Lipopolysaccharide, a component of the cell wall of Gram-negative bacteria, may be responsible for at least some of the pathophysiological sequelae of bacterial infections, probably by inducing an increase in interleukin-1␤ (IL-1␤) concentration. We report that intraperitoneal injection of lipopolysaccharide increased hippocampal caspase-1 activity and IL-1␤ concentration; these changes were associated with increased activity of the stress-activated kinase c-Jun NH 2 -terminal kinase, decreased glutamate release, and impaired long term potentiation. The degenerative changes in hippocampus and entorhinal cortical neurones were consistent with apoptosis because translocation of cytochrome c and poly(ADP-ribose) polymerase cleavage were increased. Inhibition of caspase-1 blocked these changes, suggesting that IL-1␤ mediated the lipopolysaccharide-induced changes.There is increasing awareness of the existence of bidirectional communication between the immune and nervous systems. The proinflammatory cytokine, interleukin-1␤ (IL-1␤), 1 is one molecule that may play a pivotal role in integrating neuronal immune responses with those of the endocrine system because it exerts significant effects in all systems, for example in response to stressors such as infection. Gram-negative bacterial infections are associated with multiple pathophysiological changes; it is widely accepted that these changes are stimulated by lipopolysaccharide (LPS), a component of the outer membrane of most Gram-negative bacteria. These changes, which include fever, changes in sleep pattern, and anorexia (1), are mimicked by, and therefore thought to be mediated through production of, IL-1␤. Thus LPS, injected centrally or peripherally, increases IL-1␤ concentrations (2, 3) and IL-1␤ mRNA expression (4) in rat brain.Although it appears that in certain circumstances IL-1␤ may be neuroprotective, the consensus is that prolonged exposure, or exposure of tissue to high concentrations of IL-1␤, results in degenerative changes (5). Therefore it is significant that increased IL-1 concentrations in different brain areas have been correlated with neurodegenerative disorders such as Down syndrome, Alzheimer's disease (6), and Parkinson's disease (7), whereas in experimental models, IL-1␤ is considered to be responsible for the cell damage associated with ischemia (8) and excitotoxicity (9) and is increased after experimental traumatic lesions (10). A striking example of a neuronal deficit induced by IL-1␤ is the impairment in long term potentiation (LTP) in the hippocampus in vitro (11-13) and in vivo (14 -16).IL-1␤ is produced by glia (17, 18) and neurones (19,20) in response to tissue stress. It is cleaved from the inactive percursor, pro-IL-1␤, by the action of caspase-1, a member of a large family of cysteine proteases that have been implicated in apoptotic cell death (21-25). It might be predicted therefore that any trigger such as LPS, which induces an increase in IL-1␤, will do so by increasing activity of caspase-1.Our objective was to investigate th...

BackgroundVaccination against influenza and pertussis in pregnancy can reduce the significant morbidity and mortality associated with these infections. Despite this, there is poor uptake of both vaccines in pregnancy.AimTo explore women’s perception of vaccination in pregnancy and thereby determine the reasons behind such low vaccination rates.Design & settingThis is a qualitative study undertaken at a large maternity hospital.MethodSeventeen post-partum women completed a semi-structured interview discussing vaccination. They were recruited from a quantitative study looking at vaccination rates in pregnancy. The interview transcripts were discussed among three researchers and underwent thematic analysis.ResultsThree themes emerged. The first theme explored the influencing factors that shaped the women’s decision to vaccinate in pregnancy. The recommendation of a healthcare provider was the most important influencing factor for this study's cohort of women. The second theme highlighted the deficiency in knowledge women had regarding vaccine safety. The last theme related to the pertussis vaccine, and the reluctance of healthcare providers to discuss and offer this vaccine in pregnancy.ConclusionThe qualitative approach gives voice to the thoughts and concerns of women as they make the complex decision to vaccinate in pregnancy. Clinicians must be cognizant of the important role they play in advising women to vaccinate in pregnancy. They must advise women that the vaccine is safe and address any of their concerns. Lastly, a message on vaccine safety should be included in future public health campaigns to promote vaccination in pregnancy.

