Cold season dose rate contributions from gamma, radon, thoron or progeny in legacy mines with high natural background radiation.

In areas with high natural background radiation, underground cavities tend to have high levels of airborne radionuclides. Within mines, occupancy may involve significant exposure to airborne radionuclides like radon (222Rn), thoron (220Rn) and progeny. The Fen carbonatite complex in Norway has legacy mines going through bedrock with significantly elevated levels of uranium (238U) and especially thorium (232Th), and significant levels of their progeny 222Rn and 220Rn. There are also significantly elevated levels of gamma radiation in these mines. These mines are naturally chimney ventilated and release large volumes of air to the outdoors giving a large local outdoor impact. We placed alpha track detectors at several localities within these mines to measure airborne radionuclides and measured gamma radiation of bedrock at each locality. The bedrock within the mines shows levels up to 1900 Bq kg-1 for 238U, 12 000 Bq kg-1 for 232Th and gamma dose rates up to 11 µSv h-1. Maximum levels of airborne radionuclides were 45 000 Bq m-3 for 220Rn and 6900 Bq m-3 for 222Rn. In addition, we measured levels of thoron progeny (TnP). In order to estimate radiation dose contribution, TnP should be assessed rather than 220Rn, but deposition-based detectors may be biased by the airflow of mine-draft. We present dose rate contributions using UNSCEAR dose conversion factors, and correcting for airflow bias, finding a combined cold season dose rate within these mines of 17-24 µSv h-1. Interestingly, fractional dose rate contributions vary from 0.02 to 0.6 for gamma, 0.33 to 0.95 for radon and 0.1 to 0.25 for TnP.

Outdoor thoron and progeny in a thorium rich area with old decommissioned mines and waste rock.

Radon (222Rn), thoron (220Rn) and their decay products may reach high levels in areas of high natural background radiation, with increased risk associated with mining areas. Historically, the focus has mostly been placed upon radon and progeny (RnP), but recently there have been reports of significant contributions to dose from thoron progeny (TnP). However, few direct measurements of TnP exist under outdoor conditions. Therefore, we assessed the outdoor activity concentrations of radon, thoron and TnP in an area of igneous bedrock with extreme levels of radionuclides in the thorium decay series. The area is characterized by decommissioned mines and waste rock deposits, which provide a large surface area for radon and thoron emanation and high porosity enhancing exhalation. Extreme levels of thorium and thoron have previously been reported from this area and to improve dose rate estimates we also measured TnP using filter sampling and time-integrating alpha track detectors. We found high to extreme levels of thoron and TnP and the associated dose rates relevant for inhalation were up to 8 µSvh-1 at 100 cm height. Taking gamma irradiation and RnP into account, significant combined doses may result from occupancies in this area. This applies to recreational use of the area and especially previous and planned road-works, which in the worst case could involve doses as large as 23.4 mSv y-1. However, radon and thoron levels were much more intense on a hot September day than during time-integrated measurements made the subsequent colder and wetter month, especially along the ground. This may be explained by cold air observed flowing out from inside the mines through a drainage pipe adjacent to the measurement stations. During warm periods, activity concentrations may therefore be due to both local exhalation from the ground and air ventilating from the mines. However, a substantially lower level of TnP was measured on the September day using filter sampling, as compared to what was measured with time-integrative alpha track detectors. A possible explanation could be reduced filter efficiency related to the attached progeny of some aerosol sizes, but a more likely cause is an upwards bias on TnP detectors associated with assumed deposition velocity, which may be different in outdoor conditions with wind or a larger fraction of unattached progeny. There is thus a need for better instrumentation when dealing with outdoor TnP.

Bariatric surgery and long-term cardiovascular events.

CONTEXT: Obesity is a risk factor for cardiovascular events. Weight loss might protect against cardiovascular events, but solid evidence is lacking. OBJECTIVE: To study the association between bariatric surgery, weight loss, and cardiovascular events. DESIGN, SETTING, AND PARTICIPANTS: The Swedish Obese Subjects (SOS) study is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care. Patients were recruited between September 1, 1987, and January 31, 2001. Date of analysis was December 31, 2009, with median follow-up of 14.7 years (range, 0-20 years). Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Exclusion criteria were identical in surgery and control patients. Surgery patients underwent gastric bypass (13.2%), banding (18.7%), or vertical banded gastroplasty (68.1%), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals. MAIN OUTCOME MEASURES: The primary end point of the SOS study (total mortality) was published in 2007. Myocardial infarction and stroke were predefined secondary end points, considered separately and combined. RESULTS: Bariatric surgery was associated with a reduced number of cardiovascular deaths (28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group; adjusted hazard ratio [HR], 0.47; 95% CI, 0.29-0.76; P = .002). The number of total first time (fatal or nonfatal) cardiovascular events (myocardial infarction or stroke, whichever came first) was lower in the surgery group (199 events among 2010 patients) than in the control group (234 events among 2037 patients; adjusted HR, 0.67; 95% CI, 0.54-0.83; P < .001). CONCLUSION: Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.

