Acute intoxications among humans and animals. National Poisons Information Centre. Annual Report, 2005-2006

Het Nationaal Vergiftigingen Informatie Centrum (NVIC) ontving in 2005 36.375 en in 2006 37.088 informatieverzoeken over acute intoxicaties van mensen en dieren. Deze informatievragen betroffen circa 50.000 blootstellingen aan lichaamsvreemde stoffen per jaar. Ruim de helft van deze intoxicaties betrof overdoseringen met geneesmiddelen. Het aantal vergiftigingen met pijnstillers die zonder recept verkrijgbaar zijn, zoals paracetamol en ibuprofen, is in 2005 en 2006 weer toegenomen. Daarnaast is bij volwassenen het aantal meldingen over melatonine de afgelopen jaren sterk gestegen, van 3 in 2001 naar 76 in 2006. Een relatief nieuw verschijnsel waar het NVIC in 2006 over geraadpleegd werd, waren de zogenaamde crofty-bommen: doe-het-zelfbommen gemaakt met gootsteenontstopper. Bij ontploffing van crofty-bommen en aanraking met de vloeistof, kunnen ernstige chemische letsels ontstaan aan huid en ogen. Het aantal meldingen over drugs is voor het eerst in jaren afgenomen, van 1.383 in 2005 naar 1.146 in 2006. Het aantal meldingen over amfetamine-intoxicaties is sinds 2005 echter sterk gestegen, van 31 in 2004 naar 114 in 2005 en 97 in 2006. Het aantal vergiftigingen met efedra is na 2004 met 57% afgenomen. De wetswijziging in 2004, waardoor efedra-bevattende producten uitsluitend nog als geneesmiddel mogen worden verhandeld, is hier mogelijk de oorzaak van. Nadat in november 2006 Alexander Litvinenko in Londen werd vergiftigd met radioactief polonium-210, heeft het Rijksinstituut voor Volksgezondheid en Milieu (RIVM) urinemonsters geanalyseerd van 11 mogelijk blootgestelde Nederlanders. Het NVIC heeft daarbij een actieve rol gespeeld in de opsporing van de betreffende Nederlanders en de medische beoordeling van de resultaten. Het persbericht over het RIVM onderzoek heeft veel media-aandacht getrokken, waardoor het NVIC 73 maal is geconsulteerd over het poloniumincident.In 2005 the National Poisons Information Centre (NVIC) received 36,375 enquiries and in 2006, 37,088, all on acute intoxications of humans and animals. These enquiries concerned about 50,000 exposures to chemical substances per year. More than half of these intoxications were due to a medication overdose. The number of intoxications due to over-the-counter painkillers, such as paracetamol and ibuprofen, increased again in 2005 and in 2006. In addition, the number of consultations on melatonin exposure in adults increased sharply the last few years, from 3 in 2001 to 76 in 2006. A relatively new phenomenon calling for NVIC consultation in 2006 were the so-called crofty bombs (do-it-yourself bombs made from caustic soda). Explosion of a crofty bomb and contact with the liquid can result in serious chemical injuries to skin and eyes. For the first time in years, the number of consultations on drugs decreased, from 1,383 in 2005 to 1,146 in 2006. However, the number of enquiries about intoxications with amphetamines increased sharply compared to 2004, from 31 in 2004 to 114 in 2005 and 97 in 2006. After 2004, the number of intoxications with ephedra decreased by 57%. The amendment of the law in 2004, stating that ephedra-containing products could, with immediate effect, only be marketed as medicinal products, may have induced this decrease. Following the poisoning of Alexander Litvinenko in London with radioactive polonium-210 in November 2006, the National Institute for Public Health and the Environment (RIVM) analysed urine samples from 11 Dutch citizens who had possibly been exposed. The NVIC played an active role here in tracing the people concerned and in the medical evaluation of the results. The press release on the RIVM study attracted considerable attention from the media, resulting in 73 enquiries to the NVIC for information on the polonium incident.Directie Publieke Gezondhei

Abnormal vaginal bleeding in women of reproductive age: a descriptive study of initial management in general practice

