Injury in Ireland

Injury mortality is the fourth commonest cause of death in Ireland. The treatment of injuries has a major impact on our hospitals and on our budget for health. Long term disability following accidents is a serious problem. The aim of this report is to examine the impact of accidents and injuries on the Irish population by analysing routine mortality and morbidity data, and to identify in turn those areas where preventive measures could have an impact. In Section One the literature review details the advantages and disadvantages of each type of routine data source used in this report. The interpretation of data should take account of the constraints of the available data collected. The usefulness of routine data collection is highlighted, while identifying areas for improvement. In Section Two the methodology employed in the study is detailed. In Section Three data on hospital admissions over a five-year period 1993-1997 are presented. An overview of injury admissions is presented, followed by further analysis of injury data by both cause and by age group. In Section Four data on all accident-related deaths over a 17-year period, 1980-1996, are presented, with overall mortality data and mortality data by age group and by major causes of injury death detailed. In Section Five comparisons are made between the eight health board regions for rates of admissions and deaths due to injury. In presenting the data we use a matrix format devised and recommended by the International Collaborative Effort on Injury Statistics to display injury simultaneously by cause and intent. The use of a common format will also facilitate regional and international comparisons. In Section Six the priority recommendations for injury prevention are outlined. The key findings are then discussed and further recommendations are presented with the aim of injury prevention, reduction of disability and improvement in injury surveillance

The Effect of Pulping Upon the Dimensions of Wood Tracheids

The dimensions of the fibres in oven-dry blocks of wood from three species (white spruce, Douglas-fir, and larch) were deduced from measurements of bulk density and the number of fibres per unit cross-sectional area. The blocks were then cooked by the soda process to various yields, and the fibre dimensions were redetermined after the blocks had been washed and oven-dried.The weight of the fibres per unit length decreased almost in proportion to the yield loss, being reduced at 40% yield to 42% of its value in wood. This finding indicates that the fibres were shortened to only a small extent by pulping (ca. 4% at 40% yield) and that the major changes were in the transverse dimensions of the fibres. At 40% yield, cell-wall thickness and fibre width were respectively reduced to 52.5% and 84% of their original values. The results were independent of wood species.The changes in the dimensions of the fibres are in keeping with current concepts of the structure of the cell wall

Estimating the incidence of acute infectious intestinal disease in the community in the UK:A retrospective telephone survey

Objectives: To estimate the burden of intestinal infectious disease (IID) in the UK and determine whether disease burden estimations using a retrospective study design differ from those using a prospective study design. Design/Setting: A retrospective telephone survey undertaken in each of the four countries comprising the United Kingdom. Participants were randomly asked about illness either in the past 7 or 28 days. Participants: 14,813 individuals for all of whom we had a legible recording of their agreement to participate Outcomes: Self-reported IID, defined as loose stools or clinically significant vomiting lasting less than two weeks, in the absence of a known non-infectious cause. Results: The rate of self-reported IID varied substantially depending on whether asked for illness in the previous 7 or 28 days. After standardising for age and sex, and adjusting for the number of interviews completed each month and the relative size of each UK country, the estimated rate of IID in the 7-day recall group was 1,530 cases per 1,000 person-years (95% CI: 1135 – 2113), while in the 28-day recall group it was 533 cases per 1,000 person-years (95% CI: 377 – 778). There was no significant variation in rates between the four countries. Rates in this study were also higher than in a related prospective study undertaken at the same time. Conclusions: The estimated burden of disease from IID varied dramatically depending on study design. Retrospective studies of IID give higher estimates of disease burden than prospective studies. Of retrospective studies longer recall periods give lower estimated rates than studies with short recall periods. Caution needs to be exercised when comparing studies of self-reported IID as small changes in study design or case definition can markedly affect estimated rates

The burden of self-reported acute gastrointestinal illness in Italy: a retrospective survey, 2008–2009

A retrospective telephone survey (n=3490) was conducted in Italy between 2008 and 2009 to estimate the occurrence of self-reported acute gastrointestinal illness (AGI) and to describe subjects' recourse to healthcare, using a symptom-based case definition. Three hundred and ten AGI cases were identified. The annual incidence rate was 1·08 episodes/person-year (95% confidence interval 0·90–1·14). The proportion of subjects consulting physicians was 39·5% while only 0·3% submitted a specimen for laboratory investigation. Risk factors for AGI and medical care-seeking were identified using logistic regression analysis. Females, children and young adults had a significantly higher incidence rate of AGI. Factors associated with medical care-seeking were age <10 years, presence of fever, diarrhoea, and duration of illness >3 days. Our results provide a relevant contribution towards estimating the global burden of AGI using standard methods that ensure a good level of comparability with other studies