BackgroundInfluenza during pregnancy is a potentially life threatening illness. There are limited data on influenza vaccination uptake and determinants of uptake in Irish obstetric populations.AimTo determine the uptake of influenza vaccination during pregnancy; determinants of vaccination uptake; knowledge, attitudes, and concerns of postnatal women; and knowledge and attitudes of healthcare professionals (HCPs) surrounding vaccination.Design & settingA quantitative study of postnatal women attending the Rotunda Hospital, a tertiary referral maternity hospital in Dublin, Ireland. A separate quantitative study conducted by the North Dublin City GP Training Programme surveyed GPs, pharmacists, and Rotunda Hospital clinical staff.MethodA paper-based survey was distributed to postnatal women. HCPs completed the survey via the online tool Survey Monkey.Results330 patient surveys were disseminated, with a 60.0% response rate. Of 198 responders, 109 (55.1%) were vaccinated against influenza. Non-professionals were less likely to be vaccinated (adjusted odds ratio [aOR] 0.29, 95% confidence interval [CI] = 0.09 to 0.89). Vaccination in previous pregnancy (aOR 5.2, 95% CI = 1.69 to 15.62) and information from an HCP were strongly associated with vaccination (aOR 12.8, 95% CI = 2.65 to 62.5). There was a 20.2% (n = 1180) response rate among HCPs. More GPs felt that it was their role to discuss vaccination (92.9%; n = 676), and offer to vaccinate women (91.7%; n = 666) than any other HCP.ConclusionProvision of information about the importance of vaccination against influenza and pertussis during pregnancy by HCPs and their consistent recommendations in support of vaccination were key determinants of vaccine uptake during pregnancy. The sociodemographic determinants of a woman’s vaccination status should be addressed in health promotion campaigns. Education of HCPs may address knowledge gaps surrounding vaccination.

BackgroundInfluenza infection during pregnancy can lead to significant maternal morbidity. There are limited data on influenza vaccination uptake and determinants of uptake in Irish obstetric populations.AimThe objectives of this study were to determine: the uptake of influenza vaccination during pregnancy; the determinants of vaccination uptake; knowledge, attitudes and concerns of postnatal women surrounding vaccination during pregnancy; and the recommendations of healthcare workers. Pertussis vaccination uptake was also determined.MethodA standardised 24 item questionnaire was distributed to postnatal women between January and June 2016. Questions focused on maternal characteristics, vaccination status, sources of information, and reasons for receiving / declining the vaccine. The role of the healthcare professional in recommending and offering vaccination was addressed.Results330 surveys were disseminated, there was a 60% response rate. Of the 198 surveys, 109 (55.1%) respondents were vaccinated against Influenza and 64 (32.3%) against Pertussis. Women in the professional/manager/employer socioeconomic group were more likely to be vaccinated (aOR 3.4; 95% CI 1.11–10.42). There was a strong association between vaccination uptake and receiving information during pregnancy (aOR 12.8; 95% CI 2.65–62.5) and receiving the vaccine in a previous pregnancy (aOR 5.15; 95% CI 1.70–15.62). Unvaccinated women had concerns about the harm it may cause to their baby (53%; n=30) and concerns about side effects for themselves (55%; n=33).ConclusionA key determinant of vaccination was provision of information and a recommendation to vaccinate by a healthcare professional. Uncertainty over safety of the vaccine was evident. Consistent patient education by healthcare professionals could increase vaccine uptake.

Working in urgent care requires the ability to manage medical, surgical, social and mental health presentations. It is essential to understand the organisational aspects of how such care is provided. Communication and consultation skills need to be adapted to different clinical contexts. Self-management of safety, time, and stress are important capabilities. One of the requirements of GP training is to demonstrate capabilities in urgent care, including delivery of safe patient care, demonstration of effective communication skills, maintaining continuity for patients and coordinating care across services. In this article we aim to give GP trainees an overview of the urgent care service in Scotland and to give advice on best practice.