Self-reported causes for referral to dental treatment under general anaesthesia (DGA): a cross-sectional survey.

AIM: To determine causes leading to dental care under general anaesthesia (DGA) in public health care reported by the patients or the parents/caregivers. STUDY DESIGN: All the patients referred to DGA at the Municipal Health Centre, Oulu, Finland, during 10 months were invited to participate in the present cross-sectional survey. They were sent a questionnaire on indications for referral to DGA, dental fear, possible reasons for it as well as prior treatment of dental fear. For measuring overall dental fear, the modified Corah dental anxiety scale (MCDAS) and visual analogue scale (VAS) forms were also included in the questionnaire. RESULTS: The most common self-reported indication for referral to DGA was dental fear (63.9%). For children and adolescents (<18 years), need for extensive care was the second most common reported cause. The great majority of the respondents reported having dental fear (90.8%). Dental fear was more common among females than males, but the difference between the genders was not statistically significant. The most common cause for dental fear was earlier negative experiences in dental care (51.9%). The mean MCDAS score was 19.0 (SD 5.7; 5-25) indicating severe dental anxiety. An increasing trend towards older age groups could be seen in VAS scores reporting fear of pain, needles, scaling, scolding by the dentist, extractions, as well as endodontic treatment. Dental fear had been taken into consideration in dental treatment preceding DGA. CONCLUSION: Dental fear is the most common self-reported indication for referral to DGA and should be taken into consideration.

The capacity of the distal stump of peripheral nerve to receive growing axons after two and six months denervation.

BACKGROUND AND AIMS: Peripheral nerve injury may lead to poor recovery outcome in spite of treatment with advanced microsurgical repair techniques. Delayed cross-anastomosis paradigm was used to study the axon grow to the distal nerve stump after denervation separately from the influence of prolonged axotomy in the proximal stump. MATERIAL AND METHODS: Left common peroneal nerve of 48 rats was transected and denervated over two or six months. There were two research groups in the study. In the regeneration group (REG) the proximal stump of acutely transected tibial nerve was sutured to denervated distal stump of common peroneal nerve. To our knowledge, this is the first study in which this group was compared to degeneration group (DEG) with both nerve ends denervated over two or six months. This comparison enabled us to study the capacity of denervated distal nerve stump to receive sprouting axons. Axon density in distal nerve stump was calculated after three or six week's follow-up periods. RESULTS: There were no differences in the number of axon sprouts in the distal nerve stump between the denervation periods of two and six months. When compared REG and DEG groups, there was trend to higher axon densities in the REG group, although the differences were not statistically significant. CONCLUSIONS: We conclude that the capacity of distal nerve stump to receive the growing axons from the proximal nerve stump does not decrease significantly between two and six months denervation. Cross-anastomosis paradigm provides a useful tool for detailed study of the nerve transfer procedure.

Distinct expression of TGF-beta1 mRNA in the endo- and epineurium after nerve injury.

TGF-beta is a multifunctional regulatory protein with important effects on cell proliferation and differentiation, immune reactivity and extracellular matrix (ECM). During peripheral regeneration it can have growth promoting effects for axonal sprouting, but on the other hand, it may be involved in epineurial scarring and neuroma formation. We studied the expression of TGF-beta1 mRNA in the rat peripheral nerve with real time-PCR at 1, 3, 5, 7, 14, 21, 28, 35, and 42 days after transection. The sciatic nerve was sutured after transection to prevent axonal regeneration. Samples from both proximal and distal stumps were collected. To distinguish the possible different expression in the endo- and epineurium these two compartments were studied separately. The most significant finding was observed in the epineurium of the proximal stump 35 days after the operation. The expression of TGF-beta1 mRNA was over 700 times higher than that found in the non-operated controls. At the same time the expression of TGF-beta1 mRNA in the endoneurium was only twice as high as the values measured from the non-operated controls. Distally the TGF-beta1 mRNA expression in the endoneurium reached its peak after 2 weeks, and at weeks 3-6, the expression was two to four times higher than in the controls. This study supports the concept that TGF-beta1 can affect epineurial scarring.

