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Biomedical subjects

W Hall

Publications and source records attributed to W Hall.

At least 127 records · Page 7Linked to original sources
PubMed1996

Insomnia in general practice. Results from NSW General Practice Survey 1991-1992.

OBJECTIVE: To assess whether an educational visit to GPs providing information about the non-drug and drug management of anxiety and insomnia can reduce subsequent rates of benzodiazepine prescription. METHOD: A randomised controlled trial of 286 NSW general practitioners conducted during 1991 and 1992. RESULTS: The educational visit was statistically significant in reducing the number of new prescriptions recorded by general practitioners for new diagnoses of insomnia. However, the majority of benzodiazepine prescriptions were for patients continuing treatment for insomnia or anxiety/depression. Overall, benzodiazepines were the sole management of insomnia recorded by the surveyed GPs in most cases (93.5%). In comparison, non-drug management for anxiety and depression was offered to more than a third of patients with anxiety and depression. (Benzodiazepines were the only management of anxiety and depression in just over 50% of cases.) DISCUSSION: This study shows general practitioners can change their management of insomnia and that change is most likely to occur when the problem is new, rather than old. The decreased emphasis on drug treatment in the general practice management of anxiety and depression may reflect the change in psychiatric teaching for these conditions. Further, most of the publicity about benzodiazepines has been in relation to their use for anxiety disorders. Doctors were interested in learning about advances in the understanding of sleep disorders and their non-drug management.

Australia↗
PubMed1995

Levels and correlates of polydrug use among heroin users and regular amphetamine users.

Data from a sample of 329 primary heroin users and from a sample of 301 regular amphetamine users were analysed in order to determine the extent and correlates of polydrug use among illicit drug users. Both samples exhibited high levels of polydrug use, with means of 5.2 (heroin) and 6.3 (amphetamines) drug classes used in the preceding 6 months. Multi-variate analyses indicated that being younger, being male, not being in treatment, being an injector, having recently borrowed injecting equipment and being from the regular amphetamine using sample were independently associated with higher levels of polydrug use. Rather than increasing levels of polydrug use being associated with age, illicit drug users appear to reduce their range of drugs as they get older. The 'pure' heroin or amphetamine user was extremely rare. It is concluded that to characterise drug users as 'heroin' or 'amphetamine' users misses the context in which these drugs are used.

Adolescent↗
PubMed1995

Management and treatment efficacy of drug and alcohol problems: what do doctors believe?

We conducted a survey of the attitudes of postgraduate medical trainees in Australia on the management of drug and alcohol problems and examined the medical practitioner's role in managing drug and alcohol problems, factors influencing prognosis and beliefs about the efficacy of a number of treatment interventions. Of 2461 trainees enrolled in specialty training programmes in internal medicine, psychiatry and general practice 1361 (55%) participated. There was a high level of acceptance of responsibility for management of alcohol and drug problems, with the strongest support observed among psychiatry trainees. However, views of the efficacy of various treatment interventions were less positive. Alcoholics Anonymous was considered to be an approach well supported by the research literature. Dynamic psychotherapy was less well supported, and there was considerable uncertainty about the evidence for brief advice and cognitive-behaviour therapies. The opinions expressed on treatment efficacy were in many cases in striking contrast to the research evidence. The implications for future training in drugs and alcohol in specialty programmes are discussed.

Adult↗
PubMed1995

The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users.

The Severity of Dependence Scale (SDS) was devised to provide a short, easily administered scale which can be used to measure the degree of dependence experienced by users of different types of drugs. The SDS contains five items, all of which are explicitly concerned with psychological components of dependence. These items are specifically concerned with impaired control over drug taking and with preoccupation and anxieties about drug use. The SDS was given to five samples of drug users in London and Sydney. The samples comprised users of heroin and users of cocaine in London, and users of amphetamines and methadone maintenance patients in Sydney. The SDS satisfies a number of criteria which indicate its suitability as a measure of dependence. All SDS items load significantly with a single factor, and the total SDS score was extremely highly correlated with the single factor score. The SDS score is related to behavioural patterns of drug taking that are, in themselves, indicators of dependence, such as dose, frequency of use, duration of use, daily use and degree of contact with other drug users; it also shows criterion validity in that drug users who have sought treatment at specialist and non-specialist agencies for drug problems have higher SDS scores than non-treatment samples. The psychometric properties of the scale were good in all five samples, despite being applied to primary users of different classes of drug, using different recruitment procedures in different cities in different countries.

Adult↗
PubMed1995

Injecting and sexual risk-taking behaviour among regular amphetamine users.

