Trends in Illicit Drug use in the United States: Conflicting Results from National Surveys

Data from several national studies lead to divergent conclusions regarding trends in illicit drug use in the United States. Two major population studies point to a downturn in drug use dating to the late 1970s. However, a study of drug-related deaths and hospital emergency room visits shows increases in these events in recent years. Studies also show drug use, especially cocaine, continuing to increase among criminals. Additionally, drugs were identified as the most important problem facing the nation in a Gallup poll conducted during the summer of 1989. This paper offers some possible explanations for the divergent trends. Most notably, we suggest that methodological differences in the studies being compared, and lags between trends in the general population and certain subgroups, account for most of the variation in the trend estimates. The paper concludes that illicit drug use is decreasing in the United States.     

The Type A Behavior Pattern: A Critical Assessment

Research on the Type A (coronary-prone) behavior pattern has proliferated at a rapid rate in recent years. With the cardiovascular risk value of Type A behavior well established, many studies have focused on reliability, validity, and other essentially psychological and psychometric issues. These studies are evaluated, along with the fundamental assumptions underlying the construct. Further research is suggested which examines the comparative predictive validity of Type A behavior and its defining criteria across diverse populations and the interaction of stress and behavior pattern.     

Prevalence of complementary and alternative medicine (CAM) use by menopausal women: A systematic review of surveys

Large proportions of women have turned to complementary and alternative medicine (CAM) for relief from their menopausal symptoms. This highlights the need for more rigorous research into CAM. This article is aimed at critically reviewing surveys that examine the prevalence of CAM use by menopausal women worldwide. Eleven databases were searched for peer-reviewed surveys published in any language between 01 January 2000 and 27 October 2012. The bibliographies of the retrieved articles and relevant book chapters were also hand searched. Twenty-six surveys were identified, and they included a total of 32,465 menopausal women. The majority of these surveys were of poor methodological quality. Based on 6 surveys, 32.9% of women stated they were current/regular CAM users. Based on 9 surveys, 50.5% of women reported that they used CAM specifically for their menopausal symptoms. The average 12-month prevalence of CAM use was 47.7% (range: 33.1–56.2). Fifty-five percent of women did not disclose their use of CAM to their healthcare professional. The majority of women sought information about CAM from the media. The most popular CAM modality was herbal medicine, followed by soy/phytoestrogens, evening primrose oil, relaxation and yoga. There are a large number of predominantly low-quality surveys monitoring the prevalence of CAM use among menopausal women worldwide. The available evidence suggests that the prevalence of CAM use is high.     

健康调查简表及其在妇科疼痛相关疾病中的应用进展②

本文介绍健康调查简表(SF-36)的发展及引进中国后在临床的应用概况，重点介绍其在妇科以慢性盆腔疼痛为主要症状相关疾病，如盆腔炎、子宫内膜异位症等的应用概况。临床如能将SF-36与特定疾病量表结合，将为妇科慢性盆腔疼痛评估提供一个重要而有意义的工具。     

Surveying general practitioners: a new avenue

SUMMARY

Background: The validity of opinions expressed in questionnaire surveys diminishes with lower response rates. Recent research suggests that general practitioners (GPs) are more likely to respond to questionnaire surveys if they are motivated to do so because the subject of the survey is perceived as relevant to the practitioner at the time of the survey, and there is an opportunity to respond without encroaching on existing obligations or interests.

Aim: To compare the results of a questionnaire survey administered by two routes: a postal survey with reminders and after an educational meeting with no reminders.

Methods: A validated questionnaire with 19 questions using a Likert scale seeking views about the ideal contents of a referral letter to colorectal surgeons was administered to GPs attending a monthly educational meeting in one locality in the UK and by post to a different group in a second locality. The response rate and demographic characteristics of the GPs were compared for respondents, non-respondents, attenders and non-attenders to the educational meeting. The mean responses to the questions on the Likert scale were used to produce a schedule to score the contents of referral letters. The schedules produced by the two methods (postal/educational meeting) were used to score 551 referral letters at one district general hospital. Mean scores calculated using the two schedules derived by the postal and educational routes were compared. Cases diagnosed with 'significant organic pathology' as defined in a previous study were identified. The predictive value of the scores in identifying these cases was compared.

