Orthopaedic surgeons' knowledge and practice of radiation safety when using fluoroscopy during procedures: A narrative review

OBJECTIVES

The fluoroscopy environment poses a potential occupational radiation exposure risk to theatre personnel. Risks can be mitigated with effective application of radiation protection knowledge and methods. This review aimed to determine the link between orthopaedic surgeon's knowledge and the use of appropriate safety methods when using fluoroscopy.

KEY FINDINGS

A keyword search of three databases discovered six articles, totalling 2209 orthopaedic surgeons, who completed surveys to assess knowledge on various aspects of radiation safety and training. Participants had varying levels of experience. Moreover 1981 participants always wore a lead gown (89 %), while only 1052 participants wore thyroid protection (47 %). 449 participants (20 %) received some form of training.

CONCLUSION

Although surveys asked a range of questions it appeared that there was low knowledge of the ALARP principles. Usage of protective equipment is a legal requirement and thus was observed throughout, however, there were a number of incidences of disregarding some protective measures. Although there appeared to be limited knowledge surrounding radiation protection measures and lack of training provided, no clear link was demonstrated between compliance with protective methods and knowledge of the risks.

IMPLICATIONS FOR PRACTICE

Formal and continuous training should be provided for the enhancement of knowledge to ensure the safety of all staff and help prevent the long-term effects of ionising radiation when using fluoroscopy.

Using a machine learning algorithm to detect depressed ejection fraction from a single-lead ECG

Background

Multiple studies demonstrate the benefit of intervention for left ventricular ejection fraction (LVEF) below 40%, so the development of a low ejection fraction algorithm to detect LVEF below 40% can aid in early screening of initial asymptomatic Heart Failure with reduced Ejection Fraction (HFrEF).

Objective

To demonstrate the performance of a low ejection fraction algorithm using single-lead ECG data to detect LVEF below 40%.

Methods

We collected 1325 single-lead ECG recordings (15s duration) at various chest positions using an electronic stethoscope from 197 patients. We analyzed these ECG recordings using a deep neural network model trained on individual leads extracted from a 12-lead ECG to discriminate left ventricular ejection fractions (EFs) above or below different thresholds. We compared the model output to ejection fraction measured using echocardiograms.

Results

Across all recordings from all patients, we obtained an AUROC of 0.89, with a sensitivity of 88% and specificity of 74% using a model output threshold of 0.35 (Figure 1). The AUROC of recordings taken at different orientations and stances ranged from 0.85 to 0.92 (Table 1), with a sensitivity of at least 78% and specificity of at least 66% at any orientation.

Conclusion

Using a single lead ECG measured by an electronic stethoscope and a deep neural network model, we were able to detect depressed ejection fraction (≤40%) with a sensitivity of 88% and specificity of 74%. This work demonstrates the utility of a low-cost electronic stethoscope and machine learning for early screening and detection of depressed left ventricular ejection fraction.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Eko Health

Artificial Intelligence: Guidance for clinical imaging and therapeutic radiography professionals, a summary by the Society of Radiographers AI working group

INTRODUCTION

Artificial intelligence (AI) has started to be increasingly adopted in medical imaging and radiotherapy clinical practice, however research, education and partnerships have not really caught up yet to facilitate a safe and effective transition. The aim of the document is to provide baseline guidance for radiographers working in the field of AI in education, research, clinical practice and stakeholder partnerships. The guideline is intended for use by the multi-professional clinical imaging and radiotherapy teams, including all staff, volunteers, students and learners.

METHODS

The format mirrored similar publications from other SCoR working groups in the past. The recommendations have been subject to a rapid period of peer, professional and patient assessment and review. Feedback was sought from a range of SoR members and advisory groups, as well as from the SoR director of professional policy, as well as from external experts. Amendments were then made in line with feedback received and a final consensus was reached.

RESULTS

AI is an innovative tool radiographers will need to engage with to ensure a safe and efficient clinical service in imaging and radiotherapy. Educational provisions will need to be proportionately adjusted by Higher Education Institutions (HEIs) to offer the necessary knowledge, skills and competences for diagnostic and therapeutic radiographers, to enable them to navigate a future where AI will be central to patient diagnosis and treatment pathways. Radiography-led research in AI should address key clinical challenges and enable radiographers co-design, implement and validate AI solutions. Partnerships are key in ensuring the contribution of radiographers is integrated into healthcare AI ecosystems for the benefit of the patients and service users.

