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The concentration of an environmental estrogen (4-nonylphenol) was determined in suspended solids and large volume water samples (501) collected from a major sewage treatment plant (STP) and two sites located on the lower Fraser River in British Columbia, Canada. The collection of suspended solids and large volume water samples was conducted concurrently using an in situ continuous flow centrifuge and solid phase extraction. The phase partitioning profile and log Kocof 4-nonylphenol were determined in the STP effluent and the Fraser River receiving environment. The data indicate the following: i) in situ continuous flow centrifugation and solid phase extraction techniques are appropriate methods for the determination of trace levels of 4-nonylphenol in suspended solids and water ii) the highest concentrations of 4-nonylphenol were measured in the STP final effluent iii) 4-nonylphenol showed preferential partitioning to the suspended solid phase in the STP effluent sample and iv) elevated levels of 4-nonylphenol were detected in the Fraser River receiving environment downstream of the STP. [ABSTRACT FROM AUTHOR]

This study examined changes over time in relative health inequalities among men and women in four Nordic countries, Denmark, Finland, Norway and Sweden. A serious economic recession burst out in the early 1990s particularly in Finland and Sweden. We ask whether this adverse social structural'development influenced health inequalities by employment status and educational attainment, i.e. whether the trends in health inequalities were similar or dissimilar between the Nordic countries. The data derived from comparable interview surveys carried out in 1986/87 and 1994/95 in the four countries. Limiting long-standing illness and perceived health were analysed by age, gender, employment status and educational attainment. First, age-adjusted overall prevalence percentages were calculated. Second, changes in the magnitude of relative health inequalities were studied using logistic regression analysis. Within each country the prevalence of ill-health remained at a similar level, with Finns having the poorest health. Analysing all countries together health inequalities by employment status and education showed no major changes. There were slightly different tendencies among men and women in inequalities by both health indicators, although these did not reach statistical significance. Among men there was a suggestion of narrowing health inequalities, whereas among women such a suggestion could not be discerned. Looking at particular countries some small changes in men's as well as women's health inequalities could be found. Over a period of deep economic recession and a large increase in unemployment, particularly in Finland and Sweden, health inequalities by employment status and education remained broadly unchanged in all Nordic countries. Thus, during this fairly short period health inequalities in these countries were not strongly influenced by changes in other structural inequalities, in particular labour market inequalities. Institutional arrangements in the Nordic welfare states, including social benefits and services, were cut during the recession but nevertheless broadly remained, and are likely to have buffered against the structural pressures towards widening health inequalities. [ABSTRACT FROM AUTHOR]

This article reviews a series of patients undergoing cricopharyngeal myotomy and determines whether clinically dangerous aspiration is seen postoperatively. A total of 23 patients underwent myotomy. Indications included Zenker's diverticulum (14), anticipated or real dysphagia from skull base lesions (5), dysphagia from stroke (2), and dysphagia from glossectomy and radiation therapy (2). Surgical procedures, complications, and effectiveness were reviewed. Of patients with Zenker's diverticula, 13 of 14 had clinically useful improvement in dysphagia. Of patients with skull base lesions, all 5 had improvement (4 of these also had thyroplasites and cervical plexus-to-superior laryngeal nerve anastomoses). Of the patients with strokes, neither had significant improvement. Of the patients with glossectomy and radiation, 1 had useful improvement. Complications were seen in 5 patients: 2 had self-limiting pharyngeal leaks, and 3 had pneumonia 1-4 months postoperatively. One patient also had a postoperative ipsilateral recurrent laryngeal nerve injury. There were no postoperative deaths. In conclusion, cricopharyngeal myotomy has definite utility in the management of cervical dysphagia, even though the etiology of the dysphagia can be multifactorial. Risks directly attributable to the procedure are usually self-limiting; serious complications are usually associated with the underlying disease. The addition of adjunctive procedures, such as thyroplasty and superior laryngeal nerve reinnervation, may be of additional benefit to patients with high extracranial vagal injuries. [ABSTRACT FROM AUTHOR]

