Detection of antibody responses against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis proteins in children with community-acquired pneumonia: effects of combining pneumococcal antigens, pre-existing antibody levels, sampling interval, age, and duration of illness.

We evaluated the effects of combining different numbers of pneumococcal antigens, pre-existing antibody levels, sampling interval, age, and duration of illness on the detection of IgG responses against eight Streptococcus pneumoniae proteins, three Haemophilus influenzae proteins, and five Moraxella catarrhalis proteins in 690 children aged <5 years with pneumonia. Serological tests were performed on acute and convalescent serum samples with a multiplexed bead-based immunoassay. The median sampling interval was 19 days, the median age was 26.7 months, and the median duration of illness was 5 days. The rate of antibody responses was 15.4 % for at least one pneumococcal antigen, 5.8 % for H. influenzae, and 2.3 % for M. catarrhalis. The rate of antibody responses against each pneumococcal antigen varied from 3.5 to 7.1 %. By multivariate analysis, pre-existing antibody levels showed a negative association with the detection of antibody responses against pneumococcal and H. influenzae antigens; the sampling interval was positively associated with the detection of antibody responses against pneumococcal and H. influenzae antigens. A sampling interval of 3 weeks was the optimal cut-off for the detection of antibody responses against pneumococcal and H. influenzae proteins. Duration of illness was negatively associated with antibody responses against PspA. Age did not influence antibody responses against the investigated antigens. In conclusion, serological assays using combinations of different pneumococcal proteins detect a higher rate of antibody responses against S. pneumoniae compared to assays using a single pneumococcal protein. Pre-existing antibody levels and sampling interval influence the detection of antibody responses against pneumococcal and H. influenzae proteins. These factors should be considered when determining pneumonia etiology by serological methods in children.

Factors affecting the use of hearing protectors among classical music players.

Classical musicians are often exposed to sound levels that exceed the Finnish national action limit value of 85 dB(A). Still, the use of hearing protectors is uncommon among musicians. The purpose of this study was to find out musician's attitudes towards hearing protectors, and under which conditions hearing protectors are used. The study group consisted of five major classical orchestras in the Helsinki region. The players were asked to fill out a questionnaire with questions on hearing protection, ear symptoms, including tinnitus, hearing loss, pain in the ears, and temporary ringing in the ears. Also, questions concerning stress and working environments were asked. Of those who responded, 94% were concerned about their hearing to some degree. Only 6% of the musicians always used hearing protector devices (HPDs). Self-reported hearing loss was quite common, with 31% of the musicians reporting some hearing loss. Temporary tinnitus was even more common at 37%. There were 15% of women, and 18% of men reporting permanent tinnitus. Hyper-acousis was reported by 43% of the musicians. The ear symptoms affected the usage rate. Hearing protectors were used more often among musicians having ear symptoms (20%) than those reporting no symptoms (6%). Further, the 43% of the musicians found their work to be interesting and meaningful. Stress was experienced to some extent by 60%, and musicians with ear symptoms had three to nine times more stress and felt their working environment noisier. The study shows that musicians seldom use hearing protectors before symptoms begin. Symptoms increased usage rate, but the usage levels are still far from ideal. Motivation and training is needed to improve hearing protector use among musicians.

Effects of coldness on the protective performance of earmuffs.

The type test of hearing protectors (HPD) for certification purposes will be conducted in laboratory at room temperature. Optionally, the mechanical durability of HPDs will be tested in cold environment by a drop test. The purpose of this study was to find out the relevance of the drop test, the change of performance in HPD protection, and finally to estimate the possible change of protection efficiency against noise in cold environment. In total, 22 HPDs were selected to the measurements: 18 earmuffs, and 4 earmuffs attached to an industrial helmet. Attenuation of each earmuff cup was measured by applying insertion loss method for the test subjects in cold. The change of attenuation and temperature of cushion ring was followed up to nine minutes using 30-second intervals for sampling. Three HPDs were damaged in the test. The replaceable cushion was broken in two earmuffs and in one helmet-mounted HPD. The replaceable parts were replaced, and the HPD with attachment failure was removed from insertion loss measurement. In nine HPDs the relative change was less than 3 dB, and was at worst 10 dB. This change was typically at low frequencies, 125 Hz at the beginning when cooled HPDs were placed. In various HPDs the time to get the attenuation levelled varied from 1.5 minutes to 8 minutes. The recovery was dependent on the temperature of the cushion ring. In all cases the temperature of the full attenuation was achieved when the cushion ring reached 7 degrees C. This temporary decrease in attenuation will have a minor effect to the protection efficiency, when the HPD is used full time during the whole exposure duration. A typical group of forest workers will have their exposure interrupted. The chain saws have to refuel, and the chain needs to be sharpened about every 40 minutes. During 6 hour daily operational time there will be about 9-10 minute break, long enough to cool the cushion ring back to below zero at -10 degrees C, if the helmet mounted earmuffs are placed in stand-by position. In the worst case this will cause 1.6 dB increase in daily exposure level to noise.

