Building an evidence base for occupational health interventions

This article summarizes arguments for building an evidence base for occupational health. Evidence is needed on the most effective ways of eliminating health hazards in the workplace and at work, enhancing healthy behavior or the empowerment of workers, and preventing and treating occupational diseases and occupational disability. An evidence base for occupational health must include systematic reviews. The Cochrane Collaboration has brought together some of the evidence; however, a search for systematic reviews on the top priorities in occupational health research showed that systematic reviews are lacking in many areas. Current reviewing methods can be adapted to the special features of occupational health. It is concluded that more effort should be invested in the preparation, maintenance, and dissemination of systematic reviews in order to create a necessary evidence base for occupational health interventions. Occupational health could benefit considerably from greater awareness of the evidence for and against various types of intervention.     

Evaluation of genotype and LiPA MYCOBACTERIA assays for identification of Finnish mycobacterial isolates

Two DNA strip assays, INNO-LiPA MYCOBACTERIA and GenoType Mykobakterien, were evaluated for identification of 81 Finnish mycobacterial isolates. The LiPA assay correctly identified 89.4% of the 66 isolates studied, and the GenoType assay identified 95.1% of 81 isolates. The GenoType assay had a wider selection of species and less stringent temperature requirements.     

Analysis of Pesticides in Water and Sediment Under Different Storage Conditions Using Gas Chromatography

This paper describes the process of testing a simple low-solvent method for simultaneously extracting five classes of pesticides (triazines, organophosphates, organochlorines, pyrethroids, and carbamates) from reconstituted water and sediment. This method uses techniques available in most laboratories, namely solid phase extraction (SPE) and sonication in combination with gas chromatography. The recoveries of pesticides ranged from 60 to 120% with the exception of carbaryl, dicofol, and methoxychlor that had higher recoveries. Methods were further tested with pond water and soil samples. The recoveries of pesticides from soil were comparable with those from sediments, while in pond water, recoveries of the organochlorines exceeded 100%. A matrix enhancement effect was suspected to be the cause for the observed elevated recoveries. In order to determine time range and conditions in which the samples can be stored without significant losses, recoveries of pesticides in water and sediment were monitored for 28 days. Water samples were most stable when extracted immediately and stored in SPEs in the freezer. These samples remained stable for up to six weeks in the freezer, whereas sediment samples were stored for a month without a significant decrease in pesticide concentrations. Received: 6 August 2002/Accepted: 29 October 2002     

Boron Neutron Capture Therapy of Brain Tumors: Clinical Trials at the Finnish Facility Using Boronophenylalanine

Two clinical trials are currently running at the Finnish dedicated boron neutron capture therapy (BNCT) facility. Between May 1999 and December 2001, 18 patients with supratentorial glioblastoma were treated with boronophenylalanine (BPA)-based BNCT within a context of a prospective clinical trial (protocol P-01). All patients underwent prior surgery, but none had received conventional radiotherapy or cancer chemotherapy before BNCT. BPA-fructose was given as 2-h infusion at BPA-dosages ranging from 290 to 400mg/kg prior to neutron beam irradiation, which was given as a single fraction from two fields. The average planning target volume dose ranged from 30 to 61Gy (W), and the average normal brain dose from 3 to 6Gy (W). The treatment was generally well tolerated, and none of the patients have died during the first months following BNCT. The estimated 1-year overall survival is 61%. In another trial (protocol P-03), three patients with recurring or progressing glioblastoma following surgery and conventional cranial radiotherapy to 50–60Gy, were treated with BPA-based BNCT using the BPA dosage of 290mg/kg. The average planning target dose in these patients was 25–29Gy (W), and the average whole brain dose 2–3Gy (W). All three patients tolerated brain reirradiation with BNCT, and none died during the first three months following BNCT. We conclude that BPA-based BNCT has been relatively well tolerated both in previously irradiated and unirradiated glioblastoma patients. Efficacy comparisons with conventional photon radiation are difficult due to patient selection and confounding factors such as other treatments given, but the results support continuation of clinical research on BPA-based BNCT.     

Treatment improves serotonin transporter binding and reduces binge eating

Rationale Serotonin (5-HT) is involved in the control of eating behaviour by inhibiting food intake. Obese women with binge-eating disorder (OB-BED) were recently found to have reduced 5-HT transporter binding. Objectives The aim of this study was to investigate the effect of a successful treatment on 5-HT transporters in OB-BED. Methods The 5-HT transporter binding of seven OB-BED was measured by single-photon emission computed tomography (SPECT), by using iodine-123-labelled nor-β-CIT as a tracer, before treatment and after successful treatment, when the OB-BED were asymptomatic. Treatment consisted of group psychotherapy and fluoxetine medication. The control subjects, six obese women without eating disorders, were also studied twice by using SPECT. Results The 5-HT transporter binding of the symptomatically recovered OB-BED increased significantly (24±22%) after treatment, whereas in the control group, binding remained unchanged. Conclusions The results tentatively suggest that 5-HT transporter binding in OB-BED is an adaptive mechanism, which can be affected by treatment. Furthermore, there seems to be a link between improved 5-HT transporter binding and reduced binge eating.     

