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Emphysema Findings Associated with Heavy Asbestos-Exposure in High ResolutionComputed Tomography of Finnish Construction Workers: Olli HUUSKONEN, et al. Finnish Institute of Occupational Health, Helsinki, Finland-Asbestos fibers are known to cause lung fibrosis, but their role in emphysema is unclear. We wanted to evaluate the relationship between asbestos exposure and emphysema by using high-resolution computed tomography (HRCT). Conventional and high resolution CT was performed on 600 smoking construction workers with an asbestos-related occupational disease. Emphysema subtypes (centrilobular, paraseptal, panlobular emphysema and bullae) were separately scored on a semiquantitative scale from 0 to 5, which scores were added up to yield the total emphysema score. Occupation, exposure duration, age, pack years and asbestosis diagnosis were analyzed in general linear models for possible associations with emphysema. The inter-(quadratic weighted kappa, κ qw =0.46-0.72) and intraobserver (κ qw =0.78-0.94) agreements for the subtype-scores and the reliability of the total score (Cronbach's alpha=0.87) were good. Insulators had a significantly higher paraseptal, panlobular and total score than the other occupational groups when adjusted for age and smoking. An asbestosis diagnosis was also a significant independent predictor of a higher total score. Emphysema was more common when workers had asbestosis or were heavily exposed to asbestos (insulators), but due to confounding factors the causative role of asbestos in emphysema needs further study.

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BackgroundAlthough there is a major need to record and analyse presenting complaints in emergency departments (EDs), no international standard exists. The aim of the present study was to produce structured complaint classification suitable for ED use and to implement it in practice. The structured classification evolved from a study of free text fields and ICPC-2 classification.MethodsPresenting complaints in a free text field of ED admissions during a one-year period (n=40610) were analyzed and summarized to 70 presenting complaint groups. The results were compared to ICPC-2 based complaints collected in another ED. An expert panel reviewed the results and produced an ED application of ICPC-2 classification. This study implemented the new classification into an ED.ResultsThe presenting complaints summarized from free text fields and those from ICPC-2 categories were remarkably similar. However, the ICPC-2 classification was too broad for ED; an adapted version was needed. The newly developed classification includes 89 presenting complaints and ED staff found it easy to use.ConclusionsICPC-2 classification can be adapted for ED use. The authors suggest a list of 89 presenting complaints for use in EDs adult patients.