher in 50-year olds than in 38-year olds in all investigated cohorts. The use of sleeping medications remained unchanged since 1968. There were significant associations between perceived sleeping problems and reported lower satisfaction concerning economic, social and family situations, as well as with medical retirement and mental stress. There was, however, no association between alcohol consumption and sleeping problems. Regular leisure time physical activity was not, in most cases, associated with less perceived sleeping problems. Our study indicates that the physician should take socio-economic and family situations into consideration when examining female patients complaining of sleeping problems. Improvements on society level rather than on the individual level could be expected to be more efficient in improving women's sleep.

Enlarged subcutaneous abdominal adipocytes have been shown to predict incidence of type 2 diabetes (T2D) in the Pima population of Arizona (USA). We investigated the role of subcutaneous abdominal adipocyte size (AAS), as well as femoral adipocyte size (FAS), as predictors of T2D in a population-based Swedish cohort. In 1974-1975, a sample of 1302 middle-aged women underwent a health examination, including anthropometry and evaluation of parental medical history. In addition, body composition (total body potassium and total body water), AAS and FAS (adipose tissue needle biopsy) were assessed in a subsample of 245 women. Incidence of T2D was followed until 2001, with 36 cases eligible for inclusion in this analysis. Women developing T2D had larger AAS at baseline vs. women remaining healthy (age/heredity-adjusted hazard ratio for increase of AAS by 1 sd [AAS-HR] 1.91; P

The prevalence of bacteriuria was studied in a population sample of women aged 38-60. Significant (greater than or equal to 100 000 bacteria/ml of the same species in two consecutive specimens) or "probable" bacteriuria (greater than or equal to 100 000 in the first and 20 000-90 000 bacteria/ml of the same organism in the second specimen) were found in 5% of the women, increasing from 3.5% in women aged 38 to 8.6% in women aged 60. Escherichia coli predominated (90% of those with significant bacteriuria), and 91% of the Escherichia coli strains were sensitive to sulphonamides. About half of the women who were non-bacteriuric after short-term treatment had one or more recurrent urinary tract infections during a two-year follow-up period. Serum creatinine and urine concentrating capacity did not differentiate women with significant or "probable" bacteriuria from the others. Pathological radiological changes were found in 17% of bacteriuric women who were submitted to i.v. pyelography. When re-examined six years after the first study, 23% of initially bacteriuric and 5% of initially non-bacteriuric women had bacteriuria. Patients with renal lesions have been followed for ten years, but none of them has developed progressive renal impairment. Three women with chronic pyelonephritis and acute pyelonephritic attacks in the past were discovered when screening the concentrating capacity in this population sample, but they were non-bacteriuric when screening for bacteriuria. A study of this kind must be conducted over many years before valid conclusions can be drawn.

Women with myocardial infarction had hypertension, were on antihypertensive treatment, and had a family history of hypertension significantly more often than women in the general population. The distribution of blood pressure values in women with angina pectoris did not differ significantly from that in the general population of women. Hypertensives were significantly over-represented among women with ECG changes suggestive of ischaemic heart disease. This might be interpreted either as a sign that “coronary ECG” as defined is often a pre-symptomatic manifestation of ischaemic heart disease in hypertensives, or that these ECG changes are not specific for ischaemic heart disease.

A history of previous myocardial infarction and angina pectoris was more common in women with an acute attack of myocardial infarction than in the general population of women, as were symptoms of angina pectoris and intermittent claudication. Chronic bronchitis, gallstone disease and renal stone disease were also over-represented. The women with myocardial infarction were usually inactive when taken ill. About one third of them complained of breathlessness and/or disturbance of consciousness associated with the attack. Most women with myocardial infarction had symptoms such as nausea, vomiting and cold perspiration. The infarction area was localized with about the same frequency to the anterior and posterior wall of the heart. In about half of the women the maximum registered temperature exceeded 38.0°C. The primary mortality of the women who were hospitalized was rather low (9%). The overall mortality among those who were survivors on arrival in hospital and those who died outside hospital during the first few hours or days was 30%.

Physical activity, both at work and during leisure, decreased with age, as found from a population study of women. Physical inactivity, both at work and during leisure, had been significantly more common during the age period 20–38 in women who later had an acute myocardial infarct than in women in the general population. The same was found when comparing later periods of life. A similar tendency was noted in women with angina pectoris, though the differences mostly did not reach significant levels.