CONCLUSION

Radiography is starting to work towards a future with AI-enabled healthcare. This guidance offers some recommendations for different areas of radiography practice. There is a need to update our educational curricula, rethink our research priorities, forge new strong clinical-academic-industry partnerships to optimise clinical practice. Specific recommendations in relation to clinical practice, education, research and the forging of partnerships with key stakeholders are discussed, with potential impact on policy and practice in all these domains. These recommendations aim to serve as baseline guidance for UK radiographers.

IMPLICATIONS FOR PRACTICE

This review offers the most up-to-date recommendations for clinical practitioners, researchers, academics and service users of clinical imaging and therapeutic radiography services. Radiography practice, education and research must gradually adjust to AI-enabled healthcare systems to ensure gains of AI technologies are maximised and challenges and risks are minimised. This guidance will need to be updated regularly given the fast-changing pace of AI development and innovation.

POS1432 SHORT-TERM RISK OF OSTEOPOROSIS IN ADULTS TREATED WITH CORTICOSTEROIDS: AN OBSERVATIONAL STUDY

Background:

Exposure to corticosteroids is recognised to increase the risk of osteoporosis.

Objectives:

Our aim was to evaluate patients’ short-term absolute risk of osteoporosis over the course of their first continuous exposure to corticosteroids.

Methods:

This was an observational study using UK data from the Clinical Practice Research Datalink. Adult patients were selected if exposed to systemic corticosteroids for any condition and had no prior osteoporosis. Non-exposed adults matched on age, sex, and disease burden were selected from the general population. Patients were followed from their first exposure to corticosteroid to the earlier of 90 days following the end of continuous prescribing or for a maximum of three years. Cohorts were categorised by age (18-42 years, 43-67 and 68-92 years), BMI (underweight, normal overweight, obese and obese+) and gender. Absolute risk rates were calculated for each of these categories.

Results:

In total, 573,056 exposed patients were matched 1:1 to non-exposed controls. Mean age was 52 years; 57% were female. The mean and median days’ supply were 50.9 and 13 days, respectively. Underweight females aged 68-92 years exposed to corticosteroids had the highest absolute risk of osteoporosis (70.9 per 1000 patient years (PKPY)); in matched non-exposed controls this was 26.6 PKPY. Generally, following their first continuous exposure to corticosteroids, patients taking steroids had greater risk of osteoporosis compared with those in the same age, sex and BMI category never exposed to corticosteroids.

Conclusion:

Whilst it is understood that exposure to corticosteroids increases the risk of osteoporosis, there are large differences in risk in accordance with age, sex and BMI. Alternatives to corticosteroids are urgently needed.

MaleFemaleSteroid-exposedNever exposedSteroid-exposedNever exposedAge groupBMI groupPatientsAbsolute rate (per 1,000 patient years)PatientsAbsolute rate (per 1,000 patient years)p-valuePatientsAbsolute rate (per 1,000 patient years)PatientsAbsolute rate (per 1,000 patient years)p-value18-421: Underweight1,2422.01,1950.00.56613,0794.53,4860.90.13612: Normal18,7982.219,6380.0<0.000142,2340.947,3400.10.00493: Overweight16,5362.615,1140.00.000124,8930.524,0090.10.23824: Obese +10,3110.68,4530.00.287426,6000.620,3200.30.461443-671: Underweight1,25427.46830.00.00402,42030.91,99018.50.11412: Normal27,0378.626,5692.0<0.000145,46715.950,4236.1<0.00013: Overweight42,4284.343,8720.7<0.000142,62010.843,2534.1<0.00014: Obese +31,4782.530,8520.80.000745,3396.039,8762.4<0.000168-921: Underweight93630.343210.30.15051,53270.91,23926.60.00032: Normal15,89111.315,0214.5<0.000118,30842.318,71718.6<0.00013: Overweight21,3717.323,1371.8<0.000119,14926.219,76012.9<0.00014: Obese +11,2165.611,3961.90.002114,45320.013,6148.7<0.0001

Disclosure of Interests:

Ellen Berni Consultant of: Employed by Pharmatelligence, which carries out consultancy work for AstraZeneca and other pharmaceutical companies., Philip Ambery Shareholder of: AstraZeneca, Employee of: AstraZeneca, Samuel Adamsson Eryd Shareholder of: AstraZeneca, Employee of: AstraZeneca, Sara Jenkins-Jones Consultant of: Employed by Pharmatelligence, which carries out consultancy work for AstraZeneca and other pharmaceutical companies., Mary Brown Shareholder of: AstraZeneca, Employee of: AstraZeneca, Carol Astbury Shareholder of: AstraZeneca, Employee of: AstraZeneca, Phillip Hunt Shareholder of: AstraZeneca, Employee of: AstraZeneca, Craig Currie Consultant of: Director of Pharmatelligence, which carries out consultancy work for AstraZeneca and other pharmaceutical companies

