Predictive value of readiness, importance, and confidence in ability to change drinking and smoking.

BACKGROUND: Visual analog scales (VAS) are sometimes used to assess change constructs that are often considered critical for change. Aims of Study: 1.) To determine the association of readiness to change, importance of changing and confidence in ability to change alcohol and tobacco use at baseline with the risk for drinking (more than 21 drinks per week/6 drinks or more on a single occasion more than once per month) and smoking (one or more cigarettes per day) six months later. 2.) To determine the association of readiness, importance and confidence with alcohol (number of drinks/week, number of binge drinking episodes/month) and tobacco (number of cigarettes/day) use at six months. METHODS: This is a secondary analysis of data from a multi-substance brief intervention randomized trial. A sample of 461 Swiss young men was analyzed as a prospective cohort. Participants were assessed at baseline and six months later on alcohol and tobacco use, and at baseline on readiness to change, importance of changing and confidence in ability to change constructs, using visual analog scales ranging from 1-10 for drinking and smoking behaviors. Regression models controlling for receipt of brief intervention were employed for each change construct. The lowest level (1-4) of each scale was the reference group that was compared to the medium (5-7) and high (8-10) levels. RESULTS: Among the 377 subjects reporting unhealthy alcohol use at baseline, mean (SD) readiness, importance and confidence to change drinking scores were 3.9 (3.0), 2.7 (2.2) and 7.2 (3.0), respectively. At follow-up, 108 (29%) reported no unhealthy alcohol use. Readiness was not associated with being risk-free at follow-up, but high importance (OR 2.94; 1.15, 7.50) and high confidence (OR 2.88; 1.46, 5.68) were. Among the 255 smokers at baseline, mean readiness, importance and confidence to change smoking scores were 4.6 (2.6), 5.3 (2.6) and 5.9 (2.7), respectively. At follow-up, 13% (33) reported no longer smoking. Neither readiness nor importance was associated with being a non-smoker, whereas high confidence (OR 3.29; 1.12, 9.62) was. CONCLUSIONS: High confidence in ability to change was associated with favorable outcomes for both drinking and smoking, whereas high importance was associated only with a favorable drinking outcome. This study points to the value of confidence as an important predictor of successful change for both drinking and smoking, and shows the value of importance in predicting successful changes in alcohol use. TRIAL REGISTRATION NUMBER: ISRCTN78822107.

IV thrombolysis and statins.

Objective: To examine whether prior statin use affects outcome and intracranial hemorrhage (ICH) rates in stroke patients receiving IV thrombolysis (IVT).Methods: In a pooled observational study of 11 IVT databases, we compared outcomes between statin users and nonusers. Outcome measures were excellent 3-month outcome (modified Rankin scale 0-1) and ICH in 3 categories. We distinguished all ICHs (ICH(all)), symptomatic ICH based on the criteria of the ECASS-II trial (SICH(ECASS-II)), and symptomatic ICH based on the criteria of the National Institute of Neurological Disorders and Stroke (NINDS) trial (SICH(NINDS)). Unadjusted and adjusted odds ratios (OR) with 95% confidence intervals were calculated.Results: Among 4,012 IVT-treated patients, 918 (22.9%) were statin users. They were older, more often male, and more frequently had hypertension, hypercholesterolemia, diabetes, coronary heart disease, and concomitant antithrombotic use compared with nonusers. Fewer statin users (35.5%) than nonusers (39.7%) reached an excellent 3-month outcome (OR(unadjusted) 0.84 [0.72-0.98], p = 0.02). After adjustment for age, gender, blood pressure, time to thrombolysis, and stroke severity, the association was no longer significant (0.89 [0.74-1.06], p = 0.20). ICH occurred by trend more often in statin users (ICH(all) 20.1% vs 17.4%; SICH(NINDS) 9.2% vs 7.5%; SICH(ECASS-II) 6.9% vs 5.1%). This difference was statistically significant only for SICH(ECASS-II) (OR = 1.38 [1.02-1.87]). After adjustment for age, gender, blood pressure, use of antithrombotics, and stroke severity, the OR(adjusted) for each category of ICH (ICH(all) 1.15 [0.93-1.41]; SICH(ECASS-II) 1.32 [0.94-1.85]; SICH(NINDS) 1.16 [0.87-1.56]) showed no difference between statin users and nonusers.Conclusion: In stroke patients receiving IVT, prior statin use was neither an independent predictor of functional outcome nor ICH. It may be considered as an indicator of baseline characteristics that are associated with a less favorable course. Neurology (R) 2011;77:888-895

