Diversity of needle exchange provision in the UK: findings from a national survey.
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Data Collection↗
Biomedical subjects
S Hutchinson
Publications and source records attributed to S Hutchinson.
Severe illness and death among injecting drug users in Scotland: a case-control study.
Between April and September 2000, 60 injecting drug users in Scotland died or were hospitalized with severe illness. Laboratory investigations suggested that Clostridium novyi and other bacteria were important aetiological agents. To determine associated environmental/behavioural factors a case-control study was undertaken with 19 'definite' and 32 'probable' cases in Glasgow, Scotland. For every deceased case (n=19), up to three proxy individuals were interviewed. Three controls were identified for each case. Multivariate logistic regression analyses compared (i) all cases and controls; (ii) definite cases and matched controls; (iii) probable cases and matched controls. In all three analyses injecting into muscle or skin and injecting most of the time with a filter used by someone else were the variables most strongly associated with illness. Comparing only muscle-injecting cases and controls, cases were significantly more likely to have injected larger amounts of heroin per average injection than were controls. The findings make an important epidemiological contribution to the understanding of the public health and clinical implications of the contamination of illicit drugs by histotoxic clostridia.
Adult↗
Prevalence of, and risk factors for, hepatitis C virus infection among recent initiates to injecting in London and Glasgow: cross sectional analysis.
Our aim was to compare the prevalence of antibody to hepatitis C virus (anti-HCV) among recently initiated injecting drug users (IDUs) in London and Glasgow, and to identify risk factors which could explain differences in prevalence between the cities. Complementary studies of community recruited IDUs who had initiated injection drug use since 1996 were conducted during 2001-2002. Data on HCV risk behaviours were gathered using structured questionnaires with identical core questions and respondents were asked to provide an oral fluid specimen which was tested anonymously for anti-HCV but was linked to the questionnaire. Sensitivities of the anti-HCV assays for oral fluid were 92-96%. Prevalence of anti-HCV was 35% (122/354) in London and 57% (207/366) in Glasgow (P < 0.001). Multifactorially, factors significantly associated with raised odds of anti-HCV positivity were increasing length of injecting career, daily injection, polydrug use, having had a needlestick injury, and having served a prison sentence. In addition lower odds of anti-HCV positivity were associated with non-injection use of crack cocaine and recruitment from drug agencies. After adjustment for these factors, the increased odds of anti-HCV associated with being a Glasgow IDU were diminished but remained significant. HCV continues to be transmitted among the IDU population of both cities at high rates despite the availability of syringe exchange and methadone maintenance. Effectiveness of harm reduction interventions may be compromised by inadequate coverage and failure to reduce sufficiently the frequency of sharing different types of injecting equipment, as well as the high background prevalence of HCV, and its high infectivity. Comprehensive action is urgently required to reduce the incidence of HCV among injectors.
Adult↗
Incidence of hepatitis C virus infection and associated risk factors among Scottish prison inmates: a cohort study.
To gauge the incidence of hepatitis C virus (HCV) infection and associated risk factors among inmates during their imprisonment, the authors recruited adult males in a long-stay Scottish prison into a cohort study between April 1999 and October 2000. On two occasions (at 0 and 6 months), saliva was collected for anonymous HCV antibody testing and risk behavior data were obtained through a self-administered questionnaire. The participation rate was 85% at both initial recruitment (612/719) and follow-up (375/441; 171 men were ineligible for follow-up). For inmates who reported never having injected drugs, ever having injected drugs, having injected drugs during follow-up, and having shared needles/syringes during follow-up, HCV incidences per 100 person-years of incarceration risk were 1, 12, 19, and 27, respectively. Ever having injected drugs (relative risk = 13.0, 95% confidence interval: 1.5, 114.3) and having shared needles/syringes during follow-up (relative risk = 9.0, 95% confidence interval: 1.1, 71.7) were significantly associated with HCV seroconversion. The effectiveness of existing interventions, including the provision of bleach tablets for sterilizing injection equipment, was suboptimal. The development of methadone maintenance programs in prisons and the creation of drug courts to keep offending drug injectors out of prison might help to reduce transmission in this setting.
Adult↗
Repetitive TMS of the motor cortex improves ipsilateral sequential simple finger movements.