Aims: Cardiac troponin levels are elevated in Takotsubo syndrome (TTS) with significant overlap to acute myocardial infarction (MI). Long and intact cardiac troponin T (cTnT) forms are typical for MI. This study sought to assess whether the fragmentation composition of cTnT release in TTS differs from MI., Methods and Results: The concentration of long molecular forms of cTnT (long cTnT) was measured with a novel upconversion luminescence immunoassay and total cTnT with a commercial high-sensitivity cTnT assay in 24 TTS patients and in 84 Type 1 MI patients. The ratio of long to total cTnT (troponin ratio) was determined as a measure of cTnT fragmentation. Troponin ratio was lower in TTS patients [0.13 (0.10-0.20) vs. 0.62 (0.29-0.96), P < 0.001]. In the receiver operating characteristic curve analyses, troponin ratio showed a better predictive power than total cTnT in discriminating TTS and MI patients {area under the curve [AUC] 0.869 [95% confidence interval (CI) 0.789-0.948] vs. 0.766 [95% CI 0.677-0.855], P = 0.047}. When restricting the analysis to patients with total cTnT below 1200 ng/L (maximal value in TTS patients), the respective AUC values for total cTnT and troponin ratio were 0.599 (95% CI 0.465-0.732) and 0.816 (95% CI 0.712-0.921) (P = 0.003). At a cut-off point of 0.12, troponin ratio correctly identified 95% of MI patients and 50% of TTS patients., Conclusion: In contrast to Type 1 MI, only a small fraction of circulating cTnT in TTS exists in intact or long molecular forms. This clear difference in troponin composition could be of diagnostic value when evaluating patients with cTnT elevations and suspicion of TTS., Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04465591., Competing Interests: Conflict of interest: J.K.E.A.: research grants from the Finnish Foundation for Cardiovascular Research and Clinical Research Fund of Turku University Hospital, Turku, Finland; lectures for Astra Zeneca, Bayer, and Boehringer Ingelheim; and pending patent application WO2023187258 (A1)—ASSAY FOR LONG FORMS OF CARDIAC TROPONIN T; T.P.: lectures for Astra Zeneca; T.H.: lectures for AstraZeneca, Astellas, and GSK and pending patent application WO2023187258 (A1)—ASSAY FOR LONG FORMS OF CARDIAC TROPONIN T; T.V.: pending patent application WO2023187258 (A1)—ASSAY FOR LONG FORMS OF CARDIAC TROPONIN T; T.T., S.S., H.J., M.S.: none declared; A.L.-P.: research grants from the Finnish Society of Clinical Chemistry; H.P.: lectures for Roche; K.T.: research grants from The Finnish Foundation for Cardiovascular Research, The Finnish Medical Foundation, The Finnish Foundation for Alcohol Studies, and the Finnish State Research Funding; S.J.: lectures for Amgen, Boehringer Ingelheim, and BMS Pfizer; S.W.: research grants from the Finnish Society of Clinical Chemistry, the Finnish Foundation for Cardiovascular Research, the Turku University Foundation and the Varsinais-Suomi Regional Fund of the Finnish Cultural Foundation, research funding from Business Finland, official Finnish government agency for trade, and investment promotion, innovation funding, travel promotion, and talent attraction; and pending patent application WO2023187258 (A1)—ASSAY FOR LONG FORMS OF CARDIAC TROPONIN T., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Objectives: Elevations of cardiac troponin T (cTnT) levels are common after strenuous exercise. We assessed whether the composition of cTnT release after marathon race differs from that of acute myocardial infarction (MI)., Methods: Troponin composition was analysed in plasma samples taken from 45 runners after marathon race and from 84 patients with type 1 MI. The concentration of long cTnT (intact and mildly fragmented cTnT) was measured with a novel upconversion luminescence immunoassay, total cTnT with a commercial high-sensitivity cTnT assay, and the ratio of long to total cTnT (troponin ratio) was determined as a measure of troponin fragmentation., Results: Total cTnT exceeded the upper reference limit (>14 ng/L) in 37 (82%) runners. Troponin ratio was lower in runners ((IQR) 