RESUMEN
BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) constitute a large group of compounds that are water, stain, and oil repellent. Numerous sources contribute to the blood levels of PFAS in the European population. The main contributor for perfluorooctanoic acid (PFOA) is food, house dust, consumer products and personal care products (PCPs). OBJECTIVES: The purpose of the present work is to calculate the dietary and dermal external exposure to PFOA, estimate the aggregated internal exposure from diet and PCPs using a PBPK model, and compare estimates with measured concentrations. METHODS: Detailed information on diet and PCP use from the EuroMix study is combined with concentration data of PFOA in food and PCPs in a probabilistic exposure assessment. A physiologically based pharmacokinetic model (PBPK) was further refined by incorporating a dermal exposure pathway, and changes in the kidney and faecal excretion. RESULTS: The aggregated internal exposure using the PBPK model shows that the major contributor to the internal exposure is diet for both males and females. The estimated internal exposure of PFOA for the EuroMix population was in the same range but lower than the measured blood concentrations using the lower bound (LB) external exposure estimates, showing that the LB estimates are underestimations. For seven females the internal exposure of PFOA were higher from PCPs than from diet. CONCLUSION: PCPs and diet contributed in the same range to the internal PFOA exposure for several women participating in EuroMix. This calls for additional studies on exposure to PFOA and possibly other PFAS from PCPs, especially for women. Overall, PBPK modelling was shown as valuable tool in understanding the sources of PFOA exposure and in guiding risk assessments and regulatory decisions.
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Ácidos Alcanesulfónicos , Cosméticos , Contaminantes Ambientales , Fluorocarburos , Masculino , Humanos , Femenino , Monitoreo Biológico , Dieta , Noruega , Contaminantes Ambientales/metabolismoRESUMEN
Phthalates are diesters of phthalic acid and have been widely used as plasticizers in polyvinyl chloride (PVC) plastics. Phthalates are also used as excipients in pharmaceuticals and personal care products (PCPs). Phthalates can migrate from the plastic into the air, water and food, and humans can be exposed via multiple pathways such as dermal, oral and inhalation. There is evidence that phthalates can induce reproductive and developmental toxicity not only in experimental animals but also in humans through disruption of estrogenic activity. The aim of this study was to collect concentration data on five phthalates in foods and PCPs from the scientific literature and combine these with food consumption data and PCP use frequency data from the EuroMix biomonitoring (BM) study in order to assess exposure. Probabilistic exposure assessments of phthalates were performed from foods and PCPs. Due to the very limited data available in the literature for DINCH, an exposure assessment was not carried out for this compound. The food groups with the highest contribution to phthalates exposure were: beverages, dairy, bread and meat products. The exposure estimates were compared with the measured phthalate metabolite levels from 24-hour urine samples. Regarding the oral route, measured phthalate exposure was between the lower bound (LB) and medium bound (MB) estimated exposure for all phthalates, except for DEP. The measured exposure from urine correlated with the estimated exposure from food for DEHP and DBP, while for BBP and DEP it correlated with the exposure estimates from PCPs. There were no significant differences between the BM data and the estimated exposure, except for DINP for males (p = 0.01). The LB and MB phthalate exposures estimated from foods and PCPs and the measured exposure from the urine were considerably lower than their respective tolerable daily intake (TDI) values established by the European Food Safety Authority (EFSA) and the World Health Organization (WHO). For the upper bound (UB), the exposure estimates are approximately double the TDI; however, this is regarded as a worst-case estimate and has low correlation with the measured exposure.
