Trends in intentional and unintentional poisonings among older adults - A national register-based study in Sweden

BACKGROUND

Among older people intentional poisoning outnumber unintentional ones. While there are indications that time trends differ by poisoning intent, studies are scarce. We assessed how the annual prevalence of intentional and unintentional poisoning changed over time, overall and by demographic groups.

METHODS

We conducted a national open cohort study of individuals aged 50-100 years, resident in Sweden during 2005-2016. Individuals were followed up in population-based registers for their demographic and health attributes from 2006-2016. Annual prevalence of hospitalization and death by poisoning intent (unintentional vs. intentional or undetermined; ICD-10 definitions) were compiled for the categories of four demographic attributes (age, sex, marital status, and birth cohort "baby boomers"). The time trends were assessed by multinomial logistic regression with year as an independent variable.

RESULTS

The annual overall prevalence of hospitalization and death by intentional poisonings consistently exceeded that of unintentional poisonings. There was a significant downward trend in intentional poisonings but not in unintentional ones. This difference in trends also applied when considering men and women separately, married and unmarried people, the young-old individuals (but not the older- or oldest-old ones), and the baby boomers and non-baby boomers. The largest demographic differences within intent were found between married and unmarried people, and the smallest one between men and women.

CONCLUSION

As expected, the annual prevalence of intentional poisonings considerably exceed that of unintentional ones among Swedish older people. The recent trends reveal a significant reduction of intentional poisonings, consistent across a range of demographic attributes. The scope for action regarding this preventable cause of mortality and morbidity remains considerable.

Performance of a cryo-cooled crystal monochromator illuminated by hard X-rays with MHz repetition rate at the European X-ray Free-Electron Laser

Due to the high intensity and MHz repetition rate of photon pulses generated by the European X-ray Free-Electron Laser, the heat load on silicon crystal monochromators can become large and prevent ideal transmission in Bragg diffraction geometry due to crystal deformation. Here, we present experimental data illustrating how heat load affects the performance of a cryogenically cooled monochromator under such conditions. The measurements are in good agreement with a depth-uniform model of X-ray dynamical diffraction taking beam absorption and heat deformation of the crystals into account.

Pump-probe X-ray holographic imaging of laser-induced cavitation bubbles with femtosecond FEL pulses

Cavitation bubbles can be seeded from a plasma following optical breakdown, by focusing an intense laser in water. The fast dynamics are associated with extreme states of gas and liquid, especially in the nascent state. This offers a unique setting to probe water and water vapor far-from equilibrium. However, current optical techniques cannot quantify these early states due to contrast and resolution limitations. X-ray holography with single X-ray free-electron laser pulses has now enabled a quasi-instantaneous high resolution structural probe with contrast proportional to the electron density of the object. In this work, we demonstrate cone-beam holographic flash imaging of laser-induced cavitation bubbles in water with nanofocused X-ray free-electron laser pulses. We quantify the spatial and temporal pressure distribution of the shockwave surrounding the expanding cavitation bubble at time delays shortly after seeding and compare the results to numerical simulations.

Materials Imaging and Dynamics (MID) instrument at the European X-ray Free-Electron Laser Facility

The Materials Imaging and Dynamics (MID) instrument at the European X-ray Free-Electron Laser (EuXFEL) facility is described. EuXFEL is the first hard X-ray free-electron laser operating in the MHz repetition range which provides novel science opportunities. The aim of MID is to enable studies of nano-structured materials, liquids, and soft- and hard-condensed matter using the bright X-ray beams generated by EuXFEL. Particular emphasis is on studies of structure and dynamics in materials by coherent scattering and imaging using hard X-rays. Commission of MID started at the end of 2018 and first experiments were performed in 2019.

Minimally invasive accessory splenectomy for recurrent gastric variceal bleeding due to left-sided portal hypertension: report of the first case

Upper gastrointestinal bleeding from esophagogastric varices is a common scenario, especially in patients with portal hypertension induced by liver cirrhosis or other diseases with thrombosis of the splenic vein. However, accessory spleen as pathophysiological cause of a regional, left-sided portal hypertension and consecutive development of isolated gastric varices is rare. We report a case of recurrent gastric variceal bleeding resulting from sinistral portal hypertension associated with an accessory spleen in a patient who had traumatic splenectomy many decades before. The accessory spleen is an extremely rare cause for the development of regional, left-sided portal hypertension leading to isolated gastric varices. Minimally invasive splenectomy is a safe and efficient treatment option.