Results from retrospective and prospective studies of women in Goteborg. Sweden indicate that arterial hypertension is a risk factor for ischemic heart disease in women and of similar importance as in men.

Altogether 1462 middle-aged women aged 38-60 participated in a population study which was carried out in Goteborg, Sweden in 1968-69. Of these women, 1302 were re-investigated six years later in a follow-up study. Studied cross-sectionally, headache and nycturia were found to be more common in both untreated and treated hypertensives than in a non-hypertensive reference group. The prevalences of headache seemed to be U-shaped when related to the BP levels, with the highest prevalences in the lowest and highest quintiles of BP levels. In the longitudinal study, headache did not occur more often in those women who had started antihypertensive treatment than in the others. Dizziness as a new symptom occurred more often in women who had started to take antihypertensive drugs than in those who had not, and was more common in those who had started taking diuretics than in those starting on beta-blockers. The prevalences of eyeground phenomena and ECG changes seemed to increase linearly with increasing BP levels. It is concluded that some symptoms and signs are related to BP levels, and some of the symptoms in hypertensive women may also be related to antihypertensive treatment as such and to the type of antihypertensive treatment given.

Metoprolol, a new selective adrenergic beta1-receptor blocking drug, has been compared to placebo in a series of 24 women who previously had taken alprenolol and propranolol during a cross-over study. Blood pressure (BP) and heart rate (HR) were significantly reduced during metoprolol treatment compared to placebo. The occurrence of side-effects was similar during treatment with metoprolol and placebo. After the cross-over study the patients continued on metoprolol for more than two years, except for short periods on placebo or propranolol. During this follow-up period BP remained at a similar level when the metoprolol dose was unchanged. Dose reduction (from 50 or 100 mg t.i.d. to 50 or 100 mg b.i.d.) caused no, or only a very slight, increase in BP. No side-effects were reported during long-term treatment.

A reversible deterioration of the oral glucose tolerance has been reported in subjects with initially impaired glucose tolerance when starting to take oral diuretics. This does not seem to be the case in subjects with an initially unimpaired glucose tolerance. A deterioration in the diabetic state is commonly seen when diuretics are given to subjects with clinical diabetes. Our knowledge about the effect of beta-blockers on the glucose tolerance is limited. As for diuretics there seems to be an overrepresentation of diabetics among subjects taking beta-blockers. This overrepresentation can probably be explained by an association between diabetes and disturbances in which diuretics and beta-blockers are commonly used such as arterial hypertension and ischaemic heart disease.

Morbidity and mortality in cardiovascular and cerebrovascular diseases and total mortality have been studied in a longitudinal population study initially comprising 1462 women representative of the general female population. When related to the initial blood pressure (BP) levels of women not on antihypertensive drugs (hypertensives and non-hypertensives), the distributions of women with myocardial infarction (MI) and stroke during the 12-year follow-up period seemed to be U-shaped, with the highest incidences in women with the lowest and the highest BP levels. Women recognized as untreated hypertensives in the initial study were offered regular control by the study team during the whole 12-year period and were treated when treatment was considered indicated. They were found to be similar to the non-hypertensives with regard to the incidence of MI and stroke and total mortality. Our encouraging results may be explained by continuity of medical care, the antihypertensive treatment per se or the types of antihypertensive drugs administered.

Women from five age groups (38, 46, 50, 54, and 60 years), participating in the population study "Women in Gothenburg 1968-1969", were subjected to a 24-hour recall dietary interview (n = 1361). In a randomized subsample (n = 418), a dietary history was obtained and individuals in another randomized subsample (n = 755) submitted a 24-hour urine specimen for nitrogen analyses. There were significant differences between the 24-hour recall and dietary history figures in all five age groups with respect to energy and all nutrients. The mean protein intake calculated indirectly from the urinary nitrogen excretion came close to the figures calculated from the dietary histories in four out of five age groups. The energy intake and, consequently, the intake of most nutrients calculated from the dietary histories were higher than generally ascribed to Swedish women, as most previous data have been obtained by 24-hour dietary recall interviews. Most women (71-89% in the different age groups) consumed too much fat and most women of fertile age (80-92%) consumed too little iron. A significant decrease in the mean energy intake was apparent only in the age group 60, i.e. 1870 kcal versus 1965--2 105 in the other groups.

