Tuberculosis notification and treatment outcome among migrant boat arrivals in Malta, 2007-2011.

The annual incidence of tuberculosis (TB) in Malta has remained low, at <20 per 100 000 population per year. However, TB notification among vulnerable groups is on the rise and is a matter of public health concern. We measured the TB notification rate, which ranged from 470 to 880/100 000 among migrant boat arrivals 1 year after arrival, highlighting the need to maintain high treatment success rates. Early case detection and high treatment success were observed due to post-arrival screening; however, the need for pragmatic, patient-friendly approaches that will encourage self-referral and access to treatment among migrant groups could play a significant role in preventing the re-emergence of TB in low-incidence settings.

Avian and human influenza pandemic; how prepared is the developing world?

The history of avian and human influenza pandemics showed a high case fatality and devastating socioeconomic impact on the developing world. The global epidemiology of the human influenza of 1918; 1957 and 1968 pandemics had few similarities. One of which was mass human migration; whether it being troop deployment or trade routes. How much the perennial flight patterns of wild bird had on its spread is another question for consideration? The avian influenza virus does not readily cross the species barrier; though there is a potential for genetic re-assortment and cross infection. The main finding of this review suggest a lack of historic epidemiological data from the developing world on previous influenza pandemics; a poorly developed surveillance system and lack of health service delivery capacity to effectively combat an outbreak of influenza; should it occur. The developing world already heavily burdened with endemic diseases such as malaria; HIV; Tuberculosis and other respiratory tract infections will find it difficult to cope with an influenza pandemic. A preparedness plan for developing countries should include health systems strengthening especially that providing expertise and improved surveillance tools

Systemic sclerosis associated pulmonary hypertension: improved survival in the current era.

OBJECTIVES: To measure survival, haemodynamic function and functional class in patients with systemic sclerosis associated pulmonary arterial hypertension (SSc-PAH) in two treatment eras. METHODS: Six year longitudinal study of 92 consecutive patients with SSc-PAH diagnosed by cardiac catheterisation. Data were collected both prospectively and retrospectively. Patients were given basic treatment (diuretics, digoxin, oxygen and warfarin). Where clinically indicated, a prostanoid was used as advanced treatment (historical control group). From 2002, the range of treatments available expanded to include bosentan, which was generally the preferred treatment (current treatment era group). Survival was measured from the date of diagnosis of pulmonary hypertension by cardiac catheterisation. Six minute walking distance and haemodynamic function were measured at the time of diagnosis and at least one month after treatment was started. RESULTS: The historical control group comprised 47 patients, all of whom received basic treatment; 27 of these were also treated with prostanoids. The current treatment era group comprised 45 patients, all of whom received bosentan as preferred treatment. Kaplan-Meier survival in the historical control group was 68% at one year and 47% at two years. Survival in the current treatment era group was 81% and 71% (p = 0.016) at one and two years, respectively. Pulmonary vascular resistance increased in the historical control group (by 147 dyn.s.cm(-5)), whereas in the current treatment era group, it remained stable over an average of nine months (decrease of 16 dyn x s x cm(-5), p < 0.006). CONCLUSION: Survival of selected patients with SSc-PAH has improved in the current treatment era. In contrast to patients treated historically with basic drugs and prostanoids, patients treated in the current treatment era had improved survival associated with a lack of deterioration in cardiac haemodynamic function.

The spectrum of IgG GQ1(b) syndrome: an unusual cluster.

Four patients with IgG GQ1(b)antibodies were admitted to the Gold Coast Hospital, a public hospital providing medical service to a population of approximately 400,000, over a 4-month period. This represents an unusual cluster of this syndrome, for which there is no apparent reason. Further, the four cases demonstrate the broad spectrum of the disorder from the benign ophthalmoplegia, ataxia and areflexia, Miller Fisher Syndrome, to the severe form with encephalitis (Bickerstaff's brainstem encephalitis).

Developing a regional healthcare information network.

The Internet and associated technology is transforming the dissemination of healthcare information. As this occurs, means must be developed to manage and coordinate it effectively. One approach is through community healthcare information networks (CHINs), which benefit both information providers and consumers. This paper reports on a regional CHIN operational in Scotland.