Hirschsprung disease, mental retardation and dysmorphic facial features in five unrelated children.

We report five patients with Hirschsprung disease, severe mental retardation and dysmorphic facial features including hypertelorism, prominent forehead and dysmorphic ears. All four boys had hypospadias. All had postnatally retarded growth. One of them had a de novo apparently balanced translocation 46,XY,t(2;11)(q22.2;q21). There are several reports on patients with Hirschsprung disease, mental retardation and various dysmorphic features. Some of them, especially those reported by Tanaka et al. [(1993) Pediatr Neurol 9:479-481], Lurie et al. [(1994) Genet Couns 5:11-14] and Mowat et al. [(1998) J Med Genet 35:617-623] closely resemble our patients suggesting that they have the same malformation syndrome.

Time to pregnancy among the wives of men occupationally exposed to lead.

We conducted a retrospective study on time to pregnancy among the wives of men biologically monitored for lead to assess whether paternal occupational exposure to inorganic lead is associated with decreased fertility. After three mailings, 554 (72.2%) wives of the monitored men participated. The final study population consisted of 502 couples who did not use contraception at the beginning of the pregnancy. We assessed lead exposure from blood lead measurements and from questionnaires completed by the men. We calculated the relative fecundability density ratios with discrete proportional hazards regression. The fecundability density ratios, adjusted for potential confounders, were 0.92 [95% confidence interval (95% CI) = 0.73-1.16], 0.89 (95% CI = 0.66-1.20), 0.58 (95% CI = 0.33-0.96), and 0.83 (95% CI = 0.50-1.32) for blood lead categories 0.5-0.9, 1.0-1.4, 1.5-1.8, and > or =1.9 micromol/L, respectively, as compared with <0.5 micromol/L. The findings provide limited support for the hypothesis that paternal exposure to lead is associated with decreased fertility.

[The importance of periodic medical examinations for the promotion of workers' health in the 21st century]. / Znachenie periodicheskikh meditsinskikh osmotrov dlia sokhraneniia zdorov'ia rabotaiushchikh v XXI veke.

Organization of periodic medical examinations for workers in XXI century should correspond to requirements of swiftly developing production. Successful future of periodic medical examinations necessitates regular disclosure of new aspects of those requirements and long-term planning of their application to working environment.

Increased expression of chemokines (MCP-1, MIP-1alpha, RANTES) after peripheral nerve transection.

After nerve injury, recruitment of circulating macrophages into the endoneurium is essential for degeneration and subsequently for successful regeneration. However, the factors leading to macrophage recruitment are not known in detail. Chemokines are one of many possible factors influencing recruitment. In this study we wanted to examine, immunohistochemically, the expression of MCP-1, MIP-1alpha and RANTES from 6 hours up to 4 weeks after transection of rat sciatic nerve. An increased expression of MCP-1 was noted already 6 hours after transection, mainly in Schwann cells. Later, the MCP-1 positive staining was seen also in macrophages, fibroblast-like cells and endothelial cells. An increased number of MIP-1alpha positive cells could be noticed after 24 hours, the maximum expression in Schwann cells was noted at the 5-day timepoint. Later, part of the positive cells appeared to be macrophages. RANTES was mainly expressed in inflammatory cells. Endothelial cells in the epi- and endoneurium showed positive staining for every chemokine studied after transection. The contralateral non-operated nerves showed an increased number of positive cells for MCP-1 and MIP-1alpha. In the control nerves MCP-1 and MIP-1alpha positive cells were scattered throughout the endoneurium. This study shows that increased expression of chemokines takes place within endoneurium after peripheral nerve transection. Thus, it is probable that chemokines can take part in the recruitment of macrophages. It further shows that there is an increased expression of the studied chemokines in the non-operated contralateral nerves. Even in normal conditions chemokines are needed, probably to keep resident macrophages within endoneurium.

Cyclosporin A affects axons and macrophages during Wallerian degeneration.