From a population study of middle-aged women in Goteborg, Sweden, the prevalences are given of history of myocardial infarction, angina pectoris, and ECG changes suggestive of ischaemic heart disease. A comparison is made with men of the same ages living in the same area. The prevalence of myocardial infarction was found to be higher in men than in women, while that of angina pectoris was about the same in both sexes. Q wave changes of the ECG were more common in men than in women, while other ECG changes suggestive of ischaemic heart disease such as ST depression and T wave inversion were as common in women as in men.

A larger number of co-existing “risk factors” for ischaemic heart disease was found in women who had suffered myocardial infarction than in women in the general population. Similar observations were made when comparing women who had angina pectoris or women who had ECG changes suggestive of ischaemic heart disease with women in the general population, though these differences were smaller. Diabetes mellitus, smoking and high triglycerides were especially common in women who had had myocardial infarction. At least one of these “risk factors” was present in 95 % of these women compared to 48 % of the women with angina pectoris, 43 % of women with ECG changes suggestive of ischaemic heart disease and 47 % of the women in the general population. It seems that the prevalence of a large number of “risk factors” - even though the factors may differ only moderately from those usually found in the population - per se acts as an important “risk factor” for ischaemic heart disease in women.

A longitudinal population study of 1462 women, aged 38-60, was carried out in Gothenburg, Sweden in 1968-69. Women with initially manifest diabetes mellitus had significantly increased 12-year incidence of myocardial infarction and increased mortality while no increased incidence of angina pectoris, ECG changes indicating ischaemic heart disease or stroke was observed. The association to myocardial infarction remained in multivariate analyses and was independent of age, body fat distribution, smoking, serum cholesterol and systolic blood pressure. The association to mortality was independent of these factors and also of serum triglycerides. Women who were diagnosed as "new diabetics" during the 12-year follow-up had a significantly increased 12-year incidence of myocardial infarction but no significant increase was observed for any of the other end-points studied. When women with initially manifest diabetes mellitus were excluded, no association was found between initial fasting blood glucose concentration and the end-points studied. A negative significant association was found between initial fasting blood glucose concentration and smoking.

Blood haemoglobin concentration, packed cell volume, blood cell counts, serum iron concentration, total iron binding capacity, bone marrow iron content, sideroblast count, iron absorption and menstrual blood loss were studied in 372 38-year-old women who were representative of the general female population of that age resident in Gothenburg, Sweden. The distributions of serum iron concentration, serum total iron binding capacity, and transferrin saturation were slightly skewed, whereas the distributions of iron absorption, reticulocyte count, sideroblast count, and menstrual blood loss were markedly skewed. The other variables studied were mainly normally distributed. One-third of the women (32 %) had no reticuloendothelial iron and another 14 % only traces of reticuloendothelial iron in smears from sternal bone marrow. Serum iron concentration and total iron binding capacity were rather high and menstrual blood loss low in women taking oral contraceptives, while factors such as country of origin, socio-economic group, blood donation, previous oral iron therapy or recent infection seemed to have no or only a slight influence on variables reflecting the iron status.

No significant differences in socio-economic status were found between women with IHD and women in the general population. No correlation was found between status incongruity of husband and wife and ischaemic heart disease. Women who had four children or more were significantly over-represented among those who had myocardial infarction and among those with ECG changes suggestive of ischaemic heart disease. Psychological stress, both when measured as psycho-social stress factors and as subjective stress experience, was significantly more common in women with myocardial infarction and in women with angina pectoris than in women in the general population. Among personality traits assessed, the level of aggression and neurotic self-assertiveness was significantly higher in women with myocardial infarction. Achievement and dominance displayed a tendency in the same direction but the differences did not reach statistical significance.

The number of childbirths had been significantly greater in women with angina pectoris or ECG changes suggestive of ischaemic heart disease than in women of the general population. A similar tendency was found for women with myocardial infarction. Spontaneous and/or legal abortions had been significantly more common in women with myocardial infarction. None of the women with myocardial infarction, angina pectoris or ECG changes suggestive of ischaemic heart disease had ever used oral contraceptives. Eight women who had a myocardial infarct before the age of 48 were all still menstruating when they had the infarct. A retrospective comparison revealed that significantly more women who had suffered myocardial infarction were postmenopausal at the ages of 45 and 50 than women in the general population. Menopause at the age of 50 or earlier had also taken place significantly more often in women with angina pectoris and in women with ECG changes suggestive of ischaemic heart disease. Postmenopausal 50-year old women had higher serum cholesterol and serum triglyceride values than 50-year old women still menstruating but blood pressure was lower than in the latter group of women. These differences in serum lipids and blood pressure between premenopausal and postmenopausal women were statistically significant.

