The sense of coherence and risk of injuries: role of alcohol consumption and occupation.

STUDY OBJECTIVE: To test the hypothesis that individuals with a strong sense of coherence (SOC) have a decreased incidence of external cause injuries and to study the role of alcohol consumption and occupational category in that association. DESIGN: Participants of the Helsinki Heart Study were followed up for injuries for eight years through the national hospital discharge register and cause of death statistics. Cox proportional hazards models were used to calculate the relative risks. SETTING: The Helsinki Heart Study, a clinical trial to prevent coronary heart disease. PARTICIPANTS: 4405 Finnish middle-aged employed men. MAIN RESULTS: The SOC was inversely associated with the risk of injuries, with a significant 25% lower incidence in the highest tertile of SOC (7.6 per 1000 person-years) compared with the lowest (10.2 per 1000 person-years). The association remained significant if adjusted for age, but not if adjusted additionally for alcohol consumption or occupation. When considered jointly with occupational category, the injury risk showed a decreasing trend (p = 0.02) with increasing SOC among blue collar but not among white collar workers. The use of alcohol had a great impact on injury risk among those with weak SOC, with incidences of 7.7, 10.2, and 14.9 per 1000 person-years in the non/light, medium, and heavy categories of consumption (p for trend 0.01). No such trend was seen in other SOC tertiles. CONCLUSIONS: There was an effect of SOC on the incidence of injury especially among blue collar workers. A substantial part of the effect was mediated by alcohol consumption.

The triad of shift work, occupational noise, and physical workload and risk of coronary heart disease.

BACKGROUND: Shift work, noise, and physical workload are very common occupational exposures and they tend to cluster in the same groups of workers. OBJECTIVES: To study the short and long term effects of these exposures on risk of coronary heart disease (CHD) and to estimate the joint effects of these factors. METHODS: The study population in this prospective 13 year follow up study of 1804 middle aged industrially employed men was collected at the first screening for the Helsinki Heart Study. The CHD end points (ICD-9 codes 410-414 and ICD-10 codes I20-I25) were obtained from official Finnish registers. The Finnish job-exposure matrix FINJEM provided information on occupational exposures. Relative risks (RR) of CHD for the exposures were estimated using Cox's proportional hazard models adjusting for classical risk factors of CHD. RESULTS: The RR in the five year follow up for continuous noise combined with impulse noise was 1.28; for shift work it was 1.59, and for physical workload 1.18, while in the 13 year follow up the RRs were 1.58, 1.34, and 1.31, respectively. When adjusted for white-collar/blue-collar status the RRs decreased markedly. The RR in the 13 year follow up for those exposed to two risk factors was close to 1.7 and for those exposed to all three, 1.87. CONCLUSION: Shift work and continuous noise entailed an excess risk for CHD in the shortest follow up with only a few retired workers but a decreasing risk during the longer follow up. For physical workload and impulse noise the trend was opposite: the CHD risk was increasing with increasing follow up time despite increasing numbers of retired workers.

Topical adrenaline in the control of intraoperative bleeding in adenoidectomy: a randomised, controlled trial.

OBJECTIVES: To evaluate the efficacy of topical racemic adrenaline (RA) (Micronefrin; Bird Products, Palm Springs, CA, USA) in the control of intraoperative bleeding and the prevention of postoperative bleeding, laryngeal spasm and postoperative pain in adenoidectomy among children <6 years of age. DESIGN: Prospective, randomised, blinded and placebo-controlled trial. SETTING: Kanta-Hame Central Hospital, a district referral center in Finland. PATIENTS: A consecutive sample of 93 children undergoing outpatient adenoidectomy. INTERVENTION: Patients were randomised to receive topical gauze sponges soaked in either 1:500 RA or 0.9% sodium chloride (physiological saline) for 3 min after adenoidectomy. MAIN OUTCOME MEASURES: Amount of intraoperative bleeding (surgeons' subjective estimate), need for additional packings, need for electrocautery, laryngeal spasm, postoperative bleeding and pain, duration of procedure and duration of patients' stay in the operation room (OR). RESULTS: Adrenaline significantly decreased surgeons' subjective estimate of the amount of intraoperative bleeding (proportion of patients with significant decrease 67 versus 21%, P < 0.001), reduced the mean number of packings needed (0.6 versus 1.2, P < 0.001) and use of electrocautery (22 versus 45%, P = 0.015), and shortened the mean duration of the procedure (13 versus 18 min, P = 0.043) and the mean stay in the OR (31 versus 35 min, P = 0.058). The impact of adrenaline was even more pronounced among patients with extensive adenoids and/or profuse intraoperative bleeding. A slight elevation of heart rate was observed more often in the adrenaline group (P = 0.043). CONCLUSIONS: Use of topical adrenaline can be recommended in adenoidectomy among children. It helps control the intraoperative bleeding, reduces the use of electrocautery and shortens the durations of procedure and stay in the OR.

Quality of life after primary hemiarthroplasty for femoral neck fracture. 6-year follow-up of 185 patients.

Totally, 185 patients with a mean age of 80 years treated by Austin-Moore cementless hemiarthroplasty for an acute femoral neck fracture were compared with age- and sex-matched nonfracture controls. There were 22 early complications, notably 7 percent dislocation and 4 percent deep infection. Later on, two acetabular protrusions and four loosenings of the prosthesis requiring admission were recorded. Mortality after the fracture was 12 percent above the control level at 3 months, 19 percent at 12 months, and 21 percent at 18 months. The 5-year mortality was about 60 percent in both patients and controls. The average loss of life in the fracture group compared with the control group was 425 days. After a mean follow-up period of 6 years, 24 of the 65 patients still alive and the 49 of the 60 controls were living in their own homes; and 28 of the patients were institutionalized in a hospital unit for chronic care. Half of the patients and most of the controls were able to move about independently. We concluded that Austin-Moore hemiarthroplasty is associated with serious complications that prevent social rehabilitation and function to reach acceptable levels.