Cross sectional study of childhood obesity and prevalence of risk factors for cardiovascular disease and diabetes in children aged 11–13

Background

European and Developing Countries Clinical Trials Partnership (EDCTP) was founded in 2003 by the European Parliament and Council. It is a partnership of 14 European Union (EU) member states, Norway, Switzerland, and Developing Countries, formed to fund acceleration of new clinical trial interventions to fight the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), malaria and tuberculosis (TB) in the sub-Saharan African region. EDCTP seeks to be synergistic with other funding bodies supporting research on these diseases.

Methods

EDCTP promotes collaborative research supported by multiple funding agencies and harnesses networking expertise across different African and European countries. EDCTP is different from other similar initiatives. The organisation of EDCTP blends important aspects of partnership that includes ownership, sustainability and responds to demand-driven research. The Developing Countries Coordinating Committee (DCCC); a team of independent scientists and representatives of regional health bodies from sub-Saharan Africa provides advice to the partnership. Thus EDCTP reflects a true partnership and the active involvement and contribution of these African scientists ensures joint ownership of the EDCTP programme with European counterparts.

Results

The following have been the major achievements of the EDCTP initiative since its formation in 2003; i) increase in the number of participating African countries from two to 26 in 2008 ii) the cumulative amount of funds spent on EDCTP projects has reached € 150 m, iii) the cumulative number of clinical trials approved has reached 40 and iv) there has been a significant increase number and diversity in capacity building activities.

Conclusion

While we recognise that EDCTP faced enormous challenges in its first few years of existence, the strong involvement of African scientists and its new initiatives such as unconditional funding to regional networks of excellence in sub-Saharan Africa is envisaged to lead to a sustainable programme. Current data shows that the number of projects supported by EDCTP is increasing. DCCC proposes that this success story of true partnership should be used as model by partners involved in the fight against other infectious diseases of public health importance in the region.     

Reversible multiorgan system involvement in a neonate with complex IV deficiency

Mitochondrial respiratory chain deficiencies can present as fulminant liver failure or disease, and the prognosis when associated with severe neonatal lactic acidosis is frequently guarded. We report the case of a neonate who presented with acute liver failure and fulminant lactic acidosis with profound complex IV deficiency documented in muscle and liver biopsies. The neonate subsequently experienced clinical resolution by 3 months of age, and was observed to have reversibility of the biochemical deficiency noted in muscle. This case illustrates that resolution of this severe neonatal phenotype does occur, of importance for accurate prognostic and genetic counseling for such affected neonates.     

Stoma coloproctology nurse specialist: a case study

Aims and objectives. The aim of this paper is to provide insight into the role of a Stoma Coloproctology Nurse Specialist. This paper presents the findings of an in‐depth case study of a stoma coloproctology nurse specialist employed in one health board area in Northern Ireland. This case study was part of a larger study exploring innovative nursing and midwifery roles in Northern Ireland. Background. Specialist nursing roles have evolved and developed in response to changing health care needs, patient expectations, changes in professional regulation and government initiatives. Design. A case study approach was adopted. Method. Semi‐structured interviews with the post holder (PH), her line manager and the human resource manager were undertaken. Non‐participant observation of the PH's practice was also carried out. Analysis was undertaken on secondary data such as job specification, annual reports and other documentation relating to the post. Results. Findings illustrate the PH's function and the impact of the role on patient care. Examples of innovative practices relating to providing care, support and guidance for patients and their families were identified; however, limitations to her role were also identified. Conclusions. The PH provides an invaluable service to patients, demonstrating a positive impact on care. However, the findings suggest the importance of establishing clear role boundaries, which may lead to professional growth and practice development. Relevance to clinical practice. Although this study provides a valuable insight into the role of a Stoma Coloproctology Nurse Specialist a number of challenges exist, as the CNS role requires policy and appropriate educational preparation to practice at an advanced level. Further research investigating the development of the CNS role in the clinical setting and its relationship to members of the multi‐professional team would be beneficial.     

Injuries caused by the attenuated energy projectile: the latest less lethal option

Objectives

To review the injuries resulting from the attenuated energy projectile (AEP) in patients who present to emergency departments.

Method

Review of case notes of patients presenting with injuries caused by the AEP after three episodes of serious civil disturbance in Northern Ireland from July to September 2005.

Results

14 patients with 18 injuries were identified and included in the study. All patients were male, with an average age of 26.3 years. There were six injuries above the level of the clavicle, to the head, face or neck. There were three chest injuries, seven lower limb injuries and two upper limb injuries. There were no abdominal injuries. Seven patients required hospital admission. Five patients required surgical intervention. One patient required protective, elective intubation and one patient required the insertion of a chest drain.

Discussion

Although the study numbers were small, 33.33% of injuries were to the head and neck and 16.67% of the injuries were to the chest. The AEP was introduced as a replacement for its predecessor, the L21A1 plastic baton round, because of a theoretical risk of serious or even life threatening head injury from this projectile in certain circumstances. However, in this first survey of its usage, 50% of the injuries presenting to hospital were to the face, neck, head or chest. This injury pattern was more in keeping with older plastic baton rounds than with the L21A1.The attenuated energy projectile (AEP) is the most recent projectile to be developed as a less lethal system for use against violent individuals in the management of civil unrest or conflict. It has been issued to police forces in the UK and to the police force and British Army in Northern Ireland, and has been available since 21 June 2005. It replaced the L21A1 plastic baton round, which itself had been in use since May 2001.¹The L21A1 round was introduced because of a belief that it would be less likely to cause life‐threatening injury than its predecessor, the plastic baton round, when used by appropriately trained police officers. However, in certain circumstances—for example, high‐energy ricochets—the potential for more serious and life‐threatening head injury seemed to increase. Once this conclusion was reached by the Defence Scientific Advisory Council, work was undertaken under the direction of the Northern Ireland Office to develop a weapons system that would offer energy‐attenuating features and ricochet characteristics different from the L21A1. This led to the development of the AEP. The AEP is a projectile designed to deliver an impact to an individual, to dissuade or prevent an intended course of violent action, and, thereby mitigate the threat to law‐enforcement personnel and members of the public. It is not intended to cause serious or life‐threatening injury.²The AEP was designed to be more accurate, safer and reduce the injury potential compared with the L21A1, and especially to reduce the clinical consequences of an injury to the head. It does not fragment, which in itself reduces the risk of accidental injury and the potential for ricochet injury.The AEP was designed to be fired from the L104A1 gun using the same XL1 18E3 optical sight as the old L21A1 round. There were no changes in the guidelines regarding its use.²The AEP is made of polyurethane (owing to its temperature stability and the possibility of tightly controlling the material properties). The crumple zone is polyurethane, with an air gap in the nose. Its dimensions are similar (10×3.7 cm) to its predecessor, as is its weight (98 g). The mean velocity is 72 m/s. It delivers a slightly higher kinetic energy on initial impact than its predecessor, the L21A1 (254 J upon striking its target compared with 244 J), although its design means that there is less kinetic energy transfer once the target has been struck.The L21A1 was last used in Northern Ireland in September 2002, and the AEP was first used in July 2005. It is important to point out that although the AEP had already been fired on a number of occasions by police forces in Great Britain, it may be used there against specific individuals who pose a major threat whereas in Northern Ireland, it is used against individuals in circumstances of serious public disorder and riot.