WISC-III index score profiles of 520 Swedish children with pervasive developmental disorders.

WISC-III (Wechsler, 1991) index score profiles and their characteristics were examined with traditional statistics in a large Swedish sample consisting of children with autistic disorder (n = 85), Asperger's disorder (n = 341), or pervasive developmental disorders not otherwise specified (PDD-NOS; n = 94). There was a clear and significant difference in level between children with Asperger's disorder, who performed in the average range according to the Swedish standardization, and children with either autistic disorder or PDD-NOS, who performed below the average range (almost 2 standard deviations below the mean), but few other differences between the diagnostic groups were found. The variation in this sample, compared with the Swedish standardization, was generally larger in regard to the size of standard deviations and to the proportion of individuals who exhibited significant differences between indices. The result implied that a WISC-III profile could not be used to discriminate between the different PDDs.

Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial.

BACKGROUND: Obesity is a risk factor for cancer. Intentional weight loss in the obese might protect against malignancy, but evidence is limited. To our knowledge, the Swedish Obese Subjects (SOS) study is the first intervention trial in the obese population to provide prospective, controlled cancer-incidence data. METHODS: The SOS study started in 1987 and involved 2010 obese patients (body-mass index [BMI] >or=34 kg/m(2) in men, and >or=38 kg/m(2) in women) who underwent bariatric surgery and 2037 contemporaneously matched obese controls, who received conventional treatment. While the main endpoint of SOS was overall mortality, the main outcome of this exploratory report was cancer incidence until Dec 31, 2005. Cancer follow-up rate was 99.9% and the median follow-up time was 10.9 years (range 0-18.1 years). FINDINGS: Bariatric surgery resulted in a sustained mean weight reduction of 19.9 kg (SD 15.6 kg) over 10 years, whereas the mean weight change in controls was a gain of 1.3 kg (SD 13.7 kg). The number of first-time cancers after inclusion was lower in the surgery group (n=117) than in the control group (n=169; HR 0.67, 95% CI 0.53-0.85, p=0.0009). The sex-treatment interaction p value was 0.054. In women, the number of first-time cancers after inclusion was lower in the surgery group (n=79) than in the control group (n=130; HR 0.58, 0.44-0.77; p=0.0001), whereas there was no effect of surgery in men (38 in the surgery group vs 39 in the control group; HR 0.97, 0.62-1.52; p=0.90). Similar results were obtained after exclusion of all cancer cases during the first 3 years of the intervention. INTERPRETATION: Bariatric surgery was associated with reduced cancer incidence in obese women but not in obese men. FUNDING: Swedish Research Council, Swedish Foundation for Strategic Research, Swedish Federal Government under the LUA/ALF agreement, Hoffmann La Roche, Cederoths, AstraZeneca, Sanofi-Aventis, Ethicon Endosurgery.

Effects of bariatric surgery on mortality in Swedish obese subjects.

BACKGROUND: Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality. METHODS: The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%). RESULTS: The average weight change in control subjects was less than +/-2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastroplasty, 25%; and banding, 20%. After 10 years, the weight losses from baseline were stabilized at 25%, 16%, and 14%, respectively. There were 129 deaths in the control group and 101 deaths in the surgery group. The unadjusted overall hazard ratio was 0.76 in the surgery group (P=0.04), as compared with the control group, and the hazard ratio adjusted for sex, age, and risk factors was 0.71 (P=0.01). The most common causes of death were myocardial infarction (control group, 25 subjects; surgery group, 13 subjects) and cancer (control group, 47; surgery group, 29). CONCLUSIONS: Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.

Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery.

BACKGROUND: Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk, but whether these benefits persist over time is unknown. METHODS: The prospective, controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects. We now report follow-up data for subjects (mean age, 48 years; mean body-mass index, 41) who had been enrolled for at least 2 years (4047 subjects) or 10 years (1703 subjects) before the analysis (January 1, 2004). The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years. RESULTS: After two years, the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group (P<0.001). After 10 years, the weight had increased by 1.6 percent and decreased by 16.1 percent, respectively (P<0.001). Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period. Two- and 10-year rates of recovery from diabetes, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, hypertension, and hyperuricemia were more favorable in the surgery group than in the control group, whereas recovery from hypercholesterolemia did not differ between the groups. The surgery group had lower 2- and 10-year incidence rates of diabetes, hypertriglyceridemia, and hyperuricemia than the control group; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable. CONCLUSIONS: As compared with conventional therapy, bariatric surgery appears to be a viable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolemia, amelioration in risk factors that were elevated at baseline.