Ischemic and inflammatory lung impairment by extracorporeal circulation: effect of PARP-inhibition by INO1001.

OBJECTIVE: Among the complications after cardiac surgery the development of postoperative pulmonary distress is a serious problem. Typically, the patients leave the operating theatre with good blood gas values and O(2)-saturation, but develop their respiratory problems within the next hours/days. We investigated whether extracorporeal circulation may induce biochemical and histological changes in the lungs which may help to explain this development. METHODS: Piglets (6-10 kg) were anaesthetized using isoflurane and underwent extracorporeal circulation (ECC) with hypothermic (25-28 degrees C) cardioplegic arrest for 90 min followed by 3h reperfusion. An additional group received a poly(ADP-ribose) polymerase (PARP)-Inhibitor, INO1001. Cardiopulmonary monitoring was performed during the whole procedure. Finally, lungs were explanted and investigated by histomorphometry and immunohistology for heat shock protein HSP70 (indicator for cellular damage) and TNFalpha in comparison to normal piglets without ECC. RESULTS: Histologically we found significant swelling of the type I alveocytes (thickness increased from 2.4 to 3.2 microm), interstitial oedema, intra-alveolar erythrocyte (4.8 versus 0.4 erythrocytes/alveole) and granulocyte accumulation and fibrinous exudates. There was a significant up-regulation of TNFalpha and of the cellular repair enzyme HSP70, while in control piglets only minimal levels were observed. INO1001 significantly reduced ECC-induced elevation in TNFalpha and in HSP70. Despite the dramatic changes after heart-lung-machine (HLM), blood gases and gas transport were almost not affected at that time. CONCLUSIONS: ECC can lead to early significant histological and histochemical changes which have similarities with a beginning early stage shock lung, although - at 3h reperfusion - gas transport is still sufficient. INO1001 can partially antagonize these changes.

Effort-reward imbalance and incidence of low back and neck injuries in San Francisco transit operators.

OBJECTIVES: Effort-reward imbalance (ERI) has been associated with musculoskeletal disorders in cross-sectional and case-control studies, but no longitudinal studies have been published yet. The effect of ERI on the incidence of compensated low back and neck injuries was examined in a 7.5-year follow-up study among 1179 San Francisco transit operators. METHODS: Data from medical examination and a survey on working conditions and health were linked to administrative workers' compensation databases. HRs for first low back and first neck injury were calculated with multivariate Cox regression models. Additional analyses accounted for severity of injury based on medical diagnosis. RESULTS: A 1 SD increase in ERI was associated with compensated low back (HR 1.13, 95% CI 1.02 to 1.26) and neck injuries (HR 1.14, 95% CI 1.02 to 1.27) after adjusting for gender, age, height, weight, years of professional driving, weekly driving hours, vehicle type, ergonomic problems, pain at baseline and job strain. The highest quartile of ERI showed an HR of 1.32 (95% CI 0.94 to 1.86) for low back injuries and an HR of 1.66 (95% CI 1.16 to 2.38) for neck injuries after adjustment for all covariates. The associations between ERI and low back injury were stronger for more severe injuries (HR 1.23, 95% CI 1.03 to 1.46 for a 1 SD increase in ERI) than for less severe injuries (HR 1.11, 95% CI 0.96 to 1.28). For neck injuries, stronger relationships were found for less severe injuries (HR 1.15, 95% CI 1.02 to 1.29) than for more severe injuries (HR 1.10, 95% CI 0.86 to 1.41). CONCLUSIONS: ERI is associated with low back and neck injuries in San Francisco transit operators independently of individual worker characteristics, physical workload, ergonomic problems, baseline pain and job strain. Effect sizes differ by injury severity.

A randomised controlled trial evaluating an alternative mouse and forearm support on upper body discomfort and musculoskeletal disorders among engineers.

