Doctor-staffed ambulance helicopters: to what extent can the general practitioner replace the anaesthesiologist?
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During two years, a rural ambulance helicopter programme saved 41 patients' lives. In 29 of these patients, the decisive medical interventions were carried out by the flight anaesthesiologist before reaching the hospital. We asked an expert panel to assess whether these interventions could have been carried out by a general practitioner (GP). This was the case for 17 (59%) of the 29 patients, while more advances skills, equipment or drugs were needed for 11 (38%). Among these 11, three patients would probably have died without the interventions. We conclude that GPs can manage a majority of life saving missions for a rural ambulance helicopter programme, but the lack of a flight anaesthesiologist may imply substantial health losses for a few patients. (+info)
Incidence of cancer among workers exposed to vinyl chloride in polyvinyl chloride manufacture.
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Based on results from two previous studies where an excess of melanomas was found in a cohort of workers exposed to vinyl chloride (VCM), a follow up of the incidence of cancer in the same cohort of 428 workers was carried out to scrutinize whether or not the excess could be confirmed by new cases. The total number of deaths in the study group from 1953 to the end of 1993 was 132 v 141 expected, and the total number of incident cancer cases was 56 v 57 expected. There were 11 cases of lung cancer v eight expected, seven cases of melanomas v 2.07 expected, and two cases of thyroid cancer v 0.34 expected. Five of the seven melanoma cases had occurred in the group that had been most heavily exposed to VCM v 0.7 expected. In the present follow up we also found five cases of the spinocellular cancer of the skin v 1.7 expected. Out of these five cases four were diagnosed after 1984. Two of the five cases v 0.7 expected had occurred in the most heavily exposed group. The total number of skin cancers (melanomas and spinocellular cancers) were 12 v 3.7 expected. There was one new case of melanoma between 1985 and 1993 v 0.7 expected. Hence, the strength of the relation between the observed and expected number of cases was reduced compared with the last follow up, and does not strengthen the previously indicated causal relation between exposure to VCM and development of malignant melanoma. There was no excess of testicular cancers in this study. The present results may indicate that occurrence of spinocellular skin cancer could bear some relation to work in the manufacture of polyvinyl chloride (PVC). Confirmation is needed from studies on other cohorts exposed to VCM. (+info)
Performance of population specific job exposure matrices (JEMs): European collaborative analyses on occupational risk factors for chronic obstructive pulmonary disease with job exposure matrices (ECOJEM).
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OBJECTIVES: To compare the performance of population specific job exposure matrices (JEMs) and self reported occupational exposure with data on exposure and lung function from three European general populations. METHODS: Self reported occupational exposure (yes or no) and present occupation were recorded in the three general population surveys conducted in France, The Netherlands, and Norway. Analysis was performed on subjects, aged 25-64, who provided good forced expiratory volume in 1 second (FEV1) tracings and whose occupations were performed by at least two people, in the French (6217 men and 5571 women), the Dutch (men from urban (854) and rural (780) areas), and the Norwegian (395 men) surveys. Two population specific JEMs, based on the percentage of subjects who reported themselves exposed in each job, were constructed for each survey and each sex. The first matrix classified jobs into three categories of exposure according to the proportion of subjects who reported themselves exposed in each job (P10-50 JEM, low < 10%, moderate 10-49%, high > or = 50%). For the second matrix, a dichotomous variable was constructed to have the same statistical power as the self reported exposure--that is, the exposure prevalence (p) was the same with both exposure assessment methods (Pp JEM). Relations between occupational exposure, as estimated by the two JEMs and self reported exposure, and age, height, city, and smoking adjusted FEV1 score were compared. RESULTS: Significant associations between occupational exposure estimated by the population specific JEM and lung function were found in the French and the rural Dutch surveys, whereas no significant relation was found with self reported exposure. In populations with few subjects in most jobs, exposure cannot be estimated with sufficient precision by a population specific JEM, which may explain the lack of relation in the Norwegian and the Dutch (urban area) surveys. CONCLUSION: The population specific JEM, which was easy to construct and cost little, seemed to perform better than crude self reported exposures, in populations with sufficient numbers of subjects per job. (+info)
Platyspondyly and shortness of vertebral column in farmed Atlantic salmon Salmo salar in Norway--description and interpretation of pathologic changes.
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Body malformation due to shortness of the vertebral column, in most cases of unknown cause, has been observed in fish for more than 100 yr. It periodically occurs with high prevalence in farmed Atlantic salmon Salmo salar in Norway, and this paper describes the results of macroscopic, radiographic and histologic examination of parr and seawater-transferred fish. The vertebral bodies in both age groups did not acquire the length that they normally should due to a growth disturbance leading to the condition of platyspondyly and shortness in the column. The pathologic changes became visible at different ages in both groups and the process apparently starts in intervertebral tissues. There was proliferation of connective tissue and blood vessels, and sometimes infiltration with inflammatory cells, around affected vertebrae, especially in seawater-transferred fish. This is the first description of inflammation in abnormally short-spined fish, and it may indicate an infectious etiology, at least in farmed seawater-transferred salmon. (+info)
Exposure to organic solvents in the offset printing industry in Norway.