A traumatic injury of a peripheral nerve leads to Wallerian degeneration. It includes the recruitment of macrophages and the phagocytosis of myelin and the remnants of axons. We have previously studied the recruitment of macrophages and now wished to determine if the immunosuppressant cyclosporin A (CsA) affects the number of macrophages at the site of nerve injury. The primary target of CsA is T-cells, but it may also have an effect on mononuclear phagocytes which exert a key role during Wallerian degeneration. Rats were divided into two groups: CsA-treated animals and control animals. Following transection of the sciatic nerve in the treatment group, the animals received 5 mg/kg CsA subcutaneously. The groups were further subdivided into a freely regenerating nerve group and a sutured nerve group. The number of macrophages and MHC class II positive cells were counted 3 days, 7 days, 2 weeks, 4 weeks, and 8 weeks posttransection; also CD4, CD8, IL-2 receptor positive cells, B cells, and the axonal sprouting were studied. In the CsA-treated group, there were more macrophages in the distal areas under 8 weeks than in the controls (p < 0.05); thus, the clearance of macrophages is delayed in the CsA-treated rats compared to the control rats. In the proximal area, the difference in macrophage number did not gain statistical significance. Additionally, CsA retarded axonal degeneration. CsA affects number of macrophages during Wallerian degeneration, while retarding axonal degeneration and subsequent reinnervation. Its mechanism of action appears to involve either direct or indirect via T-cells-mediated responses.

Peripheral nerve injury induces endoneurial expression of IFN-gamma, IL-10 and TNF-alpha mRNA.

Axotomy of a peripheral nerve leads to interruption of axon continuity with Wallerian degeneration in the distal segment and regenerative events in the proximal remaining neuron. Local inflammation is a consequence of trauma in general and signal molecules regulating inflammation, such as cytokines, participate in the outcome of nerve trauma. We studied a broad set of potent immunoregulatory cytokines after transection of rat sciatic nerve. The endoneurium of the transected rat sciatic nerve was taken from both proximal and distal stumps. The pooled endoneurium of 6 rats was studied using reverse transcription polymerase chain reaction (RT-PCR) after 14 h; 1, 3, 5, 7 days; 2 and 4 weeks after transection. A new observation was that TNF-alpha mRNA showed phasic expression pattern; three distinct peaks were seen, immediately (14 h), after 5 days and in the distal part also after 2 weeks. This phenomenon may be related to the breakdown of the blood-nerve barrier and to the recruitment of circulating macrophages. We further noticed that IFN-gamma mRNA was expressed between 5 days and 2 weeks. This suggests that T-cells may also take part in the regenerative processes. Furthermore, we observed that IL-10 mRNA is expressed continuously during Wallerian degeneration. The continuous expression of IL-10 mRNA may attenuate the production of inflammatory cytokines by macrophages and other cells.

Spontaneous abortions among veterinarians.

OBJECTIVES: The objective of the study was to determine whether female veterinarians have an increased risk of spontaneous abortion and whether the potential risk is related to the type of work veterinarians do. METHODS: The investigation was a retrospective cohort study among all the female members of the Finnish Veterinary Association (N=549). Information on pregnancies was obtained from hospital records from 1973-1990. The risk of spontaneous abortion among the veterinarians was compared with that of all other Finnish women and other upper-level employees. Odds ratios from logistic regression analyses were used as the estimates of the risk ratios. RESULTS: The risk of spontaneous abortion was 10.5% for the veterinarians. In the 1970s, practicing veterinarians had an increased risk of spontaneous abortion as compared with other Finnish women (adjusted odds ratio 1.8, 95% confidence interval 1.0-3.1) or other upper-level employees (adjusted odds ratio 2.0, 95% confidence interval 1.1-3.4). In the 1980s, the risk fell below that of other Finnish women. No essential differences were observed in the risk between the veterinarians employed in different occupational categories. CONCLUSIONS: The results suggest that the veterinarians had an increased risk of spontaneous abortion in the 1970s, but not in the 1980s. Factors which might have contributed to this decrease in risk include decreases in the prevalence and level of exposure to harmful agents, improvements in the occupational hygiene of the work environment, and an increased awareness of reproductive hazards and the use of sick leave during pregnancy.

Spontaneous abortions among Finnish flight attendants.

