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STUDY OBJECTIVE: It is still unclear if men and women are equally susceptible to the hazards of tobacco smoking. The objective of this study was to examine smoking related mortality among men and women. DESIGN: In 1963 a questionnaire concerning tobacco smoking habits was sent out to a random sample from the 1960 Swedish census population. Date and cause of death have been collected for the deceased in the cohort through 1996. SETTING: Sweden. PARTICIPANTS: The survey included a total of 27 841 men and 28 089 women, aged 18-69 years. The response rate was 93.1% among the men and 95.4% among the women. MAIN RESULTS: After adjustment for age and place of residence positive associations were found between cigarette smoking and mortality from ischaemic heart disease, aortic aneurysm, bronchitis and emphysema, cancer of the lung, upper aerodigestive sites, bladder, pancreas in both men and women, but not from cerebrovascular disease. When the effect of amount of the cigarette consumption was considered, female smokers displayed, for example, slightly higher relative death rates from ischaemic heart disease. However, no statistically significant gender differential in relative mortality rates was observed for any of the studied diseases. CONCLUSIONS: Women and men in this Swedish cohort seem equally susceptible to the hazards of smoking, when the gender differential in smoking characteristics is accounted for. Although the cohort under study is large, there were few female smokers in the high consuming categories and the relative risk estimates are therefore accompanied by wide confidence intervals in these categories. [ABSTRACT FROM AUTHOR]

This study examines sex differences in the relative risks of lung cancer and other smoking-related cancers (i.e. cancers of the upper respiratory tract, oesophagus, pancreas, bladder, and renal pelvis). Data on smoking habits in 1963 from a random sample of 56,000 men and women were linked with information on new cases of cancer for 1964-89. Compared with people who have never smoked, the relative risks of lung cancer at different levels of pack-years completed in 1963 (>5, 6-15, 16-25 and 25+ pack-years) were 1.6, 4.4, 14.2, and 17.9 for men, and 2.1, 6.3, 10.3, and 16.5 for women. The corresponding relative risks of other smoking-related cancers were 1.8, 3.0 5.4, and 6.4 for men, and 2.0, 3.1, 5.0, and 6.5 for women. These results suggest that men and women have similar relative risks of smoking-related cancers at different levels of smoking. [ABSTRACT FROM AUTHOR]

Monitoring food quality throughout the supply chain in a rapid and cost-effective way allows on-time decision-making, reducing food waste, and increasing sustainability. A portable multispectral imaging sensor was used for the rapid prediction of microbiological quality of fish fillets. Seabream fillets, packaged either in aerobic or vacuum conditions, were collected from both aquaculture and retail stores, while images were also acquired both from the skin and the flesh side of the fish fillets. In parallel to image acquisition, the microbial quality was also estimated for each fish fillet. The data were used for the training of predictive artificial neural network (ANN) models for the estimation of total aerobic counts (TACs). Models were built separately for fish parts (i.e., skin, flesh) and packaging conditions and were validated using two approaches (i.e., validation with data partitioning and external validation using samples from retail stores). The performance of the ANN models for the validation set with data partitioning was similar for the data collected from the flesh (RMSE = 0.402-0.547) and the skin side (RMSE = 0.500-0.533) of the fish fillets. Similar performance also was obtained from validation of the models of the different packaging conditions (i.e., aerobic, vacuum). The prediction capability of the models combining both air and vacuum packaged samples (RMSE = 0.531) was slightly lower compared to the models trained and validated per packaging condition, individually (RMSE = 0.510, 0.516 in air and vacuum, respectively). The models tested with unknown samples (i.e., fish fillets from retail stores-external validation) showed poorer performance (RMSE = 1.061-1.414) compared to the models validated with data partitioning (RMSE = 0.402-0.547). Multispectral imaging sensor appeared to be efficient for the rapid assessment of the microbiological quality of fish fillets for all the different cases evaluated. Hence, these outcomes could be beneficial not only for the industry and food operators but also for the authorities and consumers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. It should be noted that SCiO builds solutions using the model training and validation technologies applied for the production of the NN architectures described in the manuscript. Moreover, it shall be stated that Videometer develops and markets the Videometer technology., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

In the forest industry, interspecific hybridization, such as Eucalyptus urograndis (Eucalyptus grandis × Eucalyptus urophylla) and Corymbia maculata × Corymbia torelliana, has led to the development of high-performing F1 generations. The successful breeding of these hybrids relies on verifying progenitor origins and confirming post-crossing, but conventional genotype identification methods are resource-intensive and result in seed destruction. As an alternative, multispectral imaging analysis has emerged as an efficient and non-destructive tool for seed phenotyping. This approach has demonstrated success in various crop seeds. However, identifying seed species in the context of forest seeds presents unique challenges due to their natural phenotypic variability and the striking resemblance between different species. This study evaluates the efficacy of spectral imaging analysis in distinguishing hybrid seeds of E. urograndis and C. maculata × C. torelliana from their progenitors. Four experiments were conducted: one for Corymbia spp. seeds, one for each Eucalyptus spp. batch separately, and one for pooled batches. Multispectral images were acquired at 19 wavelengths within the spectral range of 365-970 nm. Classification models based on Linear Discriminant Analysis (LDA), Random Forest (RF), and Support Vector Machine (SVM) was created using reflectance and reflectance features, combined with color, shape, and texture features, as well as nCDA transformed features. The LDA algorithm, combining all features, provided the highest accuracy, reaching 98.15% for Corymbia spp., and 92.75%, 85.38, and 86.00 for Eucalyptus batch one, two, and pooled batches, respectively. The study demonstrated the effectiveness of multispectral imaging in distinguishing hybrid seeds of Eucalyptus and Corymbia species. The seeds' spectral signature played a key role in this differentiation. This technology holds great potential for non-invasively classifying forest seeds in breeding programs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Palm oil has a bad reputation due to the exploitation of farmers and the destruction of endangered animal habitats. Therefore, many consumers wish to avoid the use of palm oil. Decorative sugar contains a small amount of palm oil to prevent the sugar from melting on hot bakery products. High-oleic sunflower oil used as a substitute for palm oil was analyzed in this study via multispectral imaging and an electronic nose, two methods suitable for potential large-batch analysis of sugar/oil coatings. Multispectral imaging is a nondestructive method for comparing the wavelength reflections of the surface of a sample. Reference samples enabled the estimation of the quality of unknown samples, which were confirmed via acid value measurements. Additionally, for quality determination, volatile compounds from decorative sugars were measured with an electronic nose. Both applications provide comparable data that provide information about the quality of decorative sugars.