A sample of 301 regular amphetamine users were interviewed regarding injecting and sexual risk-taking behaviours. Two-thirds of subjects were injecting the drug, with males being 1.8 times more likely to do so. Nearly half (41%) of injectors had shared injecting equipment in the preceding month. Females were twice as likely as males to report recent needle sharing. Having a regular sexual partner who injects amphetamines, using benzodiazepines and experiencing higher levels of psychopathology were independently associated with needle sharing. The number of sexual partners in the preceding six months was independently associated with having had paid sex in that period, and higher levels of polydrug use.

Adolescent↗
PubMed1995

Changes in the characteristics of clients admitted to an Australian therapeutic community, "The Buttery", 1980-92.

Data are presented on the characteristics of clients admitted to an Australian therapeutic community, The Buttery, between 1980 and 1992. The typical client was a 28-year-old male with a primary opioid drug problem complicated by polydrug use, particularly of alcohol and stimulants. Prior treatment experience was common, with one in three having been enrolled in methadone maintenance treatment. The average age of clients increased by about 7 months per year, and there was an increase in the prevalence of alcohol, stimulant and polydrug problems over the period of study. There was also an increase in the exposure of clients to methadone maintenance treatment prior to admission to the Buttery. Overall, the characteristics of patients in this drug-free treatment programme were strikingly similar to those observed among patients in methadone maintenance treatment over the same period.

Journal Article↗
PubMed1995

Benzodiazepine prescribing in general practice: dispelling some myths.

The objective was to analyse clinical and non-clinical factors associated with the receipt of a prescription for a benzodiazepine among general practice patients. A survey of 110 consecutive patient encounters (consultations) as recorded by a representative sample of general practitioners in inner urban, outer urban and rural settings was designed. A total of 286 general practitioners took part during 1991-2. 31,256 patients (10,683 male; 34%) were surveyed and the odds of receiving a benzodiazepine script measured. Insomnia, unlike anxiety, was almost routinely managed with a benzodiazepine alone (insomnia 89.6%; anxiety 49.4%), whereas anxiety was more likely to be managed with non-drug management (insomnia 7.2%; anxiety 38.3%). In multiple logistic regression, the variables significantly associated with the prescription of a benzodiazepine included being a female patient, being an older patient and being an established patient, who attends a GP working in a busy practice in an inner urban area. A second regression model was run with the addition of three variables, namely the presenting problems of anxiety and insomnia, and the number of health problems. The only predictors of benzodiazepine prescribing in the full model were these three clinical variables together with patient age. There is a need to educate doctors about the non-drug management of insomnia. The stereotype of the doctor over-prescribing a benzodiazepine without an appropriate problem/diagnosis should be questioned. On the other hand, there is concern that patient age continues to be associated with a prescription of these medications, when all other clinical and non-clinical factors are taken into account.

Adolescent↗
PubMed1995

An improved micromethod for vancomycin determination by high-performance liquid chromatography.

A micromethod using reversed-phase high-performance liquid chromatography for the analysis of vancomycin in human serum or plasma was developed. Ristocetin was used as the internal standard. Chromatographic conditions included an amino propyl column, a mobile phase with 62% acetonitrile and 38% sodium phosphate buffer (pH 7.0), a total run time of 10 min, and ultraviolet absorbance detection at 225 nm. Multilevel calibration was found to be linear between 1.0 and 100 micrograms/ml with correlation coefficients of the calibration line slope consistently > 0.999. Recovery of vancomycin from serum was nearly complete, and no interference from commonly used drugs was observed. This procedure is simple, sensitive, rapid, precise, selective, and requires only 50 microliters of serum or plasma for completion.

Anti-Bacterial Agents↗
PubMed1995

Quitting smoking: estimation by meta-analysis of the rate of unaided smoking cessation.

The rates (after 12 months' follow-up) of unassisted smoking cessation reported in the literature have varied from 13.8 per cent to 8.5 per cent. A meta-analysis was conducted of the abstinence rates observed in 14 samples of smokers who presented at primary health settings and received either no intervention aimed at smoking or usual care (which involved no deliberate intervention for smoking cessation). The estimated rate of stopping smoking without intervention, over an average 10-month period, was 7.33 per cent. This rate is consistent with others reported in the literature when motivation to quit is taken into account. The estimate provides a baseline to judge the effects of smoking-cessation interventions.

Adult↗
PubMed1995

A controlled trial of educational visiting to improve benzodiazepine prescribing in general practice.

