Perceptions of the influence of prescription medicine samples on prescribing by family physicians

Background: The provision of free prescription medicine samples is a common and traditional marketing strategy used by pharmaceutical companies, but concerns have been raised about their influence on physician prescribing behavior and patient safety. Objective: We sought to investigate the knowledge, attitudes, and behaviors of Australian family physicians regarding the use of sample prescription medications. Methods: Qualitative and quantitative techniques were used, including (1) mailed questionnaires to family physicians, (2) semistructured interviews with family physicians, and (3) sample cupboard inventories. Results: A number of issues about samples were identified by the questionnaires (208) and interviews (17 doctors), including insufficient labeling, poor record keeping, diversion of stock (personal use by doctors.. their families, practice staff and pharmaceutical representatives), and wasting of expired stock. Prescription medicine samples also influenced prescribing behavior. Australian doctors were less likely to provide samples to patients on financial grounds compared with a previous study in the United States on medical residents. Six sample cupboards were inventoried. Median wholesale value of sample cupboards was AUD $4959 (range $2395-$8709), with 6% of stock expired. Very little generic medicine was included in the sample cupboards. Conclusions: Better methods are needed to meet legislative requirements and to ensure quality use of medicines (and optimal public health) with respect to prescription medicine samples. Doctors and practice staff require training on the appropriate handling and storage of prescription medications. Alternative ways for distribution of sample medications need to be investigated.

Trends in morphine prescriptions, illicit morphine use and associated harms among regular injecting drug users in Australia

This paper examines population trends in morphine prescriptions in Australia, and contrasts them with findings from annual surveys with regular injecting drug users (IDU). Data on morphine prescriptions from 1995 to 2003 were obtained from the Drug Monitoring System (DRUMS) run by the Australian Government Department of Health and Ageing. Data collected from regular IDU as part of the Australian Illicit Drug Reporting System (IDRS) were analysed (2001-2004). The rate of morphine prescription per person aged 15-54 years increased by 89% across Australia between 1995 and 2003 (from 46.3 to 85.9 mg per person). Almost half (46%) of IDU surveyed in 2004 reported illicit morphine use, with the highest rates in jurisdictions where heroin was less available. Recent morphine injectors were significantly more likely to be male, unemployed, out of treatment and homeless in comparison to IDU who had not injected morphine. They were also more likely to have injected other pharmaceutical drugs and to report injection related problems. Among those who had injected morphine recently, the most commonly reported injecting harms were morphine dependence (38%), difficulty finding veins into which to inject (36%) and scarring or bruising (27%). Morphine use and injection is a common practice among regular IDU in Australia. In some cases, morphine may be a substitute for illicit heroin; in others, it may be being used to treat heroin dependence where other pharmacotherapies, such as methadone and buprenorphine, are perceived as being unavailable or undesirable by IDU. Morphine injection appears to be associated with polydrug use, and with it, a range of problems related to drug injection. Further research is required to monitor and reduce morphine diversion and related harms by such polydrug injectors.

Brisbane Airport: An alluvial landscape veiled by marine sediments

At Brisbane Airport, the construction of a diversion channel for Kedron Brook exposed a former beach, low cliff and sand spit, which, with their associated sediments and acid sulfate soils, demonstrate a postglacial high sea-level 1.3 - 1.4 m above present mean sea-level. The beach appears to date from 4000 to 5000 y BP. It varies in level where it lies above soft ground; these variations, and sag depressions that follow buried streamlines, indicate sediment consolidation since withdrawal of the sea from the former shore. Most of the area consists of former estuarine deposits, mangrove and saline marshes, and stranded tidal flats on which acid sulfate soils are widely developed. The modern landforms mostly reproduce subsurface features, to the extent that the surface relief replicates the landscape transgressed by the sea 7000 years ago. A small rise of sea-level possibly to +0.65 m occurred about 2000-3000 years ago. Foredunes near the present shore that are related to a slightly lower level 1000 - 500 years ago (-0.25 m) are currently subject to wave erosion.

The psychometric properties of a psychosis screen in a correctional setting

Many people who go to gaol are mentally ill. Remandees, prisoner receptions or people in jails have a substantially higher rate of severe mental disorder than other prisoners and the general population. There are no completely satisfactory ways to screen for psychosis and few existing screening questionnaires are available for use in correctional establishments. The Screening Instrument for Psychosis (PS) was developed in the context of the Australian Mental Health Survey: Study of Low Prevalence Disorders. It can help indicate whether a person should be referred to mental health professional for a diagnostic evaluation and possible treatment and/or diversion. We trialled the PS in a high security remand and reception centre. Measures of validity and reliability are reported. (c) 2006 Published by Elsevier Inc.

