Marked deterioration in the quality of life of patients with idiopathic pulmonary fibrosis during the last two years of life.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic disease with a high symptom burden and poor survival that influences patients' health-related quality of life (HRQOL). We aimed to evaluate IPF patients' symptoms and HRQOL in a well-documented clinical cohort during their last two years of life. METHODS: In April 2015, we sent the Modified Medical Research Council Dyspnea Scale (MMRC), the modified Edmonton Symptom Assessment Scale (ESAS) and a self-rating HRQOL questionnaire (RAND-36) to 300 IPF patients, of which 247 (82%) responded. Thereafter, follow-up questionnaires were sent every six months for two years. RESULTS: Ninety-two patients died by August 2017. Among these patients, HRQOL was found to be considerably low already two years before death. The most prominent declines in HRQOL occurred in physical function, vitality, emotional role and social functioning (p < 0.001). The proportion of patients with MMRC scores ≥3 increased near death. Breathlessness and fatigue were the most severe symptoms. Symptom severity for the following symptoms increased significantly and reached the highest mean scores during the last six months of life (numeric rating scale/standard deviation): breathlessness (7.1/2.8), tiredness (7.0/2.3), dry mouth (6.0/3.0), cough (5.8/2.9), and pain with movement (5.0/3.5). CONCLUSIONS: To our knowledge this is the first study demonstrating, that IPF patients experience remarkably low HRQOL already two years before death, especially regarding physical role. In addition, they suffer from severe breathlessness and fatigue. Furthermore, physical, social and emotional wellbeing deteriorate, and symptom burden increases near death. Regular symptom and HRQOL measurements are essential to assess palliative care needs in patients with IPF.

Sleep-related factors: associations with poor attention and depressive symptoms.

BACKGROUND: Sleep duration is known to be associated with depression and attention deficits in children, though the majority of studies have focused on adolescents. Attention problems and depressive symptoms related to sleep factors have not been studied simultaneously in the non-clinical child population before. METHODS: Sleep quantity, adverse bedtime behaviour, daytime sleepiness, poor attention and symptoms of depression were assessed using self-report measures. The participants were 11 years old (n = 439). RESULTS: Short sleep duration during the school week is related to poor attention and high depression. It is not a significant predictor of low attention and high depression symptoms in logistic regression analyses. Instead, adverse bedtime behaviour and daytime sleepiness predict them highly significantly. CONCLUSIONS: Short sleep duration is related to poor attention and depressive symptoms as suggested by previous work. However, the significant role of other sleep-related factors calls for further research.

Correlation of wood-based components and dewatering properties of waste activated sludge from pulp and paper industry.

Large amounts of wet sludge are produced annually in municipal and industrial wastewater treatment. Already in pulp and paper industry, more than ten million tons of primary sludge, waste activated sludge, and de-inking sludge is generated. Waste activated sludge contains large quantities of bound water, which is difficult to dewater. Low water content would be a matter of high calorific value in incineration but it also has effects on the volume and the quality of the matter to be handled in sludge disposal. In this research waste activated sludges from different pulp and paper mills were chemically characterised and dewatered. Correlations of chemical composition and dewatering properties were determined using multivariate analysis. Chemical characterisation included basic sludge analysis, elementary analysis and analysis of wood-based components, such as hemicelluloses and lignin-derived material. Dewatering properties were determined using measurements of dry solids content, flux and flocculant dosage. The effects of different variables varied according to the response concerned. The variables which were significant regarding cake DS increase in filtration or centrifugation and flocculant dosage needed in filtration were different from those which were significant regarding flux.

Heavy metals in bottom sediments of Lake Umbozero in Murmansk Region, Russia.

