Single-Bolus Tinzaparin Anticoagulation in Extended Hemodialysis Session: A Feasibility Study

Key Points

A single bolus of tinzaparin is effective for 8-hour hemodialysis session. Eight-hour simulation sessions with anti-Xa monitoring are useful to adjust tinzaparin dose.

Background

Few studies have assessed the use of low-molecular weight heparins for anticoagulation during extended hemodialysis (HD) sessions. This study aimed to evaluate the efficacy of a single bolus of tinzaparin for anticoagulation of the extracorporeal circuit and dialyzer in 8-hour HD sessions.

Methods

This single-center study included all patients who underwent a single 8-hour simulation session as part of their nocturnal home HD training between 2009 and 2020. Tinzaparin was delivered as a single-bolus injection at time 0 with dosing on the basis of doubling of standard 4-hour session dose. Tinzaparin efficacy was examined using visual observations (score 1–4) of the dialyzer and venous bubble trap at the end of dialysis and using anti-Xa measured at 15 and 30 minutes and 1, 2, 4, 6, and 8 hours after HD start.

Results

Forty-seven patients were included. The mean tinzaparin dose was 107±20 IU/kg. Anti-Xa levels peaked at 15 minutes with 1.3±0.4 IU/ml and progressively declined reaching 0.9±0.3 IU/ml at 1 hour, 0.4±0.21 IU/ml at 4 hours, and 0.15±0.15 IU/ml at 8 hours. After the 8-hour session, none of the patients had severe clotting of their dialyzer or venous chamber. Moderate blood clotting was observed in the dialyzer of 6 patients (20%) and in the venous chamber of 22 patients (61%). On the basis of the simulation results, tinzaparin dose was increased in 27 patients (58%) with a mean home-discharge dose of 123±28 IU/kg.

Conclusions

This study shows that anti-Xa levels stabilized rapidly after administration of tinzaparin for 8-hour HD. Administration of a single-bolus tinzaparin at the start of an 8-hour dialysis session seemed effective, although dose adjustment may be required.

Advances in 211At production at Texas A&M University

Alpha emitting radionuclides with medically relevant half-lives are interesting for treatment of tumors and other diseases because they deposit large amounts of energy close to the location of the radioisotope. Researchers at the Cyclotron Institute at Texas A&M University are developing a program to produce 211At, an alpha emitter with a medically relevant half-life. The properties of 211At make it a great candidate for targeted alpha therapy for cancer due to its short half-life (7.2 h). Astatine-211 has now been produced multiple times and reliability of this process is being improved.

FRI0367 ADALIMUMAB IS MORE EFFECTIVE THAN ETANERCEPT AT PREVENTING TNF-ENHANCED OSTEOCLAST DEVELOPMENT THROUGH DOWNREGULATION OF PRO-OSTEOCLASTOGENIC FACTORS ICAM-1 AND IGFBP2 AND UPREGULATION OF ANTI-OSTEOCLASTOGENIC FACTOR FABP4

Background:

TNF has been shown to contribute to osteoclastogenesis independently and in conjunction with M-CSF and RANKL. We have previously demonstrated that TNF enhances the kinetics of RANKL-induced human osteoclastogenesis and that its effects are mitigated more effectively by the anti-TNF biologic adalimumab (ADA) as compared to etanercept (ETN).

Objectives:

To determine the mechanism responsible for the difference in effectiveness between the two biologics, a label-free quantitative proteomics study was conducted on TNF-activated human osteoclasts (OC) upon biologic treatment.

Methods:

Human bone marrow-derived OC precursors (OCP, 3 donors) were exposed for 5 days to M-CSF, M-CSF+RANKL (RANKL) alone or in combination with 100 ng/mL TNF +/- 5 ug/mL ADA, ETN or human IgG1 (IGG) as pre-formed complexes. OC differentiation was confirmed by measuring TRAP5b activity. Shotgun proteomics was performed on peptides generated from detergent based cell extracts subjected to methanol/chloroform precipitation and trypsin/Lys-C digestion. Data acquisition was performed with Orbitrap Q Exactive™ HF-X mass spectrometer. MaxQuant was utilized to quantify proteins based on MS1 peak intensities. Data matrix was normalized, imputed and subjected to differential expression analysis by limma. DAVID pathway analysis (DPA) was used to identify pathways impacted by various treatment conditions based on proteins exhibiting significant (p<0.05) 1.2-fold change in expression as compared to RANKL. Protein levels within culture supernatant or cell lysate were verified by ELISA or MSD.