Spectroscopic sensor imaging of food samples meta-processed by deep machine learning models can be used to assess the quality of the sample. This article presents an architecture for estimating microbial populations in meat samples using multispectral imaging and deep convolutional neural networks. The deep learning models operate on embedded platforms and not offline on a separate computer or a cloud server. Different storage conditions of the meat samples were used, and various deep learning models and embedded platforms were evaluated. In addition, the hardware boards were evaluated in terms of latency, throughput, efficiency and value on different data pre-processing and imaging-type setups. The experimental results showed the advantage of the XavierNX platform in terms of latency and throughput and the advantage of Nano and RP4 in terms of efficiency and value, respectively.

Arabica coffee beans are sold at twice the price, or more, compared to Robusta beans and consequently are susceptible to economically motivated adulteration by substitution. There is a need for rapid, non-destructive, and efficient analytical techniques for monitoring the authenticity of Arabica coffee beans in the supply chain. In this study, multispectral imaging (MSI) was applied to discriminate roasted Arabica and Robusta coffee beans and perform quantitative prediction of Arabica coffee bean adulteration with Robusta. The Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA) model, built using selected spectral and morphological features from individual coffee beans, achieved 100% correct classification of the two coffee species in the test dataset. The OPLS regression model was able to successfully predict the level of adulteration of Arabica with Robusta. MSI analysis has potential as a rapid screening tool for the detection of fraud issues related to the authenticity of Arabica coffee beans., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Cereal seeds safety may be compromised by the presence of toxic contaminants, such as aflatoxins. Besides being carcinogenic, they have other adverse health effects on humans and animals. In this preliminary study, we used two non-invasive optical techniques, optical fiber fluorescence spectroscopy and multispectral imaging (MSI), for discrimination of maize seeds naturally contaminated with aflatoxin B 1 (AFB 1 ) from the uncontaminated seeds. The AFB 1 -contaminated seeds exhibited a red shift of the emission maximum position compared to the control samples. Using linear discrimination analysis to analyse fluorescence data, classification accuracy of 100% was obtained to discriminate uncontaminated and AFB 1 -contaminated seeds. The MSI analysis combined with a normalized canonical discriminant analysis, provided spectral and spatial patterns of the analysed seeds. The AFB 1 -contaminated seeds showed a 7.9 to 9.6-fold increase in the seed reflectance in the VIS region, and 10.4 and 12.2-fold increase in the NIR spectral region, compared with the uncontaminated seeds. Thus the MSI method classified successfully contaminated from uncontaminated seeds with high accuracy. The results may have an impact on development of spectroscopic non-invasive methods for detection of AFs presence in seeds, providing valuable information for the assessment of seed adulteration in the field of food forensics and food safety., (© 2022. The Author(s).)

Background: The use of non-destructive methods with less human interference is of great interest in agricultural industry and crop breeding. Modern imaging technologies enable the automatic visualization of multi-parameter for characterization of biological samples, reducing subjectivity and optimizing the analysis process. Furthermore, the combination of two or more imaging techniques has contributed to discovering new physicochemical tools and interpreting datasets in real time., Results: We present a new method for automatic characterization of seed quality based on the combination of multispectral and X-ray imaging technologies. We proposed an approach using X-ray images to investigate internal tissues because seed surface profile can be negatively affected, but without reaching important internal regions of seeds. An oilseed plant (Jatropha curcas) was used as a model species, which also serves as a multi-purposed crop of economic importance worldwide. Our studies included the application of a normalized canonical discriminant analyses (nCDA) algorithm as a supervised transformation building method to obtain spatial and spectral patterns on different seedlots. We developed classification models using reflectance data and X-ray classes based on linear discriminant analysis (LDA). The classification models, individually or combined, showed high accuracy (> 0.96) using reflectance at 940 nm and X-ray data to predict quality traits such as normal seedlings, abnormal seedlings and dead seeds., Conclusions: Multispectral and X-ray imaging have a strong relationship with seed physiological performance. Reflectance at 940 nm and X-ray data can efficiently predict seed quality attributes. These techniques can be alternative methods for rapid, efficient, sustainable and non-destructive characterization of seed quality in the future, overcoming the intrinsic subjectivity of the conventional seed quality analysis.

