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Biomedical subjects

W Hall

Publications and source records attributed to W Hall.

At least 37 records · Page 2Linked to original sources
PubMed2001

The relationship between tobacco use, substance-use disorders and mental health: results from the National Survey of Mental Health and Well-being.

AIMS: To examine comorbidity between tobacco use, substance-use disorders and mental health problems among Australian adults aged 18 years and over. METHOD: Data from the 1997 Australian National Survey of Mental Health and Well-being were analyzed. This survey was a stratified, multistage probability sample of 10,641 adults, representative of the Australian population. Univariate associations between tobacco use, substance use and mental health were examined, and then multivariate analyses were conducted to control for demographic characteristics, neuroticism, and other drug use. MEASUREMENTS: Tobacco use status was defined as: never smoker, former smoker and current smoker. DSM-IV diagnoses of substance use, anxiety, and affective disorders were derived using the Composite International Diagnostic Interview (CIDI). Other measures included a screener for psychosis and measures of psychological distress and disability. FINDINGS: Current tobacco use was strongly associated with abuse/dependence upon alcohol, cannabis, and other substances, and with higher rates of anxiety and affective disorders. Current smokers were more likely to screen positively for psychosis and reported greater psychological distress and disability than non-smokers and never smokers. These higher rates of other problems were not explained by differences in demographic characteristics, neuroticism scores, or by other drug use. Former smokers did not have higher rates of affective or anxiety disorders; however, they had higher rates of alcohol-use disorders, and of cannabis-use disorders after adjusting for covariates. CONCLUSIONS: Current tobacco use is associated with a range of other substance-use and mental health problems. These are likely to reduce the success of attempts to quit smoking. The presence of these other problems needs to be considered when considering smoking-cessation treatment, and further research may provide information on more effective treatment strategies for persons with co-existing substance-use and mental health problems.

Adolescent↗
PubMed2001

Challenges and approaches to estimating mortality attributable to the use of selected illicit drugs.

A number of unique challenges are faced when attempting to estimate mortality attributable to illicit drugs. The hidden nature of illicit drug use creates difficulties in quantifying the prevalence of such use; identifying adverse health effects associated with exposure, and calculating the risk of these effects. The use of cohort studies of drug users allows the identification of causes of mortality associated with drug use and the determination of the risk of these causes. This risk estimate can then be used in conjunction with estimates of the prevalence of drug use to extrapolate the burden of mortality. We identify a number of such studies and present some solutions to the major challenges faced when attempting to estimate the global burden of mortality attributable to illicit drug use.

Cohort Studies↗
PubMed2001

Prevalence, comorbidity, disability and service utilisation. Overview of the Australian National Mental Health Survey.

BACKGROUND: Health planning should be based on data about prevalence, disability and services used. AIMS: To determine the prevalence of ICD-10 disorders and associated comorbidity, disability and service utilisation. METHOD: We surveyed a national probability sample of Australian households using the Composite International Diagnostic Interview and other measures. RESULTS: The sample size was 10 641 adults, response rate 78%. Close to 23% reported at least one disorder in the past 12 months and 14% a current disorder. Comorbidity was associated with disability and service use. Only 35% of people with a mental disorder in the 12 months prior to the survey had consulted for a mental problem during that year, and most had seen a general practitioner. Only half of those who were disabled or had multiple comorbidity had consulted and of those who had not, more than half said they did not need treatment. CONCLUSIONS: The high rate of not consulting among those with disability and comorbidity is an important public health problem. As Australia has a universal health insurance scheme, the barriers to effective care must be patient knowledge and physician competence.

Adolescent↗
PubMed2001

Ambulance calls to suspected overdoses: New South Wales patterns July 1997 to June 1999.

