Factor V Leiden: prevalence and thromboembolic complications after total hip replacement in Ireland.

BACKGROUND: The Factor V Leiden (FVL) mutation is the commonest genetic abnormality associated with venous thromboembolism. AIMS: To determine the prevalence of the FVL mutation in Irish patients undergoing total hip replacement and whether it has an increased risk of deep venous thrombosis or pulmonary embolism (DVT/PE). METHODS: Prospective screening of 113 patients over 2 years. All had prophylaxis against thrombosis. Symptomatic DVT and PE were diagnosed with venography and ventilation-perfusion scans, respectively. RESULTS: The prevalence of the FVL mutation was 2%. Six patients (5.3%) developed a DVT/PE. Half of these had a history of venous thromboembolism (resulting in a higher risk of post operative DVT/PE (P = 0.04, Fischer's exact test) but none had the FVL mutation. Of the remaining 107 patients not developing DVT/PE, 2 had the FVL mutation (heterozygotes). CONCLUSIONS: The prevalence of the FVL mutation was 2% but was not a risk factor for acute symptomatic DVT/PE.

Deliberate self-harm in Oxford, 1990-2000: a time of change in patient characteristics.

BACKGROUND: Trends in deliberate self-harm (DSH) are important because they have implications for hospital services, may indicate levels of psychopathology in the community and future trends in suicide, and can assist in identification of means of suicide prevention. METHOD: We have investigated trends in DSH and characteristics of DSH patients between 1990 and 2000 based on data collected through the Oxford Monitoring System for Attempted Suicide. RESULTS: During the 11-year study period 8590 individuals presented following 13858 DSH episodes. The annual numbers of persons and episodes increased overall by 36.3% and 63.1% respectively. Rates (Oxford City) declined, however, in the final 3 years. There were gender- and age-specific changes, with a rise in DSH rates in males aged > or = 55 years and in females overall and those aged 15-24 years and 35-54 years. Repetition of DSH increased markedly during the study period. Antidepressant overdoses, especially of SSRIs, increased substantially. Paracetamol overdoses declined towards the end of the study period. Alcohol abuse, use of alcohol in association with DSH, and violence increased, especially in females, and the proportion of patients in current psychiatric care and misusing drugs also rose. CONCLUSIONS: While overall rates of DSH did not increase markedly between 1990 and 2000, substantial changes in the characteristics of the DSH population and a rise in repetition suggest that the challenges facing clinical services in the management of DSH patients have grown.

Cost analysis of primary total hip replacement.

Arthritis of the hip is a cause of significant morbidity to the sufferer, for which total hip replacement is firmly established as an effective treatment. In order to assess the cost utility and benefit of total hip replacement, we compared the costs incurred to the health benefit accrued as measured by improvement in pre to post operative Harris hip scores, WOMAC osteoarthritis indices and SF 36 scores. Our calculations suggested the average unit cost of a total hip replacement at Cappagh National Orthopaedic Hospital, in 1999, to be in the region of 6,500 pounds. Cost utility was calculated as cost per QALY. Cost benefit was expressed as cost per 10 point increments in Harris hip scores, WOMAC and SF 36 scores. We conclude that total hip replacement is a worthwhile and efficient investment of health resources.

Substances used in deliberate self-poisoning 1985-1997: trends and associations with age, gender, repetition and suicide intent.

