Psychotropic drugs in Australia: consumption patterns

This paper reviews studies of psychotropic drug use in Australia, analyses results from the Australian Health Surveys and compares the findings with those from other countries. It identifies subpopulations with high rates of drug use, which may consequently be at greater risk of drug-related harm. The levels of consumption of psychotropic agents in Australia were estimated from the results of studies conducted in community and institutional settings between 1970 and 1986. In the absence of more recent data national prevalence rates were derived from analysis of data provided by the Australian Health Surveys (AHS) of 1977-1978 and 1983-1984, and comparisons were made with rates available from other countries. While the prevalence of current and frequent use of drugs for nervous conditions was found to have decreased in most age groups over this period, it was consistently higher in females than in males, and increased with age. An analysis of the 1983-1984 AHS data revealed that the consumption of "medicines for nervous conditions" fell by 35% but that no change occurred in the prevalence of persons taking sleeping medicines. This fall appeared to occur in both rural and urban populations. Further analysis of data relating to the consumption of hypnotic agents revealed that changes occurred in the patterns of use within age and gender subgroups. Significant differences were observed between Australian States in consumption rates of sleeping medicines (chi 2 = 282.2; df = 7; P less than 0.01) and of medicines for nervous conditions (chi 2 = 289.7; df = 7; P less than 0.01). There were high rates of use of medicines for sleep in South Australia and of medicines for nervous conditions in Queensland. The prevalence of use of both drugs for sleep (rs = 0.71; P less than 0.05) and drugs for nervous conditions (rs = 0.77; P less than 0.05) was related to the rate of consultations with doctors. Preliminary surveys of various non-British subpopulations including Aborigines were inconclusive. These results have implications for reducing the harm associated with the use of psychotropic agents, particularly hypnotics and drugs for nervous conditions, in Australia.     

Nutrient consumption patterns of families in Busselton, Western Australia

Nutrient consumption data were obtained from 211 members of 41 families living in the coastal town of Busselton, Western Australia. It was found that food consumption patterns were similar in boys and girls up to the age of 11 years. After that, as expected, males consumed more food than females. There was a general tendency for daily kilojoule intakes to be considerably less than the Australian Dietary Allowances for all age groups with the exception of males aged from 35 to 55 years. There was a significant prevalence of obesity in the subjects who were studied, particularly in the older groups of both sexes. The results suggest that, in the older adult groups, failure to make concessions to decreased levels of physical activity by modifying appetite and customary eating practices is a major factor which contributes to obesity.     

Leptospirosis in Western Australia, 1983-1984

The diagnosis of leptospirosis is often difficult to make because of vague and mild symptoms. Patients who present with a "flu-like" illness and who have had either direct or indirect contact with infected animals should be investigated by serological examination. In Western Australia during 1983 and 1984, the sera of 937 patients were tested for the presence of leptospiral antibodies. Of these, 131 gave positive results; in 45, these were consistent with recently acquired infection. Apart from one veterinary worker, all the cases that were diagnosed serologically occurred in farmers and meatworkers. Farmers were most often infected with serovar hardjo. Meatworkers demonstrated a high degree of cross-reactivity among serovars pomona, hardjo, and to a lesser extent, icterohaemorrhagiae. However, in cases in which the infecting serovar was identifiable serologically, serovar pomona predominated.     

Perinatal mortality in South Australia

A study of the recorded causes of perinatal mortality has been made in South Australia for the years 1970 to 1973. The overall perinatal mortality was 22.16 per 1,000 births. Higher mortality was observed in babies of women resident outside the metropolitan area, of those aged under 20 and over 35 years, and of those not currently married. The most frequent causes of perinatal mortality were prematurity, placental insufficiency, congenital anomalies, maternal disorders and haemorrhage, in that order. Multiple pregnancy had a high perinatal mortality. Better recording systems with record linkage are required.     

