Correlation between aggression at the veterinary clinic and problem behaviors at home for cats in the USA

OBJECTIVES

The aim of the study was to determine whether cats that exhibit aggression during veterinary visits are more likely to have behavior problems at home.

METHODS

An online, anonymous, cross-sectional survey was developed and distributed to residents in the USA who were aged over 18 years and who were the primary owners of at least one cat. The survey collected information about cat and household factors, and utilized a validated questionnaire instrument for obtaining behavioral information of pet cats.

RESULTS

Aggression at the veterinary clinic was reported in 42.6% of the cats. The frequency of aggression exhibited at the veterinary clinic was lower in cats that lived in multi-cat households. Most cats did not receive medications intended to reduce fear, anxiety and/or pain before veterinary visits. Aggression at the veterinary clinic was positively associated with behavior problems at home, including stranger-directed aggression, owner-directed aggression, resistance to restraint, familiar cat aggression, dog-directed aggression, house-soiling, separation-related behaviors and scratching claws on inappropriate surfaces indoors.

CONCLUSIONS AND RELEVANCE

Cats that exhibit aggression at the veterinary clinic are more likely to exhibit aggression and anxiety-related behaviors at home. Veterinarians should screen cats that exhibit aggression at the veterinary clinic for behavior problems at home to institute prompt diagnosis and treatment.

Assessing the Relationship Between Emotional States of Dogs and Their Human Handlers, Using Simultaneous Behavioral and Cardiac Measures

Negative stress due to human handling has been reported for a number of domestic animals, including dogs. Many companion dogs display significant stress during routine care in the veterinary clinic, risking injury to staff and potentially compromising the quality of care that these dogs receive. On the other hand, positive interactions with humans can have a beneficial effect on dogs, particularly in stressful situations such as animal shelters. Research has shown that dogs can detect human emotions through visual, auditory, and chemical channels, and that dogs will exhibit emotional contagion, particularly with familiar humans. This study investigated relationships between emotional states of dogs and unfamiliar human handlers, using simultaneous measures of cardiac activity and behavior, during two sessions of three consecutive routine handling sets. Measures of cardiac activity included mean heart rate (HR_mean), and two measures of heart rate variability (HRV): the root mean square of successive differences between normal heartbeats (RMSSD); and the high frequency absolute power component of HRV, log transformed (HF_log). We also assessed human handlers' emotional state during handling sessions following an intervention designed to reduce stress, compared with sessions conducted on a different day and following a control activity. Polar H10 cardiac sensors were used to simultaneously record cardiac activity for both canine and human participants, and behavioral data were collected via digital video. The strongest influence on the dogs' stress levels in our study was found to be increasing familiarity with the setting and the handler; HR_mean and SI decreased, and HRV (as RMSSD) increased, significantly from the first to the third handling set. Canine HRV (as HF_log) was also highest in set 3, although the difference was not statistically significant. There were no strong patterns found in the human cardiac data across handling set, session, or by pre-handling activity. We did not find consistent support for emotional contagion between the dogs and their handlers in this study, perhaps due to the brief time that the dogs spent with the handlers. Recommendations for application to dog handling, and limitations of our methods, are described.

Use of Surpass Streamline Flow Diverter for the Endovascular Treatment of Craniocervical Aneurysms: a Single-Institution Experience

INTRODUCTION

Flow diversion has revolutionized endovascular treatment for cerebral aneurysms. Surpass Streamline flow-diverter (SSFD) has shown promise for expanding flow diversion device options for aneurysm treatment. The SSFD differs from earlier stents by maintaining high porosity with increased pore density to ensure appropriate flow disruption. Given the delivery system's increased dimension options, and potential greater flow diverting properties, the SSFD is poised to extend the anatomic/pathologic reaches of flow diversion therapy.

METHODS

Data pertaining to SSFD-treated aneurysms were gathered retrospectively from 2019 to 2020. Collected information included aneurysm location, size, symptoms, complications, and occlusions rates at follow-up. Size was categorized as small (<10 mm), large (10-25 mm), and giant (>25 mm) according to SCENT trial criteria. Aneurysm occlusion on follow-up imaging was characterized by SMART grading with adequate occlusion defined as grades 3 and 4. Imaging was performed at time of treatment, six-month, and one-year follow-up.

