Evaluation of the driving ability in disabled persons: A practitioners' view

Purpose and methods.?The purpose of this paper is to present, on the basis of four genuine cases from the Rehabilitation Research Unit of Oulu University, the theoretical frame in which evaluations of driving ability of disabled persons can be made.

Results.?First, it is not the operations with the control devices but the correct mental actions which the driver carries out with the help of the control devices which are crucial for safe driving. Second, driving ability is only partly a biomedical object of research and one ought to avoid an excessive medicalisation of an evaluation of driving ability. Third, the driver meets traffic situations not by his or her separate biological or psychological functions, such as vision, attention, memory, thinking, motives, but as an integrated whole, as a personality.

Conclusions.?By its complexity an evaluation of driving ability can be compared to an evaluation of working capacity where often a multidisciplinary team is needed. When evaluating driving ability we have to take a step from low-level motor operations towards high-level mental actions, from the measurement of acuity of eyesight towards the testing of the flexibility of perception, from the diagnosis-based evaluation to the patient-based evaluation, from using the common pencil?–?paper tests towards the traffic-related task-specific tests and from the testing of separate single general non-driving-related factors towards an evaluation of the theoretically based driving performance as whole.     

A closed unventilated chamber for the measurement of transepidermal water loss

Background/aims Open chamber systems for measuring transepidermal water loss (TEWL) have limitations related to ambient and body‐induced airflows near the probe, probe size, measurement sites and angles, and measurement range. The aim of the present investigation was to develop a closed chamber system for the TEWL measurement without significant blocking of normal evaporation through the skin. Additionally, in order to use the evaporimeter to measure evaporation rates through other biological and non‐biological specimens and in the field applications, a small portable, battery‐operated device was a design criteria. Methods A closed unventilated chamber (inner volume 2.0 cm³) was constructed. For the skin measurement, the chamber with one side open (open surface area 1.0 cm²) is placed on the skin. The skin application time was investigated at low and high evaporation rates in order to assess the blocking effect of the chamber on normal evaporation. From the rising linear part of the relative humidity (RH) in the chamber the slope was registered. The slope was calibrated into a TEWL value by evaporating water at different temperatures and measuring the water loss of heated samples with a laboratory scale. The closed chamber evaporation technique was compared with a conventional evaporimeter based on an open chamber method (DermaLab^®, Cortex Technology, Hadsund, Denmark). The reproducibility of the closed chamber method was measured with the water samples and with volar forearm and palm of the hand in 10 healthy volunteers. Results The skin application time varied between 7 and 9 s and the linear slope region between 3 and 5 s at the evaporation rates of 3–220 g/m² h. A correlation coefficient between the TEWL value from the closed chamber measurements and the readings of the laboratory scale was 0.99 (P < 0.001). The reproducibility of the evaporation measurements with the water samples was 4.0% at the evaporation rate of 40 g/m² h. A correlation coefficient of the TEWL values between the closed chamber and open chamber measurements was 0.99 (P < 0.001) in the range where the response of a conventional evaporimeter was linear (until 120 g/m² h). With volar forearm and palm of the hand of 10 healthy volunteers the reproducibility of the measurements was 8.0 and 10.1%. Conclusion The closed chamber technique solves the drawbacks related to open chamber evaporimeters. Especially, it extends the measurement range to high evaporation rates and TEWL measurements can be performed practically at any anatomical sites and measurement angle. By the use of a closed chamber the disturbance related to external or body‐induced air flows on the measurement can be avoided.     

Human picornavirus and coronavirus RNA in nasopharynx of children without concurrent respiratory symptoms.

The prevalence of human rhino-, entero-, and coronaviruses was investigated by RT-PCR in nasopharyngeal aspirates from 107 children without concurrent respiratory symptoms. The children were admitted to the hospital for elective surgery. The parents filled a questionnaire about the occurrence of respiratory symptoms four weeks before and two weeks after the surgery. The rate of viral detection was 45% in children with related past or recent respiratory infection whereas 20% of the samples taken from children without any related past or recent respiratory infections were positive for picornavirus RNA, P = 0.008. Thirty-one (29%) of the nasopharyngeal aspirates were positive for viral RNA, 18% for rhinovirus, and 11% for enterovirus RNA. Coronavirus RNA was not found in any of the children. Fifty-five percent of the children with virus-positive samples had an infection-related diagnosis. In addition, 81% of the children with virus-positive samples had had previously respiratory symptoms or there were concurrent respiratory symptoms in other family members. Only four of the 31 virus-positive samples were from children without infection-related diagnosis or recent past (or immediate future) respiratory symptoms.     

Musculoskeletal symptoms of dentists assessed by a multidisciplinary approach

Musculoskeletal health was studied as part of a comprehensive health examination in 131 professionally active dentists. 42% of dentists had experienced pain and disability (interference with daily activities) by neck-shoulder problems during the preceding year, with a tendency to greater prevalence in salaried dentists than in private practitioners. For the lower back, this percentage was 37. Somatic symptoms of stress, perceiving dentistry as physically too heavy or mentally too straining and a poorer general health status rating were all associated with a greater 1-yr prevalence of neck-shoulder and lower back pain and disability and with poorer general physical fitness. Age, weekly work hours, working posture, use of an assistant, or radiographic degenerative changes in the dentist's skeleton were not associated with 1-yr prevalence of neck-shoulder or lower back pain and disability. The results provide evidence that physical exercise should be recommended to dentists and might also be applicable to subjects in other occupations with similar requirements.     

