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Issue 187 - 30 June 2011

Nursing Evidence is a free online service that will help nurses to quickly find key information on the web that is needed to ensure delivery of quality, evidence based care in all healthcare settings.

Articles from Brain Impairment

1. Two-Year Outcome Following Traumatic Brain Injury and Rehabilitation: A Comparison of Patients From Metropolitan Melbourne and Those Residing in Regional Victoria
By Ponsford, Jennie et al. Michael. Brain Impairment, 01/12/2010, Vol. 11 Issue 3: p253-261
Source: Australia New Zealand Reference Centre database
Background and Objective:
Victoria's trauma management system provides acute care and rehabilitation following traumatic brain injury (TBI), with care of more complex injuries generally provided in specialist centres in metropolitan Melbourne. Little is known about how the outcomes of TBI survivors living in metropolitan Melbourne compare to those who reside in regional Victoria once they return to their community, where support services may be less available. The aim of the present study was to compare, in TBI individuals who have been treated at an inner-city rehabilitation centre in Melbourne, the long-term outcomes of those who live in metropolitan Melbourne (termed 'Metro') with those who reside in regional Victoria, termed 'Regional.'
Design and participants: Comparative study with quantitative outcome measures. A total of 959 patients, of whom 645 were designated 'metro' and 314 'regional', were followed-up routinely at 2 years post-injury.
Outcome measures: Structured Outcome Questionnaire, Glasgow Outcome Scale - Extended, Sickness Impact Profile, Craig Handicap Assessment and Reporting Technique, Hospital Anxiety and Depression Scale, Alcohol Use Disorders Identification Test and Drug Abuse Screening Test.
Results: Few differences in outcomes were found between groups. However, after controlling for group differences in age and injury severity, some non-significant trends were suggestive of better outcomes in terms of less social isolation and anxiety and fewer dysexecutive behaviours in regional dwellers.
Conclusions: These findings suggest that outcomes in patients from regional areas are at least as good as those from metropolitan Melbourne. [ABSTRACT FROM AUTHOR]

2. The Relationship Between Physical Fitness and Work Integration Following Stroke
By Schönberger, Michael; Hansen, Niels R.; Pedersen, Daniel T.; Zeeman, Peter; Jørgensen, Jørgen Roed. Brain Impairment, 01/12/2010, Vol. 11 Issue 3: p262-269
Source: Australia New Zealand Reference Centre database
To investigate the relationship between physical fitness and work integration following stroke.
Design: Single-group study, measurement of physical fitness pre and post physical training, measurement of employment status in a follow-up assessment 2 to 36 months after rehabilitation. Setting: Interdisciplinary outpatient rehabilitation program.
Participants: 58 stroke survivors (62% male, mean age at program start 46.7 years, mean time since stroke 1.1 years) who were consecutively referred to the program. Intervention: 1½ hours of intensive training of cardiorespiratory fitness and muscle strength 1-3 times weekly as part of the 3-month program.
Measures: Physical fitness was measured with a modified Harvard Step Test, the Åstrand Cycling Test, and walking/running speed. The type of participants' employment as well as the amount of working hours was registered.
Results: Good physical fitness as measured by the Harvard Step test, but not the Åstrand Cycling Test and walking/running speed, was related to return to competitive, full-time employment. Test results from training tended to predict work reintegration better than test results from training start. Improvement of physical fitness as measured by the Harvard Step Test was also related to follow-up employment.
Conclusions: The results imply a relationship between physical fitness and work integration following stroke and should be confirmed with a randomised controlled study design. [ABSTRACT FROM AUTHOR]

3. Applying a Biopsychosocial Perspective to Investigate Factors Related to Emotional Adjustment and Quality of Life for Individuals With Brain Tumour
By Ownsworth, Tamara et al. Brain Impairment, 01/12/2010, Vol. 11 Issue 3:p270-280
Source: Australia New Zealand Reference Centre database

