First-aid training in school: amount, content and hindrances.

BACKGROUND: To increase knowledge and competence about first aid in the population, first-aid instruction is included in primary and secondary school curricula. This study aimed to establish how much time is spent on first-aid training, which first-aid measures are taught, and which factors prevent teachers from providing the quantity and quality of first-aid training that they wish to give. METHODS: A questionnaire was distributed to teachers in physical education in primary and secondary schools and to teachers in vocational subjects in higher secondary schools. RESULTS: The teachers taught a median of two lessons in first aid per year. Cardiopulmonary resuscitation (CPR) was taught by 64% of teachers, free airway and recovery position by 69% and stopping severe bleeding by 51%. Recognising heart attack and stroke was taught by 25% and 23%, respectively. The main factors that the teachers perceived as limiting the amount and quality of first-aid training were insufficient learning objective specifications in the curriculum, too many other competence aims, lack of CPR mannequins and lack of training as first-aid instructors. DISCUSSION: Norwegian teachers provide an appreciable amount of first-aid training to their students. However, several potential life-saving measures are poorly covered. The curriculum needs to contain first aid but also should specify what first-aid measures to be taught. First-aid training of teachers should adequately prepare them to be first-aid instructors.

Fatal injuries in rural and urban areas in northern Finland: a 5-year retrospective study.

BACKGROUND: Finland has the fourth highest injury mortality rate in the European Union. To better understand the causes of the high injury rate, and prevent these fatal injuries, studies are needed. Therefore, we set out to complete an analysis of the epidemiology of fatal trauma, and any contributory role for alcohol, long suspected to promote fatal injuries. As a study area, we chose the four northernmost counties of Finland; their mix of remote rural areas and urban centres allowed us to correlate mortality rates with 'rurality'. METHODS: The Causes of Death Register was consulted to identify deaths from external causes over a 5-year time period. Data were retrieved from death certificates, autopsy reports and medical records. The municipalities studied were classified as either rural or urban. RESULTS: Of 2915 deaths categorized as occurring from external causes during our study period, 1959 were eligible for inclusion in our study. The annual crude mortality rate was 54 per 100,000 inhabitants; this rate was higher in rural vs. urban municipalities (65 vs. 45 per 100,000 inhabitants/year). Additionally, a greater number of pre-hospital deaths from accidental high-energy trauma occurred in rural areas (78 vs. 69%). 42% of all pre-hospital deaths occurred under the influence of alcohol. CONCLUSION: The crude mortality rate for fatal injuries was high overall as compared to other studies, and elevated in rural areas, where pre-hospital deaths were more common. Almost half of pre-hospital deaths occurred under the influence of alcohol.

Bystander first aid in trauma - prevalence and quality: a prospective observational study.

BACKGROUND: Bystander first aid and basic life support can likely improve victim survival in trauma. In contrast to bystander first aid and out-of-hospital cardiac arrest, little is known about the role of bystanders in trauma response. Our aim was to determine how frequently first aid is given to trauma victims by bystanders, the quality of this aid, the professional background of first-aid providers, and whether previous first-aid training affects aid quality. METHODS: We conducted a prospective 18-month study in two mixed urban-rural Norwegian counties. The personnel on the first ambulance responding to trauma calls assessed and documented first aid performed by bystanders using a standard form. RESULTS: A total of 330 trauma calls were included, with bystanders present in 97% of cases. Securing an open airway was correctly performed for 76% of the 43 patients in need of this first-aid measure. Bleeding control was provided correctly for 81% of 63 patients for whom this measure was indicated, and prevention of hypothermia for 62% of 204 patients. Among the first-aid providers studied, 35% had some training in first aid. Bystanders with documented first-aid training gave better first aid than those where first-aid training status was unknown. CONCLUSIONS: A majority of the trauma patients studied received correct pre-hospital first aid, but still there is need for considerable improvement, particularly hypothermia prevention. Previous first-aid training seems to improve the quality of first aid provided. The effect on patient survival needs to be investigated.

