Effects of liver's state of health on its iron and plutonium content.

PURPOSE: Plutonium and iron share a common metabolism in terms of their transportation and accumulation in the human body. This study examined their concentrations in livers with different states of health, and the effects of fatty degeneration and cirrhosis on their accumulation in the liver. MATERIALS AND METHODS: We determined the concentrations of plutonium and iron in autopsy liver samples from 1976-1979. Using statistical analysis, we investigated the relationships between the different variables. RESULTS AND CONCLUSIONS: The burdens of 239,240Pu and Fe correlated positively (Rs = 0.411) in the healthy livers, but not in the livers that had pathological findings. In contrast to the Fe content, the 239,240Pu content in the fatty degenerated or cirrhotic livers was significantly lower than that in normal livers. This difference may suggest that plutonium and iron do not accumulate or are not excreted in the same way in fatty degenerated and cirrhotic livers. The reaction mechanisms for the binding and excretion of plutonium, particularly in a fatty degenerated liver, are not yet fully known.

Cancer Incidence of Finnish Sami in the Light of Exposure to Radioactive Fallout.

This article summarizes the results of studies on the exposure of the Finnish Sami people to radioactive fallout and the estimations of the related cancer risk. We also discuss the lifestyle, genetic origin and diet of this population. The Sami people are an indigenous people who live in the northern part of Scandinavia and Finland. The review is based on the available scientific literature of Finnish Sami. The traditional Sami diet, high in animal products, persists in Sami groups still involved in reindeer-herding, but others have adopted the typical diet of western cultures. Studies have consistently shown an overall reduced cancer risk among the Finnish Sami people, except for stomach cancer among the Skolt Sami. Common cancers among the Finnish main population, such as prostate, breast and skin cancer are especially rare among the Finnish Sami. The incidence of cancer among the Finnish Sami are mostly similar to those of the Swedish and Norwegian Sami. To conclude, we observed no effect of radioactive pollution on cancer incidence. The lifestyles and environments of the Sami are changing, and their cancer mortality rate today is similar to that of the majority of the Finnish and western population.

An analysis of dental patient safety incidents in a patient complaint and healthcare supervisory database in Finland.

OBJECTIVE: Few studies of patient harm and harm-prevention methods in dentistry exist. This study aimed to identify and characterize dental patient safety incidents (PSIs) in a national sample of closed dental cases reported to the Regional State Administrative Agencies (AVIs) and the National Supervisory Authority for Welfare and Health (Valvira) in Finland. MATERIALS AND METHODS: The sample included all available fully resolved dental cases (n = 948) during 2000-2012 (initiated by the end of 2011). Cases included both patient and next of kin complaints and notifications from other authorities, employers, pharmacies, etc. The cases analyzed concerned both public and private dentistry and included incident reports lodged against dentists and other dental-care professionals. Data also include the most severe cases since these are reported to Valvira. PSIs were categorized according to common incident types and preventability and severity assessments were based on expert opinions in the decisions from closed cases. RESULTS: Most alleged PSIs were proven valid and evaluated as potentially preventable. PSIs were most often related to different dental treatment procedures or diagnostics. More than half of all PSIs were assessed as severe, posing severe risk or as causing permanent or long-lasting harm to patients. The risk for PSI was highest among male general dental practitioners with recurring complaints and notifications. CONCLUSIONS: Despite some limitations, this register-based study identifies new perspectives on improving safety in dental care. Many PSIs could be prevented through the proper and more systematic use of already available error-prevention methods.

Can patients detect hazardous dental practice? A patient complaint study.

