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PubMed1992

[Psychological methods in the evaluation of neurotoxic effects of organic solvents].

Organic solvents comprise a large and heterogenous group of chemical compounds and mixtures, largely belonging to volatile hydrocarbons. They are widely used in various industries. Long-term exposure to organic solvents as a cause of the central nervous system impairement has been subject of extensive epidemiological and clinical studies for years, especially in Scandinavia, but often with inconsistent results. In 1985 the World Health Organization published the criteria for the evaluation of neurotoxic effects of solvents that are now commonly accepted. The present paper provides a short review of the current state of knowledge in the field emphasizing the role of neuropsychological methods in assessing solvent toxicity.

Central Nervous System↗
PubMed2004

Self-reported food hypersensitivity in Sweden, Denmark, Estonia, Lithuania, and Russia.

AIM: The main aim of the study was to describe the differences between some Northern countries regarding what foods, according to the patients, elicit hypersensitivity symptoms. METHODS: At the participating clinics, patients with a history of food hypersensitivity (n = 1139) were asked to fill in a questionnaire in which 86 different foodstuffs were listed. Skin-prick tests (SPT) were performed with common inhalant allergens. RESULTS: The foods that were reported as eliciting symptoms differed between countries. In Russia, Estonia, and Lithuania; citrus fruits, chocolate, honey, apple, hazelnut, strawberry, fish, tomato, egg, and milk were most often reported as causes of hypersensitivity. In Sweden and Denmark; birch pollen (BP) related foods, such as nuts, apple, pear, kiwi, stone fruits, and carrot were the most common causes. In all countries, children, more often than adults, had symptoms of allergic reaction to citrus fruits, tomato, strawberry, milk, egg, and fish. Most patients (95%) reported hypersensitivity to several foodstuffs (median: eight foods). The most common symptoms were oral allergy syndrome and urticaria. Severe symptoms were most common with fish, shellfish, nuts, and milk. Slight symptoms were most common with rice, coriander, poppy seed, lingonberry, corn, caraway red currant, and fig. Earlier well-known correlations, such as that between BP sensitization and some fruits and vegetables, as well as that between mugwort and some spices, were conoborated. Positive correlations were found between self-reported hypersensitivity to crustaceans and SPT with horse. A negative correlation was seen between hypersensitivity to crustaceans and SPT with BP. CONCLUSIONS: The foodstuffs that often are reported to cause food hypersensitivity, differ between Sweden/Denmark on one side and the Baltic States and Russia on the other. BP-related foods dominate in Scandinavia, whereas some mugwort-related foods are of more importance in Russia and the Baltic States.

Adolescent↗
PubMed2004

Total ankle replacement.

29 patients underwent 30 Scandinavian Total Ankle Replacements (STAR) by a single surgeon, over a four year period (1997 to 2001). There were 12 primary osteo arthritic patients with 6 post traumatic. The mean age of these 18 patients was 73. Eleven patients had rheumatoid arthritis and these had a mean age of 58 years at the time of surgery. One patient had bilateral replacements giving a total of 30 prostheses inserted. On review dorsiflexion had increased from a mean of 7 to 11 degrees while plantar flexion from 15 to 24 degrees. The American Orthopaedic Foot and Ankle hindfoot score was 95 (maximum 100) and the Kofoed ankle score revealed 17 excellent, 5 good and 4 fair. No patients had radiological evidence of loosening. Our intermediate term result for the STAR (W. Link GmbH & Co., Hamburg, Germany) ankle replacement has yielded 90% excellent and good functional outcomes in a mixed osteo arthritic and rheumatoid population which mirrors the results of those published from Scandinavia.

Adult↗
PubMed1992

Neonatal Proteus meningoencephalitis. Case report.

Proteus is an uncommon pathogen in neonatal meningitis and has, to our knowledge, not previously been described from Scandinavia. Our case illustrates the typical course of the disease when onset is within the first two weeks of life. The typical patient is a previously healthy, sometimes slightly preterm infant, who develops multiple brain abscesses and has a very poor prognosis. In cases with a later onset, factors predisposing for infection are common and the outcome is less severe. Our patient was a girl born at a gestational age of 36 full weeks, who was a little less alert than normal during the first three days and then became dramatically sick with convulsions and apnoeas. She died at the age of six days with severe brain damage.