Magnetoencephalography demonstrates multiple asynchronous generators during human sleep spindles.

Sleep spindles are approximately 1 s bursts of 10-16 Hz activity that occur during stage 2 sleep. Spindles are highly synchronous across the cortex and thalamus in animals, and across the scalp in humans, implying correspondingly widespread and synchronized cortical generators. However, prior studies have noted occasional dissociations of the magnetoencephalogram (MEG) from the EEG during spindles, although detailed studies of this phenomenon have been lacking. We systematically compared high-density MEG and EEG recordings during naturally occurring spindles in healthy humans. As expected, EEG was highly coherent across the scalp, with consistent topography across spindles. In contrast, the simultaneously recorded MEG was not synchronous, but varied strongly in amplitude and phase across locations and spindles. Overall, average coherence between pairs of EEG sensors was approximately 0.7, whereas MEG coherence was approximately 0.3 during spindles. Whereas 2 principle components explained approximately 50% of EEG spindle variance, >15 were required for MEG. Each PCA component for MEG typically involved several widely distributed locations, which were relatively coherent with each other. These results show that, in contrast to current models based on animal experiments, multiple asynchronous neural generators are active during normal human sleep spindles and are visible to MEG. It is possible that these multiple sources may overlap sufficiently in different EEG sensors to appear synchronous. Alternatively, EEG recordings may reflect diffusely distributed synchronous generators that are less visible to MEG. An intriguing possibility is that MEG preferentially records from the focal core thalamocortical system during spindles, and EEG from the distributed matrix system.

Helicopter rescue involving the winching of a physician.

INTRODUCTION: We sought to study the operational and medical aspects of helicopter rescue missions involving the use of a winch.¦SETTING: A single helicopter-based medical service of a pre-alpine region of Switzerland.¦METHODS: We prospectively studied consecutive primary rescue interventions involving winching of a physician, from October 1, 1998 to October 1, 2002. Demographic, medical and operational aspects as well as outcome at 48 hours were analyzed.¦RESULTS: We included 133 patients. Most (74%) were male, with traumatic injuries (77%). The median scene time of the nine severely injured patients (Injury Severity Scale [ISS] > 15) was significantly longer compared with the other patients (54 vs 37 minutes; P < .05). The main medical procedures performed were orotracheal intubation (n = 5), fracture reductions (n = 5), major analgesia with sedation (n = 4), and intravenous fluid administration of more than 1,500 mL (n = 4). Fourteen (10%) patients suffering from minor injuries were triaged by the physician and not airlifted to the hospital. All 133 patients were alive at 48 hours. Sixty-nine (52%) were still hospitalized. No secondary interhospital transfer was required.¦CONCLUSION: Our study provides a better knowledge of injury profile, medical aspects, and outcomes of patients rescued necessitating a winching procedure.

Friday Facts, May 1, 2015, Vol. 249

Bureau of Nutrition and Health Promotion part of the Iowa Department of Public Health produces of weekly newsletter about the Iowa WIC Program for the State of Iowa citizen.

EPI Update, May 1, 2015

Weekly newsletter for Center For Acute Disease Epidemiology of Iowa Department of Public Health.

Prognostic and predictive value of centrally reviewed Ki-67 labeling index in postmenopausal women with endocrine-responsive breast cancer: results from Breast International Group Trial 1-98 comparing adjuvant tamoxifen with letrozole.

