Stroke Risk Factors, Subtype, and Outcomes in a Multi-Ethnic Stroke Population

Aim We aim to describe differences in stroke risk factors, subtypes and outcomes in a multi-ethnic Irish Stroke population. Gaining an insight into prevalent risk factors and subtypes in ethnic groups may help target prevention efforts. Methods We retrospectively identified patients originally not of Irish ethnicity (ONIE) admitted to the acute stroke unit between 2016 and 2018 through surname recognition (N=44). Country of origin was confirmed on chart review. The presumed native Irish (PNI) patients admitted over the same time frame were used as a comparison group (N=437). Data was collected on stroke subtype, comorbidities, outcomes and socioeconomic factors. Results Patients ONIE made up 9.1% of all stroke unit admissions. Male gender was more common accounting for 33 of 44 (75%) patients ONIE and 251 of 437 (57.4%) PNI (p = 0.02). Overall ONIE were younger than PNI patients (mean age 57.5 [SD 13.0] vs 69.6yr [SD 13.2], p <0.001). Patients ONIE also recorded higher rates of intracranial haemorrhage(ICH) (N = 15 [34.1%] vs N=51 [11.7%], p <0.01). Conclusion Our study demonstrates that stroke patients ONIE have a different stroke subtype and demographic profile compared to Irish patients. Patients ONIE are more likely to be young, male with higher rates of ICH.

Hyperammonaemia in Neonates and Young Children: Potential Metabolic Causes, Diagnostic Approaches and Clinical Consequences

Hyperammonaemia is a metabolic disturbance characterized by accumulation of ammonia in the blood. Entry of ammonia into the brain via the blood-brain barrier leads to hyperammonaemic encephalopathy. The causes of hyperammonaemia in paediatric patients vary. We present 3 cases of hyperammonaemia in critically ill children in whom an inborn metabolic disorder was identified and provide insights into the phenotypes, diagnostic approaches and management. In children with acute overwhelming illness and progressive neurological deterioration plasma ammonia measurement should be included in the urgent diagnostic work-up. We here raise the awareness that hyperammonaemia is a metabolic emergency requiring prompt recognition and treatment to avoid subsequent complications.

Potential impact of cycle of care on Diabetes services in secondary care

Diabetes Cycle of Care is a new initiative recently introduced by the Health Service Executive (HSE). In this review we found that a quarter of patients attending a secondary care diabetes outpatient clinic in a large teaching hospital could potentially be managed in primary care upon implementation of Diabetes Cycle of Care.

The short-term effects of management changes on watertable position and nutrients in shallow groundwater in a harvested peatland forest

Management changes such as drainage, fertilisation, afforestation and harvesting (clearfelling) of forested peatlands influence watertable (WT) position and groundwater concentrations of nutrients. This study investigated the impact of clearfelling of a peatland forest on WT and nutrient concentrations. Three areas were examined: (1) a regenerated riparian peatland buffer (RB) clearfelled four years prior to the present study (2) a recently clearfelled coniferous forest (CF) and (3) a standing, mature coniferous forest (SF), on which no harvesting took place. The WT remained consistently below 0.3 m during the pre-clearfelling period. Results showed there was an almost immediate rise in the WT after clearfelling and a rise to 0.15 m below ground level (bgl) within 10 months of clearfelling. Clearfelling of the forest increased dissolved reactive phosphorus concentrations (from an average of 28-230 μg L(-1)) in the shallow groundwater, likely caused by leaching from degrading brash mats.