We conducted a retrospective cohort study to investigate whether work as a cabin attendant is related to an increased risk for spontaneous abortion. Data on female cabin crew members were linked to medical records on pregnancies. There were 1751 eligible pregnancies for the final analysis. Flight attendants who worked during early pregnancy had a slightly elevated risk of spontaneous abortion, as compared with attendants who were pregnant outside a time span of active flying (odds ratio [OR] = 1.3; 95% confidence interval [CI], 0.9 to 1.8). During the earliest years of the study period (1973 through 1977), the risk seemed to be decreased (OR = 0.4; 95% CI, 0.2 to 1.1), whereas during the later years (1978 through 1994) the risk was increased (OR = 1.6; 95% CI, 1.1 to 2.4). The results are in agreement with earlier studies, showing suggestive evidence of a slightly increased risk of spontaneous abortion among female cabin crew members.

Reduced fertility among female wood workers exposed to formaldehyde.

BACKGROUND: The aim of the study was to investigate whether exposure to formaldehyde, organic solvents or other chemicals in the wood-processing industry affects the fertility of women. METHODS: For this purpose, a retrospective study on time to pregnancy was conducted among female wood workers who had given birth during 1985-1995. Data on pregnancy history, time to pregnancy, occupational exposures, and potential confounders were collected by a questionnaire; 64% (699/1,094) participated. The exposure assessment was conducted by an occupational hygienist. The data on time to pregnancy were analyzed with the discrete proportional hazards regression. RESULTS: Exposure to formaldehyde was significantly associated with delayed conception: adjusted fecundability density ratio, FDR, was 0.64 (95% CI 0.43-0.92). At high exposure if no gloves were used, the FDR was 0.51 (% CI 0.28-0.92). Exposure to phenols, dusts, wood dusts, or organic solvents was not related to the time to pregnancy. Additionally, an association was observed between exposure to formaldehyde and an increased risk of spontaneous abortion (concerning previous spontaneous abortions, reported by the women). Associations between exposure to formaldehyde or to organic solvents and endometriosis, and between exposure to organic solvents or to dusts and salpingo-oophoritis were also suggested. CONCLUSIONS: The study suggests that a woman's occupational exposure to formaldehyde has an adverse effect on fertility.

Time to pregnancy among the wives of men exposed to organic solvents.

OBJECTIVES: To assess whether paternal exposure to organic solvents is associated with decreased fertility. METHODS: A retrospective time to pregnancy study was conducted among men biologically monitored for organic solvents. The workers were classified into exposure categories on the basis of work description and the use of solvents as reported in the questionnaires, and on biological exposure measurements. The relative fecundability density ratios (FDR--an analogue of incidence density ratio of clinically recognised pregnancies) were calculated with discrete proportional hazards regression. RESULTS: After three mailings 316 (72.1%) wives of the monitored men participated. The final study population consisted of 282 couples who did not use contraception at the beginning of pregnancy. The FDRs, adjusted for potential confounders, were 0.80 (95% confidence interval (95% CI) 0.57 to 1.11) and 0.74 (95% CI 0.51 to 1.06) for high or frequent and low or intermediate exposure, respectively. High or frequent and low or intermediate exposure were related to decreased fecundability among primigravida (FDRs 0.36; 95% CI 0.19 to 0.66 and 0.53; 95% CI 0.27 to 1.04) but not among couples with at least one previous pregnancy (FDRs 0.96; 95% CI 0.62 to 1.49 and 0.77; 95% CI 0.47 to 1.24). CONCLUSIONS: The findings of the study provide limited support for the hypothesis that paternal exposure to organic solvents might be associated with decreased fertility. Further studies with careful design are warranted.

The dynamics of macrophage recruitment after nerve transection.

