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Biomedical subjects

Gary Hulse

Publications and source records attributed to Gary Hulse.

14 recordsLinked to original sources
PubMed2007

Hepatitis C virus eradication in intravenous drug users maintained with subcutaneous naltrexone implants.

UNLABELLED: The effectiveness of HCV antiviral therapy in patients who have undergone recent drug dependency treatment and continue to inject drugs sporadically is presently not clear. Patients attending a community-based drug rehabilitation and naltrexone implant clinic from October 2002 until March 2005 were screened for HCV infection and if positive offered further assessment and treatment with interferon and ribavirin therapy. The first 50 patients to commence HCV therapy and complete at least 6 months follow-up were prospectively studied. ETR response (HCV PCR negative) was 34/50 (68%) and SVR 6 months post-treatment was 31/50 (62%). Viral eradication was maintained in those 22 patients that have had 12 months or more post-treatment follow-up. Eleven (22%) patients stopped therapy early due to side effects or poor compliance. Only two patients with an ETR likely reinfected due to unsafe injection practices. One was re-treated and achieved an SVR. Of the patients achieving a 6-month SVR, 17 of 31 patients reported no further IDU and 13 of 31 patients occasional IDU during treatment and this was maintained after HCV treatment cessation. 46% of patients received antidepressant and/or antipsychotic medication during treatment. CONCLUSION: This study of HCV treatment in a community-based subcutaneous naltrexone implant clinic found antiviral therapy resulted in a 62% SVR. This result is comparable to that reported in hospital-based clinics in non-IDU patients. The side effect profile and compliance was also similar. HCV antiviral therapy should be offered to this large and currently under treated group.

Adolescent↗
PubMed2006

Eating disorder attitudes and psychopathology in Caucasian Australian, Asian Australian and Thai university students.

OBJECTIVE: To examine eating disorder attitudes and psychopathology among female university students in Australia and Thailand. METHOD: Participants were 110 Caucasian Australians, 130 Asian Australians and 101 Thais in Thailand. The instruments included the Eating Attitudes Test (EAT) and the Eating Disorders Inventory (EDI). RESULTS: Eating disorder attitudes and psychopathology scores in the Thai group were found to be highest. The Asian Australian group did not have significantly higher scores on the EAT-26 than the Caucasian Australian group, but had higher scores in some subscales of the EDI-2. That the Thai group had the highest scores in susceptibility to developing an eating disorder and eating disorder psychopathology may be partially explained in sociocultural terms, with pressure to be thin more extreme in Thailand than in Australia. The evidence suggested that unhealthy eating disorder psychopathology is not limited to Western societies but is already present in Thai and other Asian societies.

Adolescent↗
PubMed2005

Acculturation and eating disorders in Asian and Caucasian Australian university students.

This study aimed to compare the attitudes and psychopathology of eating disorders of Asian and Caucasian university students using a survey method. The study also investigated the relationship between acculturation, attitudes and psychopathology of eating disorders in sub-groups of Asian girls. There were 130 Asian and 110 Caucasian adolescent girls, aged 18-24 who were screened using the Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI-2) and an Acculturation Index. The Asian group did not have higher mean EAT score than the Caucasian group, but had higher mean score in some sub-scales of the EDI-2. Eating disordered attitudes and psychopathology was not significantly different in the low compared to the high accultured Asian girls. This study suggests that Asian and Caucasian university students in Western Australia are equally susceptible to eating disorders, and that the level of acculturation does not modify the susceptibility of Asian students for eating disorders.

Acculturation↗
PubMed2005

Acculturation and eating disorders in Asian and Caucasian Australian adolescent girls.

The present study aimed to compare the attitudes and psychopathology of eating disorders between Asian and Caucasian adolescent girls; and investigate the relationship between acculturation and the attitudes and psychopathology of eating disorders in subgroups of Asian girls. Two groups of non-clinical adolescent girls in Perth, Western Australia, were compared using a survey method. There were 17 Asian and 25 Caucasian adolescent girls, aged 14-17 drawn from private high schools in Perth who were screened using the Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI-2), and an acculturation index. The psychopathology scores for eating disorders of the Asian group were significantly higher than that of the Caucasian group in terms of total EDI-2 score, Interpersonal Distrust, Maturity Fears, Impulse Regulation and Social Insecurity subscales. Eating attitudes measured by Dieting subscale of the EAT-26 was significantly different. Within the Asian group, the less acculturated girls had higher scores on the EAT-26 and the EDI-2 than the more acculturated. Less acculturated Asian girls appeared to have unhealthier attitudes and psychopathology toward eating.