Results:

Principle component analysis (PCA) of the proteomic profiling data for the 3 donors indicated that exposure of OCP to TNF induced a distinct profile from that of M-CSF and RANKL. The addition of ADA:TNF complexes restored the profile to that of RANKL, whereas those exposed to ETN:TNF complexes exhibited an intermediate profile matching differences observed in TRAP 5b activity levels. DPA identified 3 pathways most associated with osteoclastogenesis: receptor-mediated endocytosis (e.g. CD163, IGFBP2), oxidation-reduction process (e.g. FABP4), and cell adhesion (e.g. ICAM-1, TGFBI) that were significantly impacted by TNF with ADA:TNF being more effective than ETN:TNF in restoring most pathway-associated proteins to RANKL levels. Based on ELISA, two pro-osteoclastogenic factors IGFBP2 and ICAM-1 were increased 2-fold in OCP culture supernatants in response to TNF with only ADA:TNF complexes reducing these levels of both to RANKL. TNF-induced reduction of intracellular levels of CD163, an M2 macrophage polarization marker, and TGFBI were not only restored to RANKL levels by ADA:TNF but brought to a level closer to M-CSF alone, unlike ETN:TNF. One anti-osteoclastogenic factor FABP4 was found to be increased intracellularly above that of RANKL only following exposure to ADA:TNF complexes.

Conclusion:

Shotgun proteomic profiling of human OCP differentiatedin vitrowith TNF revealed at least 3 novel pathways by which TNF exerts its pro-osteoclastogenic effects. Only with the addition of ADA:TNF, not with ETN:TNF, were most pathway-associated proteins significantly restored to RANKL levels including pro-osteoclastogenic factors ICAM-1 and IGFBP2. Moreover, ADA:TNF complexes enhanced the intracellular levels of CD163 and the anti-osteoclastogenic factor FABP4, suggesting these complexes are exerting an effect on OCP beyond simple TNF neutralization. Additionalin vitroandin vivostudies need to be performed to verify our findings.

Acknowledgments:

The authors thank Drs. Jochen Salfeld, Yonghao Cao and Dhaval Nanavati for their critical review of our data, and Yucheng Zhang for her technical support.

Disclosure of Interests:

Bohdan Harvey Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc., Liang Jin Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc., John Maull Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc., Chenqi Hu Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc., Yu Tian Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc., Zehra Kaymakcalan Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc.

Ceftriaxone pharmacokinetic properties during continuous veno-veno haemofiltration using an in vitro adult, paediatric and neonatal model

During continuous venoveno haemofiltration (CVVH), extracorporeal drug clearance is dependant on blood flow, ultrafiltration rate, albumin binding, and the drug’s molecular weight and volume of distribution. Drug doses are adjusted assuming reduced drug clearance by the renal system and CVVH. High volume haemofiltration, pre-dilution and different filter membranes can greatly alter drug clearance. Consequently, assessing the adequacy of cephalosporin dosing during CVVH is complex; under- or overdosing may occur. We studied the pharmacokinetic properties of ceftriaxone during CVVH in vitro. Renaflow filters were used to model 6, 20 and 50 kg patients. Each circuit and reservoir was prepared with a known volume of Hartmann’s solution, human albumin solution 4.5% or blood. Pump speed and exchange rate were standardised for weight. Haemosol BO was used as the replacement fluid with 70% pre-dilution. Following paired sampling from the circuit and ultrafiltrate fluid, ceftriaxone was injected into the circuit. Paired samples were taken up to 720 minutes. Ceftraxione concentrations were determined using high performance liquid chromatography (HPLC). Maximum circuit concentrations (Cmax) at 2 minutes for albumin were 3.5, 2.65 and 4.85 mg/l, for blood were 4.5, 6.5 and 5.55 mg/l and for Hartmann’s were 1.65, 2.95 and 3.65 mg/l for 6kg, 20kg and 50kg models. The sieving coefficients (Sc) from blood (ratio of mean concentrations in the ultrafiltrate/circuits samples) were 0.31 and 0.51 with T1/2 (the half life) 62 and 20 minutes in the 6kg and the 20kg circuits, respectively. The data suggest in an in vitro model of ceftriaxone is rapidly cleared during CVVH. Albumin circuits had the lowest Sc and longest terminal T1/2, reflecting protein binding of the drug and suggest ceftriaxone clearance may be more rapid in hypoalbuminaemic patients. The Cmax was lower in the Hartmann circuits, possibly reflecting precipitation of the drug with calcium in this solution.