Objective: This exploratory study applied a biopsychosocial perspective to investigate cognitive and psychosocial factors related to emotional adjustment and QoL after brain tumour.
Methods: Participants included 30 adults with a brain tumour (60% benign and 40% malignant) who were aged 28 to 71 years ( M = 51.5, SD = 12.3) and on average 5.4 years post-diagnosis ( SD = 5.6 years). Participants completed a brief battery of cognitive tests and self-report measures of emotional status (Depression, Anxiety Stress Scale), subjective impairment (Patient Competency Rating Scale), coping (COPE), social support (Brief Social Support Questionnaire), and QoL (Functional Assessment of Cancer Therapy - Brain Tumour [FACT-Br]).
Results: QoL was significantly associated with global cognitive ability ( r = .49, p < .01), subjective impairment ( r = .66, p < .01), and satisfaction with support ( r = .50, p < .05). Level of depressive symptoms was significantly correlated with premorbid IQ ( r = -.49, p < .01), use of planning to cope ( r = -.48, p < .01), and satisfaction with support ( r = -.47, p < .01).
Conclusions: Overall, these exploratory findings indicate that emotional adjustment and QoL after brain tumour is related to a slightly different pattern of neuropsychological, psychological (self-perceptions and coping) and social factors. The clinical implications for interventions with individuals with brain tumour are discussed. [ABSTRACT FROM AUTHOR]

4. Caregivers of Adults With Traumatic Brain Injury: The Emotional Impact of Transition From Hospital to Home
By Turner, Ben et al. Brain Impairment, 01/12/2010, Vol. 11 Issue 3: p281-292
Source: Australia New Zealand Reference Centre database
Primary Objective:
To explore levels of depression, anxiety, stress and strain symptomatology experienced by caregivers of adults with traumatic brain injury (TBI) during the phase of transition from hospital to home. Research
Design: Prospective study with data collected at three time-points: pre-discharge, 1-month post-discharge, and 3-months post-discharge.
Methods and Procedures: Twenty-nine caregivers of adults with TBI (mean age 48 years), recruited on patient discharge from rehabilitation, completed the Caregiver Strain Index and the Depression, Anxiety and Stress Scale at the three time points.
Results: Paired t tests showed significantly lower levels of caregiver strain at one month compared to pre-discharge, and significantly less strain and depression symptoms at 3-month follow-up compared to pre-discharge. Non-significant reductions were observed in level of stress and anxiety across the follow-up time points. Independent group t tests found that female caregivers experienced greater strain than male caregivers at 3 months post-discharge, and caregivers who were immediate family members of the patient experienced greater anxiety than those who were spouses/partners of the patient at 1-month follow-up.
Conclusions: The rate of depressive symptoms in caregivers of people with TBI was greater than the general population, and strain was prevalent during the transition period. The results suggest more specific caregiver support and preparation is needed before patient discharge from hospital, and that adequate time spent in rehabilitation is beneficial for caregiver wellbeing. [ABSTRACT FROM AUTHOR]

5. Autobiographical Event Memory in Patients With Mesial Temporal Lobe Lesions: Impact of Test Methodology and Aetiology of Lesion.
By Gray, Kathryn et al. Brain Impairment, 01/12/2010, Vol. 11 Issue 3: p293-298
Source: Australia New Zealand Reference Centre database
There is some evidence that in patients with temporal lobe lesions, the presence and temporal pattern of deficits in autobiographical event memory depends on aetiology and the methodology used. In this study, 19 patients with mesial temporal lesions that involved the hippocampus (14 temporal lobectomy [TL] and 5 cerebral vascular accident [CVA]) were compared to 20 normal control [NC] subjects on the Autobiographical Memory Interview, Autobiographical Fluency Test for Events (AFT-Events) and a modified Crovitz Cue Technique. All three measures revealed impairments in autobiographical event recall for the TL patients, but only the Crovitz Cue Technique detected a deficit for the CVA group. No temporal gradients in retrograde recall were found. The findings indicate that test methodology and aetiology of lesion influence the likelihood of finding deficits in recall of autobiographical events but not the temporal pattern of deficits. [ABSTRACT FROM AUTHOR]

