A medical-toxicological view of tattooing

The Lancet: Published Online: 23 July 2015

watercolour arm tattoos


Long perceived as a form of exotic self-expression in some social fringe groups, tattoos have left their maverick image behind and become mainstream, particularly for young people. Historically, tattoo-related health and safety regulations have focused on rules of hygiene and prevention of infections. Meanwhile, the increasing popularity of tattooing has led to the development of many new colours, allowing tattoos to be more spectacular than ever before. However, little is known about the toxicological risks of the ingredients used.

For risk assessment, safe intradermal application of these pigments needs data for toxicity and biokinetics and increased knowledge about the removal of tattoos. Other concerns are the potential for phototoxicity, substance migration, and the possible metabolic conversion of tattoo ink ingredients into toxic substances. Similar considerations apply to cleavage products that are formed during laser-assisted tattoo removal.

In this Review, we summarise the issues of concern, putting them into context, and provide perspectives for the assessment of the acute and chronic health effects associated with tattooing.

Related Audio

Andreas Luch discusses a Review about the medical and toxicological concerns of tattooing:

via A medical-toxicological view of tattooing – The Lancet.

Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective case record review and regression analysis

BMJ 2015;351:h3239

Objectives To determine the proportion of avoidable deaths (due to acts of omission and commission) in acute hospital trusts in England and to determine the association with the trust’s hospital-wide standardised mortality ratio assessed using the two commonly used methods – the hospital standardised mortality ratio (HSMR) and the summary hospital level mortality indicator (SHMI).

Design Retrospective case record review of deaths.

Setting 34 English acute hospital trusts (10 in 2009 and 24 in 2012/13) randomly selected from across the spectrum of HSMR.

Main outcome measures Avoidable death, defined as those with at least a 50% probability of avoidability in view of trained medical reviewers. Association of avoidable death proportion with the HSMR and the SHMI assessed using regression coefficients, to estimate the increase in avoidable death proportion for a one standard deviation increase in standardised mortality ratio.

Participants 100 randomly selected hospital deaths from each trust.

Results The proportion of avoidable deaths was 3.6% (95% confidence interval 3.0% to 4.3%). It was lower in 2012/13 (3.0%, 2.4% to 3.7%) than in 2009 (5.2%, 3.8% to 6.6%). This difference is subject to several factors, including reviewers’ greater awareness in 2012/13 of orders not to resuscitate, patients being perceived as sicker on admission, minor differences in review form questions, and cultural changes that might have discouraged reviewers from criticising other clinicians. There was a small but statistically non-significant association between HSMR and the proportion of avoidable deaths (regression coefficient 0.3, 95% confidence interval −0.2 to 0.7). The regression coefficient was similar for both time periods (0.1 and 0.3). This implies that a difference in HSMR of between 105 and 115 would be associated with an increase of only 0.3% (95% confidence interval −0.2% to 0.7%) in the proportion of avoidable deaths. A similar weak non-significant association was observed for SHMI (regression coefficient 0.3, 95% confidence interval −0.3 to 1.0).

Conclusions The small proportion of deaths judged to be avoidable means that any metric based on mortality is unlikely to reflect the quality of a hospital. The lack of association between the proportion of avoidable deaths and hospital-wide SMRs partly reflects methodological shortcomings in both metrics. Instead, reviews of individual deaths should focus on identifying ways of improving the quality of care, whereas the use of standardised mortality ratios should be restricted to assessing the quality of care for conditions with high case fatality for which good quality clinical data exist.

via Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective case record review and regression analysis | The BMJ.

Healthy Meetings | Scottish Cancer Prevention Network

Have you noticed how difficult it can be to attain your daily healthy eating plans, activity goals and smart thinking on days where you have meetings greater than 4 hours that span lunchtime?

The SCPN has developed a score card, which focuses on ten highlights that regular meeting attenders agree, represent important examples of good practice for healthy meetings. They do not include every aspect of a healthy diet or active living but provide a brief checklist to help support meeting organisers.

We are focusing on some specific aspects of meetings that can be relatively easily assessed, although there are other issues like portions sizes, avoiding sponsorship by food and drink companies and sustainability considerations (e.g. plastic crockery/local food/minimal waste) that are also important. Good taste and adequate quantities mustn’t be forgotten and we also recognise the need to try and promote meetings that are held in places that are well served by public transport.

via Healthy Meetings | Scottish Cancer Prevention Network.

Yellow Card scheme app

A Yellow Card smartphone app has been launched for people to report problems with medicines. Fifty years on from its inception, the Yellow Card Scheme is moving into the digital age through a free-access mobile app that was launched by Life Sciences Minister, Mr George Freeman MP.

This new app supplements an existing one-stop website and allows patients, carers and healthcare professionals to report side effects directly to the Yellow Card Scheme to help MHRA ensure they are acceptably safe for patients.

See George Freeman talk about the benefits of the new app.

You can download the app from the iTunes App Store and Google Play for your IOS or Android device.

Health Secretary sets out ambition for a 21st century NHS

The Health Secretary has set out the government’s vision for a patient-led, transparent and safer NHS.  Mr Hunt has set out the direction of reform for the future NHS which includes a profound culture change which puts power into the hands of patients, enabling them to make informed choices about the services they use.  Mr Hunt also calls for a step change in transparency. He said that by next March, England will become the first country in the world to publish avoidable deaths by hospital trusts as well as ratings on the overall quality of care provided to different patient groups in every local area.

Read Jeremy Hunt’s speech


over 70s

Public Health England has launched a nationwide ‘Be Clear on Cancer’ campaign aimed at women aged 70 and over to drive awareness of the risk of breast cancer amongst this age group and to increase their knowledge of lesser-known breast cancer symptoms.

Around 13,400 women aged 70 and over are diagnosed with breast cancer each year, accounting for a third of all breast cancer cases. Approximately 30% of all women diagnosed with breast cancer report a symptom other than a lump. However, research shows that when asked to name symptoms of breast cancer, only half of women over 70 (48%) could name a symptom aside from a lump.

Watch the breast cancer in over 70s TV advert:

Recruitment and retention of nursing staff

The Good Governance Institute has published The nursing journey: recruitment and retention. This report explores the issues of recruitment and retention of nurses.  It finds that, despite some positive initiatives, workforce challenges persist across the sector, including poor workforce morale leading to high attrition rates, an aging workforce, and an over-reliance on agency nurses and foreign recruitment. It sets out a number of recommendations which are intended to address the issues raised in the report.