0.17 (0.11-0.24) vs 0.62 (0.29-0.96), p<0.001). With increasing troponin release the troponin ratio decreased (r=-0.497, p<0.001) in marathon runners and the concentration of long cTnT remained in all runners below 8.4 ng/L. In contrast to marathon runners, troponin ratio increased (r=0.565, p<0.001) with the increase of cTnT release in patients with MI. The median total and long cTnT concentrations were lower in marathon runners than in patients with MI (25 ng/L vs 835 ng/L and 4.1 vs 385 ng/L, p<0.001 for both)., Conclusion: In contrast to type 1 MI, only a small fraction of circulating cTnT exists as intact cTnT or long molecular forms after strenuous exercise and the difference in troponin composition is more pronounced in runners with higher troponin release., Trial Registration Number: NCT06000930., Competing Interests: Competing interests: JA: research grants from the Finnish Foundation for Cardiovascular Research and Clinical Research Fund of Turku University Hospital, Turku, Finland. Lectures for Astra Zeneca, Bayer, Boehringer Ingelheim, pending patent application WO2023187258 (A1) - ASSAY FOR LONG FORMS OF CARDIAC TROPONIN T. TP: lectures for Astra Zeneca. TH: lectures for AstraZeneca, Astellas and GSK, pending patent application WO2023187258 (A1) - ASSAY FOR LONG FORMS OF CARDIAC TROPONIN T. TV: pending patent application WO2023187258 (A1) - ASSAY FOR LONG FORMS OF CARDIAC TROPONIN T. SS: none. TT: none. AL-P: research grants from the Finnish Society of Clinical Chemistry. H-MP: lectures for Roche. KT: research grants from The Finnish Foundation for Cardiovascular Research, The Finnish Medical Foundation, The Finnish Foundation for Alcohol Studies and the Finnish State Research Funding. SJ: lectures for Amgen, Boehringer Ingelheim, BMS Pfizer. OJH: none. SW: research grants from the Finnish Society of Clinical Chemistry, the Finnish Foundation for Cardiovascular Research, the Turku University Foundation and the Varsinais-Suomi Regional Fund of the Finnish Cultural Foundation, and the Finnish Foundation for Cardiovascular Research. Research funding from Business Finland, official Finnish government agency for trade and investment promotion, innovation funding, travel promotion and talent attraction. Pending patent application WO2023187258 (A1) - ASSAY FOR LONG FORMS OF CARDIAC TROPONIN T., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The digital transformation of healthcare enables new ways of working in cancer care directing attention on the digital skills of healthcare professionals. This systematic review aims to identify existing evidence about digital skills among health care professionals in cancer care to identify the needs for future education and research., Methods: Database searches were conducted in PubMed, CINAHL, Web of Science, Scopus, Cochrane and ERIC to identify studies until March 2023. The inclusion criteria were digital skills of health care professionals in cancer care as described by themselves, other health care professionals, patients or significant others. The CASP tool was used for quality assessment of the studies. Data was analysed following inductive content analysis., Results: The search produced 4563 records, of which 24 studies were included (12 qualitative, 10 quantitative, 1 mixed methods design and 1 strategy paper). Four main categories were identified describing HCPs' required skills, existing skills and development areas of digital skills in cancer care: Skills for information technology, Skills for ethical practice, Skills for creating a human-oriented relationship and Skills for digital education and support. In development areas, one more main category, Skills for implementing digital health, was identified., Conclusion: The digital skills of health care professionals in cancer care are multifaceted and fundamental for quality cancer care. The skills need to be assessed to provide education based on actual learning needs. The review findings can be used for education and research in this field., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