The association of prepartum urine pH, plasma total calcium concentration at calving and postpartum diseases in Holstein dairy cattle

The use of anionic salts to prevent milk fever in dairy cattle has been an effective nutritional strategy; however, the degree of acidification that determines the most acceptable productive responses and well-being of the cow is still a controversial topic. The objective of this study was to assess urine pH in prepartum Holstein cows fed anionic diets and determine its association with plasma total Ca, Mg, P, β-hydroxyl-butyrate (BHB) concentrations at parturition and the occurrence of peripartum disorders. This investigation consisted of 2 studies. Study 1 was conducted on a grazing dairy. Between February and May 2019, 60 prepartum multiparous cows were tested for urine pH and plasma metabolite concentration at parturition. Total Ca, P, Mg and BHB at day 1 in milk (DIM) were assessed and statistically analyzed by ANOVA (models for polynomial regression). Study 2 was conducted on a drylot dairy farm. Between July 2018 and January 2019, 203 cows were evaluated for urine pH and followed-up for 30 DIM to obtain the incidence of dystocia, stillbirths, milk fever, retained fetal membranes, metritis, clinical mastitis and ketosis. Cows were categorized based on their last urine pH as group 1: pH > 7.0 (n = 135); group 2: pH between 6.0 and 7.0 (n = 46) and group 3: pH < 6.0 (n = 22). A logistic regression model for each health event was conducted considering urine pH group as the main effect. Urine sample was collected at 2.71 ± 2.84 days before parturition. In study 1, there was a quadratic effect of urine pH on total Ca. Total Ca concentration was higher between urine pH 6.0 and 7.0, while decreasing below pH 6.0 and above pH 7.0. There was a trend (P = 0.11) for a quadratic effect of urine pH on the concentration of plasma BHB at parturition. β-Hydroxyl-butyrate was lower approximately between urine pH 6.5 and 7.5. In study 2, the odds for a stillborn in cows with urine pH < 6.0 was 2.39 (95% CI = 1.06-5.40) times the odds for a stillborn in cows with urine pH ≥ 7.0. There was no association between urine pH and the other diseases. In conclusion, cows with prepartum urine pH < 6.0 and >7.0 had lower concentration of plasma total Ca and tended to have a higher concentration of BHB. Cows with urine pH < 6.0 had a higher incidence of stillbirths than cows with urine pH > 7.0.

Gravimetric Determination of Acid Detergent Fiber and Lignin in Feed: Interlaboratory Study

On the basis of AOAC Official Method 973.18, a collaborative study was performed to determine fractions of acid detergent fiber (ADF) and lignin (ADL) in animal feed. The study used 6 animal feed and forage samples as blind duplicates and involved 22 participants from 7 countries. The samples analyzed covered a range from 3.5 to 70 ADF and from &lt;1 to 20 ADL. Repeatability standard deviations ranged from 0.27 to 0.95 for ADF and from 0.08 to 0.59 for ADL. The reproducibility standard deviations ranged from 0.56 to 2.44 for ADF and from 0.52 to 2.09 for ADL. Analyzed samples comprised clover and grass silages, soy meal, cattle feed, wheat, and sawdust. The studied method has been published as the EN ISO 13906:2008 standard.

Ultra-small-angle X-ray photon correlation spectroscopy using the Eiger detector

Successful implementation of the single-photon-counting Eiger 500k pixel array detector for sub-millisecond X-ray photon correlation spectroscopy (XPCS) measurements in the ultra-small-angle scattering region is reported. The performance is demonstrated by measuring the dynamics of dilute silica colloids in aqueous solvents when the detector is operated at different counter depths, 4, 8 and 12 bit. In the fastest mode involving 4 bit parallel readout, a stable frame rate of 22 kHz is obtained that enabled measurement of intensity-intensity autocorrelation functions with good statistics down to the 50 µs range for a sample with sufficient scattering power. The high frame rate and spatial resolution together with large number of pixels of the detector facilitate the investigation of sub-millisecond dynamics over a broad length scale by multispeckle XPCS. This is illustrated by an example involving phoretic motion of colloids during the phase separation of the solvent.