OBJECTIVES: The aim of this intervention study was to determine the effects of an alternative mouse and/or a forearm support board on the change in upper body discomfort scores and the development of incident musculoskeletal disorders. METHODS: This randomised controlled intervention trial followed 206 engineers for one year. Participants were randomised to receive (1) a conventional mouse only, (2) an alternative mouse only, (3) a forearm support board, or (4) an alternative mouse plus forearm support board. Outcome measures included weekly upper body discomfort scores and incident musculoskeletal disorders. RESULTS: During the study, 42 participants were diagnosed with an incident musculoskeletal disorder. The group that received the forearm support board experienced a reduction in their right upper extremity discomfort (beta-coefficient -0.35, 95% CI -0.67 to -0.03) in comparison to those who did not receive a forearm board. The group that received the alternative mouse had a protective, but non-significant (p = 0.20), effect on incident cases of right upper extremity musculoskeletal disorders (HR 0.57, 95% CI 0.24 to 1.34) and a non-significant reduction in neck/shoulder discomfort (beta-coefficient -0.23, 95% CI -0.056 to 0.10) in comparison to those who received a conventional mouse. CONCLUSIONS: In engineers who use a computer for more than 20 h per week, a forearm support board may reduce right upper extremity discomfort attributed to computer use.

Stroke among male professional drivers in Denmark, 1994-2003.

OBJECTIVES: (1) To estimate the relative risk of stroke among various groups of professional drivers; (2) to determine if any excess risk should be attributed to infarction or haemorrhage; (3) to estimate the relative risk ratio for stroke among professional drivers living in Greater Copenhagen compared to those living outside the metropolis. METHODS: A cohort of 6285 bus drivers, 4204 car, taxi, and van drivers, and 25,879 heavy truck and lorry drivers were followed up for hospital admission due to stroke and sub-diagnoses in the period 1994-2003. Using hospital admission for all economically active men as the standard, the standardised hospitalisation ratios (SHR) were calculated, taking age and county into consideration. RESULTS: There was a high SHR for stroke among all groups of professional drivers (SHR = 132; 95% CI 121-141). Among car, taxi, and van drivers the SHR was 157 (95% CI 132-189), among bus drivers it was 139 (95% CI 119-163), and among heavy truck and lorry drivers it was 124 (95% CI 113-136). The excess risk for all groups of professional drivers was highest for cerebrovascular infarction (SHR = 139; 95% CI 124-155) and lowest for non-traumatic intracranial haemorrhage (SHR = 113; 95% CI 96-133). The excess risks for all groups were significantly higher for cerebrovascular infarction than for non-traumatic intracranial haemorrhage (relative risk ratio (RRR) 1.23; 95% CI 1.01-1.51). The RRR of stroke among drivers in the metropolitan area compared to rural areas was 1.13 (95% CI 0.94-1.36). The RRR for stroke among car, taxi, and van drivers compared to drivers of heavy trucks and of lorries was 1.28 (95% CI 1.03-1.57). CONCLUSION: All groups of professional drivers are at increased risk of stroke. The excess risk is more due to cerebral infarctions than to non-traumatic intracranial haemorrhage. The risk of stroke is higher among drivers carrying passengers than among drivers carrying goods.

A randomised controlled trial evaluating the effects of two workstation interventions on upper body pain and incident musculoskeletal disorders among computer operators.

BACKGROUND: Call centre work with computers is associated with increased rates of upper body pain and musculoskeletal disorders. METHODS: This one year, randomised controlled intervention trial evaluated the effects of a wide forearm support surface and a trackball on upper body pain severity and incident musculoskeletal disorders among 182 call centre operators at a large healthcare company. Participants were randomised to receive (1) ergonomics training only, (2) training plus a trackball, (3) training plus a forearm support, or (4) training plus a trackball and forearm support. Outcome measures were weekly pain severity scores and diagnosis of incident musculoskeletal disorder in the upper extremities or the neck/shoulder region based on physical examination performed by a physician blinded to intervention. Analyses using Cox proportional hazard models and linear regression models adjusted for demographic factors, baseline pain levels, and psychosocial job factors. RESULTS: Post-intervention, 63 participants were diagnosed with one or more incident musculoskeletal disorders. Hazard rate ratios showed a protective effect of the armboard for neck/shoulder disorders (HR = 0.49, 95% CI 0.24 to 0.97) after adjusting for baseline pain levels and demographic and psychosocial factors. The armboard also significantly reduced neck/shoulder pain (p = 0.01) and right upper extremity pain (p = 0.002) in comparison to the control group. A return-on-investment model predicted a full return of armboard and installation costs within 10.6 months. CONCLUSION: Providing a large forearm support combined with ergonomic training is an effective intervention to prevent upper body musculoskeletal disorders and reduce upper body pain associated with computer work among call centre employees.

Prolonged standing at work and hospitalisation due to varicose veins: a 12 year prospective study of the Danish population.