Alcohol consumption and risk of stroke: a meta-analysis

Context  Observational studies suggest that heavy alcohol consumption may increase the risk of stroke while moderate consumption may decrease the risk. Objective  To examine the association between alcohol consumption and relative risk of stroke. Data Sources  Studies published in English-language journals were retrieved by searching MEDLINE (1966–April 2002) using Medical Subject Headings alcohol drinking, ethanol, cerebrovascular accident, cerebrovascular disorders, and intracranial embolism and thrombosis and the key word stroke; Dissertation Abstracts Online using the keywords stroke and alcohol; and bibliographies of retrieved articles. Study Selection  From 122 relevant retrieved reports, 35 observational studies (cohort or case control) in which total stroke, ischemic stroke, or hemorrhagic (intracerebral or total) stroke was an end point; the relative risk or relative odds and their variance (or data to calculate them) of stroke associated with alcohol consumption were reported; alcohol consumption was quantified; and abstainers served as the reference group. Data Extraction  Information on study design, participant characteristics, level of alcohol consumption, stroke outcome, control for potential confounding factors, and risk estimates was abstracted independently by 3 investigators using a standardized protocol. Data Synthesis  A random-effects model and meta-regression analysis were used to pool data from individual studies. Compared with abstainers, consumption of more than 60 g of alcohol per day was associated with an increased relative risk of total stroke, 1.64 (95% confidence interval [CI], 1.39-1.93); ischemic stroke, 1.69 (95% CI, 1.34-2.15); and hemorrhagic stroke, 2.18 (95% CI, 1.48-3.20), while consumption of less than 12 g/d was associated with a reduced relative risk of total stroke, 0.83 (95%, CI, 0.75-0.91) and ischemic stroke, 0.80 (95% CI, 0.67-0.96), and consumption of 12 to 24 g/d was associated with a reduced relative risk of ischemic stroke, 0.72 (95%, CI, 0.57-0.91). The meta-regression analysis revealed a significant nonlinear relationship between alcohol consumption and total and ischemic stroke and a linear relationship between alcohol consumption and hemorrhagic stroke. Conclusions  These results indicate that heavy alcohol consumption increases the relative risk of stroke while light or moderate alcohol consumption may be protective against total and ischemic stroke.      

Alcohol consumption among the elderly: dispelling the myths

Do old people drink? Community surveys suggest that alcohol consumption is lowest among elders compared to any other age group, and that patterns of drinking are relatively stable across mid-to-late life. But is this an accurate portrayal of those individuals seeking medical guidance? In other words, what is the likelihood of alcohol abuse or misuse among the typical hospital, outpatient clinic, or emergency room patient? How difficult is it to spot potential alcohol misuse among the elderly? The purpose of this paper is to address these questions and to assist physicians of the medical community in the important function of early detection and prevention of alcohol abuse/misuse in patient populations.     

Alcohol consumption in pregnancy: results from the general practice setting

Background

There is no established safe level of alcohol consumption in pregnancy. Studies from Ireland have consistently shown lower abstention and higher binge drinking rates in pregnancy than other countries, indicating a high potential for foetal alcohol-related disorders. There has been little research on alcohol in pregnancy in primary care.

Aims

To determine the prevalence of alcohol consumption amongst pregnant women attending their GP for antenatal care, and to compare this to use in the year prior to conception.

Methods

Prospective cross-sectional study was carried out in fifteen teaching practices in the greater Dublin area. Women were recruited at their antenatal visits. Data were gathered by self-completed questionnaire in the practice, or researcher-administered telephone questionnaire. The questionnaire was based on the AUDIT, a WHO-validated data collection instrument designed for use in primary care.

Results

Two hundred and forty valid questionnaires were returned (80 % recruitment rate). Alcohol intake and binge drinking levels were much lower during pregnancy compared to the year prior to pregnancy (p < 0.001). There was a marked reduction in the prevalence of alcohol use in pregnancy compared to previous research. Over 97 % drink no more than once a week, including almost two-thirds of women who abstain totally from alcohol in pregnancy. Non-pregnant Irish women drink alcohol more frequently, and with higher rates of binge drinking, than women of other nationalities.

Conclusions

Primary care is a suitable setting to research alcohol use in pregnancy. Alcohol use in pregnancy in Ireland has decreased markedly compared to previous research from this jurisdiction.