Hypothermia and associated outcomes in seriously injured trauma patients in a predominantly sub-tropical climate.

AIM: This study aimed to determine factors linked to hypothermia (<35 degrees C) in Queensland trauma patients. The relationship of hypothermia with mortality, admission to intensive care and hospital length of stay was also explored. METHODS: A retrospective analysis of data from the Queensland Trauma Registry was undertaken, and included all patients admitted to hospital for > or =24h during 2003 and 2004 with an injury severity score (ISS)>15. Demographic, injury, environmental, care and clinical status factors were considered. RESULTS: A total of 2182 patients were included; 124 (5.7%) had hypothermia on admission to the definitive care hospital, while a further 156 (7.1%) developed hypothermia during hospitalisation. Factors associated with hypothermia on admission included winter, direct admission to a definitive care hospital, an ISS> or =40, a Glasgow Coma Scale of 3 or ventilated and sedated, and hypotension on admission. Hypothermia on admission to the definitive care hospital was an independent predictor of mortality (odds ratio [OR]=4.05; 95% confidence interval [CI] 2.26-7.24) and hospital length of stay (incidence rate ratio [IRR]=1.22; 95% CI 1.03-1.43). Hypothermia during definitive care hospitalisation was independently associated with mortality (OR=2.52; 95% CI 1.52-4.17), intensive care admission (OR=1.73; 95% CI 1.20-2.93) and hospital length of stay (IRR=1.18; 95% CI 1.02-1.36). CONCLUSIONS: Trauma patients in a predominantly sub-tropical climate are at risk of accidental and endogenous hypothermia, with associated higher mortality and care requirements. Prevention of hypothermia is important for all severely injured patients.

Speed enforcement detection devices for preventing road traffic injuries.

BACKGROUND: It is estimated that by 2020, road traffic crashes will have moved from ninth to third in the world ranking of burden of disease, as measured in disability adjusted life years. The identification of effective strategies for the prevention of road traffic injuries is of global public health importance. Measures aimed at reducing traffic speed are considered essential to preventing road injuries; the use of speed enforcement detection devices (including speed cameras and radar and laser devices) is one such measure. OBJECTIVES: To assess whether the use of speed enforcement detection devices (SEDs) reduces the incidence of speeding, road traffic crashes, injuries and deaths. SEARCH STRATEGY: We searched the Cochrane Injuries Group's Specialised Register, CENTRAL, MEDLINE, EMBASE, Science (and Social Science) Citation Index, TRANSPORT, PsycINFO, CINAHL, EconLit. We searched the websites of road safety and motoring associations, as well as general internet searches. We handsearched selected journals and conference proceedings, and contacted experts in the field. The searches were conducted during May to November 2004. SELECTION CRITERIA: Randomised controlled trials and controlled before-after studies that assessed the impact of speed enforcement detection devices on speeding, road crashes, injuries and deaths were eligible for inclusion. For studies involving co-interventions, SEDs had to be the major intervention focus of the study to be eligible. DATA COLLECTION AND ANALYSIS: We independently screened search results, assessed studies for inclusion, extracted data and assessed methodological quality. Due to variability between and within included studies, a pooled analysis was not appropriate. MAIN RESULTS: No randomised controlled trials were identified. Twenty-six studies met the inclusion criteria, of which 22 were controlled before-after trials incorporating a distinct control or comparison group(s) and four were interrupted time series designs with a comparison group(s). Fourteen studies reported speed and crash outcomes, seven reported crash outcomes only and five reported speed outcomes only. All but one study reported an absolute reduction in pre/post average speeds. A pre/post reduction in the proportion of speeding vehicles ranged across studies from 5% to 70% depending on the speed threshold set. Pre/post reductions of 50% to 65% were reported in the proportion of speeding vehicles travelling >15 km/h over the speed limit. Compared with controls, the relative improvement was from 1% to 15% for average speed and from 14% to 65% for percent speeding. All studies reporting crash outcomes reported an absolute pre/post reduction in all crashes and injury related crashes. In the vicinity of camera sites these pre/post reductions ranged from 14% to 72% for all crashes, 8% to 46% for injury crashes, and 40% to 45% for crashes resulting in fatalities or serious injuries. More generalised effects over wider areas showed an absolute pre/post crash reduction ranging from 9% to 35%, 7% to 30% for all injury crashes and 13% to 58% for crashes resulting in fatalities alone, or in combination with serious injuries. The studies of longer duration showed that these positive trends were either maintained or improved with time. Compared with controls, the relative improvement in pre/post crash numbers resulting in any type of injury ranged from 5% to 36%. AUTHORS' CONCLUSIONS: Despite the methodological limitations of the studies reviewed, the consistency of reported positive reductions in speed and crash outcomes across all studies suggest that SEDs are a promising intervention for reducing the number of road traffic injuries and deaths. More studies of a scientifically rigorous nature are necessary to provide a stronger evidence base that these interventions are worthwhile. There is a need for international harmonisation of data collection methods, including standards on how best to measure speeds and collect crash data, over lengthy intervention and follow-up periods, as well as some consensus as to the expression of outcomes in studies, so that studies can be compared.