Background: Hand eczema is a disease with large variation in clinical presentation and severity. Scoring systems for quantitative severity assessment exist. However, they are observer-dependent. An objective quantitative tool for scoring of hand eczema would improve categorization of hand eczema., Objective: To investigate the usefulness of multispectral imaging in assessing severity of hand eczema with respect to extent and the different morphological features., Methods: Patients with hand eczema (n = 60) and healthy controls (n = 28) were included. The severity of hand eczema was assessed by a dermatologist using the Hand Eczema Severity Index (HECSI) and a global assessment (Physician Global Assessment [PGA]). Multispectral imaging of the hand was performed on all patients and controls using the VideometerLab Instrument., Results: Areas of the morphological elements identified by multispectral imaging were statistically significantly correlated with the PGA scores. Analyzed by Cohen's kappa, a moderate agreement between imaging-based severity assessment and PGA was found. The imaging-based severity assessment was also correlated with HECSI (Spearman rho 0.683, P < .001). Still, the imaging-based algorithm was not capable of differentiating hand eczema patients from controls., Conclusions: Multispectral imaging allows quantitative measurements of different skin parameters to be performed. In its present form, multispectral imaging cannot replace the clinical assessment of a dermatologist. However, after refinement, this or similar technologies could prove useful., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The applicability of multispectral ultraviolet (UV) imaging in combination with multivariate image analysis was investigated to monitor API degradation within multiple unit pellet system (MUPS) tablets during storage. For this purpose, acetylsalicylic acid (ASA) layered pellets were coated with Eudragit® RL PO and compressed to MUPS tablets. These tablets were stored under four different conditions with different levels of relative humidity (0 and 75%) and temperature (21 and 40°C) and analysed at seven storage time points (0, 15, 40, 140, 165, 265, and 330d). The UV imaging results for estimation of the salicylic acid (SA) concentration as degradation product of ASA in the tablets were compared to the SA concentration measured by high performance liquid chromatography with a partial least squares regression resulting in an RMSEP of 4.86% and an R 2 of 0.9812. The estimation of the SA concentration based on mean UV reflectance spectra was possible even through the coating of the API pellets and at low concentration levels. In addition, the distribution of the SA concentration on the tablet surfaces for different storage time periods was visualized. UV imaging as fast and non-destructive method appears to offer significant potential for monitoring of API degradation during stability studies., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The applicability of off-line multispectral UV imaging in combination with multivariate data analysis was investigated to determine the coating thickness and its distribution on the tablet surface during lab-scale coating. The UV imaging results were compared with the weight gain measured for each individual tablet and the corresponding coating thickness and its distribution measured by terahertz pulsed imaging (TPI). Three different tablet formulations were investigated, 2 of which contained UV-active tablet cores. Three coating formulations were applied: Aquacoat® ECD (a mainly translucent coating) and Eudragit® NE (a turbid coating containing solid particles). It was shown that UV imaging is a fast and nondestructive method to predict individual tablet weight gain as well as coating thickness. The coating thickness distribution profiles determined by UV imaging correlated to the results of the TPI measurements. UV imaging appears to hold a significant potential as a process analytical technology tool for determination of the tablet coating thickness and its distribution resulting from its high measurement speed, high molar absorptivity, and a high scattering coefficient, in addition to relatively low costs., (Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

In the present study the applicability of multispectral UV imaging in combination with multivariate image analysis for surface evaluation of MUPS tablets was investigated with respect to the differentiation of the API pellets from the excipients matrix, estimation of the drug content as well as pellet distribution, and influence of the coating material and tablet thickness on the predictive model. Different formulations consisting of coated drug pellets with two coating polymers (Aquacoat ® ECD and Eudragit ® NE 30 D) at three coating levels each were compressed to MUPS tablets with various amounts of coated pellets and different tablet thicknesses. The coated drug pellets were clearly distinguishable from the excipients matrix using a partial least squares approach regardless of the coating layer thickness and coating material used. Furthermore, the number of the detected drug pellets on the tablet surface allowed an estimation of the true drug content in the respective MUPS tablet. In addition, the pellet distribution in the MUPS formulations could be estimated by UV image analysis of the tablet surface. In conclusion, this study revealed that UV imaging in combination with multivariate image analysis is a promising approach for the automatic quality control of MUPS tablets during the manufacturing process., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Chemical imaging techniques are beneficial for control of tablet coating layer quality as they provide spectral and spatial information and allow characterization of various types of coating defects. The purpose of this study was to assess the applicability of multispectral UV imaging for assessment of the coating layer quality of tablets. UV images were used to detect, characterize, and localize coating layer defects such as chipped parts, inhomogeneities, and cracks, as well as to evaluate the coating surface texture. Acetylsalicylic acid tablets were prepared on a rotary tablet press and coated with a polyvinyl alcohol-polyethylene glycol graft copolymer using a pan coater. It was demonstrated that the coating intactness can be assessed accurately and fast by UV imaging. The different types of coating defects could be differentiated and localized based on multivariate image analysis and Soft Independent Modeling by Class Analogy applied to the UV images. Tablets with inhomogeneous texture of the coating could be identified and distinguished from those with a homogeneous surface texture. Consequently, UV imaging was shown to be well-suited for monitoring of the tablet coating layer quality. UV imaging is a promising technique for fast quality control of the tablet coating because of the high data acquisition speed and its nondestructive analytical nature.