Perioperative chronic use of statins and the risk of muscle complaints in patients undergoing knee and hip endoprosthesis surgery

Study ObjectiveTo assess whether regular statin therapy enhances muscular and hepatic deterioration and muscle complaints in patients undergoing elective arthroplasty.DesignProspective, case-controlled, observational study.SettingTertiary-level university teaching hospital in Eastern Finland.Patients48 ASA physical status I, II, and III patients, aged 51 to 84 years, 24 of whom were scheduled for hip arthroplasty (12 pts with and 12 without statin therapy) and 24 patients who were to undergo knee arthroplasty (12 pts with and 12 without statin therapy).InterventionsBefore and after surgery, all patients were interviewed for muscular and hepatic symptoms and signs.Main MeasurementsS-creatine kinase, S-alanine aminotransferase, P-creatinine, S-lactate dehydrogenase, P-potassium, S-myoglobin, and U-myoglobin were measured at baseline and at 6, 24, and 72 hours after surgery.Main ResultsS-creatine kinase and S-myoglobin increased in all study groups at 6 hours after surgery and remained elevated for 72 hours, with no differences noted in patients treated with or without statins. There was no increase in the amount of muscular or hepatic complaints after surgery.ConclusionLong-term statin therapy does not appear to increase the risk of muscular adverse effects in patients receiving major endoprosthesis surgery.     

Site dependent bioavailability and metabolism of levosimendan in dogs.

Site specific bioavailability and metabolism of levosimendan was studied in ten dogs by placing intestinal access port catheters in different parts of the gastrointestinal tract. 14C-labelled levosimendan (0.1 mg/kg) was administered intravenously, by gastric tube and directly through catheters that were placed in the duodenum, jejunum and ileum. Plasma samples were collected and radioactivity in the different organs and tissues was measured. The results of the present study showed that bioavailability of levosimendan was high varying from 71 to 86% after extravascular administration. Metabolite OR-1855 concentrations in the plasma were about 3-4 times higher after administration to the ileum compared to the other administration routes. It can be concluded that the bioavailability of levosimendan is not affected by site specific administration. The bacteria or enzymes responsible for the metabolism of levosimendan are located in the lower parts of the gastrointestinal tract.     

Staff empowerment in Finnish intensive care units

The purpose of this study was to describe staff empowerment in Finnish intensive care units. The data were collected with a questionnaire comprising demographic background and empowerment items. The concept of empowerment was divided into three components: behavioural, verbal and outcome empowerment. The questionnaire was sent to all registered nurses at Finnish intensive care units (ICUs). Eight hundred and fourteen replied, giving a response rate of 77%. The ICU nurses demonstrated confidence in their own skills and competencies, although least so in the domain of outcome empowerment. Experience of behavioural, verbal and outcome empowerment increased linearly with age. The length of nursing experience was positively associated with behavioural, verbal and outcome empowerment. Experience in ICU nursing correlated positively with verbal and outcome empowerment. Motivation, job satisfaction, respect of job autonomy and the fact that the job of ICU nurses commanded respect in society were associated with behavioural, verbal, and outcome empowerment.     

Comparison of self-rated health in older people of St. Petersburg,Russia, and Tampere,Finland: how sensitive is SRH to cross-cultural factors?

The aim of this study was to examine if there are differences in self-rated health (SRH) between older people in St. Petersburg, Russia, and Tampere, Finland. Two SRH measures were examined: a global measure without any frame of reference, and an age-comparative SRH with an explicitly elicited reference of age peers. The Tampere data, consisting of 737 60–89-year-old respondents, came from the Tampere Longitudinal Study on Ageing (TamELSA) in 1989. The St. Petersburg data, consisting of 1,168 people aged 60–89 years, came from the Planning of Medical and Social Services within Elder Care in St. Petersburg project (IPSE) in 2000. In both cities the data were collected by same structured questionnaire. Self-rated health, both global and comparative, was better in Tampere than in St. Petersburg when symptoms, chronic diseases and functional ability were adjusted for. Also, the association of chronic diseases with global SRH was different in St. Petersburg and Tampere. In addition to the real differences in the prevalence and seriousness of health problems, the differences in SRH may be caused by different ways of evaluating health. Our conclusion is that self-rated health is sensitive to cultural and social factors. Direct comparisons between different countries should be made with caution, and the differences in language use must be taken into account when interpreting the results.