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Cosméticos , Ácidos Ftálicos , Animales , Monitoreo Biológico , Exposición a Riesgos Ambientales/análisis , Humanos , MasculinoRESUMEN
BACKGROUND: Human exposure to chemicals through the oral, dermal, or inhalation routes is significant. To assess this exposure, a human biomonitoring study was conducted in Norway to examine the plausibility of source-to-dose calculations for chemical mixtures. Per- and polyfluoroalkyl substances (PFASs) are man-made compounds used for their surfactant properties, and several are persistent and bioaccumulative. Some PFASs are toxic and are regarded as endocrine disruptors and have been shown to suppress immune function and affect cholesterol homeostasis. Using the participants from the EuroMix BM study, we set out to describe PFAS concentrations and to evaluate associations with diet and use of personal care products (PCPs). METHODS: Participants (44 males and 100 females) kept detailed diaries on their food consumption and their PCP use for two non-consecutive days. All urine (24 h) and blood samples were collected at the end of each study day. Levels of 25 PFASs were analysed in serum from study day 1 using a high throughput online solid phase extraction ultra-high-performance liquid chromatography tandem mass spectrometry method. Multivariable linear regressions were performed between each food and PCP category and each chemical and were sex-stratified when the consumption of food or use of PCPs was significantly different between men and women. RESULTS: Eight PFASs were detected in all analysed samples (PFHxS, PFHpS, PFOS, PFOA, PFNA, PFDA, PFUnDA and PFDoDA), and four PFASs were below the limit of detection (PFOPA, PFDPA, PFHxA, and EtFOSA). Several PFASs were found to be positively associated with fish consumption (PFOS, PFNA, PFUnDA, PFDoDA, PFDA, PFDS and PFTrDA). Sunscreen, mouthwash, and lip gloss/lip balm were found to be positively associated with PFASs (PFOA, PFTrDA, and PFOSA). CONCLUSION: The participants in the EuroMix study were exposed to PFASs through their diet and PCP use. Several foods and PCPs were found to be potential sources of exposure to PFASs.
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Ácidos Alcanesulfónicos , Cosméticos , Disruptores Endocrinos , Contaminantes Ambientales , Fluorocarburos , Ácidos Alcanesulfónicos/análisis , Animales , Monitoreo Biológico , Contaminantes Ambientales/análisis , Femenino , Fluorocarburos/análisis , Humanos , Masculino , NoruegaRESUMEN
Phthalates are widely used as plasticisers in flexible plastics and containers for food and personal care products (PCPs) and contaminates foods and PCPs. A human biomonitoring (BM) study was performed to study exposure of chemicals from foods and PCPs. For two 24-h periods, adult volunteers (n = 144) in Norway kept diaries on food eaten and usage of PCPs, and collected 24-h urine. Aggregated exposure to di(2-ethylhexyl) phthalate (DEHP) from dietary and PCPs was estimated by Monte-Carlo simulation using Oracle Crystal Ball©. Simulated urinary concentrations using physiologically based pharmacokinetic (PBPK) models were compared with measured urinary metabolites of DEHP, mono-2-ethylhexyl phthalate (MEHP), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), mono-2-ethyl-5-oxohexyl phthalate (MEOHP) and mono-2-ethyl 5-carboxypentyl phthalate (MECCP). DEHP exposure from food are approximately 10 times higher than exposure than from PCPs. The main contributors to dietary exposure are dairy, grain, fruits and vegetables, meat and fish. Body lotion contribute most to the exposure of DEHP from PCPs. Forward-dosimetry gives good convergence with 24-h urinary concentrations of simulated and measured BM data. The measured concentration of the MECCP metabolite correlated well with simulated high exposure, while the measured concentrations of MEHP, MEHHP and MEOHP partly overlapped with both simulated low, medium and high metabolite exposure.