BACKGROUND: Disruption of cortical function can improve behavior. Motor cortex (M1) transcallosal interactions are mainly inhibitory; after unilateral damage to M1, there is increased excitability of the unaffected M1. Repetitive transcranial magnetic stimulation (rTMS) of M1 produces a temporary reduction in cortical excitability in the same M1 that outlasts the duration of the rTMS train. The authors hypothesize that reducing cortical excitability of M1 by rTMS may improve motor performance in the ipsilateral hand by releasing the contralateral M1 from transcallosal inhibition. METHODS: Sixteen healthy volunteers participated. Using a sequential key-pressing task with the index finger, motor performance was monitored before and after rTMS (1 Hz for 10 minutes with the intensity below motor threshold) applied to the ipsilateral M1, contralateral M1, ipsilateral premotor area, or vertex (Cz). RESULTS: rTMS of M1 shortened execution time of the motor task with the ipsilateral hand without affecting performance with the contralateral hand. This effect outlasted rTMS by at least 10 minutes, was specific for M1 stimulation, and was associated with increased intracortical excitability in the unstimulated M1. CONCLUSIONS: The authors' results support the concept of an interhemispheric "rivalry." They demonstrate the utility of repetitive transcranial magnetic stimulation to explore the functional facilitation of the unstimulated counterpart motor cortex, presumably via suppression of activity in the stimulated motor cortex and transcallosal inhibition.
Adult↗
Hepatitis C virus among self declared non-injecting sexual partners of injecting drug users.
While much is known about hepatitis C virus (HCV) among injecting drug users (IDUs), there is scant information about the risk of HCV infection to non-injecting sexual partners of injecting drug users; it is possible that such individuals may have a greater risk of acquiring HCV than any other group barring injecting drug users. This study examines the prevalence of HCV among a population of non-injecting sexual partners of injecting drug users. Unlinked anonymous testing for anti-HCV of residual sera stored following the named HIV testing of specimens originally from persons who had indicated to their attending clinicians that they were non-injecting sexual partners of injecting drug users. The prevalence of anti-HCV among the sexual partners was 4.1% (25/611) overall, 6.4% (13/202) among heterosexual male and 3.0% (12/397) among the heterosexual female partners. None of the homosexual/bisexual partners were HCV antibody positive (0/12). Although we cannot be sure how non-injecting partners of injecting drug users acquire their HCV infection, having a relationship with someone who injects drugs may place an individual at appreciable risk of being infected; such individuals should consider being tested for HCV.
Adult↗
Paradoxical cerebral embolisation. An explanation for fat embolism syndrome.
Fat embolism occurs following fractures of a long bone or arthroplasty. We investigated whether paradoxical embolisation through a venous-to-arterial circulation shunt (v-a) could lead to cerebral embolisation during elective hip or knee arthroplasty. Transcranial Doppler ultrasound (TCD), following the intravenous injection of microbubble contrast, identified the presence of a shunt in 41 patients undergoing hip (n = 20) or knee (n = 21) arthroplasty. Intra-operative cerebral embolism was detected during continuous TCD monitoring. Of the 41 patients, 34 had a v-a shunt of whom 18 had an embolism and embolism only occurred in patients with a shunt (p = 0.012). Spontaneous and larger shunts were associated with a greater number of emboli (rs = 0.67 and rs = 0.71 respectively, p < 0.01). Observations in two patients with large spontaneous shunts revealed 368 and 203 emboli and unexplained post-operative confusion and pancreatitis. Paradoxical cerebral embolisation only occurred in patients with a shunt and may explain both postoperative confusion and fat embolism syndrome following surgery.
Adult↗
Carotid endarterectomy improves cognitive function in patients with exhausted cerebrovascular reserve.
OBJECTIVE: To investigate changes in cognitive function following carotid endarterectomy (CEA). DESIGN: Prospective study with controls. METHODS: CEA patients (n=159) were compared to a urology surgery control group (n=20). In CEA patients cerebrovascular reserve (CVR) was measured preoperatively. During surgery emboli and blood flow velocity in the middle cerebral artery were measured by transcranial Doppler (TCD) and cerebral oxygen saturation (CsO2) by near infrared spectroscopy. Cognitive function was measured preoperatively and at 5 days and 8 weeks postoperatively using a standardised computer battery of tests. RESULTS: Only 8% of patients had normal CVR bilaterally. The median number of emboli during CEA was 12 (range 0-181). On carotid clamping, TCD velocity fell a median of 41% and cerebral oxygen saturation by 5%. Attention deteriorated compared to controls 5 days following CEA (p=0.003) and this deterioration was related to the rise in TCD velocity on declamping (r=-0.3, p=0.002). Median attention reaction times improved significantly by 8 weeks (p=0.001) especially in patients' with severely impaired CVR before surgery (p=0.02). CONCLUSIONS: Attention improved at 2 months following CEA in patients with impaired CVR. CEA may offer more than reduced stroke risk to patients with impaired CVR.