Surgical treatment for invasive lobular carcinoma of the breast

The management and outcome of 131 women with infiltrating lobular carcinoma treated in the Belfast City Hospital between October 1987 and February 1999 were reviewed. Two patients had primary hormonal treatment and were excluded from the statistical analysis, and 129 patients were followed up. Fifty-four patients (41%) had initial breast conservation surgery, which was followed by re-excision of margins in eight patients (14.8%) and completion total mastectomy in 26 patients (48.1%). The breast conservation surgery group, 28 patients (21.7%), was compared with the total mastectomy group, 101 patients (78.2%), after a median follow-up period of 90 months (range 24-160 months). The overall survival was 68.7%. Survival analysis was performed using Kaplan-Meier and Cox regression which showed that lymph node involvement and tumour grade were the only variables affecting survival (P<0.0001, and 0.01, respectively). The type of surgery performed did not affect survival (P=0.42). The total number of patients who developed local recurrence was 17 patients (13.1%, 12 patients in the breast conservation surgery group and five patients in the total mastectomy group, P<0.0001). Kaplan-Meier analysis of local recurrence showed that the type of surgery (P<0.0001), patient age (P=0.02), tumour grade (P=0.002), adjuvant radiotherapy (P=0.013), chemotherapy (P=0.031) and hormonal treatment (P=0.003) significantly affected local recurrence. Cox regression analysis showed that the only factor significantly affecting local recurrence was the type of surgery performed (P=0.02). Patients who underwent mastectomy had less local recurrence than those who had breast conservation surgery. Local recurrence after breast conservation surgery is high, even with clear surgical margins and post-operative radiotherapy. The authors believe that total mastectomy for infiltrating lobular carcinoma is a safer option to control local disease, especially in younger patients and those with high-grade tumours. Overall survival is not affected by the type of surgical treatment. Local recurrence can be a late event and a long-term follow-up is recommended.

Project Northland high school interventions: community action to reduce adolescent alcohol use

Project Northland is a randomized community trial initially implemented in 24 school districts and communities in northeastern Minnesota, with goals of delaying onset and reducing adolescent alcohol use using community-wide, multiyear, multiple interventions. The study targets the Class of 1998 from the 6th to 12th grades (1991-1998). The early adolescent phase of Project Northland has been completed, and reductions in the prevalence of alcohol use at the end of 8th grade were achieved. Phase II of Project Northland, targeting 11th- and 12th-grade students, uses five major strategies: (1) direct action community organizing methods to encourage citizens to reduce underage access to alcohol, (2) youth development involving high school students in youth action teams, (3) print media to support community organizing and youth action initiatives and communicate healthy norms about underage drinking (e.g., providing alcohol to minors is unacceptable), (4) parent education and involvement, and (5) a classroom-based curriculum for 11th-grade students. This article describes the background, design, implementation, and process measures of the intervention strategies for Phase II of Project Northland.

Health care providers' perspectives on patient delay for seeking care for symptoms of acute myocardial infarction

To inform intervention development in a multisite randomized community trial, the Rapid Early Action for Coronary Treatment (REACT) project formative research was undertaken for the purpose of investigating the knowledge, beliefs, perceptions, and usual practice of health care professionals. A total of 24 key informant interviews of cardiologists and emergency physicians and 15 focus groups (91 participants) were conducted in five major geographic regions: Northeast, Northwest, Southeast, Southwest, and Midwest. Transcript analyses revealed that clinicians are somewhat unaware of the empirical evidence related to the problem of patient delay, are concerned about the practice constraints they face, and would benefit from concrete suggestions about how to improve patient education and encourage fast action. Findings provide guidance for selection of educational strategies and messages for health providers as well as patients and the public.

What can you teach about cardiopulmonary resuscitation (CPR) in 30 seconds? Evaluation of a television campaign

This study evaluated an 8-month media campaign, implemented in western Washington, to educate people on the basic steps of cardiopulmonary resuscitation (CPR) for cardiac arrest. A telephone survey was conducted with a total of 384 adults randomly selected from two towns, one that had been exposed to the campaign (intervention town) and one that had not been exposed to the campaign (comparison town). Results showed that respondents in the intervention town were more likely than respondents in the comparison town to report (a) having heard messages on CPR in the past month, (b) having seen the CPR media campaign, and (c) knowing the three basic steps of CPR. Respondents who had seen the campaign evaluated it very favorably. There were no differences between respondent groups in self-reported CPR training or intentions to perform CPR, suggesting that the campaign had a greater impact on knowledge and awareness than on intentions and behavior.

The discursive formation of health. A study of printed health education material used in primary care

This study analyses printed educational material on cholesterol, food and health-related lifestyle changes used in primary care in southern Sweden. Two theoretically grounded perspectives are used: orientation of knowledge and rhetoric. According to the first one, the material contained many examples of abstract and detailed knowledge, such as tables of energy contents, and a little less of action-oriented and detailed knowledge, such as food recipes. We also found a few examples of comprehensive, abstract knowledge, such as theoretic explanations. Action-oriented and comprehensive knowledge, relating health to-lifestyle, were rare. The rhetoric style of the material was generally dominated by plain facts, without any identified voice (i.e. sender) or any emotional orientation. Overall, information was not related to 'the voice of the life-world' but to 'the voice of medicine', and it was in character more general than specific.