Comparison of traps for the control of sheep blowfly in the U.K

The ability of three commercially available trap types to catch Lucilia (Diptera: Calliphoridae) blowflies was assessed on three sheep farms in southwest England in 2008. The aim was to evaluate their relative value for the control of ovine cutaneous myiasis (sheep blowfly strike) on farms. There was a highly significant difference between the total number of female Lucilia caught per day by the traps, with an Agrilure Trap (Agrimin Ltd, Brigg, U.K.) catching more than the other trap types (Rescue Disposable Fly Trap, Sterling International, Spokane, U.S.A.; Redtop Trap, Miller Methods, Johannesburg, South Africa). However, there was no significant difference between the traps in the numbers of female Lucilia sericata (Meigen) caught. Nevertheless, consideration of the rate at which female L. sericata were caught over time showed that the Agrilure trap did not begin catching until about 30 days after its initial deployment. It subsequently caught L. sericata at a faster rate than the other two traps. The data suggest that the freeze-dried liver bait used in the Agrilure trap required a period of about 30 days to become fully rehydrated and decompose to the degree required to attract and catch L. sericata. Once the bait was attractive, however, the trap outperformed the other two traps in terms of the rate of L. sericata capture. The Agrilure trap would appear to be the most effective of the designs tested for use against sheep blowfly and blowfly strike in the U.K., but care would be needed to ensure that the traps were deployed in advance of the blowfly season so that the bait was suitably aged when trapping was required.

Toxicity of fumonisin from Fusarium verticillioides culture material and moniliformin from Fusarium fujikuroi culture material when fed singly and in combination to growing barrows

The effects of fumonisin B1 (FB1) from Fasarium verticillioides culture material and moniliformin from Fusarum fujikuroi culture material on growing barrows were evaluated. Four groups of six barrows (three replicates of two each; mean body weight, 11.1 kg) were fed diets containing 0 mg of FB1 and 0 mg of moniliformin per kg of feed (control), 100 mg of FB1 per kg of feed, 100 mg of moniliformin per kg of feed, and 100 mg of FB1 plus 100 mg of moniliformin per kg of feed. Barrows were fed these diets for 28 days. Body weight gain, feed efficiency, serum biochemical analytes, and hematological values were adversely affected by the FB1 and the FB1-plus-moniliformin diets. The moniliformin diet decreased body weight gain. Two barrows in the moniliformin diet group died, and two barrows in the FB1-plus-moniliformin diet group died. All deaths occurred during the first 6 days of the study. Mild to moderate lesions were observed microscopically in heart and lung tissues of the groups fed moniliformin and FB1 plus moniliformin and in liver tissues of the groups fed FB1 and FB1 plus moniliformin. Except for the acute mortality associated with the two diets containing moniliformin. clinical disease induced by the combined feeding of these two mycotoxins appears to be additive or less than additive and due primarily to the toxic expression of FB1.

Determining the need for hip and knee arthroplasty: the role of clinical severity and patients' preferences

BACKGROUND

Area variation in the use of surgical interventions such as arthroplasty is viewed as concerning and inappropriate.

OBJECTIVES

To determine whether area arthroplasty rates reflect patient-related demand factors, we estimated the need for and the willingness to undergo arthroplasty in a high- and a low-use area of Ontario, Canada.

RESEARCH DESIGN

Population-based mail and telephone survey.

SUBJECTS

All adults aged > or =55 years in a high (n = 21,925) and low (n = 26,293) arthroplasty use area.