6. People Under 50 With Acquired Brain Injury Living in Residential Aged Care
By Winkler, Dianne et al. Brain Impairment, 01/12/2010, Vol. 11 Issue 3: p299-312
Source: Australia New Zealand Reference Centre database
The aim of this article is to describe the characteristics, needs and preferences of people under 50 with an acquired brain injury (ABI) living in residential aged care in Victoria and examine implications for service development.
Participants: Sixty-one people under 50 with an ABI living in residential aged care in the state of Victoria.
Measures: Care and Needs Scale, Community Integration Questionnaire, Overt Behaviour Scale, Health of the Nation Outcome Scale - ABI Version, Role Checklist, Resident Choice Scale.
Results: The younger people with ABI in this study were a diverse group with a complex range of health and support needs that were not being adequately met within residential aged care. Many people (44%) required the highest level of support, indicating they could not be left alone while 26% could be left for part of the day and overnight. Most people (81%) and their support networks indicated they would like to explore moving out from residential aged care into community accommodation settings.
Conclusions: This article provides clear direction for the development of services to meet the care needs of this group, to enable them to participate in the life of the community and to pursue a lifestyle of choice. [ABSTRACT FROM AUTHOR]

7. Comparison of People With ABI Living in Two Accommodation Settings: Shared Supported Accommodation and Residential Aged Care.
By Winkler, Dianne et al. Brain Impairment, 01/12/2010, Vol. 11 Issue 3: p313-325
Source: Australia New Zealand Reference Centre database
People with severe acquired brain injury (ABI) often require high and ongoing levels of paid support, which is sometimes provided within a shared supported accommodation service (SSA). In Victoria there are more than 140 people with severe ABI living in shared supported accommodation services who have a similar level of disability as young people with ABI in residential aged care (RAC).
Objectives: The aims of this article are twofold: (1) to describe the characteristics, support needs and level of community inclusion of people with an ABI living in shared SSA in Victoria and (2) to compare the characteristics, support needs, social contact, community integration and leisure participation of this group with a group of people with ABI under 50 years old living in RAC reported in a previous study. Participants: Information was obtained from SSA managers on 128 residents with an ABI, aged under 60 years, who were living in shared supported accommodation.
Measures: Questionnaires were used to obtain information about the characteristics, support needs and occupational participation of participants. Support needs were measured utilising the Care and Needs Scale (CANS). Method: Questionnaires were sent to and completed by SSA managers.
Results: Of the 39 SSA managers contacted, 32 provided information about the characteristics of 128 residents with ABI living in their facilities. While 72% of SSA residents accessed the community almost everyday or more often, 40% of this sample received a visit from a friend less often than once per year. Results of the CANS indicated that the SSA group required a similar level of support to the comparison group of people with ABI living in RAC, but went outside, participated in community based leisure activities, and visited friends significantly more often. There was no significant difference between the two groups in the frequency of visits to the facility from relatives or friends.
Conclusion: Although the relationship between client outcomes and accommodation is a complex one, this study suggests that the type of accommodation and support has a significant impact on the frequency of community participation experienced people with ABI and high care needs. [ABSTRACT FROM AUTHOR]