Monitoring of tablet quality attributes in direct vicinity of the production process requires analytical techniques that allow fast, non-destructive, and accurate tablet characterization. The overall objective of this study was to investigate the applicability of multispectral UV imaging as a reliable, rapid technique for estimation of the tablet API content and tablet hardness, as well as determination of tablet intactness and the tablet surface density profile. One of the aims was to establish an image analysis approach based on multivariate image analysis and pattern recognition to evaluate the potential of UV imaging for automatized quality control of tablets with respect to their intactness and surface density profile. Various tablets of different composition and different quality regarding their API content, radial tensile strength, intactness, and surface density profile were prepared using an eccentric as well as a rotary tablet press at compression pressures from 20MPa up to 410MPa. It was found, that UV imaging can provide both, relevant information on chemical and physical tablet attributes. The tablet API content and radial tensile strength could be estimated by UV imaging combined with partial least squares analysis. Furthermore, an image analysis routine was developed and successfully applied to the UV images that provided qualitative information on physical tablet surface properties such as intactness and surface density profiles, as well as quantitative information on variations in the surface density. In conclusion, this study demonstrates that UV imaging combined with image analysis is an effective and non-destructive method to determine chemical and physical quality attributes of tablets and is a promising approach for (near) real-time monitoring of the tablet compaction process and formulation optimization purposes., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Surface topography, in the context of surface smoothness/roughness, was investigated by the use of an image analysis technique, MultiRay™, related to photometric stereo, on different tablet batches manufactured either by direct compression or roller compaction. In the present study, oblique illumination of the tablet (darkfield) was considered and the area of cracks and pores in the surface was used as a measure of tablet surface topography; the higher a value, the rougher the surface. The investigations demonstrated a high precision of the proposed technique, which was able to rapidly (within milliseconds) and quantitatively measure the obtained surface topography of the produced tablets. Compaction history, in the form of applied roll force and tablet punch pressure, was also reflected in the measured smoothness of the tablet surfaces. Generally it was found that a higher degree of plastic deformation of the microcrystalline cellulose resulted in a smoother tablet surface. This altogether demonstrated that the technique provides the pharmaceutical developer with a reliable, quantitative response parameter for visual appearance of solid dosage forms, which may be used for process and ultimately product optimization., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The color assessment ability of a multispectral vision system is investigated by a comparison study with color measurements from a traditional colorimeter. The experiment involves fresh and processed meat samples. Meat is a complex material; heterogeneous with varying scattering and reflectance properties, so several factors can influence the instrumental assessment of meat color. In order to assess whether two methods are equivalent, the variation due to these factors must be taken into account. A statistical analysis was conducted and showed that on a calibration sheet the two instruments are equally capable of measuring color. Moreover the vision system provides a more color rich assessment of fresh meat samples with a glossier surface, than the colorimeter. Careful studies of the different sources of variation enable an assessment of the order of magnitude of the variability between methods accounting for other sources of variation leading to the conclusion that color assessment using a multispectral vision system is superior to traditional colorimeter assessments., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Fast non-destructive multi-wavelength UV imaging together with multivariate image analysis was utilized to visualize distribution of chemical components and their solid state form at compact surfaces. Amorphous and crystalline solid forms of the antidiabetic compound glibenclamide, and microcrystalline cellulose together with magnesium stearate as excipients were used as model materials in the compacts. The UV imaging based drug and excipient distribution was in good agreement with hyperspectral NIR imaging. The UV wavelength region can be utilized in distinguishing between glibenclamide and excipients in a non-invasive way, as well as mapping the glibenclamide solid state form. An exploratory data analysis supported the critical evaluation of the mapping results and the selection of model parameters for the chemical mapping. The present study demonstrated that the multi-wavelength UV imaging is a fast process analytical technique with the potential for real-time monitoring of critical quality attributes., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: OvaSpec is a new, fully automated, vision-based instrument for assessing the quantity (concentration) and quality (embryonation percentage) of Trichuris suis parasite eggs in liquid suspension. The eggs constitute the active pharmaceutical ingredient in a medicinal drug for the treatment of immune-mediated diseases such as Crohn׳s disease, ulcerative colitis, and multiple sclerosis., Methods: This paper describes the development of an automated microscopy technology, including methodological challenges and design decisions of relevance for the future development of comparable vision-based instruments. Morphological properties are used to distinguish eggs from impurities and two features of the egg contents under brightfield and darkfield illumination are used in a statistical classification to distinguish eggs with undifferentiated contents (non-embryonated eggs) from eggs with fully developed larvae inside (embryonated eggs)., Results: For assessment of the instrument׳s performance, six egg suspensions of varying quality were used to generate a dataset of unseen images. Subsequently, annotation of the detected eggs and impurities revealed a high agreement with the manual, image-based assessments for both concentration and embryonation percentage (both error rates <1.0%). Similarly, a strong correlation was demonstrated in a final, blinded comparison with traditional microscopic assessments performed by an experienced laboratory technician., Conclusions: The present study demonstrates the applicability of computer vision in the production, analysis, and quality control of T. suis eggs used as an active pharmaceutical ingredient for the treatment of autoimmune diseases., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The performance of a multispectral imaging system has been evaluated in monitoring aerobically packaged beef filet spoilage at different storage temperatures (0, 4, 8, 12, and 16°C). Spectral data in the visible and short wave near infrared area (405-970nm) were collected from the surface of meat samples and correlated with microbiological data (log counts), for total viable counts (TVCs), Pseudomonas spp., and Brochothrix thermosphacta. Qualitative analysis (PLS-DA) was employed for the discrimination of meat samples in three microbiological quality classes based on the values of total viable counts, namely Class 1 (TVC<5.5log10CFU/g), Class 2 (5.5log10CFU/g7.0log10CFU/g). Furthermore, PLS regression models were developed to provide quantitative estimations of microbial counts during meat storage. In both cases model validation was implemented with independent experiments at intermediate storage temperatures (2 and 10°C) using different batches of meat. Results demonstrated good performance in classifying meat samples with overall correct classification rate for the three quality classes ranging from 91.8% to 80.0% for model calibration and validation, respectively. For quantitative estimation, the calculated regression coefficients between observed and estimated counts ranged within 0.90-0.93 and 0.78-0.86 for model development and validation, respectively, depending on the microorganism. Moreover, the calculated average deviation between observations and estimations was 11.6%, 13.6%, and 16.7% for Pseudomonas spp., B. thermosphacta, and TVC, respectively. The results indicated that multispectral vision technology has significant potential as a rapid and non-destructive technique in assessing the microbiological quality of beef fillets., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: Knowledge on predictors of disability pension is very limited. The aim was to assess the importance of sick-leave diagnosis and socio-demographic variables as risk factors for disability pension among individuals on long-term sickness absence and to compare these factors by gender and over time., Methods: A prospective population-based cohort study in Ostergötland County, Sweden, included 19,379 individuals who, in 1985-87, were aged 16-60 years and had a new spell of long-term sickness absence lasting > or =56 days. Follow-up was done in two time frames: 0-5 and 6-10 years after inclusion. The risk of disability pension in relation to sick-leave diagnosis and socio-demographic factors was assessed by Cox proportional hazard regression analysis., Results: In 5 years, after inclusion, 28% of the cohort had been granted disability pension. Those with higher age, low income, previous sick leave, no employment and non-Swedish origin had higher risk of disability pension, while those with young children had lower risk. Considering the inclusion diagnosis, the pattern differed between men and women (P < 0.001). Among men, those with mental disorders had the highest risk and among women those with musculoskeletal disorders. Except for income, the effect of which was reversed over time, the overall pattern of disability pension predictors remained 6-10 years after inclusion but was attenuated., Conclusion: Besides socio-demographic risk factors, the sick-leave diagnoses constitute an important both medium and long-term predictor of disability pension among both men and women on long-term sickness absence.

Objective: To explore age and gender differences in the impact of diabetes on the prevalence of ischemic heart disease (IHD) in a defined population., Methods: Data were obtained from an administrative health care register covering a population of about 415,000. The study included all patients aged 45-74 years diagnosed between 1999 and 2003 with IHD (n=11,311) and diabetes (n=10,364) by physicians at all primary health care centres (PHCs) and out- and inpatient clinics at all hospitals in the county of Ostergötland, Sweden., Results: In the 45-54-year-old age group, diabetes was associated with an increase in IHD prevalence equivalent to ageing about 20 years in women and 10 years in men. The diabetes/nondiabetes IHD prevalence rate ratio (IPR) decreased with age in both men and women (trend p-values <0.001). The IPR was higher among women than men in each age group, though the female relative excess decreased from 75% higher in the 45-54-year-old age group to 33% higher in the 65-74-year-old age group (trend p-value=0.018)., Conclusions: The relative gender difference in the impact of diabetes on IHD in younger middle-aged patients remained up to the age of 65 years, decreasing considerably thereafter.

