Drug use in Australia: a community prevalence study

Comorbidities in newly diagnosed epilepsy: Pre-existing health conditions are common and complex across age groups

OBJECTIVES

People with epilepsy have a higher prevalence of medical and psychiatric comorbidities compared to the general population. Comorbidities are associated with poor epilepsy outcomes, and there have been recommendations for screening and early identification to improve clinical management. Data from 'First Seizure Clinics' (FSCs) with expert epileptological review can inform about disorders already present at the point of diagnosis of epilepsy or unprovoked seizures. Here, we aimed to describe pre-existing conditions with a focus on psychiatric, substance use, cardiac, neurological, and cancer health domains.

METHODS

We included 1383 adults who received a new diagnosis of epilepsy or unprovoked seizures at Austin Hospital (AH) or Royal Melbourne Hospital (RMH) (Australia) FSCs from 2000 to 2010. Data were audited from FSC records, primarily detailed interviews undertaken by epileptologists. Logistic regression examined age distribution and other risk factors.

RESULTS

The median age at FSC presentation was 37 years (IQR 26-53, range 18-94). Pre-existing conditions were reported by 40 %; from 32 % in the youngest group (18-30 years) to 53 % in the oldest (65+ years). Psychiatric (18 %) and substance use (16 %) disorders were most common, with higher prevalence among patients 18 to 65 years of age compared to those older than 65 years (p < 0.001). Cardiac, neurological, or cancer conditions were reported by 3-6 %, most often amongst those older than 65 years (p < 0.01). Eight percent (n = 112) reported disorders in >1 health domain. The commonest combination was a psychiatric condition with substance use disorder. Of the sixty-two patients reporting this combination, 61 were ≤65 years of age.

CONCLUSIONS

Pre-existing health conditions are present in a substantial proportion of patients diagnosed with epilepsy or unprovoked seizures. Disorders are highest amongst elders, but one-third of younger adults also reported positive histories. These are predominantly psychiatric and/or substance use disorders, conditions strongly associated with poor outcomes in the general population. These findings inform post-diagnosis planning and management, as well as research examining post-diagnostic outcomes and associations between comorbidities and epilepsy.

Effects of over-the-counter analgesic use on reproductive hormones and ovulation in healthy, premenopausal women

STUDY QUESTION

Does use of commonly used over-the-counter (OTC) pain medication affect reproductive hormones and ovulatory function in premenopausal women?

SUMMARY ANSWER

Few associations were found between analgesic medication use and reproductive hormones, but use during the follicular phase was associated with decreased odds of sporadic anovulation after adjusting for potential confounders.

WHAT IS KNOWN ALREADY

Analgesic medications are the most commonly used OTC drugs among women, but their potential effects on reproductive function are unclear.

STUDY DESIGN, SIZE, DURATION

The BioCycle Study was a prospective, observational cohort study (2005-2007) which followed 259 women for one (n = 9) or two (n = 250) menstrual cycles.

PARTICIPANTS, SETTING, METHODS

Two hundred and fifty-nine healthy, premenopausal women not using hormonal contraception and living in western New York state. Study visits took place at the University at Buffalo.

MAIN RESULTS AND THE ROLE OF CHANCE

During study participation, 68% (n = 175) of women indicated OTC analgesic use. Among users, 45% used ibuprofen, 33% acetaminophen, 10% aspirin and 10% naproxen. Analgesic use during the follicular phase was associated with decreased odds of sporadic anovulation after adjusting for age, race, body mass index, perceived stress level and alcohol consumption (OR 0.36 [0.17, 0.75]). Results remained unchanged after controlling for potential confounding by indication by adjusting for 'healthy' cycle indicators such as amount of blood loss and menstrual pain during the preceding menstruation. Moreover, luteal progesterone was higher (% difference = 14.0, -1.6-32.1, P = 0.08 adjusted) in cycles with follicular phase analgesic use, but no associations were observed with estradiol, LH or FSH.

LIMITATIONS, REASONS FOR CAUTION

Self-report daily diaries are not validated measures of medication usage, which could lead to some classification error of medication use. We were also limited in our evaluation of aspirin and naproxen which were used by few women.

