Corticosterone in feathers of laying hens: an assay validation for evidence-based assessment of animal welfare.

Studies indicate that the evaluation of animal welfare in birds may be carried out with the measurement of the stress-related hormone corticosterone in feathers. However a standardized procedure for corticosterone measurements in feathers is lacking, a validation needs to be carried out for each new species before implementation. The aim of the present study was to establish a valid method to measure corticosterone concentrations in feathers of laying hens in a precise and repeatable manner using an established and commercially available ELISA. Validation was performed with feather pools of tail and interscapular feathers of commercial Lohmann Brown laying hens. Assessment groups, consisting of 5 replicates, were created. All replicates of an assessment group were processed at the same time. Each replicate was run in 4 repetitions by ELISA. Intra-assay and interassay CV was 7.5 and 6.4%, respectively. The serial dilution showed linearity and parallelism. Examining the hormone extraction efficiency by using different methanol volumes resulted in no statistical differences (P > 0.05). Pulverized feathers showed higher corticosterone values than minced feathers (P > 0.05). Differences were shown between 2 feather types (tail vs. interscapular feathers; P < 0.05), as well as between vane and rachis (P < 0.05). Performance of a freeze-thaw cycle led to a decrease of corticosterone concentrations in the samples. A possible effect of UV-A radiation on the stability of corticosterone in the feathers was not found (P > 0.05). With the present study, a valid protocol, feasible for analyzing feather pools of laying hens, was developed. It may provide fundamentals for further investigations on corticosterone in feathers as a noninvasive indicator to evaluate aspects of animal welfare.

Hemorrhage after Major Pancreatic Resection: Incidence, Risk Factors, Management, and Outcome.

BACKGROUND AND AIMS: Hemorrhage is a rare but dreaded complication after pancreatic surgery. The aim of this study was to examine the incidence, risk factors, management, and outcome of postpancreatectomy hemorrhage in a tertiary care center. MATERIALS AND METHODS: A retrospective observational study was conducted on 500 consecutive patients undergoing major pancreatic resections at our institution. Postpancreatectomy hemorrhage was defined according to the International Study Group of Pancreatic Surgery criteria. RESULTS: A total of 68 patients (13.6%) developed postpancreatectomy hemorrhage. Thirty-four patients (6.8%) had a type A, 15 patients (3.0%) had a type B, and the remaining 19 patients (3.8%) had a type C bleed. Postoperative pancreatic fistula Grades B and C and bile leakage were significantly associated with severe postpancreatectomy hemorrhage on multivariable logistic regression. For patients with postpancreatectomy hemorrhage Grade C, the onset of bleeding was in median 13 days after the index operation, ranging from 1 to 85 days. Twelve patients (63.2%) had sentinel bleeds. Surgery lead to definitive hemostatic control in six of eight patients (75.0%). Angiography was able to localize the bleeding source in 8/10 (80.0%) cases. The success rate of angiographic hemostasis was 8/8. (100.0%). The mortality rate among patients with postpancreatectomy hemorrhage Grade C was 2/19 (10.5%), and both fatalities occurred late as a consequence of eroded vessels in association with pancreaticogastrostomy. CONCLUSION: Delayed hemorrhage is a serious complication after major pancreatic surgery.Sentinel bleed is an early warning sign. Postoperative pancreatic fistula and bile leakage are important risk factors for severe postpancreatectomy hemorrhage.

Impact of a fast-track surgery programme for pancreaticoduodenectomy.

BACKGROUND: Fast-track (FT) programmes are multimodal, evidence-based approaches to optimize patient outcome after surgery. The aim of this study was to evaluate the safety, clinical outcome and patients' experience of a FT programme after pancreaticoduodenectomy (PD) in a high-volume institution in Sweden. METHODS: Consecutive patients undergoing PD were studied before and after implementation of the FT programme. FT changes included earlier mobilization, standardized removal of the nasogastric tube and drain, and earlier start of oral intake. Patient experience was evaluated with European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-PAN26 questionnaires 2 weeks before and 4 weeks after surgery. RESULTS: Between 2011 and 2014, 100 consecutive patients undergoing PD were studied, of whom 50 received standard care (controls), followed by 50 patients treated after implementation of the FT programme. The nasogastric tube was removed significantly earlier in the FT group, and these patients were able fully to tolerate fluids and solid food sooner after PD. Delayed gastric emptying was significantly reduced in the FT group (26 versus 48 per cent; P = 0.030). Overall morbidity remained unchanged and there were no deaths in either group. Postoperative length of hospital stay was reduced from 14 to 10 days and hospital costs were decreased significantly. Health-related quality-of-life questionnaires showed similar patterns of change, with no significant difference between groups before or after surgery. CONCLUSION: The FT programme after PD was safe. Delayed gastric emptying, hospital stay and hospital costs were all reduced significantly. Although patients were discharged 4 days earlier in the FT group, this did not influence health-related quality of life compared with standard care.

