Risk factors and prevalence of declined work ability among dairy farmers.

Farm work, particularly with livestock, exposes farmers to injuries, occupational diseases, and disabling health conditions, which in many cases result in early retirement and loss of quality of life. The objectives of this study were to evaluate the prevalence of and risk factors for declined work ability among full-time dairy farmers. We conducted a postal survey using the standard Work Ability Index (WAI) questionnaire augmented with a form containing questions about working conditions and lifestyle factors that potentially affect work ability. We received 399 usable responses (245 female and 154 male; 41.5% response rate). The prevalence of declined work ability (poor or moderate WAI score) was 39% overall, 44% among females, and 32% among males. Older age, small herd size, lack of mental breaks from work, inadequate leisure, and non-use of alcohol were significantly associated with declined work ability. The odds ratios for these risk factors ranged from 2.04 to 4.67. Current injuries and diseases are part of the WAI questionnaire contributing to declined work ability. This study indicates that interventions are needed, particularly among older farmers and farmers with injuries or diseases, to restore their work ability. Life-long measures to maintain work ability are also important, preventing the steep decline in work ability currently occurring among older farmers. Based on this study, we recommend guidance addressing the identified risk factors, particularly the importance of organizing both farm and domestic work with adequate rest, leisure time, and mental breaks as counterbalance to the daily workload among livestock farmers.

Pharmacokinetics and bone effects of budesonide in primary biliary cirrhosis.

BACKGROUND/AIM: To evaluate the safety of budesonide in primary biliary cirrhosis. METHODS: 77 primary biliary cirrhosis patients, with stages I-III at entry, were randomized to use either budesonide 6 mg and ursodeoxycholic acid 15 mg/kg (group A), or ursodeoxycholic acid alone (group B) daily for 3 years. In 22 patients, budesonide pharmacokinetics was determined after 3 years. Bone mass density was measured in 62 patients at baseline and 3 years; in 57 patients also liver biopsies were performed. RESULTS: At 3 years, no significant differences in the pharmacokinetics of budesonide were found between the patients with stages 0-I, II and III primary biliary cirrhosis. In group A, bone mass density in femoral neck and lumbar spine were decreased by 3.6% (P = 0.0002) and 2.8% (P = 0.003) from the baseline. In group B, the corresponding decreases were 1.9% (P = 0.029) and 0.7% (P = 0.25), but the differences between the groups were not statistically significant (P = 0.16 for femoral neck and P = 0.08 for lumbar spine). CONCLUSIONS: The plasma concentrations of budesonide do not significantly differ within stages I-III primary biliary cirrhosis patients. The combination of budesonide and ursodeoxycholic acid may decrease bone mass density in the femoral neck and lumbar spine in some primary biliary cirrhosis patients, and bone mass density is recommended to be monitored during budesonide therapy.

Oral contraceptive containing natural estradiol for premenopausal women.

An open multicenter trial was performed in six centers in Finland to study the efficacy, safety and acceptability of a new biphasic oral contraceptive pill containing natural estradiol and cyproterone acetate. The participants were 288 women with a mean age of 39.3 +/- 3.4 years (range 30-49) who were willing to use the new pill as their only contraceptive method. In total, 23% of the women were smokers. The cumulative experience was 2800 treatment cycles during the first year. The net 12-month continuation rate was 63%. One pregnancy occurred in a woman who lost 5 tablets in the second treatment cycle, which gives a 12-month cumulative pregnancy rate of 0.4%. Serum progesterone values, determined twice during the third treatment cycle, showed ovulation inhibition in 95% of women. There were no serious side effects. Intermenstrual bleeding was recorded by 35.5% and 24.5% of women at 3 and 12 months, respectively. The bleedings became scantier in most women and dysmenorrhoea disappeared. No changes were observed in total and high density lipoprotein cholesterol concentrations after 1 year. With the exception of intermenstrual spotting, the efficacy, safety and acceptability of the new pill was almost as good as that of the modern low dose oral contraceptives. This is the first pill containing natural estradiol that has gained clinical acceptance and which can also be prescribed for smokers over 35 years old until the climacteric.

PIP: Gynecologists accepted 288 women aged 30-49 from six different clinics in Finland into a clinical trial of a new biphasic oral contraceptive (OC) containing natural estradiol and cyproterone acetate (manufactured by Leiras Oy, Turku, Finland). They aimed to determine the contraceptive efficacy, safety, cycle control, and acceptability of this OC. 24% of the women smoked cigarettes. Gastrointestinal upset in one woman led to failure to take the fourth and fifth tablets at the beginning of the second treatment cycle. She became pregnant (pregnancy rate = 0.35%). 9.3% and 13.3% of women missed pills at the 3-month and 12-month follow-up visits, respectively. 95% of the women had serum progesterone values lower than 9 nmol/l, indicating ovulation suppression. OC use reduced excessive menstrual bleeding (30% before study vs. 3% after 13 cycles; p 0.0005). It also reduced dysmenorrhea (14% vs. 2%; p 0.0005). No one had any serious side effects. The minor side effects (breast tension, edema, headache, and depression) subsided with time. The 12-month continuation rate was 63%. The main reason for discontinuation was side effects (25.9%). Total serum cholesterol and HDL-cholesterol levels did not change significantly, while serum triglyceride levels increased from 0.92 to 1.14 mmol/l (p = 0.02). Even though serum potassium and creatinine levels changed significantly, the 13-month levels fell within the normal range. These findings show that this new OC is an effective contraceptive for premenopausal women. The absence of adverse effects on the blood coagulation system and lipoprotein metabolism make this new OC safe for smokers.

Prevention of posthysterectomy infection with a combination of preoperative vaginal and perioperative intravenous administration of metronidazole.

In a prospective double-blind study 58 patients received 1000 mg of metronidazole vaginally 12--16 hours preoperatively and 500 mg intravenously during abdominal hysterectomy while 54 patients were treated with placebo. The lack of all operative site infections in the metronidazole group in comparison with 9 infections (17%) in the placebo group (P less than 0.01) proved the combined short-term vaginal and intravenous use of metronidazole to be efficacious in the prevention of posthysterectomy infections.