Bolesti vezane uz azbest u Švedskoj - opći pregled

Until recently asbestos has been extensively used in Sweden. Today its use is almost prohibited and it has been replaced by man-made mineral fibres. Pleural plaques are common among the elderly in Sweden mainly because of occupational exposure to asbestos. Fatal asbestosis is rare and only a few cases are diagnosed every year. In men there is an increasing incidence of pleural mesotheliomas. Cases among women are much fewer. Health examinations for persons exposed to asbestos are mandatory.Donedavno je azbest u Švedskoj bio u širokoj upotrebi. Njegova je upotreba gotovo zabranjena 1986. godine, te je uglavnom potpuno zamijenjen umjetnim mineralnim vlaknima. Fatalna azbestoza je rijetka, a ranih osamdesetih godina u prosjeku je troje ljudi godišnje umiralo od azbestoze. Pleuralni mezoteliom je u porastu te se godišnje otkrije 80 slučajeva u muškaraca i 15 u žena. Među starijim muškarcima vrlo je čest nalaz pleuralnih zadebljanja (plakova). Ne zna se koliki je broj karcinoma pluća u Švedskoj do sada uzrokovan izloženošću azbestu. Osobe trajno izložene azbestu trebaju biti pod liječničkom kontrolom te je stoga uvedena besplatna kontrola za svakoga tko smatra da je u prošlosti bio izložen azbestu

Neuromusculoskeletal disorders in the neck and upper extremities among drivers of all-terrain vehicles – a case series

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to investigate whether professional drivers of all-terrain vehicles (ATVs) with neck pain have a different array of neuromusculoskeletal disorders in the neck and upper extremities than a referent group with neck pain from the general population. It is hypothesized that exposure to shock-type vibration and unfavorable working postures in ATVs have the capacity to cause peripheral nervous lesions.</p> <p>Methods</p> <p>This study was based on a case series analyzed according to a case-case comparison design. The study population consisted of 60 male subjects, including professional drivers of forest machines (n = 15), snowmobiles (n = 15), snowgroomers (n = 15) and referents from the general population (n = 15) all of whom had reported neck pain in a questionnaire and underwent an extensive physical examination of the neck and upper extremities. Based on symptom history, symptoms and signs, and in some cases chemical, electroneurographical and radiological findings, subjects were classified as having a nociceptive or neuropathic disorder or a mix of these types.</p> <p>Results</p> <p>The occurrence of asymmetrical and focal neuropathies (peripheral nervous lesion), pure or in a mix with a nociceptive disorder was common among cases in the ATV driver groups (47%–79%). This contrasted with the referents that were less often classified as having asymmetrical and focal neuropathy (27%), but instead had more nociceptive disorders. The difference was most pronounced among drivers of snowgroomers, while drivers of forest machines were more frequently classified as having a nociceptive disorder originating in the muscles.</p> <p>Conclusion</p> <p>This study found a high prevalence of assymetrical and focal neuropathies among drivers with pain in the neck, operating various ATVs. It seems as if exposure to shock-type whole-body vibration (WBV) and appurtenant unfavorable postures in ATVs may be associated to peripheral nervous lesions.</p