PURPOSE: To evaluate the prognostic and predictive value of Ki-67 labeling index (LI) in a trial comparing letrozole (Let) with tamoxifen (Tam) as adjuvant therapy in postmenopausal women with early breast cancer. PATIENTS AND METHODS: Breast International Group (BIG) trial 1-98 randomly assigned 8,010 patients to four treatment arms comparing Let and Tam with sequences of each agent. Of 4,922 patients randomly assigned to receive 5 years of monotherapy with either agent, 2,685 had primary tumor material available for central pathology assessment of Ki-67 LI by immunohistochemistry and had tumors confirmed to express estrogen receptors after central review. The prognostic and predictive value of centrally measured Ki-67 LI on disease-free survival (DFS) were assessed among these patients using proportional hazards modeling, with Ki-67 LI values dichotomized at the median value of 11%. RESULTS: Higher values of Ki-67 LI were associated with adverse prognostic factors and with worse DFS (hazard ratio [HR; high:low] = 1.8; 95% CI, 1.4 to 2.3). The magnitude of the treatment benefit for Let versus Tam was greater among patients with high tumor Ki-67 LI (HR [Let:Tam] = 0.53; 95% CI, 0.39 to 0.72) than among patients with low tumor Ki-67 LI (HR [Let:Tam] = 0.81; 95% CI, 0.57 to 1.15; interaction P = .09). CONCLUSION: Ki-67 LI is confirmed as a prognostic factor in this study. High Ki-67 LI levels may identify a patient group that particularly benefits from initial Let adjuvant therapy.

Post-mortem cardiac 3-T magnetic resonance imaging: visualization of sudden cardiac death?

OBJECTIVES: This study aimed to investigate post-mortem magnetic resonance imaging (pmMRI) for the assessment of myocardial infarction and hypointensities on post-mortem T2-weighted images as a possible method for visualizing the myocardial origin of arrhythmic sudden cardiac death. BACKGROUND: Sudden cardiac death has challenged clinical and forensic pathologists for decades because verification on post-mortem autopsy is not possible. pmMRI as an autopsy-supporting examination technique has been shown to visualize different stages of myocardial infarction. METHODS: In 136 human forensic corpses, a post-mortem cardiac MR examination was carried out prior to forensic autopsy. Short-axis and horizontal long-axis images were acquired in situ on a 3-T system. RESULTS: In 76 cases, myocardial findings could be documented and correlated to the autopsy findings. Within these 76 study cases, a total of 124 myocardial lesions were detected on pmMRI (chronic: 25; subacute: 16; acute: 30; and peracute: 53). Chronic, subacute, and acute infarction cases correlated excellently to the myocardial findings on autopsy. Peracute infarctions (age range: minutes to approximately 1 h) were not visible on macroscopic autopsy or histological examination. Peracute infarction areas detected on pmMRI could be verified in targeted histological investigations in 62.3% of cases and could be related to a matching coronary finding in 84.9%. A total of 15.1% of peracute lesions on pmMRI lacked a matching coronary finding but presented with severe myocardial hypertrophy or cocaine intoxication facilitating a cardiac death without verifiable coronary stenosis. CONCLUSIONS: 3-T pmMRI visualizes chronic, subacute, and acute myocardial infarction in situ. In peracute infarction as a possible cause of sudden cardiac death, it demonstrates affected myocardial areas not visible on autopsy. pmMRI should be considered as a feasible post-mortem investigation technique for the deceased patient if no consent for a clinical autopsy is obtained.

J-shaped association between serum glucose and functional outcome in acute ischemic stroke.