RESULTS

42 SSFD-treated aneurysms were treated throughout the cerebrovascular system; 3 cervical, 4 posterior, and 35 intracranial anterior circulation. Complete occlusion rates at six months and one year were 48% and 57% with adequate occlusion achieved in 89.6% and 85.7% respectively. Rates of complete occlusion were higher for small aneurysms (69%) compared to large aneurysms (38%).

CONCLUSIONS

Our data suggests comparable complete occlusion rates compared to the SCENT trial (66.1% vs 57% in our center) and adequate occlusion rates. Similar occlusion rates to prior studies despite broadened inclusion criteria/diversity of aneurysms treated demonstrates favorable generalizability of flow-diverting technology to a wide array of aneurysmal pathology.

Early maternal separation is not associated with changes in telomere length in domestic kittens (Felis catus)

OBJECTIVE

Studies of multiple species have found that adverse early life experiences, including childhood trauma and maternal separation, can result in accelerated telomere shortening. The objective of this study was to determine if premature separation from the mother affected telomere length in domestic kittens (Felis catus). Subjects were 42 orphaned kittens and 10 mother-reared kittens from local animal rescue groups and shelters. DNA was extracted from whole blood collected from kittens at approximately 1 week and 2 months of age. Telomere length was assessed by qPCR (quantitative polymerase chain reaction) from a total of 86 samples and expressed as a ratio of telomere PCR relative to a single copy gene PCR (T/S).

RESULTS

A generalized linear mixed model found there were no detectable differences in telomere length based on survival (F 1, 76.2 = 3.35, p = 0.07), orphan status (F 1, 56.5 = 0.44, p = 0.51), time point (F 1, 43.5 = 0.19, p = 0.67), or the interaction between orphan status and time (F 1, 43.5 = 0.86, p = 0.36). Although in other species telomere shortening is commonly associated with aging, even early in life, we did not find evidence for telomere shortening by two months of age. Our results suggest that the experience of early maternal separation in domestic cats who are subsequently hand-reared by humans does not accelerate telomere shortening compared to mother-reared kittens, at least in the first few months of life.

Characterisation of Cellulose Synthase Like F6 (CslF6) Mutants Shows Altered Carbon Metabolism in β-D-(1,3;1,4)-Glucan Deficient Grain in Brachypodium distachyon

Brachypodium distachyon is a small, fast growing grass species in the Pooideae subfamily that has become established as a model for other temperate cereals of agricultural significance, such as barley (Hordeum vulgare) and wheat (Triticum aestivum). The unusually high content in whole grains of β-D-(1,3;1,4)-glucan or mixed linkage glucan (MLG), considered a valuable dietary fibre due to its increased solubility in water compared with cellulose, makes B. distachyon an attractive model for these polysaccharides. The carbohydrate composition of grain in B. distachyon is interesting not only in understanding the synthesis of MLG, but more broadly in the mechanism(s) of carbon partitioning in cereal grains. Several mutants in the major MLG synthase, cellulose synthase like (CSL) F6, were identified in a screen of a TILLING population that show a loss of function in vitro. Surprisingly, loss of cslf6 synthase capacity appears to have a severe impact on survival, growth, and development in B. distachyon in contrast to equivalent mutants in barley and rice. One mutant, A656T, which showed milder growth impacts in heterozygotes shows a 21% (w/w) reduction in average grain MLG and more than doubling of starch compared with wildtype. The endosperm architecture of grains with the A656T mutation is altered, with a reduction in wall thickness and increased deposition of starch in larger granules than typical of wildtype B. distachyon. Together these changes demonstrate an alteration in the carbon storage of cslf6 mutant grains in response to reduced MLG synthase capacity and a possible cross-regulation with starch synthesis which should be a focus in future work in composition of these grains. The consequences of these findings for the use of B. distachyon as a model species for understanding MLG synthesis, and more broadly the implications for improving the nutritional value of cereal grains through alteration of soluble dietary fibre content are discussed.

