Hospital-based case-control study of bronchiectasis in indigenous children in central Australia

Background: Childhood pneumonia has been reported to be associated with the development of bronchiectasis but there are no case-control studies that have examined this. This study examined the relationship between hospital admission for episode(s) of pneumonia and the risk of radiologically proven bronchiectasis. Methods: A medical record-based case-control study of bronchiectasis in Indigenous children was conducted in Central Australia. Controls (183), matched to cases (61) by gender, age and year of diagnosis, were Indigenous children hospitalized with other conditions. Results: There was a strong association between a history of hospitalized pneumonia and bronchiectasis [odds ratio (OR), 15.2; 95% confidence interval (95% CI) 4.4-52.7]. This was particularly evident in recurrent hospitalized pneumonia (P for trend < 0.01), severe pneumonia episodes with longer hospital stay (P for trend < 0.01), presence of atelectasis (OR 11.9; 95% CI 3.1-45.9) and requirement for oxygen (P for trend < 0.01). The overall number of pneumonia episodes, rather than its site, was associated with bronchiectasis. Although the total number of pneumonia episodes in the first year of life did not increase the risk of bronchiectasis, more severe episodes early in life did. Malnutrition, premature birth and being small for gestational age were more common findings among cases. Breast-feeding appeared to be a protective factor (OR 0.2; 95% CI 0.1-0.7). Conclusions: Although we cannot fully answer the question of why bronchiectasis is much more common in Indigenous children, we have provided strong evidence of an association between bronchiectasis and severe and recurrent pneumonia episodes in infancy and childhood.

The impact of changes to heroin supply on blood-borne virus notifications and injecting related harms in New South Wales, Australia

Background: In early 2001 Australia experienced a sudden and unexpected disruption to heroin availability, know as the 'heroin shortage'. This 'shortage has been linked to a decrease in needle and syringe output and therefore possibly a reduction in injecting drug use. We aimed to examine changes, if any, in blood-borne viral infections and presentations for injecting related problems related to injecting drug use following the reduction heroin availability in Australia, in the context of widespread harm reduction measures. Methods: Time series analysis of State level databases on HIV, hepatitis B, hepatitis C notifications and hospital and emergency department data. Examination of changes in HIV, hepatitis B, hepatitis C notifications and hospital and emergency department admissions for injection-related problems following the onset of the heroin shortage; non-parametric curve-fitting of number of hepatitis C notifications among those aged 15 - 19 years. Results: There were no changes observed in hospital visits for injection-related problems. There was no change related to the onset heroin shortage in the number of hepatitis C notifications among persons aged 15 - 19 years, but HCV notifications have subsequently decreased in this group. No change occurred in HIV and hepatitis B notifications. Conclusion: A marked reduction in heroin supply resulted in no increase in injection-related harm at the community level. However, a delayed decrease in HCV notifications among young people may be related. These changes occurred in a setting with widespread, publicly funded harm reduction initiatives.

Across the dividing range - bridging the divides: Pharmacy opportunities across the hospital/community and inter-professional divides in rural and remote Australia

Rural and remote areas of Australia offer many opportunities for innovation in healthcare services. Some true healthcare 'network' models based around rural pharmacy can be established and evaluated. The lines between community and hospital pharmacy are often blurred and communication between health professionals enhanced. The blurring divide between hospital and community pharmacy in rural and remote areas has provided significant advances in practice. Projects have been set up to investigate the feasibility of community pharmacists integrating care for patients. These projects take advantage of the dual roles and the enhanced interaction between pharmacists and other health professionals in the bush. Opportunities for provision of clinical services beyond the traditional supply role have been taken in a number of remote communities

The price elasticity of the Euro to movements in foreign reserves through European Central Bank intevention

The Euro has been used as the largest weighting element in a basket of currencies for forex arrangements adopted by several Central European countries outside the European Union (EU). The paper uses a new time-series approach to examine the relationship between the Euro exchange rate and the level of foreign reserves. It employs Zero-no-zero (ZNZ) patterned vector error-correction (VECM) modelling to investigate Granger causal relations among foreign reserves, the European Monetary Union money supply and the Euro exchange rate. The findings confirm that foreign reserves may influence movements in the Euro's exchange rate. Further, ZNZ patterned VECM modelling with exogenous variables is used to estimate the amount of foreign reserves currently required in order to again achieve a targetted Euro exchange rate

The effect of a reduction in heroin supply on fatal and non-fatal drug overdoses in New South Wales, Australia