PURPOSE: The purpose of this paper is to: determine the prevalence and distribution of patient/family-generated, dentistry-related complaints to Regional State Administrative Agencies (AVIs) and the National Supervisory Authority for Welfare and Health (Valvira) in Finland from 2000 to 2011, study patient/family safety incident experiences and other reasons for complaints, assess complaint validity and evaluate factors associated with disciplinary processes against dentists. DESIGN/METHODOLOGY/APPROACH: Data included closed cases handled by AVIs and Valvira (2000-2011) against dental practitioners or dental practice units (n=782). The authors analysed the complaints distribution and examined the antecedent factors and circumstances. FINDINGS: This study demonstrated that patients/families can detect many dental treatment hazards, substandard processes and even serious safety risks rather well. The investigation processes revealed some physical harm or potential patient safety (PS) risks in more than half the alleged cases. Many complaints accumulated against certain individuals and statistically significant positive correlations were found between some patient/family complaints, dentist-specific variables and disciplinary actions. PRACTICAL IMPLICATIONS: Patient/family-generated complaints must be taken seriously and seen as relatively good safety risk indicators. However, more knowledge on how patients might cooperate with dental care providers to prevent errors is needed. ORIGINALITY/VALUE: This work provides a unique opportunity to learn from several dentistry-related patient complaints. Despite some limitations, patient complaints appear to be useful as a complementary source together with other PS study methods.

Patient safety incident prevention and management among Finnish dentists.

OBJECTIVE: Assessing current patient safety incident (PSI) prevention measures and risk management practices among Finnish dentists. MATERIALS AND METHODS: A total of 1041 dentists practicing in the private or public sectors in southern Finland completed an online questionnaire concerning PSI prevention, PSI-reporting systems, feedback and knowledge gained from device incidents and patient-generated safety information and the knowledge of national PS-guidance. The answers were handled anonymously. Statistical evaluations were performed using chi-square analysis. RESULTS: Dentists suggested multiple methods for preventing PSIs related to dental diagnostics, various treatments, equipment and devices, medications, communication, infection control and general practice safety. Preventive methods reported most frequently included working with caution and forethought, keeping accurate patient records and the availability of correct patient information. A special PSI-reporting system was used by less than one third of respondents. Feedback received on PS-related data and the utilization of guidebooks varied significantly between the studied dentist groups. CONCLUSIONS: Several PSI prevention techniques are already used in Finland. However, wide variation exists in PSI prevention and risk management practices among Finnish dentists. Systematic implementation of available safety methods would probably prevent several PSIs. The results indicate that the more dentists know about PS risks, the easier it is for them to recognize situations possibly leading to patient harm. Anonymous PSI reports, patient complaints and claims data should, therefore, be actively used for mutual learning. Increased PS education in dentistry is also needed.

Otorhinolaryngological patient injuries in Finland.

OBJECTIVES/HYPOTHESIS: Otorhinolaryngology (ORL) is considered a specialty associated with few serious patient injuries. Research data that support this belief are, however, scarce. We analyzed claims associated with ORL to determine the number of Finnish cases and the possible common denominators. STUDY DESIGN: Register study of ORL cases in the Patient Insurance Centre (PIC), the Regional State Administrative Agencies (RSAA), and the National Supervisory Authority for Welfare and Care (Valvira) during the years 2004 to 2008. METHODS: These three agencies are the main actors in the field of patient injury in Finland. We analyzed compensated ORL patient injury cases from the PIC and cases associated with the ORL specialty for Valvira and RSAA from 2004 to 2008 and surveyed patient treatment files, statements from specialists, and compensation decisions. RESULTS: Injuries were usually associated with operations; three patients who experienced injuries during these procedures died. Common ORL operations such as tonsillectomy, septoplasty, and paranasal sinus surgery were most often associated with compensated injuries. Serious injuries were few, with a total of 110 out of 422 (26.1%) claims compensated by the PIC. Of the 110 compensated cases, 30 (27.3%) were related to tumor surgery. The most usual compensated case had iatrogenic nerve injury affecting the facial or trigeminal nerves. Of the compensated cases, 79 (71.8%) were treated by specialists, 15 (13.6%) by residents, and the rest by other medical professionals. CONCLUSIONS: Patient injuries in ORL are seldom severe and are strongly associated with surgery. A typical compensated injury was one that occurred in a central hospital during working hours. LEVEL OF EVIDENCE: N/A.

Noise sensitivity and disability retirement: a longitudinal twin study.