Aged↗
Risk of hepatitis C virus transmission from patients to surgeons: model based on an unlinked anonymous study of hepatitis C virus prevalence in hospital patients in Glasgow.
BACKGROUND: The risk of a surgeon acquiring the hepatitis C virus (HCV) through occupational exposure is dependent on the prevalence of HCV infection in the patient population, the probability of a percutaneous injury transmitting HCV, and the incidence of percutaneous injury during surgery. AIMS: To estimate the prevalence of HCV infection in the adult surgical patient population in North Glasgow and thereafter estimate the risk of HCV transmission to surgeons through occupational exposure. METHODS: The prevalence of HCV infection was estimated through the unlinked anonymous testing of samples from male surgical patients, aged 16-49 years, in two North Glasgow hospitals from 1996 to 1997, and adjusting these data for age and sex. Using published estimates of the incidence of percutaneous injury during surgery and percutaneous injury transmitting HCV, the risk of occupational transmission of HCV to surgeons was then derived. RESULTS: The estimated prevalence of anti-HCV infection for all adult patients in the two hospitals combined was 1.4% (cardiothoracic/cardiology 0.8%, orthopaedics/rheumatology 1.4%, general surgery/ENT 2.0%). The estimated probability of HCV transmission from an HCV infected patient to an uninfected surgeon was 0.001-0.032% per annum (0.035-1.12% risk over a 35 year professional career). CONCLUSIONS: The risk of an individual surgeon acquiring HCV through occupational exposure is low, even in an area with an extremely high prevalence of HCV among its injecting drug using population. Surgeons however should be encouraged to observe universal precautions and present for assessment after needlestick injuries to protect themselves and their patients from this insidious infection.
Adolescent↗
Age-related differences in movement representation.
Repetitive movements have been used as motor activation tasks in the investigation of various neurological disorders. To determine the importance of an age-matched control group in such studies we investigated whether there are significant age-related changes in the pattern of cortical activation seen during simple repetitive movements. Sixteen right-handed healthy subjects were studied-8 young and 8 old. Functional magnetic resonance images were acquired while subjects performed a motor task or a nonmovement rest condition. Two continuous motor tasks, index finger abduction/adduction and wrist extension/flexion, were performed by each hand, paced using a metronome. The fMRI data were processed and analyzed with SPM '99. For the between-group comparisons, for each motor task, contralateral primary sensorimotor cortex and premotor cortex had significantly greater activation in the Young group and caudal supplementary motor area had significantly greater activation in the Old group. Ipsilateral sensorimotor cortex was more significantly activated in the Old group for index finger motor tasks of both hands. All noted differences in the Old group were more prominent for the index finger movement and most prominent when using the nondominant hand. In conclusion, there are significant age-related differences in the activation pattern associated with repetitive movements. This may represent compensatory recruitment of motor cortical units in the older subjects as larger differences are noted in the older group during the more difficult motor tasks, those of isolated finger movement and nondominant hand use. This study has important implications for functional imaging experiments of neurological disorders in older subjects.
Adult↗
Calf compartment pressures in the Lloyd-Davies position: a cause for concern?
Lower limb compartment syndrome is a rare consequence of surgery where the lithotomy position is maintained for several hours. The aim of this study was to observe the effect of the lithotomy position on lower limb compartment pressure and blood flow to the lower limb in surgical patients having colorectal procedures. We prospectively studied 23 patients undergoing colorectal surgery requiring the lithotomy position and recorded lower limb compartment pressure, and the blood pressure in the upper and lower limbs. The lithotomy position led to a significant (p < 0.001) fall in blood pressure to the lower limb from 87 (SD 16) mmHg to 67.9 (SD 12) mmHg and a significant (p < 0.001) rise in lower limb compartment pressure from 13 (SD 7) mmHg to 31 (SD 12) mmHg. These two effects compromise blood flow to the lower limb in long surgical procedures where the lithotomy position is required. Intermittently lowering the legs and restoring blood flow may prevent compartment syndrome developing.
Adult↗
House officers and the sick ward patient.
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Critical Care↗
Twelve novel FBN1 mutations in Marfan syndrome and Marfan related phenotypes test the feasibility of FBN1 mutation testing in clinical practice.
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Adolescent↗
Confidence levels of PRHOs in caring for acutely ill patients.
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Acute Disease↗
Sediment-associated tri-n-butyltin chloride and its effects on osmoregulation of freshwater-adapted 0-group European flounder, Platichthys flesus (L.).
