Cardiorespiratory fitness in a representative sample of Belgian firefighters.

BACKGROUND: An important aspect of occupational health surveillance of firefighters is cardiorespiratory fitness. In Belgium, representative data on firefighters' cardiorespiratory fitness assessed in a standardized way are lacking. AIMS: To report data on cardiorespiratory fitness, body mass index (BMI) and total body fat percentage in a large cohort of Belgian firefighters; to relate the data on cardiorespiratory fitness to the new Belgian criteria and to explore the relationship of cardiorespiratory fitness with age, BMI and total body fat. METHODS: VO2-max was assessed in male firefighters by maximal exercise test on a treadmill. Total body fat percentage was assessed by dual-energy X-ray absorptiometry. Stratified analyses of mean VO2-max and proportions of subjects that did not meet the criteria were performed for different age, total body fat percentage and BMI categories. Relationships between VO2-max and the continuous variables were explored in univariate (correlation coefficients) and multivariate analyses (multiple linear regression analysis). RESULTS: In 1225 participating firefighters (96% participation rate), mean VO2-max was 46.5 ml/kg/min. Percentages of subjects that did not meet the criteria ranged from 1 to 83% depending on age, BMI and total body fat percentage. Both in univariate and multivariate analyses, strongly significant relationships were found between VO2-max and age, BMI and total body fat percentage, the latter being the strongest predictor. CONCLUSIONS: The study provided representative data on cardiorespiratory fitness, BMI and total body fat percentage for Belgian firefighters. The findings suggest the need for a structural approach on healthy eating and regular physical exercise in firefighters.

Pediatric renal transplantation in the Netherlands.

In the Netherlands, pediatric kidney transplantation programs are available in four centers. We retrospectively analyzed the results obtained over the past decade. Between 1985 and 1995, 231 patients (139 boys) received 269 transplants, including 61 repeat. The recipients were aged 1.9-21.8 yrs (mean 10.9), the donors 0.3-63.3 yrs (median 11.4, mean 19.7). Immunosuppression consisted of corticosteroids, cyclosporin A and azathioprine, in various combinations and dosages. The patient survival during follow-up was 97%. The overall graft survival was 73% at 1 yr and 60% at 5 yrs after transplantation. Major causes of graft loss were acute rejection (21%), thrombosis (12%) and chronic rejection (28%). Acute rejection episodes were noted in 74% of all grafts. First acute rejection episodes had a moderate predictive value for graft loss (relative risk (RR), compared to rejection-free grafts, 5.9). First rejection episodes occurring later than 3 months after transplantation were considerably more predictive (RR 18.3) than early ones. Grafts from living related donors (n = 35) yielded a superior 5-yr graft survival (77%) and remained free of rejection more often than grafts from adult cadaveric donors(43% vs. 25%). The results of pre-emptive transplants were excellent (n = 13, 5-yr survival 100%). Repeat transplants had the same results as primary transplants. Recipients younger than 4 yrs showed a poor 5-yr graft survival of 38% (n = 13). Single kidney grafts from donors younger than 4 yrs (n = 35) had a 5-yr graft survival of 44%. In contrast, kidneys from these young donors did well if transplanted en bloc (n = 10, 5-yr graft survival 89%). These overall results are in line with those of others. The results may be improved by expansion of immunosuppressive therapy in the first year and by thrombosis prophylaxis in high-risk patient-donor combinations. Better results may be expected from more extensive use of living related donations, pre-emptive transplantation and en bloc transplantation instead of single kidneys of young donors.

Examination of Raynaud's phenomenon in traumatic vasospastic disorders.

Certain types of occupation-related vibrations can cause traumatic vasospastic disorders. Findings from clinical examination are often normal at the office consultation. Measurements of finger blood flow using plethysmography while the local ambient temperature is changed can give important information about the severity of traumatic vasospastic disorder and the concomitant disability. This technique can also be used for follow-up of the finger blood flow after withdrawal from vibrations.