Acculturation↗
PubMed2004

Obstetric and perinatal outcomes in pregnancies associated with illicit substance abuse.

OBJECTIVE: To determine the obstetric and perinatal outcomes of women using illicit drugs during pregnancy by substance group. METHOD: A retrospective audit of obstetric and perinatal outcomes in women who used opiates or amphetamines during their pregnancy and delivered at King Edward Memorial Hospital (KEMH), Perth, Australia between December 1997 and April 2000 was performed. Maternal, fetal and neonatal parameters were assessed. These were compared with obstetric and perinatal data recorded by the Health Department of Western Australia (HDWA) for the 25,291 deliveries of 25,677 infants in 1998. RESULTS: Between December 1997 and April 2000 91 opiate-using and 50 amphetamine-using women were identified and included in the analysis. Both groups of drug-using women were younger (opiates P = 0.001, amphetamines P = 0.001) than the general population. There was a higher incidence of aboriginality (P = 0.001) in the amphetamine group. In the opiate-using group multiparity (P = 0.0001) and anaemia (P = 0.0001) were higher. Illicit drug-using women had a higher incidence of hepatitis C (opiates P = 0.001, amphetamines P = 0.003), and a greater need for pharmacological analgesia for labour and delivery (opiates P = 0.007, amphetamines P = 0.042). Their infants were significantly more likely to deliver at less than 37 weeks' gestation (opiates P = 0.0001, amphetamines P = 0.001), to have a birthweight of less than 2.5 kg (P = 0.0001), be small for gestational age and require admission to the special care nursery (P = 0.0001). Infants born to women in the amphetamine group were more likely to have an Apgar score < 7 (P = 0.0001) recorded. Infants of women in the opiate group required more resuscitation (P = 0.05). CONCLUSION: Women who use illicit drugs are more likely to experience adverse obstetric and perinatal outcomes than women in the general population. Differences are seen depending on the type of illicit drug used. These findings need to be replicated in a larger prospective cohort to highlight management requirements of these women and their infants. Further information is required about the effects of amphetamines in pregnancy.

Adult↗
PubMed2004

Cannabis and psychosis.

BACKGROUND: Cannabis use is commonly identified in people who present with psychosis. OBJECTIVE: This case study aims to provide a practical approach for general practitioners seeing patients with comorbid cannabis and mental health concerns. DISCUSSION: Cannabis related comorbidity is commonly seen in general practice. General practitioners can manage most presentations and help to reduce the likely occurrence of cannabis induced psychosis through the use of psychosocial support, brief interventions and harm minimisation.

Adult↗
PubMed2004

Back pain and opioid seeking behaviour.

BACKGROUND: Back pain is a common presentation associated with opioid seeking behaviour. OBJECTIVE: This case study provides general practitioners with a practical approach to seeing patients with chronic pain whom they suspect of opioid dependence and describes a framework for managing chronic pain and dependence within the general practice setting. DISCUSSION: Back pain, with or without opioid dependence, is commonly encountered in general practice. General practitioners frequently find themselves caught between the desire to treat and relieve symptoms, and not wanting to cause or exacerbate dependence. Clear guidelines and access to support are often lacking.

Adult↗
PubMed2004

Injecting drug use and skin lesions.

BACKGROUND: Many illicit drugs can be injected, with this mode of administration associated with a range of skin morbidities. OBJECTIVE: This article illustrates a dermatological presentation associated with injecting drug use. DISCUSSION: Track marks, injection site marks and skin abscesses are well known to be associated with injecting drug use. However, there are other dermatological manifestations that are less commonly known. Signs may be more subtle, particularly when drug use is recreational and patients do not fit commonly held stereotypes of injecting drug users.

Adult↗
PubMed2004

When the child with ADHD grows up.

