Biomedical subjects
Publications and source records attributed to S Aarseth.
Reports from the local hospital to the patient's own general practitioner were registered in 1993. The average time from when the patient left hospital to when the report was received was 19 days for in-patients and 12 days for out-patients. The author discusses the reasons for the delay.
66% of the hospital doctors at the Central Hospital, Akershus and Ullevål Hospital responded to a questionnaire concerning different aspects of a doctor's work situation and health. The investigation revealed a large work load and lack of consulting rooms and equipment. Violence, threats, abusive language, risk of infection, high temperatures, cytostatic drugs, narcosic gases, irradiation are all risk factors during daily work for a large percentage of the doctors. Even so, they seem to be fairly satisfied with the organization of the work, and nearly all of them enjoy their work.
We used a questionnaire to study the working situation of physicians in two large Norwegian hospitals. During the last six months 40% of the doctors reported one or more episodes of exposure to blood when transfer of infectious agents such as hepatitis B-virus or HIV would have been possible. The fact that so many doctors had been exposed to blood conflicts with the low number reported to the hospital department of the occupational health service. Surprisingly, 40% of the physicians who reported exposure were physicians not taking part in surgical procedures. All hospitals should establish follow-up procedures for employees exposed to blood or other possible infectious agents, and physicians should be urged to follow these routines.
Sentralsykehuset i Akershus is a county hospital serving a population of approximately 400,000 citizens. In 1984 a survey on smoking among the employees disclosed that 72% wanted a smoke-free working environment. According to an accepted three-year strategy the goal was a totally smoke-free hospital in 1990. This goal was not accomplished, and in 1990 a new survey (83% responders) indicated that among the 27% daily smokers only 49% were loyal to the non-smoking regulations. 76% however, wanted a smoke-free working environment. A large majority found it unrealistic to achieve a totally smoke-free hospital, and 70% wanted smoking areas for patients as well as for employees. The lack of success in achieving a totally smoke-free hospital has been analyzed. Important measures include better motivation, a well planned motivation process and various smoking cessation activities. Even more important are attitudes among leaders at different levels. They should identify with the goal "smoke-free hospital" on behalf of the hospital administration.
In 1983 doctors engaged in primary health care recorded all accidents leading to contact with a doctor. It was found that 9.1% of the total population consulted a doctor because of an accident. Of this percentage, 80.6% were treated by the local doctor, 13.7% were treated as outpatients at the local hospital, and 5.7% were admitted to hospital. The mean cost of the accidents was estimated to be NOK 1,901 (in 1983 prices, or NOK 2,841 in 1990 prices). 51% of the costs referred to sick pay, and 29% to hospital costs. Accidents at work accounted for 39% of the costs, traffic accidents 24% and accidents in the home 27%. We conclude that accidents in the home, and at school, and injuries from sports, are fields where accident prevention campaigns should be started as part of primary health care.
During the period from 1986 to 1989 a study was carried out to determine the risk of occupational exposure to hepatitis B virus and human immunodeficiency virus among approximately 5,500 employees at Aker hospital, Ullevål hospital and "Sentralsykehuset" in Akershus. Four hundred and fourteen injuries were reported during the study period of approximately 16,800 man-years, corresponding to an injury rate of 2.4/100 man-years. The majority of injuries occurred during direct patient contact in the wards. Of the known sources 8.2% were HBsAg positive and 16.8% HIV-antibody positive. One attendant contracted hepatitis B during the observation period. No HIV-seroconversion has been observed as yet.
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It is well known that the urinary excretion of oxalic acid is one of the main determinants for urinary stone formation. From 1950 to 1978 a saturated oxalic acid solution was used in a repainting and cleaning process for railroad cars in Norwegian railroad workshops. With the use of a questionnaire, the cumulative prevalence of urolithiasis-induced colic episodes was registered in the Sundland railroad depot. Forty-two (11.9%) out of 353 male workers not exposed to oxalic acid reported having had one or more such stone colic episodes. The corresponding figure for 15 individuals who had a very high exposure to oxalic acid was 8 (53.3%). Also workers in other departments, occasionally exposed to oxalic acid, had an increased stone colic prevalence rate, a finding suggesting a positive dose-response relationship. There was an increased frequency of stone colic episodes in the age group 40-69 years. Seven heavily exposed workers in the paint shop reported initial pollakiuria and slight dysuria during the exposure. The study indicates a causal relation between urinary stone formation in the investigated railroad shopmen and their exposure to oxalic acid at work.
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The bile duct was ligated in rats, and their tolerance against a small blood loss was evaluated 7 days later. A 10% blood loss precipitated a large and sometimes fatal reduction in arterial blood pressure, while no reduction was seen in shamoperated rats. The plasma and erythrocytes were labelled by isotopes and the animals were rapidly frozen in liquid nitrogen. The splanchnic and pulmonary blood volumes were estimated from the isotope content in blood and tissue. These vascular beds will normally reduce their blood volumes during a blood loss and thus serve as vascular depots. In the bile duct occluded animals, the partition of blood is changed. More blood is to be found in the splanchnic vessels, and the depot function of the lung vessels is partly used for compensation. When these rats were bled, their liver blood volumes were not reduced, and only a small further reduction took place in the lung vessels. It is concluded that rats with bile duct occlusion will suffer considerably from small blood losses. This may be due to a lacking depot function of the splanchnic vessels.
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A method involving isotope labelling of blood components and then rapid freezing of intact rats, was used for evaluation of the blood content in liver, spleen and gastrointestinal (GI) tract in cholestatic animals. For comparison also another important blood depot, i.e. the lungs were examined. After 4 days of cholestasis the animals were hypovolemic, however, the partition of blood in the liver and GI tract was unchanged or even increased. In contrast the lung blood volume and the erythrocyte content of the spleen were markedly reduced. Three days later the animals had regained their normal blood volume, but still there was a redistribution of blood from the lungs and spleen to the liver and GI tract. We suggest that during cholestasis the depot function of the splanchnic vessels is disturbed. This might be one factor of importance for development of the hepatorenal syndrome.
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