Viral markers and use of factor products among Finnish patients with bleeding disorders.

In the seventh national voluntary cross-sectional survey (in 1999) of Finnish patients with haemophilia A or B, type 3 von Willebrand disease or factor XIII deficiency, a plasma sample was received from 193 patients (67%). The samples were tested for hepatitis B and C, human immunodeficiency virus (HIV) and human T-cell leukaemia virus (HTLV) antibodies. Fifty-one percent of the patients were hepatitis C antibody positive and 34% hepatitis B core antibody positive. None of the patients had antibodies against HIV or HTLV. Eighteen percent of the patients had an elevated alanine aminotransferase activity. Abnormal alanine aminotransferase was significantly associated with hepatitis C seropositivity. No new seroconversions were detected among the haemophiliacs or patients with type 3 von Willebrand disease when compared with the last two surveys in 1993 and 1996, and there was no seroconversion in sole users of solvent/detergent-treated factor products. Currently, 32% of the patients use prophylactic factor treatment as their principal mode of therapy, particularly the younger patients with severe forms of the bleeding diseases.

The validity of the TR safety observation method on building construction.

The safety inspectors carried out monitoring visits to 305 building construction sites, and the results were compared with the accident figures of the same sites. The average number of observations per site was 144, and the observed safety aspects were: working habits, scaffolding and ladders, machines and equipment, protection against falling, lighting and electricity, and order and tidiness. Each item was scored as 'correct' if it met the safety standards, otherwise the item was scored as 'not correct'. The safety index was calculated as a percentage of the 'correct' items related to all the observed items. Only some hours of training were needed for making reliable observations, when the observers already knew the safety standards. Also the validity proved to be good. The sites were grouped according to the observed safety index in order to limit the huge random variation in the accident rates of single sites. There was a significant correlation between the observed safety index and the accident rate of the site groups. The sites with the lowest observed safety index had, on average, a three times higher accident rate than the sites with the highest safety index. The method is used by the site personnel as an internal weekly safety inspection and feedback tool. The state safety inspectors use the method as a means of objective feedback for the companies.

Multicentre evaluation of KONE Optima analysis system.

Optima from KONE Instruments Corporation is a new selective laboratory analyzer for turbidimetric, colorimetric and ion selective electrode measurements. Overall analytical performance of Optima and reagents provided by KONE was evaluated according to ECCLS guidelines, in a multicentre study involving four different laboratories, including substrates (cholesterol, high-density lipoprotein-cholesterol, creatinine), specific proteins (transferrin, IgG), enzyme activities (gamma-glutamyltransferase, alanine aminotransferase) and electrolytes (sodium, potassium, chloride). The results obtained attest good precision of the system for all the analytes tested: the range of within-run CV is 0.5 %-4.3 %, and range of between-day CV % is 0.8 %-7.9 % (median of four laboratories). Except for total cholesterol (5 % overestimation compared to the reference method) accuracy of measurement is adequate. Creatinine and uric acid assays were subjects of interference (defined as deviation > 10 % from target value) by bilirubin and haemoglobin respectively.

Verification of self-reported asthma and allergy in subjects and their family members volunteering for gene mapping studies.