A RAC-GEF network critical for early intestinal tumourigenesis

RAC1 activity is critical for intestinal homeostasis, and is required for hyperproliferation driven by loss of the tumour suppressor gene Apc in the murine intestine. To avoid the impact of direct targeting upon homeostasis, we reasoned that indirect targeting of RAC1 via RAC-GEFs might be effective. Transcriptional profiling of Apc deficient intestinal tissue identified Vav3 and Tiam1 as key targets. Deletion of these indicated that while TIAM1 deficiency could suppress Apc-driven hyperproliferation, it had no impact upon tumourigenesis, while VAV3 deficiency had no effect. Intriguingly, deletion of either gene resulted in upregulation of Vav2, with subsequent targeting of all three (Vav2-/- Vav3-/- Tiam1-/-), profoundly suppressing hyperproliferation, tumourigenesis and RAC1 activity, without impacting normal homeostasis. Critically, the observed RAC-GEF dependency was negated by oncogenic KRAS mutation. Together, these data demonstrate that while targeting RAC-GEF molecules may have therapeutic impact at early stages, this benefit may be lost in late stage disease.

Cutaneous Eccrine Adenolipoma with a Spindle Cell Component

Introduction/Objective

Cutaneous adenolipoma is a rare, benign variant of solitary lipoma characterized by a mature adipocytic proliferation with entrapped eccrine or apocrine sweat glands. It is found predominately in middle-aged females, with a predilection for lower extremities including the thigh and gluteal regions. Cutaneous adenolipoma is presumed to be a hamartomatous process. Herein, we report a unique case of a cutaneous eccrine adenolipoma with a spindle cell component, namely, an early evolving spindle cell adenolipoma.

Methods

A 43-year-old female with a recurrent history of hidradenitis presented with a 2.7 cm x 1.5 cm x 0.7 cm soft, mobile nodule on the right posterior thigh. It had been present for at least four months and clinically resembled a lipoma. An excisional punch biopsy was performed for pathological evaluation. A concurrent nevus lipomatosus superficialis was diagnosed from the right perineum.

Results

Gross examination of the thigh nodule revealed fragments of a tan-yellow, lobulated, fatty lesion. Microscopic examination demonstrated a benign lipomatous proliferation with entrapped eccrine glands associated with a surrounding spindle cell stroma. Initial differential diagnosis included a cutaneous eccrine adenolipoma variant and a cutaneous mixed solitary hamartoma composed of admixed neural, eccrine and lipomatous components.

Immunohistochemical staining showed uptake for CD34 and CD10 in the spindle cell stromal component, but negative for desmin and S100. Based on our histopathological findings, our diagnosis of an eccrine cutaneous adenolipoma with a spindle cell component was rendered. This unique lesion displayed features of an evolving spindle cell lipoma with entrapped sweat glands, which may be viewed as an early stage of a dermal spindle cell adenolipoma.

Conclusion

Cutaneous eccrine adenolipoma is a rare, benign lipomatous neoplasm with entrapped sweat glands that can also show a spindle cell component. We share this rare lesion exemplifying the histomorphological spectrum of a lipomatous hamartoma and to highlight the recognition of a cutaneous adenolipoma.

Surgical and Behavioral Relationships With Welfare

Veterinarians perform surgery for a number of reasons, from treating a problem to preventing future problems. There is an inextricable link between the physical and psychological aspects of an animal's health, and surgery is often a conduit to bridge that gap. Some surgical procedures can affect an animal's behavior, such as castration, and some pose an ethical dilemma, such as ear cropping and declawing. Ameliorating pain, decreasing stressful experiences for the animal, and identifying and treating concurrent problem behaviors are hallmarks of improving animal welfare. The purpose of this article is to outline some of these interrelationships and ethical dilemmas, providing evidence-based verification as applicable.