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Monitoreo Biológico , Cosméticos/química , Dietilhexil Ftalato/administración & dosificación , Dietilhexil Ftalato/orina , Modelos Biológicos , Adulto , Anciano , Dieta , Dietilhexil Ftalato/metabolismo , Dietilhexil Ftalato/farmacocinética , Femenino , Contaminación de Alimentos , Humanos , Masculino , Persona de Mediana Edad , Estructura Molecular , Noruega , Adulto JovenRESUMEN
BACKGROUND: Exposure to multiple chemicals occurs daily through several routes; diet, inhalation and dermal contact. Real-life exposure assessment is needed to understand the risk. Therefore, a human biomonitoring (BM) study was performed to examine the plausibility of source-to-dose calculations for chemical mixtures in the Horizon 2020 EuroMix project. OBJECTIVES: To provide a detailed description of the design of the EuroMix BM study, and to present the initial results for urinary phenols and phthalates and to describe their exposure determinants from foods and personal care products (PCPs). METHOD: Adults (44 males and 100 females) kept detailed diaries on their food consumption, PCP use and handling of cash receipts. Urine samples were collected over the same 24-hour period. Urinary levels of four parabens, five bisphenols, oxybenzone/benzophenone-3 (OXBE), triclosan (TCS), triclocarban (TCC) and metabolites of eight phthalates and 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH) were analysed by ultra-high-performance liquid chromatography and tandem mass spectrometry. Multivariable linear regressions were performed between PCPs/food categories and each dependent chemical variable separately, and were only sex-stratified when an interactions between sex and the independent variable was significant. RESULTS: The detection rate for the metabolites of phthalates and DINCH, and bisphenol A (BPA) and TCS in urine was 88-100%, while bisphenol S (BPS) and bisphenol F (BPF) were only found in 29% and 4% of the urine samples, respectively. Bisphenol B (BPB), bisphenol AF (BPAF) and TCC were not detected. Food groups associated with phenol exposure were meat, bread, beverages and butter and oil. Food determinants for phthalate exposure were sweets, butter and oil, fruit and berries and other foods. The only positive association between the use of PCPs and phenols was found between BPA and lip gloss/balm. Phthalate exposure was associated with the use of shower gel, hand cream (females), toothpaste, anti-wrinkle cream (females) and shaving products (males). CONCLUSION: The participants in the EuroMix BM study were exposed to a mixture of phenols and phthalates. A variety of food categories and PCPs were found to be possible sources of these chemicals. This indicates a complex pattern of exposure to numerous chemicals from multiple sources, depending on individual diet and PCP preferences.
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Contaminantes Ambientales/orina , Fenoles/orina , Ácidos Ftálicos/orina , Adulto , Anciano , Monitoreo Biológico , Cosméticos , Exposición Dietética , Femenino , Contaminación de Alimentos , Humanos , Masculino , Persona de Mediana Edad , Noruega , Adulto JovenRESUMEN
Cognitive impairment may cause difficulties in planning and initiating daily activities, as well as remembering to do what is scheduled. This study investigates the effectiveness of an interactive web-based mobile reminder calendar that sends text messages to the users mobile phone as support in everyday life, for persons with cognitive impairment due to neurological injury/diagnoses. The study has a randomised controlled trail design with data collection at baseline and at follow-up sessions after two and four months. Data collection started in August 2016 and continues until December 2017. The interactive web-based mobile reminder calendar may give the needed support to remind the person and thus increase the ability to perform activities and to be independence in everyday life. Preliminary results will be presented regarding what effect the interactive web-based mobile reminder calendar have for the participants performance of everyday life activities as well as perceived quality of life.
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Disfunción Cognitiva , Sistemas Recordatorios , Envío de Mensajes de Texto , Actividades Cotidianas , Teléfono Celular , Humanos , Internet , Calidad de VidaRESUMEN
BACKGROUND: Urothelial carcinoma of the urinary bladder (UCB) is the 4th most common cancer type in men in developed countries, and tumor recurrence or progression occurs in more than half of the patients. Previous studies report contradictory trends in incidence and survival over the past decades. This article describes the trends of UCB incidence and survival from 1981 to 2014, including both invasive and non-invasive UCB using data from the Cancer Registry of Norway. METHODS: In Norway, 33,761 patients were diagnosed with UCB between 1981 and 2014. Incidence and 5-year relative survival were calculated, stratified by sex, morphology, stage, age and diagnostic period. Age-period-cohort models were used to distinguish period- and cohort effects. Temporal trends were summarized by calculating the average absolute annual change in incidence and relative survival allowing for breaks in this trend by incorporating a joinpoint analysis. Excess mortality rate ratios (EMRR) quantify the relative risks by using a proportional excess hazard model. RESULTS: The incidence of UCB in men increased from 18.5 (1981-85) to 21.1 (1991-95) per 100 000 person-years and was rather stable thereafter (1996-2014). The incidence rates of UCB were lower in women increasing linearly from 4.7 to 6.2 over the past 34 years (p = 5.9 · 10-7). These trends could be explained by an increase of the incidence rates of non-invasive tumors. Furthermore, the observed pattern seemed to represent a birth cohort effect. Five-year relative survival increased annually with 0.004 in men (p = 1.3 · 10-6) and 0.003 in women (p = 4.5 · 10-6). There is a significant increase over the past 34 years in survival of UCB in both genders for local tumors but not for advanced stages. CONCLUSIONS: Increasing and stable incidence trends mirror little improvement in primary and secondary prevention of UCB for more than three decades. Survival proportions increased only marginally. Thus, any changes in treatment and follow-up care did not lead to notable improvement with respect to survival of the patients. High estimates of preventable cases together with large recurrence rates of this particular cancer type, demand more research on prevention guidelines, diagnostic tools and treatment for UCB.