Suicide mortality trends in young people aged 15 to 19 years in Lithuania.

AIM: This paper considers the suicide mortality trends from 1990-2009 in young people aged 15 to 19 years in Lithuania. METHODS: Suicide and injury mortality data, plus mortality data from all causes, were used to compare the trend lines. RESULTS: Suicide mortality rate in young people aged 15-19 years and in all population showed a rising trend from 1990, and then a decreasing trend from 2002 year. This trend was significant exclusively in boys. When comparing suicide deaths as a percentage of injury deaths and of all deaths in the age group 15-19 years, rising trends for boys were evident, whilst in girls, there was no evidence of change. CONCLUSIONS: In Lithuania, from early 1990s, the frequency of suicide increased amongst adults and young people aged 15-19 years. After 2002, a decrease in deaths by suicide was observed both for the whole population and for young people aged 15-19 years. The rise and fall was obvious for boys. The reasons for different trends may have been influenced by the political and socioeconomic instability in the 1990-2002 period, and the socioeconomic stability, together with active preventive measures, from 2002. Although the consumption of modern Selective serotonin reuptake inhibitors (SSRIs) increased during the same time, suicide mortality was again high during the economic crisis in 2008-2009.

Cross-national injury mortality differentials by income level: the possible role of age and ageing.

OBJECTIVES: To examine age- and cause-specific injury mortality differentials between low-income (LICs), middle-income (MICs) and high-income countries (HICs), and to discuss their implications in explaining changing injury mortality patterns with economic development against the background of general health transition theory. STUDY DESIGN: Cross-sectional study. METHODS: The World Health Organization's mortality database was used as the source of injury mortality data. The grouping into LICs, MICs and HICs was based on data from World Development Indicator. RESULTS: Unintentional injury mortality (UIM) rates in children and adults are highest in LICs and MICs, respectively. UIM rates in the elderly population, however, increase with higher economic conditions and are highest in HICs. CONCLUSION: Based on these findings, it is hypothesized that ageing and injury interplay mutually with regard to health transition; declining rates in child UIM with economic development contributes to the ageing process, while increasing UIM among the elderly, in combination with ageing populations, boosts the absolute number of injury deaths in this segment.

Long-term follow-up and cost analysis following surgery for small bowel obstruction caused by intra-abdominal adhesions.

BACKGROUND: This study examined the natural course of patients following surgery for small bowel obstruction (SBO) caused by abdominal adhesions. In addition, a cost analysis was performed. METHODS: A retrospective analysis was undertaken of 102 patients who underwent surgery between 1987 and 1992 for intestinal obstruction due to abdominal adhesions. RESULTS: Median follow-up was 14 years. The 102 patients experienced 273 episodes of intestinal obstruction after the index operation, of which 237 involved inpatient readmissions; 47.3 per cent of the episodes resulted in further surgery. Single band adhesions were more common in patients with no previous abdominal surgery (P < 0.001). Some 52.0 per cent of the patients had undergone only one operation for SBO. A mean of 2.7 episodes per patient occurred after the index operation. The cost of adhesion-related problems in this study was 1,588,594 euros or 6702 euros per inpatient episode. CONCLUSION: The readmission rate in a selected cohort of patients with proven intra-abdominal adhesions was higher than reported previously. The annual cost of adhesion-related problems in Sweden was estimated as 39.9-59.5 million euros, and the cost of inpatient readmissions was almost equal to that for gastric cancer.

Incidence, management and recurrence rate of acute pancreatitis.