WIDER IMPLICATIONS OF THE FINDINGS

The observed associations between follicular phase analgesic use and higher progesterone and a lower probability of sporadic anovulation indicate that OTC pain medication use is likely not harmful to reproduction function, and certain medications possibly improve ovulatory function.

STUDY FUNDING/COMPETING INTERESTS

This work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (contract # HHSN275200403394C). The authors have no conflicts of interest to disclose.

A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older

OBJECTIVE

To explore the current use of conventional and complementary medicines in Australians aged ≥ 50 years.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional postal survey sent to a random sample of 4500 Australians aged ≥ 50 years between June 2009 and February 2010.

MAIN OUTCOME MEASURES

Prevalence of medicines use, reasons for medicines use and sources of medicines.

RESULTS

Response rate was 37.3%. Medicines use was very common; 87.1% of participants took one or more medicines and 43.3% took five or more in the previous 24 hours. Complementary medicines were used by 46.3% of participants, 87.4% of whom used both conventional and complementary medicines. The most commonly used medicines were antihypertensive agents (43.2% of participants), natural marine and animal products including fish oil and glucosamine (32.4%) and lipid-lowering agents (30.4%). Doctors recommended 79.3% of all medicines and 93.0% of conventional medicines. Pharmacists commonly recommended occasional medicines (ie, as needed), while friends, family and media most often influenced use of complementary medicines.

CONCLUSIONS

The use of multiple medicines is common and higher than reported in the 1995 National Health Survey. Today, much medicines use is to prevent future disease by influencing risk factors. High levels of polypharmacy highlight the need to support the safe and effective use of medicines in the community. Although doctors recommend or prescribe most medicines, self-directed medication use is common. This highlights the need for consumer access to accurate information and strategies to improve health literacy about medicines.

Accuracy of telephone self-report of drug use in older people and agreement with pharmaceutical claims data

OBJECTIVE

To determine the agreement between two measures of medication use, namely telephone interview self-report and pharmaceutical claims data, in an elderly population.

METHODS

An agreement study of 566 community-dwelling, general practice patients aged > or =65 years was conducted to compare self-reported use of medicines with pharmaceutical claims data for different retrieval periods. Classes of drugs commonly used in the elderly were selected for comparison.

RESULTS

1094 people were eligible for the main study. Of these, 697 people completed a follow-up survey and 625 of these patients consented to the release of pharmaceutical claims data. A further 59 participants were excluded from the analysis because they had a home visit instead of a telephone interview. The proportion of observed agreement between the telephone self-report and the various retrieval periods was consistently high. Kappa coefficients showed good to very good agreement (> or = 0.75) with retrieval periods of 30, 60 and 90 days for benzodiazepines, low-risk NSAIDs, thiazide diuretics and most other drugs. The specificity of self-reported medication use compared with claims data was consistently high across all drug classes, suggesting that people usually did not mention drugs that were not included in the claims data. Sensitivity values varied according to drug class and retrieval period, and were lower for NSAIDs than for benzodiazepines and thiazide diuretics. Decline in sensitivity with increased retrieval periods was most marked for benzodiazepines, NSAIDs and low-risk NSAIDs, which are often used on an as-needed basis. Positive predictive values increased with longer retrieval periods

CONCLUSION

High agreement and accuracy were demonstrated for self-reported use of medicines when patients were interviewed over the telephone compared with pharmaceutical claims data. The telephone inventory method can be used in future studies for accurately measuring drug use in older people when claims data are not available.

Medication use and gender in Massachusetts: results of a household survey

In this study, we investigate the extent to which women and men differ in patterns of medication use, based on quantitative and qualitative data from a household survey in Western Massachusetts. Using a broad definition of medications, 96% of the sample reported taking one or more medications in the month preceding the survey (86% if vitamins, supplements, and alternative medications are excluded). Twenty-one percent of respondents reported taking five or more medications, and women were significantly more likely to report taking five or more medications in the month preceding the survey. For both sexes, analgesics and vitamins were the most commonly used medications, but women were more likely to report having taken hormones, supplements, and antihistamines. The likelihood of medicating reported health conditions did not differ by sex, but the frequency of reporting health conditions was higher among women, and the difference was significant for body aches and psychosomatic conditions. Analyses of qualitative data indicate that female networks of relatives and friends are an important source of advice on medications for both men and women. Responses to open-ended questions suggest that women's discourse about the effect of medications differs from men's in terms of the range and detail of descriptions of symptoms and side effects.