Factors Influencing the Prevalence of Animal Cruelty During Adolescence

Adolescents' interactions with animals are of increasing interest and their beneficial developmental outcomes are well known. However, negative interactions such as perpetrating cruelty toward animals during childhood and adolescence have been related with child abuse, domestic violence, and later interpersonal violence. Cruelty toward animals by adolescents has been reported predominately in criminal and clinical samples, and links have been made between animal cruelty and interpersonal violence. However, studies often lack a clear definition of animal cruelty and the animal involved. The present study addresses methodological shortcomings by providing a clear definition of the cruelty acts and the animals involved and the time frame within which cruelty acts have been taken place. Therefore, we investigated the prevalence of animal cruelty of 979 British adolescents (419 male, 497 female, M_age = 15.1 ± 1.57 years) by means of a survey questionnaire administered in school. Animal cruelty was investigated encompassing deliberate and nondeliberate cruelty acts, a clear definition of the target animals was included and a time frame was provided. Furthermore, acceptability of animal cruelty, engaging in antisocial behavior, and family affluence were investigated. Results show high reliabilities for the measures applied. Exploratory factor analysis reveals different types of animal cruelty. Gender differences were observed for deliberate and accidental cruelty acts, with boys reporting higher levels than girls. Younger adolescents reported higher accidental cruelty acts than older ones. Acceptance of animal cruelty played a significant role in predicting animal cruelty, together with antisocial behaviors and place of living. The present study shows for the first time the importance of distinguishing between different types of animal cruelty and defining the animals involved.

National level wealth inequality and socioeconomic inequality in adolescent mental wellbeing

Background

Previous research established a positive association between national income inequality and socioeconomic inequalities in adolescent health, but little is known about the extent to which national level inequalities in accumulated financial resources (i.e. wealth) are associated with these health inequalities. Therefore, we examined the association between national wealth inequality and income inequality and socioeconomic inequalities in adolescent mental wellbeing.

Methods

Data were from 17 countries participating in three successive waves (2010, 2014 and 2018) of the cross-sectional Health Behaviour in School-aged Children (HBSC) study. We combined individual-level data on adolescents' life satisfaction, psychological and somatic symptoms and socioeconomic status (SES) with country-level data on income and wealth inequality (n = 244771). We performed time-series analysis on a pooled sample of 48 country/year groups.

Results

Higher levels of national wealth inequality were associated with fewer average psychological and somatic symptoms, while higher levels of national income inequality were associated with more psychological and somatic symptoms. No associations between either national wealth inequality or income inequality and life satisfaction were found. Smaller differences in somatic symptoms between higher and lower SES groups were found in countries with higher levels of national wealth inequality. In contrast, larger differences in psychological symptoms and life satisfaction (but not somatic symptoms) between higher and lower SES groups were found in countries with higher levels of national income inequality.

Conclusions

Although both national wealth and income inequality are associated with (socioeconomic inequalities in) adolescent mental wellbeing, associations are in opposite directions. Further research is warranted to gain better understanding in the role of national wealth inequality on (socioeconomic inequalities in) adolescent health.

Key messages

This is one of the first studies to examine if socioeconomic inequalities in adolescent mental wellbeing are associated with national wealth inequality independently from national income inequality. Opposing effects of national wealth inequality and income inequality on socioeconomic inequalities in adolescents’ mental wellbeing warrant further research before policy recommendations can be made.

Socioeconomic position, macroeconomic environment and overweight among adolescents in 35 countries

OBJECTIVE

It is important to understand levels and social inequalities in childhood overweight within and between countries. This study examined prevalence and social inequality in adolescent overweight in 35 countries, and associations with macroeconomic factors.

DESIGN

International cross-sectional survey in national samples of schools.

SUBJECTS

A total of 11-, 13- and 15-year-olds from 35 countries in Europe and North America in 2001-2002 (N=162 305).

MEASUREMENTS

The main outcome measure was overweight based on self-reported height and weight (body mass index cut-points corresponding to body mass index of 25 kg/m(2) at the age of 18 years). Measures included family and school affluence (within countries), and average country income and economic inequality (between countries).