A randomised controlled trial studied the effect of an educational visit on benzodiazepine prescribing. An approximately representative sample of 286 general practitioners was allocated to an intervention or a control group. Rates of benzodiazepine prescriptions were derived from two comprehensive self-report surveys seven months apart. Two months after the first survey the intervention group received an educational visit and supporting material from a doctor or pharmacist, ostensibly unconnected with the surveys. The overall benzodiazepine prescribing rate fell by 23.7 per cent from the first to the second surveys, from 4.93 to 3.76 prescriptions per 100 encounters (P < 0.001). Anxiety and insomnia diagnosis rates also declined from 4.68 to 3.76 per 100 encounters (19.7 per cent). After adjusting for confounders, there was a differential downward trend in prescriptions per diagnosis of insomnia but not to a statistical level. The same was true of initial prescriptions per insomnia diagnosis. In a subsidiary analysis selecting only new insomnia diagnoses, the intervention had a strong effect in reducing initial prescriptions (odds ratio 0.18, 95 per cent confidence interval 0.04 to 0.73). No effect was seen on prescribing for anxiety diagnoses. Educational practice visiting for benzodiazepine prescribing in anxiety, as we conducted it, is not justified in an unselected population of general practitioners. Specific education on prescribing for insomnia is probably useful. Our interpretation of the reduction in benzodiazepine prescribing is that probably there was an effect from self-monitoring alone which overwhelmed a main-analysis intervention effect. Retrospective diagnosis may also have obscured a real intervention effect.

Anti-Anxiety Agents↗
PubMed1995

The public health significance of cannabis use in Australia.

A fair appraisal of the public health significance of cannabis use has been hampered by the polarised opinions about its health effects expressed by partisans on both sides of the debate on its legal status. The findings of a recent review of the literature on the adverse health and psychological effects of cannabis are used to estimate the major probable public health risks of cannabis use in Australia. These appear to be, in order of approximate public health importance: adverse psychological effects; motor vehicle accidents; cannabis dependence; respiratory disease; precipitation and exacerbation of schizophrenia in vulnerable individuals; low-birthweight babies; and perhaps subtle cognitive impairment. On current patterns of use, cannabis use is a modest public health concern by comparison with alcohol and tobacco, although given the scale of public health damage caused by the latter drugs, and the currently low prevalence of regular cannabis use, this is not cause for complacency.

Accidents, Traffic↗
PubMed1995

The effects of partial decriminalisation on cannabis use in South Australia, 1985 to 1993.

In 1987 the Cannabis Expiration Notice scheme decreased penalties for the personal use of cannabis in South Australia. Data from four National Campaign Against Drug Abuse (NCADA) household drug-use surveys covering the period 1985 to 1993 were analysed to measure the effect of the decriminalisation on cannabis use. The main outcomes used were the self-reported prevalence rates of having ever used cannabis and current weekly use. Logistic regression was used to control for the potentially confounding effects of age and sex. Other outcomes were rates of having ever been offered cannabis and willingness to use cannabis if offered it. Between 1985 and 1993 the adjusted prevalence rate of ever having used cannabis increased in South Australia from 26 per cent to 38 per cent. There were also significant increases in Victoria and Tasmania, and to a lesser extent in New South Wales. The increase in South Australia was not significantly greater than the average increase (P = 0.1). Adjusted rates of weekly use increased between 1988 and 1991 in South Australia, but did not change through 1993. Although the effect was in the direction of a greater increase in South Australia, this was not statistically significant when compared to increases in the rest of Australia (P = 0.07). The greatest increase in adjusted weekly use occurred in Tasmania between 1991 and 1993, from 2 per cent to 7 per cent. Although the NCADA survey data indicate that there were increases in cannabis use in South Australia in 1985-1993, they cannot be attributed to the effects of partial decriminalisation, because similar increases occurred in other states.

Adolescent↗
PubMed1995

Capacity-building influences on Illinois local health departments.

Illinois local health departments (LHDs) were surveyed in 1992 and again in 1994 in order to assess changes in, influences on, and results of practice performance during this two-year period. Illinois LHDs serving both small and large populations were found to have greatly increased the extent to which they carry out practice measures related to public health's core functions. The Assessment Protocol for Excellence in Public Health (APEXPH) and its Illinois adaptation were cited as the most positive influences on practice performance. LHDs viewed the most significant consequences of participation in needs assessment and planning processes as increased understanding of internal strengths and weaknesses and of community health problems. These findings and implications suggest that significant improvements in LHD practice performance can result from widespread implementation of APEXPH and its derivatives.

Community Health Planning↗
PubMed1995

The health risks of cannabis.

The debate about the legal status of cannabis and its effect on health has polarised public opinion. In the absence of credible non partisan advice, health education about cannabis has been neglected because of uncertainty about what information to present. This paper summarises likely adverse acute and chronic health effects of cannabis that emerged from a peer-reviewed analysis of the research literature undertaken for the National Task Force on Cannabis. From this review, suggestions are offered concerning advice that family physicians can give to their patients about the health risks of using cannabis.

Australia↗