BACKGROUND AND PURPOSE: Hyperglycemia after stroke is associated with larger infarct volume and poorer functional outcome. In an animal stroke model, the association between serum glucose and infarct volume is described by a U-shaped curve with a nadir ≈7 mmol/L. However, a similar curve in human studies was never reported. The objective of the present study is to investigate the association between serum glucose levels and functional outcome in patients with acute ischemic stroke. METHODS: We analyzed 1446 consecutive patients with acute ischemic stroke. Serum glucose was measured on admission at the emergency department together with multiple other metabolic, clinical, and radiological parameters. National Institutes of Health Stroke Scale (NIHSS) score was recorded at 24 hours, and Rankin score was recorded at 3 and 12 months. The association between serum glucose and favorable outcome (Rankin score ≤2) was explored in univariate and multivariate analysis. The model was further analyzed in a robust regression model based on fractional polynomial (-2-2) functions. RESULTS: Serum glucose is independently correlated with functional outcome at 12 months (OR, 1.15; P=0.01). Other predictors of outcome include admission NIHSS score (OR, 1.18; P<0001), age (OR, 1.06; P<0.001), prestroke Rankin score (OR, 20.8; P=0.004), and leukoaraiosis (OR, 2.21; P=0.016). Using these factors in multiple logistic regression analysis, the area under the receiver-operator characteristic curve is 0.869. The association between serum glucose and Rankin score at 12 months is described by a J-shaped curve with a nadir of 5 mmol/L. Glucose values between 3.7 and 7.3 mmol/L are associated with favorable outcome. A similar curve was generated for the association of glucose and 24-hour NIHSS score, for which glucose values between 4.0 and 7.2 mmol/L are associated with a NIHSS score <7. Discussion-Both hypoglycemia and hyperglycemia are dangerous in acute ischemic stroke as shown by a J-shaped association between serum glucose and 24-hour and 12-month outcome. Initial serum glucose values between 3.7 and 7.3 mmol/L are associated with favorable outcome.

Structural, metamorphic and geochronological relations between the Zanskar Shear Zone and the Miyar Shear Zone (NW Indian Himalaya): Evidence for two distinct tectonic structures and implications for the evolution of the High Himalayan Crystalline of Zanskar

The geologic structures and metamorphic zonation of the northwestern Indian Himalaya contrast significantly with those in the central and eastern parts of the range, where the high-grade metamorphic rocks of the High Himalayan Crystalline (HHC) thrust southward over the weakly metamorphosed sediments of the Lesser Himalaya along the Main Central Thrust (MCT). Indeed, the hanging wall of the MCT in the NW Himalaya mainly consists of the greenschist facies metasediments of the Chamba zone, whereas HHC high-grade rocks are exposed more internally in the range as a large-scale dome called the Gianbul dome. This Gianbul dome is bounded by two oppositely directed shear zones, the NE-dipping Zanskar Shear Zone (ZSZ) on the northern flank and the SW-dipping Miyar Shear Zone (MSZ) on the southern limb. Current models for the emplacement of the HHC in NW India as a dome structure differ mainly in terms of the roles played by both the ZSZ and the MSZ during the tectonothermal evolution of the HHC. In both the channel flow model and wedge extrusion model, the ZSZ acts as a backstop normal fault along which the high-grade metamorphic rocks of the HHC of Zanskar are exhumed. In contrast, the recently proposed tectonic wedging model argues that the ZSZ and the MSZ correspond to one single detachment system that operates as a subhorizontal backthrust off of the MCT. Thus, the kinematic evolution of the two shear zones, the ZSZ and the MSZ, and their structural, metamorphic and chronological relations appear to be diagnostic features for discriminating the different models. In this paper, structural, metamorphic and geochronological data demonstrate that the MSZ and the ZSZ experienced two distinct kinematic evolutions. As such, the data presented in this paper rule out the hypothesis that the MSZ and the ZSZ constitute one single detachment system, as postulated by the tectonic wedging model. Structural, metamorphic and geochronological data are used to present an alternative tectonic model for the large-scale doming in the NW Indian Himalaya involving early NE-directed tectonics, weakness in the upper crust, reduced erosion at the orogenic front and rapid exhumation along both the ZSZ and the MSZ.