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Carcinoma de Células Transicionales/epidemiología , Neoplasias de la Vejiga Urinaria/epidemiología , Anciano , Carcinoma de Células Transicionales/diagnóstico , Carcinoma de Células Transicionales/historia , Carcinoma de Células Transicionales/mortalidad , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Noruega/epidemiología , Modelos de Riesgos Proporcionales , Sistema de Registros , Factores de Riesgo , Tasa de Supervivencia , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/historia , Neoplasias de la Vejiga Urinaria/mortalidadRESUMEN
The genetically modified (GM) maize event MON810 has been inserted with a processed version of the transgene, cry1Ab, derived from the soil bacterium Bacillus thuringiensis (Bt) to express proteins with insecticidal properties. Such proteins may introduce new allergens and also act as adjuvants that promote allergic responses. While focus has been on safe consumption and hence the oral exposure to GM food and feed, little is known regarding inhalation of pollen and desiccated airborne plant material from GM crops. The aim of this study was to investigate whether plant material from the Cry1Ab-expressing maize variety MON810, or trypsin-activated Cry1Ab (trypCry1Ab) protein produced in recombinant bacteria, may act as adjuvants against the allergen ovalbumin (OVA) in a mouse model of airway allergy. A clear proallergic adjuvant effect of the mucosal adjuvant cholera toxin (CT) was demonstrated, determined as increased specific IgE, eosinophils and Th2 cytokines in MLN cell supernates, while no elevation in OVA-specific antibodies or cytokine release from MLN cells after stimulation with OVA were observed in mice receiving Cry1Ab-containing plant materials or the trypCry1Ab protein. Our data suggest that Cry1Ab proteins had no detectable systemic adjuvant effect in mice after airway exposure. Further experiments with purified plant proteins, as well as long-term exposures needs be conducted to further evaluate exposures experienced in real-life situations.
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Adyuvantes Inmunológicos/farmacología , Proteínas Bacterianas/genética , Proteínas Bacterianas/farmacología , Endotoxinas/genética , Endotoxinas/farmacología , Proteínas Hemolisinas/genética , Proteínas Hemolisinas/farmacología , Proteínas Recombinantes de Fusión/metabolismo , Proteínas Recombinantes de Fusión/farmacología , Adyuvantes Inmunológicos/genética , Alérgenos/inmunología , Animales , Anticuerpos/sangre , Bacillus thuringiensis/genética , Toxinas de Bacillus thuringiensis , Líquido del Lavado Bronquioalveolar/citología , Toxina del Cólera/inmunología , Citocinas/metabolismo , Eosinófilos/inmunología , Femenino , Inmunoglobulina E/biosíntesis , Inmunoglobulina E/inmunología , Insecticidas/farmacología , Recuento de Linfocitos , Linfocitos/inmunología , Macrófagos/inmunología , Ratones , Ratones Endogámicos BALB C , Mutagénesis Insercional/genética , Neutrófilos/inmunología , Ovalbúmina/inmunología , Proteínas de Plantas/genética , Distribución Aleatoria , Proteínas Recombinantes de Fusión/genética , Células Th2/inmunología , Tripsina/metabolismo , Zea mays/genética , Zea mays/metabolismoRESUMEN