Results: 88% (138/157) of GPs in the locality attended the educational meeting and were invited to participate in the survey. Non-attenders were more likely to be assistants, locums or part-time practitioners. Overall 71% (98) of the GPs responded to the survey. There were no significant demographic differences between the respondents and non-respondents to the survey. Response rates to the survey conducted by the two routes were similar. Referral letter 'quality' scores derived via the two alternative routes were equally valuable in predicting which patients had significant organic pathology.

Conclusions: Responses to questionnaire surveys are equally valid when administered via an educational meeting or by post. The value of the educational meeting approach was the relative ease of administering the questionnaire and the rapid turn around of replies. However this method may exclude the views of part-time practitioners who were more likely to fail to attend. These practitioners may need to be targeted by alternative routes in questionnaire surveys.     

Shorter sentences for drug mules: The early impact of the sentencing guidelines in England and Wales

Abstract

Aims: In February 2012, new sentencing guidelines for drug offences became effective in all courts in England and Wales. An explicit aim was to reduce the length of sentences for drug “mules” and so make them more proportionate. Methods: This article examines their early impact drawing on data from the Court Proceedings Database and the Crown Court Sentencing Survey for importing/exporting a Class A drug. Findings: Overall, the guidelines have achieved their intended aim. The length of the average custodial sentence for drug trafficking fell following the introduction of the guidelines, largely due to taking defendants' roles into account. Notably, three-quarters of those in “lesser” roles received sentences less than four years, representing an important change. Nonetheless, around 10% of mules received very long sentences due to the continued use of drug weight in sentencing. Conclusion: The new guidelines represent an internationally important innovation in drug policy reform.     

Effects of differential privacy techniques: Considerations for end users

We study the effects of differentially private (DP) noise injection techniques in a survey data setting, using the release of cost of early care and education estimates from the National Survey of Early Care and Education as a motivating example. As an example of how DP noise injection affects statistical estimates, our analysis compares the relative performance of DP techniques in the context of releasing estimates of means, medians, and regression coefficients. The results show that for many statistics, basic DP techniques show good performance provided that the privacy budget does not need to be split over too many estimates. Throughout, we show that small decisions, such as the number of bins in a histogram or the scaling of a variable in a regression equation, can have sometimes dramatic effects on the end results. Because of this, it is important to develop DP techniques with an eye towards the most important aspects of the data for end users.     

Patient knowledge of hysterectomy and pap screening after minimally invasive hysterectomy

ObjectiveTo determine whether women know their own cervical cancer screening recommendations after hysterectomy, and to evaluate patients’ understanding of hysterectomy terminology and cervical cancer screening.MethodsA 19-item questionnaire was developed and administered to 413 women who had undergone minimally invasive hysterectomy with benign pathology between January 2008 and January 2012.ResultsA total of 190 women (46%) participated in the survey. The majority of respondents were Caucasian (61%) and had a college education (66%). Fifty-nine percent of respondents knew that a Pap test screens for cervical cancer, and 40% knew that HPV is related to cervical cancer. Eight-four percent understood that Pap screening is recommended if a woman still has a cervix after hysterectomy. Only 67% correctly identified if their cervix had been removed during their own surgery and if they needed future cervical cancer screening per current guidelines. Caucasian race and higher income were significant predictors of hysterectomy and screening knowledge.ConclusionKnowledge regarding Pap tests, HPV, and implications of a supracervical hysterectomy is lacking, even among a post-hysterectomy population.Practical implicationsPatient educational information is needed to improve perioperative counseling regarding the type of hysterectomy performed and indications for future cervical cancer screening.