American College of Sports Medicine roundtable. The physiological and health effects of oral creatine supplementation.

Creatine (Cr) supplementation has become a common practice among professional, elite, collegiate, amateur, and recreational athletes with the expectation of enhancing exercise performance. Research indicates that Cr supplementation can increase muscle phosphocreatine (PCr) content, but not in all individuals. A high dose of 20 g x d(-1) that is common to many research studies is not necessary, as 3 g x d(-1) will achieve the same increase in PCr given time. Coincident ingestion of carbohydrate with Cr may increase muscle uptake; however, the procedure requires a large amount of carbohydrate. Exercise performance involving short periods of extremely powerful activity can be enhanced, especially during repeated bouts of activity. This is in keeping with the theoretical importance of an elevated PCr content in skeletal muscle. Cr supplementation does not increase maximal isometric strength, the rate of maximal force production, nor aerobic exercise performance. Most of the evidence has been obtained from healthy young adult male subjects with mixed athletic ability and training status. Less research information is available related to the alterations due to age and gender. Cr supplementation leads to weight gain within the first few days, likely due to water retention related to Cr uptake in the muscle. Cr supplementation is associated with an enhanced accrual of strength in strength-training programs, a response not independent from the initial weight gain, but may be related to a greater volume and intensity of training that can be achieved. There is no definitive evidence that Cr supplementation causes gastrointestinal, renal, and/or muscle cramping complications. The potential acute effects of high-dose Cr supplementation on body fluid balance has not been fully investigated, and ingestion of Cr before or during exercise is not recommended. There is evidence that medical use of Cr supplementation is warranted in certain patients (e.g.. neuromuscular disease); future research may establish its potential usefulness in other medical applications. Although Cr supplementation exhibits small but significant physiological and performance changes, the increases in performance are realized during very specific exercise conditions. This suggests that the apparent high expectations for performance enhancement, evident by the extensive use of Cr supplementation, are inordinate.

Co-operative health information networks in Europe: experiences from Greece and Scotland.

BACKGROUND: Internet technology is transforming the general approach to communication and dissemination of information in the field of healthcare. However, it is also creating problems in terms of finding information, and knowing what credibility to place on the information found. The chaotic nature of the World Wide Web (WWW) and the simplistic approach adopted by search engines can make the task of finding relevant information difficult, and the user can waste considerable amounts of time on the process. Even when information is found, there is no general quality assurance process that can guarantee the credibility of the resulting information. OBJECTIVE: The aim of this research was to develop an approach for establishing co-operative health information networks (CHINs) with different focuses, which can be used in different parts of Europe. The resulting CHINs would provide organised healthcare information and support comprehensive and integrated sets of healthcare telematic services for a broad range of users. Such developments would reduce the difficulties of finding information and knowing what credibility to ascribe to it. METHODS: A common approach has been developed based on drawing together contributions from the major healthcare service providers in the region. Standard structures are recommended so that information is presented in a uniform way. Appropriate mechanisms ensure adequate security and a level of quality assurance for the end user. RESULTS: Since 1996, CHINs have been developed in six European countries as part of a European Union (EU) project. This paper presents the overall approach adopted, and the achievements in two different regions of Europe (Greece and Scotland). Although the circumstances in these two regions are very different, in both cases the resulting CHIN has proved successful. CONCLUSIONS: CHINs offer a solution to the difficulty of finding relevant health information on the Internet and guaranteeing its credibility. They can be used in different ways in different regions, and have major benefits for both information providers and end users.

Facts and fallacies of purported ergogenic amino acid supplements.