BACKGROUND: Recent studies suggest that prolonged standing at work is associated with the development of diseases of varicose veins (VV). AIMS: To assess the risk of hospitalisation due to VV in the lower extremities prospectively in workers standing or walking at least 75% of their time at work. METHODS: A representative random sample of 9653 working age adults was drawn from the Central Population Register of Denmark in 1991. Of these, 8664 accepted to be interviewed by telephone (response rate 90%). Respondents (2939 men and 2708 women) were 20-59 years old and employed in 1990. Risk ratios for VV were estimated by log-linear Poisson regression models separately for men and women with adjustment for smoking status, body mass index (BMI), heavy lifting, and, for females only, number of children at baseline. RESULTS: During 12 years of follow up, 40 hospitalisations due to VV were observed among the men and 71 among the women. For employees with jobs that require prolonged standing or walking compared to all other employees, the relative risk was 1.75 (95% CI 0.92 to 3.34) for men and 1.82 (95% CI 1.12 to 2.95) for women. The pooled estimate of the relative risk was 1.78 (95% CI 1.19 to 2.68). The aetiological fraction of prolonged standing or walking at work was estimated as 22.5% for men and 22.6% for women. CONCLUSIONS: This prospective study confirms that prolonged standing at work constitutes an excess risk of hospital treatment due to varicose veins and accounts for more than one fifth of all cases of working age.

[Cognitive dysfunction after abdominal surgery in elderly patients]. / Kognitive Dysfunktionen nach abdominal-chirurgischen Operationen bei älteren Patienten.

Elderly patients often suffer from postoperative cognitive deficits (POCD) after serious surgical operations. The reasons for this are not well understood. We investigated the influence of the invasiveness of the operation and the duration of the operation as well as the patient's preoperative physical status on measures of cognitive dysfunction. In a prospective study 59 elderly patients (mean age 69.2 years) were subjected to a neuropsychological test battery and a questionnaire following an abdominal surgical operation. The postoperative recovery with a focus on memory function was assessed using the Wechsler Memory Scale (WMS) seven days after the operation. Self-reported cognitive deficits were studied using the a questionnaire of experienced attention deficits (FEDA) three months after the operation. Postoperative psychological and self-reported test results varied as a function of the invasiveness and the duration of the operation. After more invasive operations patients reported a stronger deficit in activities of daily living and a reduction in drive than after less invasive operations. In addition, the duration of anesthesia influenced the experienced deficits. The self-reported deficits were more strongly influenced by the features of the operation than the psychological test data. The physical status of the patients according to the American Society of Anesthesiologists (ASA) along with the duration of anesthesia as covariate was identified as a good predictor for the cognitive recovery post operation.

Socioeconomic status, occupation, and risk of hospitalisation due to coxarthrosis in Denmark 1981-99.

OBJECTIVES: To predict the relative risk and time trend in hospitalisation due to coxarthrosis (CA) among groups of different socioeconomic status and occupations in order to test existing aetiological hypotheses. METHODS: Four consecutive cohorts of all gainfully employed Danish men were followed up for CA. Standardised hospitalisation ratios (SHR) and time trends were calculated. RESULTS: Self employed men had an SHR due to CA of 140 (95% confidence interval (CI) 130 to 151) in 1994-99. It changed -1.2% (95% CI -2 to -0.4) annually from 1981 to 1999. Self employed farmers had an SHR of 286 (95% CI 262 to 313) during 1994-99, increasing 0.14% a year (95% CI -0.9 to 1.1) from 1981 to 1999. Unskilled men had an SHR of 121 (95% CI 113 to 130) in 1994-99. The SHR increased 1.6% annually (95% CI 0.7 to 2.4) from 1981 to 1999. Employed agricultural workers had an SHR of 189 (95% CI 158 to 227) from 1994 to 1999. The SHR increased 3.7% annually (95% CI 1.2 to 6.2) from 1981 to 1999. CONCLUSIONS: The relative risk of hospitalisation due to CA was consistently high among farmers in four successive analyses spanning an 18 year period. The relative risks remained stable over time despite the fact that the number of farmers decreased. The risk increased among employed workers in agriculture and horticulture over that period, and an increased risk was also found among tractor drivers and a few other occupations.

Psychosocial job factors and return-to-work after compensated low back injury: a disability phase-specific analysis.