BACKGROUND: There is significant controversy surrounding attention deficit hyperactivity disorder (ADHD). While the existence of this disorder is generally accepted, debate continues in relation to aspects of assessment, as well as the effectiveness and choice of treatment options and their continuation into adult life. Management is further complicated as people with ADHD often have chaotic lives which impedes medication compliance and motivation to continue treatment vacillates. Concern also exists over the misuse of amphetamine-like medications by some patients. OBJECTIVE: This case study does not provide comprehensive information on current diagnosis and ADHD treatment guidelines, but explores the issues and management role of general practitioners treating patients with ADHD. DISCUSSION: The diagnosis of ADHD is common, and many patients are managed using a range of social and behavioural interventions that are commonly combined with pharmacotherapies (provided in the main by psychiatrists and paediatricians). However, while specialists may appropriately choose not to treat where a diagnosis is unclear, or discontinue treatment for reasons such as doubtful response to treatment, possible medication misuse, concurrent illicit drug use or poor motivation, GPs frequently continue to manage ongoing care and the impact of ADHD on the rest of the family. When the specialist formulation suggests there is little to gain from further treatment, the GP is likely to be the sole health professional remaining engaged in support and ongoing management.

Adolescent↗
PubMed2004

Management of the impaired doctor.

BACKGROUND: The lifetime prevalence of substance abuse disorders among doctors in Australia has been estimated to be approximately 8%. These disorders can interfere with a doctor's ability to function and pose a risk to patient welfare and safety.' OBJECTIVE: This article identifies key indicators to the development of problem alcohol and drug use in a general practitioner, associated possible psychiatric morbidity, work deficits, and the need for colleagues to recognise and respond in a timely manner to resolve these events. DISCUSSION: Where intervention, treatment and monitoring are initiated early in problem drug use, outcomes for the GP are typically positive. Outcomes are better where there is adequate support by friends and colleagues, and where there is a clearly defined management strategy.

Alcoholism↗
PubMed2004

Alcohol and other drug use in later life.

BACKGROUND: Problem alcohol and other drug use is rarely suspected in the elderly. However, the elderly are more susceptible to problems related to drug use at lower doses because of age related changes, comorbidities and polypharmacy. Like other age groups, the elderly sometime seek the use of alcohol and other drugs, to help them feel better or to avoid negative feelings such as loneliness and depression. Drug use in the elderly is associated with significant morbidity anid can be masked by other medical problems. OBJECTIVE: This article demonstrates a gradual onset alcohol problem in a longstanding elderly patient, in whom changes in drug or alcohol use may not be easily detected. It also highlights some key differences in drug related presentations in the elderly. DISCUSSION: Some health professionals consider intervention for problem alcohol or other drug use in the elderly ineffective. However, because of the high prevalence of polypharmacy and comorbid pathology, intervention is more likely to result in a significant health improvement. General practitioners have a high level of contact with and are trusted by the elderly, giving them an unparalleled opportunity among health professionals to intervene in problem alcohol and other drug use.

Aged↗
PubMed2004

Benzodiazepine dependence.

BACKGROUND: Benzodiazepine dependency can occur as a result of treatment for anxiety disorders or sleep disturbance. While benzodiazepine withdrawal can be challenging, cessation of use can be even more difficult if there are other comorbidities such as oestrogen deficiency with vasomotor symptoms and anxiety disorders. OBJECTIVE: This article provides practical information for general practitioners in the management of patients with benzodiazepine dependence. DISCUSSION: Some patients may have common medical presentations and coexisting drug dependence. It is often difficult to separate these two issues. In the case of benzodiazepine dependence, gradual withdrawal over time and nonpharmacological treatment of the symptoms of withdrawal such as anxiety or insomnia is effective. Better outcomes are achieved where the GP discusses and plans strategies well in advance with the patient. Treatment often involves multiple interventions from various health professionals. General practitioners are ideally placed to coordinate such treatment.

Anti-Anxiety Agents↗
PubMed2002

The identification and management of the drug impaired doctor.

BACKGROUND: Problem drug use occurs within the medical fraternity as it does in other parts of the population. However, doctors have traditionally been discouraged from admitting vulnerability and frequently fail to recognise or respond to early signs of problem alcohol and drug use. OBJECTIVE: This article aims to identify sequential strategies to assist the doctor to detect and intervene early when problem drug use arises in themselves or a colleague. DISCUSSION: Where treatment and monitoring is instituted early in problem drug use, outcomes are typically positive while late acknowledgment commonly results in sanctions for the impaired practitioner and greater risk to patients. Medical boards in Australia have developed supportive mechanisms for doctors to facilitate early management. Procedures are aimed at maintaining or restoring ability to work while maintaining public confidence.

Australia↗