Incomplete Restoration of the Bursa-Dependent Immune System After Transplantation of Allogeneic Stem Cells into Immunodeficient Chicks

Transplantation of allogeneic cells from bursa of Fabricius into cyclophosphamide-treated, immunodeficient chicks resulted in immunological tolerance to donor line skin grafts; graft-versus-host disease did not occur. Allogeneic bursal stem cells taken from 3-day-old donors induced restoration of bursal morphology, of antibody formation to Brucella abortus and of occurrence of pyroninophilic cells and immunoglobulin-bearing cells in the peripheral lymphoid tissues. Secondary response to sheep red blood cells and production of germinal centers were not restored. Transplantation of histocompatible bursal stem cells resulted in a complete reconstitution of the bursa-dependent lymphoid system, both in function and in morphology. Allogeneic postbursal stem cells taken from the bursa of 10-week-old donors had a reconstitutive effect only on the production of antibodies to Brucella. Transplanted stem cells maintained their functional potential in the allogeneic environment, since, when transferred back to histocompatible hosts, they displayed normal function. These findings indicate that a complete functional and morphological restoration of the bursa-dependent immune system cannot be achieved without identity of the donor and recipient at loci near to or identical with those determining the major histocompatibility antigens, even though graft-versus-host disease is avoided. This identity permits a full cooperation of the donor and host cells.     

Increased bone marrow blood flow in polycythemia vera

Bone marrow blood flow was measured in polycythemia vera, in compensatory and in relative polycythemia with a ¹³³Xe washout method. In the treated polycythemia vera bone marrow blood flow was significantly increased compared with the age-matched controls. The fraction of blood flow entering the bone and flowing through the hematopoietic marrow was markedly increased in both the untreated and the treated polycythemia vera. Although the number of observations in compensatory and relative polycythemia was small, the results suggest that bone marrow blood flow is not markedly increased in these disease. The results also suggest that in older patients the simple ¹³³Xe method may support the diagnosis of polycythemia vera.     

Meningococcus group A vaccine in children three months to five years of age. Adverse reactions and immunogenicity related to endotoxin content and molecular weight of the polysaccharide.

Vaccination of 21,007 children between the ages of three months and five years was completed with five different lots of the meningococcal group A capsular polysaccharide vaccine. A correlation was found between the frequency and severity of adverse reactions and the endotoxin content of the vaccine lots. All vaccine lots elicited a serum antibody response. The endotoxin content of the vaccines did not correlate with the serum antibody response.     

Mothers' perceptions of and feelings towards their babies' crying

The frequency and type of crying and the parents' perceptions of it were evaluated in 281 Finnish infants underthe age of 1 year. Not many mothers [14#pc] claimed that their babies cried often or very often. The infants less than three months old cried significantly more in the evening than the older ones. Most mothers [94#pc] reported that the crying aroused feelings of tenderness, but 4#pc found it irritating. The most common response to the cry [97#pc] was to pick the baby up. Additional help was wanted by 49 mothers because of their babies' disturbing crying spells. These mothers reorted that their infants cried more and they stated that the cry made them feel more irritated and more often gave them a feeling of failure than the mothers not in need of help. The majority of these mothers would have been glad to help, including advice, whent the infants were under 3 months of age.     

Intrauterine contraception with Nova-T and Copper-T-200 during three years

A randomized comparative trial on the clinical performance of two copper-releasing IUDs (Nova-T and Copper-T-200) was performed simultaneously in Denmark, Finland and Sweden. After three years the cumulative pregnancy rate was 1.9 for Nova-T and 5.0 for Copper-T. This difference in efficacy was statistically significant (p < 0.001). Copper-T had a lower expulsion rate (p < 0.05) in the total series but not in postmenstrual insertions. Differences between the two devices in other termination rates were not statistically significant. Analysis according to age and parity demonstrated that the pregnancy rate of Nova-T was lower than that of Copper-T in every age and parity group. The pregnancy rate of Nova-T was not affected by age or parity whereas the pregnancy rate and the expulsion rate of Copper-T decreased with increasing age and parity. The removal rate because of infection decreased markedly after the first year of use for both devices. The cumulative rate of removals for infection during the three years of use was not significantly correlated to age and there was no correlation to parity. The continuation rates increased with age and parity. The continuation rates of nulli- and primiparous women were almost identical with both devices and lower than continuation rates of women with 2 or three or more children. Only 11% of the women were lost to follow-up during 36 months. Nova-T had superior effectiveness in preventing undesired pregnancies when compared with Copper-T. The performance of Nova-T is less affected by age and parity than the performance of Copper-T. The silver core in copper wire gives a prolongation of the life-span for Nova-T. For these reasons, Nova-T appears to meet the requirements for an ideal IUD.