Injurious falls and subsequent adverse drug events among elderly - a Swedish population-based matched case-control study

Background

Fall injuries are stressful and painful and they have a range of serious consequences for older people. While there is some clinical evidence of unintentional poisoning by medication following a severe fall injuries, population-based studies on that association are lacking. This is investigated in the current study, in which attention is also paid to different clinical conditions of the injured patients.

Methods

We conducted a matched case-control study of Swedish residents 60 years and older from various Swedish population-based registers. Cases defined as adverse drug events (ADE) by unintentional poisoning leading to hospitalization or death were extracted from the National Patient Register (NPR) and the Cause of Death Register from January 2006 to December 2009 (n = 4418). To each case, four controls were matched by sex, age and residential area. Information on injurious falls leading to hospitalization six months prior to the date of hospital admission or death from ADE by unintentional poisoning, and corresponding date for the controls, was extracted from the NPR. Data on clinical conditions, such as dispensed medications, comorbidity and previous fall injuries were also extracted from the Swedish Prescribed Drug Register (SPDR) and NPR. Effect estimates were calculated using conditional logistic regression and presented as odds ratios (OR) and 95% confidence intervals (CI).

Results

We found a three-fold increased risk of unintentional poisoning by medication in the six-month period after an injurious fall (OR 3.03; 95% CI, 2.54–3.74), with the most pronounced increase 1–3 weeks immediately after (OR, 7.66; 95% CI, 4.86–12.1). In that time window, from among those hospitalized for a fall (n = 92), those who sustained an unintentional poisoning (n = 60) tended to be in poorer health condition and receive more prescribed medications than those who did not, although this was not statistically significant. Age stratified analyses revealed a higher risk of poisoning among the younger (aged 60–79 years) than older elderly (80+ years).

Conclusion

Medication-related poisoning leading to hospitalization or death can be an ADE subsequent to an episode of hospitalization for a fall-related injury. Poisoning is more likely to occur closer to the injurious event and among the younger elderly. It cannot be ruled out that some of those falls are themselves ADE and early signs of greater vulnerability among certain patients.

Electronic supplementary material

The online version of this article (10.1186/s12877-017-0594-1) contains supplementary material, which is available to authorized users.

Effectiveness of interventions on physical activity in overweight or obese children: a systematic review and meta-analysis including studies with objectively measured outcomes

There is no consensus on interventions to be recommended in order to promote physical activity among overweight or obese children. The objective of this review was to assess the effects on objectively measured physical activity, of interventions promoting physical activity among overweight or obese children or adolescents, compared to no intervention or to interventions without a physical activity component. Publications up to December 2015 were located through electronic searches for randomized controlled trials resulting in inclusion of 33 studies. Standardized mean differences from baseline to post-intervention and to long-term follow-up were determined for intervention and control groups and meta-analysed using random effects models. The meta-analysis showed that interventions had no effect on total physical activity of overweight and obese children, neither directly post-intervention (-0.02 [-0.15, 0.11]) nor at long-term follow-up (0.07 [-0.27, 0.40]). Separate analyses by typology of intervention (with or without physical fitness, behavioural or environmental components) showed similar results (no effect). In conclusion, there is no evidence that currently available interventions are able to increase physical activity among overweight or obese children. This questions the contribution of physical activity to the treatment of overweight and obesity in children in the studied interventions and calls for other treatment strategies.

Polaron-induced lattice distortion of (In,Ga)As/GaAs quantum dots by optically excited carriers

We report on a high resolution x-ray diffraction study unveiling the effect of carriers optically injected into (In,Ga)As quantum dots on the surrounding GaAs crystal matrix. We find a tetragonal lattice expansion with enhanced elongation along the [001] crystal axis that is superimposed on an isotropic lattice extension. The isotropic contribution arises from excitation induced lattice heating as confirmed by temperature dependent reference studies. The tetragonal expansion on the femtometer scale is tentatively attributed to polaron formation by carriers trapped in the quantum dots.

Increased risk for bronchitis after discharge in non-vaccinated very low birth weight infants

BACKGROUND

In very low birth weight (VLBW) infants, obstructive bronchitis is a frequent cause of hospital re-admission. For VLBW infants, early vaccinations starting at 2 months after birth have been recommended.