RESULTS

There were large variations in adolescent overweight, from 3.5% in Lithuanian girls to 31.7% in boys from Malta. Prevalence of overweight was higher among children from less affluent families in 21 of 24 Western and 5 of 10 Central European countries. However, children from more affluent families were at higher risk of overweight in Croatia, Estonia and Latvia. In Poland, Lithuania, Macedonia and Finland, girls from less affluent families were more overweight whereas the opposite was found for boys. Average country income was associated with prevalence and inequality in overweight when considering all countries together. However, economic inequality as measured by the Gini coefficient was differentially associated with prevalence and socioeconomic inequality in overweight among the 23-high income and 10-middle income countries, with a positive relationship among the high income countries and a negative association among the middle income countries.

CONCLUSION

The direction and magnitude of social inequality in adolescent overweight shows large international variation, with negative social gradients in most countries, but positive social gradients, especially for boys, in some Central European countries. Macroeconomic factors are associated with the heterogeneity in prevalence and social inequality of adolescent overweight.

Inequalities in toothbrushing among adolescents in Scotland 1998-2006

The aim of this study was to examine trends in toothbrushing and inequalities in toothbrushing among girls and boys in Scotland between 1998 and 2006. A secondary aim was to investigate the association between the health promoting school (HPS) initiative and toothbrushing. Data from the Health Behaviour in School-aged Children 1998, 2002 and 2006 surveys were analysed using multilevel logistic regression for boys and girls aged 11, 13 and 15 years. Girls' twice-a-day toothbrushing increased with age while that of boys' remained stable. Toothbrushing increased significantly between 1998 and 2006 for all but 15-year-old girls. Family structure was significantly associated with toothbrushing for 11-year-old boys and 13-year-old boys and girls. Socio-economic inequalities in toothbrushing were significant for both boys and girls at all ages. Largest inequalities were seen among 13-year-old girls and 15-year-old boys. Inequalities persisted over time for all but 15-year-old boys who saw a significant reduction between 1998 and 2006. The HPS initiative in schools in deprived areas was associated with increased odds of twice-a day toothbrushing among 11-year-old boys and 15-year-old girls.

High agreement on family affluence between children's and parents' reports: international study of 11-year-old children

OBJECTIVE

To examine the agreement between parents' and children's reports on four items of family affluence: number of cars, own bedroom, number of family holidays and number of computers, and to analyse predictors of disagreement.

DESIGN

Cross-sectional child-parent validation study of selected items from an internationally standardised questionnaire.

SETTING

Survey conducted in schools in Denmark, Germany, Hungary, Italy, Poland and Scotland.

PARTICIPANTS

972 11-year-old children and their parents responded to the questionnaires.

RESULTS

The child item response rates were high (above 93%). The per cent agreement was low for holidays spent with family (52.5%), but high for the other three items of family affluence (76.2-88.1%). The kappa coefficients were good or excellent for all items (between 0.41 and 0.74) and the gamma coefficients were strong for all items (between 0.56 and 0.96). Children from single-parent families were more likely to over-report family affluence (OR 2.67; CI 1.83 to 3.89).

CONCLUSIONS

Young adolescents' self-reports of family affluence are fairly valid across the six countries. This finding suggests that the variables measured can be used in epidemiological studies that aim at ranking children according to socioeconomic position.

Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns

The purposes of this systematic review were to present and compare recent estimates of the prevalence of overweight and obesity in school-aged youth from 34 countries and to examine associations between overweight and selected dietary and physical activity patterns. Data consisted of a cross-sectional survey of 137 593 youth (10-16 years) from the 34 (primarily European) participating countries of the 2001-2002 Health Behaviour in School-Aged Children Study. The prevalence of overweight and obesity was determined based on self-reported height and weight and the international child body mass index standards. Logistic regression was employed to examine associations between overweight status with selected dietary and physical activity patterns. The two countries with the highest prevalence of overweight (pre-obese + obese) and obese youth were Malta (25.4% and 7.9%) and the United States (25.1% and 6.8%) while the two countries with the lowest prevalence were Lithuania (5.1% and 0.4%) and Latvia (5.9% and 0.5%). Overweight and obesity prevalence was particularly high in countries located in North America, Great Britain, and south-western Europe. Within most countries physical activity levels were lower and television viewing times were higher in overweight compared to normal weight youth. In 91% of the countries examined, the frequency of sweets intake was lower in overweight than normal weight youth. Overweight status was not associated with the intake of fruits, vegetables, and soft drinks or time spent on the computer. In conclusion, the adolescent obesity epidemic is a global issue. Increasing physical activity participation and decreasing television viewing should be the focus of strategies aimed at preventing and treating overweight and obesity in youth.