Aims: Knowledge is limited regarding the association between disability pension (DP) and mortality. The aim of this study was to examine the relative risk (RR) of mortality associated with DP among women and men of different ages over a 12-year period, for DP in general, and for full-time DP, part-time DP, and DP for labour-market reasons, respectively., Methods: A prospective cohort study was performed covering the total population of the Swedish county of Ostergötland aged 16-64 years in December 1984 (n = 245,704) followed up from 1985 to 1996. The RR of mortality was analysed in relation to DP, age, and gender using a Cox proportional hazards model., Results: The RR of mortality was higher for DP recipients than for individuals without DP, and this was true for both women (RR 2.79, 95% confidence interval (CI) 2.63 to 2.96) and men (RR 2.97, CI 2.83 to 3.11), and for all age groups. The RR of mortality was highest among the youngest DP recipients. The RR of mortality was especially high the first year of DP and remained elevated over the whole follow-up period. The RR of mortality among part-time DP recipients was lower than among full-time DP recipients and was significantly higher than seen for non-DP recipients. Individuals granted DP for labour-market reasons exhibited much lower RR of mortality than all other DP recipients., Conclusions: Further research is needed to investigate which factors explain the very high RR of mortality among disability pensioners.

Aims: In Ostergötland County, Sweden, all data on hospital care and primary healthcare (PHC) have been entered in a diagnosis-related administrative database since 1999. This database was used to estimate the prevalence of four chronic diseases and to examine the capture of data in PHC, outpatient hospital care, and inpatient hospital care, considered in different time frames., Methods: A case-finding algorithm identified patients with at least one healthcare contact involving a diagnosis of diabetes, hypertension, asthma, or chronic obstructive pulmonary disease (COPD) in 1999-2003. Prevalence rates were calculated as the ratio of the number of identified patients alive to the total number of inhabitants on 31 December 2003 (n approximately 415,000)., Results: Prevalence rates were 4.4% for diabetes, 10.3% for hypertension, 4.5% for asthma, and 1.2% for COPD. For all four diagnoses, the proportions of patients identified on only one healthcare level were greatest for PHC, reaching rates of 23%, 68%, 53%, and 48%, respectively. The cases identified solely in PHC comprised larger proportions of women and patients over the age of 65 years. Considering the proportion of patients identified in 2003 in relation to the total five-year period gave values of 71%, 50%, 38%, and 58%, respectively, for the four diagnoses., Conclusions: The administrative healthcare databases in Sweden today can be important tools in epidemiological research. However, data on several consecutive years and both PHC and hospital data are needed to achieve valid prevalence estimates.

A method for visual clone identification of Penicillium commune isolates was developed. The method is based on images of fungal colonies acquired after growth on a standard medium and involves a high degree of objectivity, which in future studies will make it possible for non-experts to perform a qualified identification of different species as well as clones within a species. A total of 77 P. commune isolates from a cheese dairy were 3-point inoculated on Yeast Extract Sucrose (YES) agar and incubated for 7 days at 25 degrees C. After incubation, the isolates were classified into groups containing the same genotype determined by DNA fingerprinting (AFLP). Each genotype also has a specific phenotype such as different colony colours. By careful image acquisition, colours were measured in a reproducible way. Prior to image analysis, each image was corrected with respect to colour, geometry and self-illumination, thereby gaining a set of directly comparable images. A method for automatic extraction of a given number of concentric regions was used. Using the positions of the regions, a number of relevant features--capturing colour and colour-texture from the surface of the fungal colonies--was extracted for further analysis. We introduced the Jeffreys-Matusitas (JM) distance between the feature distributions to express the similarity between regions in two colonies, and to evaluate the overall (weighted) similarity. The nearest neighbour (NN) classification rule was used. On a dataset from 137 isolates, we obtained a "leave-one-out" cross-validation identification rate of approximately 93-98% compared with the result of DNA fingerprinting., (Copyright 2003 Elsevier Science B.V.)

This paper presents a method for direct identification of fungal species solely by means of digital image analysis of colonies as seen after growth on a standard medium. The method described is completely automated and hence objective once digital images of the reference fungi have been established. Using a digital image it is possible to extract precise information from the surface of the fungal colony. This includes color distribution, colony dimensions and texture measurements. For fungal identification, this is normally done by visual observation that often results in a very subjective data recording. Isolates of nine different species of the genus Penicillium have been selected for the purpose. After incubation for 7 days, the fungal colonies are digitized using a very accurate digital camera. Prior to the image analysis each image is corrected for self-illumination, thereby gaining a set of directly corresponding images with respect to illumination. A Windows application has been developed to locate the position and size of up to three colonies in the digitized image. Using the estimated positions and sizes of the colonies, a number of relevant features can be extracted for further analysis. The method used to determine the position of the colonies will be covered as well as the feature selection. The texture measurements of colonies of the nine species were analyzed and a clustering of the data into the correct species was confirmed. This indicates that it is indeed possible to identify a given colony merely by macromorphological features. A classifier (in the normal distribution) based on measurements of 151 colonies incubated on yeast extract sucrose agar (YES) was used to discriminate between the species. This resulted in a correct classification rate of 100% when used on the training set and 96% using cross-validation. The same methods applied to 194 colonies incubated on Czapek yeast extract agar (CYA) resulted in a correct classification rate of 98% on the training set and 71% using cross-validation.