Stress and Feline Health

In the health sciences, stress often is defined in terms of stressors; events that are perceived as threats to one's perception of control. From this perspective, a stressor is anything that activates the central threat response system (CTRS). Recent research shows that the CTRS can be sensitized to environmental events through epigenetic modulation of gene expression. When CTRS activation is chronic, health and welfare may be harmed. Environmental modification can mitigate the harmful effects of chronic CTRS activation by reducing the individual's perception of threat and increasing its perception of control, which improves health and welfare.

Owner observations regarding cat scratching behavior: an internet-based survey

Objectives

This study was performed to examine aspects of the cat, environment and scratching post that might influence scratching behavior, in an effort to determine how inappropriate scratching behavior might be refocused on acceptable targets.

Methods

An internet survey, posted on several public websites, gathered details about scratching behavior, as described by owners in their home environments, from 4331 respondents over a 4 month period. Responses from 39 different countries were analyzed, mostly from the USA, Canada and the UK.

Results

Owners offered traditionally recommended scratching substrates including rope, cardboard, carpet and wood. Rope was most frequently used when offered, although carpet was offered most commonly. Most owners provided at least one scratching post; cats scratched the preferred substrate more often when the post was a simple upright type or a cat tree with two or more levels and at least 3 ft high. Narrower posts (base width ⩽3 ft) were used more often than wider posts (base width ⩾5 ft). Intact or neutered cats (males and females) were as likely to scratch inappropriately, and inappropriate scratching decreased with age. Geriatric cats between the ages of 10 and 14 years preferred carpet substrate most frequently; all other ages preferred rope first. Inappropriate scratching decreased as the different types/styles of posts increased in the home. Inappropriate scratching did not increase if the number of cats or dogs increased in the household. Declawed cats were preventatively declawed most often to prevent household item destruction.

Conclusions and relevance

Although cats can have individual preferences, our data provide a starting point for veterinarians recommending scratching posts to clients.

Targeted genotyping-by-sequencing permits cost-effective identification and discrimination of pasture grass species and cultivars

A targeted amplicon-based genotyping-by-sequencing approach has permitted cost-effective and accurate discrimination between ryegrass species (perennial, Italian and inter-species hybrid), and identification of cultivars based on bulked samples. Perennial ryegrass and Italian ryegrass are the most important temperate forage species for global agriculture, and are represented in the commercial pasture seed market by numerous cultivars each composed of multiple highly heterozygous individuals. Previous studies have identified difficulties in the use of morphophysiological criteria to discriminate between these two closely related taxa. Recently, a highly multiplexed single nucleotide polymorphism (SNP)-based genotyping assay has been developed that permits accurate differentiation between both species and cultivars of ryegrasses at the genetic level. This assay has since been further developed into an amplicon-based genotyping-by-sequencing (GBS) approach implemented on a second-generation sequencing platform, allowing accelerated throughput and ca. sixfold reduction in cost. Using the GBS approach, 63 cultivars of perennial, Italian and interspecific hybrid ryegrasses, as well as intergeneric Festulolium hybrids, were genotyped. The genetic relationships between cultivars were interpreted in terms of known breeding histories and indistinct species boundaries within the Lolium genus, as well as suitability of current cultivar registration methodologies. An example of applicability to quality assurance and control (QA/QC) of seed purity is also described. Rapid, low-cost genotypic assays provide new opportunities for breeders to more fully explore genetic diversity within breeding programs, allowing the combination of novel unique genetic backgrounds. Such tools also offer the potential to more accurately define cultivar identities, allowing protection of varieties in the commercial market and supporting processes of cultivar accreditation and quality assurance.

Non-clinical health services – what do they contribute to patient care and how can we measure their contribution?

Background and aims

Assessing the contribution of ‘support services’ to improving healthcare is challenging. Despite involving a significant part of the NHS budget, there is very little published literature on methods and approaches. This article describes the development of an integrated approach to assessing and measuring the health impact of these services.

