Routine Urinalysis Not Helpful After Blunt Abdominal Trauma.


Routine urinalysis after blunt abdominal trauma won’t help find urogenital injury, Dutch researchers say.

“With the advancements made in CT scanning, there is now much greater accuracy in the detection (or ruling out) of injury to the urogenital system,” Dr. J. Carel Goslings from Academic Medical Center in Amsterdam told Reuters Health.

“In this study,” Dr. Goslings added, “we found the value of the routine performance of urinalysis in patients with a blunt trauma mechanism to be limited.”

The retrospective study involved 1815 patients. Most patients — 1031, or 57% — also had imaging studies, according to a paper online September 16th in Emergency Medicine Journal.

Among the patients who had imaging studies done, 795 (77%) had no hematuria, 220 (21%) had microscopic hematuria, and 16 (2%) had macroscopic hematuria.

Of the 220 patients with microscopic hematuria, eight had abnormal urogenital imaging studies, but only three of the eight had clinical consequences. Another eight patients with microscopic hematuria did have clinical consequences despite normal-looking imaging.

There were 332 patients who had urine collected but no imaging studies. In this group, 278 patients (84%) had no hematuria. In the 54 patients (16%) who did have microscopic hematuria, there were no clinical consequences, according to the authors.

Two hundred sixty-eight patients (15%) had urogenital imaging but no urinalysis. Only 10 had abnormal findings; four of the 10 had clinical consequences.

Ten percent of patients had neither urine collection nor imaging.

“The potential danger of performing urinalysis without imaging is to miss clinically relevant injuries (e.g., bleeding sites in the kidney parenchyma), which can only be shown by imaging,” the authors wrote. “Bypassing urinalysis and going straight for imaging…results in clinical consequences in 1.5% of the patients (4 out of 268). This is comparable to the percentage of clinical consequences in the patients who receive both urinalysis and imaging (2%; 22 out of 1031).”

They added, “The remaining 0.5% difference in clinical consequences consists of relatively minor consequences such as additional imaging and re-evaluation at the outpatient department, and this indicates little added value of the performance of urinalysis.”

Dr. Goslings told Reuters Health that the researchers “advise omitting this investigation as a routine part of the assessment of trauma patients, given that (good) imaging facilities are available in the hospital.”

But in specific circumstances, urinalysis might still be appropriate. Repeating by email some points from the paper, Dr. Goslings wrote, “In particular, patients with specific trauma mechanisms (e.g., fall from height, fall from horse or direct blow to the flank) or patients with a suspicion of pelvic (ring) injuries or thoracolumbar spinal cord injuries might benefit from urinalysis.”

“Future studies should focus on identifying the subgroups of patients in whom urinalysis is helpful,” Dr. Goslings added.

Europeans consume far less sugar than Americans, and yet health officials there recognize a growing health epidemic.


If you have ever visited Europe, then you may recall that most of the foods produced and sold there are generally far less sweet than foods produced and sold in the U.S. And yet, despite this difference, Van der Velpen still sees a major public health epidemic brewing in his country as a result of sugar consumption — how much worse must the situation be here in the U.S., where public health officials generally avoid tagging sugar as a major factor in declining public health?
“Sugar is actually a form of addiction,” adds Van der Velpen. “It’s just as hard to get rid of the urge for sweet foods as of smoking. Thereby diets only work temporarily. Addiction therapy is better … Health insurers should have to finance addiction therapy for their obese clients.”

It is important to note that Amsterdam has long tolerated the presence and use of other typically restricted substances such as cannabis, a plant that government authorities the world over have long referred to as a “drug,” within its borders. Cannabis, of course, does not harm the body and is not a public health threat, thus Amsterdam’s relaxed approach to its availability within the city. Sugar, on the other hand, is an actual threat, and Van der Velpen hopes others will learn this truth and take action.

Sources
http://www.telegraph.co.uk

Sugar named ‘most addictive and dangerous substance’ of our time, worse than cigarettes and alcohol.


While the rest of the world is busy obsessing over the dangers of cigarettes and alcohol, the head of Amsterdam‘s health service in the Netherlands is trying to raise awareness about a much bigger and more pervasive health threat: sugar. According to Paul Van der Velpen, sugar is the most dangerous and addictive substance of modern times, and more needs to be done in the interests of public health to make people aware of the many harms caused by this ubiquitous drug.

Sugar-Cubes

In a recent letter posted by GGD Nederland, an association of the country’s community health services, Van der Velpen discusses the issue of obesity, rates of which have risen dramatically in the Netherlands in recent years. Pointing out that obesity, which is linked to metabolic syndrome, cardiovascular disease and a host of other chronic ailments, saps the healthcare system of tens of millions of dollars annually, Van der Velpen emphasizes that exercise is simply not enough to reverse this growing trend.

Bravely defying processed food industry claims, which insist that sugar consumed “in moderation” is just fine, Van der Velpen delves into the actual science behind how the body responds to sugar as opposed to protein and fat. In his letter, Van der Velpen explains that sugar intensifies food cravings, for instance, and causes people to eat far more than they otherwise would without it. Additionally, he points out that sugar also disrupts normal food metabolism, eventually leading to addiction.

“Just like alcohol and tobacco, sugar is actually a drug,” writes Van der Velpen, in an English translation from the original Dutch. “This may seem exaggerated and far-fetched, but sugar is the most dangerous drug of the times and can still be easily acquired everywhere … The use of sugar should be discouraged. And users should be made aware of the dangers.”

Why do people lie about their age?


British TV and radio host Nicholas Parsons says he has been covering up his real age for years. Why are some people reluctant to say how old they are, asks Kathryn Westcott.

Parsons, who is coming up to his 90th birthday, says that he was worried that disclosing his real age would make him unemployable.

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Celebrities have been holding back the years since the dawn of celluloid. Joan Crawford, for one, was evasive about her date of birth. Depending on who you read, it was 1904, 1905 or 1906. Her gravestone says 1908.

My own mother took a more devil-may-care approach.

Nicholas Parsons Parsons – approaching a big birthday

In the days when the personal details on passports were filled in by a civil servant with a Biro, my mother would subsequently alter her DOB from 1931 to 1937 with a similar-coloured pen.

It worked until the 1970s, when an official at Amsterdam‘s Schiphol airport spotted the deceit. A fine and threat of deportation knocked that on the head. Then she carried photographs of her three children flushed with the youth of primary school, long after those same children had completed their university applications. She used to joke that it made her appear younger, when she was asked if she had children.

We honoured her secret by omitting her DOB on her funeral memorial card.

Nowadays, men and women lie about their age on online dating sites – desperate to appear younger. Teenagers lie, desperate to appear older – unless they happen to be certain Nigerian footballers. The country will be without key players for the Under-17 World Cup after scans showed them to be over the age limit.

“It used to be that we shouldn’t ask a women her age but nowadays we shouldn’t ask anyone,” says William Hanson, an etiquette and protocol consultant.

“I get asked it all the time. But it’s not socially relevant – age really is just a number. I’m young but I have a mind of a 50-year-old.”

Hanson blames the media. A recent story in a tabloid about Joanna Lumley and National Service went for just four paragraphs before it referred to the “67-year-old”.