The influence of the Pro12Ala mutation of the PPAR-gamma receptor gene on metabolic and clinical characteristics in treatment-naïve patients with type 2 diabetes

Peroxisome proliferator activated receptor-gamma is an important factor in adipocyte differentiation and energy metabolism and is thus a candidate gene for obesity, insulin resistance and dyslipidaemia. We therefore assessed the associations between the most common variant of the PPAR-gamma, the Pro12Ala (P12A) substitution in the PPAR-gamma 2 gene, with BMI, blood pressure, fasting plasma glucose, HbA1c, total cholesterol, LDL and HDL cholesterol and plasma triglyceride in 183 treatment-naïve patients with type 2 diabetes (T2D). The P12A allele associated with lower fasting plasma glucose but had no influence on HbA1c or BMI. In obese patients (BMI > 29 kg/m2), the P12A substitution associated with elevated total and non-HDL cholesterol levels.

Increased islet cell proliferation, decreased apoptosis, and greater vascularization leading to beta-cell hyperplasia in mutant mice lacking insulin

The targeted disruption of the two nonallelic insulin genes in mouse was reported previously to result in intrauterine growth retardation, severe diabetes immediately after suckling, and death within 48 h of birth. We have further used these animals to investigate the morphology and cell biology of the endocrine pancreas in late gestation and at birth when insulin is absent throughout development. Pancreatic beta-cells were identified by detecting the activity of the LacZ gene inserted at the Ins2 locus. A significant increase in the mean area of the islets was found at embryonic d 18.5 (E18.5) and in the newborn in Ins1-/-, Ins2-/- animals compared with Ins1-/-, Ins2+/- and wild-type controls, whereas the blood glucose levels were unaltered. The individual size of the beta-cells in the insulin-deficient fetuses was similar to controls, suggesting that the relative increase in islet size was due to an increase in cell number. Immunohistochemistry for proliferating cell nuclear antigen within the pancreatic ductal epithelium showed no differences in labeling index between insulin-deficient and control mice, and no change in the number of beta-cells associated with ducts, but the relative size distribution of the islets was altered so that fewer islets under 5,000 microm(2) and more islets greater than 10,000 microm(2) were present in Ins1-/-, Ins2-/- animals. This suggests that the greater mean islet size seen in insulin-deficient animals represented an enlargement of formed islets and was not associated with an increase in islet neogenesis. The proportional contribution of alpha- and beta-cells to the islets was not altered. This was supported by an increase in the number of cells containing immunoreactive proliferating cell nuclear antigen in both islet alpha- and beta-cells at E18.5 in insulin-deficient mice, and a significantly lower incidence of apoptotic cells, as determined by molecular histochemistry using the terminal deoxynucleotidyl transferase-mediated deoxy-UTP nick end labeling reaction. The density of blood vessels within sections of whole pancreas, or within islets, was determined by immunohistochemistry for the endothelial cell marker CD31 and was found to be increased 2-fold in insulin-deficient mice compared with controls at E18.5. However, no changes were found in the steady-state expression of mRNAs encoding vascular endothelial growth factor, its receptor Flk-1, IGF-I or -II, the IGF-I and insulin receptors, or insulin receptor substrates-1 or -2 in pancreata from Ins1-/-, Ins2-/- mice compared with Ins1-/-, Ins2+/- controls. Thus, we conclude that the relative hyperplasia of the islets in late gestation in the insulin-deficient mice was due to an increased islet cell proliferation coupled with a reduced apoptosis, which may be related to an increased vascularization of the pancreas.

Differences in levels of secreted locus of enterocyte effacement proteins between human disease-associated and bovine Escherichia coli O157

