Assessing public health risk in the London polonium-210 incident, 2006.

OBJECTIVES: Mr Alexander Litvinenko died in a London hospital on 23 November 2006, allegedly from poisoning with the radionuclide polonium-210 ((210)Po). Associated circumstances required an integrated response to investigate the potential risk of internal contamination for individuals exposed to contaminated environments. STUDY DESIGN: Descriptive study. METHODS: Contaminated locations presenting a potential risk to health were identified through environmental assessment by radiation protection specialists. Individuals connected with these locations were identified and assessed for internal contamination with (210)Po. RESULTS: In total, 1029 UK residents were identified, associated with the 11 most contaminated locations. Of these, 974 were personally interviewed and 787 were offered urine tests for (210)Po excretion. Overall, 139 individuals (18%) showed evidence of probable internal contamination with (210)Po arising from the incident, but only 53 (7%) had assessed radiation doses of 1mSv or more. The highest assessed radiation dose was approximately 100mSv. CONCLUSIONS: Although internal contamination with (210)Po was relatively frequent and was most extensive among individuals associated with locations judged a priori to pose the greatest risk, a high degree of assurance could be given to UK and international communities that the level of health risk from exposure to the radionuclide in this incident was low.

The Health of the Nation 4 years on: what have we done, what must we do?

The Health of the Nation programme has been running for 4 years. We have made real progress on many of the targets but on a few key ones we appear to be having little impact. The concern is that we are storing up problems for the future. To tackle these, we need a sustained programme of action, and clinicians have an important role to play.

The risk of urinary tract infection in bowel incontinent men.

Immobility, confusion, and incontinence are considered the primary reasons for institutionalization of the elderly. The literature suggests that incontinence has the greatest medical, psychological, social, and economic effects on the patient and caregivers. The magnitude of the relationship of UTI and bowel incontinence is illustrated by the results of this study. Bowel incontinent patients developed UTIs almost three times as frequently as their bowel continent counterparts. The majority of the isolates found in urine cultures of the sample population are normally present in the gastrointestinal tract. Health-care providers need to be consistently aware of the possibilities of contamination and deal with the patients accordingly. Patients should be examined frequently for bowel incontinence and not allowed to sit or lie in feces for long periods.

Prognostic implications of complicated ventricular arrhythmias early after hospital discharge in acute myocardial infarction: a serial ambulatory electrocardiography study.

To assess the prevalence and prognostic implications of complicated ventricular ectopic depolarizations (VEDs) after hospital discharge in patients with acute myocardial infarction (AMI), we obtained serial 24-hour Holter recordings in 85 patients during the first 6 weeks after AMI. Recordings were obtained during two coronary care unit time intervals, two hospital ward time intervals, and during four weekly time intervals after discharge. Complicated VEDs were defined as unifocal VEDs greater than or equal to 10/1000 beats for 24 hours, multiform VEDs, pairs, or ventricular tachycardia. At 1 year follow-up, there were nine cardiac deaths (six sudden deaths and three deaths from recurrent AMI). The mean left ventricular ejection fraction at discharge in the cardiac death patients was 29 +/- 12% (sudden death patients 24 +/- 11% and AMI death patients 40 +/- 6%) compared to 49 +/- 13% in the survivors (p less than 0.001). Patients with complicated VEDs at discharge (2 weeks after AMI) or during the first 4 weeks after discharge (3 to 6 weeks after AMI) were significantly more likely to have sudden death at follow-up compared to patients without complicated VEDs. Of the six sudden death patients, four (66%) had complicated VEDs at discharge compared to 18 of 68 survivors (26%) (p less than 0.05). One of three patients who died of recurrent AMI had complicated VEDs. No Holter data were obtained at hospital discharge in eight of the survivors.(ABSTRACT TRUNCATED AT 250 WORDS)