INTRODUCTION: GH activity may be involved in male reproductive function. A common genetic polymorphism in the gene encoding the GH receptor (GHR) results in deletion of the entire exon 3 sequence (GHRd3 isoform). The short GHRd3/d3 isoform seems more sensitive compared with full-length receptors (GHRfl/fl). AIM: TO INVESTIGATE THE ASSOCIATIONS BETWEEN GH ACTIVITY, EVALUATED BY EXON 3 GHR POLYMORPHISM, AND SERUM IGF1 VS REPRODUCTIVE HORMONES, SEMEN QUALITY, AND PRE- AND POSTNATAL GROWTH IN HEALTHY YOUNG MALES (N=838, MEAN AGE: 19.4 years). RESULTS: Compared with GHRfl/fl homozygous individuals (n=467) GHRd3/d3 homozygous individuals (n=69) tended to have larger semen volume (3.2 (2.4-4.3) vs 3.6 (2.6-4.7) ml, P=0.053) and higher serum inhibin-B levels (208âpg/ml (158-257) vs 227âpg/ml (185-264), P=0.050). Semen quality, levels of gonadotropins, testosterone, estradiol, sex hormone-binding globulin, and IGF1 were not associated with GHRd3 genotype. A twofold increase in serum IGF1 was associated with a 13% (4-23) increase in calculated free testosterone (P=0.004). By contrast IGF1 was inversely associated with serum inhibin-B (P=0.027), but showed no associations to semen quality. GHR genotype and serum IGF1 were not associated with size at birth or final height. CONCLUSIONS: GHRd3 polymorphism seemed only to have a weak influence on male reproductive function of borderline significance. The sensitive GHRd3/d3 genotype may slightly increase testicular function, as evaluated by semen volume and levels of inhibin-B, but does not seem to influence Leydig cell steroidogenesis. GHR genotype did not influence pre- and postnatal growth.
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Secuencia de Bases , Proteínas Portadoras/genética , Factor I del Crecimiento Similar a la Insulina/metabolismo , Análisis de Semen , Eliminación de Secuencia , Adolescente , Estradiol/sangre , Exones/genética , Genotipo , Gonadotropinas/sangre , Homocigoto , Humanos , Subunidades beta de Inhibinas/sangre , Masculino , Polimorfismo Genético , Globulina de Unión a Hormona Sexual/metabolismo , Testosterona/sangre , Adulto JovenRESUMEN
Growth hormone (GH) and insulin-like growth factor I (IGF-I) receptors are present on pituitary gonadotrophs and on testicular Leydig and Sertoli cells. Thus, the GH/IGF-I system may modulate the pituitary-gonadal axis in males. This is a randomized cross-over study. Eight healthy male volunteers (mean age 35, range 29-46 years) were treated with GH for 3 weeks (1st week 0.01, 2nd week 0.02, 3rd week 0.03 mg/day/kg) or a GH receptor antagonist (Pegvisomant) (1st week 10, last 2 weeks 15 mg/day), separated by 8 weeks of washout. Before and after the two treatment periods, concentrations of luteinizing hormone (LH), follicle-stimulating hormone, testosterone, oestradiol, sex hormone-binding globulin, inhibin B and Anti-Müllerian Hormone (AMH) were measured. During GH treatment, IGF-I increased [(median (IQR)] 166 (162-235) vs. 702 (572-875) µg/L, p < 0.001) together with oestradiol [(mean ± SD) 78 ± 23 vs. 111 ± 30 pm, p = 0.019], and the oestradiol/testosterone ratio (p = 0.003). By contrast, AMH (42 ± 14 vs. 32 ± 7 pm, p = 0.018), Inhibin B (211 (146-226) vs. 176 (129-204) ng/L, p = 0.059) and LH (3.8 ± 1.5 vs. 3.2 ± 1.2 U/L, p = 0.096) decreased. During pegvisomant treatment IGF-I (204 (160-290) vs. 106 (97-157) µg/L, p = 0.001) and oestradiol (86 ± 28 vs. 79 ± 25 pm, p = 0.060) decreased. No significant changes or trends in the other reproductive hormones occurred during the two treatment regimens. GH/IGF-I activity was positively associated with serum oestradiol, suggesting that GH/IGF-I stimulates aromatase activity in vivo. As a novel observation, we found that high GH activity was associated with reduced levels of the Sertoli cell marker AMH. Further studies are needed to evaluate possible effects of GH on Sertoli cell function and/or spermatogenesis.