Optimization of the ink removal in deinking plant

Diplomityön tarkoituksena oli parantaa Stora Enso Sachsenin siistausprosessissa tuotetun uusiomassan vaaleuden kehitystä ja tutkia siihen vaikuttavia tekijöitä. Työn kirjallisessa osassa käsiteltiin uusiomassan kuidutusta ja vaahdotussiistausprosessia, sekä keräyspaperin ominaisuuksia ja käyttöä paperiteollisuuden raaka-aineena. Kokeellisessa osassa keskityttiin modifioidun natriumsilikaatin annostuksenoptimointiin ja vaikutuksiin laboratorio- ja prosessioloissa, sekä kesäefektin vaikutuksen tutkimiseen kuidutuksessa ja flotaation eri vaiheissa. Natriumsilikaatin laboratoriotutkimuksessa havaittiin, että korkein vaaleus suhteellisesti pienimmällä laboratorioflotaation häviöllä saavutettiin korkeimmalla tutkitulla natriumsilikaatin annostuksella, joka oli 1,1 %. Korkea natriumsilikaattiannostus yhdistettyinä korkeisiin vetyperoksidiannostukseen, 0,5 %, sekä korkeaan kokonaisalkaliteettiin, 0.33 %, johti korkeimpaan massan vaaleuteen ja pienimpiin häviöihin. Laboratoriotutkimuksen pohjalta modifioidulla natriumsilikaatilla suoritettiin koeajoja prosessissa. Noin 1 % natriumsilikaatin annostuksella havaittiin parempi pH:n bufferointikyky, pienempi kalsiumkarbonaatin määrä flotaation primäärivaiheissa, sekä lievästi parempi massan vaaleus verrattuna prosessissa aiemmin käytettyyn standardinatriumsilikaattiin. Kesäefektitutkimuksessa havaittiin, että kesäefektillä on suurin vaikutus esiflotaation primäärivaiheeseen, sillä primäärivaiheessa kuitujen osuus on huomattavasti suurempi kuin sekundäärivaiheissa. Esiflotaation primäärivaiheen uusiomassojen laboratorioflotaatioiden avulla saavutettujen maksimivaaleuksien ero kesän ja talven välillä oli noin 1,5 %ISO. Kesäefektin ei havaittu suuresti vaikuttavan flotaation sekundäärivaiheisiin.

Blood pressure levels and haematoma growth in patients with Intracerebral Haemorrhage (ICH) A retrospective observational study

Intracerebral haemorrhage (ICH) is a spontaneous extravasation of blood into brain parenchyma. Although ICH represents approximately only 15% of all strokes, it is one of the major causes of stroke-related death and disability. One of the causes of poor outcome is the haematoma growth. The association between elevated blood pressure (BP) and haematoma enlargement in acute ICH has not been clarified. Our objective is to try to identify this relationship that may suggest an immediate target for intervention to possibly improve outcomes in patients with spontaneous ICH and might settle the controversy surrounding the optimal management of blood pressure.We propose a retrospective revision using a sample present in our database of approximately 250 patients with primary ICH and less than 12h from symptoms onset. Systolic blood pressure levels (SBP) are assessed at baseline, at 6h, at 12h, at 24h and at 72h, being these last four the average levels of the different recordings during those time intervals. Haematoma growth will be defined as an increase in the volume of intraparenchymal haemorrhage of >33% as measured by image analysis on the 24-hour CT or 72-hour CT compared with the baseline CT scan. A qualified neuroradiologist not informed of the aim of the study, will review the CT images. The secondary objective will be to correlate the BP levels in the acute phase of ICH with clinical outcome. We will evaluate early neurologic deterioration at 72h by using the National Institutes of Health Stroke Scale (NIHSS); outcome at 90 days by using the modified Rankin scale and mortality at 72h and 90 days. The statistical analysis will be adjusted by possibly confounding variables

Virtuaalitekniikoiden ja riskianalyysin käyttö kivenmurskainten tuotekehityksessä