In a liberalized market economy, states tend to purchase supplies required for producing publicly funded services, such as healthcare, from the markets instead of producing them themselves. The availability of critical supplies thus becomes a question of supply-side availability and supply chain management, and therefore their availability is conceptualized in terms of security of supply. The European Union's security of supply policy has focused on energy and security and defence. Security has primarily been sought from the markets, while the purpose of EU law has been to establish these markets and to guarantee their functioning. During the COVID-19 pandemic the European Union has sought to secure the availability of medical supplies by relying on a variety of internal market measures: free movement law, State aid law, competition law and public procurement law have all been used in this effort. Collectively these measures have aimed at securing the functioning of the markets and thus the availability of necessary supplies. Following the crisis, the European Union is now adopting a broader policy perspective to security of supply. However, this is still carried out mainly through internal market competences and by relying on the markets as the source of security., (© The Author(s) 2022.)

We investigated the short- and long-term effects of two different evidence-based mindfulness training on students' stress and well-being. A randomised controlled trial with three measurement points (baseline, post-intervention, and 4 months post-intervention) was conducted among undergraduate students of medicine, dentistry, psychology, and logopaedics at the University of Helsinki. The participants were randomly assigned into three groups: (1) face-to-face mindfulness training based on the Mindfulness Skills for Students course (n = 40), (2) a web-based Student Compass program using Mindfulness and Acceptance and Commitment therapy (n = 22), and (3) a control group that received mental health support as usual (n = 40). The primary outcome was psychological distress measured using the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). Secondary outcomes included hair cortisol concentrations and a wide range of well-being indicators. Psychological distress increased in all the groups from baseline to post-intervention, but significantly less so in the intervention groups than in the control group. At 4-month follow-up, were found no differences between the primary outcomes of the control and intervention groups, but the participants who continued practising mindfulness at least twice a week were less stressed than the others. Our results suggest that participating in a mindfulness course may mitigate health care students' psychological distress during the academic year, but only if the participants continue practising mindfulness at least twice a week., (© 2022. The Author(s).)

Background: Neurocognitive deficits are frequent among male offenders and tend to be associated with a more serious risk of anti-social activity, but they are not systematically allowed for in rehabilitation programmes., Aim: The aim of this study was to evaluate neurocognitive performance in a sample of sentenced Finnish male prisoners and consider the implications for prison programme entry., Methods: Seventy-five sentenced male prisoners were examined using a neurocognitive test battery., Results: Depending on the neurocognitive domain, from 5% to 49% of the men demonstrated marked neurocognitive deficits in tests of motor dexterity, visuospatial/construction skills, verbal comprehension, verbal and visual memory and attention shift. Verbal IQ was more impaired than performance IQ. There was no association between most serious offence type and neurocognitive performance, but correlations between attention deficit indices and number of previous convictions suggested that recidivists may have an attention disorder profile. Cluster analysis identified two subgroups of offenders, separated by very poor or merely poor cognitive performance. Motor dexterity, visuo-construction and verbal memory deficits were not wholly explained by lower IQ measures., Conclusions and Implications for Practice: Our sample was small, but the nature and extent of the neurocognitive deficits found suggest that wider use of neurocognitive assessments, which the men generally tolerated well, could help select those most likely to need offender programmes and that the effectiveness of these may be enhanced by some specific cognitive remediation before progressing to more complex social tasks., (Copyright © 2013 John Wiley & Sons, Ltd.)

Age-related changes in visual spatial biases in children, young adults, and older adults were studied with unilateral and bilateral stimulus conditions in fast-paced linguistic and non-linguistic attention tasks. Only rightward spatial biases were observed. The incidence of the biases changed as a function of age: in childhood and in old age the rightward spatial biases were more common than in young adulthood. The present rightward spatial biases were similar to those observed in the corresponding auditory spatial linguistic and non-linguistic attention tests (Takio, Koivisto, Laukka, & Hämäläinen, 2011) and in the dichotic listening forced-attention task (Takio et al., 2009). We suggest that the multimodal rightward spatial bias observed under intensive attentional load is related to a right hemispace preference and modulated by age-dependent changes in executive functions.

Objectives: Hypothermic circulatory arrest (HCA) provides an optimal operating field in aortic arch surgery, but it is associated with neurological complications. Levosimendan is an inotropic agent with clinical indications for open-heart surgery. Through peripheral vasodilatation, cardiac contractility enhancement and anti-inflammatory function it has a potential to improve cerebral protection after HCA., Design: Eighteen piglets were randomly assigned to a levosimendan group (n = 9) and a placebo group (n = 9) and underwent a 60-minute period of hypothermic circulatory arrest at 18°C. A levosimendan or placebo infusion (0.2 μg/kg/min) was commenced at the onset of anesthesia and continued for 24 hours. Animals were followed for one week and their neurological recovery was assessed daily. Finally the animals were electively sacrificed and their brain was harvested for histopathological examination., Results: Levosimendan decreased intracranial pressure during the experiment. There were no differences between the groups in terms of hemodynamic or metabolic data, brain metabolism, neurological recovery or histopathology of the cerebral tissue. In the levosimendan group, cardiac enzymes were slightly more elevated., Conclusions: Levosimendan decreased intracranial pressure during the experiment, but in terms of cerebral metabolism, neurological recovery and histopathology of the brain tissue levosimendan did not improve brain protection in this experimental setting.