Brain↗
PubMed2004

[Vitamin and minerals supplements--required for good health?].

Both laymen and the learned are discussing the need for vitamin and minerals supplements and their eventual preventive and therapeutic potential. Documentation is needed, but this word is most of the time used without clarifying the criteria it is based on. In this article we use vitamin E in order to illustrate that there is generally a long way to go from initial hypothesis to eventual practical advice and recommendations. Promising cell and animal studies combined with epidemiological observation studies are not sufficient as evidence; randomised intervention studies are required before conclusions can be drawn. Because high intakes of vitamins and minerals can have negative health effects, we also present the work carried out to decide upper safe intake levels in the Nordic countries, the EU and the USA. Women of fertile age should under certain circumstance take iron and folate supplements, and everyone in Scandinavia should take a supplement with vitamin D. It is sensible and harmless to take a multivitamin and mineral pill for people in risk groups, e.g. people eating very little or have an unbalanced diet (children, old people, patients). Except for these groups it is poorly documented that vitamins and minerals in large doses have a preventive or therapeutic potential. The largest health potential lies in a healthy diet.

Cardiovascular Diseases↗
PubMed2004

The fifty percent male excess of infant respiratory mortality.

AIM: To test whether infant mortality from clearly respiratory causes has a consistent male excess that is different from the male excess in most cardiac conditions. METHODS: Analysis of male excess in infant mortality data from the United States and from north European countries. Data are analyzed for the period 1979-2002 in autopsied and unautopsied cohorts. RESULTS: Several modes of respiratory death in infancy are characterized by an approximate 50% male excess. This common excess is demonstrated in vital statistics for infant respiratory distress syndrome, sudden infant death syndrome, inhalation of food and other objects causing obstruction of respiratory tract or suffocation, congenital pneumonia, viral pneumonia, bronchiolitis and bronchitis, and accidental drowning. Results are presented for these and other respiratory causes of mortality in all United States infant deaths from 1979-1998 and for sudden infant death syndrome from the United Kingdom and Scandinavia. In sudden infant death syndrome, the common male excess appears to exist only for the autopsied post-neonatal cases. Comparisons are made to the male excess mortality from congenital cardiac anomalies showing a similarly large male excess for those conditions resulting in severe hypoxic and ischemic hypoxia. CONCLUSION: Because these respiratory disease conditions are quite different, it is proposed that their common approximately 50% male excess implies a common terminal hypoxic condition and mechanism of death reached via the different pathways. We hypothesize that an unknown X-linkage may be responsible for this consistent male excess in infant mortality.

Europe↗
PubMed2004

[Hormone replacement therapy in breast cancer survivors: the Israeli Society for Clinical Oncology and Radiotherapy policy letter].

The Israeli Society for Clinical Oncology and Radiotherapy appointed experts in breast cancer therapy to assess the Society's policy regarding hormone replacement therapy (HRT) in breast cancer survivors with menopausal symptoms. The first policy letter was published in November 2002, and referred to available literature at that time which included retrospective data alone. The professional literature suggested no increased risk in breast cancer recurrence or cancer specific mortality, and no effect on overall survival with the use of HRT for a limited period (up to 3 years). This data served as the rationale for international prospective studies. Former committee recommendations and precautions are detailed in the original publication. In February 2004, the interim analysis of a prospective trial, the HABIT (Hormonal replacement therapy after breast cancer--is it safe?) was published. In that trial, breast cancer survivors with menopausal symptoms were randomized to HRT (estrogens with or without progestins) or no therapy for 2 years. A total of 434 women were recruited from centers in Scandinavia who participated with the International Breast Cancer and the European Organization for Research and Treatment groups. Analysis was restricted to 345 women with at least one follow up report; median follow-up period was 2.1 years. The relative risk for breast cancer event was 3.5 (95% C.I. 1.5-8.1) in HRT users as compared with the non-HRT group and the HABIT trial was terminated. Study limitations are discussed. Thereby, at this time HRT can no longer be considered safe in breast cancer survivors. Physicians treating breast cancer survivors for severe menopausal symptoms should present study results and alternative non-hormonal treatment options to allow patients optimized consented treatment decisions.

