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Investigates the long-term effects of weight change on medication for diabetes and cardiovascular disease in severely obese subjects. Changes in the use and costs of medication in relation to treatment and weight change; Results of the Swedish Obese Subjects (SOS) intervention study.

To examine how soil organisms affect soil organic nitrogen (N) storage and mineralisation, we theoretically derive the soil substrate nitrogen to carbon ratio and total soil N storage for both donor-controlled (DC) and Lotka-Volterra (LV) soil systems with three trophic levels: substrate, microbes and grazers. We show that substrate N:C ratioand soil N storage are functions of the structure of the soil food web, of the properties of the organisms in the soil community, and of the properties of litter input from above ground. The carbon production-to-assimilation efficiency of soil organisms is the most importantproperty determining how the substrate N: C ratio and soil N storageare affected by changes in the soil community. The qualitative effects of grazers depend on whether they have an efficiency larger or smaller than some critical efficiencies. In this paper, we derive these critical efficiencies mathematically. Within the normal range of efficiencies, substrate N:C ratio and soil N storage will usually decrease, and the nitrogen mineralization will increase, with addition of grazers, or as a result of a succession of species from a lower to a higher level of metabolic activity. Numerical analyses show that an increase in soil temperature has a pronounced negative effect on soil N storage through the effects on the metabolic activity of organisms atall trophic levels. N dilution in litter, because of increased CO2 levels in the atmosphere, can lead to a moderate increase in soil N storage. [ABSTRACT FROM AUTHOR]

The aim of this work was to evaluate the use of Monte Carlo-based calibrations for in situ gamma-ray spectrometry. We have performed in situ measurements at five different sites in Sweden using HPGe detectors to determine ground deposition activity levels of (137)Cs from the 1986 Chernobyl accident. Monte Carlo-calculated efficiency calibration factors were compared with corresponding values calculated using a more traditional semi-empirical method. In addition, results for the activity ground deposition were also compared with activity densities found in soil samples. In order to facilitate meaningful comparisons between the different types of results, the combined standard uncertainty of in situ measurements was assessed for both calibration methods. Good agreement, both between the two calibration methods, and between in situ measurements and soil samples, was found at all five sites. Uncertainties in in situ measurements for the given measurement conditions, about 20 years after the fallout occurred, were found to be in the range 15-20% (with a coverage factor k=1, i.e. with a confidence interval of about 68%).

Objective: Lack of adherence with pharmacological therapy is a public health concern that compels tremendous costs for the health care system and the community. To analyse the association between socioeconomic disadvantage and primary non-adherence with medication, and to explore possible mediating effects of trust in health care and lifestyle profile., Design: Cross-sectional population-based study based on data from the Swedish national public health surveys 2004-2005., Participants: The study comprised 13603 men and 18292 women aged 21-84 years who had any contact with a physician at a hospital or primary care centre. Measures Primary non-adherence with medication based on whether respondents reported that they refrained from purchasing at the pharmacy prescribed medication. Socioeconomic Disadvantage Index was based on four different indicators of economic deprivation., Results: Socioeconomic disadvantage was associated with primary non-adherence with medication independent of long-term illness, risky lifestyle, low education, living alone and low trust for health care. This association increased with older age, particularly among women. Among individuals aged 21-34 years, severe compared with no socioeconomic disadvantage, was associated with two-fold increased odds for non-adherence with medication. The corresponding odds among individuals aged 65-84 years were three-fold increase among elderly men (OR=3.3, 95% CI: 1.4-7.8) and six-fold increase among elderly women (OR=6.2, 95% CI: 2.5-15.3). Yet every seventh elderly woman aged 65-84 years suffered from long-term illness., Conclusions: Results indicate that health policies for 'care on equal terms' in Sweden have been less successful in relation to equitable access to prescribed medication, especially among the elderly.