OBJECTIVE: To analyze whether noise sensitivity increases the risk of disability pension (DP). METHODS: Questionnaire data of a sample of 706 Finnish twin individuals (age range, 31 to 65 years) with record linkage to information on DP during 16 years of follow-up were analyzed using individual and pairwise Cox proportional hazards models. RESULTS: Noise sensitivity increased the risk of DP (hazard ratio = 1.41; 95% confidence interval [CI]: 1.03 to 1.93) and DP due to musculoskeletal disorders (hazard ratio = 1.63; 95% CI: 1.00 to 2.66). In within-pair analyses, noise sensitivity increased the risk of DP: among all twin pairs, odds ratio was 1.80 (95% CI: 1.08 to 3.06). CONCLUSIONS: Noise sensitivity may be a potential risk factor for disability retirement. It is associated with DP independently of familial background and genetic factors.

Patient safety incidents reported by Finnish dentists; results from an internet-based survey.

BACKGROUND: Few data are available on dental patient safety (PS), as most PS studies have focused on other activities in health care. OBJECTIVE: To detect types and causes of dental PS incidents (PSIs), including adverse events (AEs) and near misses (NMs), in Finnish dental care. MATERIAL AND METHODS: Altogether 1041 privately or publicly employed dentists in southern Finland completed a structured questionnaire using an internet-based system (Webropol) in 2010. RESULTS: Nearly one third of the dentists reported some PSI in the previous 12 months. Of the 872 reported events, 53% were classified as AEs, 45% as NMs and 2% remained unclassified. Nearly half of the PSIs had occurred during some form of dental treatment. One third of the AEs were related to dental equipment, devices and supplies. Most of the reported AEs resulted in little or no permanent harm to patients. However, 13% of AEs were considered as serious enough to potentially cause severe harm or did in fact cause permanent harm. CONCLUSIONS: Reported dental PSIs in Finland are in many respects similar to those reported in other countries. Compared to all annual dental visits in Finland, severe dental AEs seem to be relatively rare. Less severe AEs and NMs are not uncommon, especially in dental surgery, endodontic and restorative treatment. The results of this retrospective study, however, reveal more about incident types than their true prevalence and that further studies on dental PS are needed.

Noise sensitivity and multiple chemical sensitivity scales: properties in a population based epidemiological study.

Noise sensitivity is considered to be a self-perceived indicator of vulnerability to stressors in general and not noise alone. Multiple chemical sensitivity (MCS) has to some extent been accompanied by noise sensitivity, indicating a moderate correspondence between them. The aim of this study is to investigate if the Weinstein's Noise Sensitivity Scale and Quick Environmental Exposure and Sensitivity Inventory's (QEESI) Chemical Intolerance Subscale can differentiate noise sensitivity and MCS as different entities, and if there are overlaps in the characteristics of noise sensitivity and MCS. In 2002, 327 individuals (166 men, 161 women; age range 45 - 66 years) from the Finnish Twin Cohort answered a questionnaire on noise-related and MCS items. Somatic, psychological, and lifestyle factors were obtained through earlier questionnaires for the same individuals. Both confirmatory and exploratory factor analyses (CFA and EFA) of the questionnaire items on the Weinstein's Noise Sensitivity Scale and QEESI's Chemical Intolerance Subscale indicated the presence of three factors - Noise Sensitivity, Chemical Sensitivity, and Ability to Concentrate factors - arising from the forming of two factors from the items of the Weinstein's scale. In the regression analyses, among all subjects, the Noise Sensitivity Factor was associated with neuroticism and smoking, and the Chemical Sensitivity Factor was associated with allergies and alcohol use. The study indicates that the Weinstein's Noise Sensitivity Scale and QEESI's Chemical Intolerance Subscale differentiate noise sensitivity and MCS as different entities.

Noise sensitivity and hearing disability.

The aim of this study was to investigate the association of noise sensitivity with self-reported hearing disability and hearing levels, with consideration of the role of self-reported history of noise exposure and use of hearing protectors. The study is based on the Finnish Twin Cohort. In 1988, a noise questionnaire was sent to 1005 twin pairs, 1495 individuals (688 men, 807 women) replied. The age range was 31-88 years. Information on some potential confounders was obtained from the questionnaire in 1981 for the same individuals. A subsample of thirty-eight elderly women with noise sensitivity response from 1988 had audiometry data from 2000 to 2001. Noise sensitivity was associated with self-reported hearing disability among all subjects [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.14-2.12] and among women (OR 1.90, 95% CI 1.19-3.04), but no-more significantly among men (OR 1.31, 95% CI 0.86-1.98). The association was primarily seen among younger subjects (50 years or less). The difference between noise sensitive and non-noise sensitive elderly women in the average of thresholds at frequencies of 0.5-4 kHz in the better ear was not significant (Pr = 0.18). Noise sensitivity did not modify the association of hearing disability with the self-reported history of occupational noise exposure. Noise sensitivity was associated with the use of hearing protectors at work. The study shows the importance of recognizing the noise sensitive in noise effect studies, since sensitivity in annoyance has implications in most of the effect categories.