Wastewater treatment plant (WWTP) effluents can contain estrogenic chemicals, which potentially disrupt fish reproduction and development. The current study focused on the use of an estrogen-responsive in vitro cell bioassay (T47D-KBluc), to quantify total estrogenicity of WWTP effluents. We tested a novel sample preparation method for the T47D-KBluc assay, using powdered media prepared with direct effluent. Results of the T47D-KBluc assay were compared with the induction of estrogen receptor-regulated gene transcription in male fathead minnows (Pimephales promelas) exposed to the same effluents. Effluent samples for the paired studies were collected over the course of three months. According to the T47D-KBluc assay, the effluent estrogenicity ranged from 1.13 to 2.00 ng 17β-estradiol (E2) equivalents/L. Corresponding in vivo studies exposing male fathead minnows to 0, 10, 50, and 100% effluent dilutions demonstrated that exposure to 100% effluent significantly increased hepatic vitellogenin (VTG) and estrogen receptor α subunit transcripts relative to controls. The induction was also significant in males exposed to 250 ng E2/L or 100 ng E2/L. The in vitro and in vivo results support the conclusion that the effluent contains significant estrogenic activity, but there was a discrepancy between in vitro- and in vivo-based E2 equivalent estimates. Our results suggest that the direct effluent preparation method for the T47D-KBluc assay is a reasonable approach to estimate the estrogenicity of wastewater effluent., (© 2010 SETAC.)

While violence against sexual minorities is a well-known phenomenon, sexual homicides committed by men with cross-dressing or transsexual identity are not, because they are relatively few. We report a 23-year follow-up of the case of a transvestite, possibly transsexual, man who killed his mother by strangulation at the age of 20, and later in two separate cases strangled a female victim towards whom he felt sexual desire. He reported being sexually aroused by being strangled himself. The case raises questions concerning legislation which does not allow life-long control of criminals.

In Part I of this work we presented pesticide levels in the surface waters of the Lower Fraser Valley (LFV) region of British Columbia, Canada. In Part II pesticide levels in the groundwater of the LFV are presented. During the period 2003 to 2005 a study was conducted to determine the occurrence and spatial distribution of 78 pesticides in the groundwater of the LFV. Samples were collected and analyzed from one reference, nine agricultural, one urban, and three urban-agriculture mixed sites. Overall 24 different pesticides were detected in the sites monitored. The maximum single pesticide concentration observed was for simazine (90 ng L(-1)) at one of the agricultural sites. All concentrations of pesticides detected in groundwater samples were below Canadian surface water quality criteria and below available drinking water quality criteria set by World Health Organization (WHO), Health Canada, USEPA, and the European Union (EU). Pesticide levels in surface and groundwater were compared in the Abbotsford area. Generally, a pesticide with a high groundwater concentration tended to also have a high surface water concentration (Simazine 29 ng L(-1) in groundwater and 58 ng L(-1) in surface water, atrazine 5.5 ng L(-1) in groundwater and 14 ng L(-1) in surface water). For pesticides that were detected above 1 ng L(-1) concentration the only exception to this was desethylatrazine that showed greater concentration in groundwater (2.2 ng L(-1)) than surface water (1.5 ng L(-1)). Herbicides were the predominant pesticides detected in the agricultural sites and insecticides were predominant in the urban sites. Pesticide data presented in this study provide reference levels for future pesticide monitoring programs in the region.