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Hormona Antimülleriana/sangre , Estradiol/sangre , Antagonistas de Hormonas/administración & dosificación , Hormona de Crecimiento Humana/análogos & derivados , Hormona de Crecimiento Humana/administración & dosificación , Reproducción/efectos de los fármacos , Adulto , Biomarcadores/sangre , Estudios Cruzados , Dinamarca , Regulación hacia Abajo , Hormona Folículo Estimulante Humana/sangre , Humanos , Inhibinas/sangre , Inyecciones Subcutáneas , Factor I del Crecimiento Similar a la Insulina/metabolismo , Hormona Luteinizante/sangre , Masculino , Persona de Mediana Edad , Receptores de Somatotropina/antagonistas & inhibidores , Receptores de Somatotropina/metabolismo , Proteínas Recombinantes/administración & dosificación , Globulina de Unión a Hormona Sexual/metabolismo , Testosterona/sangre , Factores de Tiempo , Regulación hacia ArribaRESUMEN
Previous studies have shown that infaunal deposit feeders may enhance the loss of organic contaminants from sediments. However, the extent to which this occurs as a result of sediment microbial stimulation, porewater flushing, or biotransformation by infauna remains unclear. The purpose of this study was to determine whether the infaunal polychaete Capitella sp. I is able to metabolize the polycyclic aromatic hydrocarbon (PAH) fluoranthene and to provide an initial characterization of the metabolites produced. Our results showed that Capitella sp. I is able to metabolize fluoranthene to more hydrophilic products and that, after 24 h in clean sediment, fluoranthene could no longer be detected in worm tissues whereas a number of fluoranthene-derived metabolites were present. None of the metabolites released or retained by worms resembled known bacterial metabolites, suggesting that Capitella, and not bacteria associated with its gut or body surface, were responsible for the biotransformation of fluoranthene in our system. On the basis of ultraviolet maxima, peak shape, relative height, and order of elution, tentative identities of two metabolites (i.e., 3- and 8-hydroxyfluoranthene) are proposed. The results demonstrate that, in addition to their effects on sediment geochemical properties, infaunal polychaetes such as Capitella can enhance the degradation of sediment-associated contaminants by directly metabolizing them.
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Fluorenos/metabolismo , Poliquetos/metabolismo , Animales , Sistema Enzimático del Citocromo P-450/metabolismo , Poliquetos/enzimologíaRESUMEN
BACKGROUND: "The-Baby-Friendly Hospital Initiative" was introduced in the early 1990s by WHO/UNICEF to reverse a declining trend in breastfeeding worldwide. We wanted to investigate factors influencing breastfeeding and whether this initiative, introduced between 1993 and 1996, had improved breastfeeding in our region, Tromsø, a mid-sized city in northern Norway. MATERIAL AND METHODS: Medical records at maternal and child health centres of 1,374 infants born 1992 (n = 653) and 1997 (n = 721) were studied. The number of mothers breastfeeding, duration of lactation, parents' age, their occupation and education, maternal marital status and parity were registered. RESULTS: In a multiple regression analysis, birth, year 1997, high parental level of education/occupational prestige, and higher maternal age significantly prolonged the total period of breastfeeding. Parental age, education/occupation, the number of women starting breastfeeding, the duration of exclusive breastfeeding and the total lactation period significantly increased from 1992 to 1997. When correcting for parental age and education/occupation in a multiple regression analysis we found an increase in exclusive breastfeeding and the total lactation period by 0.5 month (mean (95% CI)) 0.5 (0.2-0.8) and 1.1 month (0.6-1.5) respectively. INTERPRETATION: This improvement might be due to "the Baby-Friendly Hospital Initiative", but also to unknown factors.