BACKGROUND: Acute pancreatitis is a common condition that is still associated with substantial morbidity and mortality rates. Management, outcome and recurrence rate in acute pancreatitis in a clinical setting using a conservative management approach are described. METHODS: A total of 1376 consecutive cases representing 2211 hospitalizations due to acute pancreatitis treated at the Dept. of Surgery, Lund University Hospital, Lund, were reviewed retrospectively. Management, outcome and recurrence rate were recorded. RESULTS: Incidence, including recurrences, was 300 per million per year; 21% of patients had recurrent (> or =2) attacks. In relapsing disease, two-thirds of patients had the first attack within 3 months. Mortality decreased over the period studied, but overall it was 4.2%; mortality in relapsing attacks was 2.5%, related to multiple organ dysfunction (MODS) in 67% and occurring within the first week in 36%. CONCLUSIONS: Despite a conservative approach in the management of acute pancreatitis, mortality is still substantial, frequently occurs early after admission, is associated with MODS and is also seen in relapsing disease. Early cholecystectomy and bile duct clearance could decrease recurrent attacks of biliary pancreatitis.

Relationship between economic development and suicide mortality: a global cross-sectional analysis in an epidemiological transition perspective.

AIM: The aim of this study was to analyse the relationship between suicide rates and economic development within the theoretical framework of epidemiological transition. RESULT: A weak positive correlation was found between suicide rates and GNP per capita in both sexes for all ages. DISCUSSION: According to previous studies, there is a clear decline in deaths due to unintentional injuries with improved economic conditions. This example of a man-made disease that declines during the fourth stage is in agreement with the theory of epidemiological transition. However, our results found the opposite pattern for deaths due to intentional self-inflicted injury. CONCLUSION: Mortality rates due to unintentional and intentional self-inflicted injury show deviating patterns from an epidemiological transition perspective.

The Swedish system for quality assessment of agricultural soils.

Soil quality assessment is based on the concept of soil functions. The performances of three soil functions, crop production, biological decomposition and matter exchange with the atmosphere and groundwater, are used as quality criteria. Soil properties that can be used as indicators for the degree of functional performance were identified. Each soil property selected was graded into five classes--from best (class 1) to worst (class 5). Grading was based biological on boundary conditions as well as on statistical distribution. The system outlined can be used to interpret the quality state of agricultural soils, provides for a relative comparison between soils, and may be helpful in an environmental monitoring program to assess trends in data.

The impact of structural factors on the injury rate in different European countries.

BACKGROUND: A previous study pointed to there being two kinds of injuries--those with a mainly social genesis and those with a mainly environmental genesis. The aim of this study was to analyse how socioeconomic factors--such as level of economic development, alcohol consumption and unemployment and more cultural factors--such as education and religion--relate to kinds of injury. METHODS: Motor vehicle traffic accidents were chosen to represent injuries with a predominantly environmental genesis and suicides those with a mainly social genesis. Qualitative comparative analysis (QCA) complemented by Pearson correlation was employed. The data come from 12 European countries. RESULTS: Four groups of countries emerged from the analysis. Group 1 was high on both kinds of injuries and was also high on all the independent variables considered. Group 2 was low on social injuries and high on environmental injuries; it had a low level of economic development, high alcohol consumption and a high proportion of Roman Catholics. Group 3 was high on social injuries and low on environmental injuries; it had a high level of economic development, low alcohol consumption and few Roman Catholics. Group 4 was low on both kinds of injuries; the independent variables formed a similar pattern to those of group 3. CONCLUSION: The pattern for traffic fatalities differs from that of suicides. There is also patterning with regard to structural factors; economic level, education and religion seem to be more important with regard to injury rate differentials than alcohol consumption or unemployment.

Canadian Aboriginal communities and medical service patterns for the management of injured patients: a basis for surveillance.