Methods and results

An empirical approach was developed by the main provider of national support services to NHS Scotland. This involved identifying meaningful ways to describe health impact of services several steps removed from patient care, applying this to the full range of national support services provided by NHS National Services Scotland and developing relevant measurement methodologies. Through this approach it was possible to assess the relative health impact of all 63 NSS services and to use this for planning and prioritisation.

Conclusion

Assessing the contribution of support services to improving patient outcomes is a neglected area, despite the significant dependency of direct patient care services upon these services and the resource involved. The methods described in this article have potential to be used across the range of support services within the NHS to improve quality and efficiency of healthcare services.

Drought adversely affects tuber development and nutritional quality of the staple crop cassava (Manihot esculenta Crantz)

Cassava (Manihot esculenta Crantz) is the staple food source for over 850million people worldwide. Cassava contains cyanogenic glucosides and can be toxic to humans, causing paralysing diseases such as konzo, and even death if not properly processed. Konzo epidemics are often associated with times of drought. This may be due to a greater reliance on cassava as it is drought tolerant, but it may also be due to an increase in cyanogenic glucosides. Episodic droughts are forecast to become more common in many cassava-growing regions. We therefore sought to quantify the effect of water-stress on both yield and cyanogenic glucoside concentration (CNc) in the developing tubers of cassava. Five-month-old plants were grown in a glasshouse and either well watered or droughted for 28 days. A subset of droughted plants was re-watered half way through the experiment. Droughted plants had 45% fewer leaves and lower tuber yield, by 83%, compared with well-watered plants. CNc was 2.9-fold higher in the young leaves of droughted plants, whereas CNc in tubers from droughted plants was 4-fold greater than in tubers from well-watered plants. Re-watered plants had a similar biomass to control plants, and lower CNc than droughted plants. These findings highlight the important link between food quality and episodic drought.

The importance of understanding epidemiology in order to inform financial decisions: a lesson from the Scottish Home Oxygen Service

OBJECTIVES

To ensure that decisions on the future planning of the Scottish Home Oxygen Service reflect population needs by examining the epidemiology of the main conditions that require home oxygen therapy and trends in their management.

STUDY DESIGN

Analysis of routinely available vital event and health service data supplemented by published literature. Use of linked data to provide person-based analyses.

METHODS

Consideration of trends in key risk factors, disease incidence, prevalence and mortality for chronic neonatal lung disease, cystic fibrosis, chronic interstitial lung disease in adults and chronic obstructive pulmonary disease. Examination of trends in management of these conditions including hospital admissions, length of stay and re-admissions.

RESULTS

The prevalence of all the conditions studied has increased in Scotland over recent years due to a combination of increased incidence, increased survival, more active case finding and demographic changes. There have been changes in management with trends towards shorter hospital stays.

CONCLUSIONS

The clinical need for home oxygen therapy is likely to continue to increase over the next 10-20 years. It will encompass all age groups and a complex range of conditions. Public health needs to be proactive in providing relevant needs assessment information to ensure that planning within financial constraints is appropriately informed on population needs.

Effect of egg washing on the cuticle quality of brown and white table eggs

Egg washing is currently not permitted within the European Union, with few exceptions. This is mainly because there are concerns that cuticle damage could occur during or after the washing process, as a result of a suboptimal operation. In this study, the cuticle coverage levels of 400 washed or unwashed eggs, derived from either a brown or a white egg-laying flock at the end of lay, were compared. The eggs from older hens inherently have poorer cuticle coverage and as a result arguably constitute a greater risk to consumer safety if they are then washed. Thus, the effects of the washing procedure used in this study on cuticle quality were tested under the worst-case scenario. A standard Swedish egg washing process was used. The cuticle coverage of the eggs was assessed by a colorimeter by quantifying the color difference before and after staining with Tartrazine and Green S. The cuticle of an additional 30 eggs from each of the four groups was then visually assessed by scanning electron microscopy. The staining characteristics of the cuticle varied greatly within each group of eggs and showed that the washing process did not lead to cuticle damage. Scanning electron microscopy confirmed that there was no irreversible damage to the cuticle of the washed eggs and that it was not possible to correctly assign the treatment (washed or not) based on a visual assessment. In conclusion, no evidence could be found to suggest that the washing procedure used in this investigation irreversibly changed the quality of the cuticle.

