Alprazolam utilisation in 1991.
Explore the source record for details and available documents.
Alprazolam↗
Biomedical subjects
A Mant
Publications and source records attributed to A Mant.
Panic disorders and the listing of alprazolam on authority on the PBS. Beware of overdiagnosis.
The RACGP guidelines on benzodiazepine use (Table 2) were endorsed in March 1993, and drew on the experience of hundreds of general practitioners. Following them should ensure that there is a rational response to the new listing.
Alprazolam↗
Determination of the unfrozen water content of maximally freeze-concentrated carbohydrate solutions.
The heat capacity change at T'g has been studied in freeze-concentrated carbohydrate solutions. The values obtained have been compared with those found for high concentration solutions that do not undergo freezing above Tg. The analysis has indicated that the freezing process influences the degree of stress in the glassy phase. This results in a complex power-time curve when frozen solutions are heated in a differential scanning calorimeter. The endotherm produced by the stress relaxation can cause considerable error in W'g measurement obtained by any method that relies on the integration of the power-time curve. A more reliable method for W'g determination is via the intersection of T'g with a previously prepared Tg/Wg calibration curve.
Carbohydrates↗
Benzodiazepine utilisation in Australia: report from a new pharmacoepidemiological database.
This study surveys the total community prescription use of benzodiazepine agents in Australia for the years 1990 and 1991. Also included is information on the utilisation of these agents on the Pharmaceutical Benefits and Repatriation Pharmaceutical Benefits Schemes (PBS/RPBS) over the period 1987 to 1991. The Australian data are from the Drug Utilization Subcommittee (DUSC) database, which is derived from two sources: the PBS/RPBS (subsidized prescriptions), and a national sample of Pharmacy Guild of Australia pharmacies (private and under-copayment general prescriptions). The data are converted to defined daily doses per 1000 inhabitants per day (DDD/1000/day) in accordance with the unit of measurement for drug utilisation studies approved by the World Health Organization. Benzodiazepine utilisation was 33.96 DDD/1000/day for 1990 and 29.31 DDD/1000/day for 1991. The four drugs listed on the Pharmaceutical Benefits Scheme, namely diazepam, oxazepam, nitrazepam and temazepam, constituted 82 per cent of the Australian market. The availability of government subsidy appears to influence benzodiazepine- prescribing behaviour. Benzodiazepine utilisation has been falling in recent years. The fall may be related to the impact of new guidelines and community awareness campaigns. There are major differences in the composition of the market between Australia and the Nordic countries.
Anti-Anxiety Agents↗
Post marketing surveillance. Traps for the unwary.
General practitioners are being asked increasingly to participate in post marketing surveillance studies. These studies may be valuable or worthless; it is important to be aware of the factors that distinguish one from the other before agreeing to participate.
Clinical Trials as Topic↗
Neuropsychological functioning and sleep patterns in the elderly.
OBJECTIVE: To discover whether reported sleep-wake disturbances in the elderly (more frequent nocturnal awakenings, earlier waking and more day time naps) are associated with neuropsychological dysfunction. DESIGN AND SETTING: A sample of 124 residents of a retirement village complex were interviewed about their sleep patterns and given neuropsychological assessments. Reported sleep-wake difficulties were combined to form two variables, "night sleep" and "day sleep". Additional sleep variables analysed were reported sleep duration and time of wakening. Principal components analysis of the neuropsychological test scores yielded four factors: "general ability", "memory", "motor", and "cerebral efficiency". MAIN OUTCOME MEASURES: A correlation analysis was performed for sleep variables, neuropsychological factors and age, mood scale and scores on indices of participation in physical and passive activities. RESULTS: There was no correlation between "night sleep" and the factor scores derived from the neuropsychological tests. "Day sleep" was correlated with "cerebral efficiency" only. Age was correlated with the "memory" and "motor" factors, the latter also being associated with participation in physical activities. CONCLUSION: Night sleep problems are not associated with neuropsychological deficits in a non-clinic population.
Affect↗
General practitioner databases in Australia.