Although current research suggests that individuals involved in either high-intensity resistance or endurance exercise may have an increased need for dietary protein, the available research is either equivocal or negative relative to the ergogenic effects of supplementation with individual amino acids. Although some research suggests that the induction of hyperaminoacidemia via intravenous infusion of a balanced amino acid mixture may induce an increased muscle protein synthesis after exercise, no data support the finding that oral supplementation with amino acids, in contrast to dietary protein, as the source of amino acids is more effective. Some well-controlled studies suggest that aspartate salt supplementation may enhance endurance performance, but other studies do not, meriting additional research. Current data, including results for several well-controlled studies, indicated that supplementation with arginine, ornithine, or lysine, either separately or in combination, does not enhance the effect of exercise stimulation on either hGH or various measures of muscular strength or power in experienced weightlifters. Plasma levels of BCAA and tryptophan may play important roles in the cause of central fatigue during exercise, but the effects of BCAA or tryptophan supplementation do not seem to be effective ergogenics for endurance exercise performance, particularly when compared with carbohydrate supplementation, a more natural choice. Although glutamine supplementation may increase plasma glutamine levels, its effect on enhancement of the immune system and prevention of adverse effects of the overtraining syndrome are equivocal. Glycine, a precursor for creatine, does not seem to possess the ergogenic potential of creatine supplementation. Research with metabolic by-products of amino acid metabolism is in its infancy, and current research findings are equivocal relative to ergogenic applications. In general, physically active individuals are advised to obtain necessary amino acids through consumption of natural, high-quality protein foods.

Developing a health care information system for Scotland.

The rapid development and uptake of Internet technology has created opportunities for large-scale information networks to replace paper-based information sources. In order to obtain the maximum benefits for patients and medical practitioners it is important that health care providers work together to produce an integrated information service. However, the task of bringing together a large number of different information providers to create a huge structured pool of information covering a wide range of topics with appropriate quality assurance is non-trivial. This paper describes an approach being used to create healthcare information systems in a set of co-operative healthcare information networks in Europe, and specifically in Scotland.

A secure Web-based interface to maternity records with decision support.

The recent developments in Web technology now make it easy to create user-friendly interfaces to databases and link them to the Internet or to local Intranets. With the acceptance of this new approach one can take advantage of the opportunity to use this development to incorporate additional knowledge into the interface. Not only can this provide a more supportive interface, but it can also create the opportunity for sharing and comparing such knowledge in the future. This paper describes how this has been used to develop an interface to a database of maternity case records which incorporates a knowledge base of rules relating to care plan protocols and uses this to provide decision support to the carer. The issue of security is a serious problem and some aspects of the measures taken are discussed.

Creatine supplementation and exercise performance: an update.

Creatine, a natural nutrient found in animal foods, is alleged to be an effective nutritional ergogenic aid to enhance sport or exercise performance. Research suggests that oral creatine monohydrate supplementation may increase total muscle creatine [TCr], including both free creatine [FCr] and phosphocreatine [PCr]. Some, but not all, studies suggest that creatine supplementation may enhance performance in high-intensity, short-term exercise tasks that are dependent primarily on PCr (i.e., < 30 seconds), particularly laboratory tests involving repeated exercise bouts with limited recovery time between repetitions; additional corroborative research is needed regarding its ergogenic potential in actual field exercise performance tasks dependent on PCr. Creatine supplementation has not consistently been shown to enhance performance in exercise tasks dependent on anaerobic glycolysis, but additional laboratory and field research is merited. Additionally, creatine supplementation has not been shown to enhance performance in exercise tasks dependent on aerobic glycolysis, but additional research is warranted, particularly on the effect of chronic supplementation as an aid to training for improvement in competitive performance. Short-term creatine supplementation appears to increase body mass in males, although the initial increase is most likely water. Chronic creatine supplementation, in conjunction with physical training involving resistance exercise, may increase lean body mass. However, confirmatory research data are needed. Creatine supplementation up to 8 weeks has not been associated with major health risks, but the safety of more prolonged creatine supplementation has not been established. Creatine is currently legal and its use by athletes is not construed as doping.

Changes in public psychiatric hospitalization in Oregon over the past two decades.

