Abstract. Westin L, Carlsson R, Israelsson B, Willenheimer R, Cline C, McNeil TF (University of Lund, University Hospital, Malmö, Sweden). Quality of life in patients with ischaemic heart disease: a prospective controlled study. J Intern Med 1997; 242: 239-47.Objectives. To assess quality of life in patients after acute myocardial infarction (AMI), coronary artery by-pass grafting surgery (CABG) and percutaneous transluminal coronary angioplasty (PTCA) as compared with healthy controls. Design. Self-administered questionnaires were completed 1 month and 1 year after the event. Setting. Department of Cardiology, University Hospital, Malmö, Sweden; 1989. Subjects. 296 AMI, 99 CABG, 18 PTCA patients and 88 randomly selected healthy controls were included; 349 patients completed the entire programme. Main outcome measures. Quality of life in the dimensions of perceived general health, thoracic pain, breathlessness, feeling of arrhythmia, anxiety, depression, self-esteem, experience of social life and sex life.Results. Patients differed from controls in both psychological and somatic aspects of QL after 1 month. Furthermore, 1 month after the event AMI patients experienced more anxiety (P ϭ 0.001) than CABG patients, whilst CABG patients experienced a poorer sex life (P Ͻ 0.001) than AMI patients. One year after the event patients differed from controls primarily in somatic symptoms; no significant differences were found across patient groups. Patients who sought emergency out-patient care during the follow-up year for clinically diagnosed angina pectoris or cardiac incompensation had reported higher levels of thoracic pain (P Ͻ 0.001) and breathlessness (P Ͻ 0.001) at 1 month follow-up than patients who did not seek such care. Conclusions. Quality of life is considerably affected in patients following a cardiac event, especially during the initial recovery phase. Although substantial improvement in quality of life occurs over time, the persistence of residual distress at 1-year follow-up is a challenge for clinicians concerned with the full rehabilitation of the cardiac patient.

The psychological and psychosocial consequences of screening for alpha 1-antitrypsin deficiency (alpha 1 ATD) were investigated when the subjects were 5-7 years old. The present study was conducted when the subjects were 18-20 years old, the foci of interest being their health, psychosomatic problems, knowledge about alpha 1 ATD and the potential effect of that knowledge on their lives and future family planning. Samples of 61 PiZ and 61 demographically matched control subjects, 18-20 years old, were asked to participate. Written, structured questionnaires covered the following items: basic familial characteristics, psychosomatic symptoms, opinions on medical check-ups, information and views on future alpha 1 ATD screening, whether the knowledge about alpha 1 ATD had affected the life and family planning of alpha 1 ATD individuals. Items concerning the "alpha 1 ATD matter" were excluded in the questionnaires given to the controls. Questionnaire data were obtained from 50 alpha 1 ATD and 48 control individuals, 41 of each being matched alpha 1 ATD-control pairs. No significant differences were found in demographic or educational backgrounds, psychosomatic complaints such as headache, sleep difficulties, stomach ache, tiredness or anxiety. Lung symptoms occurred more frequently in alpha 1 ATD subjects (p = 0.05). Six per cent of the alpha 1 ATD individuals planned working careers with a high risk of air pollution. The majority (86%) of the alpha 1 ATD subjects perceived the contact with the medical services as positive; 14% as both positive and negative. The information concerning alpha 1 ATD was assessed as satisfactory by 73%, as both good and bad by 17% and as unsatisfactory by 10%. All alpha 1 ATD subjects advocated general screening for alpha 1 ATD, the neonatal period being chosen as optimal by 94%. Half of the alpha 1 ATD individuals thought that the knowledge of their high-risk condition had affected their lives, particularly their awareness of the dangers of smoking and environmental pollution. The majority, 88%, knew that they should avoid smoking to protect their lungs. In conclusion, no negative psychosocial consequences of the neonatal alpha 1 AT-screening were found in early adulthood. The alpha 1 ATD individuals were aware of the dangers of smoking and were of the opinion that alpha 1 AT-screening should be recommended.

Thelin T, Sveger T, McNeil TF. Primary prevention in a high-risk group: smoking habits in adolescents with homozygous N , -antitrypsin deficiency (ATD). Acta Paediatr 1996;85: 1207-12. Stockholm. ISSN 0803-5253The serious form of alpha-1 -antitrypsin deficiency (ATD) Pi ZZ strongly predisposes the individual for pulmonary emphysema and premature death in adulthood, especially if exposed to tobacco smoking. General screening of all new-born children was conducted in Sweden during 1972-1974, the major purpose being to reduce exposure of the child to parental smoking while growing up and to prevent the child from starting to smoke. Sixty-one children with ATD neonatally identified through massscreening, and their families, have been compared with a demographically matched control group regarding smoking habits, as studied through interviews and questionnaires on two occasions. When the children were 5-7 years old, the smoking rates among parents of the ATD children and especially among the ATD fathers exceeded smoking rates for controls. Thirteen years later no differences in parental smoking were found between the groups. At 18-20 years of age the ATD children reported smoking significantly less than the control children (p < 0.05). From the perspective of prevention, the goal of the neonatal screening to reduce the smoking rates among the parents of the ATD children was not attained, while it was achieved among the ATD children. The results indicate that a screening program with early detection of ATD effectively prevents adolescent childrell from starting to smoke.

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Other than among young-onset males we found no increase in labour and delivery complications among cases.