Sediment cores collected from different locations of Lake Umbozero were studied with respect to concentration and mobility of trace and heavy metals Co, Cu, Fe, Mn, Ni, Pb, U, and Zn. Lake Umbozero is the second largest lake in the Murmansk Region and subjected to contamination by air-borne emissions and river transportation from the nearby metallurgical and mining industries. Unlike its neighboring, more industry-prone Lake Imandra, Lake Umbozero is relatively unexplored with respect to its state of pollution. In our study, metal distribution in sediments was found to vary with respect to the cores, although in general the concentrations were at the same level throughout the lake indicating uniform horizontal distribution of metals. When compared to Lake Imandra, the concentrations of most of the metals studied were significantly lower and represented the levels in sediments measured in lakes of Kola Peninsula located further off from industrial pollutant sources. An exception was Pb the concentration of which was at the same level as in Lake Imandra, probably due to long-distance transport. Sediment layers were subjected to four-step sequential extraction procedure to reveal the metal distribution in soluble, exchangeable, acid-soluble, and residual fractions. Indicative of their potential higher lability, Mn, U, and Zn were generally found in exchangeable fraction; as also Mn and U extensively in the acid-soluble fraction.

Plutonium in the air in Kurchatov, Kazakhstan.

Weekly air samples of 25000 m(3) volume were taken with two air samplers over a period of one year in 2000-2001 in the town of Kurchatov in Kazakhstan. For another three-month period in 2001, the samplers were run in the city of Astana, about 500 km west of Kurchatov. (137)Cs, Pu and U concentrations were determined from the filters. Pu activities in Kurchatov varied in a 100-fold range; median (239,240)Pu activities were 100 nBq/m(3) and (238)Pu activities 34 nBq/m(3). The corresponding values for Astana were considerably lower: 29 and 9 nBq/m(3), respectively, and in half of the filters the (238)Pu activity was below the detection limit. Plutonium concentration correlated with the amount of dust retained on the filters only at the highest dust loads. Also no correlation between wind speed and the plutonium activity in the filters was observed. Thus, resuspension does not seem to be the mechanism responsible for the airborne plutonium. No clear seasonal variation of Pu air concentration was observed, though levels were somewhat elevated in February to April. There was no correlation between the plutonium and (137)Cs concentrations. In most of the filters the cesium concentration was below the detection limit, but in those filters where it could be detected the cesium concentration was practically constant at 3.9+/-1.6 microBq/m(3). Dose estimation for the inhalation of the airborne plutonium gave a low value of 0.018 microSv/a for the inhabitants in Kurchatov, which is about a thousand times lower than the dose caused by the naturally occurring (210)Po. Air parcel trajectory analysis indicated that the observed Pu activities in the air could not unambiguously be attributed to the most contaminated areas at the Semipalatinsk Test Site.

The specific sorption of Np(V) on the corundum (α-Al2O3) surface in the presence of trivalent lanthanides Eu(III) and Gd(III): A batch sorption and XAS study.

The sorption of pentavalent neptunium, Np(V), on corundum (α-Al2O3) was investigated in the absence and presence of trivalent europium or gadolinium as a competing element under CO2-free conditions. The objective of this study was to investigate how a trivalent metal ion with a higher charge than that of the neptunyl(V) ion would affect the sorption of Np(V) when allowed to adsorb on the mineral surface before the addition of Np(V). Batch sorption experiments conducted as a function of pH (pH-edges) and as a function of Np(V) concentration (isotherms) in the absence and presence of 1×10(-5)M Eu(III) showed no sign of Eu being able to block Np sorption sites. Surface complexation modelling using the diffuse double layer model was applied to the batch data to obtain surface complexation constants for the formed Np(V) complexes on corundum. To account for potential changes occurring in the coordination environment of the neptunium ion in the presence of a trivalent lanthanide, X-ray absorption spectroscopy (XAS) measurements were carried out on the samples containing only Np(V) and Np(V)+Gd(III). The results reveal the presence of a bidentate Np(V) edge-sharing complex on the corundum surface in the absence of Gd(III), while the coordination environment of Np(V) on the corundum surface could be changed when Gd(III) is added to the sample before the sorption of Np(V).