In the period 2003 to 2005, a study was conducted to determine the occurrence, and spatial and temporal distribution of 78 pesticides in surface waters of the Lower Fraser Valley (LFV) region of British Columbia, Canada. A high resolution gas chromatography/electron impact high resolution mass spectrometry (HRGC/[EI]HRMS) method capable of detecting analytes at the subnanograms per liter level was developed for this study. Samples were collected and analyzed from three reference, five agricultural and two urban sites. Endosulfan sulfate was detected in all samples collected during the study period including the samples from the reference sites. The maximum concentration of a pesticide detected at the reference sites was 0.261 ng L(-1) for beta-endosulfan. Over the study period, the numbers of pesticides detected at the agricultural sites ranged from 22 to 33 of which 20.8 to 40.9% had a 100% detection frequency. At the agricultural sites, the greatest concentration was detected for diazinon (12,500 ng L(-1)), followed by linuron (1050 ng L(-1)) and simazine (896 ng L(-1)). The greatest pesticide concentration observed for the urban sites was 90.4 ng L(-1) for simazine followed by diazinon (5.39 ng L(-1)). With few exceptions, greater concentrations of herbicides were observed for samples collected during spring than for samples collected during fall. Pesticide data presented in this study provide reference levels for future pesticide monitoring programs in the region.

The right-ear advantage (REA) in Dichotic listening (DL) reflects stimulus-driven bottom-up asymmetry in speech processing. The REA can be modified by top-down attentional control. We investigated attentional control in DL task as a function of age. A total of 186 participants between the ages of 5 and 79 years were tested. The youngest children demonstrated a REA that was not modified by attention, suggesting that bottom-up functional asymmetry was present. The 10-11-year-olds began to show ability to voluntarily modify DL, but only young adults were fully capable of doing so. In 59-79-year-olds, this top-down attentional control was lost again.

In the period 2003-2005 a study was conducted to determine the occurrence, spatial and temporal distribution of five acidic herbicides in the Lower Fraser Valley (LFV) region of British Columbia, Canada. A high-resolution gas chromatography/high-resolution mass spectrometry (HRGC/HRMS) method capable of detecting analytes at the sub ng/L level was developed for this study. Samples were collected and analyzed from two references, five agricultural, two urban and five agricultural and urban mixed sites. Only (4-chloro-2-methylphenoxy)acetic acid and triclopyr were detected at the reference sites. The highest concentration of herbicide detected at the reference sites was 0.109ng/L for (4-chloro-2-methylphenoxy)acetic acid. Varying levels of all of the herbicides monitored were detected at the urban, agricultural and the mixed sites. For the urban sites the highest concentration of herbicide detected was 66.6ng/L for 2-(4-chloro-2-methylphenoxy)propanoic acid. For the agricultural sites the highest concentration of herbicide detected was 345ng/L for (2,4-dichlorophenoxy)acetic acid (2,4-D). For the mixed sites the highest concentration of herbicide detected was 1230ng/L for 2,4-D. Overall the mixed sites showed highest concentrations and detection frequencies followed by the agricultural and urban sites. With few exceptions higher concentrations of herbicides were observed for samples collected during spring than for samples collected during fall. The detected concentrations of herbicides were evaluated against established water quality criteria. Herbicide data presented in this study provide reference levels for future pesticide monitoring programs in the region.

In this work, an isotope dilution method for determination of selected acidic herbicides by high-resolution gas chromatography/high-resolution mass spectrometry (HRGC/HRMS) was developed for surface water samples. Average percent recoveries of native analytes were observed to be between 70.8 and 93.5% and average recoveries of labeled quantification standards [(13)C(6)]2,4-D and [(13)C(6)]2,4,5-T were 85.5 and 101%, respectively. Using this method, detection limits of 0.05 ng/L for dicamba, MCPA, MCPP, and triclopyr, and 0.5 ng/L for 2,4-D were routinely achieved. The method was applied to measuring the concentration of these analytes in surface water samples collected from five sampling locations in the Lower Fraser Valley region of British Columbia, Canada. All of the herbicides monitored were detected at varying levels in the surface water samples collected. The highest concentrations detected for each analyte were 345 ng/L for 2,4-D, 317 ng/L for MCPA, 271 ng/L for MCPP, 15.7 ng/L for dicamba, and 2.18 ng/L for triclopyr. Average detection frequencies of the herbicides were 95% for MCPA, 80% for MCPP, 70% for dicamba, 65% for 2,4-D, and 46% for triclopyr. Seasonal variations of herbicide levels are also discussed.