The expression of ras was investigated by using immunohistochemistry in 245 primary colorectal adenocarcinomas and 49 corresponding metastases in the lymph nodes. One hundred and forty-four (59%) of the primary tumours presented as ras positive and 37 (76%) were positive in metastases. The ras expression was positively related to cell proliferation (p=0.01) and significantly increased in tumours with aneuploidy (68%) compared to tumours with diploidy (51%) and tetraploidy (53%, p=0.01). The frequency of ras expression was increased from Dukes' stage A to stages B-D (41% vs 62%, p=0.01). ras expression was compared in 40 paired primary tumours and their corresponding metastases, and the difference in expression did not reach statistical significance (73% vs 83%, p=0.32). In survival analyses, ras overexpression predicted a poor prognosis independent of Dukes' stage, DNA ploidy and S-phase fraction (p=0.049). We did not find any significant relationship between ras expression and patients' sex, age, tumour location, growth pattern, differentiation, p53 expression or heat shock protein. The results indicate that the alteration of ras expression may be involved in the instability of DNA and cellular overproliferation, but not in the progression to advanced stage and the development of metastases. The expression of ras was an important biological marker for evaluating the prognosis in patients with colorectal adenocarcinoma.

A random sample of 26,000 Swedish women who were asked about their smoking habits in the early 1960s have now been followed for 26 years with respect to cancer incidence. Most findings regarding tobacco smoking and cancer from studies of men were confirmed also among the women. Elevated relative risk for current smokers compared with women who never smoked regularly were seen for cancers of the lung, upper aerodigestive sites, pancreas, bladder, cervix and all cancers combined, as well as a notably high relative risk for cancers of organs of the urinary tract other than kidney and bladder. Relative risk increased with dose, measured as grams of tobacco smoked per day, for cancers of the upper aerodigestive sites, lung, cervix, bladder, organs of the urinary tract other than kidney and bladder and all cancers combined. For cancers of the lung, bladder and cervix, there was an inverse relationship with age when starting to smoke tobacco. The reported inverse relationship between smoking and endometrial cancer could not be corroborated, nor was there any significant relationship between smoking and colorectal or breast cancer.

Purpose: To compare 2 methods of colonic cleansing before double-contrast barium enema. A standard preparation of bisacodyl was compared with a preparation of dietary fibre (ispaghula)., Material and Methods: The patients referred for double-contrast barium enema were randomly allocated to one of the colonic cleansing regimens. The effectiveness and patient acceptance of the preparations were evaluated., Results: There was a significantly poorer colon cleanness score in the ispaghula group (p = 0.0001). Patient tolerance of the 2 regimens was not significantly different., Conclusion: Ispaghula alone is not sufficient as a cleansing preparation for double-contrast barium enema.

The prognostic significance of nuclear and cytoplasmic p53 protein, detected immunocytochemically using CM1 and PAb 1801 antibodies, was evaluated in right-sided and left-sided colorectal adenocarcinomas from 293 patients. CM1 nuclear and cytoplasmic p53 accumulation occurred in 38 and 25% of cases, respectively. PAb 1801 nuclear staining occurred in 18%, with no cytoplasmic staining. CM1 expression either in the nucleus or in the cytoplasm was positively related to PAb 1801 expression (P < 0.001 and P = 0.009, respectively). The incidence of CM1 nuclear and cytoplasmic expression was more frequent in right-sided tumours (P = 0.023 and P = 0.034, respectively), while PAb 1801 nuclear staining was more common in left-sided tumours (P = 0.011). In survival analyses, CM1 nuclear overexpression in the right-sided tumours (P = 0.016) and CM1 cytoplasmic overexpression in left-sided tumours (P = 0.04) were prognostic indicators, independent of Dukes' stage, DNA ploidy, PAb 1801 expression and each other. Further analysis showed that the prognostic value of CM1 nuclear expression was greater in right-sided tumours than in left-sided tumours (P = 0.018). The nuclear and cytoplasmic p53 protein detected with CM1 and PAb 1801 may play different roles in tumour progression and provide prognostic indicators for right- and left-sided colorectal tumours.

Proliferating cell nuclear antigen (PCNA) expression was studied by immunohistochemistry on paraffin-embedded sections of 293 primary colorectal adenocarcinomas and 56 corresponding lymph node metastases. PCNA-positive expression was detected in <25% of tumour cells in 172 (59%) cases and in > 25% in 121 (41%) cases. PCNA accumulation was related to over-expression of c-erbB-2 and p53 and tended to be increased in cases with ras over-expression. PCNA expression was identical in primary and corresponding metastases. No significant relationship was observed between PCNA expression and prognosis and other clinico-pathological variables, including grade of differentiation, growth pattern, Dukes' stage, site, age or sex. We conclude that PCNA expression may be related to alterations of oncoproteins but that PCNA itself could not provide additional information for the development of metastasis and prognosis in colorectal adenocarcinoma.

Treatment results in 223 patients with T1 and T2 glottic carcinoma were analysed. A multivariate analysis was performed to evaluate the prognostic significance of factors related to tumour, patient and treatment. Locoregional control after radiotherapy was 90% for 129 patients with T1 tumours and 73% for 94 with T2 tumours. Disease-specific survival was 96% and 81% for patients with T1 and T2 tumours, respectively. In the multivariate analysis of locoregional control, subglottic extension contributed prognostic information to T-stage. In the univariate analysis, number of involved tumour sites, cord mobility and treatment interruption had a significant influence, which was lost in the multivariate analysis. Age gave additional prognostic information in the multivariate analysis of disease-specific survival. Significant adverse effects of radiotherapy were found in 9 patients (4%). Forty-nine patients (22%) had a second malignancy, 11 (5%) diagnosed before the glottic carcinoma.

We analyzed the interrelations of sex, age, tumor site, Dukes' stage, growth pattern and differentiation, and their prognostic value in 293 patients with primary colorectal adenocarcinoma. Simultaneously, growth pattern, differentiation, DNA and S-phase fraction (SPF) in paired primary tumors and lymph node metastases from 97 colorectal cancer patients were compared. The results revealed that poorly differentiated and mucinous tumors, as against well/moderately differentiated tumors, were frequently located in the proximal colon, and their frequencies were increased as Dukes' stage advanced (p=0.03). Tumor differentiation was usually identical in primaries and corresponding metastases (p=0.002), but this was not true of tumor growth pattern, DNA ploidy or SPF. In multivariate survival analyses, Dukes' stage provided strongly prognostic information (p<0.001) and mucinous tumors tended to predict worse survival (p=0.08).

