Estimation of TETRA radio use in the Airwave Health Monitoring Study of the British police forces.

BACKGROUND: The Airwave Health Monitoring Study aims to investigate the possible long-term health effects of Terrestrial Trunked Radio (TETRA) use among the police forces in Great Britain. Here, we investigate whether objective data from the network operator could be used to correct for misreporting in self-reported data and expand the radio usage availability in our cohort. METHODS: We estimated average monthly usage of personal radio in the 12 months prior to enrolment from a missing value imputation model and evaluated its performance against objective and self-reported data. Factors associated with TETRA radio usage variables were investigated using Chi-square tests and analysis of variance. RESULTS: The imputed data were better correlated with objective than self-reported usage (Spearman correlation coefficient = 0.72 vs. 0. 52 and kappa 0.56 [95% confidence interval 0.55, 0.56] vs. 0.46 [0.45, 0.47]), although the imputation model tended to under-estimate use for higher users. Participants with higher personal radio usage were more likely to be younger, men vs. women and officer vs. staff. The median average monthly usage level for the entire cohort was estimated to be 29.3 min (95% CI: [7.2, 66.6]). CONCLUSION: The availability of objective personal radio records for a large proportion of users allowed us to develop a robust imputation model and hence obtain personal radio usage estimates for ~50,000 participants. This substantially reduced exposure misclassification compared to using self-reported data and will allow us to carry out analyses of TETRA usage for the entire cohort in future work

Case completeness in the Norwegian Cardiac Arrest Registry

Introduction This study aimed to assess the case completeness of out-of-hospital cardiac arrests (OHCA) in the Norwegian Cardiac Arrest Registry (NorCAR) and describe the differences between the registered and missing patients identified from the case-control assessment. Methods We identified the relevant patients in the Norwegian Patient Registry and the Norwegian Cause of Death Registry and compared them with the patients in NorCAR. Data processors used patient records to confirm if the potential cardiac arrest cases met the inclusion criteria in NorCAR. Results Between 2015 and 2017, 8612 OHCA patients were registered in NorCAR. Through the Patient Registry and the Cause of Death Registry we identified 11,114 potential OHCA patients, 3469 of these were already registered in NorCAR. After evaluating the patient records for the remaining 7645 patients, we found 344 patients (4%), were eligible for inclusion in NorCAR, giving a case completeness of 96%. The registered and missing patients were similar in age and gender distribution. Initial shockable rhythm and presumed cause were also comparable. However, the missing patients more frequently achieved return of spontaneous circulation, were more often transported to hospital, and had higher survival rates. The already registered patients had more key variables registered than the missing patients. Conclusion Our results indicate high case completeness in NorCAR. The missing patients were too few to introduce significant changes in the distribution of patient characteristics, indicating that NorCAR is representative of the Norwegian OHCA population

Transthoracic Impedance Measured with Defibrillator Pads-New Interpretations of Signal Change Induced by Ventilations

Compressions during the insufflation phase of ventilations may cause severe pulmonary injury during cardiopulmonary resuscitation (CPR). Transthoracic impedance (TTI) could be used to evaluate how chest compressions are aligned with ventilations if the insufflation phase could be identified in the TTI waveform without chest compression artifacts. Therefore, the aim of this study was to determine whether and how the insufflation phase could be precisely identified during TTI. We synchronously measured TTI and airway pressure (Paw) in 21 consenting anaesthetised patients, TTI through the defibrillator pads and Paw by connecting the monitor-defibrillator’s pressure-line to the endotracheal tube filter. Volume control mode with seventeen different settings were used (5–10 ventilations/setting): Six volumes (150–800 mL) with 12 min−1 frequency, four frequencies (10, 12, 22 and 30 min−1) with 400 mL volume, and seven inspiratory times (0.5–3.5 s ) with 400 mL/10 min−1 volume/frequency. Median time differences (quartile range) between timing of expiration onset in the Paw-line (PawEO) and the TTI peak and TTI maximum downslope were measured. TTI peak and PawEO time difference was 579 (432–723) m s for 12 min−1, independent of volume, with a negative relation to frequency, and it increased linearly with inspiratory time (slope 0.47, R 2 = 0.72). PawEO and TTI maximum downslope time difference was between −69 and 84 m s for any ventilation setting (time aligned). It was independent ( R 2 < 0.01) of volume, frequency and inspiratory time, with global median values of −47 (−153–65) m s , −40 (−168–68) m s and 20 (−93–128) m s , for varying volume, frequency and inspiratory time, respectively. The TTI peak is not aligned with the start of exhalation, but the TTI maximum downslope is. This knowledge could help with identifying the ideal ventilation pattern during CPR