All the rivers run red

Diversion of the McArthur River for the zinc-lead mine and Aboriginal land.

Studio Integrato Geomorfologico-Geofisico dell'Area Epicentrale del Terremoto del 20 Maggio 2012 (Mw 5.9) in Emilia-Romagna

La Sequenza Sismica Emiliana del 2012 ha colpito la zona compresa tra Mirandola e Ferrara con notevoli manifestazioni cosismiche e post-sismiche secondarie, soprattutto legate al fenomeno della liquefazione delle sabbie e alla formazione di fratturazioni superficiali del terreno. A fronte del fatto che la deformazione principale, osservata tramite tecniche di remote-sensing, ha permesso di individuare la posizione della struttura generatrice, ci si è interrogati sul rapporto tra strutture profonde e manifestazioni secondarie superficiali. In questa tesi è stato svolto un lavoro di integrazione di dati a varia scala, dalla superficie al sottosuolo, fino profondità di alcuni chilometri, per analizzare il legame tra le strutture geologiche che hanno generato il sisma e gli effetti superficiali percepiti dagli osservatori. Questo, non solo in riferimento allo specifico del sisma emiliano del 2012, ma al fine di trarre utili informazioni in una prospettiva storica e geologica sugli effetti di un terremoto “tipico”, in una regione dove le strutture generatrici non affiorano in superficie. Gli elementi analizzati comprendono nuove acquisizioni e rielaborazioni di dati pregressi, e includono cartografie geomorfologiche, telerilevamenti, profili sismici a riflessione superficiale e profonda, stratigrafie e informazioni sulla caratterizzazione dell’area rispetto al rischio sismico. Parte dei dati di nuova acquisizione è il risultato dello sviluppo e la sperimentazione di metodologie innovative di prospezione sismica in corsi e specchi d’acqua continentali, che sono state utilizzate con successo lungo il Cavo Napoleonico, un canale artificiale che taglia ortogonalmente la zona di massima deformazione del sisma del 20 Maggio. Lo sviluppo della nuova metodologia di indagine geofisica, applicata ad un caso concreto, ha permesso di migliorare le tecniche di imaging del sottosuolo, oltre a segnalare nuove evidenze co-sismiche che rimanevano nascoste sotto le acque del canale, e a fornire elementi utili alla stratigrafia del terreno. Il confronto tra dati geofisici e dati geomorfologici ha permesso di cartografare con maggiore dettaglio i corpi e le forme sedimentarie superficiali legati alla divagazione fluviale dall’VIII sec a.C.. I dati geofisici, superficiali e profondi, hanno evidenziato il legame tra le strutture sismogeniche e le manifestazioni superficiali seguite al sisma emiliano. L’integrazione dei dati disponibili, sia nuovi che da letteratura, ha evidenziato il rapporto tra strutture profonde e sedimentazione, e ha permesso di calcolare i tassi geologici di sollevamento della struttura generatrice del sisma del 20 Maggio. I risultati di questo lavoro hanno implicazioni in vari ambiti, tra i quali la valutazione del rischio sismico e la microzonazione sismica, basata su una caratterizzazione geomorfologico-geologico-geofisica dettagliata dei primi 20 metri al di sotto della superficie topografica. Il sisma emiliano del 2012 ha infatti permesso di riconoscere l’importanza del substrato per lo sviluppo di fenomeni co- e post-sismici secondari, in un territorio fortemente eterogeneo come la Pianura Padana.