AIM: Using data on New South Wales ambulance calls to suspected overdoses from July 1997 to June 1999 to: a) examine temporal and geographic trends in calls; and b) compare geographic patterns of fatal and non-fatal opioid overdose. METHOD: The NSW Ambulance Service provided data on the occasions when an ambulance attended a person on whom the drug overdose/poisonings protocol was used, and to whom naloxone was administered. The geographic distribution of ambulance attendances was approximated to the Australian Bureau of Statistics Statistical Local Area (SLA) and Statistical Subdivision (SSD). Estimates of social disadvantage were correlated with the rate of ambulance attendances for each region. RESULTS: 9,116 callouts were made. In cases with data on age and gender, 89% were aged 15-44 years, and 31% were female. South Sydney (n=1,819) and Liverpool (n=1,602) SLAs accounted for 37% of calls; the higher rates outside Sydney were in Newcastle, Orange and Kiama. There was a strong correlation between rates of ambulance callouts and fatal heroin overdoses. The number of calls increased from an average of 361 calls per month in 1997-98 to 399 in 1998-99. The majority of calls (54%) were made between midday and 9 pm. CONCLUSIONS: Rates of ambulance attendance at suspected overdoses is a promising indicator that allows monitoring of trends and identification of areas with high rates of opioid use.

Adolescent↗
PubMed2000

One year follow-up of cannabis dependence among long-term users in Sydney, Australia.

Eighty one percent of a sample of long-term cannabis users was followed up at 1 year (162/200). Half (51%) were daily smokers, while 20% had substantially decreased or ceased use. More than half received a dependence diagnosis on each of three measures in the last year, with 44% dependent on all three. Remission was much more common than incidence of dependence. Nevertheless, use and dependence patterns were strongly related over time. Longitudinal analyses revealed that quantity of use and severity of dependence at baseline were the primary predictors of those same variables at follow-up. These data suggest that cannabis use and dependence are fairly stable among long-term users.

Adolescent↗
PubMed2000

Trends in opiate-related deaths in the United Kingdom and Australia, 1985-1995.

This paper compares data on rates of opiate overdose mortality in the UK and Australia between 1985 and 1995. Data on rates of ICD 9-coded overdose mortality were obtained from the Office of National Statistics in the UK and from the Australian Bureau of Statistics mortality register. The proportion of all deaths attributed to opioid overdose increased in both countries between 1985 and 1995. The proportion of all deaths attributed to opioid overdose was substantially higher in Australia than in the UK, but methadone appeared to contribute to more opioid overdose deaths in the UK (50%) than in Australia (18%). Given deficiencies in the available data, the reasons for these differences between the two countries are uncertain but a plausible hypothesis is that the greater availability and ease of access to methadone maintenance in the UK contributes to both the lower rate of opioid overdose mortality and the greater apparent contribution that methadone makes to opioid overdose deaths in that country.

Adolescent↗
PubMed2000

Fluid phase endocytosis in oral epithelia: variation with site and effect of cancer.

The structure of the oral mucosa has been extensively studied but its cell physiology has been less well characterised. This study aimed to show the range in variation in fluid phase endocytic capability in biopsies from different oral sites. Oral epithelial cells were obtained from both biopsies and single-cell suspensions obtained by brushing the oral cavity. Biopsies in organ culture and single cells in suspension were incubated with fluorescent microspheres of 0.02, 0.1 or 1.0 microm diameter. Endocytosis of fluorescent microspheres was quantitated by flow cytometry and visualised by confocal microscopy. Epithelial cells from all oral sites that were sampled internalised 0.02 microm and 0.1 microm but not 1.0 microm microspheres, with no significant differences observed between oral regions. Single cells from non-cancer patients endocytosed significantly more 0.02 microm microspheres than cells removed from patients with oral cancer. This model may be used to study integrated oral cell function both in health and disease.

Biopsy↗
PubMed2000

The effects of adolescent cannabis use on educational attainment: a review.