Tässä työssä keskitytään Metso Mineralsin valmistamien tuotteiden suunnitteluympäristöön ja erityisesti sen kehittämismahdollisuuksiin uusien teknologioiden avulla. Käyttövarmuuden parantamiseksi yksi potentiaalisimmista keinoista on parantaa laitteiden huollettavuutta. Tyypillisesti huollettavuuden verifiointi tapahtuu vasta prototyyppien testauksessa työmaaolosuhteissa, jolloin havaittujen ongelmien muuttaminen on hankalaa. Siksi huollettavuuteen tulisi kiinnittää enemmän huomiota jo tuotekehitysvaiheessa. Tässä työssä selvitetään virtuaalitekniikoiden tarjoamia mahdollisuuksia em. asioiden parantamiseksi. Työn toisena osakokonaisuutena tutkitaan riskianalyysien kehittämismahdollisuuksia. Tavoitteena on kehittää toimiva menetelmä riskianalyysin suorittamiseen virtuaaliprototyyppien avulla ja testata kaupallisten riskianalyysiin tarkoitettujen sovellusten käyttöä. Lopuksi tarkastellaan vielä uusien menetelmien integrointia osaksi tuotekehitysprosessia. Tehtyjen Case-tutkimusten perusteella havaittiin, että virtuaaliympäristöjen ja -tekniikoiden avulla saavutetaan hyötyä tuotekehityksen varhaisessa vaiheessa. Kyselytutkimuksesta saadun palautteen perusteella virtuaalitekniikoiden sovelluksille annettiin asteikolla 1–5 yleisarvosanaksi keskimäärin kolme. Virtuaalitekniikoiden ja riskianalyysien yhteiskäyttöä testattiin onnistuneesti, mutta tämä vaatii vielä kehittämistä.

Suomen satamissa käsiteltävät pakatut vaaralliset aineet ja esimerkkejä niiden vaaraominaisuuksista