Studies which aim at mapping genes contributing to the development of asthma and atopy demand that hundreds of patients and their family members be assessed. In Finland, the Social Insurance Institution (SII) grants substantial reimbursement for medication to all patients who meet diagnostic criteria of asthma, which include a history of asthmatic symptoms and a measured reversibility of bronchial obstruction. To recruit a large number of asthma patients efficiently in a short period of time, we took advantage of the national reimbursement procedure and retrospectively collective data on patients' medical history and lung function test results at the time of diagnosis. First, we wanted to investigate if the reimbursements could be regarded as objective verification for self-reported asthma. Altogether 335 adult self-reported asthma patients were evaluated, 87% of them were verified as having chronic asthma. Reimbursement for medication showed a sensitivity of 95% and a specificity of 76% for verified asthma. Second, we were interested to see if self-reported nasal allergic symptoms or self-reported physician diagnosed allergic rhinitis were sensitive and specific measures of allergy. The self-reported allergic nasal symptoms had a poor specificity (31% in the proband group and 59% in the family members group) when compared to the allergy screening test (Phadiatop). The best verification for self-reported asthma was achieved by combining the information on self-reported disease, granted reimbursement by the SII and the medical records. For allergies, the specificity of self-reporting was far too low to be used alone, and a positive allergy screening test together with relevant symptoms was chosen as a marker of allergy.

Genetic control of serum IgE levels and asthma: linkage and linkage disequilibrium studies in an isolated population.

Immunoglobulin E (IgE) concentration in serum is elevated in atopic diseases such as asthma. A large genomic region on chromosome 5 has previously been implicated in the control of IgE levels and bronchial hyperreactivity and may, therefore, harbor genes predisposing to asthma. In an effort to confirm this linkage and to delimit the critical region, we took advantage of an isolated founder subpopulation in Finland to study genetic linkage and haplotype associations. Sixteen polymorphic markers, including the Interleukin-4 and -9 genes (IL4, IL9), were physically ordered and genotyped in 157 nuclear families. Genetic linkage studies involving sib- and cousin-pair analyses found no evidence of genetic linkage between markers in 5q and either serum IgE levels or asthma. Haplotype association studies were also performed. Although initial inspection suggested the possibility of linkage disequilibrium in the region of IL9, we developed a rigorous permutation test for assessing association and determined that the association was no greater than would be expected by chance. Sequence analysis of the IL9 gene in three patients sharing a possibly conserved haplotype revealed a T113M coding polymorphism, but this variant showed no association with either serum IgE levels or asthma. We conclude that allelic variation at chromosome 5q31 is not likely to contribute to inheritance of serum IgE levels or the development of asthma in this Finnish subpopulation.

Patients' experience of confusion in the intensive care unit following cardiac surgery.

This article reports a study of postoperative intensive care as experienced by coronary artery by-pass patients. The purpose is to describe and reflect upon the patients' experience of confusion in the intensive care unit (ICU). The study was performed according to the phenomenological-hermeneutic research tradition, with ten patients participating. In a free dialogue, the patients were each asked to discuss their experiences in the ICU. The patients remembered their confusion well; it was a significant, incomprehensible experience for them. They felt anxiety while on the threshold between awareness and unawareness, and the fast-paced activity of the ICU environment threatened to draw them into the 'vicious circle' of confusion. In this situation patients emphasised the importance of closeness with a professional person to whom they could turn. The quality of the presence of the nursing staff was significant for the patients, for it was through the true presence of the nurses that patients felt safe, understood and accepted. Patients' comments concerning their confusion verified the challenge this phenomenon poses in nursing care. A research methodology which highlights the individuality of the patients can uncover other hidden or unquestioned issues in nursing. Accordingly, further areas for study are suggested here.

Evaluation of hazards in CO2 laser welding and related processes.

High-power CO2 lasers are used extensively in various industrial applications. In most cases they form part of open-beam equipment and have a power of several kilowatts, and are thus designated as Safety Class 4 systems. In addition to the invisible i.r. laser beam (10.6 microns), u.v. radiation and visible light may be emitted. In the present work a power meter controlled by microprocessor and a spectroradiometer measured the scattered or reflected laser radiation. In addition, concentration levels of welding and cutting fumes and of pyrolysis products of plastics were determined during various laser processes. Finally, a safety analysis was performed to compare the hazards of laser welding with those of conventional welding methods: this showed that the use of laser systems can eliminate many traditional risks, but the worker must be protected not only against the coherent laser beam, but also from incoherent blue light and u.v. radiation.

Fibrinolytic defect in chronic back pain. A controlled study of plasminogen activator activity in 20 patients.

