1We have retrospectively analysed data collected by a local adverse drug reactions reporting scheme in an acute hospital medical setting and have determined the numbers and types of reactions that would have merited notification as yellow card reports according to the guidelines of the Committee on Safety of Medicines. 2The data related to 20 695 consecutive acute general medical admissions on seven general medical wards (140 beds) and were collected over 3 years, from April 1990 to March 1993. 3Over 3 years there were 1420 reports of suspected adverse drug reactions, a rate of 68.7 per 1000 admissions. 4If the guidelines for reporting issued by the Committee on Safety of Medicines had been strictly followed, 477 yellow cards would have been sent (23.1 per 1000 admissions). In 357 of these reports (74.8%), the reaction had caused admission to hospital. Only 31 of the 477 potential cards (6.5%) involved black triangle drugs and 10 of these were for minor reactions. 5Only 30 of the 477 potential yellow cards (6.3%) were known to have been sent. The majority of those reactions not reported were for drug‐related admissions, most of which were for well‐known reactions to established drugs. 6We have confirmed and quantified the extent of under‐reporting of serious suspected adverse drug reactions to the Committee on Safety of Medicines from our hospital medical unit.

Global temperatures are rising; extreme environmental heat can result in adverse health effects including heatstroke. Acute effects of heat are well recognised, but there is less understanding of potential long-term adverse outcomes. Our aim was to review recent medical literature for clinical cases of environmental heatstroke with a focus on neurological outcome. Structured search strategies were designed to retrieve publications of heatstroke case reports using Ovid Medline and Embase (2000-2016). One thousand and forty-nine abstracts were identified, and after application of exclusion criteria 71 articles deemed relevant. Ninety cases were identified from 71 articles. 100% presented with acute neurological symptoms; 87.8% presented with non-neurological symptoms. 44.4% patients recovered fully, 23.3% died, 23.3% suffered convalescent or long-term neurological sequelae, and in 8.9% no long-term follow up was available. 57.1% of the patients who died or had a neurological deficit had no documented co-morbidity. Patterns of neurological deficits included 66.7% patients with motor dysfunction, 9.5% cognitive impairment, 19% both motor and cognitive impairment and 4.7% other. In total 71.4% of the impaired patients had long-term cerebellar dysfunction. Adverse long-term neurological outcomes were common in surviving patients presenting with environmental heatstroke. Permanent neurological deficits were present in 34.4% of survivors where outcome was known; many were young, healthy individuals. Cerebellar injury was common suggesting cerebellar structures are vulnerable to heat. These findings highlight that people of all ages and pre-morbid states are at risk of severe heat-related illness. In the face of climate change, effective interventions for heat-related illness, including both treatment and prevention are necessary.

BackgroundUrinary mercury concentrations are used in research exploring mercury exposure. Some theorists have proposed that autism is caused by mercury toxicity. We set out to test whether mercury concentrations in the urine of children with autism were significantly increased or decreased compared to controls or siblings.MethodsBlinded cohort analyses were carried out on the urine of 56 children with autism spectrum disorders (ASD) compared to their siblings (n = 42) and a control sample of children without ASD in mainstream (n = 121) and special schools (n = 34).ResultsThere were no statistically significant differences in creatinine levels, in uncorrected urinary mercury levels or in levels of mercury corrected for creatinine, whether or not the analysis is controlled for age, gender and amalgam fillings.ConclusionsThis study lends no support for the hypothesis of differences in urinary mercury excretion in children with autism compared to other groups. Some of the results, however, do suggest further research in the area may be warranted to replicate this in a larger group and with clear measurement of potential confounding factors.

Purpose Autism spectrum disorder (ASD) brings out the limitations of the Criminal Justice Service. The purpose of this paper is to review some of the salient issues and their remedies. Design/methodology/approach A narrative review based on the literature and the clinical experience of the authors. Findings ASD’s hidden disabilities, even without the frequent coexistence of other disorder, derail the standard responses to offending. Practical implications Management of these individuals as offenders depends on awareness of the issues, adaptation and the input of a variety of other services, especially health, social care and employment. Originality/value Although this is a very active field of work, there is relatively little written about it.