BACKGROUND: Rates of deliberate self-poisoning have increased in recent years. While over-the-counter availability and prescribing patterns may influence trends in substances used in overdose, these may also be related to clinical characteristics of patients. We investigate trends in substances used for self-poisoning and the influence of age, gender, suicidal intent and repetition status on the substances used. METHOD: Data collected by the Oxford Monitoring System for Attempted Suicide were used to review trends and patterns of self-poisoning between 1985 and 1997. RESULTS: There were substantial increases in self-poisoning with paracetamol and antidepressants. While the increase in antidepressant self-poisoning closely paralleled local prescribing figures during 1995-97, SSRI antidepressant overdoses occurred somewhat more often than expected compared with tricyclic overdoses. Paracetamol overdoses were more common in first-timers and young people, whereas overdoses of antidepressants and tranquillizers were more common in repeaters and older people. Self-poisoning with gas and non-ingestible poisons was associated with high suicidal intent. CONCLUSIONS: There have been marked changes in the substances used for self-poisoning, which seem primarily to reflect availability, as do the influences of age and repeater status on choice of substances used. Degree of suicidal intent may also influence choice of method of self-poisoning.

Social class and suicidal behaviour: the associations between social class and the characteristics of deliberate self-harm patients and the treatment they are offered.

BACKGROUND: Rates of deliberate self-harm (DSH) in the United Kingdom are much higher in lower than upper social class groups. Previous investigations have shown differences in socio-demographic and clinical characteristics of male patients according to social class. In two studies of DSH patients in Edinburgh the extent of provision of psychiatric aftercare was inversely related to social class. These findings have not been investigated in other areas. METHOD: Data collected through the Oxford Monitoring System for Attempted Suicide were used to examine the association between social class and socio-demographic and clinical characteristics in male and female DSH patients who presented to the general hospital in Oxford between mid-1988 and 1996 and to determine whether the previously reported social class differences in provision of psychiatric aftercare were replicated. RESULTS: Data on social class were available for 2,828 DSH patients (1,290 males, 1,538 females). In both genders, lower social class group tended to be associated with younger age. In males, the main social class differences were found in under-35-year-olds, in whom lower social class was related to criminal record, violence to others and drug misuse. In females, psychiatric disorders were diagnosed more frequently in the higher social class groups, but only in the under-35 age group. In neither gender was there a significant association between social class and the frequency of offer of psychiatric aftercare following DSH. CONCLUSIONS: There are considerable variations in socio-demographic and clinical characteristics of both male and female DSH patients in different social classes, especially in younger patients. The reason for the absence of a marked social class gradient in psychiatric aftercare found in this study in contrast to the results from previous investigations may be related to differences in styles of service.

Deliberate self-harm in adolescents in Oxford, 1985-1995.

Deliberate self-harm (DSH) has been one of the major health problems of adolescents in the U.K. for many years. Any changes in rates of DSH or the demographic characteristics of the patient population are likely to have important implications for clinical services and for future suicidal behaviour. Following a decline in rates in the late 1970s and mid 1980s, there were signs in the late 1980s that rates were beginning to increase again. We have used data collected by the Oxford Monitoring System for Attempted Suicide on the basis of patients presenting to the general hospital in Oxford to review trends in DSH in under 20-year-olds between 1985 and 1995. There was a substantial increase in the numbers of teenage DSH patients during the 11-year study period, with an increase between 1985-1986 and 1994-1995 of 27.7% in males, 28.3% in females, and 28.1% overall. There were no demographic changes within the catchment area to explain a change of this size. As rates of repetition of DSH also increased in both sexes during the study period the overall number of episodes of DSH rose even more between 1985-1986 and 1994-1995 (+56.9% in males, +46.3% in females, and +49.4% overall). As in previous studies the majority of adolescents had interpersonal problems and/or difficulties with studying or employment. Self-poisoning with paracetamol and paracetamol compounds became increasingly common such that by 1995 these were used in almost two-thirds of overdoses. The recent increase in DSH in adolescents has important implications for general hospital and adolescent psychiatric services. The greater frequency of repetition of DSH may herald increased future suicide rates. The case for restricting the amount of paracetamol available is overwhelming. Evaluative trials of specific interventions following adolescent DSH are urgently required.

Trends in deliberate self-harm in Oxford, 1985-1995. Implications for clinical services and the prevention of suicide.