OBJECTIVE: In 1988 a governor's commission in Oregon recommended dramatic changes in the state's approach to public psychiatric hospitalization. To evaluate the effect of the recommendations, this study examined characteristics of hospitalization for patients with schizophrenia and bipolar disorder in public psychiatric facilities between 1981 and 1984 and between 1991 and 1994. METHODS: Patients with schizophrenia and bipolar disorder (N=621) were identified as part of a larger study that examined civil commitment in one of Oregon's state hospitals in 1986. Data on the patients' hospitalizations were obtained from a statewide computerized mental health information system. RESULTS: The legal status of hospitalized patients differed between the two time periods, with voluntary hospitalizations overrepresented in 1981-1984 and civil commitments overrepresented in 1991-1994. The locus of hospitalization varied greatly between the two time periods. All hospitalizations in 1981-1984 took place in one of Oregon's three state hospitals. In 1991-1994, subjects were hospitalized in 13 different institutions, including state and community hospitals and specially designed nonhospital inpatient facilities. CONCLUSIONS: Patterns of inpatient hospitalization for public psychiatric patients changed dramatically from 1981-1984 to 1991-1994. The extensive use of community and nonhospital facilities raises questions about monitoring of quality of care in these diverse and decentralized facilities.

Treatment refusal procedures and service utilization: a comparison of involuntarily hospitalized populations.

This article examines treatment refusal in a large group of hospitalized civilly committed patients. Comparison is made between those subjects whose refusal was reviewed by Oregon's administrative procedures for treatment refusal (override group) and those committed patients who more readily accepted treatment and were not evaluated by this procedure. The objective was to examine the override process and to explore potential differences between these groups in their utilization of hospital and community mental health services before and after the index hospitalization. We reviewed hospital charts on all subjects who went through the administrative override procedure and collected state hospital and community mental health services information from the statewide computerized information system on all subjects in the study. Several key differences were found between the groups. The override sample had significantly more women, and these patients spent significantly more time in the index hospitalization and had had more past hospitalizations. There were no differences between the groups in their utilization of community services before or after the index hospitalization and no difference in hospitalization rates after the index hospitalization. The conclusion is that the Oregon override procedure is functioning consistently, without undue delay in decision making. More investigation is necessary to determine whether override subjects represent a distinct subpopulation within the larger group of chronically mentally ill patients.

The effect of oral creatine monohydrate supplementation on running velocity.

Creatine supplementation has been shown to augment muscle PCr content and increase the rate of ATP resynthesis. Thus, we hypothesized that creatine supplementation might enhance sprinting performance. Eighteen subjects completed both of two testing sessions (control and postsupplement) 1 week apart, wherein they sprinted three 60-m distance trials that were recorded with videotape. Following the control session, for 7 days, subjects in the treatment group ingested a creatine-glucose mixture, while the placebo group consumed a glucose powder, followed by the postsupplementation session. Velocities of the subjects through three testing zones within the 60-m sprint were calculated from the videotape. Resultant velocities were analyzed using a MANOVA with a 2 x 2 x 3 x 3 (Group x Session x Trial x Zone) design. Results indicated that there were no statistically significant main or interaction effects on velocity between groups for session, trial, or zone. These data do not support the hypothesis that supplementary creatine ingestion will enhance velocity during the early or latter segments of a 60-m sprint.

Effect of Eleutherococcus senticosus on submaximal and maximal exercise performance.

We investigated the effect of Eleutherococcus senticosus Maxim L (ESML) on performance during submaximal and maximal aerobic exercise. Twenty highly trained distance runners randomly assigned in matched pairs to either an experimental (ESML) or placebo (PL) group, participated in an 8-wk double-blind study during which they completed five trails of a 10-min treadmill run at their 10 km (10K) race pace and a maximal treadmill test (T(max)). Following a baseline trail, ESML and PL consumed, respectively, 3.4 ml of ESML extract or placebo daily for 6 wk. Subjects were tested every 2 wk during supplementation and 2 wk following withdrawal. Heart rate (HR), oxygen consumption (VO2), expired minute volume (VE), ventilatory equivalent for oxygen (VE/VO2), respiratory exchange ratio (RER), and rating of perceived exertion (RPE) were measured during the 10K and T(max) tests. Resting, post-10K and post-T(max) blood samples were analyzed for serum lactate. No significant differences were observed between ESML and PL for: HR, VO2, VE, VE/VO2, RER, or RPE; T(max) time to exhaustion; or serum lactate. The data do not support an ergogenic effect of ESML supplementation on selected metabolic, performance, or psychologic parameters associated with submaximal and maximal aerobic exercise tasks.