A narrative review shows the unvalidated use of self-report questionnaires for individual medication as outcome measures

OBJECTIVE

Accurate individualized data on drug consumption is required for a number of purposes. While electronic medication event monitoring is the best objective measure available, self-report tools would be a useful alternative in certain situations. We searched for validated self-completion questionnaires suitable for measuring change in medication.

METHODS

A systematic search of the English language literature since 1980, and a narrative literature review.

RESULTS

Few articles described the development or use of self-report methods to measure change in medication over time. We found no questionnaire that was commonly used for this purpose, nor one that had been evaluated and published. Considerable work has been undertaken to develop questionnaires or diaries for individual projects, but because these tools and their validation are rarely published, they are not available for other researchers to use, and comparison across studies is difficult. Some work has been done developing diary formats and the Medication Quantification Scale converts complex medication change data to a single numerical score.

CONCLUSION

Medication change is rarely considered as an outcome, and when it is measured, nonstandardized methods are used. More attention needs to be given to developing self-report tools and validating them across a range of criteria.

Prevalence, health outcomes, and patterns of psychotropic substance use in a Chinese population in Hong Kong: a population-based study

Two anonymous population-based surveys were conducted between August 2001 and April 2002 using computer-assisted telephone interviews of 3793 male and 3244 female randomly selected residents of Hong Kong in order to estimate the prevalence of psychotropic substance use and identify risk factors and associations with health outcomes among users in Hong Kong. The study cohort was comprised of ethnically Chinese adults between the ages of 18 and 60 years of age. In the last 12 months, 5% of males and 1.8% of females had used psychotropic substances such as cannaboids, methylamphetamines, ketamines, cocaine, opiates, barbiturates, and benzodiazepines. Of the male drug users, almost one-third had done so outside of Hong Kong. "Risk factors" for substance use included: younger age, unemployment, being an early school leaver, being unmarried, "heavy alcohol consumption," and smoking. Psychotropic substance use in the past year was strongly associated with increased prevalence of long-lasting (> or =3 months) sexual health problems during the past year and with a higher prevalence of HIV/STD risk behaviors. The prevalence of substance use in Hong Kong has been under-reported. Although significant correlations were noted between substance use and various respondent attributes, the directionality of the associations needs to be determined with longitudinal studies. It may be prudent to integrate substance use and HIV/STD prevention efforts.

Frequency of use of acetaminophen, nonsteroidal anti-inflammatory drugs, and aspirin in US women

PURPOSE

To determine the frequency of use of the three main classes of over-the-counter analgesics: acetaminophen, non-steroidal anti-inflammatory drugs, and aspirin in two large US female cohorts.

METHODS

We conducted a cross-sectional study of the frequency of analgesic use and the characteristics of users in female participants in the Nurses Health Study I (n = 86,985) and the Nurses Health Study II (n = 93,002) who were between the ages of 33 and 77 years. Information on frequency of current analgesic use was assessed by mailed questionnaire.

RESULTS

All three classes of analgesics were used frequently. For example, acetaminophen was used > or = 1 day/week by more than 20% of women. NSAIDs were used > or = 1 day/week by 42% of women aged 51 years or younger, and aspirin was used > or = 6 days/week by 25% women over age 51 years. The frequency of use of the individual analgesics varied by age (p < 0.001). In addition, women in the highest category of use of any of the analgesics tended to have a higher body mass index, were more likely to have hypertension and diabetes, and were more likely to be current smokers.

CONCLUSIONS

Analgesic use is very common among US women. Physicians should be cognizant of the frequency of use of the various over-the-counter analgesics in their female patient population.