Fatal injury caused by low-energy trauma - a 10-year rural cohort.

BACKGROUND: Death after injury with low energy has gained increasing focus lately, and seems to constitute a significant amount of trauma-related death. The aim of this study was to describe the epidemiology of deaths from low-energy trauma in a rural Norwegian cohort. METHODS: All deaths from external causes in Finnmark County, Norway, from 1995 to 2004 were identified retrospectively through the Norwegian Cause of Death Registry. Deaths caused by hanging, drowning, suffocation, poisoning, and electrocution were excluded. Trauma was categorised as high energy or low energy based on mechanism of injury. All low-energy trauma deaths were then reviewed. RESULTS: There were 262 cases of trauma death during the period. Low-energy trauma counted for 43% of the trauma deaths, with an annual crude death rate of 13 per 100,000 inhabitants. Low falls accounted for 99% of the injuries. Fractures were sustained in 89% of cases and head injuries in 11%. Ninety per cent of patients had pre-existing medical conditions, and the median age was 82 years. Death was caused by a medical condition in 85% of cases. Fifty-two per cent of the patients died after discharge from the hospital. CONCLUSION: In this cohort, low-energy trauma was a significant contributor to trauma related death, especially among elderly and patients with pre-existing medical conditions.

A systematic literature review on first aid provided by laypeople to trauma victims.

Death from trauma is a significant and international problem. Outcome for patients suffering out-of-hospital cardiac arrests is significantly improved by early cardiopulmonary resuscitation. The usefulness of first aid given by laypeople in trauma is less well established. The aim of this study was to review the existing literature on first aid provided by laypeople to trauma victims and to establish how often first aid is provided, if it is performed correctly, and its impact on outcome. A systematic review was carried out, according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, of all studies involving first aid provided by laypeople to trauma victims. Cochrane, Embase, Medline, Pubmed, and Google Scholar databases were systematically searched. Ten eligible articles were identified involving a total of 5836 victims. Eight studies were related to patient outcome, while two studies were simulation based. The proportion of patients who received first aid ranged from 10.7% to 65%. Incorrect first aid was given in up to 83.7% of cases. Airway handling and haemorrhage control were particular areas of concern. One study from Iraq investigated survival and reported a 5.8% reduction in mortality. Two retrospective autopsy-based studies estimated that correct first aid could have reduced mortality by 1.8-4.5%. There is limited evidence regarding first aid provided by laypeople to trauma victims. Due to great heterogeneity in the studies, firm conclusions can not be drawn. However, the results show a potential mortality reduction if first aid is administered to trauma victims. Further research is necessary to establish this.

Restraint stress in biomedical research: an update.

Since the publication of our initial review of restraint stress in 1986, much work has continued with this technique, either as a tool for the investigation of other pharmacological, physiological, or pathologic phenomena or with restraint stress itself serving as the object of the study. As we noted in 1986, the major use of restraint has been for the induction of stress responses in animals and, more specifically, for the investigation of drug effects, particularly as they affect typical stress-related pathology--gastrointestinal, neuroendocrine, and immunological agents have been extensively studied. In compiling this update on restraint stress and its effects, we noted an increasing emphasis on central nervous system mechanisms in peripheral disease, especially gastrointestinal disease. In particular, many CNS-active agents have been tested for their effects on gastric and duodenal lesion formation and gastric secretion, including antidepressants, antipsychotics, anxiolytics, noradrenergic, serotonergic, dopaminergic, and peptidergic compounds. Some of these agents are especially active in the gastrointestinal tract even when administered centrally, further solidifying the concept of a brain-gut axis. The present update includes studies of: methods and procedures, pre-restraint manipulations, post-restraint/healing effects, and drug effects. In addition, a current bibliography of reports that have employed restraint is included.

CNS effects on gastric functions: from clinical observations to peptidergic brain-gut interactions.