OBJECTIVE: General practitioner-based research has been hampered by the poorly defined database and the cost of continuous updating of lists of practitioners. Little is known about the general practitioner workforce. Fresh awareness by health planners of the serious maldistribution of general practitioners has heightened the need for workforce planning. Integral to this is the availability of an accurate listing of general practitioners. DATA SOURCES: A CD-ROM Medline review of all surveys involving general practitioners which were conducted in Australia in the period 1983-1990 was performed. All general practitioner listings still existing at the end of the decade were identified. STUDY SELECTION: Nine listings considered for use as general practitioner databases. DATA EXTRACTION: Each listing was assessed in six ways--quality of information provided, availability for research purposes, cost, potential to provide the correct postal address, ability to identify general practitioners in active practice and comparative advantage over other lists. DATA SYNTHESIS: Each listing has limitations and advantages, with individual peculiarities and variable information relating to identifying characteristics of general practitioners. None was specifically created for research or workforce planning purposes. The Medical Provider File (formerly called the Central Register of Medical Practitioners) was the most used list. CONCLUSIONS: We propose a framework for the ideal database and avenues for its development.
Australia↗
Sleep disordered breathing and cognitive function in a retirement village population.
Sleep disordered breathing (SDB) may be associated with cognitive dysfunction in non-demented elderly people. A random sample of 96 retirement village residents were given both neuropsychological assessment and overnight sleep monitoring with a portable microprocessor based system (Vitalog PMS-8). Respiratory disturbance index (RDI) was calculated as the number of apnoeas and hypopnoeas per hour of sleep. RDI was not associated with 'memory', 'verbal', and 'motor' factors identified from the analysis of cognitive tests, but was associated with the 'cerebral efficiency' factor (R2 = 0.21, p less than 0.0001). Seventy-three subjects had repeat neuropsychological tests, median time to follow-up being 17 months. Baseline RDI did not predict changes in scores on the two factors identified from the second analysis. We conclude that mild to moderate disturbance of breathing during sleep is not associated with cognitive dysfunction in non-demented subjects.
Activities of Daily Living↗
Sleep-disordered breathing in elderly people and subjective sleep-wake disturbance.
Sleep-disordered breathing and subjective reports of sleep-wake disturbances are both common in elderly people but previous studies investigating the relationship between the two have produced uncertain results. We hypothesized that there is no relationship between sleep-disordered breathing and subjective reports of sleep-wake disturbance. Ninety-three random-sampled retirement-village residents, mean age 77.6 years, were monitored overnight with a portable microprocessor-based system. The respiratory disturbance index (RDI) was used as a measure of sleep-disordered breathing. Subjects were interviewed regarding sleep-wake patterns and snoring history and the Mini Mental State Examination, Geriatric Depression Scale and Nelson Adult Reading Test were administered. The sleep-wake responses were entered into a principal components analysis. Two components, reflecting night-time and daytime disturbance, accounted for 34% of the variance. Multiple regression analyses were performed using RDI as a continuous dependent variable, and three predictor variables, night-time, and daytime disturbance and history of snoring. Together, these variables accounted for only 2% of the variance. We conclude there is no relationship between mild and moderate sleep-disordered breathing and subjective sleep-wake disturbance in this population.
Aged↗
Estimates of the number of injecting drug users in a defined area.
Three estimates of the number of injecting drug users residing within the Eastern Sydney Area Health Service (ESAHS) were obtained by applying the capture-recapture technique to data from three reliable sources, specifically, Methadone Services, the Bourke Street Drug Advisory Service and the Albion Street Clinic. The obtained estimates were 3449, 3046 and 1103 respectively. Statewide methadone statistics were also used to obtain an estimate of 15,082 injecting drug users in New South Wales. This estimate was close to the linearly projected estimates (14,274 and 14,416) from two previous studies. Estimates based upon the methadone statistics indicate that approximately 23% of injecting drug users in New South Wales reside within the ESAHS. A sensitivity analysis was performed to assess the effects on the estimates of the likely violation of the closed population assumption.
Ambulatory Care↗
Use of H2-receptor antagonists in patients with dyspepsia and heartburn: a cost comparison.
OBJECTIVE: Under the Pharmaceutical Benefits Scheme, the use of H2-receptor antagonists (H2A) in the treatment of dyspepsia and heartburn is only subsidised when there is a proven diagnosis of ulcer. This study compared the costs of this Australian practice with a simulation of British practice, which allows unrestricted prescribing of subsidised H2A. DESIGN: Patients with heartburn and/or dyspepsia were prospectively randomised to either a "British" group treated freely at the discretion of their general practitioner without necessarily being investigated or an "Australian" group where use of H2A was allowed only after gastroscopy or a barium meal had demonstrated a peptic ulcer or ulcerative oesophagitis. The patients were followed up for six months and all direct and indirect costs were recorded. SETTING: Forty-nine Sydney general practitioners recruited primary care patients for the study. PATIENTS: Any patient with heartburn or dyspepsia was considered for recruitment; 139 patients entered the study and 137 completed it. MAIN OUTCOME MEASURES: The outcome measures were the costs of general practitioner consultations, specialist consultations, radiology and gastroscopy, other tests, H2A, other medications, personal costs, and total cost per patient. RESULTS: The cumulative total cost per patient at the end of the study was equivalent in the "Australian" ($392) and "British" ($406) groups. A higher initial cost per patient of H2A in the "British" group was offset by a rapid decrease in the proportion that continued to use H2A and by the cost of specialist consultations and investigations in the "Australian" group. CONCLUSION: Over a six-month period the cost of early investigation of heartburn and dyspepsia was equivalent to the cost of a therapeutic trial of H2A.