<p>Abstract</p> <p>Background</p> <p>Abnormal vaginal bleeding (AVB) in women of reproductive age is a common reason for consulting a general practitioner. Nevertheless, how general practitioners (GPs) choose to initially manage AVB is largely unknown, as is the prevalence of underlying pathology of AVB in primary care.</p> <p>Methods</p> <p>To investigate the initial diagnostic procedures and treatment for AVB used in general practice, we performed a descriptive study based on computerised medical records. New consultations for AVB in 2000 and 2001 were selected. Patient characteristics, diagnostic procedures and treatment were analysed.</p> <p>Results</p> <p>In total, 270 new consultations were included. The majority of patients (75%) consulted the GP for AVB only once. GPs performed diagnostic procedures in 54% of all consultations. Overall, additional diagnostic procedures revealed abnormalities in 11% of women. However, the diagnostic procedures implemented by the GPs varied widely per bleeding type and contraceptive use. Anaemia was found in 36% of 45 women tested. Uterine fibroids were found in 41% of 27 women examined by ultrasound. Medication was prescribed in 34% of all consultations. A gynaecological referral was registered in 4% of all contacts.</p> <p>Conclusion</p> <p>Initially, GPs tend to follow a policy of expectant management in women of reproductive age with AVB. However, when additional diagnostic procedures were performed, anaemia and uterine fibroids were found in a considerable number of women.</p

Evaluation of instructions in patient information leaflets for the use of intranasal corticosteroid sprays: an observational study

OBJECTIVES: In this study, we analysed patient information leaflets (PILs) of intranasal corticosteroid sprays (INCS) of different manufacturers in the UK to determine if instructions for the use of INCS are complete and uniform. SETTING: PILs of all INCS of all manufacturers, available for patients in the UK, were collected from the British National Formulary website and the Medicines and Healthcare products Regulatory Agency website. All instructions in these PILs were analysed. PARTICIPANTS: We identified PILs of INCS from 21 different manufacturers, available for patients in the UK. RESULTS: We analysed the instructions for the use of INCS in 21 different PILs and there is large variation in the PIL instructions for the technique of using INCS across PILs. CONCLUSION: Complete and uniform instructions for the use of INCS are lacking in PILs for registered preparations in the UK. Structured and standardised instructions to be used by both professionals and patients are essential in order to optimise daily use of INCS

Effect of dexamethasone on quality of life in children with acute lymphoblastic leukaemia: a prospective observational study

<p>Abstract</p> <p>Background</p> <p>Glucocorticoids are important in the treatment of childhood acute lymphoblastic leukaemia (ALL). However, cyclic administration of high dose glucocorticoids may cause rapid and substantial changes in quality of life (QoL). The maintenance phase of the Dutch ALL-9 protocol consisted of alternating two weeks on and five weeks off dexamethasone (6 mg/m²/day). The present study was performed to assess the effect of dexamethasone on QoL during treatment for ALL according to this protocol.</p> <p>Methods</p> <p>In a multicentre prospective cohort study, QoL was assessed halfway (T1) and at the end of the two-year treatment (T2). A generic (Child Health Questionnaire) and disease specific (PedsQL™ cancer version) QoL questionnaire were used to assess QoL in two periods: on and off dexamethasone, respectively.</p> <p>Results</p> <p>41 children (56% males) were evaluated, mean age at diagnosis was 5.6 years. The CHQ physical and psychosocial summary scores were significantly lower than population norms. At T1 and T2, overall QoL showed no significant change. However, regarding specific domains (pain, cognitive functioning, emotion/behaviour and physical functioning) QoL decreased over time. QoL was significantly more impaired during periods on dexamethasone.</p> <p>Conclusion</p> <p>Dexamethasone was associated with decreased QoL. At the end of treatment, reported QoL during dexamethasone deteriorated even more on certain scales (pain, cognitive functioning, emotion/behaviour and physical functioning). Knowledge of the specific aspects of QoL is essential to improve counselling and coping in paediatric oncology. Adverse effects of specific drugs on QoL should be taken into account when designing treatment protocols.</p

European Respiratory Society International Congress 2018: four shades of epidemiology and tobacco control