Sorption of radioiodide in an acidic, nutrient-poor boreal bog: insights into the microbial impact.

Batch sorption experiments were conducted to evaluate the sorption behaviour of iodide and the microbial impact on iodide sorption in the surface moss, subsurface peat, gyttja, and clay layers of a nutrient-poor boreal bog. The batch distribution coefficient (Kd) values of iodide decreased as a function of sampling depth. The highest Kd values, 4800 L/Kg dry weight (DW) (geometric mean), were observed in the fresh surface moss and the lowest in the bottom clay (geometric mean 90 mL/g DW). In the surface moss, peat and gyttja layers, which have a high organic matter content (on average 97%), maximum sorption was observed at a pH between ∼ 4 and 5 and in the clay layer at pH 2. The Kd values were significantly lower in sterilized samples, being 20-fold lower than the values found for the unsterilized samples. In addition, the recolonization of sterilized samples with a microbial population from the fresh samples restored the sorption capacity of surface moss, peat and gyttja samples, indicating that the decrease in the sorption was due to the destruction of microbes and supporting the hypothesis that microbes are necessary for the incorporation of iodide into the organic matter. Anoxic conditions reduced the sorption of iodide in fresh, untreated samples, similarly to the effect of sterilization, which supports the hypothesis that iodide is oxidized into I2/HIO before incorporation into the organic matter. Furthermore, the Kd values positively correlated with peroxidase activity in surface moss, subsurface peat and gyttja layers at +20 °C, and with the bacterial cell counts obtained from plate count agar at +4 °C. Our results demonstrate the importance of viable microbes for the sorption of iodide in the bog environment, having a high organic matter content and a low pH.

The microbial impact on the sorption behaviour of selenite in an acidic, nutrient-poor boreal bog.

(79)Se is among the most important long lived radionuclides in spent nuclear fuel and selenite, SeO3(2-), is its typical form in intermediate redox potential. The sorption behaviour of selenite and the bacterial impact on the selenite sorption in a 7-m-deep profile of a nutrient-poor boreal bog was studied using batch sorption experiments. The batch distribution coefficient (Kd) values of selenite decreased as a function of sampling depth and highest Kd values, 6600 L/kg dry weight (DW), were observed in the surface moss and the lowest in the bottom clay at 1700 L/kg DW. The overall maximum sorption was observed at pH between 3 and 4 and the Kd values were significantly higher in unsterilized compared to sterilized samples. The removal of selenite from solution by Pseudomonas sp., Burkholderia sp., Rhodococcus sp. and Paenibacillus sp. strains isolated from the bog was affected by incubation temperature and time. In addition, the incubation of sterilized surface moss, subsurface peat and gyttja samples with added bacteria effectively removed selenite from the solution and on average 65% of selenite was removed when Pseudomonas sp. or Burkholderia sp. strains were used. Our results demonstrate the important role of bacteria for the removal of selenite from the solution phase in the bog environment, having a high organic matter content and a low pH.

Factors affecting the sorption of cesium in a nutrient-poor boreal bog.

