Social engagement and health and social care use and medication use among older people

Social engagement has been associated with improved health outcomes in older people, although the precise mechanisms by which this is mediated are not clear. The aim of this study was to examine the relationship between social engagement and health and social care use and medication use in older people. Data were derived from the 1985, 1989 and 1993 waves of the Nottingham Longitudinal Study of Activity and Ageing, a nationally representative sample of people aged 65 and over. Logistic regression models were used to determine whether social engagement predicted cross-sectional and longitudinal health and social care use and medication use. People with higher social engagement were significantly less likely to have seen their family doctor, the district nurse or home help services, and to be taking two or more medications cross-sectionally. This relationship was independent of demographic factors, physical and mental health and physical activity for contact with the district nurse or home help services. Higher social engagement was associated with reduced contact with home help services after 4 years, independent of demographic factors, physical and mental health, and with reduced medication use after 4 years in unadjusted models. Higher social engagement was associated with increased contact with home help services after 8 years, when controlling for demographic factors, physical and mental health and physical activity. Higher social engagement may help to reduce cross-sectional health and social care service and medication use but further research is required to understand the benefits of social engagement and medium- and long-term service/medication use.     

Social engagement and health and social care use and medication use among older people

Social engagement has been associated with improved health outcomes in older people, although the precise mechanisms by which this is mediated are not clear. The aim of this study was to examine the relationship between social engagement and health and social care use and medication use in older people. Data were derived from the 1985, 1989 and 1993 waves of the Nottingham Longitudinal Study of Activity and Ageing, a nationally representative sample of people aged 65 and over. Logistic regression models were used to determine whether social engagement predicted cross-sectional and longitudinal health and social care use and medication use. People with higher social engagement were significantly less likely to have seen their family doctor, the district nurse or home help services, and to be taking two or more medications cross-sectionally. This relationship was independent of demographic factors, physical and mental health and physical activity for contact with the district nurse or home help services. Higher social engagement was associated with reduced contact with home help services after 4 years, independent of demographic factors, physical and mental health, and with reduced medication use after 4 years in unadjusted models. Higher social engagement was associated with increased contact with home help services after 8 years, when controlling for demographic factors, physical and mental health and physical activity. Higher social engagement may help to reduce cross-sectional health and social care service and medication use but further research is required to understand the benefits of social engagement and medium- and long-term service/medication use.     

Concomitant use of activated charcoal and N-acetylcysteine

Activated charcoal is a safe, effective, inexpensive adjunct in the management of most toxic ingestions. It has the ability to adsorb a wide variety of drugs and chemicals, one of which is acetaminophen. N-acetylcysteine (NAC) is the specific antidote available for serious overdoses of acetaminophen. Current management of acetaminophen overdose, however, does not recommend the concomitant oral administration of these two useful agents because adsorption and inactivation of NAC by charcoal is believed to occur. Our study was designed to help evaluate the effect of activated charcoal on N-acetylcysteine absorption. Ten healthy male volunteers were each given in the first, or control, phase of the study an oral dose of 140 mg/kg NAC, and venous blood samples were obtained. In the second phase, after a washout period, each subject received 60 g activated charcoal orally followed immediately by 140 mg/kg NAC. NAC serum levels were measured using gas-liquid chromatography, and levels were compared with and without the concomitant administration of charcoal. Although only a small number of the subjects completed the study, the results showed that in both phases there were no significant differences in the peak NAC levels, the plasma half-life of NAC, or the calculated area under the curve. We recommend that NAC and activated charcoal not be used clinically until further studies are completed.     