BACKGROUND: Deliberate self-harm (DSH) has been a major health problem in the UK for nearly three decades. Any changes in rates of DSH or the demographic characteristics of the patient population are likely to have important implications for clinical services and suicide prevention. METHOD: Data collected by the Oxford Monitoring System for Attempted Suicide were used to review trends in DSH between 1985-1995. RESULTS: There was a substantial increase in DSH rates during the 11-year study period, with a 62.1% increase in males and a 42.2% increase in females. The largest rise was in 15-24-year-old males (+ 194.1%). Changes in DSH rates correlated with changes in national suicide rates in both males and females in this age group. Rates of repetition of DSH increase in both genders during the study period. Paracetamol self-poisoning has continued to increase, half of all overdoses in 1995 involving paracetamol, and antidepressant overdoses have become more common. CONCLUSIONS: The increase in DSH, especially in young males, has important implications for general hospital DSH and medical services. It may herald a reversal of recent progress towards achievement of national suicide targets.

Neonaticide, infanticide, and filicide: a review of the literature.

This article summarizes and reviews the literature on neonaticide, infanticide, and filicide. A literature review was conducted using the Medline database: the cue terms neonaticide, infanticide, and filicide were searched. One hundred-fifteen articles were reviewed; of these, 51 are cited in our article. We conclude that while infanticide dates back to the beginning of recorded history, little is known about what causes parents to murder their children. To this end, further research is needed to identify potential perpetrators and to prevent subsequent acts of child murder by a parent.

Morphometric studies of the epidermal-dermal junction in the rat ear: some effects of experimental friction on epidermis and anchoring fibrils.

The aim of this investigation was to determine whether, following the application of experimental friction to the skin, qualitative an quantitative differences could be induced in the epidermis and in anchoring fibrils. The skin of rat ears was subjected to repeated mild fractional stimulation with a rotating bristle brush moistened with saline thrice weekly for three weeks, untreated ears being used as controls. A stratified random sampling design was followed for the morphometric analysis of interfollicular epidermis. With the light microscope, the lengths of the granular cell/keratin (BGK) and epithelial-connective tissue (BEC) junctions were measured using an image analyser, as was the epithelial thickness (T). The ratio BEC/BGK provides an index of the degree of irregularity of the epithelial-connective tissue junction. Using electron microscopy, the numbers of anchoring fibrils per unit length of lamina densa (NB) were determined using stereological intersection counting. There are no significant differences in BEC/BGK or T between control and experimental groups, but anchoring fibril frequency NB increased from 10.29 micrometers in control epidermis to 18.9 micrometers in friction-treated epidermis. It is concluded that a mild frictional stimulus which fails to produce significant alterations in epidermal thickness can produce a marked increase in anchoring fibril frequency. This response may reflect a functional alteration associated with increased mechanical loading, in which epidermal-dermal adherence is augmented by either synthesis of anchoring fibrils or their insertion into the lamina densa.

Quantitative light and electron microscopical studies of the epithelial-connective tissue junction in intraoral mucosae.

The present study was designed to clarify the morphological nature of epithelial-connective tissue attachment by quantitative comparison of palatal and buccal mucosae. Tissue samples were obtained from ferrets and, following a strict sampling regime, sections were obtained for quantitative light and electron microscopy. Electron micrographs from the epithelial-connective tissue junction were subjected to analysis by serological intersection counting. Quantitative results show that palatal epithelium has a comparatively convoluted interface, and is twice as thick as buccal epithelium. Stereological data are presented for relative surface area of basal plasma membrane occupied by hemidesmosomes, mean hemidesmosomal diameter and numerical density of hemidesmosomes per unit area of basal plasma membrane. Larger hemidesmosomes are found in the palatal epithelium. Results suggest that a prominent rete-ridge pattern, as seen in the palatal epithelium, along with a greater specialized surface for adhesion, may be responsible for providing epithelial-connective tissue stability in regions subjected to high mechanical stress.