Clinical observations as early as the last century pointed to the stomach's link to the brain. Animal studies in this century have given us detailed information about the neuroanatomical and neurophysiological basis of brain-gut interactions. Psychological stress models and stereotaxic brain procedures have been important tools in gaining this information. During the last 10 years, there has been much focus on the effects of neuropeptides on gastric functions. Several CNS-peptides have indeed been shown to influence multiple gastric functions such as: acid secretion, bicarbonate secretion, mucus secretion, motility, blood flow and prostaglandin synthesis. Accordingly, direct CNS-application of these peptides also influences the development of gastric erosions during experimental stress procedures.

The neurobiology of stress ulcers.

We have reviewed the neurobiology of stress ulcers from animal models to potential pharmacotherapeutic mechanisms. The evidence strongly supports the hypothesis that certain stress-related gastric lesions are 'brain-driven' events which may be more effectively managed through central manipulations than by altering local, gastric factors. Recent advances in the use of anxiolytic and antidepressant drugs in the management of stress-related gastric mucosal injury further supports the contention that a brain-gut axis, which may have nervous, peptidergic and classic monoaminergic components, modulates the intricate and complicated pattern of communication between the brain and the stomach. Delineation of the precise pathways which make up this communication as well as their manipulation by various pharmacological agents will be the focus of future research endeavour.

Studies on the interaction between ICV effects of CRF and CNS noradrenaline depletion.

The role of an intact locus coeruleus (LC) noradrenergic system for the central effects of corticotropin-releasing factor (CRF) was studied. Rats were treated with N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine hydrochloride (DSP-4), a highly selective noradrenergic neurotoxin permanently affecting mainly the LC system. This procedure did not affect the activation of the sympathetic nervous system, as measured by plasma catecholamine levels, after either intracerebroventricular (ICV) or intraperitoneal (IP) administration of 8-micrograms CRF. Neither was the increased emotionality seen in an open field test after ICV injection of CRF altered. However, the ulceroprotective effect of 8-micrograms CRF ICV during a 2-hr water restraint stress was significantly antagonized by pretreatment with DSP-4, while CRF did exhibit an ulceroprotective effect after IP administration to DSP-4-treated animals. Our data indicate that the ulceroprotective effect of CRF under restraint stress is, at least partly, dependent on an intact locus coeruleus noradrenergic system.

Paradoxical DSP-4 effects: protection against gastric erosions and depletion of mucosal glycoproteins.

We have previously reported that rats pretreated with the central noradrenergic neurotoxin DSP-4 are protected against 23 h restraint-induced gastric erosions. To elucidate the peripheral mechanisms of this protection, we undertook direct biochemical analyses of the gastric mucosa in terms of glycoproteins and proteins. A simple method for preparation of gastric mucosa devoid of the muscular stomach wall tissue is described. A restraint-induced decrease in gastric mucosal wet weight and mucosal glycoprotein content was revealed. Restraint had no effect on mucosal protein content, and no changes were found in gastric wall glycoprotein or protein content. Despite showing protection against restraint-induced gastric erosions, unrestrained DSP-4-treated animals exhibited reduced mucosal wet weight and mucosal glycoprotein content when compared to unrestrained controls. After the stress period, no significant differences on mucosal weight or glycoproteins could be detected between control and DSP-4-treated animals. The results indicate that the protective effect of DSP-4 in this paradigm is not due to enhanced gastric mucosal protection against erosive factors. We suggest that an additional effect of central nervous NA depletion by DSP-4 may be elimination of aggressive factors which precipitate overt ulcers.

Plasma corticosterone and restraint induced gastric pathology: age-related differences after administration of corticotropin releasing factor.

Corticotropin releasing factor (CRF) or saline was administered i.p. to rats aged either 100 or 220 days, followed by either brief handling or water immersion restraint. Plasma corticosterone was measured 75 min. later. Age of the animals in itself was not a significant factor either for basal levels of plasma corticosterone or for extent of restraint induced gastric pathology. However after CRF administration, young but not older animals revealed a significant increase in plasma corticosterone levels, and post restraint gastric ulcerations were more severe in older than young animals. CRF significantly decreased the number of restraint induced ulcers in young rats, while the cumulative ulcer length was increased in older animals.

