Survival of patients with alcohol use disorders discharged from an emergency department: a population-based cohort study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.The aim was to study the cause-specific mortality of users of the emergency department (ED) who received a diagnosis of alcohol use disorder (AUD) in comparison with mortality of other users of the department.A population-based prospective cohort study.All patients aged 18 years and above who were subsequently discharged home from the ED during the years 2002-2008. A total of 107,237 patients were followed by record linkage to a nationwide cause-of-death registry: 1210 patients with AUD as the main discharge diagnosis and 106,027 patients in the comparison group. HR and 95% CIs were calculated.ED at Landspitali-the National University Hospital of Iceland, Reykjavik, Iceland. The hospital offers tertiary care and is the number one trauma centre and community hospital for the greater Reykjavik area. According to the population registry, 78% of the inhabitants of the area attended the ED during the study period.72 patients died in the AUD group and 4807 in the comparison group. The adjusted HR for all causes of death was 1.91 (95% CI 1.51 to 2.42). The HR for AUDs was 47.68 (95% CI 11.56 to 196.59) while for alcohol liver disease the HR was 19.06 (95% CI 6.07 to 59.87). The HR was also elevated for diseases of the circulatory system: HR 2.52 (95% CI 1.73 to 3.68); accidental poisoning: HR=13.64, (95% CI 3.98 to 46.73); suicide: HR=2.72 (95% CI 1.08 to 6.83); and event of undetermined intent: HR=10.89 (95% CI 4.53 to 26.16).AUD as the discharge diagnosis at the ED, among patients who were not admitted to a hospital ward but discharged home, predicts increased mortality. As the results conclusively show the vulnerability of these patients, one can question whether their needs are adequately met at the ED.Landspitali—the National University Hospital Research Fund, Icelandic Nurse’s Association Research Fund/311055-2249; e University of Iceland Research Fund/1238-123368

A review of wastewater handling in the Arctic with special reference to Pharmaceuticals and Personal Care Products (PPCPs) and microbial pollution

Treatment of wastewater is often inadequate or completely lacking in Arctic regions. Wastewater contains different kinds of substances that can be harmful for the environment and human health, including residues of pharmaceuticals and personal care products. Bioaccumulation and biomagnifications of chemicals in the food web are of concern. This can affect fishery that is a significant industry in many Arctic coastal regions. Wastewater from human settlements may also contain antibiotic resistant bacteria and pathogens that can cause negative impacts on human health and the environment. In the Arctic, especially, the direct release of untreated sewage may have severe consequences for the receiving environment due to low biological diversity, low ambient temperatures and consequently high vulnerability of the Arctic ecosystem to environmental contaminants. Bucket toilets are common in remote settlements but are also used in towns. In settlements having inadequate sanitary facilities the risk of contracting diseases, such as hepatitis A, is unacceptably high. Conventional centralized wastewater collection systems and treatment plants are a challenge to build in the Arctic and expensive to operate. Thus alternative methods are needed. Possible solutions are improved dry or low flush toilets with collection of toilet waste at the household level and subsequent centralized treatment by dry composting or anaerobic digestion. Both treatment methods facilitate co-treatment of wastewater along with other organic waste fractions and provide a by-product that is environmentally safe and easy to handle. Combining the above with decentralized greywater treatment will reduce the costs for expensive infrastructure