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Tracheostomies are indicated in children to facilitate long-term ventilatory support, aid in the management of secretions, or to manage upper airway obstruction. Children with tracheostomies often experience ongoing airway complications, of which respiratory tract infections are common. They subsequently receive frequent courses of broad spectrum antimicrobials for the prevention or treatment of respiratory tract infections. However, there is little consensus in practice with regard to the indication for treatment/ prophylactic antimicrobial use, choice of antimicrobial, route of administration, or duration of treatment between different centres. Routine antibiotic use is associated with adverse effects and an increased risk of antimicrobial resistance. Tracheal cultures are commonly obtained from paediatric tracheostomy patients, with the aim of helping guide antimicrobial therapy choice. However, a positive culture alone is not diagnostic of infection and the role of routine surveillance cultures remains contentious. Inhaled antimicrobial use is also widespread in the management of tracheostomy associated infections; this is largely based upon theoretical benefits of higher airway antibiotic concentrations. The role of prophylactic inhaled antimicrobial use for tracheostomy associated infections remains largely unproven. This systematic review summarises the current evidence base for antimicrobial selection, duration, and administration route in paediatric tracheostomy associated infections. It also highlights significant variation in practice between centres and the urgent need for further prospective evidence to guide the management of these vulnerable patients.

The Armed Forces are not exempt from wider UK societal trends of increasing prevalence of overweight and obesity. Unhealthy body weight adversely impacts on physical and mental health, and in the military is associated with reduced physical fitness, increased risk of injury, and reduced deployability (1)(2) . Overweight and obesity represent complex and multi-faceted challenges, but maintaining a healthy body weight might be influenced by eating styles (i.e. why people eat and/ or overeat).The aim of this study was to investigate whether eating style (uncontrolled, restrained, emotional and external) was associated with dietary choice (behaviour) in a sample of military personnel. The identification of dominant eating styles and subsequent food intake is important to identify since it could be used by health professionals to inform dietary therapy, promoting healthy weight maintenance.The population used in this study was a sample (n 123) of military personnel. Questionnaires detailing demographics and eating style were administered in conjunction with a four-day food diary (n 101), to identify eating style and dietary choice. Seven food groups of interest were identified; fruit and vegetables, sweet foods (e.g. sweet pastries, cakes, biscuits, puddings, custard and confectionary), savoury snacks, energy-dense savoury meals, meat products, sugary soft drinks and alcohol. Data were analysed using SPSS 23 software package; descriptive statistics were determined, and multiple regression analyses were performed where significant correlations were identified.The sample (n 79 male; n 44 female) comprised 42 Officers, 35 Senior Rates and 46 Junior Rates. The mean (SD) age was 36·5 (9·7) years, median (interquartile range, IQR) height was 1·76 (0·16) m, mean body mass was 82·1 (15·5) kg, mean waist circumference was 87 (12) cm and mean body mass index (BMI) was 26·9 (3·7) kg.m −2 . There were significant associations between: uncontrolled eating and savoury snacks and uncontrolled eating with sweet foods (P < 0·05; r = 0·20); restrained eating and energy-dense savoury meals (P < 0·03; r = -0·30); emotional eating and sweet foods (P < 0·002; r = 0·30); emotional eating and energy-dense savoury meals (P < 0·044; r = -0·20); external eating and sweet foods (P < 0·002 and r = 0·31); and external eating and sugary soft drinks (P < 0·004; r = 0·20). However, when other variables were controlled (i.e. age, gender, education and rank), food group choice (i.e. eating behaviour) could not be predicted from an individual's preferred eating style. There was a positive correlation between restrained eating and BMI (P < 0·006; r = 0·25), where 13·3 % of the variance in BMI could be accounted for by a restrained eating preference.These preliminary observations provide tentative associations between eating styles and "less healthy" dietary choices. Awareness of these preferences in an individual could inform dietary behaviour change to support healthy weight management. Further research in a larger military cohort is certainly warranted.