Gender differences in substance use treatment and substance use among adults on probation

Background: Although many formal and informal substance use treatment programs were originally designed for men, no studies have investigated how gender affects the use of substance use treatment modalities, and how gender differences in treatment utilization impact substance use in the unique probation context. Objective: To describe gender differences in use and effectiveness of substance use treatment modalities (formal and informal) among probationers. Methods: Longitudinal data were obtained from 335 individuals (93 women) who participated in the Motivational Assessment Program to Initiate Treatment (MAPIT) study. Timeline follow-back measures were used to quantify daily substance use and treatment modality (formal treatment included inpatient and outpatient treatment; informal treatment included self-help, religious, and all other group meetings). Multivariate generalized estimating equations were used to examine relationships between gender, treatment, and substance use. Results: Gender was not associated with alcohol use. Use of formal treatment programs reduced the odds of alcohol use by 15%. The probability of alcohol use was the lowest (8%) for men who participated in formal treatment. For men using informal treatment programs, the probability of alcohol use was 11%. The probability of alcohol use for women was similar regardless of the type of treatment utilization (15–16%). No differences in illicit drug use by gender or type of treatment were detected. Conclusion: This research found limited evidence of a relationship between gender, substance use treatment modality, and alcohol use. These findings have clinical significance in that both formal and informal treatment approaches are similarly effective across both men and women.     

A longitudinal assessment of change in marijuana use with other substance use problems

Background: Despite increasing marijuana use rates over the past decade, the longitudinal association between marijuana use and other substance use problems among adults is unclear. Objectives: To examine associations of self-reported changes in marijuana use and marijuana use frequency with self-reported other substance use problems over a 12-month period. Methods: Two waves (W1 and W2) of the Population Assessment of Tobacco and Health Study provided data. The study sample (N = 26,204, female = 13,261; male = 12,943, aged 18+) included W1-W2 never marijuana users, W1-W2 ex-users (used prior to 12 months of W1), and those who either quit, initiated, resumed, or continued marijuana use between W1 and W2. We used multinomial and binary logistic regression analyses. Results: The past-year marijuana use rate was 12.4% at W2. A quarter of W1 users quit using marijuana in the 12 months preceding their W2 interview, and one-third of all the W2 users were new/resumed users since W1. Compared to W1-W2 ex-users, W2 quitters were more likely to report alcohol use problems and tobacco addiction at W2. Compared to quitters, continued users were more likely to report alcohol use problems (RRR = 1.62, 95% CI = 1.27–2.07) and tobacco addiction (RRR = 1.37, 95% CI = 1.11–1.69). New users (RRR = 2.05, 95% CI = 1.12–3.74), resumed users (RRR = 2.69, 95% CI = 1.55–4.70), and continued users (RRR = 3.40, 95% CI = 2.08–5.55) reported more drug use problems. Compared to less frequent marijuana users, frequent users had greater odds of reporting alcohol use problems (RRR = 1.44, 95% CI = 1.21–1.72) and drug use problems (OR = 1.63, 95% CI = 1.19–2.23). Conclusions: Given increased prevalence of marijuana use, polysubstance use problems among marijuana users should be assessed.     

Syringe exchange, injecting and intranasal drug use

Objective   To assess trends in injecting and non-injecting drug use after implementation of large-scale syringe exchange in New York City. The belief that implementation of syringe exchange will lead to increased drug injecting has been a persistent argument against syringe exchange.
Methods   Administrative data on route of administration for primary drug of abuse among patients entering the Beth Israel methadone maintenance program from 1995 to 2007. Approximately 2000 patients enter the program each year.
Results   During and after the period of large-scale implementation of syringe exchange, the numbers of methadone program entrants reporting injecting drug use decreased while the numbers of entrants reporting intranasal drug use increased ( P  < 0.001).
Conclusion   While assessing the possible effects of syringe exchange on trends in injecting drug use is inherently difficult, these may be the strongest data collected to date showing a lack of increase in drug injecting following implementation of syringe exchange.     

Patterns of simultaneous and concurrent alcohol and marijuana use among adolescents