In a population study in Göteborg, Sweden, comprising women in the age strata 44, 52, 56, 60 and 66 years, serum thyrotrophin (S-TSH) was determined in 283 women representative of the general population of women of these ages. No women with previously unknown hypothyroidism were found at the clinical examination; 47 (3.7%) were on thyroxine treatment, 9 (0.7%) because of spontaneous hypothyroidism. Sixteen women (1.2%) had markedly elevated S-TSH concentration (less than 14 mU/l). They were studied further by determination of thyroid hormones and circulating antithyroid microsomal and thyroglobulin antibodies, and those with goiter were subjected to fine-needle biopsy of the thyroid gland. They were furthermore followed for four years. Four euthyroid women were given thyroxine because of goiter and abnormal laboratory test results. Of nine individuals with high S-TSH concentration as well as high titers of thyroid antibodies and/or biopsy evidence of autoimmune thyroiditis, seven became hypothyroid within the four years of follow-up. The other two women had consistently elevated basal S-TSH concentration and exaggerated S-TSH response after thyroliberin administration. We conclude that the majority of individuals without previously recognized thyroid disease who have S-TSH concentration above 14 mU/l with the assay used will require thyroxine therapy within a few years. In one woman, however, with multinodular colloid goiter and high titer of antimicrosomal antibodies, the basal S-TSH concentration decreased during follow-up to a high normal value; the S-TSH response to thyroliberin was high borderline. She remained euthyroid during follow-up. The results suggest an annual incidence of spontaneous hypothyroidism of 1-2 cases per 1000 middle-aged females in Swedish west-coast population.

Smoking was more common in younger than in older women in the general population as found from a population study of women aged 38–60. Almost half of the women aged 38 were smokers as compared to about 20% of those aged 60. There was no over-representation of smokers in women who had angina pectoris or ECG changes suggestive of ischaemic heart disease. Women who had an acute attack of myocardial infarction were significantly more often smokers than women in the general population. In addition, cigarette consumption was significantly higher among female smokers who had MI than among female smokers in the general population.

Regression analysis was performed on a number of haematological variables obtained from a population sample of 38-year-old women. The correlation coefficients were higher between the blood haemoglobin concentration on the one hand and serum iron concentration, total iron binding capacity, transferrin saturation, sideroblast count, iron absorption and menstrual blood loss on the other than between packed cell volume or erythrocyte count and the same haematological variables mentioned above. The correlation coefficients between transferrin saturation and the above haematological variables were higher than the correlation coefficients between serum iron concentration or total iron binding capacity and the same variables. The highest correlation coefficients with the above mentioned haematological variables were found for reticuloendothelial iron in the bone marrow. The prevalence of women with a lack of reticuloendothelial iron in the bone marrow was high when haemoglobin concentrations and mean corpuscular haemoglobin values were within the lowest two decentiles defined as a haemoglobin concentration below 127 g/l and a mean corpuscular haemoglobin below 31 pg/erythrocyte. Mean corpuscular haemoglobin and transferrin saturation were relatively low in women with an iron absorption above 80 % and a menstrual blood loss above 40 ml per menstrual cycle.

The serum cholesterol levels of women who had suffered myocardial infarction were not higher than in the general population of women, nor the serum cholesterol levels of women with angina pectoris or ECG changes suggestive of ischaemic heart disease. The serum triglyceride values were significantly higher in women who had had myocardial infarction, and in women with ECG changes suggestive of ischaemic heart disease. There was no significant over-representation of high serum triglyceride values in women with angina pectoris.