Ongoing extensive epidemiological studies of verotoxin-carrying Escherichia coli O157 (stx(+) eae(+)) have shown this bacterial pathogen to be common in cattle herds in the United States and the United Kingdom. However, the incidence of disease in humans due to this pathogen is still very low. This study set out to investigate if there is a difference between strains isolated from human disease cases and those isolated from asymptomatic cattle which would account for the low disease incidence of such a ubiquitous organism. The work presented here has compared human disease strains from both sporadic and outbreak cases with a cross-section, as defined by pulsed-field gel electrophoresis, of E. coli O157 strains from cattle. Human (n = 22) and bovine (n = 31) strains were genotyped for carriage of the genes for Shiga-like toxin types 1, 2, and 2c; E. coli secreted protein genes espA, espB, and espP; the enterohemolysin gene; eae (intimin); ast (enteroaggregative E. coli stable toxin [EAST]); and genes for common E. coli adhesins. Strains were also phenotyped for hemolysin, EspP, Tir, and EspD expression as well as production of actin and cytoskeletal rearrangement associated with attaching and effacing (A/E) lesions on HeLa cells. The genotyping confirmed that there was little difference between the two groups, including carriage of stx(2) and stx(2c), which was similar in both sets. ast alleles were confirmed to all contain mutations that would prevent EAST expression. espP mutations were found only in cattle strains (5 of 30). Clear differences were observed in the expression of locus of enterocyte effacement (LEE)-encoded factors between strains and in different media. EspD, as an indicator of LEE4 (espA, -B, and -D) expression, and Tir levels in supernatants were measured. Virtually all strains from both sources could produce EspD in Luria-Bertani broth, although at very different levels. Standard trichloroacetic acid precipitation of secreted proteins from tissue culture medium produced detectable levels of EspD from the majority of strains of human origin (15 of 20) compared with only a few (4 of 20) bovine strains (P < 0.001), which is indicative of much higher levels of protein secretion from the human strains. Addition of bovine serum albumin carrier protein before precipitation and enhanced detection techniques confirmed that EspD could be detected after growth in tissue culture medium for all strains, but levels from strains of human origin were on average 90-fold higher than those from strains of bovine origin. In general, levels of secretion also correlated with ability to form A/E lesions on HeLa cells, with only the high-level protein secretors in tissue culture medium exhibiting a localized adherence phenotype. This research shows significant differences between human- and bovine-derived E. coli O157 (stx(+) eae(+)) strains and their production of certain LEE-encoded virulence factors. These data support the recent finding of Kim et al. (J. Kim, J. Nietfeldt, and A. K. Benson, Proc. Natl. Acad. Sci. USA 96:13288-13293, 1999) proposing different E. coli O157 lineages in cattle and humans and extend the differential to the regulation of virulence factors. Potentially only a subset of E. coli O157 isolates (stx(+) eae(+)) in cattle may be capable of causing severe disease in humans.

Dietary trends among Scottish schoolchildren in the 1990s

BACKGROUND

In recent years, healthy eating messages have sought to highlight the advantages of a healthy balanced diet, but there is little evidence that the recommendations have been translated into sustained behavioural change. In Scotland, the national diet has become a major focus in key policy documents, and the diet of children and young people has been consistently highlighted as an area of particular concern. This paper reports on dietary trends among Scottish schoolchildren during the 1990s.

METHODS

Data were collected from a representative sample of Scottish schoolchildren as part of the WHO Cross-national Health Behaviour of School-aged Children (HBSC) study. Three consecutive national surveys were undertaken in Scotland, in 1990, 1994 and 1998, using self-completion food frequency questionnaires with 11-, 13- and 15-year-old school pupils.

RESULTS

Between 1990 and 1998, fruit and vegetable consumption increased among Scottish schoolchildren, especially among girls, but levels of consumption fell below current dietary recommendations. There has been a concomitant increase in consumption of high-fat and high-sugar foods, and consumption of these foods is higher among boys and children from lower socio-economic groups.

CONCLUSION

The findings emphasize the need for continued health promotion efforts to improve the diet of schoolchildren in Scotland especially among lower socio-economic groups.

Analysis of type 1 fimbriae expression in verotoxigenic Escherichia coli: a comparison between serotypes O157 and O26

Previous research has shown that verotoxin-producing Escherichia coli (VTEC) O157 strains appear unable to express type 1 fimbriae although other serotypes such as O26 and O118 can. This study has investigated the molecular basis of this difference. The study confirmed the presence of a 16 bp deletion within the regulatory region of fimA (fim switch) in 63 VTEC O157 strains but not in other VTEC serotypes tested. The fim switch was shown to be detectable only in the phase off orientation in VTEC O157, but detection of the switch in the phase on orientation correlated with the degree of mannose-sensitive yeast agglutination in VTEC O26. Repair of the 16 bp deletion in the VTEC O157 fim switch region restored phase-variable expression of fimA in a permissive background. Non-O157 VTEC, especially O26 and O118, can be pathogenic in cattle; the role of type 1 fimbriae in this and colonization is discussed.

Quantitation of primitive and lineage-committed progenitors in mobilized peripheral blood for prediction of platelet recovery post autologous transplant

