Pharmacotherapeutic aspects of dementia care in Malta

Dementia is the most common neurodegenerative disorder of old age affecting one percent of the local general population. It is a major predictor of morbidity and mortality in the elderly, adding a significant burden on health and social care systems across Europe. The financial impact of caring for individuals with dementia is considerable and progressive loss of cognitive function does not only pose challenges to the patients but also adds significant strain on the well-being of caregivers and family members. Although no cure is available, disease progression can be delayed by early intervention and by the use of pharmacotherapeutic agents that interfere with central neurotransmitter systems involved in cognitive processes. This review presents current trends in pharmacotherapeutic intervention in dementia care together with caregiver perceptions on treatment expectations in Malta.peer-reviewe

Slotting Allowances and Retail Product Variety under Oligopoly

Slotting fees are fixed charges paid by food manufacturers to retailers for access to the retail market. The role of the practice and its effects on market efficiency are highly controversial. To date, the literature has focused on the effect of the practice on retail prices; however, slotting allowances also have the potential to alter the range of products available to consumers. Our analysis reveals that the strategic use of slotting allowances by oligopoly firms leads to a superior allocation of product variety among retailers. Indeed, absent price effects, we show that slotting allowances lead to the socially optimal provision of product variety.Slotting fees, vertical contracts, monopolization., Agribusiness, Agricultural and Food Policy, Industrial Organization, Marketing, L13, L14, L42, D43,

Seasonal variation in the selection and use of habitats by large herbivores at Mole National Park, Ghana

There is scanty information on herbivore habitat ecology at Mole National Park (MNP) despite the fact that understanding habitat interactions, such as habitat selection and use, by large herbivores is fundamental for its management. Our aim was to determine the effects of seasonal variation on habitat selection and use by large herbivores at MNP, Ghana. Eight large herbivores were counted within transects, located in six habitat types, over one year and Jacobs’ selectivity index was used to calculate their selectivity of the habitat types. Six of the eight herbivores maintained their preferred habitats throughout all seasons or showed unpredictable seasonal pattern of habitat selectivity, but a seasonal change was clear for elephant (Loxodonta africana) and buffalo (Syncerus caffer). Elephant shifted from riverine forest to swamp habitats in the dry season but preferred both riverine and swamp in other seasons. Buffalo selected and used Anogeissus in all seasons but used swamp in the rainy season and riverine forest in the fire season. Kob (Kobus kob), warthog (Phacochoerus africanus) and bushbuck (Tragelaphus scriptus) appeared to minimise predation risk by avoiding the open savanna, waterbuck (Kobus defassa) preferred swamp in all seasons, whereas roan antelope (Hippotragus equinus) and hartebeest (Alcelaphus bucelaphus) avoided swamp. All eight herbivores were less selective in the rainy season and more selective in the fire season. Shrinkage of habitat resources by fire increased selectivity, while post-fire regrowth in the rainy season increased forage resources and reduced selectivity. Of the factors that influenced the seasonal patterns of herbivore selectivity, only fire can be addressed by National Park management policies, particularly to determine which habitat types should be the focus of fire control operations

Forward Modelling of a Brightening Observed by AIA

A comprehensive understanding of the different transient events is necessary for any eventual solution of the coronal heating problem. We present a cold loop whose heating caused a short-lived small-scale brightening that was observed by AIA. The loop was simulated using an adaptive hydrodynamic radiation code that considers the ions to be in a state of non-equilibrium. Forward modelling was used to create synthetic AIA intensity plots, which were tested against the observational data to confirm the simulated properties of the event. The hydrodynamic properties of the loop were determined. We found that the energy released by the heating event is within the canonical energy range of a nanoflare

Evidence of continued injecting drug use after attaining sustained treatment-induced clearance of the hepatitis C virus: implications for reinfection

Background: People who inject drugs (PWID) are at the greatest risk of hepatitis C virus (HCV) infection, yet are often denied immediate treatment due to fears of on-going risk behaviour. Our principal objective was to examine evidence of continued injecting drug use among PWID following successful treatment for HCV and attainment of a sustained viral response (SVR). Methods: PWID who attained SVR between 1992 and June 2012 were selected from the National Scottish Hepatitis C Clinical Database. Hospitalisation and mortality records were sourced for these patients using record linkage techniques. Our primary outcome variable was any hospitalisation or death, which was indicative of injecting drugs post-SVR. Results: The cohort comprised 1170 PWID (mean age at SVR 39.6y; 76% male). The Kaplan Meier estimate of incurring the primary outcome after three years of SVR was 10.59% (95% CI, 8.75–12.79) After adjusting for confounding, the risk of an injection related hospital episode or death post-SVR was significantly increased with advancing year of SVR: AHR:1.07 per year (95% CI, 1.01–1.14), having a pre-SVR acute alcohol intoxication-related hospital episode: AHR:1.83 (95% CI, 1.29–2.60), and having a pre-SVR opiate or injection-related hospital episode: AHR:2.59 (95% CI, 1.84–3.64). Conclusion: Despite attaining the optimal treatment outcome, these data indicate that an increasing significant minority of PWID continue to inject post-SVR at an intensity which leads to either hospitalisation or death and increased risk of reinfection