RESILIÊNCIA EM IDOSOS QUE MEDITAM

Resiliência é definida como a capacidade das pessoas em enfrentar, vencer e serem fortalecidos ou transformados por experiências adversas. Estudos têm mostrado que pessoas resilientes adoecem menos e possuem melhor desempenho no trabalho, nas relações familiares e na vida, além da resiliência poder ser desenvolvida desde a infância até a velhice. Por sua vez, a meditação tem mostrado ser um recurso útil para a melhoria da saúde em geral, incluindo a qualidade de vida daqueles que a praticam por proporcionar maiores níveis de bem estar, melhoria nos relacionamentos interpessoais e redução de estresse. Parece que a meditação, assim como a resiliência, pode contribuir para melhores níveis de saúde da população. O objetivo deste estudo foi verificar os níveis de resiliência em idosos que meditam. Participaram 60 pessoas, sendo 78% mulheres, com idade média de 69 anos, 82% aposentados, 65% praticantes de meditação, 42% com baixa escolaridade e 60% católicos. O instrumento utilizado foi um questionário auto-aplicável, composto pela Escala de Avaliação de Resiliência (EAR) em sua forma reduzida e um questionário para coletar dados sociodemográficos dos participantes. Análise de variância revelou não haver diferença nos níveis de resiliência entre o grupo que medita uma vez ao dia e aquele que o faz mais do que uma vez ao dia. Médias fatoriais e desvios-padrão revelaram que os participantes possuem capacidade levemente acima da média de adaptarem-se positivamente diante das dificuldades da vida, persistindo para superar crises e adversidades, poucas vezes se resignando, embora algumas vezes não se julguem competentes para enfrentá-las. Para defrontarem as dificuldades da vida, contam com as crenças de que podem confiar no apoio de um ente ou algo superior e acreditam que podem aprender e melhorar com as adversidades.

A review of barriers to kerbside recycling household waste in the UK

The aim of this work is to use systematic review methodology to answer the question “What are the current barriers to kerbside recycling of household waste in the UK?” A systematic search of electronic databases and journals was undertaken to identify academic published work. A critical scoping review of research published between 2000 – 2008 profiles theory and research design. The systematic review identified twelve relevant papers, of which seven contain original data. To define the current barriers the explanations of barriers were systematically aggregated into four main categories: household / individual behaviour; services / local situation; attitudes / motivation; information and knowledge. The purpose of the work is to inform future marketing campaigns which will assist the UK to reach the statutory targets of waste diversion. The synthesis will be useful to environmental professionals working in waste authorities and researchers and students. The framework offers an opportunity to develop better marketing and communications strategies to help more people recycle more things more often and will inform future recycling policy development.

Medicines non-use in primary care

This study expands the current knowledge base on the nature, causes and fate of unused medicines in primary care. Three methodologies were used and participants for each element were sampled from the population of Eastern Birmingham PCT. A detailed assessment was made of medicines returned to pharmacies and GP surgeries for destruction and a postal questionnaire covering medicines use and disposal was used to patients randomly selected from the electoral roll. The content of this questionnaire was informed by qualitative data from a group interview on the subject. By use of these three methods it was possible to triangulate the data, providing a comprehensive assessment of unused medicines. Unused medicines were found to be ubiquitous in primary care and cardiovascular, diabetic and respiratory medicines are unused in substantial quantities, accounting for a considerable proportion of the total financial value of all unused medicines. Additionally, analgesic and psychoactive medicines were highlighted as being unused in sufficient quantities for concern. Anti-infective medicines also appear to be present and unused in a substantial proportion of patients’ homes. Changes to prescribed therapy and non-compliance were identified as important factors leading to the generation of unused medicines. However, a wide array of other elements influence the quantities and types of medicines that are unused including the concordancy of GP consultations and medication reviews and patient factors such as age, sex or ethnicity. Medicines were appropriately discarded by 1 in 3 patients through return to a medical or pharmaceutical establishment. Inappropriate disposal was by placing in household refuse or through grey and black water with the possibility of hoarding or diversion also being identified. No correlations wre found between the weight of unused medicines and any clinical or financial factor. The study has highlighted unused medicines to be an issue of some concern and one that requires further study.

The L-31E Surface Water Rediversion Project Final Report: Implementation, Results, and Recommendations

Throughout the Biscayne Bay watershed, existing coastal wetland communities have been cut off from sheet flow for decades. With the expectation that reconnection of these wetlands to upstream water sources would alter existing hydrologic conditions and recreate a more natural sheet flow to Biscayne National Park, a demonstration project on freshwater rediversion was undertaken. The objectives of the project were to document the effects of freshwater diversion on: (a) swamp and nearshore water chemistry and hydrology; (b) soil development processes; (c) macrophyte and benthic algal community composition, structure and production; (d) abundance of epiphytic and epibenthic invertebrates; (e) zonation, production, and phenology of primary producers in the nearshore environment, and (f) exchanges of nutrients and particulates between nearshore and mangrove ecosystems.