Community-based drug and alcohol counselling: who attends and why?

In order to develop and tailor treatment approaches in drug and alcohol counselling accurately, it is necessary to identify characteristics of the relevant client group. This study describes the demographic and substance use characteristics of 1212 community-based drug and alcohol counselling clients from a regional Area Health Service in NSW, Australia. Findings identify these clients as predominantly young, unmarried, unemployed males with low incomes. Alcohol use is characterized by binge consumption (83%) and alcohol-related problems (94%). A substantial proportion use tobacco (74%), cannabis (61%), opiates (15%) and amphetamines (22%). Of those using illicit drugs other than marijuana, the incidence of sharing syringes (10%) is of concern. These data differ from those reported by both general practice patients in the same geographical area, as a treatment-seeking population in an alternative community-based setting, and a general community sample. It is argued that there is a need for interventions delivered in community-based drug and alcohol settings that are aimed specifically at polydrug use, attempt to minimize drug-related harm and are relevant to those of lower socio-economic status.

Accidents in older people living at home: a community-based study assessing prevalence, type, location and injuries

OBJECTIVES

To assess the prevalence, type, location of and injuries from home accidents, including falls and other accidents, and to explore whether variables including socio-demographic characteristics, medication use and home hazards were associated with all home accidents and falls.

METHOD

657 older people were interviewed about accidents in the previous four weeks. For a subsample (n = 425), a home hazard check was completed.

RESULTS

Of the 101 accidents reported, 51% (n = 51) were falls and 50% (n = 50) were other accidents. The most common location for all accidents was outside (30%). Most resulted in minor injury to the legs (43%) or arms (39%). Medical treatment was sought for 14% of accidents. Having more than five hazards and infrequent home visits by healthcare providers were associated with having at least one accident and at least one fall. Use of a walking aid was also associated with falling.

CONCLUSION

Rates of falls and other accidents are considerable.

IMPLICATIONS

Work is required to confirm the importance of the relationships suggested and to provide data on the burden of injury associated with non-fall accidents.

Necrotizing pulmonary granulomata in a marijuana smoker

We describe the case of a heavy marijuana and tobacco smoker who presented with progressive exertional dyspnea of 2 months' duration, and bilateral nodular lung infiltrates. Examination of the lung fields was normal, and lung function tests showed mild airflow obstruction with moderately reduced gas transfer. BAL returned green-black fluid consisting predominantly of macrophages laden with carbon pigment. Thoracoscopic lung biopsy showed miliary necrotizing granulomata with an alveolar exudate of carbon-laden macrophages within macroscopically blackened lung. The differential diagnosis of pulmonary granulomata in this patient is discussed.

Alcohol use by parents who present their child to a paediatric emergency department

OBJECTIVES

Parental alcohol misuse exposes children to risk, but is poorly identified in paediatric settings. We aimed to (i) measure the alcohol use in parents of a sample of children attending emergency and (ii) assess the quality of documentation of this alcohol use by paediatric residents.

METHOD

Parents of children presenting to the Emergency Department of a children's hospital were interviewed regarding their alcohol use, and each completed an AUDIT CORE questionnaire. The child's case notes were reviewed for documentation of parental alcohol use.

RESULTS

One hundred and ninety-three parents were interviewed. Although per capita alcohol use for both sexes, and hazardous drinking for females were found to be significantly less than general population figures, rates of hazardous drinking were high for fathers. Yet only 1% of case notes reviewed contained any documentation of parental alcohol use.

CONCLUSION

This small study suggests that although average alcohol intake amongst parents presenting their children to a paediatric emergency department may be lower than for the general population, there is a significant prevalence of undetected hazardous drinking amongst parents.

Prescription and nonprescription analgesic use in Sweden

OBJECTIVE

To analyze patterns of prescription and nonprescription analgesic use in the general Swedish population, in association with predisposing factors, enabling factors, need, and health behavior.

DESIGN

Cross-sectional interview survey.

SETTING

The Swedish Surveys of Living Conditions for the 2-year period 1988-1989.

PARTICIPANTS

A probability sample of all inhabitants of Sweden aged 18-84 years (n = 11996).