Content analysis of coverage of alcohol control policy issues in black-oriented and mainstream newspapers in the U.S

We conducted a content analysis of alcohol control policy issues in Black-oriented and mainstream newspapers in the United States from 1993 to 1995, using computerized content analysis methods. The specific purpose of our study was to compare differences in coverage of alcohol control policy issues in Black-oriented and mainstream newspapers. Fifteen Black-oriented and 12 mainstream newspapers were selected and analyzed. The number of policy paragraphs per year and the number of paragraphs in different policy thematic categories per year were examined. Regional differences in coverage of alcohol policy themes were examined for selected policies in mainstream newspapers. We found more similarities than differences in coverage of alcohol policy issues in Black-oriented and mainstream newspapers. Limiting the marketing/advertising and promotion of alcohol products was the most widely covered alcohol control policy issue over the three-year period in both Black-oriented media and mainstream newspapers. There were some important differences in coverage of alcohol policy issues. While economic alcohol policy issues were covered extensively in mainstream newspapers, these issues received far less attention in Black-oriented newspapers. Findings suggest that certain alcohol control policies may have less salience in African-American communities than in other communities.

Advances in the molecular genetic analysis of the flax-flax rust interaction

The L6 and M rust-resistance genes, representing two of the five rust-resistance gene loci in flax (Linum usitatissimum), have been cloned. The molecular data are fully consistent with earlier genetic data: the L locus is a single gene with multiple alleles expressing different rust resistance specificities, and the M locus is complex, containing an array of about 15 similar genes. Thus, while L6 and M resistance genes have 86% nucleotide identity, their locus structure is very different. These genes encode products belonging to the nucleotide binding site-leucine-rich repeat class of disease-resistance proteins. Analysis of alleles from the L locus and chimeric genes is providing evidence suggesting that important specificity determinants occur in the C-terminal half of the proteins, the region containing the leucine-rich repeats. The isolation and characterization of the rust (Melampsora lini) avirulence genes that correspond to the cloned rust-resistance genes is one of the major challenges remaining to the understanding of this system.

Notification of a family history of breast cancer: issues of privacy and confidentiality

Little information is available about notifying individuals with a family history of cancer about their risk of cancer. With the recent identification of BRCA1, an important predisposition gene for breast and ovarian cancer, genetic testing is becoming available to high-risk women and their families. Some of these individuals, may not be aware of their family history and may be notified of their family history by medical personnel or biomedical investigators. This disclosure could be detrimental to the individual by changing their perception of risk, sense of privacy, or psychosocial well-being. Members of 544 breast cancer families are currently being contacted as part of an epidemiologic follow-up study at the University of Minnesota. Some family members were unaware of their relative's diagnosis and therefore, notification occurred when they were contacted by study personnel. To determine the impact of risk notification in this context, 376 male and female relatives of 160 breast cancer probands were surveyed to assess their prior knowledge of their family history of cancer, issues relating to study participation, and their concerns regarding the possibility of developing cancer. Following a telephone interview about family history, family members were administered a short, open-ended questionnaire. The majority of individuals (82%) were blood relatives of the proband and 71% were either first- or second-degree relatives. A proportion of blood relatives (24%) were not aware of their family history of breast cancer. More blood relatives (76%) than nonblood relatives (62%, P < 0.01) were aware of their family history. 43 respondents (12%) expressed specific concerns about participating in the large genetic follow-up study and 16 comments concerned privacy issues. Neither the reasons for participation nor an individual's concern about developing cancer was associated with gender of the respondent, relationship to the proband, or awareness of breast cancer in the family. Interestingly, individuals who were notified about their family history through the large follow-up study were no more likely than other family members to be more concerned about developing cancer. Understanding the privacy and psychosocial issues of family members who are informed about a family history of breast cancer may aid in developing appropriate guidelines for notification. Risk notification in this setting does not appear to have a significant impact on these family members.

The shape up challenge: a community-based worksite exercise competition

PURPOSE

To assess organizational and employee participation during three community-wide worksite exercise competitions in two communities.

DESIGN

A one-group, posttest-only design was used. Lack of controls, exercise baseline, and the short-term nature of the interventions were limitations.

SETTING

The Minnesota Heart Health Program conducted annual exercise campaigns between 1982 and 1989 within three intervention communities to reduce behavioral risk for cardiovascular disease. The Shape Up Challenge was a worksite exercise competition designed, in conjunction with other campaign activities, to increase levels of physical activity.