Background: Alcohol and marijuana are the most commonly used substances among adolescents but little is known about patterns of co-use. Objectives: This study examined patterns of concurrent (not overlapping) and simultaneous (overlapping) use of alcohol and marijuana among adolescents. Methods: Data from US-national samples of 12th graders (N = 84,805, 48.4% female) who participated in the Monitoring the Future study from 1976 to 2016 and who used alcohol and/or marijuana in the past 12 months were used to identify latent classes of alcohol use, marijuana use, and simultaneous alcohol and marijuana (SAM) use. Results: A four-class solution indicated four patterns of use among adolescents: (1) Simultaneous alcohol and marijuana (SAM) use with binge drinking and recent marijuana use (SAM-Heavier Use; 11.2%); (2) SAM use without binge drinking and with recent marijuana use (SAM-Lighter Use; 21.6%); (3) Marijuana use and alcohol use but no SAM use (Concurrent Use; 10.7%); and (4) Alcohol use but no marijuana or SAM use (Alcohol-Only Use; 56.4%). Membership in either SAM use class was associated with a higher likelihood of truancy, evenings out, and use of illicit drugs other than marijuana. SAM-Heavier Use, compared to SAM-Lighter Use, class members were more likely to report these behaviors and be male, and less likely to have college plans. Conclusions: Among 12th graders who use both alcohol and marijuana, the majority use simultaneously, although not all use heavily. Given the recognized increased public health risks associated with simultaneous use, adolescent prevention programming should include focus on particular risks of simultaneous use.     

Alcohol use disorders in Australia

Alcohol use disorders are common in Australia and are often unrecognised. Alcohol places a significant burden on our healthcare system by increasing the risk of injuries as well as many chronic medical conditions. Diagnosis requires a high index of suspicion and can be aided by the use of specific questionnaires, such as the Alcohol Use Disorder Identification Test‐C. The current available laboratory tests are of limited sensitivity and specificity, but can nevertheless aid in the diagnosis in some circumstances. Newer tests, such as ethyl‐glucuronide and phosphatidylethanol, are more sensitive and specific but are costly and not widely available. The effective management of alcohol use disorder entails psychosocial or pharmacological treatments or a combination of both. In those who cannot reduce alcohol consumption, harm reduction strategies can be applied to reduce the burden of harm to the drinkers as well as the community at large.     

The longitudinal association between multiple substance use discrepancies and marital satisfaction

Aims   The objective of this work was to examine the relation between patterns of substance use among newly married couples and marital satisfaction over time. In particular, this work examined if differences between husbands' and wives' heavy alcohol use and cigarette smoking, rather than simply use per se , predicted decreases in marital satisfaction over the first 7 years of marriage.
Methods   Married couples ( n  = 634 couples) were assessed on a variety of substance use and relationship variables at the time of marriage and again at the first, second, fourth and seventh years of marriage.
Results   After controlling for key socio-demographic variables, discrepancies in husband and wife cigarette smoking and heavy alcohol use were related to significant reductions in marital satisfaction. Importantly, couples who were discrepant on both substances experienced the greatest declines in marital satisfaction over time.
Conclusions   Patterns of substance use among newly married couples are important predictors of changes in marital functioning over time. It was not simply the heavy alcohol use or cigarette smoking that predicted dissatisfaction but, rather, differences between husbands' and wives' substance use that impacted the relationship.     

The use of record linkage to examine illicit drug use in pregnancy

AIMS: To examine the obstetric and perinatal outcomes for women with a drug-related hospital admission during pregnancy. DESIGN: Antenatal and birth admissions to New South Wales (NSW) hospitals from the NSW Inpatient Statistics Collection were linked to birth information from the NSW Midwives Data Collection over a 5-year period (1998-2002). MEASUREMENTS: Birth admissions were flagged as positive for drug use where a birth admission or any pregnancy admission for that birth involved an opioid, cannabis or stimulant-related International Classification of Diseases version 10 Australian modification (ICD-10AM) code. FINDINGS: A total of 416 834 live births were analysed over a 5-year period (1998-2002). Of these, 1974 pregnancies had an opioid ICD-10AM diagnosis recorded, 552 a stimulant-related ICD-10AM and 2172 a cannabis ICD-10AM diagnosis. Births in each of the drug groups were to women who were younger, had a higher number of previous pregnancies, were indigenous, smoked heavily and were not privately insured. These women also presented later in their pregnancy to antenatal services and were more likely to arrive at hospital unbooked. Neonates born to women in each of the drug groups were more likely to be premature and were admitted to neonatal intensive care and special care nursery more often, with neonates born to women in the opioid group admitted most often. CONCLUSIONS: Linked population level administrative data is a powerful method for examining the maternal and neonatal outcomes associated with the use of specific illicit drugs during pregnancy.