MEASURES

We determined arthritis severity and comorbidity with questionnaires, established the presence of arthritis with examination and radiographs, and evaluated willingness to have arthroplasty with interviews. Potential arthroplasty need was defined as severe arthritis, no absolute contraindication for surgery, and evidence of arthritis on examination and radiographs. Estimates of need were then adjusted for patients' willingness to undergo arthroplasty.

RESULTS

Response rates were 72.0% for questionnaires and interviews. The potential need for arthroplasty was 36.3/1,000 respondents in the high-rate area compared with 28.5/1,000 in the low-rate area (P <0.0001). Among individuals with potential need, only 14.9% in the high-rate area and 8.5% in the low-rate area were definitely willing to undergo arthroplasty (P = 0.03), yielding adjusted estimates of need of 5.4/1,000 and 2.4/1,000 in the high- and low-rate areas, respectively.

CONCLUSIONS

Demonstrable need and willingness were greater in the high-rate area, suggesting these factors explain in part the observed geographic rate variations for this procedure. Among those with severe arthritis, no more than 15% were definitely willing to undergo arthroplasty, emphasizing the importance of considering both patients' preferences and surgical indications when evaluating need and appropriateness of rates for surgery.

Cigarette smoking in multicultural, urban high school students

PURPOSE

To profile patterns of cigarette use among a multiethnic population of high school students, and identify important factors associated with cigarette use by ethnicity, in order to plan effective health promotion strategies.

METHODS

This cross-sectional study involved the completion of a lifestyle questionnaire by 1236 Grade 9-13 students (86% response rate) from 62 randomly selected classrooms in three urban high schools in Toronto. Chi-square analysis of the association between tobacco use and other variables took account of the clustered sample using CSAMPLE in Epi Info.

RESULTS

The students self-identified their ethnicity as follows: 388 Canadian, 269 European, 171 East Indian, 137 Asian, 76 West Indian, and 194 "other." Students who identified themselves as Canadians were significantly more likely to be current smokers (29%) than students reporting other ethnicities (13%). There was no apparent increase in smoking rates for immigrants after 2 or more years in Canada. Current drinking, sexual activity, and especially friends smoking was most strongly associated with current smoking for most ethnic groups, although the relative importance of these variables was not identical for all groups.

CONCLUSIONS

Prevention programs may benefit from a focus on the influence of peer smoking and on the grouping together of lifestyle factors associated with smoking for students in all ethnic groups in this multicultural city.

Characterization of a Mycobacterium smegmatis mutant that is simultaneously resistant to D-cycloserine and vancomycin

A mutant of Mycobacterium smegmatis has been isolated that is simultaneously resistant to both D-cycloserine (D-CS) and vancomycin. Genetic complementation with a PBP4 homolog restores sensitivity to both drugs. Resistance to D-CS and vancomycin in this mutant is most likely due to a novel mechanism involving peptidoglycan assembly at the cell surface.

Role of pericytes in vascular calcification: a review

Pericytes are defined by their location in vivo; the pericyte partially surrounds the endothelial cell of the microvessel and shares a common basement membrane with it. As an integral part of the microvasculature, pericytes play a fundamental role in maintaining local and tissue homeostasis. Current evidence also suggests that pericytes function as progenitor cells capable of differentiating into a variety of different cell types including osteoblasts, chondrocytes and adipocytes. It is now apparent that cells resembling microvascular pericytes, and termed 'pericyte-like' cells, have a widespread distribution in vivo. Pericyte-like cells have been identified in the inner intima, the outer media, and in the vasa vasora of the adventitia of large, medium and small human arteries (1, 2). Moreover, recent studies have suggested that these cells may be responsible, at least in part, for mediating the calcification commonly associated with atherosclerosis (1, 3, 4). In this review, we a) examine the evidence that microvascular pericytes deposit a bone-like mineralised matrix in vitro, b) compare the morphological and biochemical properties of microvascular pericytes, calcifying vascular cells (CVCs) and 'classical' smooth muscle cells (SMCs) isolated from bovine aorta, c) demonstrate that microvascular pericytes deposit a well-organised matrix of bone, cartilage and fibrous tissue in vivo, and d) discuss recent studies designed to gain a better understanding of how pericyte differentiation is regulated.