AAV2-mediated in vivo immune gene therapy of solid tumours

Abstract Background Many strategies have been adopted to unleash the potential of gene therapy for cancer, involving a wide range of therapeutic genes delivered by various methods. Immune therapy has become one of the major strategies adopted for cancer gene therapy and seeks to stimulate the immune system to target tumour antigens. In this study, the feasibility of AAV2 mediated immunotherapy of growing tumours was examined, in isolation and combined with anti-angiogenic therapy. Methods Immune-competent Balb/C or C57 mice bearing subcutaneous JBS fibrosarcoma or Lewis Lung Carcinoma (LLC) tumour xenografts respectively were treated by intra-tumoural administration of AAV2 vector encoding the immune up-regulating cytokine granulocyte macrophage-colony stimulating factor (GM-CSF) and the co-stimulatory molecule B7-1 to subcutaneous tumours, either alone or in combination with intra-muscular (IM) delivery of AAV2 vector encoding Nk4 14 days prior to tumour induction. Tumour growth and survival was monitored for all animals. Cured animals were re-challenged with tumourigenic doses of the original tumour type. In vivo cytotoxicity assays were used to investigate establishment of cell-mediated responses in treated animals. Results AAV2-mediated GM-CSF, B7-1 treatment resulted in a significant reduction in tumour growth and an increase in survival in both tumour models. Cured animals were resistant to re-challenge, and induction of T cell mediated anti-tumour responses were demonstrated. Adoptive transfer of splenocytes to naïve animals prevented tumour establishment. Systemic production of Nk4 induced by intra-muscular (IM) delivery of Nk4 significantly reduced subcutaneous tumour growth. However, combination of Nk4 treatment with GM-CSF, B7-1 therapy reduced the efficacy of the immune therapy. Conclusions Overall, this study demonstrates the potential for in vivo AAV2 mediated immune gene therapy, and provides data on the inter-relationship between tumour vasculature and immune cell recruitment

Left ventricular dysfunction after open repair of simple congenital heart defects in infants and children: Quantitation with the use of a conductance catheter immediately after bypass

AbstractObjective: Quantification of myocardial injury after the simplest pediatric operations by load-independent indices of left ventricular function, using conductance and Mikro-Tip pressure catheters (Millar Instruments, Inc., Houston, Tex.) inserted through the left ventricular apex. Methods: Sixteen infants and children with intact ventricular septum undergoing cardiac operations had left ventricular function measured, immediately before and after bypass. Real-time pressure-volume loops were generated by conductance and Mikro-Tip pressure catheters placed in the long-axis via the left ventricular apex, and preload was varied by transient snaring of the inferior vena cava. Results: Good quality pressure-volume loops were generated in 13 patients (atrial septal defects, n = 11; double-chambered right ventricle, n = 1; supravalvular aortic stenosis, n = 1; age 0.25 to 14.4 years, weight 3.1 to 46.4 kg). Their mean bypass time was 41 ± 14 minutes and mean aortic crossclamp time 27 ± 11 minutes. End-systolic elastance decreased by 40.7% from 0.34 ± 0.17 to 0.21 ± 0.15 mm Hg-1·ml-1·kg-1 (p < 0.001). There were no significant changes in the slope of the stroke work–end-diastolic volume relationship, end-diastolic elastance, time constant of isovolumic relaxation, and normalized values of the maxima and minima of the first derivative of developed left ventricular pressure. Conclusion: Load-independent indices of left ventricular function can be derived from left ventricular pressure-volume loops generated by conductance and Mikro-Tip pressure catheters during the perioperative period in infants and children undergoing cardiac operations. Incomplete myocardial protection was demonstrated by a deterioration in systolic function after even short bypass and crossclamp times.Ignorance of the cause of postoperative myocardial dysfunction in the immature heart is compounded by the incomplete myocardial protection afforded by current cardioplegic strategies.1,5 Investigations of the mechanisms and treatment of postoperative ventricular dysfunction are hampered by use of nonspecific clinical end points as indirect estimates of ventricular function, for example, requirement for inotropic agents, duration of ventilation, intensive care unit stay, and mortality. These clinical indices are relatively insensitive to changes in ventricular function and necessitate large cohorts of patients to detect even major differences in outcome from differing myocardial protective strategies.To measure left ventricular function optimally during the perioperative period, with its dramatic changes in loading conditions, necessitates the use of load-independent indices of systolic and diastolic function. In infants and children with an intact ventricular septum undergoing cardiac operations (mainly atrial septal defect closure), we report the changes in left ventricular function assessed from the pressure-volume plane with the use of a conductance catheter and Mikro-Tip pressure catheter (Millar Instruments, Inc., Houston, Tex). In animal and human studies the conductance catheter is placed in the long axis of the left ventricle, most commonly through the aortic valve, with the use of retrograde arterial cannulation or aortotomy.6-11 This is clearly impractical in children undergoing bypass procedures, and in this study we report the first clinical use of custom-built miniature catheters placed in the same long axis, but via the left ventricular apex