BACKGROUND: Job characteristics may constitute a barrier to return-to-work (RTW) after compensated disabling low back pain (LBP). This study examines the impact of psychosocial job factors on time to RTW separately during the acute and subacute/chronic disability phases. METHODS: This is a retrospective cohort study of 433 LBP workers' compensation claimants with 1-4 years of follow-up. The association of psychosocial job factors with duration of work disability was estimated with Cox regression models, adjusting for injury history and severity, physical workload, and demographic and employment factors. RESULTS: High physical and psychological job demands and low supervisory support are each associated with about 20% lower RTW rates during all disability phases. High job control, especially control over work and rest periods, is associated with over 30% higher RTW rates, but only during the subacute/chronic disability phase starting 30 days after injury. Job satisfaction and coworker support are unrelated to time to RTW. CONCLUSIONS: Duration of work disability is associated with psychosocial job factors independent of injury severity and physical workload. The impact of these risk factors changes significantly over the course of disability.

Determinants of duration of disability and return-to-work after work-related injury and illness: challenges for future research.

BACKGROUND: The purpose of this review was to identify critical data and research needs in addressing the following question: What are the primary factors that affect the time lost from work, return-to-work (RTW), subsequent unemployment, and changes in occupation after disabling illness or injury? METHODS: Review of the literature to identify research challenges originating from the multitude of disciplines, data sources, outcome measures, and methodological and analytical problems. RESULTS: About 100 different determinants of RTW outcomes were identified. Their impact varies across different phases of the disablement process. Recommendations are provided for addressing five selected research challenges. CONCLUSION: Interdisciplinary research needs to develop a comprehensive conceptual framework. Priority should be given to studies on specific domains of risk factors meeting five selection criteria: amenability to change; relevance to users of research; generalizability across health conditions, disability phases, and settings; "degree of promise" as derived from qualitative exploratory studies; and capacity to improve measurement instruments. Combining qualitative and quantitative research methods is necessary to bridge existing knowledge gaps.

Social exchange and well-being: is giving better than receiving?

This research examined the effects of giving and receiving assistance on psychological well-being while taking into account other salient dimensions of social support including negative interaction and anticipated support. Structural equation models were evaluated by using data derived from a national probability sample of 1,103 individuals aged 65 years or older. Results indicate that the major dimensions of social support are significantly interrelated, not only directly but also indirectly. Giving and receiving support have both positive and negative consequences on well-being. With reference to the role of reciprocity, the evidence provides some support for the hypothesis of esteem enhancement instead of social exchange and equity theories.

Gold(III) chloride catalyzed cyclization of alpha-hydroxyallenes to 2,5-dihydrofurans.

[reaction: see text] Functionalized alpha-hydroxyallenes 1 were smoothly converted into the corresponding 2,5-dihydrofurans 2 by using 5-10 mol % of gold(III) chloride as catalyst. This mild and efficient cyclization method can be applied to alkyl- and alkenyl-substituted allenes at room temperature, furnishing tri- and tetrasubstituted dihydrofurans in good to excellent chemical yields and with complete axis to center chirality transfer.

Mechanism of 1,6-addition reactions of organocuprates: detailed NMR spectroscopic study of a cuprate-enyne pi complex.

A detailed NMR-spectroscopic study of the multiply 13C-labeled cuprate pi complexes 2, 2a and 2b was carried out. The 13C,13C coupling constants observed were interpreted in terms of a deformation of the cuprate-alkene complex from the expected idealized square plane. This conclusion is in agreement with NOESY and ROESY data acquired with unlabeled material.

Doctor proactive communication, return-to-work recommendation, and duration of disability after a workers' compensation low back injury.

Although doctors are increasingly evaluated on the basis of return-to-work (RTW) outcomes, the effect of doctor-patient communication about the workplace and RTW after an occupational injury has received little research attention. The effect of patient-reported doctor communication on duration of disability was examined retrospectively in a 3-year cohort of 325 claimants with a lost-time low back injury. Although doctor proactive communication was associated with a greater likelihood of RTW during the acute phase (< 30 days of disability), this effect disappeared when injury and workload characteristics were taken into account. A positive RTW recommendation was associated with about a 60% higher RTW rate during the subacute/chronic phase (> 30 days of disability) only. Prospective studies are needed to confirm this effect. The impact of physician communication on RTW is largely confounded by injury and workplace factors.

Exploring race variations in aging and personal control.