MAIN OUTCOME MEASURES

Prescription and nonprescription analgesic use during a 2-week period.

RESULTS

Women reported use of analgesics both with and without prescriptions to a greater extent than did men. Among women, 12.2% reported prescription analgesic use and 30.4% reported nonprescription analgesic use. The corresponding proportions among men were 7.2% and 20.0%, respectively. In the descriptive analyses, prescription analgesic use was most common among persons aged 45 years and older, while use of nonprescription analgesics was most common in people aged 18-44 years. The polychotomous logistic regression analyses showed that headache and musculoskeletal pain were strongly associated with prescription analgesic use to a similar extent among men and women. Headache was associated with nonprescription analgesic use among men and women, but a gender difference was found in the association between musculoskeletal pain and nonprescription analgesic use. Women with musculoskeletal pain used nonprescription analgesics to a greater extent than did men with musculoskeletal pain. Poor health--measured as self-perceived health status and physical function--and high use of health care were related only to prescription analgesic use. Smoking and being overweight were associated with prescription analgesic use among men and with nonprescription analgesic use among women; alcohol consumption was associated with both types of analgesic use only among women.

CONCLUSIONS

This study shows that men and women differ in their choice between prescription and nonprescription analgesics and that the choice between prescription and nonprescription analgesics is influenced by an individual's pain, self-perceived health, and lifestyle.

Substance misuse in Aboriginal Australians

Australia's Aborigines lived in isolation from the rest of humanity as successful hunter-gatherers for tens of thousands of years. That isolation ended abruptly with British colonization in the late 18th century and was followed by a traumatic 200 years for Aborigines who are now seriously disadvantaged, socio-economically and in terms of their health standards. It has often been assumed that the Aborigines had no access to psychotropic substances before permanent European contact but several pieces of evidence dispute this view. The history of Aboriginal contact with and usage of intoxicating substances, including alcohol, is extremely complex and affected by a maze of restrictive government policies. These interact with a wide range of other Federal and State policies which have changed rapidly since the late 1960s when Aborigines were first granted the franchise; access to unrestricted drinking followed soon afterwards. Today Aborigines suffer disproportionately to other Australians from the physical and social consequences of excess alcohol consumption, tobacco usage, petrol and other solvent sniffing, usage of marijuana, amphetamines, cocaine and heroin, as well as other drugs. The Aboriginal population is dispersed in cities, towns, fringe settlements, rural and remote areas over this vast continent and there are different patterns of drug usage from place to place. This review attempts to synthesize some of this information in order to give an overview to the history, background, current status of substance misuse by Aborigines as well as some strategies being used to try to overcome this serious problem.

Sex differences in prescribed medications: another case of discrimination in general practice

Biological, social and behavioural factors influence doctors to prescribe different types of medications to male and female patients. Secondary analysis of data from the Australian Morbidity and Treatment Survey 1990-1991 was conducted using multiple logistic regression to discriminate male and female patient encounters in general practice. The approach used considered possible confounding influences of GP and patient characteristics. The results showed that females were significantly more likely than males to receive prescriptions for: antibiotics; hormones; drugs affecting the central nervous, cardiovascular and urogenital systems; drugs for allergy and immune disorders; ear and nose topical preparations, and skin preparations, even after taking into account morbidity differences. If males and females were treated according to their presenting problems, differences in morbidity patterns would account for the management differences. However, the present investigation would suggest that GP and patient behaviours are also important factors that lead to differences in the prescriptions received by male and female patients in general practice.

The health of Filipinas in the Hunter region

An interview survey found life-style behaviours (including risk factors and screening), social support and psychological health (GHQ-12) among a sample of 198 Filipina-Australians to be conducive to good health. Knowledge of local health services was good, and most women expressed general satisfaction with all aspects of life in Australia, except in the area of employment prospects. Despite these indications of good health in the group, there remains a need for health service providers to be aware of the difficulties faced by a proportion of Filipina migrants to Australia.

Psychotropic drug use by women: could violence account for the gender difference?