Detection of stx1 and stx2 Genes in Pennsylvanian White-Tailed Deer

Shiga toxin-producing E. coli carrying the stx1 and/or stx2 genes can cause multi-symptomatic illness in humans. A variety of terrestrial and aquatic environmental reservoirs of stx have been described. Culture based detection of microbes in deer species have found a low percentage of samples that have tested positive for Stx-producing microbes, suggesting that while deer may contain these microbes, their overall abundance in deer is low. In this study, quantitative PCR (qPCR) was utilized to test for the presence of stx genes in white-tailed deer fecal matter in western Pennsylvania. In this culture independent screening, nearly half of the samples tested positive for the stx2 gene, with a bias towards samples that were concentrated with stx2. This study, while limited in scope, suggests that deer may be a greater reservoir for stx than was previously thought

The effect of dentifrice abrasion on denture topography and the subsequent retention of microorganisms on abraded surfaces

Statement of problem. Denture surfaces provide hard nonshedding niches for the adhesion and subsequent accumulation of oral microorganisms into denture plaque, which can harbor various potential pathogens linked with oral mucosal lesions and inhalation pneumonia. The initial adhesion is the prerequisite for subsequent biofilm growth, and surface roughness niches facilitate this process by trapping cells. Retained microorganisms are then able to proliferate when the denture is returned to the oral cavity.Purpose. The purpose of this study was to measure the amount and strength of the attachment of microorganisms to a roughened denture acrylic resin surface. An increase in surface roughness increases the retention of microorganisms and a greater amount of cell-surface contact interface may increase the strength of adhesion and, therefore, retention. Cleaning denture surfaces with brushes and dentifrices can influence the denture surface topography and, therefore, may affect retention.Material and methods. Denture acrylic resin specimens were abraded to provide different surface roughness. The amount of attachment of Streptococcus oralis or Candida albicans to these surfaces was assessed by measuring the area of a microscopic field covered by stained cells after 1 hour of incubation. The strength of attachment was assessed with atomic force microscopy, whereby an increasing force was applied to the attached cells until they detached from the surface.Results. Both bacteria and yeast cells were retained in increasing amounts on surfaces of increasing roughness. Cells were most strongly attached on surfaces whose linear features (scratches) were of comparable size with the cells (the streptococci on the low-abraded surfaces, and the yeast on high-abraded surfaces).Conclusion. Analysis of findings reveal that even small abrasions may enhance retention on denture surfaces and reduce surface cleanability. The strength of attachment instead of the amount is more important in terms of surface hygiene. © 2014 Editorial Council for the Journal of Prosthetic Dentistry

Emerging advantages and drawbacks of telephone surveying in public health research in Ireland and the U.K

BACKGROUND: Telephone surveys have been used widely in public health research internationally and are being increasingly used in Ireland and the U.K. METHODS: This study compared three telephone surveys conducted on the island of Ireland from 2000 to 2004, examining study methodology, outcome measures and the per unit cost of each completed survey. We critically examined these population-based surveys which all explored health related attitudes and behaviours. RESULTS: Over the period from 2000 to 2005 the percentage of calls which succeeded in contacting an eligible member of the public fell, from 52.9% to 31.8%. There was a drop in response rates to the surveys (once contact was established) from 58.6% to 17.7%. Costs per completed interview rose from €4.48 to €15.65. Respondents were prepared to spend 10–15 minutes being surveyed, but longer surveys yielded poorer completion rates. Respondents were willing to discuss issues of a sensitive nature. Interviews after 9 pm were less successful, with complaints about the lateness of the call. Randomisation from electronic residential telephone directory databases excluded all ex-directory numbers and thus was not as representative of the general population as number generation by the hundred-bank method. However the directory database was more efficient in excluding business and fax numbers. CONCLUSION: Researchers should take cognisance of under-representativeness of land-line telephone surveys, of the increasing difficulties in contacting the public and of mounting personnel costs. We conclude that telephone surveying now requires additional strategies such as a multimode approach, or incentivisation, to be a useful, cost-effective means of acquiring data on public health matters in Ireland and the U.K