In the present study rat sciatic nerves (n = 60) were transected; in half of the animals nerve was allowed to regenerate freely, in the other half the regeneration was prevented by suturing beside the point of transection. Macrophages were stained with ED-1 antibody and counted (number/mm2) in both the epi- and endoneurium 3, 7, 14, 48 and 56 days post transection. Macrophages were observed first in the epineurium; the local density of macrophages was considerably higher in the epineurium than in the endoneurium during the first few days. The number of macrophages in the epineurium was maximal at 3 days (1,000-2,000/mm2), and thereafter it declined sharply. In the endoneurium macrophages were most abundant after 2 weeks (1,000/mm2), after which their number declined steadily. A migration of epineurial macrophages appeared to take place through the perineurium from epineurial areas containing a high concentration of macrophages. Initially an endoneurial accumulation of macrophages was noted in the subperineurial area. These findings suggest an alternative route for macrophages into the endoneurial space. No statistical difference was observed between the regenerating and non-regenerating experimental groups. The present study indicates that regenerating axons do not have an effect on the number of macrophages in either the epineurium or the endoneurium.

Nursing and social work students' initial orientation towards their studies.

The worldwide rapid social and economic changes also give challenges to health and social policies. Nowadays there is a need for integration of health and social services and self-managed work teams, which can improve the quality of services offered to clients. This is especially a challenge to nursing and social work education. One approach to respond to this challenge is to develop students' self-direction during training. Today self-direction is one of the central principles in adult learning, as one of its aims is to prepare students to manage changes in society. In this study, nursing (n = 68) and social work (n = 71) students' orientation towards their studies was investigated at the beginning of their professional education. The data were collected by a questionnaire developed for the study. The results suggest that, in general, both nursing and social work students are orientated actively towards their studies. However, nursing students were less willing to participate in planning their studies than were social work students. Moreover, nursing students were more teacher-directed than social work students.

Communication Concerning the Risks of Occupational Exposures in Pregnancy.

The health professional who is involved in communicating information about reproductive risks from occupational hazards needs to consider several important aspects. Uncertainties in risk assessment, timing of exposure in relation to pregnancy, and the consequences of different preventive measures for the woman (family), as well as for the employer and other persons at the workplace are examples of such aspects. The basis for the pregnant woman's perception of risk must be recognized. The risk-communication goal is that the persons concerned fully understand the risk and its possible consequences, so that they will be able to make informed decisions about how to act. More attention should be given to risk communication in the training of health professionals.

Time to pregnancy among women occupationally exposed to lead.

A retrospective time-to-pregnancy study was conducted among women biologically monitored for exposure to lead. The women were participants of a previous study on spontaneous abortion. They were classified into exposure categories on the basis of questionnaire information, and individual blood lead (B-Pb) measurements. The adjusted incidence density ratios (IDR) of clinically recognized pregnancies were .93 (95% confidence interval [CI] .56 to 1.57) for very low (B-Pb < .5 mumol/L), .84 (CI .48 to 1.45) for low (B-Pb .5 to .9 mumol/L), and .80 (CI 0.42 to 1.54) for higher (B-Pb > or = 1.0 mumol/L) exposure compared with no exposure, in the discrete proportional hazards analysis. Exposure to inorganic lead was not associated with fecundability at current, low-exposure levels. The suggestive finding among the eight most heavily exposed women (B-Pb 1.4 to 2.4 mumol/L, IDR .53; CI .19 to 1.52) should be confirmed or refuted in a larger study.

Nordic criteria for reproductive toxicity.

Scientific criteria for assessment of the reproductive toxicity of chemicals have been proposed by a Nordic group of experts and regulatory representatives. The criteria take into account the results of clinical studies as well as of experimental research. The criteria should be useful in, for example, product control and labeling and planning of a safe work environment. The proposed Nordic criteria and examples of the assessment of the reproductive toxicity of some chemicals are presented.

Experiences in developing legislation protecting reproductive health.

The law regarding special maternity leave for pregnant women in hazardous work situations has been in effect since 1981 in Denmark. In Finland, legislation regarding the protection of the reproductive health of working men and women and of pregnant women has been in effect since 1991. According to the special maternity leave law, women who are exposed to certain chemical, physical, or biological agents that are considered to be harmful to the fetus may be entitled to special maternity leave and benefits. In Denmark and in Finland, approximately 1% and 0.1%, respectively, of pregnant women have used the special maternity leave due to a risky work situation. In Finland, the yearly costs of the leave have been US $200,000 to $250,000. Trained occupational physicians can facilitate changes at the workplace that will decrease the need for special maternity leave.