Differences between men and women in the rate of use of hip and knee arthroplasty

BACKGROUND

Previous studies suggest that, for some conditions, women receive fewer health care interventions than men. We estimated the potential need for arthroplasty and the willingness to undergo the procedure in both men and women and examined whether there were differences between the sexes.

METHODS

All 48,218 persons 55 years of age or older in two areas of Ontario, Canada, were surveyed by mail and telephone to identify those with hip or knee problems. In these subjects, we assessed the severity of arthritis and the presence of coexisting conditions by questionnaire, documented arthritis by examination and radiography, and conducted interviews to evaluate the subjects' willingness to undergo arthroplasty. The potential need for arthroplasty was defined by the presence of severe symptoms and disability, the absence of any absolute contraindications to surgery, and clinical and radiographic evidence of arthritis. The estimates of need were then adjusted for the subjects' willingness to undergo arthroplasty.

RESULTS

The overall response rates were at least 72 percent for the questionnaires and interviews. As compared with men, women had a higher prevalence of arthritis of the hip or knee (age-adjusted odds ratio, 1.76; P<0.001) and had worse symptoms and greater disability, but women were less likely to have undergone arthroplasty (adjusted odds ratio, 0.78; P<0.001). Despite their equal willingness to have the surgery, fewer women than men had discussed the possibility of arthroplasty with a physician (adjusted odds ratio, 0.63). The numbers of people with a potential need for hip or knee arthroplasty were 44.9 per 1000 among women and 20.8 per 1000 among men. After adjustment for willingness to undergo the procedure, the numbers were 5.3 per 1000 for women and 1.6 per 1000 for men.

CONCLUSIONS

There is underuse of arthroplasty for severe arthritis in both sexes, but the degree of underuse is more than three times as great in women as in men.

Operation Safe Haven: an evaluation of health surveillance and monitoring in an acute setting

From May to June 1999, 3,920 ethnic Albanians from Kosovo arrived in Australia as part of Operation Safe Haven. These people were evacuated from refugee camps in the former Yugoslav Republic of Macedonia. Initial processing in Australia occurred at East Hills Reception Centre, and accommodation for the duration of stay was provided in eight Haven Centres in five States. The arrival of a large number of refugees in a short time frame is unprecedented in Australia. A health surveillance system was developed and critical health data were collected to assess health status and needs, plan care, monitor for potential outbreaks of communicable diseases, track service use, to meet international reporting requirements and document our response to this crisis. In this article the health surveillance system is evaluated and suggestions are offered for the formulation of specific guidelines necessary for health surveillance in acute settings.

Evaluation of a drama-in-education programme to increase AIDS awareness in South African high schools: a randomized community intervention trial

A community intervention trial was undertaken in KwaZulu Natal, South Africa to evaluate the effectiveness of a high school drama-in-education programme. Seven pairs of secondary schools were randomized to receive either written information about HIV/AIDS or the drama programme. Questionnaire surveys of knowledge, attitude and behaviour were compared before and 6 months after the interventions. One thousand and eighty students participated in the first survey and 699 in the second. Improvements in knowledge (P=0.0002) and attitudes (P < 0.00001) about HIV/AIDS were demonstrated in pupils at schools receiving the drama programme when compared to pupils receiving written information alone. These changes were independent of age, gender, school or previous sexual experience. In schools receiving the drama programme, sexually active pupils reported an increase in condom use (P < 0.01). It is important to provide resources to sustain such programmes and to obtain stronger evidence of effect on behaviour by measuring changes in HIV incidence.

Complications of complicated grief in renal failure

This paper sets out to bring together recurrent themes in the understanding and care of patients with Chronic/End Stage Renal Failure centering on the key issue of loss. A multi-disciplinary conceptual framework is proposed based on three perspectives--Systemic, Existential and Narrative. The integrated framework for understanding the complexity of grief issues for dialysis and pre-dialysis patients focuses on the perception of self and the inter-relationship with others directly involved in their care.

Surveillance of acute flaccid paralysis in Australia, 1995-97. Australian Paediatric Surveillance Unit

OBJECTIVE

Acute flaccid paralysis (AFP) surveillance in Australia as part of the World Health Organization (WHO) certification process for polio eradication in the Western Pacific region.