Breast Neoplasms↗
PubMed2004

Mountains: top down.

Mountainous regions offer not only essential habitat and resources, including water, to the earth's more than 6 billion inhabitants, but also insights into how the global human habitat works, how it is being changed at the moment as global climates are disrupted, and how the disruption may lead to global biotic and economic impoverishment. At least 600 million of the earth's more than 6 billion humans dwell in mountainous regions. Such regions feed water into all the major rivers of the world whose valleys support most of the rest of us. At least half of the valley dwellers receive part or all of their water from montane sources, many from the melt water of glaciers, others from the annual snow melt. Glaciers are retreating globally as the earth warms as a result of human-caused changes in the composition of the atmosphere. Many are disappearing, a change that threatens municipal water supplies virtually globally. The warming is greatest in the higher latitudes where the largest glaciers such as those of Greenland and the Antarctic Continent have become vulnerable. The melting of ice in the northern hemisphere raises serious concerns about the continued flow of the Gulf Stream and the possibility of massive climatic changes in Scandinavia and northern Europe. Mountains are also biotic islands in the sea life, rich in endemism at the ecotype level. The systematic warming of the earth changes the environment out from under these genetically specialized strains (ecotypes) which are then maladapted and vulnerable to diseases of all types. The process is systematic impoverishment in the pattern conspicuous on mountain slopes with increasing exposure to climatic extremes. It is seen now in the increased mortality and morbidity of plants as climatic changes accumulate. The seriousness of the global climatic disruption is especially clear in any consideration of mountains. It can and must be addressed constructively despite the adamancy of the current US administration.

Altitude↗
PubMed2004

[The berserks--what was wrong with them?].

The terms berserk and going berserk reflect the violent and ferocious warriors and ruthless murderers of Scandinavia and Northern Europe, active from before the Viking age until the advent of Christianity. The main source on the phenomenon is the Old Norse literature, mainly the Icelandic sagas with their sober descriptive accounts of the berserks and their behaviour. The berserks are frequently depicted as having had antisocial character traits; often as bullies who evince, by way of autosuggestion, an enormous and uncontrollable rage, slaughtering and killing. They felt no pain and hardly took in the environment they lived in. The fits were followed by exhaustion or sleep. Although the phenomenon waned completely by the advent of Christianity, it can hardly be discarded as just myth or folklore. Most likely it could be explained as a kind of dissociative reaction. The widespread idea of toadstool as causative agent is at best debatable. The conceptions of pre-Christian heathenism about the human mind are of importance to the understanding of suggestibility and capacity for trance reaction. The condition is considered a culture-bound syndrome. Comparisons are drawn to lycanthropy (werewolf madness), frequently considered an identical phenomenon. Clinically (i.e. historically) it was mainly something different, namely psychotic conditions.

Aggression↗
PubMed2004

[Fraud in fundamental and clinical investigations. The necessity for an independent commission for scientific integrity].

Scientific misconduct takes various different forms and is real fraud only if there is evidence of intention. There are many forms of scientific dishonesty ranging from very serious to just below the limit of what is permissible, and it occurs at all stages of scientific research. Tracing fraud is by no means easy and its discovery is often only accidental. American, British and Dutch incidences are reported. We know the causes of fraud to be profit-seeking in all its forms, vanity and sloppy research practice. Oddly enough, the consequences of fraud are often more advantageous to the perpetrators than to the whistle-blowers. Literature becomes polluted and faith in scientific knowledge is damaged. In summary the measures and sanctions employed to combat fraud in the United States, Scandinavia, the United Kingdom and The Netherlands, are described. In The Netherlands are recently two commissions appointed. Points of discussion include: a governmental or other commission organized at a national or regional level, what protocol should be implemented, should the commission have powers of sanction, for how long should the members of commission be appointed and how is the extent of their liabilities to be decided upon?