Patients referred to an indoor air health clinic: exposure to water-damaged buildings causes an increase of lymphocytes in bronchoalveolar lavage and a decrease of CD19 leucocytes in peripheral blood.

BACKGROUND: Respiratory and other symptoms are often associated with exposure to microbes present in water-damaged buildings. MATERIAL AND METHODS: We examined 82 consecutive patients referred to the Indoor Air Clinic, Helsinki University Hospital, due to symptoms suspected of having been caused by long-term exposure to water damage in the home or workplace. Exposure to water damage was assessed by building inspections and microbial analyses as needed. Bronchoalveolar lavage, lung function measurements, skin prick tests to inhalant allergens and radiological examinations were performed in all patients. Leucocyte subsets in peripheral blood were analysed in 35 patients. RESULTS: Marked water damage was detected in the homes or workplaces of 47 (59%) patients; the remaining 34 patients formed the control group. The exposed group expressed more symptoms in total than the control group: fatigue, conjunctival symptoms, rhinitis with sinusitis, recurrent bronchitis and asthma were more common in the exposed group, but a significant difference was seen only for headache. In BAL (bronchoalveolar lavage) samples, lymphocytes represented 25% of the total cell population in non-smoking-exposed patients compared with 12% in control patients (p=0.004). In peripheral blood, CD19 leucocytes were significantly decreased in the exposed group (7.5% versus 12.3%; p<0.01). CONCLUSIONS: Confirmed exposure to water damage was associated with an increase in symptoms. Exposure to water damage caused a significant change in the cellular composition in BAL fluid (lymphocytosis) and blood (decrease of CD19 cells). The depletion of CD19 leucocytes in peripheral blood may indicate an active immune response in the lungs.

Low tumor necrosis factor alpha levels and neutrophil counts in nasal lavage after mold exposure.

BACKGROUND: The results of allergy tests against molds usually remain negative in patients with upper respiratory tract and conjunctival symptoms after microbial exposure in a water-damaged building. Most mold-exposed persons report nasal irritation. Immune mechanisms of the nasal symptoms have not been fully elucidated. OBJECTIVE: To investigate local inflammatory responses after mold exposure in the upper respiratory tract and the feasibility of nasal lavage in diagnosing work-related exposure. METHODS: Altogether, 26 mold-exposed and 20 nonexposed workers from the same hospital were selected for the present study. The work premises of the exposed workers had detectable moisture and microbial problems. All exposed workers and their nonexposed controls underwent clinical examination, laboratory tests to detect allergy to molds, and nasal lavage. Inflammatory cells and proinflammatory cytokines were measured in the nasal lavage fluid. Nasal lavages were performed again 6 months after a thorough renovation of the building. RESULTS: In the nasal lavage, the neutrophil count and the level of tumor necrosis factor alpha in the exposed employees were lower, whereas the macrophage and epithelial cell counts were higher than in the control group. After the renovation, no difference was found in inflammatory response between the study group and the control group. The mean concentration of serum IgG to Stachybotrys chartarum was higher in the exposed workers. CONCLUSIONS: These results suggest that exposure to toxin-producing microbial growth in a water-damaged building caused immunosuppression in nasal mucosa, leading to a decrease in neutrophil counts and tumor necrosis factor alpha levels. Nasal lavage is a suitable method for examining inflammatory responses in work-related mold exposure.

The association of noise sensitivity with coronary heart and cardiovascular mortality among Finnish adults.