Högskärmar och kalhyggesfritt skogsbruk på bördig mark i Medelpad

Under senare år har intresset för ett alternativ till kalhyggesbruk vuxit sig starkare i både Sverige och andra länder i Europa. I Sverige ses skärmskogsbruk och blädning i granskogar som två högst intressanta alternativ till kalhyggesbruk. De båda alternativen utgör dock mycket komplexa skogsskötselsystem och kräver god kunskap och gott om tid för att lyckas. På fuktiga marker där det kan vara svårt att föryngra skog eller områden med höga naturvärden kan de dock utgöra ett mycket bra alternativ till det konventionella kalhyggesbruket. En högskärm av gran används ofta på fuktiga och känsliga marker där markberedning kan vara svår eller kostsam. Ofta finns i beståndet sedan tidigare en god beståndsföryngring som kan nyttjas till det framtida beståndet. För att man skall kunna bedriva blädning krävs att skogen är flerskiktad och att diameterfördelningen följer den så kallade inverterade J-kurvan. Det är idag svårt att hitta skogar i Sverige som uppfyller dessa krav. Att omforma en enskiktad skog till en flerskiktad är en mycket långdragen process som förvisso liknar den man använder vid skärmställning, men med den skillnaden att alla skärmträden inte avverkas i ett steg när man fått en godtagbar föryngring. Att omvandla enskiktade skogar till flerskiktade skogar som sköts som kontinuitetsskogar kan vara ett alternativ där skogen brukats hårt och där man har behov av att öka variationen i skogen eller i områden där kalhyggen av någon anledning ej lämpar sig men det finns ett behov av inkomster från skogen. I samarbete med SLU anlade skogsbolaget SCA AB i början av 1994 ett skärmförsök på ett område ca 6 mil väster om Sundsvall där granskärmar med olika tätheter ställdes. Försöket består av två block med vardera fyra olika försöksled, 250 härskande (H) träd per ha, 250 medhärskande (MH) träd per ha, 400 (H) och 400 (MH). Fyra examensarbeten har genom åren undersökt en rad faktorer i beståndet och föryngringen har undersökts kontinuerligt under åren. Skärmen skulle avverkas under 2010 och man ville undersöka hur skogen utvecklats i försöket. Detta examensarbete syftar till att 1) bestämma vilka skador som uppkommer på skogsföryngringen efter en skärmavveckling, 2) ange huruvida föryngringen är tillfredställande eller inte, samt att 3) avgöra om det är möjligt att omforma den tätaste skärmtypen (400 H) till en kontinuitetsskog (blädningsskog). Skärmen avvecklades under vårvintern 2010. I den tätaste delen av skärmen skedde i stället för avveckling en mycket svag huggning med ett uttag på ca 36 stammar per ha. Under maj och juni 2010 inventerades området och skador samt plantantal registrerades. Plantförekomsten var under alla skärmar relativt god. I de tätaste skärmarna var antalet plantor betydligt lägre än i de glesare skärmarna, omkring 3400 resp. 9000 plantor per ha. Endast ca 3 % av provytorna saknade helt granplantor, men det fanns dock i de flesta fall lövplantor på dessa provytor. Föryngringen som uppkommit under skärmen räknas som godkänd enligt skogsvårdslagen. Från en produktionssynpunkt är det dock mer tveksamt om man kan anse föryngringen godkänd. Antalet potentiella huvudplantor var på en och två meters avstånd från varandra ca 1700 respektive 1150 plantor per ha i medeltal för alla skärmtyper. Det fanns en tydlig korrelation mellan andelen skadade plantor och avståndet från närmaste stickväg. På de provytor där det återfanns skadade plantor var avståndet till närmaste stickväg 3,4 m. På ytor utan skador var avståndet 5,9 meter. Den vanligaste skadan på plantor var att de var helt eller delvis uppdragna eller böjda och den vanligaste skadeorsaken var täckning av hyggesrester. Ca 30 % av de skadade plantorna var så allvarligt skadade att de troligen inte kommer att överleva. Skadade plantor fanns på 54 % av de inventerade provytorna och i medeltal var 14 % av plantorna skadade. Sammanfattningsvis kan sägas att en majoritet av de plantor som fanns i beståndet före avverkningen klarade sig oskadda eller med lindrigare skador. Detta bör innebära att beståndet har en god möjlighet att utvecklas i önskvärd riktning förutsatt att det björkuppslag som finns i beståndet inte tillåts ta överhanden. I den skärm där det endast utfördes en lättare gallring och där intentionen var att skärmen skulle omvandlas till en kontinuitetsskog inventerades skärmträden. När skärmarna ställdes 1994 hade de en täthet på 400 stammar per ha och vid avverkningstillfället (2010) återstod 261 stammar per ha. Dessa stammar skall för att omvandlingen skall lyckas räcka för uttag och naturliga avgångar till dess att den nya generationen skog kommit upp i avverkningsbar storlek. På försöksområdet beräknades omställningen ta minst 200 år och antalet uttag beräknades bli 10-13 stycken. Omställningsprocessen kräver att man kontinuerligt inventerar området för att säkerställa att utvecklingen går i önskvärd riktning.  