In this article, early career members and experienced members of the Epidemiology and Environment Assembly of the European Respiratory Society highlight and summarise a selection of six sessions from the Society’s annual congress, which in 2018 was held in Paris, France. The topics covered in these sessions span from cutting-edge molecular epidemiology of lung function to clinical, occupational and environmental epidemiology of respiratory disease, and from emergent tobacco products to tobacco control

FOXO transcription factor activation by oxidative stress mediated by the small GTPase Ral and JNK

Forkhead transcription factors of the FOXO class are negatively regulated by PKB/c-Akt in response to insulin/IGF signalling, and are involved in regulating cell cycle progression and cell death. Here we show that, in contrast to insulin signalling, low levels of oxidative stress generated by treatment with H 2 O 2 induce the activation of FOXO4. Upon treatment of cells with H 2 O 2 , the small GTPase Ral is activated and this results in a JNK-dependent phosphorylation of FOXO4 on threonine 447 and threonine 451. This Ral-mediated, JNK-dependent phosphorylation is involved in the nuclear translocation and transcriptional activation of FOXO4 after H 2 O 2 treatment. In addition, we show that this signalling pathway is also employed by tumor necrosis factor a to activate FOXO4 transcriptional activity. FOXO members have been implicated in cellular protection against oxidative stress via the transcriptional regulation of manganese superoxide dismutase and catalase gene expression. The results reported here, therefore, outline a homeostasis mechanism for sustaining cellular reactive oxygen species that is controlled by signalling pathways that can convey both negative (PI-3K/PKB) and positive (Ras/Ral) inputs

Epigenome-wide association study (EWAS) on lipids: the Rotterdam Study

Background DNA methylation is a key epigenetic mechanism that is suggested to be associated with blood lipid levels. We aimed to identify CpG sites at which DNA methylation levels are associated with blood levels of triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and total cholesterol in 725 participants of the Rotterdam Study, a population-based cohort study. Subsequently, we sought replication in a non-overlapping set of 760 participants. Results Genome-wide methylation levels were measured in whole blood using the Illumina Methylation 450 array. Associations between lipid levels and DNA methylation beta values were examined using linear mixed-effect models. All models were adjusted for sex, age, smoking, white blood cell proportions, array number, and position on array. A Bonferroni-corrected p value lower than 1.08 × 10−7 was considered statistically significant. Five CpG sites annotated to genes including DHCR24, CPT1A, ABCG1, and SREBF1 were identified and replicated. Four CpG sites were associated with triglycerides, including CpG sites annotated to CPT1A (cg00574958 and cg17058475), ABCG1 (cg06500161), and SREBF1 (cg11024682). Two CpG sites were associated with HDL-C, including ABCG1 (cg06500161) and DHCR24 (cg17901584). No significant associations were observed with LDL-C or total cholesterol. Conclusions We report an association of HDL-C levels with methylation of a CpG site near DHCR24, a protein-coding gene involved in cholesterol biosynthesis, which has previously been reported to be associated with other metabolic traits. Furthermore, we confirmed previously reported associations of methylation of CpG sites within CPT1A, ABCG1, and SREBF1 and lipids. These results provide insight in the mechanisms that are involved in lipid metabolism

Student midwives' perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study

BACKGROUND: A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives' perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care. METHODS: This qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed. RESULTS: Students felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care. CONCLUSIONS: Final year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth. The graduating midwives are motivated to undertake an expanded intrapartum skill set. It can be important to involve students' views in the discussion, because they are the future maternity care providers. (aut. ref.

The proper name as starting point for basic reading skills

Does alphabetic-phonetic writing start with the proper name and how does the name affect reading and writing skills? Sixty 4- to 5½-year-old children from middle SES families with Dutch as their first language wrote their proper name and named letters. For each child we created unique sets of words with and without the child’s first letter of the name to test spelling skills and phonemic sensitivity. Name writing correlated with children’s knowledge of the first letter of the name and phonemic sensitivity for the sound of the first letter of the name. Hierarchical regression analysis makes plausible that both knowledge of the first letter’s name and phonemic sensitivity for this letter explain why name writing results in phonetic spelling with the name letter. Practical implications of the findings are discussed