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Lactancia Materna , Actitud Frente a la Salud , Lactancia Materna/psicología , Lactancia Materna/estadística & datos numéricos , Femenino , Salud Global , Humanos , Lactante , Recién Nacido , Noruega , Padres/psicología , Factores Socioeconómicos , Factores de TiempoRESUMEN
This investigation examines forty cases dealing with compulsory admission or detention which have been presented at the Local Magistrates Court in a Danish county under the Danish Mental Health Legislation of 1989 during a five year period from 1990-1994. The amount of time spent in processing the cases by the psychiatric department, the Forensic Medical Council and the magistrate was registered. The results show a written psychiatric statement from the department is available after seven to ten days. Five weeks pass when the case is presented to the Forensic Medical Council, (four weeks with the Council and one week with the magistrate). The importance of obtaining statements from the Forensic Medical Council and the time spent in considering the cases with reference to the Justice Department's survey of the Danish Mental Health Legislation of 1989 is discussed. The investigation concludes that despite the resulting prolonged case evaluation it is recommended that cases involving detainment are brought before the Forensic Medical Council.
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Internamiento Obligatorio del Enfermo Mental/legislación & jurisprudencia , Adulto , Internamiento Obligatorio del Enfermo Mental/estadística & datos numéricos , Dinamarca , Femenino , Estudios de Seguimiento , Medicina Legal/legislación & jurisprudencia , Medicina Legal/estadística & datos numéricos , Humanos , Tiempo de Internación , Masculino , Factores de TiempoRESUMEN
Neuroleptic malignant syndrome (NMS) is a rare, potentially life-threatening disorder that results from the use of neuroleptics. NMS was first recognised as a complication of dopamine receptor antagonists characterized by extrapyramidal disturbances, hyperthermia, muscle rigidity, autonomic instability, mental status changes and elevated serum creatine kinase levels. Concepts of NMS have changed because medications other than classic neuroleptic drugs have been implicated as triggering agents. The incidence of NMS is about 0.2% with a mortality between 4-30%, which may be diminished by treatment. The neurochemical key features in all these conditions probably result from disruption of the dopamine system in the brain and the effects of neuroleptics on muscle. Recognition of NMS is the most important step in its management by discontinuation of the causative drugs and applying supportive care and therapeutic measures. Specific therapeutic measures include the application of dopamine receptor agonists, e.g. dantrolene and use of benzodiazepines. The differential diagnosis of NMS comprises an extensive list of disorders presenting with fever and with muscle rigidity. Neuroleptics may be reintroduced in the majority of patients by using an atypical neuroleptic drug such as clozapine.
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Síndrome Neuroléptico Maligno , Adolescente , Adulto , Anciano , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Síndrome Neuroléptico Maligno/diagnóstico , Síndrome Neuroléptico Maligno/epidemiología , Síndrome Neuroléptico Maligno/etiología , Síndrome Neuroléptico Maligno/genética , PronósticoRESUMEN
The object of this retrospective descriptive investigation was to illustrate how compulsory committed or detained patients are evaluated in psychiatric statements from the hospital, Forensic Medical Council, and court under the Danish Mental Health Legislation of 1989. The cases were evaluated using topics and areas dealing with the previous and present medical history, legal topics, and legal premises. The investigation examines a 5-year period with 40 cases involving 30 patients, 22 cases of which were presented to the Forensic Medical Council. The investigation reveals that in dealing with the medical history only, symptoms and treatment are of interest to the court, whereas the legal grounds are of very high interest both to the court and the hospital. This investigation raises the question as to whether the form of the psychiatric statement faces reality and whether the judiciary and psychiatry view the patient from very different angles. This requires that the instrument of communication, that is, the psychiatric statement, should be accurate.