The disruption of osmoregulatory processes was examined in European flounders exposed to environmental concentrations (150 ng TBTCl g(-1) dry weight sediment) of sediment-associated tri-n-butyltin chloride (TBTCl), by using radiotracers to measure changes in hydromineral fluxes and water balance. The water permeabilities of TBTCl-exposed fish varied during the course of the experiment and were significantly lower than those of the corresponding controls that did not change significantly with time. It was found that the maximum decrease in water permeability of TBTCl-exposed fish occurred after 14 days; thereafter there was an increase towards control values. However, there was a differential reduction of the diffusional (P(d)) and osmotic (P(os)) permeability coefficients, where the former decreased more rapidly than the latter, reflecting the reduction of diffusional membrane permeability and the increasing importance of osmotic permeability. In fish exposed to TBTCl sodium efflux and drinking rates were significantly increased but Na(+)/K(+)-ATPase activities and urine production rates were not affected. The effects of TBTCl exposure are also manifested at the level of the whole organism by a reduction in the increase of the body length of exposed fish, when compared to controls. It was concluded that tributyltin-n-chloride in sediments is capable of significantly disrupting the osmoregulatory functions of a benthic estuarine fish, at concentrations found in the sediments of Southampton Water and the River Itchen.
Animals↗
Variation in European antibiotic use.
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Anti-Bacterial Agents↗
The effects of sediment-associated triorganotin compounds on the gills of the European flounder, Platichthys flesus (L.).
The effects of exposure to sediment-associated tri-n-butyltin chloride (TBT) and triphenyltin chloride (TPhT) were examined in the euryhaline European flounder, Platichthys flesus (L.). The effects were quantified by measuring the changes in sodium efflux, Na(+)/K(+)-ATPase activity and the numbers, areas and distribution of chloride cells in the gills of freshwater-adapted fish, following a rapid transfer to seawater. After transfer, the Na(+)/K(+)-ATPase activity and the sodium efflux significantly increased in both the TPhT and control groups but not in the TBT group. However, Na(+)/K(+)-ATPase activity and the sodium efflux in the TPhT group had returned to pre-salinity transfer levels by day 15 after the initial exposure to TPhT. Morphological changes in the numbers and areas of chloride cells, known to be associated with seawater adaptation, took place in the control group, i.e. there was a significant reduction in the number of lamellar chloride cells accompanied by an increase in the number of interlamellar chloride cells. There was a reduction in the numbers of lamellar chloride cells in the TBT-exposed group following transfer to seawater but the mean number was significantly higher than the control group by the end of the experiment. In the TPhT-exposed group, the reduction was not significantly different to that seen in the control group. By the end of the experiment, both organotin-exposed groups had significantly lower mean numbers of interlamellar chloride cells than the control group. Before transfer to seawater, the mean areas of lamellar and interlamellar chloride cells of all three groups were not significantly different. On transfer, the mean areas of lamellar chloride cells in the control group became significantly smaller than the mean areas of the organotin groups. There was no significant difference in the mean areas of interlamellar chloride cells in the control and TBT groups between the start and finish of the experiment but there was a significant increase in the mean area of TPhT-treated animals at the end of the experiment when compared to the control group. The results presented in this study lead to the conclusion that tri-n-butyltin chloride and triphenyltin chloride in sediments are capable of significantly disrupting both the physiological as well as morphological components of ionic regulatory functions of an estuarine fish, at concentrations currently found in estuarine sediments.
Journal Article↗
Organotin and osmoregulation: quantifying the effects of environmental concentrations of sediment-associated TBT and TPhT on the freshwater-adapted European flounder, Platichthys flesus (L.).
Chronic (5 weeks) exposure of freshwater-adapted European flounder, Platichthys flesus (L.), to environmental concentrations of sediment-associated tri-n-butyltin chloride (TBTCl) and triphenyltin chloride (TPhTCl) caused significant changes to hydromineral fluxes and membrane permeability, mechanisms that maintain osmotic homeostasis. The half-time of exchange of tritiated water (THO) in TBTCl- and TPhTCl-exposed fish was significantly increased during the first 2 weeks of the experiment and then decreased steadily, eventually reaching the level that the control group had constantly maintained throughout the experiment. This change in apparent water permeability was accompanied by a significant decrease in diffusional water flux across the membranes. Passive Na(+)-efflux across the gills was increased significantly but effluxes in the control group were near constant over the same time span. Drinking rates in the organotin groups increased significantly while the rate of urine production did not change. This lead to an increased net water balance in the organotin groups and consequently to a significant reduction of the blood osmolality of both organotin groups when compared to a control. There would appear to be a metabolic cost attached to the changes produced by exposure to environmental levels of organotin compounds which are manifested as a minimal increase in body length compared to the controls.
Journal Article↗