A population sample of women in Goteborg, Sweden, was studied in 1968-69 and restudied in 1974-75. A number of metabolic variables could be studied cross-sectionally (in 1974-75) and longitudinally (intraindividual changes between 1968-69 and 1974-75). When studied cross-sectionally, increased serum urate concentrations were observed in women on diuretics and increased serum triglycerides in women on beta-blockers, compared to other women, while no obvious differences were found in blood glucose and serum cholesterol concentrations or in packed red cell volume (PCV). When studied longitudinally, a slight decrease in serum triglyceride concentration was found in women who started to take diuretics and an increase in women who started to beta-blockers compared to other women. Serum urate concentration tended to increase in women who started to take diuretics and PCV tended to decrease in women who started to take beta-blockers. Blood glucose was unimpaired. In conclusion, the differences observed were rather small and seemed to be rather unimportant compared to the threat presented by the arterial hypertension itself.

We determined the catalytic concentration of gamma-glutamyltransferase in serum from a population sample of 1408 women in seven age strata between 26 and 72 years. The range in healthy individuals for the different age groups was found to increase with age with a maximum of the central 0.95 fractile interval at 58 years (0.17-1.68 microk/l). The serum gamma-glutamyltransferase activity correlated with body mass index, blood pressure and concentrations of blood glucose and serum ferritin, triglycerides and cholesterol. During follow-up of women with gamma-glutamyltransferase activity greater than 1.20 microk/l, no woman developed any disease possibly related to the original finding of raised serum gamma-glutamyltransferase activity, several individuals being apparently healthy. Apparently, the serum gamma-glutamyltransferase assay is an unspecific indicator of several metabolic abnormalities. High values may be found in individuals in whom all commonly done investigations have given results within the health-associated reference interval.

A comprehensive population study of women aged 38–60 was carried out in Goteborg, Sweden in 1968-69. The same women were re-studied six years later, in 1974-75. Erythrocyte sedimentation rate (ESR) was studied on both occasions. A statistically significant rise in ESR with age was noted both cross-sectionally and longitudinally, which means that the increase was related to age and was not a cohort effect. The mean annual increase in ESR was about 0.6 mm/h, but there was a significant difference between the ages studied, the increment being larger in the upper age groups. Women with high ESR (here defined as ESR ≥30 mm/h) had lower Hb and Hct values than other women. Leucocyte counts were higher in women with ESR ≥30 mm/h than in the others, but differences were statistically significant only in the upper age groups. Serum iron levels were lower in women with high ESR, while TIBC values were similar to those in the other women. Significant differences were found for transferrin saturation (lower in women with high ESR). Cholesterol levels were similar, while triglyceride levels either tended to be or were significantly higher in women with high ESR. About half of the women with ESR ≥30 mm/h had a possible explanation for their increased ESR. In no case did an increased ESR give rise to a new diagnosis of clinical significance, either in 1968-69 or in 1974-75. Nor had any diagnoses been missed in women with a high ESR in 1968-69, according to the re-examination six years later. All except one woman, in whom the diagnosis of neoplastic disease was made in the interval between the two examinations, had ESR ≥30 mm/h in 1968-69, and women in whom a neoplastic disease was found later had on average no higher ESR in 1968-69 than the others. It is concluded that for screening purposes, ESR is of very limited value.

Objectives. To assess the prevalence of urinary incontinence and its influence on the quality of life. Material and methods. A random sample of every fourth woman aged ≥20 years resident in a primary health care district of the city of Goteborg was obtained from the population register (n=2911). The women were invited by letter to complete a questionnaire concerning urinary incontinence. The women were also requested to assess their quality of life using a visual analogue scale. Results. The overall response rate was 77%. The prevalence of urinary incontinence increased (p

Department of Internal Medicine, Goteborg University, Sweden. Lauren.Lissner@medfak.gu.se OBJECTIVE: Leptin seems to be involved in the regulation of energy balance, although little is known about the epidemiology of leptin with respect to prediction of weight gain and incidence of obesity-related diseases. The dual aim of this study is to document characteristics of leptin after long-term storage, and to describe its relation to body weight, from birth to old age, in an ongoing prospective study. RESEARCH METHODS AND PROCEDURES: A population-based sample of Swedish women was first examined at the ages of 38 to 60 and re-examined 24 years later. This study used 1358 frozen serum samples that had been stored 29 years for analysis of leptin concentrations and their relation to body weight history. RESULTS: Leptin values obtained from stored samples showed the same correlation with relative weight as that seen in a contemporary sample with similar demographic characteristics. Lower self-reported birth weight was associated with higher leptin levels in adulthood (p = 0.01), controlling for age and adult BMI. Prospective analyses revealed that high leptin in 38 to 46-year-olds predicted subsequent long-term weight gain (p = 0.003), although no significant associations were seen in women initially aged 50 or older. DISCUSSION: It is feasible to use frozen serum for studying leptin in relation to obesity and related developments many years later. High leptin level was a risk factor for subsequent weight gain in 38- and 46-year-old women. Retrospective analyses involving birth weight suggest that leptin resistance in adulthood might have fetal origins. PMID: 10102251 [PubMed - indexed for MEDLINE]