METHODS

Active monthly AFP surveillance through the Australian Paediatric Surveillance Unit, from March 1995 to December 1997.

RESULTS

Based on 80 cases, the reported overall rate of AFP was 0.73 per 10(5) children < 15 years (below the expected 1 per 10(5)). The major causes of AFP were Guillain-Barré syndrome (51%) and transverse myelitis (19%). According to the WHO virological classification, there was no case of poliomyelitis, 37.5% were 'non-polio' and 62.5% cases were 'polio compatible' due to inadequate stool testing and follow-up. However, case review by an expert panel enabled 95% to be classified as 'non-polio'.

CONCLUSION

Australia must improve AFP surveillance to confirm absence of wild poliovirus. Paediatricians can help Australia meet its certification requirements and contribute to the global eradication effort by reporting and investigating all cases of AFP.

Altering the fat content affects flavor release in a model yogurt system

Flavored yogurts differing in fat content were eaten, and the release of flavor volatiles was measured by monitoring the volatile composition of air from the nose in real time by atmospheric pressure ionization mass spectrometry. Low-fat yogurts (0.2%) were found to release volatiles more quickly and at higher intensity but with less persistence than yogurts containing fat at 3.5 and 10% fat. Yogurts with increasing fat content had higher viscosity and lower relative particle size. Lipophilic compounds were more affected by fat for maximum volatile intensity, but not time-to-maximum intensity or persistence. Sensory assessment of the yogurts found significant differences in intensity and speed of onset of flavor, but not overall length of perception.

Establishment and characterization of adenoviral E1A immortalized cell lines derived from the rat suprachiasmatic nucleus

Primary cultured cells from the presumptive anlage of the rat suprachiasmatic nucleus (SCN) were immortalized by infection with a retroviral vector encoding the adenovirus 12S E1A gene. After drug selection, the resulting neural cell lines (SCN1.4 and SCN2.2) displayed (a) extended growth potential without evidence of transformed or tumorigenic properties, (b) expression of E1A protein within all cell nuclei, and (c) heterogeneous cell types in various stages of differentiation. A large proportion of the SCN1.4 and SCN2.2 cells were characterized by gliallike morphologies, but showed limited expression of corresponding cell type-specific antigens. In addition, both lines exhibited a stable population of cells with neuronlike characteristics. When treated so as to enhance differentiation, these cells were often distinguished by fine, long processes and immunocytochemical expression of neuronal markers and peptides found within SCN neurons in situ. Observations on SCN neuropeptide immunostaining, content, release, and mRNA expression followed a concordant pattern in which somatostatin and vasopressin cells were the most and least common peptidergic phenotypes in both lines, respectively. Since these results indicate that constituents of E1A-immortalized lines derived from the primordial SCN can differentiate into cells with phenotypes resembling parental peptidergic neurons, it will be critical to explore next whether these lines also retain the distinctive function of the SCN to generate circadian rhythms. Cloning of immortalized cell types could subsequently yield useful tools for studying the development of SCN glial and peptidergic cell types and delineating their distinct roles in mammalian circadian time-keeping.

Alcohol use beliefs and behaviors among high school students

PURPOSE

To identify specific alcohol use beliefs and behaviors among local high school students; to determine whether relationships exist between alcohol use and various sociodemographic and lifestyle behaviors; and to assist in the development and implementation of alcohol abuse prevention programs.

METHODS

This cross-sectional study involved the completion of a questionnaire by 1236 Grade 9-13 students (86% response rate) from 62 randomly selected classrooms in three Canadian urban schools. Data analyzed here are part of a larger lifestyle survey.

RESULTS

A total of 24% of students reported never having tasted alcohol, 22% have tasted alcohol but do not currently drink, 39% are current moderate drinkers, 11% are current heavy drinkers (five or more drinks on one occasion at least once a month), and 5% did not answer. Reasons stated most often for not drinking were "bad for health" and "upbringing," while reasons stated most often for drinking were "enjoy it" and "to get in a party mood." Student drinking patterns were significantly related to gender, ethnicity, grade, and the reported drinking habits of parents and friends. Older male adolescents who describe their ethnicity as Canadian are at higher risk for heavy drinking than students who are younger or female, or identify their ethnicity as European or Asian. Current heavy drinkers are at higher risk than other students for engaging in other high-risk behaviors such as drinking and driving, being a passenger in a car when the driver is intoxicated, and daily smoking.