Objective: Bariatric surgery improves cardiovascular risk factors and quality of life, but few studies have directly addressed the relation between obesity treatment and hospitalization costs. This prospective controlled study compares in-patient care between surgically and conventionally treated obese patients., Research Methods and Procedures: A total of 962 surgically and conventionally treated obese patients from the intervention study, Swedish Obese Subjects, were followed for 6 years. Changes in days of hospitalization and hospitalization costs were analyzed. Information on hospitalizations for each subject were obtained from the Swedish Hospital Discharge Register., Results: After 6 years, weight change was -16.7% in the surgical group and +0.9% in the control group (p < 0.0001). The cumulated hospital stay over 6 years was 23.4 days in the surgical group and 6.9 days in the control group (p < 0.0001). The average hospital cost for the surgical intervention was US$4300. Incremental costs that could be attributable to obesity surgery averaged US$1200 per year. After exclusion of hospitalizations for the surgical intervention and conditions common after bariatric surgery, there were no significant differences between the groups in number of hospital days or hospitalization costs., Discussion: Our experience from bariatric surgery indicates that average weight reductions of 16% will not reduce hospitalization costs over 6 years. Costs of bariatric surgery are limited and seem to be motivated given the marked improvements of cardiovascular risk factors, cardiac structure, and function and health-related quality of life.

Unlabelled: Postoperative pain has been an important limiting factor for ambulatory laparoscopic cholecystectomy. We anesthetized 40 ASA physical status I-II patients using propofol for the induction and sevoflurane in oxygen and air for the maintenance of anesthesia. At the end of the anesthesia, the patients were randomized into one of two groups: Group P (Placebo) and Group R (0.5% Ropivacaine). Twenty milliliters of normal saline or ropivacaine, respectively, were injected intraperitoneally at the end of surgery via a catheter placed in the bed of the gall bladder. Postoperatively, intermittent injections (10 mL) of the study solution were given when required for pain. Ketobemidone 1-2 mg was given IV as rescue medication. Pain was assessed using a visual analog scale at 1, 2, 3, 4, 8, 12, 16, and 20 h after surgery and once each day for 1 wk at rest (deep pain), shoulder and incision sites, and pain during coughing. Recovery was assessed by the time to transfer from Phase 1 to 2, the ability to walk, drink, and eat, and the ability to void. Plasma concentrations of ropivacaine were measured in eight patients. Time to ability to walk, defecation, driving a car, and return to normal activities were also recorded through a questionnaire sent home with the patient. During the first 4 postoperative h, patients in Group R had lower scores for deep pain and during coughing compared with Group P (P < 0.05). No differences were found in the postoperative consumption of ketobemidone. Median times to recovery at home were similar between the groups. By the seventh day, 93% of the patients had returned to normal activities of daily living. We conclude that the early postoperative pain after ambulatory laparoscopic cholecystectomy could be relieved using intermittent injections of ropivacaine 0.5% into the bed of the gall bladder., Implications: Early postoperative pain can be relieved by intermittent injections of ropivacaine 0.5% through a catheter placed in the bed of the gall bladder after ambulatory laparoscopic cholecystectomy.

The phosphoryl group transfer from (gamma(32)P)ATP into acceptor proteins by an endogenous protein kinase at the surface of Ehrlich cells has been further studied as regards possible stimulation by different concentrations of dibuturyl cyclic guanosine monophosphate (3',5'-GMP). Using the endogenous acceptor protein of the surface of Ehrlich cells the cyclic nucleotide had no stimulatory effect on the protein kinase of the plasma membrane. The lack of stimulatory action of the cyclic nucleotide was also observed when an exogenous acceptor protein was present. Instead, a slight inhibitory effect was usually seen in both types of experiments. Labeled phosphorylserine was always in excess of labeled phosphoryl threonine. Both were isolated from hydrolyzed acceptor proteins. The lack of stimulation by a cyclic nucleotide on the phosphorylation of acceptor protein(s) on the cell surface does not rule out a regulatory function by the protein kinase of the plasma membrane. Instead, we propose an autoregulatory mechanism for the phosphorylation at the cell surface. This mechanism is based upon the high sensitivity of the enzyme to Ca-ions.