Factors associated with spontaneous clearance of chronic hepatitis C virus infection

Background & Aims: Spontaneous clearance of chronic hepatitis C virus (HCV) infection (CHC) is rare. We conducted a retrospective case-control study to identify rates and factors associated with spontaneous clearance of CHC. Methods: We defined cases as individuals who spontaneously resolved CHC, and controls as individuals who remained chronically infected. We used data obtained on HCV testing between 1994 and 2013 in the West of Scotland to infer case/control status. Specifically, untreated patients with ⩾2 sequential samples positive for HCV RNA ⩾6 months apart followed by ⩾1 negative test, and those with ⩾2 positive samples ⩾6 months apart with no subsequent negative samples were identified. Control patients were randomly selected from the second group (4/patient of interest). Case notes were reviewed and patient characteristics obtained. Results: 25,113 samples were positive for HCV RNA, relating to 10,318 patients. 50 cases of late spontaneous clearance were identified, contributing 241 person-years follow-up. 2,518 untreated, chronically infected controls were identified, contributing 13,766 person-years follow-up, from whom 200 controls were randomly selected. The incidence rate of spontaneous clearance was 0.36/100 person-years follow-up, occurring after a median 50 months’ infection. Spontaneous clearance was positively associated with female gender, younger age at infection, lower HCV RNA load and co-infection with hepatitis B virus. It was negatively associated with current intravenous drug use. Conclusions: Spontaneous clearance of CHC occurs infrequently but is associated with identifiable host and viral factors. More frequent HCV RNA monitoring may be appropriate in selected patient groups. Lay summary: Clearance of hepatitis C virus infection without treatment occurs rarely once chronic infection has been established. We interrogated a large Scottish patient cohort and found that it was more common in females, patients infected at a younger age or with lower levels of HCV in the blood, and patients co-infected with hepatitis B virus. Patients who injected drugs were less likely to spontaneously clear chronic infection

The organisation of dementia care by families in Malta : the experiences of family caregivers

This paper discusses the experiences of dementia family caregivers in Malta. The study design was essentially exploratory as this is the first funded social research on dementia in the island of Malta. In-depth semi-structured interviews were conducted in October 2008 with 17 caregivers. Identification of caregivers was through their relatives’ attendance at a hospital based outpatient memory clinic. Interviews were recorded, transcribed and when required, phrases were translated from Maltese to English. A thematic analysis was guided by the questions; What are the experiences of family caregiving in Malta? And what impact does caregiving have for individual/family life? Three key findings are discussed, namely: the organization of family care in Malta; the use of formal services; and the dislocation of dementia caregiving experiences from wider community life. This paper raises questions about support mechanisms currently available in Malta while presenting cross-national learning opportunities to apply established knowledge to the Maltese context.peer-reviewe

Uptake of hepatitis C specialist services and treatment following diagnosis by dried blood spot in Scotland

Background: Dried blood spot (DBS) testing for hepatitis C (HCV) was introduced to Scotland in 2009. This minimally invasive specimen provides an alternative to venipuncture and can overcome barriers to testing in people who inject drugs (PWID). Objectives: The objective of this study was to determine rates and predictors of: exposure to HCV, attendance at specialist clinics and anti-viral treatment initiation among the DBS tested population in Scotland. Study design: DBS testing records were deterministically linked to the Scottish HCV Clinical database prior to logistic regression analysis. Results: In the first two years of usage in Scotland, 1322 individuals were tested by DBS of which 476 were found to have an active HCV infection. Linkage analysis showed that 32% had attended a specialist clinic within 12 months of their specimen collection date and 18% had begun anti-viral therapy within 18 months of their specimen collection date. A significantly reduced likelihood of attendance at a specialist clinic was evident amongst younger individuals (<35 years), those of unknown ethnic origin and those not reporting injecting drug use as a risk factor. Conclusion: We conclude that DBS testing in non-clinical settings has the potential to increase diagnosis and, with sufficient support, treatment of HCV infection among PWID