Endovascular treatment of carotid embolic occlusions has a higher recanalization rate compared with cardioembolic occlusions

BACKGROUND AND PURPOSE

Treatment of large artery cerebral occlusions is rapidly evolving. We hypothesized that patients with intracranial embolic occlusions secondary to an extracranial carotid artery stenosis or occlusion have a higher probability of successful endovascular recanalization compared with those with cardioembolic occlusions.

METHODS

We retrospectively reviewed the databases of three institutions (University of Pittsburgh Medical Center (UPMC), Michigan State University (MSU) and Cleveland Clinic Foundation (CCF)) for acute anterior circulation ischemic strokes treated with endovascular therapies from January 2006 to July 2008. After collection of demographic, radiographic and angiographic variables, two groups were identified: artery to artery embolic occlusions and cardioembolic/cryptogenic intracranial occlusions. We defined recanalization as TIMI 2 or 3 flow. A binary logistic regression model was constructed to determine which characteristics were unique to patients with carotid embolic occlusions.

RESULTS

A total of 207 patients were identified (UPMC=100, CCF=71, MSU=36) with a mean age of 69±11 years and mean NIHSS of 17±5. Of these, 157 (75%) were due to a cardiac or cryptogenic source and 50 (25%) were from a carotid embolic source. The use of multimodal therapy (OR 2.6 (1.2-5.6), p<0.009) and the presence of a carotid embolic intracranial occlusion (OR 3.6 (1.2-7.1), p<0.012) were associated with successful recanalization, while carotid terminus occlusions were associated with unsuccessful recanalization (OR 0.35 (0.18-0.68), p<0.002).

CONCLUSIONS

Patients with intracranial occlusions secondary to an extracranial carotid stenosis or total occlusion appear to have more successful recanalization rates when treated with endovascular therapy compared with those with cardioembolic occlusions.

Inflammation-dependent expression of SPARC during development of chronic pancreatitis in WBN/Kob rats and a microarray gene expression analysis

The pathophysiology of human chronic pancreatitis is not well understood and difficult to follow on a molecular basis. Therefore, we used a rat model [Wistar-Bonn/Kobori (WBN/Kob)] that exhibits spontaneous chronic inflammation and fibrosis in the pancreas. Using microarrays we compared gene expression patterns in the pancreas during development of inflammation and fibrosis of WBN/Kob rats with age-matched healthy Wistar rats. The extracellular matrix protein SPARC (secreted protein, acidic, and rich in cysteines) and other transcripts of inflammatory genes were quantified by real-time PCR, and some were localized by immunohistochemistry. When pancreatic inflammation becomes obvious at the age of 16 wk, several hundred genes are increased between 3- and 50-fold in WBN/Kob rats compared with healthy Wistar rats. Proteins produced by acinar cells and characteristic for inflammation, e.g., pancreatitis-associated protein, are highly upregulated. Other proteins, derived from infiltrating inflammatory cells and from activated stellate cells (fibrosis) such as collagens and fibronectins are also significantly upregulated. SPARC was localized to acinar cells where it increased in the vicinity of inflammatory foci. However, acinar expression of SPARC was lost during destruction of acinar cells. In human pancreatic specimens with chronic pancreatitis, SPARC exhibited a similar expression profile. During chronic inflammation and fibrosis in the WBN/Kob rat, inflammatory genes, growth factors, and structural genes exhibit a high increase of expression. A temporal profile including pre- and postinflammatory phases indicates a concurrent activation of inflammatory and fibrotic changes. Inflammation dependent expression of SPARC appears to be lost during acinar-to-duct metaplasia both in rat and human pancreas.