An endogenous protein kinase at the surface of Ehrlich cells has been studied. Using exogenous (gamma32P)ATP as a phosphoryl group donator, a transfer was demonstrated into endogenous acceptor protein(s) as well as to exogenous phosvitin. Seryl- and threonyl-residues isolated from the endogenous and exogenous acceptor protein were found to be labeled. The ratio between the labeled phosphorylserine and phosphorylthreonine was about 3.5:1 for both the endogenous acceptor of the intact cells and the exogenous acceptor. In similar experiments with a membrane preparation from Ehrlich cells, this ratio increased to about 7:1 provided the exogenous acceptor protein was absent. The results were independent of whether 1 X 10(-5) M dibutyryl cyclic AMP was used or not with intact cells and a membrane fraction mainly consisting of vesicles. Whether the regulatory subunit of the membrane-associated protein kinase was in cis- or trans-disposition to the catalytic subunit no binding and dependence of the cyclic nucleotide was observed. Since the purified membrane fraction was considered free from endogenous cyclic AMP, it was concluded that the membrane-associated protein kinase of Ehrlich cells is not dependent on cyclic AMP. The critical role of arginine for the cyclic AMP dependence of the serine-containing residue in the catalytic subunit is discussed.

The formation of ATP at the cell surface of intact glia and glioma cells in culture has been established. The ATP-forming capacity at the surface of the malignant cells was several times greater than that of the normal glia cells. The ATP-forming capacity was about the same on reincubation one hour after the first incubation. The cells were kept in Eagle's medium in the meantime. ADP, NAD+ and 3-phosphoglyceraldehyde could all be available from a postulated intramembranous metabolic pool and take part in biochemical reactions at the cell surface, provided that albumin was not present in the incubation medium. An incubation medium which was complete except for 3-phosphoglyceraldehyde was only slightly less effective as regards ATP formation at the surface of both glia and glioma cells, compared with the complete incubation medium. The presence of nucleoside diphosphate kinase at the glioma cell surface was confirmed. When intact cells were incubated with only the phosphoryl group donor (ATP) of the reaction but with the acceptor nucleoside diphosphates (CDP, GDP, UDP) ommitted, only CTP and GTP were formed. No UTP was found. Thes latter results indicate that both CDP and GDP are available from the postulated intramembranous metabolic pool, while UDP is not.

In Sweden sales of alcohol dropped 17% from 1976 to 1982. Similarly, comparison of data from 1979 and 1982 shows that the mortality from cirrhosis of the liver declined appreciably, by 28% in men and 29% in women. During 1979-82 mortality from pancreatitis also declined noticeably, by 30% in men and 36% in women. By contrast, no decrease occurred in mortality from alcoholic psychosis, alcoholism, or alcohol intoxication. The decrease in mortality from cirrhosis of the liver and pancreatitis is probably explained by a decrease in the consumption of alcohol among an important subgroup of high consumers of alcohol. The lack of a decrease in mortality from alcoholic psychosis, alcoholism, and alcohol intoxication may be because such diagnoses are often made in socially deteriorated, more dependent alcoholic subjects who have not been able to reduce their consumption.

A considerably simplified assay for recording sialyl- and fucosyltransferase in human serum is presented. Serum samples incubated with labeled nucleotide-sugar and glycosylated endogenous acceptor molecules were adsorbed to Con A Sepharose and quantitated by scintillation counting. The results correlated with those of a much more time consuming acid precipition method, and displayed a higher diagnostic sensitivity due to the improved specificity of the method and the combined recording of the two activities. A correlation between serum sialyl- and fucosyltransferase activities as well as quantitative agreement between the amount of incorporated sialic acid and fucose indicated that rhe endogenous acceptor molecules were rate-limiting for transfer and may themselves have diagnostic potential.