Prevalence of megabacteria in budgerigar colonies.

OBJECTIVE: To measure the prevalence of megabacteria in budgerigar-breeding colonies and to evaluate possible methods to reduce the prevalence. DESIGN: A monitoring study over several years. SAMPLE POPULATION: Two budgerigar (Melopsittacus undulatus) colonies with over 300 birds each. PROCEDURE: The prevalence of megabacteria in the faeces in two budgerigar breeding colonies, colony 1 and 2, was determined by faecal examination of each bird. Following an initial survey (1990), most of the birds that were scored 2+ or more were culled and a management practice was implemented to discriminate against positive birds. Consecutive yearly surveys (1991, 1992) were conducted on the young birds bred in these colonies. The prevalence of megabacteria in colony 2 was also evaluated in 1994 and 1996 after all the birds were treated with amphotericin B administered in drinking water. RESULTS: The prevalence of megabacteria in the two colonies was significantly (P < 0.001) different. Overall the prevalence of megabacteria adjusted for colony differences was significantly higher (P < 0.025) in males compared to females. Age was not an influencing factor. After the initial survey, the prevalence in the offspring did not significantly (P > 0.05) decrease in the following two annual breeding seasons but by inference it did significantly decrease after amphotericin B treatment. CONCLUSION: The practice of culling most birds with more megabacteria in faeces and discriminating against positive birds when selecting birds for breeding or culling birds on show quality does not decrease megabacteria prevalence in the offspring. However, a reduction in prevalence does occur with administration of amphotericin B. Birds may have amphotericin B-resistant organisms and these birds need to be identified and culled.

Over representation of Burmese cats with diabetes mellitus.

OBJECTIVE: To determine if Burmese cats in Queensland have an increased risk of diabetes mellitus. DESIGN: A retrospective study of diabetic and nondiabetic cats that had blood submitted to a veterinary clinical laboratory over a 22 month study period. SAMPLE POPULATION: 4402 cats PROCEDURE: Cats were considered diabetic if blood glucose concentration was > 11 mmol/L and fructosamine was > 406 mumol/L or hydroxybutyrate was > 1 mmol/L. Cats were grouped into Burmese and non-Burmese. Adjusted odds ratios of diabetes were calculated for breed, gender and age group amongst cats with blood glucose > 11 mmol/L. RESULTS: Burmese cats comprised 20% of 45 diabetic cats of known breed, which was higher (P < 0.001) than among the normoglycemic reference population of 2203 cats (7% Burmese). There were more females among the diabetic Burmese (62%), but this did not differ (P > 0.05) from the Burmese reference population (45% females). In contrast, males seemed to predominate among diabetic non-Burmese (63%), although this also did not differ (P > 0.05) from the reference population (55%) of from diabetic Burmese (38% males). The majority (90%) of diabetic cats were older than 6 years, irrespective of breed (median age 12 years, interquartile range 10 to 13 years). This was higher (chi(2) = 8.13, P < 0.005) than among the normoglycaemic reference population, where 69% were older than 6 years. CONCLUSIONS: Burmese cats were significantly over represented among cats with diabetes mellitus. Irrespective of breed, the risk of diabetes in the study population increased with age.

Evaluation of a simplified intravenous glucose tolerance test and a reflectance glucose meter for use in cats.

A simplified intravenous glucose tolerance test has been developed for use in domestic cats and the results compared with those obtained using the standard test. The simplified test used two cephalic catheters, implanted in unsedated, unanaesthetised cats three hours before the test. Blood samples were collected before and after intravenous administration of glucose (0.5 g/kg bodyweight). Blood glucose concentration was measured with a reflectance glucose meter and an automated chemistry analyser. There were no significant differences between the results derived from the two tests. Because the simplified glucose tolerance test is easier to perform, requires no anaesthesia, uses only cephalic catheters and can be done on an outpatient basis, it is more cost effective and more clinically applicable. There were no significant differences between the results of glucose measurements with the two machines and the simplified glucose tolerance test can therefore be carried out with the reflectance glucose meter.

Evaluation of Mesocyclops aspericornis (Cyclopoida:Cyclopidae) and Toxorhynchites speciosus as integrated predators of mosquitoes in tire habitats in Queensland.

