Backlash in the treatment of cancer pain: use of opioid analgesics in a Finnish general hospital in 1987, 1991, and 1994.

Finland belongs to the group of countries in which the consumption of strong opioids is low. This seems to reflect the general quality of cancer pain treatment. During the last 10 years, many efforts have been made to improve the treatment of cancer pain in Finland. To assess one parameter of change, the present study compared the quantity of opioid and nonopioid analgesics used in the treatment of terminal cancer pain in a Finnish general hospital in 1987, 1991, and 1994. Specifically, the records of all patients who died of cancer in Kymenlaakso Central Hospital (KCH) in 1991 and in 1994 and during the last 6 months of 1987 were reviewed to acquire information about the use of analgesic medication. The total proportion of cancer patients receiving analgesic medication on a regular basis was 39% in 1987, 63% in 1991, and 52% in 1994. The mean daily dose of strong opioids changed from 24 mg in 1987 to 58 mg in 1991, and to 43 mg in 1994. These data suggest a possible backlash in prescribing practices during recent years. In spite of various efforts to improve the treatment of cancer pain, the medical records demonstrate a decline in prescribing of the drugs needed for this treatment.

Field testing of new aerosol sampling method with a porous curved surface as inlet.

A new aerosol sampling method, utilizing a porous curved surface as the sampling inlet, has recently been developed. Previous laboratory evaluations of this method have demonstrated its important features, such as low wind sensitivity and good filter collection uniformity. In this study a prototype incorporating the new method was evaluated in the field as a stationary and personal sampling device. The small sampler, utilizing a 25-mm filter is called the button aerosol sampler and was evaluated for collecting total airborne dust and fungal spores. The study was performed in nine poorly maintained inner-city houses during environmental cleanups at different cleanliness levels. The button sampler was used in parallel with the standard 37-mm closed-face filter cassette. Four collocated samplers of each type were tested at all sites as stationary samplers, and three samplers of each type were tested at two sites as personal samplers. Aerosol samples were collected on filters and analyzed using the gravimetric method for total dust and epifluorescence microscopy for fungal spores. The average particle concentration values measured with the button sampler and with the standard sampling cassette were found to correlate well within ranges of 10(1)-10(3) micrograms/m3 for total dust and 10(3)-10(5) spores/m3 for airborne fungi. The measurement results obtained with the new button sampler showed lower intersample variations of the measured concentration levels and higher uniformity of the particle deposits on the filters than those obtained with the standard cassette.

Effects of ultrafine and fine particles in urban air on peak expiratory flow among children with asthmatic symptoms.

It has been suggested that ultrafine particles in urban air may cause the health effects associated with thoracic particles (PM10). We therefore compared the effects of daily variations in particles of different sizes on peak expiratory flow (PEF) during a 57-day follow-up of 39 asthmatic children aged 7-12 years. The main source of particulate air pollution in the area was traffic. In addition to the measurements of PM10 and black smoke (BS) concentrations, an electric aerosol spectrometer was used to measure particle number concentrations in six size classes ranging from 0.01 to 10.0 microns. Daily variations in BS and particle number concentrations in size ranges between 0.032 and 0.32 micron and between 1.0 and 10.0 microns were highly intercorrelated (correlation coefficients about 0.9). Correlations with PM10 were somewhat lower (below 0.7). All these pollutants tended also to be associated with declines in morning PEF. However, the only statistically significant associations were observed with PM10 and BS. Different time lags of PM10 were also most consistently associated with declines in PEF. Therefore, in the present study on asthmatic children, the concentration of ultrafine particles was no more strongly associated with variations in PEF than PM10 or BS, as has earlier been suggested.

Behavior of Chernobyl fallout radionuclides in peat combustion.

The fallout from the explosion and fire at the Chernobyl nuclear power plant concentrated levels of up to 10 kBq 137Cs kg-1 dry weight in the fuel peat harvested during the summer of 1986 in Finland. We investigated the behavior of fallout radionuclides 137Cs, 134Cs, 106Ru, 144Ce, 125Sb, 95Zr, and 110mAg together with naturally occurring 210Pb and 226Ra in the combustion of this contaminated peat in four different power plants. The elements antimony, ruthenium, lead, and cesium were enriched on the smallest particles, indicating that they were in a volatile chemical form, while cerium, zirconium, and radium were nonvolatile at the combustion temperatures. This result confirms the previous finding that ruthenium is volatile in combustion. Although metallic ruthenium requires 2,310 degrees C to melt, some of its oxides melt and evaporate at much lower temperatures.

Chernobyl fallout in southern and central Finland.

To study the levels and distributions of radionuclides released in the Chernobyl accident, we sampled surface peat from 62 sites in Southern and Central Finland and measured 131I, 134Cs, 137Cs, 132Te, 140Ba, 103Ru, 90Sr, 141Ce, and 95Zr. The distribution of fallout activities was highly uneven, depending on movement of the contaminated air mass and rainfall distribution during the critical days. The highest values observed were 420 kBq m-2 of 131I and 70 kBq m-2 of 137Cs. The nuclide ratios showed wide and partly unexpected variations. The high-boiling-point, or nonvolatile, elements Ce and Zr were spread mostly on a 200-km-wide zone extending across Finland from southwest to northeast. The more volatile elements, I, Ce, and Te, showed quite a different, more widespread, fallout distribution, while an intermediate behavior was observed for Ba, Ru, and possibly Sr. These results can be explained by assuming that pulverized nuclear fuel material released in the reactor explosion on 26 April reached Finland via Poland and the Baltic Sea and traversed the country along the above-mentioned narrow zone, while volatile material, evaporated in the reactor fire from 26 April to 5 May, arrived in several waves and was consequently more widely and evenly spread. From their elemental melting and boiling points, Ru and Mo would appear to belong to the nonvolatile group and Sr to the volatile. Yet, their actual behaviors were opposite; Ru in particular was found in the nonvolatile as well as the volatile fallout, possibly because Ru activities were present in the fuel partly in the metallic state and partly as volatile oxides.

Artificial radioactivity in fuel peat and peat ash in Finland after the Chernobyl accident.

The accident at the Chernobyl nuclear power plant in April 1986 caused very uneven deposition of radionuclides in Finland. The deposited radionuclides were found in relatively high concentrations in fuel peat and especially in peat ash because a thin surface layer of peat-production bogs was extracted as fuel peat soon after the fallout occurred. Concentrations of artificial radionuclides in fuel peat and peat ash were measured at six peat-fired power plants in Finland throughout the heating season 1986-87. Concentrations of 137Cs in composite peat samples varied between 30 and 3600 Bq kg-1 dry weight and in ash samples between 600 and 68,000 Bq kg-1. High concentrations in peat ash caused some restrictions to the utilization of peat ash for various purposes.