(135)Cs is among the most important radionuclides in the long-term safety assessments of spent nuclear fuel, due to its long half-life of 2.3 My and large inventory in spent nuclear fuel. Batch sorption experiments were conducted to evaluate the sorption behavior of radiocesium ((134)Cs) in the surface moss, peat, gyttja, and clay layers of 7-m-deep profiles taken from a nutrient-poor boreal bog. The batch distribution coefficient (Kd) values of radiocesium increased as a function of sampling depth. The highest Kd values, with a geometric mean of 3200 L/kg dry weight (DW), were observed in the bottom clay layer and the lowest in the 0.5-1.0 m peat layer (50 L/kg DW). The maximum sorption in all studied layers was observed at a pH between 7 and 9.5. The in situ Kd values of (133)Cs in surface Sphagnum moss, peat and gyttja samples were one order of magnitude higher than the Kd values obtained using the batch method. The highest in situ Kd values (9040 L/kg DW) were recorded for the surface moss layer. The sterilization of fresh surface moss, peat, gyttja and clay samples decreased the sorption of radiocesium by 38%, although the difference was not statistically significant. However, bacteria belonging to the genera Pseudomonas, Paenibacillus, Rhodococcus and Burkholderia isolated from the bog were found to remove radiocesium from the solution under laboratory conditions. The highest biosorption was observed for Paenibacillus sp. V0-1-LW and Pseudomonas sp. PS-0-L isolates. When isolated bacteria were added to sterilized bog samples, the removal of radiocesium from the solution increased by an average of 50% compared to the removal recorded for pure sterilized peat. Our results demonstrate that the sorption of radiocesium in the bog environment is dependent on pH and the type of the bog layer and that common environmental bacteria prevailing in the bog can remove cesium from the solution phase.

Formula feeding results in lower selenium status than breast-feeding or selenium supplemented formula feeding: a longitudinal study.

Thirty-two infants completely weaned by age 3.2 mo were randomized into two groups. Unsupplemented group was fed cow's milk-based liquid formula containing 3-5 micrograms Se/L. Se-supplemented group received the same formula supplemented with 20 micrograms Se/L. A third group consisted of exclusively breast-fed infants (51 at age 4 mo, 41 at 6 mo, 12 at 9 mo). Mean serum Se concentration in unsupplemented group decreased from 41 to 31 micrograms/L during the first 2 mo and remained constant until age 6 mo increasing gradually thereafter. In Se-supplemented group it increased steadily from 41 to 68 micrograms/L at age 6 mo and remained constant while supplemented formula was used. In breast-fed group it increased steadily until age 9 mo, between the levels of the two formula-fed groups, when it reached the concentration of Se-supplemented group. At age 12 mo no significant differences were present among the three groups.

Effect of inorganic chromium supplementation on glucose tolerance, insulin response, and serum lipids in noninsulin-dependent diabetics.

A placebo-controlled double-blind cross-over study was carried out to assess the effect of chromium supplementation (200 micrograms trivalent chromium daily for 6 wk) on glucose tolerance, insulin response, long-term diabetic control, and serum lipids in 10 noninsulin-dependent diabetics aged 37 to 68 yr. After chromium supplementation 24-h urinary chromium excretion showed a 9-fold increase indicating a positive chromium balance in the subjects. There was no significant difference between chromium supplementation and placebo periods in glucose tolerance and in fasting or 2-h postglucose serum insulin levels but the 1-h postglucose serum insulin level was slightly lower on chromium supplementation than on the placebo (55 +/- 9.0 versus 64 +/- 11; p less than 0.01, paired t test). Serum total cholesterol and triglycerides and their high-density, low-density, and very low-density lipoprotein subfractions showed no change after chromium supplementation as compared to the placebo period.

Plasma zinc and copper concentrations in rheumatoid arthritis: influence of dietary factors and disease activity.

Forty patients with rheumatoid arthritis performed a thorough 7-d diet recording. The food diaries were analyzed together with clinical and laboratory data by means of stepwise multiple linear regression to clarify the effects of both diet and the inflammatory disorder on the plasma concentrations of zinc and copper. The patients' daily dietary intakes of zinc and copper (24.3 +/- 7.54 and 3.48 +/- 1.55 mg/MJ) were comparable to the corresponding intakes in the ordinary Finnish diet (24.0 and 3.68 mg/MJ). In multivariate analyses the best predictors of plasma trace elements were the measures of disease activity and not the dietary factors. As an exception to this, there was a strong correlation between plasma copper-copper intake ratio and zinc intake both in univariate (r = -0.638, P less than 0.001) and multivariate analysis. This suggests that zinc depresses copper absorption with intakes in normal, physiological ranges.