Articles from Drugs & Aging

8. Comparison of Published Explicit Criteria for Potentially Inappropriate Medications in Older Adults
By Chirn-Bin Chang & Ding-Cheng Chan. Drugs & Aging, 2010, Vol. 27 Issue 12: p947-957
Source: Australia New Zealand Reference Centre database
Several sets of explicit criteria for potentially inappropriate medications (PIMs) have been developed by expert consensus. The purpose of this review is to summarize and compare existing criteria to enable more informed choices about their use. After a systematic literature search was conducted, seven examples of criteria published between 1991 and 2009 were included in the review and their individual characteristics are presented. Common medications listed in the majority of these criteria are also summarized. PIMs listed regardless of co-morbidities in all seven criteria sets were long-acting benzodiazepines and tricyclic antidepressants. PIMs regardless of co-morbidities were most similar among the Beers, Rancourt and Winit-Watjana criteria. Several drug-disease interactions such as benzodiazepines and falls were cited in most criteria. With respect to drug-drug interactions, most criteria agreed that concomitant use of warfarin and NSAIDs should be avoided. The prevalence of PIMs varied with patient population, availability of medications in local markets, the specialties of the prescribing physicians and the assessment instruments used. The associations between PIMs use and health outcomes were largely inconclusive because of limited data. Further research is necessary to validate these published criteria in terms of reducing the incidence of adverse drug reactions and improving health outcomes among older adults. Incorporation of these criteria into computer-assisted order entry systems would increase their utilization in daily practice. [ABSTRACT FROM AUTHOR]

9. Lipid Lowering for Secondary Prevention of Cardiovascular Disease in Older Adults
By Thomas, Joseph al. Drugs & Aging, 2010, Vol. 27 Issue 12: p959-972
Source: Australia New Zealand Reference Centre database
A perceived lack of evidence for benefit and safety concerns may lead to underprescription of HMG-CoA reductase inhibitors (statins) in older adults. This article reviews clinical data regarding the effect of lipid-lowering therapies on cardiovascular outcomes in older adults with a focus on secondary prevention and safety considerations in this population. A literature search of the PubMed database (January 1984 to April 2009) was performed using search terms that included: 'aged' (MeSH heading), 'elderly', 'anticholes-teremic agents', 'antilipemic agents', 'hydroxymethylglutaryl-CoA reductase inhibitors', 'cardiovascular diseases', 'randomized controlled trial', 'metaanalysis' and 'drug safety'. Results from large, randomized, controlled trials show that statin therapy lowers both all-cause and coronary heart disease mortality and reduces myocardial infarction, stroke and the need for revascularization in individuals aged =65 years who have a history of coronary heart disease. Given the high rate of recurrent cardiovascular events in older adults, there is substantial potential for statin treatment to provide benefits in this population. When older patients are prescribed statins, attention should be given to potential drug interactions, age-related changes in drug pharmacokinetics, adverse effects such as myopathy and risks arising from co-morbid conditions. Additional studies on the benefits and risks of lipid-lowering therapy in individuals aged =70 years who have no history of cardiovascular disease, and particularly in those aged =80 years, are needed. Other available lipid-modifying drugs — bile acid sequestrants (bile acid binding protein modulators), ezetimibe, niacin and fibrates (fibric acid derivatives) — may be required in patients who are statin-intolerant or have mixed dyslipidaemia, or in whom standard doses of statins may not be sufficient to achieve low-density lipoprotein cholesterol goals. [ABSTRACT FROM AUTHOR]