OBJECTIVE

To analyze risk factors for bronchitis during the first year after discharge and the effects of in-hospital standard vaccination (hexavalent/pneumococci) and/or RSV immunoprophylaxis with palivizumab.

METHODS

A standardized questionnaire was sent to the parents of VLBW infants 7 month after discharge. The reported episodes of bronchitis were correlated with clinically recorded parameters including risk factors for pulmonary morbidity. The effects of in-hospital vaccination were assessed in a subgroup discharged after day 60.

RESULTS

A sample of 1 967 responses of infants born 2009-2011 was analyzed. Risk factors for bronchitis were male gender and older siblings. 24% of the population had episodes of bronchitis. In the subgroup discharged after day 60, episodes of bronchitis were reported for 31% of infants who were not vaccinated in-hospital. A significant reduction of the bronchitis rate was found in infants who received palivizumab±standard vaccination (17% bronchitis, p=0.003). Interestingly, in-hospital standard vaccination without RSV immunoprophylaxis was protective (20% bronchitis; p=0.037) as well.

CONCLUSIONS

Non-vaccinated male VLBW infants with older siblings are at increased risk for bronchitis during the first year after discharge. Vaccination according to schedule seems to have protective effects, while underlying mechanisms are unknown. The rate of timely vaccination in preterm infants should be increased.

[Generation 55+: leadership and motivation of generations in hospitals]

BACKGROUND

Demographic changes in Germany are leading towards a decrease of the population from the current 82 million to 74 million in the year 2050. As a consequence the shortage of qualified staff will be aggravated and intensifying recruiting efforts will increase competition among employers. An alternative is to utilize the potential of jobholders older than 55 years, the so-called generation 55 +. However, little is known about the hospital workforce generation 55 +.

METHODS

An internet search was conducted using google.de, yahoo.de and altavista.de for "generation 55 + and medicine" and "demographics, personnel and hospital" In Medline/pubmed a search was conducted for the key words "aging workforce" (949 sources) and in combination with AND "doctors" (134 sources), "demographic changes", "staff" (794 sources) as well as for "generation 55 + AND doctors" (312 sources). Finally, sources from reputable public institutions and academic medical societies were analyzed. The data were sorted by main categories and relevance for hospitals. Statistical analysis was done mainly using descriptive measures.

RESULTS

From initially more than 530,000 sources, a total of 289 studies and reports on the topic were plotted. There was no evidence for a negative correlation between age and work ability or fitness. Jobholders senior to 55 years can be divided into the "economic miracle generation" and into the so-called baby-boomers. Both groups have differences in values, communication needs and leadership requirements. They jointly prefer direct communication and seek appreciation for their experience on the job.

CONCLUSIONS

Generation 55 + is not asking for an upscaled position in hospitals. They expect respect and appreciation for their sound experience of work and life. Generation 55 + wants to be integrated and sought after. Keeping these employees fit, motivated and qualified is a sound approach to fight the foreseeable shortage of qualified staff in hospitals.

Dynamic CpG-DNA methylation of Il10 and Il19 in CD4+ T lymphocytes and macrophages: effects on tissue-specific gene expression

The IL-10 family of cytokines consists of 9 members, including the immune-regulatory IL-10; Il19 is in close physical relationship with Il10 in the so-called IL-10 cytokine cluster on chromosome 1q32. While IL-10 is ubiquitously expressed, IL-19 expression is restricted to myeloid and epithelial cells. Little is known about molecular mechanisms that control tissue-specific expression of IL-10, and IL-19. Modifications in CpG-DNA methylation are a key mechanism in controlling transcription. Using bisulfite sequencing, we demonstrate that murine Il19 is methylated in CD4+ T lymphocytes. Macrophages display site-specific demethylation of Il19. The ubiquitously expressed Il10 gene is methylated to a lower degree and exhibits tissue-specific methylation patterns. DNA demethylation with 5-azacytidine resulted in an induction of IL-10, and IL-19 expression in CD4+ T cells, and CpG-DNA methylation through DNMT3a resulted in transcriptional silencing in macrophages. Thus, our findings suggest a role of CpG-DNA methylation in the regulation of Il10 and Il19.