The association of coronary heart and cardiovascular mortality with noise sensitivity was studied. We also investigated how this association is affected by self-reported lifetime noise exposure. In 1988 a case-control study, based on the Finnish Twin Cohort, was carried out to investigate the relationship between noise and hypertension (n=1495). Potential confounders were obtained from questionnaire in 1981 for the same individuals. Data on deaths and causes of death were obtained from record linkage to the nationwide register of death certificates. All deaths that occurred among the study population during the 15 years of follow-up were classified as being due to all causes (n=382), to cardiovascular diseases (n=193), including the number of deaths due to coronary heart diseases (n=111) and to other causes than cardiovascular diseases (n=189). Cardiovascular mortality (Hazard ratio 1.80, 95% CI 1.07-3.04) was significantly increased among noise-sensitive women. Among men, there were no statistically significant effects. Noise sensitivity may be a risk factor for cardiovascular mortality in women.

Genetic component of noise sensitivity.

We investigated the genetic component of noise sensitivity using a twin-study design. The study sample consisted of 573 same-sexed twin pairs from the Finnish Twin Cohort. The 131 monozygotic (MZ) and 442 dizygotic (DZ) twin pairs with an age range of 31 to 88 years replied to a questionnaire on noise and health-related items in 1988. The noise sensitivity of respondents was defined as high, quite high, quite low or low. MZ pairs were more similar with regards noise sensitivity than DZ pairs, and quantitative genetic modeling indicated significant familiality. The best z-fitting genetic model provided an estimate of heritability of 36% (95% CI = .20-.50) and when hearing impaired subjects were excluded this rose to 40% (95% CI = .24-.54). In conclusion, noise sensitivity does aggregate in families and probably has a genetic component.

Good practices in managing work-related indoor air problems: a psychosocial perspective.

BACKGROUND: Indoor air problems at workplaces are often exceedingly complex. Technical questions are interrelated with the dynamics of the work community, and the cooperation and interaction skills of the parties involved in the problem solving process are also put to the test. The objective of our study was to analyze the process of managing and solving indoor air problems from a psychosocial perspective. METHODS: This collective case study was based on data from questionnaires, interviews and various documentary materials. Technical inspections of the buildings and indoor air measurements were also carried out. RESULTS: The following four factors best differentiated successful cases from impeded cases: extensive multiprofessional collaboration and participative action, systematic action and perseverance, investment in information and communication, and process thinking and learning. The study also proposed a theoretical model for the role of the psychosocial work environment in indoor air problems. CONCLUSIONS: The expertise related to social and human aspects of problem solving plays a significant role in solving indoor air problems. Failures to properly handle these aspects may lead to resources being wasted and result in a problematic situation becoming stagnant or worse.

Somatic and psychological characteristics of noise-sensitive adults in Finland.

The authors examined the relationship of noise sensitivity with health status and psychological factors in individuals <70 yr of age in Finland. Subjects (n = 1,355) were selected from a 1988 case-control study, based on the Finnish Twin Cohort, that assessed noise sensitivity, lifetime noise exposure, and hypertension. Other health status and psychological factors were obtained from a questionnaire that had been administered to the same individuals in 1981. Statistical analysis showed that noise sensitivity was associated significantly with hypertension, emphysema, use of psychotropic drugs (i.e., sleeping pills, tranquilizers, and pain relievers), stress, smoking, and hostility, even after adjustment for lifetime noise exposure. These results indicate that noise sensitivity has both psychological and somatogenic components.

IgE-mediated allergy to fungal allergens in Finland with special reference to Alternaria alternata and Cladosporium herbarum.

BACKGROUND: Alternaria alternata and Cladosporium herbarum are common fungi in outdoor environments, but their clinical significance has not been elucidated in Finland. OBJECTIVE: To evaluate the prevalence of IgE-mediated allergy and clinical outcomes caused by sensitization to fungal allergens in patients with suspected allergy. METHODS: Skin prick tests (SPTs) were performed with C. herbarum in 6,376 patients and also with A. alternata in 1,504 of these patients. SPTs were repeated in 40 patients who showed a positive reaction to either allergen using commercial and in-house extracts. The association of SPT with allergen-specific IgE antibodies in serum was evaluated. Seven patients also underwent a conjunctival challenge test with these fungal allergens. RESULTS: The prevalence of positive SPT results to A. alternata and C. herbarum was low (2.8% and 2.7%, respectively). Among the 40 patients, atopic eczema/dermatitis syndrome was found in 58%, asthma in 44%, and rhinitis in 31%. Most of the patients displayed SPT reactions also to several other fungal allergens, and 75% to 80% showed a positive SPT reaction to allergens of pet animals or pollens. Four patients had a positive reaction to A. alternata and 6 to C. herbarum in the conjunctival challenge test. CONCLUSION: In the Finnish population with allergic symptoms, IgE-mediated sensitization to 2 common fungal allergens was rare and of minor clinical importance. SPT reactions to fungi are mostly observed in patients with multiple sensitivity to various allergens.