The economics of alcohol.

The use of economic arguments with regard to four aspects of alcohol policy is described and discussed. The first aspect is the impact of a potential reduction in alcohol consumption on employment by alcohol production and trade. It is shown that employment is quite independent of the level of consumption. The second aspect is the opportunity for serving the public health and state finance interests at the same time by developing alcohol taxation. The third aspect is the relationship between the public revenue from alcohol and the public costs for alcohol-related problems. A "polluter pays" principle with regard to alcohol would mean higher taxation of alcoholic beverages. The fourth aspect is the need for cost-effectiveness analyses to support the choices by the decision makers between different alcohol policy options. It is concluded that such analyses could have impact on the priorities in public health policy on alcohol.

Alcohol and the future health of Europe.

The impact of alcohol consumption on trends in the European health situation is analysed. Particular attention is given to the impact of alcohol on the widening of the East-West health gap in Europe. It is concluded that between 1950-75 the negative health impact of a rapid increase in per capita alcohol consumption in most European countries was hidden behind a strong positive development in many other socio-economic determinants of health. Between 1980 and 1995, health trends have been more closely parallel to trends in alcohol consumption. Changes in alcohol consumption explain a significant proportion of changes in life expectancy, particularly in the newly independent states of the former Soviet Union. Public health policy on alcohol, as part of a general development of public health policies outside the health sector, is important in reducing the East-West health gap and sustaining the positive health trend in western Europe.

Decreased serum selenium and magnesium levels in drunkenness arrestees.

Serum levels of selenium magnesium, copper, zinc and iron were studied in chronic drunkenness arrestees and a healthy control group. The mean serum concentrations of selenium and magnesium were both significantly lower (P less than 0.01) in drunkenness arrestees than in the control subjects. The mean alcohol intake was 190 g of absolute alcohol daily in drunkenness arrestees and 14 g in controls. The erythrocyte glutathione peroxidase concentrations of the study groups did not support poor selenium intake as a principal cause of low selenium concentration in the serum.

Serum cholesterol and vitamins A and E in juvenile chronic arthritis.

Serum total cholesterol is decreased during acute infections and in adults with rheumatoid arthritis, probably partly because of enhanced lipid peroxidation. Oxidative stress also causes augmentation of inflammation and tissue damage in arthritic synovium. Therefore, concentrations of serum total cholesterol and the antioxidant vitamins A and E were studied in 125 children with juvenile chronic arthritis. Total serum cholesterol was significantly lower in the patients than in healthy children in most age groups and correlated with the markers of disease activity, haemoglobin and the erythrocyte sedimentation rate. In age- and sex-adjusted stepwise multiple linear regression, serum zinc had a significant predictive value for cholesterol. The vitamin A concentrations in the sera of the patients was virtually the same as in the healthy controls, though serum vitamin E concentrations were low (22.8 +/- 15.2 vs 30.5 +/- 4.3 mumol/l, p less than 0.001). The deficiency in vitamin E was not compensated for by another lipoperoxide antioxidant, glutathione peroxidase. Only serum cholesterol had an independent explanatory significance for vitamin E in multiple linear regression analysis (partial correlation 0.554, p less than 0.001). It is suggested that low vitamin E and impairment of the anti-oxidant protection further contribute to low serum cholesterol values in JCA.

Increase in serum selenium levels in Finnish children and young adults during 1980-1986: a correlation between the serum levels and the estimated intake.