Growing attention has been placed on injury as a major public health problem which has served to highlight the need for relevant injury data for preventive purposes at the community level. In the case of reserve-based Aboriginal communities in Canada, available injury data, from large datasets, often has little or no relevance at the community level. In addition, the availability of local data is complicated by unique health service and community infrastructures. As such, a prerequisite to establishing injury surveillance requires an understanding of Medical Service Patterns (MSPs) for injured patients intrinsic to a community's health service infrastructure. In determining patterns, cultural and environmental contexts are integral to methodological considerations as historically, Canada's Aboriginal population has been 'controlled' by others in the areas of health, education and social services. The objective of the study was to investigate MSPs in a Canadian Aboriginal community, specific to the management of injured patients, for the purpose of identifying data sites, sources, and collectors. The method relied on a four-step qualitative process designed explicitly for the study community, comprising: (1) semi-structured interviews with key informants; (2) a flow diagram process; (3) focus group discussions; and (4) a summary matrix diagram. This methodology was later replicated with three additional pilot communities. Three major MSPs were identified from nine original patterns generated through the initial data collection process. MSPs were found to be most directly impacted by severity of injury and the proximity of health service providers. Data collection practices were inconsistent, sporadic and poorly coordinated. Data was exclusive to respective data sources and off-reserve documentation was not reported back to the community. MSPs identified key data sites, sources, and collectors relevant to the study population. In conclusion, the four-step qualitative methodology employed in the study was found to be reliable and feasible in identifying community MSPs. Empirical findings confirm the need to investigate MSPs in communities considering surveillance activities, as intra-national differences may be considerable given social inequalities, geographic uniqueness and cultural factors. The use of sophisticated methodologies may detract rather than promote collaborative efforts.

Socio-demographic risk factors for home-type injuries in Swedish infants and toddlers.

UNLABELLED: In this paper we use data from Swedish national registers to study socio-demographic patterns of hospital admissions as a result of injuries sustained at home (poisoning, falls, scalding and ingestion/intrusion of foreign objects) in children 0-3 y. The study population comprised 546 336 children born in Sweden during the period 1987-91. The different injury mechanisms peaked at different ages: ingestion of foreign objects at 10-12 mo, scald injuries at 13-15 mo, non-drug poisoning at 16-18 mo and drug poisoning at 24-30 mo. In a multivariate analysis it was demonstrated that children of young mothers (<24 y) were more likely to have been admitted to hospital because of fall injuries and poisonings, while children with more than two siblings had a slightly increased risk for all injuries. Children of mothers born in a non-western country were more likely to have been admitted to hospital because of scald injuries; odds ratio (OR) 1.7 (95% CI: 1.4-2.1), while they were less likely to have been admitted because of fall injuries; OR 0.8 (0.7-0.8) and non-drug poisoning; OR 0.5 (0.4-0.6). Children in families who received social welfare benefits were more likely to have been admitted to hospital because of fall injuries; OR 1.3 (1.2-1.4), drug poisoning; OR 1.8 (1.7-2.0), non-drug poisoning; OR 1.4 (1.3-15) and scald injuries; OR 1.1 (1.1-1.5), while injuries with ingestion/intrusion of foreign objects tended to vary little with socio-economic indicators. CONCLUSION: Infants and toddlers in families with young mothers and in families on social welfare are at particular risk for home injuries in Sweden. The knowledge that the risk of poisoning, scalding and ingestion of foreign objects is related to specific ages can be used in timing of parent counselling.

Unintentional injury mortality and socio-economic development among 15-44-year-olds: in a health transition perspective.

Injury imposes one of the greatest health risks in terms of mortality and morbidity among 15-44-y-olds. There is evidence that socio-economic development (SED) is related to injury risk, but the findings are inconsistent. We aimed to study the magnitude, pattern and relative importance of unintentional injury mortality (UIM) in relation to SED in this age group. Cross-sectional data on UIM by age-sex specific groups were obtained for 54 countries from the World Health Statistics Annuals 1993-1995. The relationship between UIM and SED (measured in gross national product (GNP) per capita) was studied using two methods: (1) with regression analysis, and (2) by categorizing the data into four income-based country groups and then comparing the differences in their mean values. The results were: (1) UIM rates were inversely correlated with GNP per capita and the relationship became stronger with increasing age (r=-0.22 for both sexes in the 15-24-y-olds, r=-0.65 for males, r=-0.54 for females in the 35-44-y-olds); (2) there was an increase in UIM rates between low-income and lower-middle-income countries (LoMIC), but a decrease between LoMIC and upper middle-income (UpMIC), and finally also a significant decrease between UpMIC and high-income countries in most age-sex groups (ie P<0.005 for males, P<0.05 for females in the 35-44-y-olds). The highest rates of UIM were in LoMIC for all age-sex groups. Male rates were consistently higher than female in all age groups. In conclusion, SED was inversely related to UIM. There was an initial positive relation between GNP per capita and UIM, which became negative with increasing GNP per capita. We also found a health transition that had taken place in all country groups.