Effect of central noradrenaline depletion on corticosterone levels and gastric ulcerations in rats.

Effects of central noradrenergic depletion on the stress responses of rats were explored using the new selective neurotoxin (N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP-4)). Noradrenergic depletion using DSP-4 was followed by a reduction in basal corticosterone levels after 7 days. Three weeks after DSP-4 treatment, animals exhibited less severe and fewer gastric ulcerations than control animals following 23 h immobilization stress, but stress levels of corticosterone were similar for the two groups. No differences could be found in the peripheral gastric levels of noradrenaline between experimental and control animals, while central noradrenaline was reduced to approximately 30% of control levels. The data support previous findings using other methods that central noradrenaline is an important factor in stress-induced gastric ulceration. The peripheral mechanisms for the protective effects of DSP-4 remain to be elucidated, and studies of these may cast light on the efferent pathways between the central nervous system and gastric mucosa which are involved in stress-induced gastric pathology.

Behavioral effects after ibotenic acid, 6-OHDA and electrolytic lesions in the central amygdala nucleus of the rat.

Selective lesions of central amygdaloid neurons with ibotenic acid and electrolytic destruction of the nucleus both led to marked increases in open field activity and activity during passive avoidance conditioning. However, electrolytic lesions of both neurons and fibers resulted in the most pronounced passive avoidance impairments and it is suggested that this lesion effect should be attributed to a combined destruction of intrinsic neurons and neurons located outside the central amygdala nucleus. The 6-OHDA lesions resulted in no significant changes in the behavioral parameters under investigation or in plasma corticosterone levels. The lack of reduced corticosterone levels in any of the lesioned groups do not indicate that general fear arousal is critically dependent on intact central amygdala neurons in the rat. The behavioral data are, however, still compatible with a hypothesis of a temporary reduction in fear arousal during the initial phase of the passive avoidance conditioning.

Comparison of electrolytic and ibotenic acid lesions in the lateral hypothalamus.

Electrolytic lesions in the lateral hypothalamus (LH) seriously affect ingestive behavior and sensorimotor functions in the rat. We here report that bilateral infusions of the neurotoxin, ibotenic acid (IBO) in the LH yield a decrease in body weight, but not to the same extent as electrolytic lesions. The sensorimotor impairments were most severe after electrolytic lesions. When tested in a residential maze on days 5-7 and 18-20 after surgery, both lesioned groups showed no lack of motivation to seek food and water. Histological examination of the LH following IBO exposure revealed extensive degeneration of neuronal cell bodies with little evidence of non-specific damage. Biochemical analysis of the rostral forebrain content of norepinephrine (NE) and serotonin (5-HT) revealed that the fibers passing through the LH remained largely intact in the IBO treated rats. The results suggest that the observed aphagia and adipsia is not due to a lack of motivation, but rather reflects changes in the process which operate to initiate eating and drinking. Furthermore, selective neuronal degeneration induced the same behavioral changes as the electrolytic ones, though not to the same extent.

Passive avoidance after ibotenic acid and radio frequency lesions in the rat amygdala.

Ibotenic acid (IBO) is assumed to lesion neurons and to spare fibers of passage. The effects of such lesions in the amygdaloid complex of rats were compared to those of radio frequency lesions (RF) on a passive avoidance task. Both lesions impaired the acquisition of the passive avoidance response. Plasma corticosterone levels were measured after a retention test in which no electrical shocks were applied. None of the lesion groups showed reduced corticosterone levels, the IBO lesioned rats actually showed significantly higher corticosterone levels than both RF lesioned and control animals. The corticosterone results are not consistent with a general reduction in fear. The slower avoidance learning may be a conditioning deficit due to impaired sensory information processing in the amygdaloid complex.