The overall aim of the present study was to widen our knowledge about the biopharmaceutical behaviour of novel hydroxypropyl methylcellulose (HPMC)-based two-piece capsules by comparing them with the classic hard gelatine capsules. Firstly, the tendency of the HPMC capsules to stick to isolated porcine oesophageal preparation was evaluated. The force needed to detach the HPMC capsules from the oesophagus was significantly lower than that for the gelatine capsules (P<0.001), which is evidently an advantage of this new dosage form. The second aim was to investigate the possibility of preparing sustained-release capsules using different powdered HPMCs as diluents (K100, K4M and K15M) and the effect of the molecular weight of HPMC powder on the in vitro and in vivo behaviour of the capsules. In addition to peroral drug administration also rectal dosing was applied. Two groups of eight healthy volunteers participated in randomised, cross-over, single-dose studies. One group was administered capsules orally and the other rectally. There were no marked differences in the bioavailability properties of either the oral or rectal HPMC capsules containing ibuprofen as model drug as compared with corresponding gelatine capsule formulations. Using different viscosity grades of HPMC powders as diluents it was possible to control the absorption rate of the model drug both from gelatine and HPMC capsules as far as the oral route was concerned. After rectal administration there were no statistically significant differences between the formulations containing different grades of HPMC powder. Only partial correlation was observed between the results of the bioavailability studies and the in vitro dissolution studies. From a biopharmaceutical point of view these two shell materials can be regarded as interchangeable.

The study examined changes over time in health inequality in Denmark, Finland, Norway and Sweden. Data derive from comparable interview surveys carried out in 1986/87 and 1994/95. Limiting long-standing illness and perceived ill health were analysed regarding age, gender; educational attainment, and employment status. Age adjusted prevalence rates were calculated. Changes in differences in health were found in education and employment status groups. There was little or no change in the prevalence of ill health during the time period studied. Despite social and economic changes differences in health remained broadly stable in the examined countries.

A review of U.S. dental amalgam waste management activities finds a wide variety of approaches, processes and results, within which the authors have observed an inconsistency of definitions, measurements, standards and even of clearly applied goals. As a result, outcomes have varied greatly from community to community. This manuscript attempts to deliver logical options, which might prevail even within an atmosphere of differing perspectives. The authors believe that successful outcomes are achievable within a collaborative environment of shared learning and cooperative planning. By example, the authors attempt to demonstrate how the joint acceptance of certain definitions and goals has served as a pathway to success in one community's dental waste management project. The goal of this paper is to share tools that may contain some measure of applicability to other similar collaborations.

In reviewing U.S. dental amalgam waste management activities, one finds a wide variety of approaches, processes, and results, within which the authors have observed an inconsistency of definitions, measurements, standards, and even of clearly applied goals. As a result, outcomes have varied greatly from community to community. This manuscript attempts to deliver logical options which might prevail even within an atmosphere of differing perspectives. The authors share the belief that successful outcomes are achievable within a collaborative environment of shared learning and cooperative planning. By example, the authors attempt to demonstrate how the joint acceptance of certain definitions and goals has served as a pathway to success in one community's dental waste management project. The goal of this paper is to share tools that may contain some measure of applicability to other similar collaborations.

The sinking of the car ferry, Estonia, was one of the world's most devastating marine disasters that has ever occurred in peace time. Altogether 138 passengers and crew members were rescued, and 38 of them were taken to the Turku University Central Hospital in Finland. The present article describes the various psychological reactions among the survivors during the first three days of the recoil phase.

One 3 g intravenous dose of cefuroxime during the induction of anaesthesia was administered randomly in a series of 162 consecutive hip fractures. The overall infection rate was 8.0%, and 2.4% for deep infections. The number of infections was seven in the prophylaxis group and six in the control group. The percentage of deep infections was 3.9 and 1.4, correspondingly. Antibiotic prophylaxis given did not seem to have an effect on the infection rate.