Unintentional injury mortality in children: a priority for middle income countries in the advanced stage of epidemiological transition.

OBJECTIVES: To examine the relationship between the magnitude, and the relative importance of unintentional child injury mortality with socioeconomic development, and to conceptualise the dynamic changes in injury mortality within the framework of epidemiological transition. DESIGN: Ecological cross sectional study using data on 51 countries. MAIN OUTCOME MEASURES: The relationship between total mortality rates, unintentional injury mortality rates, and percentage in children 1-14 years of age with gross national product (GNP) per capita. RESULTS: Unintentional injury mortality rates in children were negatively correlated with GNP per capita. However, by categorising the data, we found some areas of non-correlation: in children 5-14 years in low income versus lower middle income countries, and in all age and gender groups in lower high income versus higher high income countries. A high percentage of total deaths due to injuries was clearest in the lower middle income countries in all age and gender groups. CONCLUSIONS: The changes in child injury mortality in relation to socioeconomic development could be conceptualised as three stages: a stage of high magnitude; a stage of high priority; and a stage of improvement. Most middle income countries are in the high priority stage where both injury mortality rates and injury percentage of total deaths are high.

The effects of political and economic transitions on health and safety in Estonia: an Estonian-Swedish comparative study.

A general and dramatic deterioration of health in Estonia during the transition period 1990-1994 was analysed using Sweden as a comparative example. Though there were diverging trends between Estonia and Sweden in the leading cause of death, cardiovascular diseases, the gap in mortality from injury had increased most rapidly. While the injury mortality rate slightly decreased in Sweden from 1990 to 1994, it almost doubled in Estonia. In 1994, the total injury death rate for men was about 6 times higher in Estonia than in Sweden. The death rates for some types of injuries, such as alcohol intoxication and homicide, were many tenfolds higher in Estonia than in Sweden. Injury contributed the most to the widening health gap between the countries, especially in males. The mechanisms of this sudden health deterioration remain to be fully explained. It could be hypothesised that behind the traditional behavioural risk factors, the influence of socio-political factors related to economic and political reconstruction is present. A widespread risk-taking and unhealthy behaviour among Estonians can likely be partly explained as a way of coping with the distress created by the new demands of transition society. An important challenge on the way to improvement is creating the political will among policy-makers to confront the tremendous problems of controlling the factors in society that affect the population's health in Estonia.

Maternal nutrition and socio-economic status as determinants of birthweight in chronically malnourished African women.

The birthweight is the most important determinant of mortality and morbidity in the neonatal period and may have an influence on health in adult life. The high rate of low birthweight in developing countries is therefore a major health problem. Maternal malnutrition is usually assumed to be a causal factor but other environmental factors are also involved. In this study we analysed maternal nutritional and socio-economic factors as determinants of birthweight in term infants from a rural African society characterised by a high rate of chronic malnutrition. Relations of maternal weight, gestational weight gain, parity, socio-economic status and infant sex with birthweight were analysed in 1,477 women and child pairs. The selected women were followed from early pregnancy and had an uncomplicated delivery at term of a living singleton child. The gestational weight gain was 5.6 (SD 6.0) kg and the mean birthweight 2.933 kg (SD 408). Maternal weight, representing the maternal long-term nutritional situation, was the most important independent determinant of birthweight, accounting for 13.0% of the variance in birthweight. The weight gain, representing the short-term nutritional situation, explained only 5.6% of the variance. Birthweight increased by 20 g (CI 18-23) for each kg maternal weight and by 15 g (CI 12-18) for each kg gestational weight gained. The socio-economic difference in birth-weight was 153 g (CI 109-196) 88 of which (CI 48-128) remained unexplained after adjustment for differences in maternal weight, parity and gender. Improved long-term nutritional situation and living conditions seems to be the most important prerequisites to counteract low birthweight in developing countries.