OBJECTIVES: The purpose of this study is twofold: (a) to see whether the association between age and perceived control is the same for Blacks as well as Whites; and (b) to see if education, health, income, social support, cognitive function, and religion account for the relationship between age and control in the same way for Blacks and Whites. METHODS: Data for this study come from the first wave of the Americans' Changing Lives panel study. Complete data are available for 357 Black and 2,792 White individuals. Respondents were asked questions about their feelings of control, health status, income, social support, cognitive function, religious participation, and demographic information. RESULTS: The findings suggest that age has an inverse and nonlinear association with feelings of control. Moreover, this relationship is similar for Blacks and Whites. The data further reveal that, across all age groups, Blacks report a lower sense of control than Whites. Less education, less income, greater cognitive impairments, and more religiosity are associated with a lower sense of control. These factors, along with health and social support, account for 69% of the association between age and control, with no differences according to race. DISCUSSION: These results show that lower levels of control are associated with older age in both Blacks and Whites, and that racial disparities in feelings of control persist across all age groups. This suggests that Blacks may be at a particular disadvantage in the face of the increasing challenges of aging.

Sentinel lymph node detection in patients with cervical cancer.

PURPOSE: We investigated the validity of sentinel lymph node (SLN) detection after radioactive isotope and/or blue dye injection in patients with cervical cancer. PATIENTS AND METHODS: Between December 1998 and May 2000, 50 patients (mean age 44 years) with cervical cancer FIGO stage I (n = 32), stage II (n = 16), or stage IV (n = 2) underwent SLN detection during primary operation (radical laparoscopic-vaginal or abdominal hysterectomy, exenteration). The day before surgery 1 ml of Albu-Res labeled with 50 MBq Technetium 99m was applied into the cervix at 3(00), 6(00), 9(00), and 12(00). Blue dye injection (Patentblue) occurred intraoperatively into the cervix at the same locations. RESULTS: The detection rate of SLN was 78%. Ten patients (20.0%) were diagnosed with lymph node metastases. No SLN was detected in 10 patients, of which 4 patients had positive lymph nodes. Sensitivity and negative predictive value were 83.3 and 97.1%, respectively. The false-negative rate was 16.6% (1 of 6 patients). After the combined injection, the detection rate, sensitivity, and negative predictive values were 100%. A mean of 2.7 pelvic and 2.6 para-aortic SLNs were detected. Para-aortic SLNs were located in the paracaval region in 66.6%, whereas pelvic SLNs were detected in 25.7% at the origin of the uterine artery and in 24.7% at the division of the common iliac artery. CONCLUSION: A combination of radioactively labeled albumin with blue dye allows successful detection of SLN in patients with cervical cancer. The clinical validity of this technique must be evaluated prospectively.

Standing at work and varicose veins.

OBJECTIVES: This study attempts to determine whether or not prolonged standing at work involves an excess risk for the occurrence of varicose veins. METHODS: A cohort of 1.6 million 20-to-59-year-old Danes gainfully employed in 1991 were followed for 3 years according to first hospitalization due to varicose veins of the lower extremities. The exposure data came from a representative sample of the baseline population. Altogether 5940 people were interviewed about occupational exposure and confounding factors. RESULTS: For men working mostly in a standing position, the risk ratio for varicose veins was 1.85 [95% confidence interval (95% CI) 1.33-2.36] in a comparison with all other men. The corresponding risk ratio for women was 2.63 (95% CI 2.25-3.02). The results were adjusted for age, social group, and smoking. CONCLUSIONS: Working in a standing position is associated with subsequent hospitalization due to varicose veins for both men and women.

Giving social support to others, socioeconomic status, and changes in self-esteem in late life.

OBJECTIVE: The purpose of this study was twofold: (1) to see if providing emotional support to others bolsters the self-esteem of older adults over time; and (2) to assess whether the salubrious effects of helping others are more likely to be enjoyed by high socioeconomic status (SES) elders. METHODS: Interviews were conducted with a nationally representative sample of older adults at three points in time: 1992-1993, 1996-1997, 1998-1999. Complete data are available for 511 elderly people. During each round of interviews, respondents were asked how often they provided emotional support to their social network members. Information on the self-esteem of older support providers was also gathered at each point in time. RESULTS: Initially, the findings revealed that helping others tends to bolster the self-esteem of all study participants regardless of their SES standing. However, these benefits began to taper off for lower SES elders during the course of the study. By the third wave of interviews, the salutary effects of helping others were evident only among older adults in upper SES levels. DISCUSSION: The results highlight the dynamic nature of the helping process and underscore the importance of taking SES into account when studying the effects of assisting others in late life.