This study addressed biological control of peridomestic Aedes notoscriptus, known to be a highly effective colonizer of tire habitats and a possible vector of Ross River virus. A laboratory trial of the compatibility of the predators Mesocyclops aspericornis and Toxorhynchites speciosus in small container habitats showed that 4th-instar Tx. speciosus did not significantly affect M. aspericornis mortality. Introduced M. aspericornis and naturally occurring Tx. speciosus were found to form a compatible predator pair for reduction of larval Ae. notoscriptus and Culex quinquefasciatus populations in tire habitats. Over 22 months of field survey, 97% of tires without predators contained mosquito larvae, at a median density of 43 larvae/liter. By comparison, 51% of tires containing both predator species held mosquito larvae at a median density of 4 larvae/liter. Predation by Tx. speciosus persisted for the duration of the study. The inability of the Lake Kurwongbah strain of M. aspericornis to tolerate temperatures of < or = 10 degrees C, which are prevalent in Brisbane during winter, resulted in a failure to deliver persistent reduction of mosquitoes in tires. The temperature-dependent population characteristics of M. aspericornis emphasize the long-recognized importance of matching a biological control candidate's physiological requirements to the environment in which control is sought.

Microscopic age changes in the human occipital bone.

The value of histological examination of the human occipital bone for estimation of age-at-death was assessed. Undecalcified sections of occipital bone from eighteen male Caucasian subjects between the ages of 21 and 70 years were prepared for analysis using polarized light microscopy. The fractional volumes of primary osteons, secondary osteons, osteon fragments, and lamellar bone in both the outer and inner cortical tables were determined. It was found that with increasing age there is a decrease in the fractional volume of primary osteons and a significant decrease in the fractional volume of lamellar bone. The fractional volume of secondary osteons was not found to change significantly with age, while the fractional volume of osteon fragments significantly increases. The microscopic results reflect the continuous process of bone remodeling that is responsible for the variation in cortical parameters with age and is the primary basis for age predicting methods. While observable changes in the occipital bone do occur with increasing age, the amount of random variation in the parameters examined preclude their use for accurate age estimation.

Evaluation of Australian Mesocyclops (Cyclopoida: Cyclopidae) for mosquito control.

Six of seven species of Mesocyclops copepods, collected from northeastern Australia, showed potential as biological control agents of Aedes mosquitoes. Methods of laboratory evaluation included predation trials at different larval mosquito densities, population growth rates at different temperatures, and laboratory cage simulations. The predation efficacy of Mesocyclops aspericornis, M. australiensis, and M. mb1 from southern Queensland, and M. darwini, M. mb2, M. notius and M. mb3 from northern Queensland were compared with M. aspericornis (used successfully in French Polynesia) against laboratory populations of Aedes aegypti (L.), Culex quinquefasciatus Say, and Anopheles farauti Laveran (No. 1). M. aspericornis (L. Kurwongbah) proved to be the most effective Queensland predator and exhibited an elevated reproductive rate at 20-25 degrees C. M. darwini was less efficient as a predator but was more fecund at 25-35 degrees C. Based on these evaluations, M. aspericornis (L. Kurwongbah) has been selected for small-scale field trials in Queensland.

Iron deficiency in inner city pre-school children: development of a general practice screening programme.

Iron deficiency in children has been associated with behavioural disorder and developmental delay. Screening for iron deficiency was offered to all 527 children aged between one and four years in an inner city practice. Half the children belong to an ethnic minority group, and there is widespread social deprivation in the area. Capillary haemoglobin concentration and mean corpuscular volume were estimated in 365 children (69%). Dietary history, birth weight and current weight were also recorded. Fifty-eight (16%) of the children were iron deficient as defined by a mean corpuscular volume of less than 75 fl and/or a haemoglobin concentration of less than 10.5 g dl(-1). All were hypochromic and among 23 tested all had serum ferritin levels below 10microg I(-1). Twenty-one children (5.8%) were anaemic (haemoglobin concentration less than 10.5 g dl(-1)). Anaemia was significantly more common among children who were currently underweight but was not related to weight at birth. Iron deficiency was significantly more prevalent in non-Caucasian children - 25.0% compared with 7.8% of Caucasian children. There was also a significant linear decrease in iron deficiency with increasing age. Sex, weight at birth, current weight, whether breast fed, age weaned or whether on a vegetarian diet were not significant factors in iron deficiency. Iron supplements were given to all the children with iron deficiency.In view of the high prevalence of iron deficiency, all children in the practice are now routinely offered screening for iron deficiency at the age of 14 months. The programme has been welcomed by all parents. It is suggested that screening for iron deficiency should be part of routine child surveillance.