Adult↗
Night-to-night variability of disturbed breathing during sleep in an elderly community sample.
Night-to-night variability of breathing and oxygenation during sleep was examined with portable monitoring equipment in 30 residents of a retirement village. Subjects had a variety of health problems as might be expected in the elderly, but all were living independently in self-contained units. None had clinical features to suggest obstructive sleep apnea. Two pairs of consecutive nights were studied, separated by 4-6 months. Satisfactory recordings on all four nights were obtained in 15 subjects, and in these subjects variability of measurements was examined across nights 1-4 using the kappa (K) statistic. There was low but significant agreement in estimated total sleep time (K = 0.23, p less than 0.01) and estimated wakefulness after sleep onset (K = 0.18, p less than 0.05) as assessed with a wrist actigraph. Good agreement was found among measures of disturbed breathing during sleep whether expressed in terms of numbers of events [respiratory disturbance index (RDI), K = 0.62, p less than 0.0001], their duration (event minutes, K = 0.53, p less than 0.0001), or associated disturbance of oxygenation (% cumulative time less than 90% SaO2, K = 0.50, p less than 0.001, n = 9). Twenty-eight subjects had at least two nights' satisfactory recordings. Although some of these individuals showed considerable variation in RDI, this had little overall effect on classification of them into normal (RDI less than or equal to 15) and abnormal groups. The accuracy of the first night's recording in predicting classification derived from recording on three or four nights was 83%.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Rectal bleeding. Patient delay in presentation.
Patient delay in presentation of rectal bleeding has been identified as a factor in delayed diagnosis among patients with colorectal cancer. The aim of this study was to identify demographic or psychological factors, or beliefs or behaviors related to delay in presentation of rectal bleeding. In 93 patients presenting with this symptom to their general practitioner, delay ranged from 0 to 249 days with a median of 7 days; 27 (29 percent) delayed more than 14 days. Delay was unrelated to age, sex, ethnic origin, competence in English, length of schooling, social status, availability of social support, measured psychologic traits, and to the belief that the cause might be cancer. The proportions delaying more than 14 days were statistically significantly elevated among those who were not worried by the bleeding (47 percent delayed); those who did not regularly look at their feces or the toilet paper after use (37 percent); and those who took some other action before presenting to their general practitioner (43 percent).
Adult↗
Dementia and abnormal breathing during sleep.
We have examined a group of cognitively impaired elderly people who already showed some increase in indices of sleep-disordered breathing and applied standard criteria for dementia to them. This resulted in a subgroup of truly demented subjects who showed significantly more abnormal breathing during sleep than either normal subjects or those whose cognitive impairment may not have been due to a dementing illness.
Aged↗
Recognition of depression in the elderly: a comparison of general practitioner opinions and the Geriatric Depression Scale.
As part of a larger study, 133 subjects aged 70 years and over were screened for depression using the Geriatric Depression Scale, a 30-item questionnaire, as the screening instrument. Cognitive status was assessed using the Mini Mental State Examination. The subject's own general practitioner was asked his/her opinion as to whether the subject was depressed. Poor agreement was found between depression as measured by the Geriatric Depression Scale and the general practitioner's assessment. Possible reasons for this include the difficulty of finding a satisfactory operational definition of depression for use by general practitioners, the problems of identifying depression in the elderly, the arbitrary definition provided by the scale and the confounding of depression, as measured by the scale, with cognitive status.
Aged↗
Use of medications by the elderly.
Our study confirms that multiple medications are frequently taken by relatively healthy residents of a retirement village, the more so when they are less socially active during the day, and when they are living in hostel accommodation. There were few drug combinations that caused a potential interaction, suggesting that safe use of medication by the elderly should be an achievable goal.
Aged↗