Frozen tissue from primary tumours of 152 premenopausal breast cancer patients, who participated in a trial comparing radiotherapy with adjuvant chemotherapy (cyclophosphamide, methotrexate, 5-fluorouracil, CMF), was analysed for c-erbB-2 protein expression, measured by flow cytometry. The relative risk of distant recurrence or death in the chemotherapy group as compared with the radiotherapy group was 3.0 (95% confidence interval (CI) 1.1-7.8) for patients whose tumours showed high c-erbB-2 levels and 0.87 (95% CI 0.43-1.7) for those with tumours with low levels of c-erbB-2 protein. Patients with highly proliferative tumours that did not overexpress c-erbB-2 benefited most, in terms of survival, from CMF. In addition, we found an increased risk of locoregional recurrence for tumours overexpressing c-erbB-2 when radiotherapy was replaced by chemotherapy.

Overexpression of the c-erbB-2 oncogene has been demonstrated in a variety of tumours, including colorectal tumours. In breast carcinoma, c-erbB-2 overexpression is associated with DNA ploidy, some other prognostic indicators, and unfavourable survival prospects. However, there is little such information available regarding colorectal tumours. In this study, c-erbB-2 was analysed retrospectively by immunohistochemistry in 293 primary colorectal adenocarcinomas to assess its relation to DNA ploidy, S-phase fraction, other prognostic factors, and patient survival. Using the monoclonal antibody NCL-CB11, we found that 23% of the tumours were strongly c-erbB-2 positive, while 36% showed weak expression. The highest frequency of c-erbB-2 expression was 81% in DNA tetraploid tumours, compared to 63% in aneuploid and, 53% in diploid tumours (test for heterogeneity, p = 0.031). Overexpression of c-erbB-2 indicated a favourable prognosis in patients with DNA aneuploid tumours (p = 0.0088), but not in those with diploid or tetraploid tumours. The prognostic value of c-erbB-2 in DNA aneuploid tumours remained even after adjustment for Dukes' stage (p = 0.027). The results suggest that a combination of c-erbB-2 expression and DNA ploidy may improve the identification of patients' risk of cancer death.

Expression of c-erbB-2 and p53 protein was analysed retrospectively by immunohistochemistry in formalin-fixed tissue samples from 293 patients with colorectal adenocarcinoma. There was a significant positive relationship between c-erbB-2 and p53 expression (P < 0.0001). Co-overexpression of c-erbB-2 and p53 tended to be increased in tumours with infiltrative growth (P = 0.08) and higher S-phase fraction (P = 0.085). In combined survival analysis, patients with tumours in both c-erbB-2 positivity and p53 negativity had a more favourable outcome (P = 0.03). Multivariate analysis revealed that p53 overexpression was significantly associated with poor prognosis independent of c-erbB-2 expression, DNA-ploidy, S-phase fraction, growth pattern and Dukes stage (P = 0.002). We conclude that there is an inter-reaction between the two oncoproteins in the tumour development and that the overexpression of p53 proteins may be a powerful prognostic predictor in colorectal adenocarcinoma.

Nephrogenic metaplasia in two cases of renal transplant recipients, following immunosuppressive treatment is reported. The lesion is rare with unknown pathogenesis. Histologically the tumor consists of cystic and tubular structures resembling the distal parts of the nephron, but may occur in any part of the urothelium lined organs from calyxes to urethra. Watchful waiting is the treatment of choice in the absence of microscopically malignant changes.

A fast routine method for estimating bacterial cell growth rates by using the metachromatic dye acridine orange is described. The method allows simultaneous estimates of cellular RNA and DNA contents of single cells. Acridine orange staining can be used as a nonspecific supplement to quantitative species-specific hybridizations with fluorescence-labelled ribosomal probes to estimate the single-cell concentration of RNA. By automated analysis of digitized images of stained cells, we determined four independent growth rate-related parameters: cellular RNA and DNA contents, cell volume, and the frequency of dividing cells in a cell population. These parameters were used to compare physiological states of liquid-suspended and surface-growing Pseudomonas putida KT2442 in chemostat cultures. The major finding is that the correlation between substrate availability and cellular growth rate found for the free-living cells was not observed for the surface-bound cells; in contrast, the data indicate an almost constant growth rate for attached cells which was independent of the dilution rate in the chemostat.

Flow cytometry was performed on frozen specimens from the primary tumour of 184 women with recurrent breast cancer. No significant association was seen between DNA ploidy and the other prognostic factors investigated. Patients with a high S-phase fraction had more often a negative estrogen receptor (ER) status and a short disease-free interval. A shorter survival after disease recurrence was seen both in patients with DNA aneuploid tumours and among those with a high S-phase fraction. Patients with DNA tetraploid tumours showed the longest survival after recurrence. In this subgroup, half of the patients survived more than 3 years after recurrence and the estimated survival rate at 10 years was 17%. In a Cox's regression analysis including 116 patients, site of recurrence, number of positive nodes at time of primary operation, size and ER content of the primary tumour as well as DNA ploidy showed additional prognostic value.

A patient with a radically resected rectosigmoid cancer underwent two liver resections for metachronous metastases. When a third hepatic recurrence was diagnosed, further surgery was considered technically impossible, and the patient was given chemotherapy with 5-fluorouracil and folinic acid. He went into complete remission, and seven and a half years after the resection for colorectal cancer no metastases in the liver can be shown by ultrasonography or CT scan. The patient has normal CEA, and is at work.

p53 expression, DNA ploidy and S-phase fraction were analysed retrospectively in colorectal adenocarcinomas from 293 patients in whom the long-term outcome was known. The frequency of nuclear p53 staining was increased in non-diploid tumours (42%) when compared with diploid tumours (33%). Cytoplasmic p53 positive tumours were more common in the proximal colon (32%) than in the distal sites (21%). In univariate survival analysis, nuclear p53 and cytoplasmic staining were significantly associated with poor prognosis in patients with Dukes' A-C tumours. The patients showing both nuclear and cytoplasmic p53 staining had the poorest survival and the patients with tumours negative in both the nucleus and cytoplasm showed the best prognosis. The patients with tumours positive in the nucleus alone or in the cytoplasm alone presented an intermediate survival. In multivariate survival analyses, nuclear p53 expression, cytoplasmic p53 expression and DNA ploidy were prognostic indicators independent of Dukes' stage and each other. Further analysis suggested that the prognostic importance of cytoplasmic p53 expression was greater in diploid than in non-diploid tumours. We conclude that nuclear p53 expression, cytoplasmic p53 expression and DNA ploidy provide important prognostic information in colorectal adenocarcinomas.