[Predictors for low birth weight--an epidemiological case-control study with women in childbed in the federal state Saarland, Germany]

BACKGROUND AND AIMS

Low birth weight is associated with elevated health-care costs and adverse conditions for the newborn's start to life. A variety of health problems and an impaired potential for the infant's development are known long-term effects. Only few studies have examined the role of psychosocial and socioeconomic determinants for the incidence of low birth weight, especially in Germany. The aim of our study was to test the impact of maternal socioeconomic and psychosocial characteristics as well as health behaviour on the infant's birth weight.

METHODS

In an exploratory case-control study we tested whether the before mentioned potential determinants of low birth weight were observed more often among cases (birth weight <2,500 g) than among controls. Standardised interviews were conducted with maternal cases and controls.

RESULTS

The results show that mothers in the control group more often were married or cohabiting (100% vs. 77%; p<0.05) and that they had a higher occupational status (83% non-manual vs. 54%; p<0.05). Level of education was not significantly related to birth weight. Mothers in the case group more often reported exhaustion (p<0.05) and marital problems [M=1.8 (1.1) vs. M=1.3 (0.5); p<0.05). They were characterised by a higher burden of work-strain in terms of weather conditions, heat or infiltration [M=1.7 (1.0) vs. M=1.1 (0.4); p<0.05). The available living space was slightly smaller in the case group [M=96.5 m(2) (31.5 m(2)) vs. M=118.5 m(2) (46.8 m(2)); p<0.1).

DISCUSSION AND CONCLUSIONS

Our results confirm international studies showing differences regarding the social context of women who give birth to a child with normal or low birth weight. Apart from vertical status characteristics, marital conditions and resulting psychosocial stressors seem to have an impact.

Results of lumbosacral distraction spondylodesis for the treatment of spondylolisthesis, failed-back syndrome, and lumbar instability

Various methods of lumbosacral fusions for the treatment of degenerative spinal diseases are used clinically. Results vary greatly depending on indication, type of fusion, implants, and method of evaluation. In a retrospective clinical and radiological examination after an average follow-up time of 3.9 years this study reports on the outcome of lumbosacral distraction spondylodesis (LSDS) in a consecutive series of 147 patients being fused for the treatment of spondylolisthesis, failed-back syndrome, or lumbar instability. LSDS consists of a posterolateral fusion together with an autologous corticocancellous H-graft wedged under distraction between the spinous processes of L4 and S1. With 81.0% good and excellent results this noninstrumented fusion technique showed the best outcome in patients with spondylolisthesis, while in cases with a failed-back syndrome or lumbar instability only 62.3% excellent to satisfying outcomes were noted. The rate of pseudarthrosis was 13.6% in the whole patient group; no major complications such as nerve root damage, postoperative neurological deficits, or spinal stenosis were found.

Surfactant without intubation in preterm infants with respiratory distress: first multi-center data

BACKGROUND

Recently in a report of a single center a method has been described to apply surfactant via a thin endotracheal catheter to very low birth weight infants spontaneously breathing with nasal continuous positive airway pressure. We now analyzed available multicenter data.

PATIENTS AND METHODS

In a multicenter study investigating genetic risk factors, clinical and outcome data and data of antenatal and postnatal treatment of infants with a birth weight below 1,500 g were prospectively recorded. The measures of infants treated with the new method of surfactant application were compared to those of infants who received standard care. The analysis was restricted to infants with a gestational age below 31 weeks (n=1,541).

RESULTS

319 infants were treated with the new method and 1,222 with standard care. The need for mechanical ventilation during the first 72 h (29% vs. 53%, p<0.001), the rate of bronchopulmonary dysplasia defined as oxygen at 36 weeks of postmenstrual age (10.9 % vs. 17.5%, p=0.004) and the rate of death or bronchopulmonary dysplasia were significantly lower in the treatment group than in the standard care group. Surfactant, theophyllin, caffeine and doxapram were significantly more often and analgetics, catecholamines and dexamethasone were significantly less frequently used in the treatment group.

CONCLUSIONS

A new method of surfactant application was associated with a lower prevalence of mechanical ventilation and better pulmonary outcome. A prospective controlled trial is required to determine whether this approach is superior to standard care.