Felodipine*, a new antihypertensive calcium antagonist, was compared with metoprolol, a beta-blocker, and hydrochlorothiazide, a diuretic, with respect to glucose tolerance in a randomized double-blind cross-over study consisting of 11 patients, of age range 50-70 years, who had developed diabetes during antihypertensive treatment. Each treatment period lasted for 10 weeks. The blood pressure was similar irrespective of treatment. Serum glucose levels during the oral glucose tolerance test were significantly lower when the patients were treated with felodipine than when they were taking hydrochlorothiazide. Serum insulin levels appeared to decrease at an earlier stage of the test when the patients were treated with felodipine, the calcium antagonist, than with the other two antihypertensive substances, which suggests that glucose tolerance is impaired to a lesser extent during treatment with the calcium antagonist. Glucose tolerance was never completely normalized with any of the drugs tested.

Advice by telephone is an important part of primary health care service. Telephone advice is given at different levels of care. In order to give people confidence in the health care system it is important that personnel at different levels give similar advice for the same symptom or complaint. In order to establish generally accepted guidelines, discussions were held between personnel at different levels of care. This procedure was laborious but successful. Generally accepted guidelines could be agreed upon for all the symptoms and complaints discussed, altogether more than 60. This paper describes the procedure used during the collaborative work to provide these guidelines. It must be emphasised, though, that the guidelines should be adapted to local circumstances before being used as a practical aid in the health care service at health centres and at other outpatient units.

SUMMARY The serum T3 assay has been regarded as the most sensitive single test for hyperthyroidism although impaired conversion of T4 to T3 in non-thyroidal illness (NTI) might decrease its diagnostic sensitivity. The present report gives experience from the T3 assay in middle-aged females under conditions similar to those in a general health survey. The assays were performed during two periods with an interval of six years. In 1974–75 we studied a representative sample (n= 1283) of women of ages 44, 52, 56, 60 and 66 years in Goteborg, Sweden. Individuals with serum T3 concentration > mean + 2·5 SD were selected for a follow-up study (n= 21). Of 16 individuals with no previous thyroid disease and no present treatment with thyroid hormones or oestrogens, 14 were subjected to a TRH-stimulation test giving a normal TSH response in 10 cases having T3 concentrations up to mean + 3·5 SD. Four women with serum T3 concentration ≥ mean + 3·5 SD had previously unrecognized autonomous function thyroid function, of whom two developed hyperthyroidism after two years. The original population sample was reinvestigated after six years in 1980-81 (n= 1138) together with an additional sample of women giving a total sample of 1422 women of ages 26, 38, 50, 58, 62, 66 and 72 years. Of the females studied in 1974–75 eight had developed hyperthyroidism between the two studies; three of these had raised serum T3 at the investigation in 1974–75. No case of hyperthyroidism had been missed by the T3 assay in the 1974–75 study. Of individuals with serum T3≥mean + 2·5 SD selected for a follow-up (n= 29) at least five were found to have previously unrecognized thyroid autonomy. We found a raised serum T3 to be associated with hyperthyroid (n= 2) and euthyroid GRAVES' disease, autonomously functioning thyroid adenoma(s), possible painless subacute thyroiditis, possible thyrotoxicosis factitia, diminished thyroid reserve and thyroid substitution therapy. Since we did not correct for variations in protein binders a number of individuals with oestrogen-associated rise of total T3 were identified, but the rises were usually modest. The incidence of hyperthyroidism for the original sample as calculated for the six-year period was 1.3 cases/1000 women/year whereas the prevalence by 1980-81 was 13 cases/1000 women. We conclude that a single T3 determination will in most cases be sufficient for the diagnosis of clinical hyperthyroidism in a non-hospitalized population. Our study indicates some of the problems associated with the follow-up of a general screening for hyperthyroidism, the possible benefit of which remains to be studied.