Mutation of p53, a tumour-suppressor protein, leads to overexpression of the protein and loss of its tumour-suppressive properties. In some tumours (eg, breast) p53 expression is related to well-known prognostic factors, but findings in colorectal tumours are equivocal. We have used the polyclonal antibody CM1 to investigate nuclear and cytoplasmic p53 expression in colorectal tumours and to assess their relations with prognosis. Of 293 colorectal adenocarcinomas, 71 (24%) showed p53 expression in the nucleus alone, 30 (10%) showed p53 in the cytoplasm alone, and 43 (15%) showed both nuclear and cytoplasmic expression. Nuclear p53 expression showed no relation with survival or Dukes' stage of the tumour. However, the frequency of cytoplasmic expression increased with advancing Dukes' stage (chi 2 for trend 11.18, 1 df, p = 0.0008) and cytoplasmic expression was associated with poor survival (rate ratio 2.3 [95% CI 1.6-3.3], p < 0.0001). Among tumours of Dukes' stage A-C, cytoplasmic expression showed prognostic value independent of nuclear staining, grade of differentiation, and Dukes' stage (2.3 [1.4-3.7], p = 0.0021). We conclude that cytoplasmic expression of p53 may be a useful biological indicator of prognosis in colorectal adenocarcinoma.

The objective of the Värmland Study was to examine how serum cholesterol can be used to predict short- and long-term ischemic heart disease (IHD) mortality, especially in women aged 65 or older. This prospective cohort study involved about 20 years of follow-up after a single determination of serum cholesterol and included participants in a health screening undertaken from 1962 to 1965 (48,076 men, 48,732 women). The main outcome measures were mortality from IHD, acute myocardial infarction (MI), and chronic ischemic heart disease (CIHD). An IHD mortality trend was associated with increasing cholesterol levels for people younger than 65 years, and was more pronounced for men than women. For people 65 years or older, there was a weak trend for men, but not even a tendency for women. Regarding acute MI, significant trends were observed for males as well as females, for young as well as old people. A mild CIHD mortality trend was observed for young men. Otherwise no significant trend was seen.

Ras gene protein products (p21) reacting with the monoclonal antibodies ras 11, DWP, R256 and E184 were studied with an immunohistochemical method which was applied to 17 normal and 79 colorectal adenocarcinoma specimens. Normal colorectal epithelium showed positive staining for ras 11 in 35% of the cases, but not for DWP, R256 and E184. The antibodies showed positive staining in colorectal adenocarcinomas in 76, 53, 29 and 35% of the cases respectively. The degree of staining for ras 11 was significantly related to the grade of differentiation and increased from Dukes stage A to C. Strong staining for ras 11 predicted a significantly shorter recurrence-free interval (p less than 0.001). In Cox's regression analysis, the degree of staining for ras 11 was a prognostic factor independent of the grade of differentiation and Dukes stage (p less than 0.01). The results indicate that the enhanced expression of pan ras p21 may provide an important biological marker for determining prognosis in colorectal adenocarcinomas.

ras p21 expression, as indicated by the monoclonal antibody ras 11, was estimated using immunohistochemistry on 69 primary colorectal adenocarcinomas. Also, DNA ploidy and S-phase fraction (SPF) were analysed with flow cytometry. Positive staining for ras 11 tended to be more common in DNA non-diploid tumours (P = 0.11), but was significantly correlated with high SPF (P = 0.038). Positive ras 11 staining, Dukes' stage, DNA ploidy and SPF were related to the recurrence-free interval of patients with Dukes' A-C tumours (P = 0.0014, P = 0.023, P = 0.035 and P = 0.040, respectively). ras 11 staining was a prognostic factor independent of both Dukes' stage and DNA ploidy (P = 0.011). The results indicate that pan ras p21 expression is associated with proliferative activity and has an independent prognostic value in colorectal adenocarcinoma.

In order to examine the risks of cancer, particularly of rectal cancer, among Swedish brewery workers, 6,230 men employed in the brewery industry in 1960 were followed-up during 1961-79 by the Swedish Cancer Registry. Using all Swedish men as a reference group, relative risks (RR) were computed with standardization for year of birth, year of follow-up, and geographic region. A total of 712 new cases of cancer were observed compared to 570.7 expected (p less than 0.001). Significantly increased risks were seen for several cancer sites, e.g. esophagus (RR = 2.5, 95% confidence interval (Cl) = 1.5-3.8), rectum (RR = 1.7, Cl = 1.3-2.3), pancreas (RR = 1.7, Cl = 1.2-2.3), and lung (RR = 1.4, Cl = 1.1-1.7). An excess risk of liver cancer was almost significant (p = 0.053, RR = 1.7, Cl = 1.0-2.8). The risk of colon cancer was not significantly increased (RR = 1.2, Cl = 0.9-1.5), and the difference between the relative risk of colon cancer and that of rectum cancer was nearly significant (p = 0.07). Our results support the hypothesis that high beer consumption is associated with an increased risk of rectal cancer.

Using data from a record-linkage between the Swedish population census of 1960 and the Swedish Cancer Registry, we performed an explorative, hypothesis-generating analysis of the incidence of thyroid cancer in 208 occupations and 231 industries. Relative risks were computed with adjustment for age, period of follow-up, and geographic region. A total of 1,230 male and 2,937 female cases of thyroid cancer were reported during 1961-1979 among individuals aged 20-69 years in 1960. As a group, male blue-collar workers had a lower reported incidence than other men. Significantly elevated risks were seen among drivers, pharmacists, workers in the canning and preserving industry, workers in the petroleum industry, and among X-ray operators and laboratory assistants. Horticulture workers, painters in the construction industry, and unskilled manual workers showed decreased risks.