Smoking and associated factors among adolescents in Tallinn, Helsinki and Moscow: a multilevel analysis.

AIMS: To investigate variations in smoking and associated factors on individual and aggregate level among adolescents in Tallinn (Estonia), Helsinki (Finland) and Moscow (the Russian Federation). METHODS: The data was collected in Tallinn (N=1268 in Estonian and N=901 in Russian schools), in Helsinki (N=1396) and in Moscow (N=618) from pupils aged 13-18 by self-administered questionnaire. Multilevel analysis was used to estimate the possible effects of background characteristics, of the proximity of other smokers and the school context on the tobacco use of pupils. RESULTS: The prevalence rate of smoking among girls in Russian schools in Tallinn (34.6%), among girls in Helsinki (39.5%), and in Moscow (32.1%) was higher than that among girls in Estonian schools in Tallinn (17.6%). Smoking was slightly less prevalent among boys in Helsinki (27.5%), compared to boys in Estonian (33.6%) and Russian (35.6%) schools in Tallinn, and to boys in Moscow (32.8%). Smoking increased with age. Multilevel analysis showed that smoking differed by school among pupils. Individual determinants of smoking as study site, grade, friends', siblings' and parental smoking behaved differently depending upon school. Friends and siblings' smoking showed interaction with study site to the smoking among girls. CONCLUSIONS: Strategies aimed at influencing smoking behaviour need to be directed not only towards the individual, but also towards the influences within the child's school environment.

Phytosterols affect endocrinology and metabolism of the field vole (Microtus agrestis).

Phytosterols or plant sterols (PS) enter the ecosystem via pulp mill effluents. They are also consumed by the general population of developed countries in natural remedies and margarines to lower elevated serum cholesterol levels. This study screened the endocrine and enzymatic parameters of the field vole (Microtus agrestis) for the effects of subchronic PS exposure at three doses (0, 5, or 50 mg of PS kg(-1) day(-1)). PS at 5 or 50 mg kg(-1) day(-1) decreased the relative liver weight of the voles. The kidney glycogen phosphorylase activity decreased at 5 or 50 mg kg(-1) day(-1), but the liver glycogen phosphorylase activity increased at 5 mg kg(-1) day(-1). The plasma estradiol and testosterone concentrations of males were higher due to PS supplement at 5 mg kg(-1) day(-1). This can be due to increased sex steroid synthesis from PS precursors. Biotransformation enzyme activities were not affected. PS caused multiple, previously unreported effects that were more pronounced at a low dose. As 5 mg PS kg(-1) day(-1) is the recommended dose for various health products, a thorough risk assessment of the effects and interactions of PS is warranted.

In vivo effects of bisphenol A on the polecat (mustela putorius).

Bisphenol A (BPA), an environmental estrogen derived from the plastic industry, was given orally via incorporation into the food of 30 male and female polecats at 3 different doses (10, 50, or 250 mg/kg body weight/day) for 2 wk with 10 animals acting as controls. Several hormone levels in the plasma were determined as well as the activities of the phase I and II biotransformation enzymes 7-ethoxyresorufin O-deethylase (EROD), cytosolic glutathione S-transferase (GST), and UDP-glucuronosyltransferase (UDPGT). BPA did not cause any macroscopic effects on body mass or the health of the animals. UDPGT and GST activities increased significantly in direct correlation with increasing BPA exposure in females and UDPGT increased in a dose-related manner in males. There was no change in the plasma T4 and testosterone concentrations of the males with increasing BPA exposure. Discriminant analysis indicated that the group receiving 10 mg BPA/kg body weight/d was not different from the control group but the groups receiving 50 and 250 mg/kg body weight/d were different from the control group. This suggests physiological changes in the groups receiving 50 or 250 mg BPA/kg body weight/d.