CONCLUSIONS

Heavy alcohol use in adolescents remains an important community health concern. Older self-described Canadian and Canadian-born male adolescents are at higher risk for heavy drinking. Current and heavy drinking rises significantly between Grades 9 and 12. Students who drink heavily are more likely to drink and drive, to smoke daily, and to have friends and parents who drink alcohol.

Tuberculosis notifications in Australia, 1996. Communicable Diseases Network Australia New Zealand

Since the implementation of the National Mycobacterial Surveillance System (NMSS) in 1991, the epidemiology and trends of tuberculosis in Australia have been described in a series of annual reports. This article presents an analysis of the data for tuberculosis notifications for 1996. A total of 1,037 notifications of tuberculosis were received for the year 1996, and the crude rates of new and relapsed disease were reported at 5.37 per 100,000 and 0.29 per 100,000 respectively. Rates of tuberculosis have remained stable over the last decade and the majority of notifications and highest rates of disease continue to occur in the overseas-born population.

Pertussis vaccines: past, present and future in Australia

In August 1997, a workshop was convened by the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases to consider current issues in the use of pertussis vaccines and implications for the Australian immunisation schedule. Topics covered included the history, efficacy and reactogenicity of whole-cell and acellular vaccines and vaccine schedules. Acellular pertussis vaccine is preferred by the National Health and Medical Research Council for the primary course as well as the 18 month and 4-5 year old childhood doses. At the time of the workshop, a 3-component acellular vaccine (DTPa) had been approved (licensed) in Australia for all doses in the childhood schedule. It was the first vaccine subject to a cost-effectiveness evaluation under the new vaccine funding arrangements. Issues considered in the evaluation of the cost-effectiveness of the vaccine were discussed. These included comparative efficacy, adverse events and compliance, and the question of community as well as individual benefit from the use of the vaccine.

Australia's notifiable diseases status, 1996. Annual report of the National Notifiable Diseases Surveillance System

In 1996 there were 65,024 notifications to the National Notifiable Diseases Surveillance System. The record high number of Ross River virus infection notifications was of particular note. The highest rates were recorded in Western Australia, where an outbreak was documented in the South West, and in Queensland. Most cases occurred in the late summer and early autumn months. The number of measles cases has continued to fall markedly following the outbreak in 1993 and 1994. Rubella notifications also fell in 1996. The number of cases of pertussis remained at a similar level to that recorded in recent years, the highest notification rate being recorded for children under the age of one year. A peak in late 1996 marked a resurgence in the pertussis epidemic which has continued into 1997. Notifications of Haemophilus influenzae type b continued to decline reaching a record low rate of 0.3 notifications per 100,000 population. For the enteric diseases, the number of cases of campylobacteriosis rose, with an annual adjusted notification rate of 100.4 per 100,000 population; more notifications were received for this disease than for any other in 1996. The number of hepatitis A cases also rose relative to 1995. This is a reversal of the trend observed in recent years when the notification rate fell. The number of cases of salmonellosis and shigellosis remained stable. Notifications for chlamydial infection and gonococcal infection rose relative to 1995, whilst those for syphilis fell.

Tuberculosis notifications in Australia, 1995

This is the fifth annual report of the National Mycobacterial Surveillance System (NMSS), for new and relapsed cases of tuberculosis notified to State and Territory health authorities in 1995. Cases of atypical mycobacterial infection notified to the scheme are also briefly summarised. The notification rate for new cases of tuberculosis was 5.47 per 100,000 population, and for relapsed cases 0.28 per 100,000. These rates have remained stable for a number of years in Australia, and are low compared with rates in other countries. Some identifiable groups in the Australian community continue to experience higher rates of tuberculosis, including members of indigenous communities and some groups born overseas. Surveillance through the NMSS has a major role to play in the control of tuberculosis.