The mortality and the causes of death have been studied in a cohort consisting of 1548 male alcoholics in Stockholm. During the period 1969-1981 there were 542 cases of death in this population. The mortality rates were triple those for males in Stockholm generally. Using the official causes of death there was a highly significant excess mortality in the following diagnostic groups: Cancer in the upper digestive region, primary hepatic cancer, cirrhosis in the liver, pancreatitis, pneumonia, alcoholism and alcoholic poisoning, suicides and other causes of violent death as well as ischemic heart disease. The underlying and contributing causes of death on the death certificates were reclassified according to ICD-rules using clinical records and autopsy protocols. It was found that the underlying cause of death was incorrect in 21.8% of the cases. Important information was withheld in further 19.8%. After validation there was no longer any excess mortality in ischemic heart disease. The number of alcohol-related diagnoses, i.e. alcoholic cardiomyopathy, cirrhosis and fatty liver with alcoholism and alcoholic intoxication, was much greater. It is concluded that there is a underreporting of alcohol-related diseases and injuries which has a great influence on the reliability of death statistics.

A Mg2+- and Ca2+-stimulated adenosine triphosphatase (ATPase) at the outer surface of intact Ehrlich ascites tumor cells is described. A surface-bound adenosine triphosphate (ATP)-splitting activity at a lower rate was also demonstrated in the absence of Ca2+ but with Mg2+, Na+, and K+ present in the isotonic medium. Hence, when part of the Mg2+ was exchanged for Ca2+, a marked increase of the ATP-splitting activity was observed. The stimulatory effect of Ca2+ was seen only if both Na+ and K+ were present in the isotonic incubation medium. Thus, the enzyme activity was Mg2+- and Ca2+-dependent. Ca2+, together with the monovalent cations was inhibitory compared with Mg2+ under similar conditions. The apparent Km for ATP for the Mg2+-stimulated ATPase is 0.05 mM, while that of the Mg2+- and Ca2+-stimulated enzyme is 0.10 mM. The Vmax of the former is 0.8 mu-mole per 100 mg Schneider protein per 30 sec compared with 1.92 mu-moles per 100 mg Schneider protein per 30 sec for the latter. The calculated Km for the Mg2+- and Ca2+-stimulated ATPase after subtraction of the Mg2+-stimulated part is 0.22 mM. Ethacrynic acid and N-ethylmaleimide both inhibited the Mg2+- and Ca2+-stimulated ATPase by about 10 percent, while the ouabain inhibition was 15 percent. Cytochalasin B did not influence the enzyme activity, whereas La3+ had a slight stimulatory effect.

Glyceraldehyde 3-phosphate dehydrogenase and 3-phosphoglycerate kinase are, together with some other enzymes, present on the surface of intact Ehrlich tumor cells. Aldolase, on the contrary, represents cytoplasmic enzymes not present at all on the external surface, provided 2.5 percent of bovine albumin is included in the isotonic assay medium. A flux of aldolase from the cell interior to the cell exterior could be demonstrated in the absence of albumin. Therefore, any enzymatic activity monitored when keeping the Ehrlich tumor cells in the isotonic assay medium containing 2.5 percent albumin was considered to be primarily related to the outside of the plasma membrane. Of the total glyceraldehyde 3-phosphate dehydrogenase, 0.7 percent was located on the outer surface of the tumor cell, while the corresponding figure for 3-phospoglycerate kinase was 2.7 percent. Eighty percent of this surface-located 3-phosphoglycerate kinase was released into the assay medium during incubation, while the release of glyceraldehyde 3-phosphate dehydrogenase, at the same time, was minimal. A plasma membrane preparation of Ehrlich cells, mainly consisting of vesicles, showed the presence of 3-phosphoglycerate kinase but the absence of glyceraldehyde 3-phosphate dehydrogenase. Because of the vesicular nature of the membrane preparation, it was assumed that only one side of the membrane was exposed during assay. The specific binding properties of the two enzymes to the plasma membrane, as well as possible differences in their intramembranous location, are discussed.