Cross-national studies show that the female to male ratio of psychotropic drug use is approximately 2:1. Twenty per cent of female general practice patients are prescribed psychotropic drugs. The reasons behind this remain unclear but research points to the higher levels of psychopathology either experienced or reported by women. Recent studies have shown a strong association between the experience of domestic violence and sexual abuse and the development of mental ill health. It may be that women who use psychotropic drugs represent a group who are more likely to be victims of violence. If this is the case then doctors should be incorporating questioning about violence when thinking of prescribing such drugs. Further research is necessary to clarify whether or not a relationship exists between psychotropic drug use by women and a previous or current history of physical or sexual abuse.

Use of analgesics in Sweden--the importance of sociodemographic factors, physical fitness, health and health-related factors, and working conditions

In this study, factors related to analgesic use-independent of their association with pain-were studied in the general Swedish population. These included sociodemographics, health and health-related factors, physical fitness and working conditions. Data from the Swedish Survey of Living Conditions for the two-year period 1988/89 were used. In this survey a random sample (n = 13,295, response rate 79.4%) of the Swedish population aged 16 years and older was interviewed about health, medication use and related matters, among other things. In all, 35% of the population used analgesics at least once during a two-week period, and analgesic use was more than 50% higher among women than men. Analgesic use was less common among those aged 45-64 years and 65-74 years than those 18-44, after controlling for all other variables. The study showed that self-perceived poor health and pain explain much analgesic use. Analgesic use is further explained by lifestyle, sleeping problems, and health care utilization. Marital status, educational level, socioeconomic status, social network and working conditions were found to be of minor importance.

Recall, retention, utilisation and acceptability of written health education materials

The effects of two distribution strategies on the recall of receipt, retention, utilisation and perceived acceptability of written health education materials were investigated in two semirural communities. We randomly selected 512 people, 212 from general practitioners' surgeries, who received the materials from their general practitioners at the end of a routine consultation, and 300 from the electoral register, who received it through the mail in a personally addressed envelope. Of all those who received the materials, 55 (10.7 per cent) were not contactable and 386 (84.5 per cent) of those contacted consented to the survey. Structured interviews were conducted with consenting individuals two weeks after distribution to assess recall of receipt, retention, utilisation and perceived acceptability. Of those receiving the material by mail, 77.4 per cent recalled receiving it, 75.4 per cent reported keeping the booklet and 66.7 per cent reported reading it. Of those receiving it from a general practitioner, 90.9 per cent recalled receiving it, 93.3 per cent reported keeping the booklet and 56 per cent reported reading it. Perceived acceptability of the material was high, with over 80 per cent of respondents finding it very or fairly eye-catching, believable, interesting and easy to read. Although general practitioner distribution led to higher rates of receipt and retention, mail-out distribution led to higher utilisation rates and allowed access to a larger proportion of the population, resulting in more people being exposed to the education message.

Patterns of common drug use in teenagers

To ascertain current levels of drug use among teenagers and to examine interrelationships in use, a two-stage cluster sample of Victorian secondary school students in years 7 (aged 12 to 13 years), 9 (14 to 15 years) and 11 (16 to 17 years) were surveyed using a questionnaire on computer. Tobacco use and alcohol consumption were evaluated by self-reported frequency of use and seven-day retrospective diaries. Marijuana and coffee consumption were assessed by self-reported frequency of recent use. The questionnaire was completed by 2525, a participation rate of 83 per cent. Tobacco use rose with year, with 24 per cent of young women and 16 per cent of young men in year 11 being regular smokers. Trends across year level for heavier alcohol consumption were also observed, with just under 10 per cent of year 11 students reporting a weekly consumption higher than the current recommended guidelines for adults. Strong interrelationships in drug use were found, with a pattern of association between smoking and drinking consistent with a mutual elevation of risk. Frequent use of tobacco and alcohol had a high risk for associated marijuana use. Coffee consumption carried a significant independent association with regular smoking. Teenage substance use is common and most occurs at low level and frequency. However, for a substantial and increasing minority across the teenage years, high levels of tobacco and alcohol consumption potentially compromise health. Frequent alcohol or tobacco use rather than heavy intermittent consumption is most likely to be associated with concurrent substance use potentially damaging to health.

