Addressing tuberculosis among Inuit in Canada.

The average annual rate of tuberculosis (TB) among Inuit in Canada is now more than 290 times higher than Canadian born non-Indigenous people. How did this happen? Using the Territory of Nunavut as a case example, the roots of this situation can largely be traced back to social determinants of health and challenges in access to health care. Half (52%) of all Nunavut residents live in social housing, often under overcrowded conditions. Many experience food insecurity, with food prices in Nunavut that are twice those in southern Canada. Sixty percent of Nunavut residents smoke. Challenges in health care delivery include the small isolated communities, with few roads and difficult weather conditions during the long winters, which impede the ability to reach or provide healthcare, staff that arrive with little TB experience or cultural knowledge, multiple competing health care demands, limited resources and high staff turnover. The housing shortage is not only a social determinant of health, it also impacts the ability to hire new staff or mount an effective response in the event of an outbreak. Yet despite these challenges, progress has been made. Tuberculosis care in Nunavut includes active case finding, contact tracing for all cases of infectious TB, and screening of school age children. Rapid testing with the GeneXpert© platform has resulted in a quicker diagnosis of active TB, earlier treatment (preventing progression of disease) and less transmission. Progressively, there has been a switch from plain film to digital x-rays reducing x-ray turnaround time from as long as two to three weeks to one or two days. Standard treatment protocols include quadruple therapy until sensitivities are known, the use of home isolation for active cases and directly observed treatment (DOT) for both latent and active TB. Special access to rifapentine (Priftin), and its use in combination therapy (3HP), requires only once weekly treatments that can be completed in 12 visits instead of 78 visits for isoniazid (INH) or 120 visits for rifampin, which increases adherence and greatly reduces the health care resources needed to treat TB. In October 2017, the Honourable Jane Philpott, then Minister of Health and now Minister of Indigenous Services, and Natan Obed, president of Inuit Tapiriit Kanatami (ITK) announced the establishment of a Task Force to develop an Inuit TB Elimination Action Framework, accompanied by regional action plans. It is hoped that the task force, and current efforts in Nunavut, will lead to the long term changes needed to ultimately eliminate TB among Inuit in Canada.

Transthecal digital block at the proximal phalanx.

This study assessed the efficacy of a modified transthecal digital block. Three-hundred-and-sixty consecutive digits were anaesthetised with this technique for the treatment of fractures, infections and foreign bodies. Complete palmar and dorsal anaesthesia was achieved in 357 of the 360 digits (99%), including 52 of 53 thumbs (98%). The technique was extremely easy to perform and no complications occurred.

Seizure after exercise in the heat: recognizing life-threatening hyponatremia.

A 20-year-old military recruit suffered a generalized tonic-clonic seizure following 9 hours of moderate activity in a hot, humid environment. He had drunk at least 5.8 L of plain water before the seizure, and laboratory studies revealed that his serum sodium concentration was 113 mmol/L. Overconsumption of fluids during exercise may precipitate acute hyponatremia, a potentially life-threatening medical condition. Prompt correction of serum sodium in acute exertional hyponatremia is important to reduce the risk of permanent neurologic sequelae or death. Recommendations for prevention include ingesting the correct amount of fluid for the activity (the most important method) and consuming adequate salt through diet or beverage.

The Clinton administration's adolescent pregnancy prevention program: ignorance does not equal abstinence.

PIP: In January 1997, the US president noted that birth rates for US teenagers have declined for four years in a row. Two days later, the US Department of Health and Human Services issued a report outlining the federal government's strategy to support effective, local-level programs to prevent adolescent pregnancy. The proposed strategy promotes funding for "abstinence-until-marriage" education, which is likely to have the opposite of its intended impact. The first section of the strategy recaps and promotes abstinence-only provisions of the previous year's welfare reform law and promotes funding for restrictive and inaccurate sex education programs. The second section and its accompanying appendix make the misleading claim that the programs listed directly target teen pregnancy. The third section describes the vital process of building partnerships among state, local, and national organizations to address the problems of teen pregnancy. The fourth section calls for an essential improvement in data collection, research, and evaluation. The fifth section describes the importance of disseminating information about innovative and effective approaches to the problem, but none of the cited programs, which work because they include information about family planning and contraception, would qualify for the abstinence-only funding. The final section reiterates a national strategy supporting abstinence in a campaign built around a program entitled "Girl Power]" and a more vague effort to encourage boys to delay fatherhood. This national strategy will either accomplish nothing or it will actually harm young people because it is ineffective and dishonest. Pregnancy prevention experts in the Clinton administration have acknowledged that young people must have proper information to avoid pregnancy and sexually transmitted diseases, yet the Clinton administration is promoting an unworkable proposal.^ieng

Caffeine ingestion prior to incremental cycling to exhaustion in recreational cyclists.

Nine male recreational cyclist served as subjects in this experiment which included a control, placebo and caffeine trial. The aim of the experiment was to determine whether a 10 mg.kg-1 dose of caffeine given three hours prior to an incremental cycle ergometer exercise test, for caffeine naive subjects, would increase the time to exhaustion and therefore increase the amount of work undertaken by the cyclists. The cyclists initially worked at 100 watts for three minutes and then increased the workload by 50 watts every three minutes until exhaustion. Blood was drawn at the beginning of the test and every three minutes from an ante-cubital vein and was analysed for blood lactate, glucose and free fatty acids (FFA). Respiratory analysis was also undertaken and heart rate was monitored throughout the test. Subjects in the caffeine trial worked significantly longer and performed more work (p less than 0.05) than they did in either the control or placebo trials. FFA's were also significantly higher in this trial (p less than 0.05) and the lactate threshold was moved to the right as a percentage of the VO2max, which suggests less acidity and a decreased bicarbonate flushing. The respiratory exchange ratio data was significantly lowered (p less than 0.05) during workloads between 250 and 450 watts. No changes were seen in blood glucose or heart rates during the experiment. In conclusion, we feel that a 10 mg.kg-1 dose of caffeine is an ergogenic aid during incremental exercise when it is taken 3-4 hours prior to the exercise in fasting subjects who have diets low in caffeine.