SUBJECTS

A total of 119 participating companies in two Minnesota communities, and 17,626 employees within these worksites, composed the subjects in this study.

INTERVENTION

Eligible worksites were invited to participate in a month-long competition during which employees recorded minutes spent daily in aerobic activities. Incentives were established to promote intragroup cooperation and intergroup competition. Companies competed for awards that were based on average minutes of exercise per employee versus per participant.

MEASURES

Numbers of companies recruited and participating, campaign activities, minutes of exercise, and costs were recorded on implementation logs. Companies completed surveys describing business type, number and sex of employees, existing health promotion programs, and perceived benefits of participation.

RESULTS

Of the 365 companies invited to participate, 33% participated (range 15% to 50%). Participating companies were more likely than nonparticipating companies to offer other health promotion programs and perceived greater benefits from participation. Women and smaller companies had significantly greater participation rates than men and larger companies. Average employee participation rates ranged from as high as 84% in smaller organizations to as low as 16% as organization size increased.

CONCLUSIONS

Community-based worksite exercise competitions appear to be a viable strategy for promoting employee exercise, particularly in smaller companies. Group-based contingencies applied in natural work units may facilitate employee participation. Further research is needed to assess the relative efficacy of this approach, compare alternative incentives, and identify strategies to enhance exercise maintenance after the intervention has ceased.

Toward the assessment of psychological empowerment in health promotion: initial tests of validity and reliability

Because of the importance of empowerment in health promotion, the measurement of empowerment is a priority for health promotion research. The present study sought to develop a valid and reliable instrument to assess psychological empowerment and to resolve the theoretical question of whether psychological empowerment is a topic-specific or general construct. University of Minnesota employees (n = 160) completed two different versions of empowerment questionnaires. One of the questionnaires measured general empowerment; the other was specific to alcohol use prevention. Reasonable reliability was demonstrated in a previously developed general empowerment instrument (Cronbach's alpha coefficient of 0.84) and for an alcohol-specific instrument (Cronbach's alpha coefficient of 0.78). Construct validity for the alcohol-specific instrument was demonstrated by appropriate significant correlations between subscales and overall scores for both instruments. Predictive validity tests partially supported the concept that psychological empowerment is topic-specific, although further testing with a more representative population may be needed to resolve this question. The results suggest that the alcohol-specific psychological empowerment instrument could be used in the evaluation of community alcohol abuse prevention programmes.

Factors which explain amount of participation in rural adolescent alcohol use prevention task forces

Project Northland task force members are typically female, have children, and belong to a number of other community or social groups. Members were likely to participate more in the task forces if they were relative newcomers to the community and if they got satisfaction from their participation. While explaining only a modest amount of the variance (15.5%), the explanatory power of the results are comparable to other studies of this nature, where 23% of explained variance predicting participation has been considered informative. Future models will need to consider other factors to increase the explained variance. Satisfaction with being a task force member was associated with the amount of control and ownership each member felt and the extent of agreement with the direction of the task force. These variables explained 26% of the variance. It may be that relative newcomers to the community, who tended to participate more, have lived elsewhere and been exposed to environments where alcohol was less frequently used, and this contrast contributed to their motivation and preparedness to work towards change. They may not be as integrated into the community as task force members who have lived in their communities for their entire lives, and may not be part of the dominant "alcohol culture" that exists in the region. If membership in community or social groups is an indicator of integration into the community, then the results suggest less integrated task force members were more active participants.(ABSTRACT TRUNCATED AT 250 WORDS)

Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health Program

OBJECTIVES

The Minnesota Heart Health Program is a 13-year research and demonstration project to reduce morbidity and mortality from coronary heart disease in whole communities.

METHODS

Three pairs of communities were matched on size and type; each pair had one education site and one comparison site. After baseline surveys, a 5- to 6-year program of mass media, community organization, and direct education for risk reduction was begun in the education communities, whereas surveys continued in all sites.

RESULTS

Many intervention components proved effective in targeted groups. However, against a background of strong secular trends of increasing health promotion and declining risk factors, the overall program effects were modest in size and duration and generally within chance levels.

CONCLUSIONS

These findings suggest that even such an intense program may not be able to generate enough additional exposure to risk reduction messages and activities in a large enough fraction of the population to accelerate the remarkably favorable secular trends in health promotion activities and in most coronary heart disease risk factors present in the study communities.