Psychotropic drug use by women: current prevalence and associations

OBJECTIVE

To determine the current prevalence of psychotropic drug use by women and any association between use and demographic variables.

DESIGN

A cross-sectional, questionnaire-based survey.

SETTING

Metropolitan Melbourne between November 1993 and February 1994.

SUBJECTS

Consecutive women aged over 18, attending 15 randomly selected general practices for a consultation.

OUTCOME MEASURES

Psychotropic drugs taken in the last year and duration of their use, reported by the doctor from the patients' clinical notes and patient interview. Patient demographic characteristics.

RESULTS

The questionnaire was returned complete for 2048/3026 women. Of these, 20.4% had taken at least one psychotropic drug for at least a month in the past year. Most of these women had taken the drug for longer than 12 months and a quarter had taken more than one psychotropic drug in the past year. Psychotropic drug use by women was significantly associated with increasing age, having been married, parity, lower educational attainment, manual occupation, unemployment and being supported by a government pension.

CONCLUSIONS

Psychotropic drug use by women is common and mostly long term. Psychotropic drugs should be prescribed carefully and judiciously, with continual review of the indications for their use and with an awareness of the association with social situation.

Burn injuries and characteristics of burn patients in New South Wales, Australia

This study describes the burn injuries and characteristics of patients admitted to the major adult burn unit in New South Wales, Australia. Data were collected from the medical records of all patients admitted in the 30-month study period (184 persons, 143 (78 per cent) males, 41 (22 per cent) females). The findings identified that patients were most likely to be males, aged between 25 and 34 years, who experienced a 11-20 per cent total surface burn area flame injury whilst using an accelerant in a domestic environment. Patients were more likely to smoke tobacco, drink alcohol to hazardous levels and take prescribed psychotropic medications than the general population. Preburn morbid conditions were prevalent, especially in the females. The actions of patients who had sustained a non-intentional burn commonly indicated a lack of understanding of the danger of certain equipment or the combustibility and volatility of some materials and flame. Prevention appears to be the most effective way to reduce burn injury through education of at-risk groups. However, because of the multicausality identified in the study, other preventive measures, such as improvement in product safety design, are suggested. Some similarities and differences with studies reported from Australia and overseas are noted.

Self reports of the interaction between substance abuse and schizophrenia

Fifty-three psychiatric hospital inpatients with a dual diagnosis of substance abuse and schizophrenia were given the Brief Symptom Inventory and the Schizophrenia/Substance Abuse Interview Schedule. Mean age was 29; 49 were men. Only 11% were employed. Forty percent abused mainly alcohol, 40% cannabis and 8% amphetamines; 20% abused more than one substance. Mean onset age of drug abuse was 16 years; schizophrenia was diagnosed a mean of 5 years later, and subjects had been admitted to hospital an average of 7 times since then. Most believed that drug abuse initiated or exacerbated their schizophrenia; 80% took drugs primarily to relieve dysphoria and anxiety. Amphetamines improved subjective well-being significantly more than alcohol, but choice of drugs was determined mainly by price and availability. Only cannabis increased positive symptoms of schizophrenia and only amphetamines reduced negative ones. Effectively treating this population requires an integration of psychiatric and drug treatment services, ideally in a community context.

Smoking in hotels: prevalence, and opinions about restrictions

Exposure to high levels of environmental tobacco smoke can occur in hotels. Controversy exists about smoking regulation on licensed premises. This survey of 138 people attending one of three Newcastle hotels during 1993 found that 57 per cent of respondents were nonsmokers. Fifty-eight per cent (95 per cent confidence interval (CI) 50 to 66 per cent) of respondents in these hotels believed their health was being adversely affected by other people's smoke in the hotel. Seventy per cent (CI 62 to 78 per cent), including half the smokers, were in favour of restriction of smoking in the hotels. Most preferred the establishment of smoke-free areas to the introduction of total smoking bans in hotels. The failure of hotels to regulate smoking suggests that a legislative approach is required. The case for legislation would be strengthened by a larger study elsewhere in Australia.