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The purpose of this study was to document the conditions regarding solvent exposure at offset printing offices in Norway at present and to study the variation of exposure between printing office technologies. Measurements were made at seven offset printing offices. The measurements consisted of five to 10 whole day personal exposure measurements at each office performed over a period of 2 months. Variables that may influence the level of exposure were registered by the occupational hygienist at the end of each measuring day using a check list. The influence of the variables on the "additive factor" was examined by linear regression analysis.The main contributor to the "additive factor" was isopropanol. The exposure to isopropanol sometimes exceeded the Norwegian TLV. The exposure decreased when a separate exhaust ventilation was used. The exposure increased when the machine had automatic cleaning. The variables automatic cleaning and separate exhaust ventilation explained 59% of the variation in the "additive factor". The results of this study indicate that the most important source of solvent exposure in printing offices at present is the moisturizer used in the printing machines. We think it is worth giving attention to this exposure and making efforts to reduce it. (+info)
Serotypes of Neisseria meningitidis isolated from patients in Norway during the first six months of 1978.
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During the first 6 months of 1978, 114 strains of Neisseria meningitidis isolated from patients in Norway were serotyped. Among 27 group C strains, type 2 was most common, whereas 82% of the 82 group B isolates did not react with antisera to the standard serotypes 1 to 12. These strains were shown to belong to a new serotype, type 15. Also some group A and C strains had the type 15 antigen. Investigations on a possible immunoprophylaxis against group B meningococcal disease in Norway should accordingly proceed with type 15 rather than with type 2 meningococci. (+info)
Seasonal variations in incidence of fractures among elderly people.
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OBJECTIVE: To investigate seasonal variations in the incidence of fall related fractures among people 65 years and older. POPULATION AND METHODS: A prospective, population based cohort study was performed on people aged 65 years and older followed up from 1990 to 1997, a total of 459,904 person years. Cases were identified through a prospective registration system. RESULTS: There were 10,992 (2390 per 100,000 person years) fall related fractures. The risk was higher in the colder seasons (October through March) among people aged 65-79 years (relative risk (RR) = 1.39, 95% confidence interval (CI) 1.32 to 1.47) and in people aged 80 years and older (RR = 1.17, 95% CI 1.09 to 1.22). For arm fractures, the RR was 1.69 (95% CI 1.56 to 1.83) among people aged 65-79 years and 1.30 (95% CI 1.13 to 1.43) among those aged 80 years and older. The RR for hip fractures was 1.27 (95% CI 1.15 to 1.37) among people aged 65-79 years and 1.08 (95% CI 1.00 to 1.15) for people aged 80 years and older. Slipping on ice and snow seems to entirely explain the excessive incidence of hip and arm fractures during winter months. CONCLUSION: Season affects the incidence of all types of fractures in elderly people. Slipping on ice and snow seems to be a causal mechanism behind the seasonal effect. Preventive measures targeting this causal mechanism are likely to reduce the risk of fracture, but the size of the effect is difficult to estimate with certainty. (+info)
Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register.
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OBJECTIVE: To examine the bone mineral density (BMD), frequency of osteoporosis, and risk factors for BMD reduction in a representative population of female rheumatoid arthritis (RA) patients ages 20-70 years. METHODS: BMD in the femoral neck, total hip, and spine L2-4 (anterior-posterior view) was measured in 394 RA patients recruited from a validated county RA register (completeness 85%) comprising 721 women ages 20-70 years. BMD was measured with dual-energy x-ray absorptiometry, and age-specific values were compared with pooled values from a European/US population of healthy subjects free from earlier fractures, chronic diseases, and medications influencing bone metabolism. A multiple linear regression model was used to determine individual predictors of BMD. RESULTS: No statistically significant differences were found in demographic, disease activity, disease severity, or health status parameters between the RA register patients in whom BMD was measured and the remaining register patients. Femoral neck BMD was significantly reduced by 4.2% in the age group 50-59 years, and by 5.0% in those ages 60-70 years. For BMD in the total hip, the significant reductions were 3.7%, 6.0%, and 8.5% in the age groups 40-49 years, 50-59 years, and 60-70 years, respectively. No significant reduction in spine L2-4 BMD was found. A 2-fold increased frequency of osteoporosis was observed in all 4 age groups of RA patients compared with the reference population, ranging from 0% to 28.6% in the femoral neck, 0% to 29.9% in the total hip, and 1.8% to 31.5% in the spine. Predictors of reduced BMD were as follows: at the femoral neck, older age, low body weight, current use of corticosteroids, greater physical disability (as measured by the modified Health Assessment Questionnaire [M-HAQ]), and presence of rheumatoid factor; at the total hip, older age, low weight, current use of corticosteroids, and higher M-HAQ disability score; and at the lumbar spine, older age, low weight, and current use of corticosteroids. CONCLUSION: Register-based prevalence data on BMD reduction in female RA patients ages 20-70 years are presented for the first time in this report, which demonstrates a 2-fold increase in osteoporosis in this representative population. (+info)