SUMMARY We measured serum procollagen-III-peptide in 67 women with long-term L-thyroxine treatment and compared the results with age-matched controls. The strong correlation between serum free thyroxine and procollagen-III-peptide concentrations previously found after 6 months of L-thyroxine treatment was not found after long-term treatment. There were slightly higher procollagen-III-peptide concentration values in those chronically treated patients who had high free thyroxine levels but this increase was less marked than in patients previously studied after short-term treatment. An increase in procollagen-III-peptide concentration reflects an increased biosynthesis of collagen III, which is present in connective tissues throughout the body, and our findings may be explained by slow tissue adaptation to increased levels of thyroxine. We conclude that the increased thyroxine levels found in L-thyroxine-treated patients are of less clinical importance than thought previously. We also conclude that peripheral markers of thyroid hormone peripheral effects such as procollagen-III-peptide may be of less use than thought previously due to this slow tissue adaptation to changes in thyroxine concentration.

A dental examination was included in a mainly medically oriented population study of women in Gothenburg, Sweden. From panoramic radiographs the numbers of remaining teeth, restored teeth (fillings and crowns), pontics, and endodontically treated teeth were assessed in 1968-69 and in a 12-yr follow-up study in 1980-81. Women aged 38, 46, 50, 54 and 60 yr were initially studied. In the follow-up study, a group of 38-yr-old women was added. A comparison between cross-sectional data in 1968-69 and in 1980-81 in women aged 38 and 50 yr showed some marked differences. Dentulous women of the same age had in 1980-81 a larger mean number of teeth and a larger number of restored teeth (including crowns). The number of restored teeth in relation to remaining teeth was the same in the 38-yr-old women in 1980-81 but had increased in the 50-yr-olds. The absolute and relative numbers (in relation to remaining teeth) of crowns (also studied separately), pontics, and endodontically treated teeth were about the same in 1968-69 and 1980-81 both for the 38-yr-olds and the 50-yr-olds. There was a slight but statistically significant increase only in the absolute number of crowns for the 50-yr-olds. The follow-up study showed a moderate decrease of remaining teeth in all age groups. Related to remaining teeth, the number of restored teeth (including crowns), crowns, pontics, and endodontically treated teeth showed a statistically significant increase for all age groups except for the oldest, in which group a significant increase was only observed for crowns.

A population study of women in Göteborg, Sweden, was carried out in 1968--69. Altogether 1 462 women participated (participation rate 90.1 per cent). Five age strata were studied: 38, 46, 50, 54 and 60 (women born in 1930, 1922, 1918, 1914 and 1908, respectively). The same women were re-studied in 1974--75. At this time 1 302 women participated, corresponding to 89.1 per cent of those studied in 1968--69 and 80.3 per cent of those initially sampled. The vast majority of the women had a natural menopause. The median age at the menopause was found to be about 50. The criteria for definition of menopause are discussed. No support was found for the theory of increased menopausal age with time. Estrogen therapy of postmenopausal women was found to be much more common in 1974--75 than in 1968--69.

Women of different age groups in Gothenburg, Sweden were examined in 1968-69 and in 1980-81 by means of orthopantomography. The frequencies of missing teeth and edentulousness were determined. The follow-up results among the same women showed only a small increase in edentulousness and in number of lost teeth during the period. A substantial decrease in edentulousness and frequency of missing teeth was observed between women of comparable age groups over the 12-yr interval, presumably as a result of preventive measures and increased availability of dental health care resources.

A total of 226 women participating in a longitudinal study who were found to be hypertensive (initial values greater than or equal to 160 mmHg for the systolic blood pressure and/or greater than 95 mmHg for the diastolic blood pressure) were followed up with respect to the risk of developing diabetes during a 12-year study period. For each year of follow-up, information on whether each participant was taking antihypertensive drugs or not was collected. As a result there were 1339 'treatment years' and 1449 'non-treatment years' of follow-up. All 16 women who developed diabetes during the follow-up period were taking antihypertensive drugs at the time of onset of their diabetes. A similar observation was made when 145 women within the upper age-specific decentiles of systolic blood pressure were followed up in the same way. These results suggest that in hypertensive subjects antihypertensive drugs rather than the hypertensive state per se predispose to diabetes mellitus.