In recent years the interest of an alternative to clear-cutting has grown stronger both in Sweden and in other European countries. In Sweden the shelterwood and the selection silvicultural systems are two highly interesting alternatives for Norway spruce forests. These forest management practices are however complex and require good knowledge and plenty of time to apply successfully. On moist soils where conventional forest regeneration is hard and in areas with high conservation value, the two alternative systems could come into practice. Shelterwoods of spruce is often used in wet and fragile sites where soil scarification may be difficult or costly. Advance growth is often present in these forests and will be a part of the new generation of trees. To manage a forest by selection cutting a number of criteria need to be fulfilled. The forest needs to have a multi-layered canopy structure and the distribution of the trunk diameter should follow the so-called inverted J-curve. It is difficult to find forests in Sweden that meet these requirements. Transforming a single-layer forest into a multi-layered forest is a time consuming process. It is however similar to that used in the shelterwood systems but still different since the seed trees are not harvested at one occasion. Converting single-layer forests to multilayered forests that are managed by continuous forest cover may be an option where forests are intensely managed and where there is a need to increase forest biodiversity. It may also be an option in areas where clear-cuts are not suitable for some reason but an income from the forest is desired. SCA AB has since 1994 had a shelterwood experiment on an area about 60 km west of Sundsvall, central Sweden. The experiment was designed as a randomized blocks trial with two blocks and four shelterwoods of two densities: 400 Dominant trees (400 H) per hectare, 250 Dominant trees (250 H) per hectare, 400 Co- dominant trees (400 MH) per hectare, and 250 Co- dominant trees (250 MH) per hectare. The area has earlier been studied in four master theses and the forest regeneration has been monitored continuously. In 2010 the shelterwood was scheduled for harvesting. One aim of this master thesis was to determine to what extent the forest regeneration was damaged in the shelterwood harvesting and whether or not the regeneration was sufficient for the establishment of a new stand. Another aim was to examine the possibility to convert the shelterwood with the highest density (400 H) to a forest that can be managed by a continuous forest cover practice. The shelterwood was harvested during late winter in 2010. Instead of a total harvest a very light thinning of about 36 stems per hectare was made in the densest shelterwood. An inventory and registering on the number of seedlings and damage to these where made during May and June 2010. The number of seedlings was relatively good in all shelterwoods. In the densest shelterwood the seedling number was much lower than in the sparser shelterwood, 3426 and 8974 seedlings ha-1, respectively. Only 3.1 % of the plots were completely missing spruce regeneration, but on most of these plots there where birch seedlings present. The existing forest regeneration in the shelterwood fulfilled the minimum requirements stated in the Forestry Act. From a growth and yield perspective it was however more doubtful. The number of potential main seedlings with a distance of 1 and 2 m from each other was on average 1684 and 1157 ha-1, respectively. There was a clear correlation between the number of damaged seedlings and the distance to the nearest forwarder trail. On plots with damaged seedlings the distance to the nearest forwarder trail was 3.4 meters. On plots where no damaged seedlings were observed the distance was 5.9 meters. The most common type of damage was that the plant were entirely or partially bent or pulled up from the soil. The most common reason for damage was that the plants were covered with slash debris. About 30 % of the damaged plants were so severely damaged that they would probably not survive. In total, damaged seedlings were found on 54 % of the plots and on average 14 % of all the seedlings were damaged. Most of the seedlings that were present in the stand before the harvest had fared without any damage or ligther injuries. In the shelterwood that was thinned with the aim of transformation into a forest managed by continues forest cover, the shelter trees were inventoried. The original shelterwood density, 400 trees ha-1, was reduced to 261 trees ha-1. To succeed with the conversion these trees need to cover both natural decline and thinning until the new generation of trees reach a size suitable for harvest. On the experimental area the conversion period was estimated to at least 200 years and the number of thinnings will be 10-13. The conversion process requires continuous inventories to ensure that the conversion is evolving as desired.