Polymorphisms in eggshell organic matrix genes are associated with eggshell quality measurements in pedigree Rhode Island Red hens

Novel and traditional eggshell quality measurements were made from up to 2000 commercial pedigree hens for a candidate gene association analysis with organic eggshell matrix genes: ovocleidin-116, osteopontin (SPP1), ovocalyxin-32 (RARRES1), ovotransferrin (LTF), ovalbumin and ovocalyxin-36, as well as key genes in the maintenance and function of the shell gland [estrogen receptor (ESR1) and carbonic anhydrase II (CAII)]. Associations were found for (i) ovalbumin with breaking strength and shell thickness; (ii) ovocleidin-116 with elastic modulus, shell thickness and egg shape; (iii) RARRES1 with mammillary layer thickness; (iv) ESR1 with dynamic stiffness; (v) SPP1 with fracture toughness and (vi) CAII with egg shape. The marker effects are as large as 17% of trait standard deviations and could be used to improve eggshell quality.

Legislation restricting paracetamol sales and patterns of self-harm and death from paracetamol-containing preparations in Scotland

AIMS

To describe how changes in legislation to restrict paracetamol sales have affected overdose discharges and death associated with the drug in Scotland.

METHODS

A descriptive analysis of routine death and hospital discharge data for the entire Scottish population between 1995 and 2004. Patients in Scotland participated who were discharged from hospital with a diagnosis of poisoning; deaths in Scotland from diagnosis of poisoning 1995-2003 were also analysed. Outcome measures were changes in mortality and overdose due to poisoning involving paracetamol. A comparison was made of in-hospital and out-of-hospital mortality in fatalities involving paracetamol.

RESULTS

The majority of paracetamol-associated deaths were due to co-proxamol. Deaths associated with paracetamol alone or with ethanol occurred principally in hospital and were a minority of deaths overall. The proportion of in-hospital deaths attributed to paracetamol increased (post/pre ratio 1.347; 95% confidence interval 1.076, 1.639; P = 0.013). Overall numbers of cases discharged with poisoning fell. The proportion of these involving paracetamol in any form increased significantly in all groups except young men aged 10 to <20 years.

CONCLUSIONS

Legislation has not reduced mortality or proportional use of paracetamol in overdose, both of which appear to have increased in Scotland since pack-size limitations. Other approaches are necessary to reduce the death rate from overdoses involving paracetamol.

Hospital admissions and deaths relating to deliberate self-harm and accidents within 5 years of a cancer diagnosis: a national study in Scotland, UK

The risk of suicide in cancer patients has been reported as elevated in several countries. These patients are exposed to many medicines that may confuse or provide a means for harm, potentially also increasing their risk from accidents. Ratios of observed/expected numbers of hospital admission and death events relating to deliberate self-harm (DSH) and accidents were calculated in the 5 years from a cancer diagnosis in Scotland 1981–1995, compared to the matched general population. The relative risk (RR) of suicide was 1.51 (95% confidence interval (CI): 1.29–1.76). The RR of hospital admissions for DSH was not significantly increased, suggesting a strong suicidal intent in DSH acts in cancer patients. Accidental poisonings and all other accidents were both increased (RR death=3.69, 95% CI: 2.10–6.00; and 1.58, 95% CI: 1.48–1.69, respectively) (RR hospital admissions=1.32, 95% CI: 1.19–1.47; and 1.55, 95% CI: 1.53–1.57, respectively). The association of only certain tumour types (e.g. respiratory) with suicide and accidental poisoning, and a broad range of tumour types with an elevated risk of all other accidents, suggests accidental poisoning categories may be a common destination for code shifting of some DSH events. A previous history of DSH or accidents, significantly increased the RR of suicide or fatal accidents, respectively (RR suicide=14.86 (95% CI: 4.69–34.97) vs 1.16 (95% CI: 0.84–1.55)) (RR accidental death=3.37 (95% CI: 2.53–4.41) vs 1.29 (95% CI: 1.12–1.49)). Within 5 years of a cancer diagnosis, Scottish patients are at increased RR of suicide and fatal accidents, and increased RR of hospital admissions for accidents. Some of these accidents, particularly accidental poisonings, may contain hidden deliberate acts. Previous DSH or accidents are potential markers for those most at risk, in whom to target interventional techniques.