The prevalence of drug use in urban aboriginal communities

The use of both licit and illicit drugs has been identified as a major health issue for Australian Aborigines. However, data on the proportion of people who use such drugs is scant. This cross-sectional survey of a randomly selected sample of urban Aboriginal people provides information on the use of the drugs alcohol, tobacco, marijuana, cocaine, heroin as well as petrol sniffing. Overall, a significantly smaller proportion of Aboriginal people were found to be current alcohol drinkers compared to non-Aboriginal Australians. A larger proportion of these drinkers were, however, found to be drinking at levels that were hazardous to their health. A significantly greater proportion of people from the Aboriginal sample were also found to be smokers compared to their non-Aboriginal counterparts. An examination of the use of the illicit substances revealed that a greater proportion reported they had ever used marijuana, compared to the other substances. The findings are discussed in terms of their implications for the health of Aboriginal people.

Variability in the risk of major gastrointestinal complications from nonaspirin nonsteroidal anti-inflammatory drugs

BACKGROUND

We have assessed the extent to which the risk of serious gastrointestinal complications from nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDs) varies with the age and sex of recipients, use of aspirin or alcohol, administration by the oral or rectal route, and dose and choice of drug.

METHODS

A case-control study was performed with prospective recruitment of cases of gastrointestinal bleeding or ulcer perforation and age- and sex-matched controls. Information on preadmission drug use obtained by structured interview.

RESULTS

Six hundred forty-four patients and 1268 controls were recruited. The odds ratio for upper gastrointestinal complications in users compared with nonusers of NANSAIDs increased with age: < or = 59 years, odds ratio 2.0; 60-79 years, odds ratio 3.0; > or = 80 years, odds ratio 4.2; and was higher in women (5.4) than in men (1.9). There was a linear dose-response curve that was steeper in women than in men. Combined exposure suggested additive risks: NANSAIDs and aspirin, odds ratio 6.7; NANSAIDs and alcohol, odds ratio 6.0 NANSAIDs by the oral route were associated with an odds ratio of 2.3, compared with 11.4 with rectal administration. Piroxicam was associated with the highest risk, odds ratio 4.8; and ibuprofen the lowest risk, odds ratio 0.7.

CONCLUSIONS

A number of factors can alter the risk of major gastrointestinal complications with NANSAIDs and need to be considered when individual prescribing decisions are made.

Nonsteroidal anti-inflammatory drugs and peptic ulcer hospitalization rates in New South Wales

BACKGROUND

Consumption of nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDS) increased substantially during the 1980s. The effects of this trend on hospitalization rates for peptic ulcer in different age groups in New South Wales, Australia, was investigated.

METHODS

A population model based on sales of NANSAIDS and aspirin, age specific estimates of the relative risk of ulcer complications with these drugs, and hospitalization data for 1979 through 1988 was created.

RESULTS

All age groups increased consumption of NANSAIDS. The increases were greatest in elderly subjects, with women over age 65 years increasing the prevalence of their use of the drugs from 11.9% in 1979 to 22.5% in 1988 and males over age 65 increasing use from 9.7% to 20%. Aspirin use remained relatively unchanged in all age groups. Hospitalization rates for peptic ulcer decreased in both sexes under age 64 despite increasing use of NANSAIDs. Hospitalization increased in males and females over age 65, but in females the increase was substantially greater than predicted by the computer model. In women and men over age 75 the increases in hospitalization rates predicted by the model were only 18% and 33%, respectively, of the observed rises.

CONCLUSIONS

The increasing hospitalization rate for peptic ulcer among elderly subjects was only partly explained by the increasing consumption of NANSAIDS. Further research is needed.

Application of pharmacological principles to benzodiazepine therapy

The benzodiazepines are a group of drugs which have recently received considerable adverse publicity from within the media, much of which is undeserved. It is not unusual for drugs to produce these strong reactions from within both the professional and the general community. This paper examines the validity of the benzodiazepines in clinical practice and suggests rational guidelines for their continued use based on the clinical pharmacology of the compounds concerned.