Ethics, Research↗
PubMedDate not supplied

Milk as storage medium for exarticulated teeth: report of case.

In Scandinavia, traumatic dental injuries can usually be treated professionally within a few hours. A fourteen-year-old boy suffered an avulsed tooth while playing basketball. Despite an extraoral period of more than twelve hours, a functional PDL survived.

Adolescent↗
PubMed2005

[Hantavirus infections].

Hantaviruses are cosmopolite anthropozoonosis considered as an emerging disease. Four pathogenic types for humans and part of the Bunyaviridae species are hosted by rodents and have been isolated: the Sin nombre virus responsible for the severe American respiratory form; the Hantaan and Seoul viruses responsible for hemorrhagic fevers with renal syndrome (HFRS) of severe to moderate expression in Asia and also in the Balkans; the Puumala virus responsible for HFRS of moderate expression or the socalled nephropathia epidemica in Europe. The Puumala virus is responsible for a minor form of the disease that is observed in areas of the Occidental sector of the ex-URSS, in Scandinavia and in the rest of Europe, notably in the North-East of France. The epidemic episodes occur every three years. They follow the proliferation of rodents, notably russet voles, the reservoir hosts, and their degree of infection. The concept of an occupation at risk in 20 to 49 year-old men (working in forests, agriculture, living near a forest, contact with wood) in an endemic area has not always been found. Its clinical form can vary greatly in its presentation. Basically it is a severe algic influenza syndrome accompanied by acute myopia in 38% of cases, but is nearly pathognomonic in the context. Respiratory involvement is frequent but benign. The initial syndrome can suggest an abdominal or urological surgical emergency, which is source of diagnostic and therapeutic errors. Early biological examination reveals thrombopenia and proteinuria. Then more or less severe acute kidney failure appears in slightly more than 50% of cases. Although it usually regresses with symptomatic treatment, after effects remain in some patients. The environmental changes, the geographical distribution depending on the biotope, the dynamics and behaviour of rodents and the viral circulation between them and its transmission to human beings and its risk factors must continue to be studied in order to gain further knowledge on the epidemiology of this anthropozoonosis.

Animals↗
PubMed2005

The European school of total hip arthroplasty and 35 years of total hip arthroplasty in the Czech Republic.

The development of the European total hip arthroplasty in the sixties of 20th century is associated mainly with the names of G. K. McKee, J. Charnley and M. E. Muller. The SICOT meeting in Paris in 1966 introduced THA as a new method of treatment of osteoarthritis of the hip and paved the way for the commercialization of the manufacturing of prostheses. The success of this method consisted primarily in the fixation of individual components by bone cement and application of metal-to-polyethylene and metal-to-metal joints. The book presents these historical events as they have been reflected in the development of THA in the countries of the former Czechoslovakia and in the development of implants of domestic provenance. The development of THA in the former Czechoslovakia started in 1969 and was based on the Swiss school established by M. E. Muller. The Muller component with the "banana-shaped" stem was implanted using the Watson-Jones approach, the proximal femur canal was prepared by a rasp and the Palacos cement was used. This prosthesis served also as the model for the first Czech implant Poldi-Cech of I generation (the Chirulen cup available in three sizes, the "banana- shaped" femoral component with a 32 mm head-diameter and 130 degree neck-shaft angle) the development of which started in 1969 and the serial production began in 1972 in the Poldi Kladno steel company. Fatigue fractures of the "banana-shaped" stem led to the development of the concept of a femoral component with an "anatomical" stem. In Switzerland, this concept was developed by B. G. Weber. In the former Czechoslovakia the development of a new femoral component with an "anatomical" stem following the shape of the intramedullary canal with an ovoid profile and without sharp edges started in 1972. Due to the incidence of fatigue fractures of the "banana-shaped"stem and material that was not sufficiently strong (steel used for the production of osteosynthetic components), 144 degree neck-shaft angle was chosen. Reduction of the effect of bending forces on the valgus stem had eliminated fatigue fractures. This Poldi-Cech prosthesis of II generation was provided in nine sizes. The diameter of the head remained the same. Three Chirulen cups were supplemented with a "flat" cup for implantation in a dysplastic acetabulum. The prosthesis was implanted with an exact instrument set (reamer for acetabular preparation, rasp for proximal femoral preparation, alignment device for accurate positioning of both the cup and the femoral component) with the use of the Palacos cement. The production of the Poldi-Cech prosthesis of II. generation started in 1974 with the fabrication of a monoblock. Since 1986 it has been developed into a modular system (14/16 cone) with the possibility to use a ceramic head of 32 mm diameter (only in the nineties the cone size was changed to 12/14 and the heads were provided also in the 28 mm diameter). The Poldi-Cech prosthesis of II generation with the "anatomical" stem has been implanted since 1974 (i. e. during 30 years) in more than 140 000 patients in the Czech and Slovak Republics. In the same year cemented monoblock hemiarthroplasty was developed on the same basis as THA using the same "anatomical" stem and 36 to 60mm head diameter. Until now more than 35,000 of these hemiarthroplasty systems have been implanted. Until 1992 the Poldi-Cech implant was practically the only available cemented total hip replacement in the former Czechoslovakia and retrospectively it may be considered a highly successful implant. In the authors' view, the further development of THA will lead in the following years to the use of implants proved by a long-term follow-up. Preference will be given to prostheses the implantation of which will require a minimal loss of the bone stock during primary surgery and which will allow a technically easy reimplantation. The continental Europe has been recently preferring hybrid prostheses while Scandinavia witnesses an evident increase in the number of implanted cemented prostheses to the detriment of the cementless and hybrid ones. Naturally, cementless prostheses will keep dominating in young patients.