Switching From Originator to Biosimilar Human Growth Hormone Using Dialogue Teamwork: Single-Center Experience From Sweden

INTRODUCTION: A new treatment plan was implemented at Skåne University Hospital, on economic grounds, for children requiring recombinant human growth hormone (rhGH) treatment. This involved switching patients from treatment with originator rhGHs to treatment with a biosimilar rhGH, somatropin (Omnitrope(®)), using a Dialogue Teamwork approach. The feasibility of using this approach to implement the switch of treatment was assessed, as well as the impact of the switch on treatment efficacy and cost of therapy. METHODS: As part of the Dialogue Teamwork approach, patients/parents received several opportunities for dialogue and sources of information, including discussions with the Head of Department, the responsible physician and a specialized endocrinology nurse. Height and height standard deviation score (HSDS) data were plotted for each individual patient (N = 98). A modeling approach was also used, to predict growth after switching to biosimilar rhGH; the predictions were then compared to the actual observed height after the switch. Costs to the clinic of rhGH therapy were calculated between May–August 2009 and May–August 2012. RESULTS: Of the 102 patients offered the switch, 98 accepted. Height and HSDS data indicated there was no negative impact on growth velocity after the switch to biosimilar rhGH. Modeling demonstrated that observed growth following the switch was consistent with predicted growth based on data before patients were switched. There were no reports of serious or unexpected adverse drug reactions following the switch to biosimilar rhGH. Following the switch, the cost to the clinic of rhGH treatment decreased from approximately 6 million SEK (May–August 2009) to approximately 4 million SEK (May–August 2012). This corresponds to an annual saving of 6 million SEK (€650,000). CONCLUSION: Patients were successfully switched from originator to biosimilar rhGH (somatropin), with no negative impact on growth, and no serious or unexpected adverse drug reactions. The switch from originator to biosimilar rhGH is associated with substantial cost savings

Bolesti vezane uz rad s azbestom u švedskim brodogradilištima

Asbestos has been extensively used in Swedish shipyards, but its use has come to an end in the early 1970s. Asbestos-related diseases are still common. There are many cases of pleural plaques, strongly related to age. The risk ratio of lung cancer was about 2 among shipyard workers compared to the general population. It has decreased during recent years. The actual incidence of mesothelioma is about 0.5 per 1 000 person-years. Severe asbestosis is rareU švedskim brodogradilištima azbest se mnogo upotrebljavao sve do ranih sedamdesetih godina. Šezdesetih i sedamdesetih godina rizik pojave karcinoma pluća bio je gotovo dvostruk u ovih radnika, no čini se da se otada polako smanjuje. Međutim, s druge je strane vrlo česta pojava mezotelioma. Od 1978. do 1983. godine incidencija pleuralnih mezotelioma bila je oko 0,5 na 1000 osoba, s vremenom latencije od 20 godina. Pleuralni plakovi su česti i prevalencija među muškarcima rođenim od 1920. do 1929. godine iznosi 37%. Pojavljuju se slučajevi azbestoze, ali je teška azbestoza rijetka. Među radnicima je provedena vrlo jaka propaganda protiv pušenja. Godine 1985. bilo je 31% pušača, 42% bivših pušača, a 26% radnika nikada nije pušilo. Nema redovnih zdravstvenih pregleda radi ranog otkrivanja karcinoma pluća

Импульсное зондирование при исследовании импедансных свойств биосегментов

Тез. докл. Междунар. науч.-техн. конф. (науч. чтения, посвящ. П. О. Сухому), Гомель, 4-6 июля. 2002 г

Height, body mass index and prostate cancer risk and mortality by way of detection and cancer risk category.

Obesity is a risk factor for advanced, but not localised, prostate cancer (PCa), and for poor prognosis. However, the detection of localised PCa through asymptomatic screening might influence these associations. We investigated height and body mass index (BMI) among 431 902 men in five Swedish cohorts in relation to PCa risk, according to cancer risk category and detection mode, and PCa-specific mortality using Cox regression. Statistical tests were two-sided. Height was positively associated with localised intermediate-risk PCa (HR per 5 cm, 1.03, 95% CI 1.01-1.05), while overweight and obesity were negatively associated with localised low- and intermediate-risk PCa (HRs per 5 kg/m2 , 0.86, 95% CI 0.81-0.90, and 0.92, 95% CI 0.88-0.97). However, these associations were partially driven by PCa's detected by asymptomatic screening and, for height, also by symptoms unrelated to PCa. The HR of localised PCa's, per 5 kg/m2 , was 0.88, 95% CI 0.83 to 0.92 for screen-detected PCa's and 0.96, 95% CI 0.90 to 1.01 for PCa's detected through lower urinary tract symptoms. BMI was positively associated with PCa-specific mortality in the full population and in case-only analysis of each PCa risk category (HRs per 5 kg/m2 , 1.11-1.22, P for heterogeneity = .14). More active health-seeking behaviour among tall and normal-weight men may partially explain their higher risk of localised PCa. The higher PCa-specific mortality among obese men across all PCa risk categories in our study suggests obesity as a potential target to improve the prognosis of obese PCa patients