Kartlegging av den akuttmedisinske kjeden

Denne rapporten er utført på bestilling fra Helsedirektoratet, og er et samarbeidsprosjekt mellom NAKOS og NKLM. Bestillingen var en såkalt trendanalyse av den akuttmedisinske kjeden: ambulansetjenesten, AMK-sentralene, akuttmottakene, legevaktene og legevaktsentralene. Det er aldri før blitt laget en oversikt over en samlet status av de akuttmedisinske tjenestene. Denne rapporten er derfor i første omgang en kartlegging av den akuttmedisinske kjeden. Ved gjentagelse av datainnsamling vil en kunne etablere en trendanalyse. Rapporten bygger på data samlet inn gjennom en elektronisk spørreundersøkelse som ble sendt ut til ledere i ambulansetjenesten, AMK-sentraler, akuttmottak, legevakter og legevaktsentraler. I tillegg brukes statistikk fra Statistisk sentralbyrå (SSB) og Norsk pasientregister (NPR). Hovedtemaene for spørsmålene dreide seg om organisering, rekruttering, kompetanse og veiledere. Akuttmedisinforskriften er brukt som et utgangspunkt for flere av spørsmålene. Hovedpunkter fra resultatene: • For ambulansetjenesten og AMK-sentralene er det en økning i oppdrag og henvendelser ifølge tall fra SSB. For akuttmottak og legevakter etterlyses en bedret felles registrering av aktivitetsdata. • Oppfatningen blant majoriteten av ambulanseavdelingene var at det ikke var blitt noen økning i bemanning og ressurser i deres avdeling til tross for økning i oppdragsmengde • Ved spørsmål til ledere i ambulansetjenesten om responstid på røde/akutte oppdrag dreide mange kommentarer seg om at andre akuttmedisinske ressurser som legevaktlege og akutthjelpere bør registreres. • Samtlige ambulanseavdelinger og AMK-sentraler oppga å ha akutthjelpere i sitt distrikt. For legevaktene oppga 37 % å ha akutthjelpere i en eller flere av kommunene. Kommunalt brannvesen var hyppigst benyttet blant alle tjenester som akutthjelper. • 56 % av legevaktene og 25 % av AMK-sentralene oppga at legevaktene alltid eller oftest rykker ut på røde/akutte oppdrag på lege/ambulansealarm. Det var samsvar mellom legevakter og AMK-sentraler på hvilke regioner der legevaktlege hyppigst rykker ut ved lege/ambulansealarm. • RETTS/METTS er det mest brukte triageverktøyet i ambulansetjenesten og akuttmottak, mens MTS er mest brukt ved legevaktene. • Ambulansetjenesten opplevde å ha tilgang på best kvalifiserte søkere. Én av ti legevakter oppga å ha vansker med rekruttering, det samme gjorde én av ti akuttmottak. For AMK-sentralene var dette tallet noe høyere. • Legevaktene var den tjenesten med flest registrerte vold- og trusselhendelser i 2017. Ambulanseavdelingene var tjenesten med høyest andel avdelinger som hadde registrert vold- og trusselhendelser. • Vi fant ingen sammenheng mellom samarbeidsavtaler inngått mellom kommuner og helseforetak, og deltagelse i felles akuttmedisinsk trening. Det samme gjelder for omforente beredskapsplaner og deltagelse på beredskapsøvelser med samarbeidspartnere

Personal radio use and cancer risks among 48,158 British police officers and staff from the Airwave Health Monitoring Study

Background Radiofrequency electromagnetic fields (RF-EMF) from mobile phones have been classified as potentially carcinogenic. No study has investigated use of Terrestrial Trunked Radio (TETRA), a source of RF-EMF with wide occupational use, and cancer risks. Methods We investigated association of monthly personal radio use and risk of cancer using Cox proportional hazards regression among 48,518 police officers and staff of the Airwave Health Monitoring Study in Great Britain. Results During median follow-up of 5.9 years, 716 incident cancer cases were identified. Among users, the median of the average monthly duration of use in the year prior to enrolment was 30.5  min (inter-quartile range 8.1, 68.1). Overall, there was no association between personal radio use and risk of all cancers (hazard ratio [HR] = 0.98, 95% confidence interval [CI]: 0.93, 1.03). For head and neck cancers HR = 0.72 (95% CI: 0.30, 1.70) among personal radio users vs non-users, and among users it was 1.06 (95% CI: 0.91, 1.23) per doubling of minutes of personal radio use. Conclusions With the limited follow-up to date, we found no evidence of association of personal radio use with cancer risk. Continued follow-up of the cohort is warranted