Toxic oil syndrome (TOS), a previously undescribed disease that occurred in Spain in epidemic form in 1981, has been associated with ingestion of a reprocessed denatured rapeseed oil illegally marketed. However, the association between the syndrome and the adulterated rapeseed oil rests exclusively on epidemiological data because of the absence of toxicologic confirmation and the inability to reproduce the disease in animals. An analysis of the epidemiological evidence available on TOS is carried out in this paper, in an attempt to elucidate the aetiological role of the purported toxic oil. The adulterated oil was found to be highly statistically associated with the syndrome, such an association being extremely unlikely to be due to the effects of bias and/or confounders. The association is very strong, as the estimated relative risk shows (odds ratio = 30), and a dose-response relationship was found. Likewise, the specificity of the association is very high. The temporal sequence of events, although not entirely clear, also helps to support the hypothesis of causality. No other criterion was met, but none of these unmet criteria stands against this hypothesis. From these findings, the adulterated rapeseed oil can be considered a necessary cause for the syndrome to have occurred. Further toxicologic investigations are required to elucidate the precise toxic agent.

Adult↗

PubMed1992

Outbreak of food poisoning due to Salmonella typhimurium DT4 in mayonnaise.

In July 1989 a large outbreak of food poisoning (68 cases) occurred at a private club in Teddington (London Borough of Richmond-upon-Thames). Initial enquiries indicated that the peak of the outbreak occurred between 20th and 26th July. An epidemiological investigation (using self-completed questionnaires) was set up to determine the probable source of infection. Two groups among those exposed were selected: club staff (129), and cricket teams playing in a club tournament (105). Response rates were 89% and 64% respectively. Overall 50% (89) had gastrointestinal symptoms, including two hospital admissions. A highly significant association was found between illness and eating sandwiches containing mayonnaise. Microbiological investigations found Salmonella typhimurium DT4 in 36 of 68 faecal samples taken. This organism is not usually associated with food poisoning outbreaks. The probable source was identified as a flock of one of the egg suppliers.

Bacterial Typing Techniques↗

PubMed1992

Towards the audit of geriatric day hospitals: a pilot project in west Surrey/north east Hampshire.

Following the recommendation of a report on the performance of two geriatric day hospitals (GDHs) in West Surrey and North East Hampshire District Health Authority in 1988, a pilot study was set up to assess the efficacy of a proposed form of audit involving multidisciplinary teams. An outcome measure which consisted of four different scales was developed and agreed upon by the multi-professional team. These scales were used to work out a composite index (Patient Achievement Inventory-PAI). In addition, a new data form was designed for collection of patient data. To carry out this prospective clinical audit, targets were agreed for each patient, and progress was measured against them. Sixty-one (61) patients were studied (30 and 31 per respective hospital). Data form completion was 90 per cent and 81 per cent respectively. The PAI index proved to be reliable (kappa index of agreement = 0.72), and useful as an outcome measure. However, because the PAI index is made up of ordinal scales, it can only be used to measure change within individuals, not between them. The outcome measures, data forms and the continuous audit of these two GDHs proved to be meaningful and acceptable in practice.

Aged↗

PubMed1991

Skewed distributions and parametric tests.

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Coronary Disease↗