Serum selenium concentrations of Finnish children and adolescents (ages: 3, 6, 9, 12, 15 and 18 years) were analysed in 1980. The sample included 1706 subjects from five different areas, each containing rural and urban sectors. The serum selenium concentration levels were compared to the intakes of energy, selenium, protein, fat and carbohydrate estimated by a dietary survey (in a total of 1090 subjects from the 1706). In 1986 corresponding data were obtained from 280 of the subjects from the 1980 sample. The mean intake of selenium from food in 1980 ranged from 12 to 23 micrograms per day for the different age groups. In 1986, after the addition of selenium to fertilizers, the mean daily intake of selenium ranged from 69 to 82 micrograms per day for the groups of subjects, who were 9, 12, 15, 18, 21 and 24 years old by that time. In 1980, the children aged 3 and 6 years had lower selenium concentrations in their sera compared to the other age groups. However, serum selenium levels were higher in the Tampere and Oulu areas. In 1986 the selenium concentrations in sera increased with age (9-21-year-olds) and no regional differences were found. The selenium levels in sera were higher in 1986 than in 1980 due to the increased intake after the addition of selenium to fertilizers used in Finland. The increase in selenium levels between the 1980 and 1986 studies were, on the average, 45%.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum trace elements in juvenile chronic arthritis.

We evaluated the serum concentrations of zinc, copper and selenium in 125 patients with juvenile chronic arthritis (JCA). Trace element levels showed distinct abnormalities as compared with those of a large group of healthy children. Serum zinc and selenium concentrations were lower and those of copper higher in children with arthritis than in healthy children and, further, patients with polyarthritis had significantly higher copper and lower zinc levels than those with oligoarthritis. Serum zinc levels showed a direct correlation with hemoglobin and an inverse correlation with values for the erythrocyte sedimentation rate (ESR), whereas copper correlated directly with ESR. Selenium values did not correlate with the activity of the disease, but were low in the patients with arthritis of long duration.

Determination of chromium in human milk, serum and urine by electrothermal atomic absorption spectrometry without preliminary ashing.

In the present study a Perkin-Elmer 5000 atomic absorption spectrometer equipped with a tungsten--iodide lamp for improved background correction at the 357.9 nm chromium absorption line and an HGA 500 graphite furnace were employed for the direct determination of chromium in human serum, milk and urine. The method of standard additions was used: 0.25-0.75 ng Cr was added to 1 ml samples. Except for urine samples, a dilution of 1 + 1 to 1 + 2 with H2O was necessary in order to obtain correct calibration curves. The average concentration of chromium in all the samples of normal subjects was less than 0.5 ng Cr ml-1. The day-to-day variation for all of the pooled samples was around 10% (relative standard deviation). For urine, the accuracy of the method was tested by comparing the results of another laboratory for the same two round robin samples. Excellent agreement was found between the present method and those of the other laboratory that had used isotope dilution--mass spectrometry and continuum source wavelength modulated echelle--atomic absorption spectrometry to define the chromium concentration in the samples. The detection limit of the method, 0.05 ng Cr ml-1 for urine and serum and 0.1 ng Cr ml-1 for human milk, was sufficient for the biological fluids analyzed. The method was employed for the determination of chromium in 24-h urine samples of maturity onset diabetics supplemented with 20 or 200 micrograms Cr3+ d-1 for six weeks. It was shown that the 24-h urinary chromium excretion accurately indicates the daily dietary chromium intake of these patients.

Tower of Hanoi and working memory in adult persons with intellectual disability.

Persons with intellectual disability (ID) have been found to perform more poorly than their mental age would suggest in the visuo-spatial problem solving task Tower of Hanoi (TOH). Inefficient performance has been assumed to be related to inability to use sophisticated problem solving strategies because of restricted working memory capacity. In the present study, the TOH performance of adult persons with ID was found to be equal to that of fluid-intelligence-matched general children. However, persons with ID violated the rules of the TOH more often, and needed more trials to solve the TOH problems than the children did. Visuo-spatial and executive working memory tasks were significantly connected to the TOH performance of persons with ID, whereas phonological working memory tasks were not. Poor inhibition ability was related to the poor performance of subjects with ID in the TOH. We suggest that for persons with ID, TOH performance is determined by individual differences in fluid intelligence, controlled attention, and inhibition ability.