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Internamiento Obligatorio del Enfermo Mental/legislación & jurisprudencia , Derecho Penal/legislación & jurisprudencia , Lenguaje , Psiquiatría/legislación & jurisprudencia , Dinamarca , Humanos , Institucionalización/legislación & jurisprudencia , Estudios RetrospectivosRESUMEN
Medical humour is often an important part of the treatment of patients in hospitals and in general practice. Therefore, medical humour should be distinguished from other forms of humour. The author of this article has served over forty years in Rigshospitalet of Copenhagen. He has observed the remarkable difference in the frequency of homour in the two surgical departments of the hospital. Department D had as a chief Wilhelm Schaldemose. He seemed to be completely without any sense of humour, and this spread to the rest of the department. When Schaldemose died Sigurd Kjaergard became head of the department. His sense of humour was limited, and he was not able to induce the humour to the rest of the department. It was first in 1953 when Erik Husfeldt took over as chief that the humour developed in the department, and it took several years before humour became a part of the daily treatment of patients. On the other department C the humour has always had good days starting with Thorkild Rovsing, the first chief, and later when Erling Dahl-Iversen was leader of the department. He had a special way to educate his staff in his sense of humour which became well known all over the hospital. In the beginning of this year a new society: >>Nordic Society of Medical Humour<< has been founded in Norway. This seems to be a remarkable positive development in the field of medical humour.
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Actitud , Hospitales/historia , Relaciones Médico-Paciente , Tacto Terapéutico/historia , Conducta , Dinamarca , Historia del Siglo XX , Ingenio y Humor como AsuntoRESUMEN
From 1970 to 1986 a total of 4578 hip fractures were registered in persons > or = 40 years in a Danish urban municipality. During that period, the annual number almost tripled. The statistical analysis revealed an increase in the age-specific incidence for both females and males (p < 0.0001). Furthermore, the number of fractures increased due to demographic aging. The overall incidence for individuals > or = 40 years increased 9-10% annually; from 2.1 to 5.4 per 1.000 females, and from 0.9 to 2.1 per 1.000 males. The female:male ratio was 2.8 without changes over time. If the observed increase in incidence is extrapolated to the next 17 years, a doubling of the annual number of fractures is predicted by the year 2002, whereas an unchanged incidence would result in a 20% increase in number.
Asunto(s)
Envejecimiento/fisiología , Fracturas de Cadera/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Razón de MasculinidadRESUMEN
Fourteen children were seen prior to adenoidectomy and at 1 month, 3 months, and 6 months following surgery. On each visit, nasal airway resistance values, nasal cross-sectional area estimates, nasalance scores, and perceptual ratings of nasality were collected. These data were analyzed to identify changes that were related to the time of the test, and to the primary indication for surgery (nasal airway obstruction or recurrent infection). Results revealed significant reduction in nasal airway resistance and significant changes in nasalance following surgery. Perceptual changes were not significant. Clinical implications of these findings are discussed.
Asunto(s)
Adenoidectomía/efectos adversos , Ventilación Pulmonar/fisiología , Trastornos de la Voz/etiología , Calidad de la Voz , Presión del Aire , Resistencia de las Vías Respiratorias/fisiología , Análisis de Varianza , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Masculino , Obstrucción Nasal/complicaciones , Obstrucción Nasal/cirugía , Nariz/anatomía & histología , Nariz/fisiología , Reproducibilidad de los Resultados , Pruebas de Función Respiratoria/instrumentación , Rinitis/complicaciones , Rinitis/cirugía , Factores Sexuales , Sinusitis/complicaciones , Sinusitis/cirugía , Acústica del Lenguaje , Factores de Tiempo , Transductores de Presión , Trastornos de la Voz/fisiopatologíaRESUMEN
This retrospective study included 1812 hip-fracture patients 40 years of age or older who did not receive prophylactic anticoagulation. Two hundred seventy-three patients (15.1%) died within 90 days after hospitalization. In 180 autopsies, 27 cases of major pulmonary embolism (PE), defined as occluding at least one lobar or several segmental arteries, were found. Based on an autopsy frequency of 72%, a rate of 1.4% major PEs during the first 30 days could be estimated. No major PE was found among patients with femoral neck fractures treated conservatively or by internal fixation or among patients younger than 66 years of age.