Changes in liver graft rejections over time.

Incidence and possible risk factors of acute rejection, time to acute rejection, graft rejection within 3 months, multiple rejections within 1 year, steroid-resistant rejection, and graft lost to chronic rejection or to chronic dysfunction were evaluated in 388 liver transplantations. HLA matches, anti-HLA class I antibodies, positive crossmatch test, or positive cytomegalovirus serology did not have an effect on the occurrence of acute or chronic rejection. Increased total bleeding diminished occurrence of acute rejection, lengthened the time to acute rejection, and reduced the risk of steroid-resistant rejection. Immunological pretransplant factors did not have a major effect on the occurrence of rejection after liver transplantation. Different types of rejections diminished over time and the time period to the first acute rejection increased, although the basic immunosuppression stayed mainly the same over 20 years in our center.

Risk factors predicting survival of liver transplantation.

Prognostic models were developed for analyzing graft survival in a single-center study consisting of all 388 adult liver transplantations performed during 20 years. Proportional hazard models and generalized linear models were used to assess which risk factors, related to donor and recipient characteristics as well as graft preservation and operation, had an effect on graft survival. The prognostic modeling evidenced favorable trends in graft survival time during the successive quinquennials 1982-1987, 1988-1992, and 1993-1997, in comparison to the referent time period 1998-2002. Significant predictors of graft survival time were donor's age, recipient-donor gender compatibility, recipient's blood group, intraoperative blood transfusion, size of the transplanted organ, and indication for transplantation. Conventional histocompatibility matching did not correlate with graft outcome.

Mortality from occupational exposure to environmental tobacco smoke in Finland.

This article aimed to estimate the mortality from exposure to passive smoking at work in Finland. The estimation used statistics on causes of death, exposure prevalences, and risk ratios from epidemiologic studies. The attributable fractions of cause-specific mortality from passive smoking at work were 2.8% for lung cancer, 1.1% for chronic obstructive pulmonary disease, 4.5% for asthma, 3.4% for ischemic heart disease, and 9.4% for cerebrovascular stroke. Altogether, about 250 fatalities were estimated to have occurred in 1996. This is approximately 0.9% of the total mortality in the Finnish population in the relevant disease and age categories. The magnitude of mortality related to past occupational exposure to passive smoking is considerable. Preventive measures to reduce environmental tobacco smoke in the workplace will be a powerful means of reducing the high burden of respiratory and cardiovascular diseases.

Mortality of doctors: do doctors benefit from their medical knowledge?

Official population and mortality statistics show that overall mortality of male doctors in Finland in 1971-80 was lower than that of all economically active men. Doctors had lower death rates from cardiovascular disease, tumours, other diseases, causes of death amenable to medical interventions, and accidents and violence, but not suicide. Except for tumours, mortality of male doctors was at the same level or higher than that of men in other professions. Risk of suicide was twice as high for male doctors as for other professions. The numbers of women doctors were too small for firm conclusions about their mortality to be drawn. It is concluded either that doctors do not use their professional knowledge and skills in a way that reduces their own mortality risk or that they are exposed to occupational hazards that cancel out such an effect. Possible hazards are more likely to be mental than physical or chemical.

Respiratory cancers and chemical exposures in the wood industry: a nested case-control study.

A cohort of 3805 men who had worked for at least one year in the particleboard, plywood, sawmill, or formaldehyde glue industries between 1944 and 1965 was followed up until 1981. From within the cohort the 57 patients with verified "respiratory" cancer (ICD 7 codes: 160-162.1, 141, 143-8) were defined as "cases," and 171 men without respiratory cancer from within the cohort were matched on birth year and used as controls. The comparison of exposures was carried out according to work histories and job exposure matrices for each plant. The odds ratio for exposure to wood dust was 1.03 (32 exposed cases) without provision for any latent period, and 0.97 (27 exposed cases) when provision for a minimum latent period of ten years was applied. The odds ratios were 1.60 and 1.68, respectively, when smoking was controlled by stratification. These results did not differ significantly from unity. The estimated average level of exposure to wood dust among the exposed was 1-2 mg/m3 and the mean duration of exposure about ten years. Significantly (one sided test, 5% level) raised odds ratios were observed for exposure to pesticides and phenol. No single pesticide could be identified as "causative" because of frequent multiple exposures. The raised odds ratios for phenol were partly explained by smoking and exposure to pesticides which confounded the observed associations for phenol exposure. Exposure to terpenes and other heating products of coniferous woods was significantly associated with a risk of respiratory cancer when the duration of exposure exceeded five years.