Predicted and observed prevalences and latency periods of vibration-induced white finger (VWF) were examined among workers exposed to hand-arm vibration. The different physical characteristics of vibration--spectra and impulsiveness--were measured. The following groups of workers were included in the study: forest workers (n = 199), pedestal grinders (n = 12), stone workers (n = 16), shipyard workers (n = 171), and platers (n = 5). The exposure to vibration was measured according to the ISO 5349 method. The impulsiveness of vibration was defined as the difference between peak levels and RMS levels. A good agreement was observed between the predicted and observed data for prevalence and latency of VWF in the forest workers. For the tools with high impulsiveness used in grinding, stone works, and shipyard assembly hall, the results were nonconfirmative; and there was a poor correlation between vibration and VWF. The ISO 5349 standard does not consider the high peak values of the vibration signal which may comprise high-frequency components and cause short transients in the underlying tissue of the worker's hand. These characteristics in vibration may be hazardous in the genesis of VWF and cannot be predicted when measuring vibration by the present standard method.
In countries with active renal transplant programs and wide acceptance criteria for transplant patients, the number of cadaveric donors is not, and probably never will be, sufficient to meet the demand for renal allografts. In general between 15 and 20 cadaveric donors PMP per year (maximum 23.7 in Denmark in 1986) have been available in the Scandinavian countries in the 1980s. In most other countries fewer donors are available, but there are regions where higher figures have been reached. Continuous registrations of potential cadaveric donors in Sweden have shown that the number of donors could increase by 40% to 60% if relatives of all medically suitable patients had given consent to organ donation. Since a public survey has shown that factual information on cadaveric organ donation and transplantation had a positive effect on the public's attitude, more public awareness programs are needed. Donor acceptance criteria are already broadly based, particularly with respect to age, and could probably not be further broadened without risking results after transplantation. A varying proportion of renal allografts from living donors are used in the Scandinavian countries. An increased use of living donors, related and unrelated, in the countries where few currently are used might help meet demand in the future. At present the need for nonrenal organs can be met, but as the programs for liver and heart transplantations are developed to reach their predicted levels, the current number of donors will most likely prove insufficient.
Chlorhexidine mouth rinsing is commonly used for oral flora reduction. Indigenous microorganisms (viridans streptococci) are significantly suppressed, while "hospital-acquired" gram-negative bacilli are not affected in vivo. To explain the discrepancies between good in vitro and poor in vivo activity of chlorhexidine, minimum bactericidal concentration values for 120 isolates were studied by means of a standard dilution method in fresh whole saliva, broth, and glucose 5%. Both saliva and broth significantly reduced the bactericidal activity of chlorhexidine against all microorganisms tested as compared to glucose 5% (p less than 0.01). Minimum bactericidal concentrations for indigenous flora were significantly lower than the values obtained for the "hospital-acquired" microorganisms (p less than 0.05). These observations of chlorhexidine inactivation by saliva may explain why chlorhexidine mouth rinsing is of limited value in decontaminating the oral cavity.
In this retrospective study, the TRISS method of trauma care analysis is used to compare trauma care at the Hamilton General Hospital (HGH) and the Ottawa Civic Hospital (OCH) with the standards reported in the Major Trauma Outcome Study (MTOS). A total of 274 adult patients with multiple-system injuries were studied; their demographic data, Trauma Scores (TS) on arrival to the Emergency Room, and Injury Severity Scores (ISS) were reviewed. The TRISS scores and Z and M statistics were then calculated. In the Hamilton group, 106 consecutive patients from April through July 1987 were studied. The majority of patients (72%) were male, and the median age was 26 years. The majority of patients (96.2%) sustained blunt trauma, with motor vehicle accidents (MVA) being the most common (76.4%) mechanisms of injury. Fifty-four (51%) of the patients were transferred from outlying hospitals. The Z and M statistics were -0.05 and 0.92, respectively. In the Ottawa group, 168 consecutive patients from April 1987 through October 1988 were studied. The majority of patients (73%) were male, and the median age was 39 years. Blunt trauma accounted for the majority (91.7%) of injuries, with MVAs being responsible for 58% of injuries. Most patients (63.5%) were transferred from regional hospitals. The Z and M statistics were 1.20 and 0.56, respectively. We conclude that the survival statistics of trauma patients treated at both centres are comparable to those of trauma patients in the MTOS.
Motor vehicle crashes remain a leading cause of death and injury in the industrialized world. Alcohol consumption is implicated as a major factor in fatal motor vehicle crashes (MVCs), but only poor estimates of blood alcohol concentrations among nonfatally injured crash victims are available. A 3-year study was undertaken at a Regional Trauma Unit to determine the demographics, injury severity, and alcohol positivity of motor vehicle crash victims. Between August 1, 1986 and July 31, 1989, 825 motor vehicle crash victims were available for study; 368 drivers were admitted to the unit within a period of 4 hours. Of 715 patients tested for alcohol, 31.0% were positive. A total of 333 drivers were tested for blood alcohol; 128 (38.4%) were positive. The mean blood alcohol concentration (BAC) at admission for the drivers was 145.6 mg/100 ml; the estimated mean BAC at crash was 180.9 mg/100 ml. The mean age of BAC positive drivers was 31.4 years, compared to a mean age in the BAC negative drivers of 35.2 years (p less than 0.02). Male patients represented 76.6% of the drivers, yet represented 83.6% of the BAC positive drivers (p less than 0.05). There was a marked seasonal variation in BAC positivity, with 46.1% of drivers positive during the summer months. Alcohol appears to be a significant factor in nonfatal MVCs.
Seatbelt usage has been consistently documented to decrease mortality and injury severity from motor vehicle crashes (MVC); however, conflicting results are available comparing mortality and injury severity, and blood alcohol positivity. Prospective testing on all MVC admissions showed that 51.5% of the non-belted, and 22% of the shoulder-belted drivers had a positive blood alcohol content (p less than 0.001). A comparison of belted and non-belted MVC drivers revealed a significantly higher mean length of stay (LOS) (p less than 0.05) and Injury Severity Score (ISS) (p less than 0.01) for the non-belted drivers. A comparison of groups positive and negative for blood alcohol revealed no significant differences in LOS or ISS, suggesting that these parameters are related to seatbelt use and not alcohol consumption.