In a continuing screening and intervention programme in Malmó, elevated serum-gamma-glutamyltransferase (GGT) values were used for selection of heavy drinkers. The study population consisted of 585 individuals born 1926-1933 with two consecutive GGT values in the upper decile of the GGT distribution, randomly allocated either to an intervention group of to a control group. The subjects in the intervention group were further investigated and 75% of them were judged to have elevated GGT values caused by alcohol consumption. These individuals were repeatedly encouraged to lower their overall alcohol consumption and GGT measurements were used as biofeedback method in the treatment program. The controls were informed by letter to be restrictive with their alcohol consumption and that they should receive new invitations for measurements of their liver enzymes after 2, 4, and 6 years. The intervention and control groups were well matched and followed over a 2-6-year period. Two and 4 years after the screening investigation, the GGT values in both groups were significantly decreased. There were differences, however, between the two groups with regard to sick absenteeism, hospitalization, and mortality. A significant reduction was found in sick absence during 4 years by 80%, in hospital days during 5 years by 60%, and in mortality during 6 years by 50% in the intervention group compared with the control group. Thus, the intervention program was effective in preventing medico-social consequences of heavy drinking.

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A questionnaire consisting of nine questions about drinking habits was used in a preventive programme for middle-aged males in Malmo. With a cut-off point of two yes-answers to the questions, 66% of a group of heavy drinkers, 73% of all registered alcoholics and 90% of not previously identified alcoholics were identified. Serum y-glutamyltransferase (GGT), used as an indicator of heavy alcohol consumption in the screening, was a poor instrument for the detection of alcoholism in the same population, assigning correctly only 35 %. In combination, the two tests identified 82 % of all registered alcoholics, and 97 % ofthe alcoholics who were registered in the period following the screening investigation. Thus Mm-MAST is a useful screening test for alcoholism in medical screening examinations and may successfully be used in combination with biochemical tests.

The oral and intravenous glucose tolerance tests have been compared in middle-aged, normal-weight male non-smokers, ex-smokers and smokers who participated in a general health screening programme in Malmö, Sweden. Subjects with diabetes, previous gastric resection and/or present medication with diuretic agents were excluded. No difference was found when comparing fasting glucose in non-smokers, ex-smokers and smokers. In the oral glucose tolerance test, plasma glucose at 40 and 60 min increased stepwise from non-smokers (8.7 and 7.4 mmol/l) to ex-smokers (8.9 and 7.5 mmol/l), smokers (9.2 and 7.9 mmol/l) and heavy smokers (9.7 and 8.2 mmol/l). Blood glucose levels at 120 min were inversely arranged. Plasma insulin at 120 min was lower in heavy smokers (16.2 mU/l) than in non-smokers (24.8 mU/l). The mean intravenous glucose tolerance test k-value was lower in smokers than in non-smokers. K-values below 1.0 were twice as common in smokers (30%) as in non-smokers. It is concluded that smoking has a clinically significant influence on both the oral and intravenous glucose tolerance tests.

Background: The health workforce has a dynamically changing nature and the regular documentation of the distribution of health professionals is a persistent policy concern. The aim of the present study was to examine available human medical resources in primary care and identify possible inequalities regarding the distribution of general practitioners in Albania between 2000 and 2004.

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The causes of premature death and the associated risk factors were analysed in a cohort of 7935 middle aged men participating in a preventive population programme in Malm8. They were screened when aged 46-48 and then followed up for 31-8 years. Two hundred and eighteen died, of whom 181 (83%) underwent necropsy. Three major causes of death were established: cancer in 61 (28%), deaths related to consumption of alcohol in 55 (25%), and coronary heart disease in 50 (23%).Distinctly different patterns of risk factors were found to be associated with each of the three main causes of premature death. In death due to coronary heart disease smoking (p= 0-0062), serum cholesterol concentration (p = 0 00014), serum triglyceride concentration (p=0 00013), systolic blood pressure (p= 0000012), and diastolic blood pressure (p=00021) were the strongest single determinants but diastolic blood pressure ceased to be a predictive factor in a multivariate analysis whereas all the other variables could be combined in a highly predictive logistic model. In death related to consumption of alcohol equal or even stronger associations were found for serum y glutamyltransferase activity (p <0 0001), points scored in a questionnaire screening for alcoholism (p <0 0001), and, inversely, serum cholesterol (p= 00046) and serum creatinine (p <0 0001) concentrations both when applied independently and when combined in a logistic model. In death due to cancer significant associations were found for serum urate concentration (p=0 023) and, inversely, serum cholesterol concentration (p= 0056-0-031).Malignant diseases and diseases related to consumption of alcohol were at least as prominent as cardiovascular disorders in causing premature death in the cohort of men studied. All three types of conditions are potentially avoidable and seem to be associated with significant and distinctive patterns of risk factors. These patterns should be used, as blood pressure and serum lipid concentrations already are, to predict the risk of premature death and indicate preventive measures.