Leukapheresis collections obtained following one of four mobilization regimens from 90 cancer patients were analyzed for their content of various progenitor cell types including erythroid and granulopoietic colony-forming cells in methylcellulose (total CFC), CFC-megakaryocyte (CFC-Mk), CFC detected after 10, 35 and 56 days in long-term culture (LTC), and total CD34+ cells. The number of each of these progenitor cell types collected from individual patients varied over 1000-fold. Nevertheless, within an individual leukapheresis, there was a significant correlation between the number of CD34+ cells and each progenitor type (except day 56 LTC CFC) suggesting that all of them are mobilized by a common mechanism. Patients who had previously received extensive chemotherapy and/or radiotherapy mobilized fewer of all these cell types than those who had not. For the 65 patients who proceeded to autologous transplantation, the median times to an absolute neutrophil count (ANC) of > or =0.5 x 109/l and the last platelet transfusion post transplant were 13 and 11 days, respectively, with 14 (22%) of patients having platelet recovery delayed beyond day 21. There was no significant difference between patients who had or had not received extensive chemo/radiotherapy or among the different mobilization regimens for time to neutrophil or platelet recovery or the number of platelet or red blood cell transfusions received post transplant. Threshold doses of the different cell types transplanted (per kg of patient weight) which predicted rapid platelet recovery were 2 x 106 CD34+ cells, 5 x 105 total CFC and 2.5 x 104CFC-Mk. Corresponding thresholds for progenitor activity measured in LTC could not be established. These results further support the view that standard mobilization regimens yield progenitor numbers that are, in most cases, nonlimiting for generating neutrophil and platelet recoveries within 2 to 3 weeks after myeloablative therapy. Assessment of the CD34+ cell and/or CFC content of leukapheresis collections may identify patients in whom platelet recovery is likely to be significantly delayed although CFC-Mk enumeration does not appear to offer any unique predictive advantage.

Enhancement of platinum-drug cytotoxicity in a human head and neck squamous cell carcinoma line and its platinum-resistant variant by liposomal amphotericin B and phospholipase A2-II

Platinum drugs comprise one of the main classes of chemotherapy drugs that can induce remissions in various solid tumors. Although tumors often regress on treatment with cis-diamminedichloroplatinum II (cisplatin) or cis-diammine-1,1-cyclobutane dicarboxylate platinum II (carboplatin), they usually relapse as a drug-resistant tumor. Most mechanisms of platinum resistance could be overcome by increasing the amount of drug that is accumulated by tumor cells. Amphotericin B (Amph B) is efficient at increasing platinum drug uptake, but because of nephrotoxicity associated with extended usage, and the potential for synergistic nephrotoxicity when used with platinum drugs, Amph B has not been used clinically for this purpose. A liposomal preparation of Amph B (LipoAmph B), which is substantially less nephrotoxic, was studied for its ability to enhance platinum-drug toxicity to a human oral squamous cell carcinoma line, HN-5a, and its carboplatin-resistant variant, 5a/carbo-15a, in which cisplatin accumulation was reduced by approximately 40%. Amph B at 10 microg/ml enhanced cisplatin accumulation by approximately 100% in both cell lines, enhancing cytotoxicity of the drugs by 35 to 60%, and completely reversed resistance to both cisplatin and carboplatin. LipoAmph B in the presence of phospholipase A(2)-II (PLA2-II) was able to enhance cisplatin and carboplatin cytotoxicity as effectively as free Amph B in both cell lines. At optimal concentrations, LipoAmph B plus PLA2-II enhanced drug uptake sufficiently to abolish resistance in the platinum-resistant line. Because PLA2-II is elevated in some tumor microenvironments and in plasma of ill patients, LipoAmph B has potential clinical usefulness as a modulator of platinum-drug efficacy.

Changes in HIV/AIDS education, knowledge and attitudes among Scottish 15-16 year olds, 1990-1994: findings from the WHO: Health Behaviour in School-aged Children Study (HBSC)

There is concern about the high prevalence of adolescent sexual health problems, such as sexually transmitted diseases (STDs) and unwanted pregnancies, that currently exist in the UK. If young people are to reduce their risk from HIV/AIDS and other STDs it is imperative, in the first instance, they know what the risks are and how they can avoid them. However, effective school-based sex education can only be delivered if there are accurate data on young people's current levels of knowledge and existing sex education needs. This paper details findings from the WHO: Health Behaviours of School-aged Children Study on the changes that have occurred between 1990 and 1994 in Scottish school-children's knowledge, attitudes and perceived educational needs in relation to HIV/AIDS. There have been significant changes in knowledge and attitudes that may affect their sexual behaviour, e.g. in their attitudes to condom use, risk of HIV/AIDS and other STDs, and also other sexual health problems, such as the risk of unwanted pregnancies and abortions. Finally, areas that require future research and recommendations for future sexual health education interventions are highlighted.

Role of percutaneous gastrostomy tubes in the postoperative care of patients with cancer of the oral cavity and oropharynx

OBJECTIVE

The purpose of this study was to document the use and complications of gastrostomy tubes placed following surgery for oral cancer at our institution and to determine preoperative predictors of the procedure.