10. Botanical Extracts as Anti-Aging Preparations for the Skin: A Systematic Review
By Hunt, Katherine J. et al. Drugs & Aging, 2010, Vol. 27 Issue 12: p973-985
Source: Australia New Zealand Reference Centre database
Although topical creams and other anti-aging products purport to reduce the appearance of aging and skin wrinkling, there has been no critical analysis in the scientific literature of their effectiveness. This systematic review critically evaluates the evidence for the effectiveness or efficacy of botanical treatments in reducing skin aging and wrinkling. MEDLINE, Embase, CINAHL<sup>®</sup>, CENTRAL and AMED databases were searched from their inception until October 2009. Reference lists of retrieved articles were hand-searched. Manufacturers and professional associations were contacted in order to identify further non-published studies. No language restrictions were applied. Only randomized clinical trials or controlled clinical trials assessing the effectiveness of botanical extracts in reducing wrinkling and aging of the skin were included. Data were extracted by two independent reviewers and methodological quality was assessed using the Jadad score and key aspects of the Cochrane risk of bias tool. Of 36 potentially relevant studies, 11 trials of botanical extracts for reducing skin wrinkling and the appearance of aging met all the inclusion criteria. No trials were identified following contact with anti-aging and cosmetic organizations, companies and professional bodies. A significant reduction in skin wrinkling was noted for date kernel extract, cork extract, soy extract, Rosaceae and peony extract. No significant reduction was noted for green tea, Vitaphenol<sup>®</sup> (a combination of green and white teas, mangosteen and pomegranate extract) or maca root. All trials were of poor methodological quality. Adverse effects were frequently not reported. In summary, there is some weak evidence to suggest that several botanical extracts may be effective in reducing the appearance of skin aging but no evidence that this effect is enduring. Independent replications with larger, more diverse samples, longer treatment durations and more rigorous study designs are required to validate these preliminary findings. [ABSTRACT FROM AUTHOR]

11. Prevalence and Predictors of Anticholinergic Medication Use in Elderly Nursing Home Residents with Dementia: Analysis of Data from the 2004 National Nursing Home Survey
By Chatterjee, Satabdi et al. Drugs & Aging, 2010, Vol. 27 Issue 12: p987-997
Source: Australia New Zealand Reference Centre database
Medications with anticholinergic properties are frequently used in the elderly population. However, evidence suggests that these medications are associated with significant adverse effects and may lead to worsening of cognitive impairment, particularly in elderly patients with dementia.
Objective: To examine the utilization of anticholinergic medications and factors associated with anticholinergic medication use in elderly nursing home patients with dementia.
Methods: The study examined anticholinergic medication utilization for patients aged =65 years with dementia, using the 2004 US National Nursing Home Survey (NNHS) data. Anticholinergic drugs were identified using the Anticholinergic Drug Scale (ADS), which classifies anticholinergic drugs into four levels in increasing order of their anticholinergic activity. Descriptive analysis was conducted using sampling weights to determine the prevalence of anticholinergic medication use. Multiple logistic regression within the conceptual framework of the Andersen Behavioral Model was used to examine the factors associated with anticholinergic medication use in the study population. Use of medications with marked anticholinergic activities (ADS level 2 or 3) was the dependent variable, and independent variables were the various predisposing, enabling and need factors.
Results: According to the 2004 NNHS, 509 931 (95% CI 490 160, 529 702) or 73.62% (95% CI 72.23, 75.00) of elderly patients with dementia used anticholinergic medications. The highest prevalence of anticholinergic medication use among elderly patients with dementia was seen for level-1 medications (67.96%; 95% CI 66.51, 69.41), and 21.27% (95% CI 19.93, 22.60) used ADS level-2 or level-3 medications. Multivariate regression analysis showed that the predisposing factor of age was negatively associated with the use of medications with marked anticholinergic activities (ADS level 2 or 3) and the enabling factor of Medicaid as the source of payment increased the likelihood of receiving these higher-level anticholinergics. Among the need factors, dependence in decision-making ability and behavioural symptoms decreased the likelihood of receiving higher-level anticholinergics, whereas factors such as total number of medications, depressed mood indicators and diagnoses of schizophrenia, anxiety and Parkinson's disease increased the likelihood of use of such medications.
Conclusions: Over one in five elderly nursing home residents with dementia used medications with marked anticholinergic activities. The study findings suggest the need to optimize the use of anticholinergic medications in vulnerable patients with dementia given the potentially severe adverse cognitive effects of these agents. [ABSTRACT FROM AUTHOR]