We analyzed the fibrinolytic system in patients with chronic low back pain using a venous occlusion test to stimulate fibrinolysis, and we subsequently determined the levels of tissue plasminogen activator (TPA) and fast-acting inhibitor of TPA (PAI). There were 20 patients with a mean age of 50 years. Two thirds had radiographically spinal stenosis. Scar tissue around the spinal nerves was seen in 11 cases. Thirteen patients had undergone back surgery, whereas 21 healthy subjects served as controls. In the basal samples, TPA activity was decreased in the patients while TPA antigen level was increased compared with the controls. No clear explanation for this defective function of TPA in the patients was obtained, because no difference was seen in PAI level in basal samples. After the venous occlusion, no difference was observed in TPA activity between the two groups excluding the constitutionally defective fibrinolytic system in the patients. However, our results confirm low basal fibrinolytic activity in patients with chronic low back pain with manifest spinal pathology.

Changes in composition of peptidoglycan during maturation of the cell wall in pneumococci.

An experimental system which allows the selective reisolation and structural analysis of a newly made (nascent) segment of pneumococcal peptidoglycan at various times after its incorporation into the preexisting old cell wall was developed. Age-related changes were observed in each one of the major nine wall peptide components resolvable by a high-performance liquid chromatography method. The nascent wall segment (made in 1.7% of a generation time) contained 60% of its peptides as the alanyl-isoglutamyl-lysine tripeptide monomer, 12% as the directly cross-linked peptide dimer (tri-tetra peptide), and a total of 2% as the two major peptide trimers. In the mature wall segment reisolated 1 h later (1 generation time), the proportion of the tripeptide monomer dropped to 40%, while the major dimer and trimers increased to 23% and 8%, respectively. The age-related structural changes were completely inhibited by cefotaxime. The observations indicate that covalent bonds in the structure of pneumococcal peptidoglycan undergo substantial secondary rearrangements after incorporation into the preexisting wall. These changes are likely to be related to the movement of the conserved cell wall segments within the cell surface during cell division.

Involvement of the manubrio-sternal articulation in rheumatoid arthritis.

Changes in the manubrio-sternal articulation (MSA) were examined radiologically in 87 patients with rheumatoid arthritis and in a control group comprised of 23 patients with osteoarthritis and 72 subjects without joint disease. Erosions, reactive sclerosis and ankylosis were encountered in 70% of the rheumatoid arthritis group and in 27% of controls. There was no difference in the incidence of changes in persons with osteoarthritis and in the other control subjects.

The effect of ethanol on the release of free fatty acids from the brain in vivo; a study with push-pull cannula.

The release of nonesterified fatty acids (NEFA) in vivo from the brain after a single dose of ethanol (3 g/kg) in naive rats was studied. A guide cannula was implanted stereotaxically above the striatum. After one week the striatum of the freely moving rat was superfused through a push-pull cannula with artificial CSF. One hour samples were collected. The concentrations of NEFA were measured by GC in four samples, one before and three after ethanol or water was given by gavage. Preliminary results suggest that the concentrations of palmitate and stearate in superfusate decrease after ethanol administration. Of the unsaturated NEFA only oleic and linoleic acids were found in the superfusion fluid even then only in trace amounts and with no major change after ethanol. It remains to be studied whether the reduced outflow of saturated NEFA is related to the increased rigidity of membranes.

Hypolactasia in a fixed cohort of young Finnish adults. A follow-up study.

Selective late-onset hypolactasia (lactose malabsorption) was examined in a fixed cohort of Finnish adolescents, now aged 17 to 25 years. This was the third examination of the same subjects. In the first examination 10 years ago the prevalence of hypolactasia was 6.2%. In the second examination 5 years ago three more cases of hypolactasia were diagnosed, and the prevalence was 9.3%. In this examination the prevalence was 10.3% (10/97); 2 newly manifested hypolactasia cases were diagnosed. If those subjects were included who were not examined this time but whose hypolactasia was diagnosed previously or who were at least 20 years old at the second examination, the prevalence of hypolactasia was 12.7% (13/102). In the 17- to 20-year-olds the prevalence was 15.4%, and in the 21- to 25-year-olds it was 11.1%. The results were in agreement with our previous conclusions that hypolactasia manifests itself in the Finnish population mostly between 10 and 20 years of age and that the prevalence in adults is 17%. Eight of the 13 subjects with hypolactasia had weekly abdominal symptoms; all except one of them had symptoms after the lactose tolerance test. Nine subjects had realized milk intolerance; six of them had symptoms from one glass of milk or less. Symptoms varied considerably from person to person, the commonest symptom being meteorism. The reason was probably the variation in the remaining small-intestinal lactase activity and in the functional stability of the colon.