Thoracoscopic drainage and decortication as definitive treatment for empyema thoracis following penetrating chest injury

PURPOSE

The purpose of this study is to describe our experience with thoracoscopic drainage and decortication as definitive treatment for empyema thoracis following penetrating chest trauma.

METHODS

Over a 9-month period, eight patients at two institutions were treated for empyema thoracis that developed following penetrating chest injury. Seven patients sustained gunshot wounds and one a stab wound. All were treated for hemothorax with a closed tube thoracostomy. Associated injuries included six spinal cord injuries, a liver and diaphragmatic injury, a subclavian injury, and a carotid injury. Each patient subsequently developed an empyema. All patients underwent one thoracoscopic drainage and decortication of the empyema.

RESULTS

In all patients, complete resolution of the empyema was achieved with the thoracoscopic technique. Chest tubes were removed a median of 8.5 days after the procedure. Median blood loss was 200 mL. The average duration of the operation was 110 minutes. There were two complications, a persistent air leak and a trapped lung, both treated with thoracoscopic intervention.

CONCLUSION

Thoracoscopic drainage and decortication offers an alternative to thoracotomy for definitive therapy of empyema thoracis developing after penetrating chest trauma.

Instability of the L6 gene for rust resistance in flax is correlated with the presence of a linked Ac element

In a programme aimed at tagging rust-resistance genes in flax with the maize transposable element Ac, a primary transformant of a line called 'Forge' that is homozygous for four rust-resistance genes, L6, M, N and P2, was identified that possessed 10 copies of the Ac element, one of which was linked (29 map units) to L6. Descendants of this plant, which had from 8 to 15 copies of Ac, were crossed to a rust-susceptible line and the progeny screened for rust-susceptible mutants. When the Ac linked to L6 was present in the parent, a high frequency of L6 mutants was observed (29 mutants in 30,575). By contrast, when this Ac was absent, no such mutants were observed in 9258 progeny. The background frequency of L6 mutants was low (five in 124,088). A detailed analysis was made of the first 11 L6 mutants recovered from parents carrying the L6-linked Ac element. While none of the mutants possessed a tagged resistance gene, all lacked an RFLP marker closely linked to L6, suggesting that deletions were responsible for loss of the L6 specificity. In many of the mutants, one or more RFLP markers in the vicinity of the linked Ac were also absent. These findings suggest that the linked Ac may be inducing chromosome breakage.

Community-wide prevention of cardiovascular disease: education strategies of the Minnesota Heart Health Program

The Minnesota Heart Health Program (MHHP) is a research and demonstration project of population-wide primary prevention of cardiovascular disease. Study goals are to achieve reductions in cardiovascular disease risk factors and morbidity and mortality in three education communities compared with three reference communities. The program in the first of the three intervention communities, Mankato, has been operating for 3 of the planned 5 years. Early objectives of the program have been achieved based on data obtained from population-based random samples surveyed in education and comparison communities. After 2 years of participation, Mankato was significantly more exposed to activities promoting cardiovascular disease prevention. In this town of 38,000 inhabitants, 190 community leaders were directly involved as program volunteers, 14,103 residents (over 60% of adults) attended a screening education center, 2,094 attended MHHP health education classes, 42 of 65 physicians and 728 other health professionals participated in continuing education programs offered by MHHP, and distribution of printed media averaged 12.2 pieces per household. These combined educational strategies have resulted in widespread awareness of MHHP and participation by the majority of the Mankato adult population in its education activities.

Plasmid ColE1 conjugal mobility: the nature of bom, a region required in cis for transfer

Conjugal mobility of ColE1 and related plasmids is promoted by a wide range of conjugative plasmids. ColE1 produces trans-acting products and has a region required in cis (bom ; basis of mobility) for such mobility. Here we show that plasmid pBR322 contains a functional bom sequence located within a 141 bp HhaI fragment. This bom region is functional for conjugation promoted by several different conjugative plasmids and is highly conserved in ColE1 and contains nic the putative origin of transfer. The orientation and position of bom with respect to the ColE1 vegetative origin of replication can be changed without affecting the frequency of conjugal mobility promoted by R64drd11.

In vivo transcription studies of coliphage 186

The temporal apperance of transcripts from the 186 chromosome has been determined by pulse-labeling at different times after prophage induction and hybridization of RNA extracts to cloned restriction fragments of 186. Studies with different mutants and induction in the presence of chloramphenicol suggested a controlled pattern of transcription and led us to propose the existence of a primary control gene analogous to the lambda gene N.