12. Older Women's Views about Prescription Osteoporosis Medication: A Cross-Sectional, Qualitative Study
By Mazor, Kathleen M. et al. Drugs & Aging, 2010, Vol. 27 Issue 12: p999-1008
Source: Australia New Zealand Reference Centre database
Osteoporosis is a significant health problem, especially for older women. Prescription osteoporosis medication can reduce fractures, but many women do not accept treatment or discontinue treatment before benefits are achieved.
Objectives: To explore older women's views about prescription osteoporosis medication use in depth and to identify specific beliefs and experiences that influence these views.
Methods: We conducted in-depth telephone interviews with women aged =65 years with clinically confirmed osteoporosis. Interviewees were asked about their beliefs and experiences related to osteoporosis and osteoporosis treatment. Interviews were recorded and transcribed; key themes were identified using qualitative analysis.
Results: Perceived need, medication effectiveness and medication safety were identified as critical influences on women's views about prescription osteoporosis medication. These perceptions were in turn influenced by various beliefs, experiences and behaviours, including interactions with the physician, personal experience and behaviours, and vicarious experience.
Conclusions: Older women with osteoporosis need clear information about their condition, including the diagnosis, the implications of the diagnosis, treatment options, medication effectiveness and side effects. Physicians should check with their patients to confirm understanding and address concerns, as older women may not always voice their reservations and concerns. [ABSTRACT FROM AUTHOR]

13. Reduction of Inappropriate Medications among Older Nursing-Home Residents: A Nurse-Led, Pre/Post-Design, Intervention Study
By Blozik51, Eva et al. Drugs & Aging, 2010, Vol. 27 Issue 12: p1009-1017
Source: Australia New Zealand Reference Centre database
Medication-related problems are common in the growing population of older adults and inappropriate prescribing is a preventable risk factor. Explicit criteria such as the Beers criteria provide a valid instrument for describing the rate of inappropriate medication (IM) prescriptions among older adults.
Objective: To reduce IM prescriptions based on explicit Beers criteria using a nurse-led intervention in a nursing-home (NH) setting.
Study Design: The pre/post-design included IM assessment at study start (pre-intervention), a 4-month intervention period, IM assessment after the intervention period (post-intervention) and a further IM assessment at 1-year follow-up. Setting: 204-bed inpatient NH in Bern, Switzerland.
Participants: NH residents aged =60 years.
 Intervention: The intervention included four key intervention elements: (i) adaptation of Beers criteria to the Swiss setting; (ii) IM identification; (iii) IM discontinuation; and (iv) staff training.
Main Outcome Measure: IM prescription at study start, after the 4-month intervention period and at 1-year follow-up.
Results: The meant SD resident age was 80.3 ± 8.8 years. Residents were prescribed a mean ± SD 7.8 ± 4.0 medications. The prescription rate of IMs decreased from 14.5% pre-intervention to 2.8% post-intervention (relative risk [RR] = 0.2; 95% CI 0.06, 0.5). The risk of IM prescription increased nonstatistically significantly in the 1-year follow-up period compared with post-intervention (RR = 1.6; 95% CI 0.5, 6.1).
Conclusions: This intervention to reduce IM prescriptions based on explicit Beers criteria was feasible, easy to implement in an NH setting, and resulted in a substantial decrease in IMs. These results underscore the importance of involving nursing staff in the medication prescription process in a long-term care setting. [ABSTRACT FROM AUTHOR]