Arthroplasty, Replacement, Hip↗
PubMed2001

CoFactor (Biokeys Pharmaceuticals).

BioKeys is developing CoFactor (methylenetetrahydrofolate), a thymidylate synthase inhibitor and modulator of 5-fluorouracil (5-FU), for the potential enhancement of cancer treatments using 5-FU [357795]. By March 2000, phase I/II trials had been completed and phase III trials were in preparation for the US and Scandinavia [357806,357795]. In November 2000, the company initiated a pharmacogenomic study of CoFactor [389157]. The company believes that genomic screening will be very useful for determining the most likely candidates for successful 5-FU/CoFactor therapy, therefore, Biokeys is undertaking a study on tissue samples from 62 patients who were previously treated in phase I/II trials. Analyses will be based upon a RT-PCR from paraffin-embedded tissues. This improved technology, which permits retrospective analyses from paraffin-fixed tissues, will enable BioKeys' scientists to better understand previous responses by the patients treated in the phase I/II trials [389157]. In phase I/II trials, CoFactor was administered to 62 cancer patients receiving 5-FU therapy and resulted in partial responses of 21 to 55% in colorectal, pancreas, stomach, gallbladder and breast cancer patients. Toxicity was milder than expected for 5-FU or 5-FU/leucovorin [357806,357795]. CoFactor has been shown to be 100-fold stronger than leucovorin in the promotion of thymidylate synthase inhibition [357795].

Journal Article↗
PubMed1992

Epidemiology of occupational neurobehavioural hazards. Methodological experiences from organic solvent research.