This paper reviews research examining the link between cannabis use and educational attainment among youth. Cross-sectional studies have revealed significant associations between cannabis use and a range of measures of educational performance including lower grade point average, less satisfaction with school, negative attitudes to school, increased rates of school absenteeism and poor school performance. However, results of cross-sectional studies cannot be used to determine whether cannabis use causes poor educational performance, poor educational performance is a cause of cannabis use or whether both outcomes are a reflection of common risk factors. Nonetheless, a number of prospective longitudinal studies have indicated that early cannabis use may significantly increase risks of subsequent poor school performance and, in particular, early school leaving. This association has remained after control for a wide range of prospectively assessed covariates. Possible mechanisms underlying an association between early cannabis use and educational attainment include the possibility that cannabis use induces an 'amotivational syndrome' or that cannabis use causes cognitive impairment. However, there appears to be relatively little empirical support for these hypotheses. It is proposed that the link between early cannabis use and educational attainment arises because of the social context within which cannabis is used. In particular, early cannabis use appears to be associated with the adoption of an anti-conventional lifestyle characterized by affiliations with delinquent and substance using peers, and the precocious adoption of adult roles including early school leaving, leaving the parental home and early parenthood.

Adolescent↗
PubMed2000

Cannabis use and psychosis: a review of clinical and epidemiological evidence.

OBJECTIVE: This paper evaluates evidence for two hypotheses about the relationship between cannabis use and psychosis: (i) that heavy cannabis use causes a 'cannabis psychosis', i.e. a psychotic disorder that would not have occurred in the absence of cannabis use and which can be recognised by its pattern of symptoms and their relationship to cannabis use; and (ii) that cannabis use may precipitate schizophrenia, or exacerbate its symptoms. METHOD: Literature relevant to drug use and schizophrenia is reviewed. RESULTS: There is limited clinical evidence for the first hypothesis. If 'cannabis psychoses' exist, they seem to be rare, because they require very high doses of tetrahydrocannabinol, the prolonged use of highly potent forms of cannabis, or a preexisting (but as yet unspecified) vulnerability, or both. There is more support for the second hypothesis in that a large prospective study has shown a linear relationship between the frequency with which cannabis had been used by age 18 and the risk over the subsequent 15 years of receiving a diagnosis of schizophrenia. CONCLUSIONS: It is still unclear whether this means that cannabis use precipitates schizophrenia, whether cannabis use is a form of 'self-medication', or whether the association is due to the use of other drugs, such as amphetamines, which heavy cannabis users are more likely to use. There is better clinical and epidemiological evidence that cannabis use can exacerbate the symptoms of schizophrenia.

Adolescent↗
PubMed2000

Australia's mental health: an overview of the general population survey.

OBJECTIVES: The objectives of this study were to estimate the 1-month and 1-year prevalence of mental disorders in the Australian adult population; to determine the amount of disablement associated with this; and to determine the use of health and other services by persons with common mental disorders. METHOD: For the Adult Survey, a household sample of 10600 persons aged 18 years and over were interviewed across Australia by experienced field staff of the Australian Bureau of Statistics. This was 78% of the target sample. The interview consisted of the composite international diagnostic interview in its automated presentation (CIDI-A) and other components to determine disablement, use of services and satisfaction with services received. The diagnostic classifications used in the analyses were both ICD-10 and DSM-IV. Only the results from ICD-10 are reported here. RESULTS: A total of 17.7% of the sample had one or more common mental disorders, anxiety, depression, alcohol or substance abuse and neurasthenia. This morbidity was associated with considerable disablement in daily life: 3 days of impaired social role performance in the previous 4 weeks, compared with 1 day for the general population. Of all cases, 64.6% had had no contact with health services in the previous year; 29.4% had seen GPs and 7.5% had seen psychiatrists. CONCLUSION: Australia now has its own national estimates of psychiatric morbidity. The morbidity is associated with considerable disablement, but most of it is untreated. General practitioners encounter by far the largest proportion of those reaching services.

Adolescent↗