14. Prevalence and Risk of Polypharmacy among the Elderly in an Outpatient Setting: A Retrospective Cohort Study in the Emilia-Romagna Region, Italy.
By Slabaugh, S. Lane et al. Drugs & Aging, 2010, Vol. 27 Issue 12: p1019-1028
Source: Australia New Zealand Reference Centre database
Polypharmacy, the simultaneous taking of many medications, has been well documented and is a topic of much concern for those looking to improve the quality of care for the elderly. Elderly patients often develop complicated and multifactorial health states that require extensive pharmacotherapy, leaving this population at risk for exposure to drug-drug interactions and other adverse events. Previous literature supports an association between an increase in the rate of adverse events as the number of drugs taken by a patient increases.
Objective: We sought to evaluate the prevalence of polypharmacy, and to determine patient characteristics that are predictive of exposure to polypharmacy, in the elderly population of the Emilia-Romagna region in Italy.
Methods: We conducted a retrospective cohort study of the 2007 Emilia-Romagna outpatient pharmacy database linked with- patient information available from a demographic file of approximately 1 million Emilia-Romagna residents aged =65 years. The cohort comprised 887165 elderly subjects who had at least one prescription filled during the study year. Using the WHO's defined daily dose (DDD) to determine the duration of treatment for a given drug, we defined a polypharmacy episode as overlapping treatment with five or more medications occurring for at least 1 day. The prevalence of polypharmacy was measured together with subject characteristics found to be predictive of polypharmacy exposure.
Results: A total of 349 689 elderly people in the population (39.4%) were exposed to at least one episode of polypharmacy during the study period. The prevalence of polypharmacy substantially increased with age and with a higher number of chronic conditions. Over 35% of those exposed to polypharmacy were exposed for 101 or more days of the year. The top three classes of medications involved in polypharmacy were antithrombotics, peptic ulcer disease and gastro-oesophageal reflux disease agents, and ACE inhibitors. The odds of exposure to polypharmacy were higher for older subjects, males and subjects living in urban areas.
Conclusions: This study provides evidence that the prevalence of polypharmacy in the elderly in Emilia-Romagna is substantial. Educational programmes should be developed to inform clinicians about the magnitude of the polypharmacy phenomenon and the patient characteristics associated with polypharmacy. Raising physicians' awareness of polypharmacy may help to ensure safe, effective and appropriate use of medication in the elderly. [ABSTRACT FROM AUTHOR]

Journals - Table of Contents

15. From LOGIC - The Official Journal of the New Zealand College of Primary Health Care Nurses, NZNO, June 2011
Feature - Infection Control

15A. Keeping respiratory disease out of the community: The sneezesafe programme
15B. What is ESBL - E? and is it a problem for the community?
15C. Hepatitis A: Keeping our communities safe through vaccination
15D. Changes to the National Immunisation Schedule
15E. Vaccine varieties: A pharmacist explains
15F. Case no 109889 - NZ court of healthy eating in the case of food safety vs foodborne illness
15G. Housing and Health: The housing and health research programme
15H. Internet based weight loss programme: A New Zealand example []
15I. NZNO Library: Selected articles on infection control

News - National

16. Flight link to Auckland measles outbreak
TVNZ - 29 June 2011

Auckland's measles epidemic is worsening with health officials saying new cases coming from overseas are adding to the woes.
The latest outbreak is linked to a Thai Airways flight, TG491, which landed in Auckland on June 19 with a passenger in the early stages of measles and capable of infecting others.

17. Pharmac drug ruling 'a death sentence'
TVNZ - 18 June 2011

Laurie Hill can't afford to live.
The 49-year-old New Plymouth man has a rare medical condition and without an expensive treatment - which Pharmac says will cost almost $1 million a year and may not even work - he believes he is being sentenced to an early death. Hill is dying from Pompe Disease, caused by an enzyme deficiency which causes muscle damage.

News - International

18. Older people warned to cut alcohol intake: British report by Royal College of Psychiatrists
The Australian - 23 June 2011

THE level of alcohol abuse by people aged 65-plus and its impact on their lives is little understood, experts say. A British report by the Royal College of Psychiatrists warns of a growing generation of "invisible addicts" abusing alcohol, and proposes cutting the recommended number of standard drinks for older people.
The report calls for an upper safe limit of 1.5 units of alcohol a day for men over-65 (equivalent to one small glass of wine), down from three or four units, and one unit for women over-65, down from two or three. Older people tended to drink in private, and their drinking could increase with life changes such as retirement, death of a spouse or loneliness.


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