METHOD

A retrospective chart review of 105 patients treated surgically for oral cancer between March 1990 and June 1995 at St. Joseph's Health Care Centre, London, Ontario was conducted. Twenty patients were studied with regard to timing, indication, and morbidity (n = 24) of the procedure. Regression analysis was performed regarding preoperative predictors of postoperative gastrostomy including tumour site and stage, and the percentage of tongue resected. Outcome measures included time from surgery to gastrostomy, length of postoperative hospital stay, time gastrostomy tube in situ, complications of gastrostomy, and the predicted risk of postoperative gastrostomy tube.

RESULTS

The mean time to gastrostomy tube placement was 17.4 days, and the mean length of hospital stay in gastrostomy patients was 26.8 days. Gastrostomy was temporary in 55% of patients. No significant complications of percutaneous gastrostomy were encountered. Oropharyngeal tumour site and advanced T stage were predictive of the need for postoperative gastrostomy.

CONCLUSIONS

In oral cavity and oropharyngeal cancer patients treated surgically, early postoperative percutaneous gastrostomy tube placement is indicated in those at high risk for significant postoperative dysphagia.

Healthy or druggy? Self-image, ideal image and smoking behaviour among young people

Recent research indicates that there is an important, though complex, relationship between the social image of smoking and young people's self- and aspirational images. This study explored how young people see themselves (self-image), how they would like to be (ideal image), and whether these differ according to age, gender and smoking status. Focus groups were used to elicit attributes which young people use to describe smoking and non-smoking images taken from fashion pages in youth magazines. These attributes were incorporated into a self-completion questionnaire which was administered to 897 young people from three age groups (12-13 years, 15-16 years and 18-19 years). The respondents rated their self- and ideal images on each of these attributes. Overall, there were few differences between the rank order of attributes by age, sex or smoking status. However, there were differences in the trait scores, with males and smokers tending to rate themselves more positively. The two traits which most clearly differentiated smokers and non-smokers were druggy/takes drugs (self- and ideal image) and healthy (self-image). It appears that smokers in general, and male smokers in particular, embraced certain dimensions of self- and aspirational image of which druggy, tough and tarty are signifiers. In contrast, the differences between female smokers and non-smokers were less consistent and differed with age. The implications for health promotion are discussed.

Left-handedness increases injury risk in adolescent girls

In a self-report survey of a representative national sample of 4081 Scottish schoolchildren, injuries requiring medical assistance were more common in left-handers; these were also more severe and likely to involve an overnight stay in hospital. Particularly at risk were adolescent girls with a 32% greater chance of being injured if they were left-handed compared with their right-handed peers. The corresponding relative risk for boys was not significant.

Patterns of unhealthy eating behaviours in a middle aged Scottish population

This paper examines unhealthy eating in a middle aged Scottish population. Data from a 1989 survey of 500 Scottish men and women aged 45 to 59 years are used to explore inter-relations among five items of unhealthy eating, smoking and alcohol consumption. The results show that unhealthy eating behaviours are highly correlated, indicating strong links among certain nutrition habits. The findings also reveal that such patterns of unhealthy eating vary considerably between males and females. Finally, unhealthy eating behaviours were also found to be significantly associated with smoking and alcohol consumption. Implications of these findings for future research in epidemiology and health promotion are considered.

A comparison of the consistency of self-reported behavioural change within a study sample--postal versus home interviews

Much health promotion research is directed towards increasing our understanding of the process of health-related behavioural change. However, little is known about the validity of self-reported changes in behaviour. This study aimed to assess the validity of self-reported changes in five behaviours--diet, cigarette smoking, alcohol consumption, weight control and physical activity--by comparing reports obtained from the same people through postal questionnaires and face-to-face interviews. It was found that overall there was a consistency between self-reports with interviewers confirming that in most cases change had taken place. However, in a large number of cases changes were reported that had occurred before the period specified in the questionnaire. The nature of the change, whether discrete or incremental, as well as the behaviour in question, were found to be related to the accuracy of self-reporting. The possible reasons for the observed discrepancies are discussed.

Misplacement in long stay geriatric care, psychogeriatric care and Part IV accommodation

The dependency and behavioural characteristics of 1,461 elderly people in long stay geriatric and psychogeriatric wards and Part IV accommodation were surveyed. Misplacement, defined as having dependency and behaviour characteristics normally associated with admission to another form of care, was widespread, ranging from 5-51% in the different facilities visited. It was greatest in psychogeriatric wards and least in geriatric wards. In Part IV accommodation there was a significant inverse relationship between length of stay and appropriateness of placement.