Twenty year follow up of a patient with a new de-novo NLRP3 mutation (S595G) and CINCA syndrome

We report on a 22-year-old girl with a history of recurrent febrile episodes, chronic arthritis, urticarial rash, and neurological symptoms including right hemiparesis, internal hydrocephalus, mental retardation, progressive deafness, and visual impairment. Treatment starting at age 20 months, including different combinations of immunosuppressive and antiinflammatory drugs such as corticosteroids and anti-TNFalpha antibody, was unsuccessful. Four years ago, we found a heterozygous S595G mutation in the NLRP3 gene of this patient. This prompted us to introduce anakinra, which resulted in considerable improvement of the patient's complaints.

[Patient satisfaction--a potential cornerstone of hospital management]

BACKGROUND

Hospitals consider themselves to be exposed to intense competition for patient admissions. Yet their competitive performance is only rarely assessed in terms of patient satisfaction.

METHODS

Following agreed guidelines, formulated on the basis of interdisciplinary research, the University Clinical Centre (2,500 beds, 10,000 employees) of Schleswig Holstein, Germany's most northerly Bundesland, developed and distributed standardized questionnaires on patient satisfaction and collected them after completion.

RESULTS

18,711 completed questionnaires were collected from a population of 71,000 treated patients (rate of return: 26%; males 50,6%; females 49,4%). Two-thirds of admissions were elective whereas the remainder were emergencies. The quarterly evaluation revealed quality of food and cleanliness as the main areas of complaint. Patients' dissatisfactions was the greater the longer the stay in hospital. Other differences between patients on statutory or private health insurance, respectively, were voiced regarding "respectful treatment" and "professional ability" (especially by private patients). Furthermore, patient satisfaction related to the duration of doctors' rotation (i.e. how long they were on duty), satisfaction being greater the longer the period of rotation.

CONCLUSION

The study has provided information on patient satisfaction as a measure of effective hospital management.

Gravimetric determination of acid detergent fiber and lignin in feed: interlaboratory study

On the basis of AOAC Official Method 973.18, a collaborative study was performed to determine fractions of acid detergent fiber (ADF) and lignin (ADL) in animal feed. The study used 6 animal feed and forage samples as blind duplicates and involved 22 participants from 7 countries. The samples analyzed covered a range from 3.5 to 70% ADF and from <1 to 20% ADL. Repeatability standard deviations ranged from 0.27 to 0.95% for ADF and from 0.08 to 0.59% for ADL. The reproducibility standard deviations ranged from 0.56 to 2.44% for ADF and from 0.52 to 2.09% for ADL. Analyzed samples comprised clover and grass silages, soy meal, cattle feed, wheat, and sawdust. The studied method has been published as the EN ISO 13906:2008 standard.

[Risk scores and outcomes after cholecystectomy: a comparison between a university hospital and a short-stay clinic--a prospective observational study]

BACKGROUND

This study was designed to compare the risks of morbidity and mortality of patients in a surgical department of an academic medical centre and a short-stay clinic. Furthermore, economic and patient-related parameters were assessed.

METHODS

A number of 50 respectively 33 consecutive patients scheduled for a cholecystectomy were included in this prospective study. Data were collected well-assorted against the POSSUM score, the duration of the operation, complications and the length of stay as well as quality of life and patient satisfaction.

RESULTS

No differences among patients of the two hospitals became apparent as they were referenced against the POSSUM score, nor were any discrepancies in expected respectively ex-post complications upon cholecystectomy observed. The continuance of the operative procedure was found to be significantly lengthened in the university hospital as compared with the non-academic clinic (120.1 +/- 34.3 min vs. 65.6 +/- 16.3 min; p < 0.001). The difference in durability splits up in 1.2 days pre-operatively versus 2.4 days post-operatively. In return, the post-operative pain therapy was esteemed much better in the university hospital.

CONCLUSION

The POSSUM score is a reliable tool to assess morbidity and mortality in surgical patients. The scores were found to be equal for patients in a university hospital and those in a short-stay clinic. Complications likewisely were equally low in both hospitals. The longer duration of the operation and the higher length of stay revealed structural benefits of the smaller unit. Advantages of the academic centre were found in the standards for pain therapy. The present study is taken both as a reference and as a basis for a fundamental process-redesign to the benefit of involved parties e. g. patients, relatives, staff in the university hospital.