Tämä raportti on tehty osana Kymenlaakson ammattikorkeakoulun hallinnoiman NELIn (North European Logistics Institute) esiselvitystä vaarallisten aineiden tunnistamisesta konttiliikenteessä. Tässä Turun yliopiston merenkulkualan koulutus- ja tutkimuskeskuksen Kotkassa toimivan Merenkulun logistiikan tutkimus -yksikön tekemässä selvityk-sessä on tutkittu kansallista satamaliikenteen PortNet-järjestelmää hyödyntäen, mitä pakattuina kuljetettavia vaarallisia aineita ja kuinka suuria määriä Suomen satamissa käsitellään. PortNet-analyysin tulosten pohjalta tutkimuksessa on selvitetty Suomen satamissa eniten käsiteltyjen, pakattuina kuljetettavien vaarallisten aineiden vaaraominaisuuksia sekä ihmisten että ympäristön kannalta. Tutkimuksessa tehdyn PortNet-analyysin perusteella pakattuja vaarallisia aineita käsiteltiin 16:ssa Suomen satamassa vuonna 2012. Käsiteltyjen aineiden kokonaismäärä oli noin 820 000 tonnia, josta viennin osuus oli 53 % ja tuonnin 47 %. Eniten kuljetettuja IMDG-luokkia olivat luokan 3 palavat nesteet (31 %:n osuus), luokan 9 muut vaaralliset aineet ja esineet (25 %) sekä luokan 8 syövyttävät aineet (23 %). Muiden luokkien osuus oli alle 10 %. Suomen satamissa käsiteltiin vuonna 2012 yhteensä noin 1 020 eri-laista, pakattua vaarallista ainetta. Yli 10 000 tonnia käsiteltyjä aineita oli yhteensä 16, 1 000–10 000 tonnia käsiteltyjä aineita 84, 100–1 000 tonnia käsiteltyjä aineita 148 ja alle 100 tonnia käsiteltyjä aineita noin 770. Eniten käsiteltyjä aineita olivat pääasiassa erilaiset aineyhdisteet ja tarkemmin määrittelemättömät aineet, kuten ympäristölle vaarallinen aine n.o.s, maalit, polymeeripelletit, hartsiliuos, kohotetussa lämpötilassa oleva neste n.o.s. ja nikkelimetallihybridiakut. Näitä kaikkia käsiteltiin Suomen satamissa yli 20 000 tonnia vuonna 2012. Varsinaisista yksittäisistä vaarallisista aineista eniten käsiteltyjä olivat muurahaishappo, vetyperoksidin vesiliuos, natriumkloraatti, ammoniumnitraatti, fenoli ja kloorietikkahappoliuos. Näitä kaikkia käsiteltiin yli 10 000 tonnia vuonna 2012. PortNet-analyysin tulosten pohjalta valittiin kymmenen ainetta, joiden vaaraominaisuuksia sekä ihmisten että ympäristön kannalta tarkasteltiin tarkemmin. Tarkasteluun valittiin, tieteellistä harkintaa käyttäen, eniten kuljetettavia vaarallisia yksittäisiä kemikaaleja. Tarkasteluun valitut kemikaalit olivat muurahaishappo, vetyperoksidi, natrium-kloraatti, kloorietikkahappo, fenoli, akryyliamidiliuos, ksyleenit, akryylinitriili, tolueeni ja epikloorihydriini. Tutkituista kemikaaleista ympäristölle haitallisimpia ovat fenoli, kloorietikkahappo ja akryyliamidiliuos. Ihmisen kannalta kaikki 10 tutkittua kemikaalia muodostavat onnettomuustilanteessa riskin ihmisten terveydelle joko syövyttävyytensä, reaktiivisuutensa tai myrkyllisyytensä vuoksi. Osa kemikaaleista voi aiheuttaa ihmisille myös kroonisia haittoja, kuten kohonnutta syöpäriskiä tai muutoksia perimässä, joko suurina kerta-annoksina tai pieninä toistuvina pitoisuuksina. Suomen satamissa käsiteltävien pakattujen kemikaalien erilaisuus ja suuri lukumäärä tekevät niistä vaikeasti hallittavissa olevan riskitekijän. Yleisesti ottaen voidaan sanoa, että pakatuista kemikaaleista aiheutuu pienehköissä vuototilanteissa suurempi uhka ihmisen terveydelle kuin ympäristölle, kun taas irtolastikuljetuksissa tapahtuvien onnettomuuksien yhteydessä vuotaneen aineen määrä on yleensä suurempi ja näin ollen myös ympäristölle koituva uhka voi olla suuri.

Sleep habits and complaints of adults in the city of São Paulo, Brazil, in 1987 and 1995

This study compares the prevalence of complaints of insomnia, excessive diurnal sleepiness, parasomnias, and sleep habits of the adult population in the city of São Paulo, Brazil, estimated in surveys carried out in 1987 and 1995. Representative samples of 1000 adult residents per survey were interviewed using a validated structured sleep questionnaire, the "UNIFESP Sleep Questionnaire". Difficulty maintaining sleep, difficulty initiating sleep and early morning awakening, occurring at least three times a week, were reported in 1987 and 1995, by 15.8/27.6, 13.9/19.1, and 10.6/14.2% of the interviewees, respectively, significantly increasing throughout time. These sleep problems were more often found among women. Frequencies of excessive diurnal sleepiness and sleep attacks were unchanged comparing 1987 with 1995 (4.5 vs 3.8 and 3.1 vs 3.0%, respectively). Parasomnia complaints remained unchanged, with the exception of leg cramps, which doubled in prevalence from 1987 to 1995 (2.6 to 5.8%). Snoring was the most common parasomnia (21.5% in 1995), reported more often by men than by women, and somnambulism was the least common (approximately 1%). Besides sleeping slightly less, interviewees went to bed and woke up later in 1995. Approximately 12% of the subjects in both surveys had consulted a physician due to sleep problems and 3.0% reported habitual use of sleep-promoting substances in 1995. Overall, there was a significant increase in insomnia complaints from 1987 to 1995 in the general population of the city of São Paulo. This major change over a little under a decade should be considered as an important public health issue.