Neurobehavioral hazards have been identified since long in occupational health, e.g. lead, mercury, certain solvents, and many others agents. There are reviews and books on "Occupational neurology" or "Prevention of neurotoxic illness in working populations". Many methods have been applied for studies of the central and peripheral nervous systems in humans: registered diagnoses, questionnaire ratings, clinical evaluation, psychometric tests, neurophysiological and neuroradiological methods, cerebrospinal fluid components etc. Some neurological disorders are well defined, while neuropsychiatric syndromes often are less precisely diagnosed. Decreased subclinical test results in exposed groups might predict an increased risk for later, more serious disorders but the longitudinal information on clinical importance is often lacking. Some historical lessons from the epidemiology of occupational neurology will be repeated and a few reflections on the suitability of different diagnostic entities for epidemiological research shall be made. Since the beginning of the 1970s' a number of studies from the Scandinavian countries have demonstrated long-term neurobehavioral effects from working conditions with relatively moderate exposure to organic solvents. Similar findings have been verified in studies from some countries outside Scandinavia while other studies have been inconclusive. Those results have caused considerable controversy and have been discussed at international conferences and in scientific journals. Very different outcomes have been investigated in those solvent studies, however, and most studies have had a cross-sectional design with inherent problems. The exposure has been assessed in different ways, e.g. by years of occupation, hygienic measurements of the present working conditions, biological monitoring, retrospective assessments on qualitative or semi-quantitative scales. Sometimes single solvent exposures have been studied but most of the studies concern mixtures of solvents from aromatic and aliphatic hydrocarbons. As the designs have varied the exposure assessment has been crude and many different outcomes have been studied, it is hardly surprising that the results and the interpretations have differed. The first results from a comprehensive investigation on 135 solvent exposed painters and 71 carpenters as referents, selected from active members of the respective trade union 1965-70 and investigated in the late 80s, will be presented. Clinical, including psychiatric, diagnostic work up and neuropsychological as well as neurophysiological tests have been performed. Psychological test results from military conscripts at age 19 were available for all. The individual exposure history has been carefully assessed.(ABSTRACT TRUNCATED AT 400 WORDS)

Case-Control Studies↗
PubMed2005

[Future perspectives in screening for colorectal cancer].

Based on international experience, pilot studies with fecal occult blood tests and colonoscopy in those with blood in the stools are now to be performed in Scandinavia in limited geographic areas before introducing countrywide screening. The Danish State has offered to pay for feasibility studies in two counties. Provided that the results of randomised clinical trials are reproduced according to acceptability and stage of the cancer found and the organisation is feasible, it will then be possible to evaluate newer technologies as well as other methods which have not previously been evaluated in a satisfactory way.

Biomarkers, Tumor↗
PubMed1992

[Crib death, sleeping position and temperature].

Sudden infant death syndrome (SIDS) is the commonest cause of death in children over one week of age. Norway has the highest incidence in Scandinavia and the figure has increased during the last 20 years. There has been much discussion as to whether sleeping in the prone position rather than in the supine or lateral position may be a predisposing factor to cot death. In all 14 studies in seven countries where the question has been investigated, there was a higher proportion of prone infants in the SIDS group than in the control group. Intervention studies have shown that reducing the proportion of infants sleeping prone was followed by a reduction in cot deaths. There is also evidence that overheating is a risk factor for SIDS. In one British study it was found that infants who died of SIDS had more clothes on, and blankets covering them, and that both prone position and overheating were independently associated with SIDS. A possible mechanism is that overheating interferes with respiratory control. Although we do not completely understand the mechanisms underlying the links between SIDS and the prone position, the epidemiological evidence and the evidence from intervention are now so strong that it is fully justified to advice against the general use of the prone sleeping position for babies.

Australia↗
PubMed2004

Serological screening of Tick-borne encephalitis (TBE) among Malaysian encephalitis patients.

Tick-borne encephalitis (TBE) is a viral infection of the central nervous system and is caused by tick bites, usually after travel to rural or forested areas. The disease is prevalent in Scandinavia, Western Europe, Central Europe and the former Soviet Union and East Asia including Japan. In Malaysia, so far there are no reported cases of TBE. In the present time, many illnesses have been attributed to traveling to other parts of the world. Thus it is important to carry out TBE prevalence study to determine whether the virus is present among Malaysian population. Samples (sera and CSF) from patients admitted to major MOH hospitals in Peninsular Malaysia and Sabah with a clinical diagnosis of encephalitis but is IgM negative for JE, were tested for TBEV IgM ELISA and TBEV IgG ELISA (DRG, Germany). Out of the 600 samples screened for TBEV IgG, all were non-reactive. In addition, out of the 100 samples screened for TBEV IgM, all the samples were also non-reactive. Our results indicate that currently TBE is not present in the Malaysian population. Among the reasons for this could be lack of the infection agent, absence of the suitable vector or subjects selected for the study did not fit the criteria of possible exposure to TBE infections. Hence we recommend that for any future study, the selection of subjects should include those who returned from tick-infested forested areas.

Journal Article↗