The impact of the juvenile intervention facility on the adjudication of delinquent youth in Broward County

Considerable funds have been allocated in the area of juvenile justice in attempts to reduce and prevent the problem of juvenile delinquency. Much of these funds have been funneled to various community-level intervention programs. This dissertation reports the results of a study that examined the effects of one such program, the Juvenile Intervention Facility (JIF) in Broward County, Florida, on reducing the number of cases handled judicially by the Juvenile Court in that county. ^ Juvenile justice policy, which precipitated the creation of the JIF program, assumed that more structured and integrative efforts at the point of entry into the juvenile justice system would lead to greater diversion from the courts to much needed intervention services. By virtue of this process, the number of juveniles handled judicially by the courts was expected to decrease and future delinquent behavior would be prevented. Archival data from four fiscal years were examined, two years pre-JIF, two years post-JIF, a third-year follow-up, and a concurrent outcome measure corresponding to the first year of JIF operations. Data included all juvenile cases referred during the fiscal years defined for Broward and St. Lucie Counties, the state of Florida, and the United States. The study tested four hypotheses: (a) the JIF would reduce the number of cases handled judicially in Broward County Juvenile Court, (b) the decrease in judicially handled cases would be greater for females than for males, (c) there would be greater decreases in judicially handled cases for whites than non-whites, (d) there would be greater decreases in judicial handling for younger than older offenders. Bivariate analyses were conducted, consisting of chi square tests, to test the hypotheses. ^ Results indicate that the impact of the JIF was in the opposite direction of what was expected in that more juvenile offenders were handled judicially through juvenile court. This fact points to the possibility that the JIF has failed to provide the intended consequences of the policy. In the discussion, these “unintended” consequences are addressed in the context of juvenile justice policy creation and the competing constituencies involved in such policy development. ^

Development of prediction models for freeway incident durations using data mining techniques

The nation's freeway systems are becoming increasingly congested. A major contribution to traffic congestion on freeways is due to traffic incidents. Traffic incidents are non-recurring events such as accidents or stranded vehicles that cause a temporary roadway capacity reduction, and they can account for as much as 60 percent of all traffic congestion on freeways. One major freeway incident management strategy involves diverting traffic to avoid incident locations by relaying timely information through Intelligent Transportation Systems (ITS) devices such as dynamic message signs or real-time traveler information systems. The decision to divert traffic depends foremost on the expected duration of an incident, which is difficult to predict. In addition, the duration of an incident is affected by many contributing factors. Determining and understanding these factors can help the process of identifying and developing better strategies to reduce incident durations and alleviate traffic congestion. A number of research studies have attempted to develop models to predict incident durations, yet with limited success. ^ This dissertation research attempts to improve on this previous effort by applying data mining techniques to a comprehensive incident database maintained by the District 4 ITS Office of the Florida Department of Transportation (FDOT). Two categories of incident duration prediction models were developed: "offline" models designed for use in the performance evaluation of incident management programs, and "online" models for real-time prediction of incident duration to aid in the decision making of traffic diversion in the event of an ongoing incident. Multiple data mining analysis techniques were applied and evaluated in the research. The multiple linear regression analysis and decision tree based method were applied to develop the offline models, and the rule-based method and a tree algorithm called M5P were used to develop the online models. ^ The results show that the models in general can achieve high prediction accuracy within acceptable time intervals of the actual durations. The research also identifies some new contributing factors that have not been examined in past studies. As part of the research effort, software code was developed to implement the models in the existing software system of District 4 FDOT for actual applications. ^

Tracking rates of ecotone migration due to salt-water encroachment using fossil mollusks in coastal South Florida