Objective: To examine the impact of a sudden and dramatic decrease in heroin availability, concomitant with increases in price and decreases in purity, on fatal and non-fatal drug overdoses in New South Wales, Australia. Design and setting: Time-series analysis was conducted where possible on data on overdoses collected from NSW hospital emergency departments, the NSW Ambulance Service, and all suspected drug-related deaths referred to the NSW Coroner's court. Main outcome measures: The number of suspected drug-related deaths where heroin and other drugs were mentioned; ambulance calls to suspected opioid overdoses; and emergency department admissions for overdoses on heroin and other drugs. Results: Both fatal and non-fatal heroin overdoses decreased significantly after heroin supply reduced; the reductions were greater among younger age groups than older age groups. There were no clear increases in non-fatal overdoses with cocaine, methamphetamines or benzodiazepines recorded at hospital emergency departments after the reduction in heroin supply. Data on drug-related deaths suggested that heroin use was the predominant driver of drug-related deaths in NSW, and that when heroin supply was reduced overdose deaths were more likely to involve a wider combination of drugs. Conclusion: A reduction in heroin supply reduced heroin-related deaths, and did not result in a concomitant increase, to the same degree, in deaths relating to other drugs. Younger people were more affected by the reduction in supply.

Archaeological Identification and Significance of ÉSAG (Agricultural Storage Pits) at Kaman-Kalehöyük, Central Anatolia

Evidence for the presence of storage pits described in Hittite texts by the Sumerogram "ÉSAG" is presented from Kaman-Kalehöyük, a multi-period tell site in central Turkey occupied during the second and first millennia BC. Small earthen pits matching the description of "ÉSAG" were part of the normal suite of domestic installations at the site throughout the period. Similar to pits seen across western Eurasia, they were probably used to store seed corn or seed for trade. Large earthen pits (>7m in diameter) were also present that matched the description of the "ÉSAG" form, and in some cases contained archaeological cereal remains. Evidence from Kaman shows "ÉSAG" were part of Anatolian life for at least 4,000 years and suggests that the term was generic for lined, earthen storage pits. The presence of so many small pits at Kaman-Kalehöyük showed that it was an agricultural production site for much of its existence. The appearance of the large pits, confined to the Hittite period, reflects centralised control of grain supply, probably by the Hittite Kingdom, and fits a pattern seen at other sites in the region during the second millennium BC. /// Hitit metinlerinde Sumerogram "ÉSAG" ile tanimlanan depo çukurlarinin varliğina dair kanit, Orta Anadolu'da M.Ö. İkinci ve Birinci binde iskan edilmiş çok dönemli bir yerleşim alani olan Kaman-Kalehöyük'ten taninmaktadir. Küçük toprak çukurlar "ÉSAG" in tanimlamasina uygun olarak bu dönem süresince normal ev düzeninin bir parçasi olarak karşimiza çikmiştir. Çukurlar, Bati Avrasya'daki benzer çukurlar gibi olasilikla ticaret maksadi ile misir tohumu ya da tohum muhafaza etmişlerdir. "ÉSAG" formunun tanimina uyan büyük toprak çukurlara (çapi 7m. den büyük) rağmen bunlarin tahil depolama ile ilgili bağlantilari tam olarak belirlenmemiştir. Kaman'daki delil, "ÉSAG" in en az 4,000 yildir Anadolu yaşaminin bir parçasi olduğunu ve bu sözcüğün sivanmiş toprak çukurlar için kullanildiğini işaret etmektedir. Kaman-Kalehöyük'te ele geçen birçok küçük çukur, yerleşimin varliğini sürdürdüǧü sürecin büyük bir bölümünde zirai üretim yapildiğini göstermektedir. Hitit Döneminde büyük çukurlarin ortaya çikmasi muhtemelen Hitit Kralliği tarafindan gerçekleştirilen tahil tedarikinin merkezi kontrolünü yansitmakta ve M.Ö. İkinci binde bu bölgedeki diğer yerleşim alanlarinda görülen şekle uymaktadir.

Structural ambiguity of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease

Background The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool designed as a case detector for clinically relevant anxiety and depression. Recent studies of the HADS in coronary heart disease (CHD) patients in European countries suggest it comprises three, rather than two, underlying sub-scale dimensions. The factor structure of the Chinese version of the HADS was evaluated in patients with CHD in mainland China. Methods Confirmatory factor analysis (CFA) was conducted on self-report HADS forms from 154 Chinese CHD patients. Results Little difference was observed in model fit between best performing three-factor and two-factor models. Conclusion The current observations are inconsistent with recent studies highlighting a dominant underlying tri-dimensional structure to the HADS in CHD patients. The Chinese version of the HADS may perform differently to European language versions of the instrument in patients with CHD.