We determined the rate of migration of coastal vegetation zones in response to salt-water encroachment through paleoecological analysis of mollusks in 36 sediment cores taken along transects perpendicular to the coast in a 5.5 km2 band of coastal wetlands in southeast Florida. Five vegetation zones, separated by distinct ecotones, included freshwater swamp forest, freshwater marsh, and dwarf, transitional and fringing mangrove forest. Vegetation composition, soil depth and organic matter content, porewater salinity and the contemporary mollusk community were determined at 226 sites to establish the salinity preferences of the mollusk fauna. Calibration models allowed accurate inference of salinity and vegetation type from fossil mollusk assemblages in chronologically calibrated sediments. Most sediments were shallow (20–130 cm) permitting coarse-scale temporal inferences for three zones: an upper peat layer (zone 1) representing the last 30–70 years, a mixed peat-marl layer (zone 2) representing the previous ca. 150–250 years and a basal section (zone 3) of ranging from 310 to 2990 YBP. Modern peat accretion rates averaged 3.1 mm yr)1 while subsurface marl accreted more slowly at 0.8 mm yr)1. Salinity and vegetation type for zone 1 show a steep gradient with freshwater communities being confined west of a north–south drainage canal constructed in 1960. Inferences for zone 2 (pre-drainage) suggest that freshwater marshes and associated forest units covered 90% of the area, with mangrove forests only present along the peripheral coastline. During the entire pre-drainage history, salinity in the entire area was maintained below a mean of 2 ppt and only small pockets of mangroves were present; currently, salinity averages 13.2 ppt and mangroves occupy 95% of the wetland. Over 3 km2 of freshwater wetland vegetation type have been lost from this basin due to salt-water encroachment, estimated from the mollusk-inferred migration rate of freshwater vegetation of 3.1 m yr)1 for the last 70 years (compared to 0.14 m yr)1 for the pre-drainage period). This rapid rate of encroachment is driven by sea-level rise and freshwater diversion. Plans for rehydrating these basins with freshwater will require high-magnitude re-diversion to counteract locally high rates of sea-level rise.

Salinity and Chlorophyll a as Performance Measures to Rehabilitate a Mangrove-Dominated Deltaic Coastal Region: the Ciénaga Grande de Santa Marta–Pajarales Lagoon Complex, Colombia

Salinity, water temperature, and chlorophyll a (chl-a) biomass were used as performance measures in the period 1999–2001 to evaluate the effect of a hydrological rehabilitation project in the Ciénaga Grande de Santa Marta (CGSM)–Pajarales lagoon complex, Colombia where freshwater diversions were initiated in 1995 and completed in 1998. The objective of this study was to evaluate how diversions of freshwater into previously hypersaline (>80) environments changed the spatial and temporal distribution of environmental characteristics. Following the diversion, 19 surveys and transects using a flow-through system were surveyed in the CGSM–Pajarales complex to continuously measure selected water quality parameters. Geostatistical analysis indicates that hydrology and salinity regimes and water circulation patterns in the CGSM lagoon are largely controlled by freshwater discharge from the Fundacion, Aracataca, and Sevilla Rivers. Residence times in the CGSM lagoon were similar before (15.5 ± 3.8 days) and after (14.2 ± 2.0 days) the rehabilitation project and indicated that the system is flushed regularly. In contrast, chl-a biomass was highly variable in the CGSM–Pajarales lagoon complex and not related to discharge patterns. Mean annual chl-a biomass (44–250 μg L−1) following the diversion project was similar to values recorded since the 1980s and still remains among the highest reported in coastal systems around the world owing to its unique hydrology regulated by the Magdalena River and Sierra Nevada de Santa Marta watersheds and the high teleconnection to the El Niño Southern Oscillation (ENSO). Our results confirm that the reduction in salinity in the CGSM lagoon and Pajarales complex during 1999–2000 was largely driven by high precipitation (2500 mm) induced by the ENSO–La Niña rather than by the freshwater diversions.

Adventures and Misfortunes in Macondo: Rehabilitation of the Cienaga Grande

We describe trajectories of selected ecological indicators used as performance measures to evaluate the success of a mangrove rehabilitation project in the Ciénaga Grande de Santa Marta (CGSM) Delta-Lagoon complex, Colombia, as result of freshwater diversions initiated in 1995. There is a significant reduction in soil and water column salinity in all sampling stations following the hydraulic reconnection of the Clarín and Aguas Negras channels to the Magdalena River. Soil intersticial water salinity (depth: 0.5 m) (7 stations) and water column salinity (0.5 m) (10 stations) values declined significantly (soil <30 g kg-1; water <10 g kg-1) from 1994 to 2000. During 1994 soil interstitial water salinity ranged from 40 g kg-1 (Rinconada) to 100 g kg-1 (KM 13), while water column salinity fluctuated between 25-35 g kg-1 for most of the sampling stations. This salinity reduction increased mangrove forest regeneration promoting a net gain of 99 km2 from 1995 to 1999. The high precipitation recorded in 1995 and 1999 caused by El Niño-La Niña (ENSO), coinciding with the channels rehabilitation, influenced rapid mangrove regeneration. The lack of economic investment in the maintenance of the diversion structures from 2001 to 2004 caused a salinity increase affecting negatively already restored vegetation. A sustainable effort from the international community and the Colombian government is needed to maintain the strategic social and economic benefits reached until 2000 in the CGSM region.