The New South Wales Medical Board established a Health Programme for the assessment and rehabilitation of doctors whose clinical performance was impaired by alcohol or psychoactive substance use, mental or physical illness. This programme was developed to be individualized to the needs of each registrant. The present study has three aims: 1. To describe those doctors who participated in the Board???s Health Programme. 2. To chart the duration of involvement of these doctors through the programme. 3. To examine the outcomes associated with this programme. The study is based on the prospective cohort of all 181 impaired doctors who participated in the Health Programme between July 1st 1993 and April 30th 2001. Information on each registrant was collected at the time of the initial assessment and at each review conducted as part of the programme. Additional qualitative data was also collected and supplemented by a file audit conducted in August and September 2001. One hundred and eighty-one doctors were prospectively monitored as part of this study. The largest source of impairment was psychiatric illness (45.3%), 77% of the doctors were male. The average age of the cohort was 41.6 (sd 11.1) years. Impaired doctors were more likely to be working in emergency medicine or psychiatry and be based in a rural area. Of those who had finished their involvement in the programme, successful graduates participated for a mean of 38.2 (sd 22.3) months. In general outcomes of involvement were positive, 64 of 113 (56.6%) of doctors successfully graduated from the programme. One hundred and ten of 168 (65.5%) improved during the period of their involvement and 111 of 126 (88.1%) were working in medicine. Five, 2.8% of the participants died during the period of this study. Measures of registrant insight and support tended to increase during the period of involvement with the Health Programme. Future studies will need to establish evidence for the most appropriate interventions with impaired doctors. This process would be strengthened by the collection of standardized data across intervention programmes, supplemented with functional assessments and the collection of qualitative data.

There is increasing concern about hepatitis C virus (HCV) and potential HIV transmission among ethnic Vietnamese injecting drug users (IDUs) in Australia. To date ethnic and cultural differences in vulnerability to blood-borne viruses (BBV) have received little attention and few studies have attempted to explore the role of cultural beliefs and values in influencing injection risk behaviour. This study aimed to systematically explore the cultural beliefs and behavioural practices that appear to place ethnic Vietnamese IDUs at increased risk of BBV infection, identify barriers to this group accessing health and preventive programs, and document antibody HIV and HCV prevalence and associated risk behaviours. The first component of the research consisted of an ethnographic study designed to explore underlying explanatory models of health and illness employed by Vietnamese IDUs and identify cultural influences on risk behaviours and vulnerability to BBVs. These data were subsequently used to inform the development of the instrument used in the second component ??? a cross-sectional survey and collection of capillary blood samples designed to assess risk behaviours and antibody HIV and antibody HCV prevalence. Analysis of data from both components indicates that cultural beliefs and practices influence risk-taking and health-seeking behaviours and suggests pathways through which this influence occurs. Relevant cultural characteristics include those pertaining to spiritual and religious beliefs, the role of the family and traditional Vietnamese family values, cultural scripts of self-control and stoicism, the importance of ???face??? and non-confrontational relationships, trust and obligation, and a reluctance to discuss problems with outsiders. Vulnerability to BBVs is influenced by these cultural characteristics, together with Vietnamese IDUs??? perceptions of risk, knowledge about HIV and HCV, and situational and environmental factors. Main factors contributing to the under-utilisation of health services include the use of self-managed care practices, ambivalence surrounding Western medicine, long waiting times, concerns in relation to confidentiality, stigmatisation of drug use, and limited knowledge of BBVs. The data indicate a need for interventions based on understanding of culturally specific meanings and contexts of health, illness and risk in order to better meet the needs of this vulnerable group.

This study addressed the incidence of drug use by freshmen at Siuslaw High School in Florence, Oregon, and sought their opinions about effective drug and alcohol prevention programs. The purpose was to provide basic data which would ultimately assist in specific drug and alcohol programs for this population. In phase one, 83 students from four of seven freshmen Health Education randomly selected classes were given the Washington State Survey of Adolescent Health Behavior. This survey consisted of 81 questions about student demographics, students' drug use, and their opinions of drug prevention programs. During phase two, the students were asked open-ended questions about their suggestions for more effective drug prevention programs and curriculum. The survey revealed an average amount of drug use and that the students did not think the drug prevention program at Siuslaw was working. The survey also revealed that teenagers are influenced to drink and use drugs by the media, their friends, and by a lack of activities offered by the community. The study conclusions showed that Florence does have teenage drug use and the community should consider a variety of approaches. Data suggest that more youth support groups, more affordable counseling, and more recreational activities may help reduce drug use. The school needs to develop a more comprehensive drug prevention curriculum and implement it at the younger grade levels. The school combined with the community, should offer more drug-free alternatives and target those youths who are not using drugs and promote their positive behavior. / Graduation date: 1995

This thesis discusses the evolution of the role of the pharmacist in U.S. health care delivery from its early origins to modern day practice. Public policy, education and licensing requirements, and technological advances have substantially shaped the role of the pharmacist and what health care services they provide. Where pharmacists once provided direct patient care when formal modes of pharmacist professionalization did not exist, post-WWII mass production of pharmaceuticals confined pharmacists to dispensing and distribution duties that did not fully utilize their drug knowledge. Consequently, pharmacy educators and leaders have pushed pharmacy practice into an era of “pharmaceutical care,” emphasizing direct patient care activities and the employment of pharmacists’ drug expertise. Pharmacists today have moved back into clinical roles, participating in patient care activities alongside other health care professionals—sometimes even providing primary care services. Due to the U.S.’s growing dependence of prescription drugs and the American public’s continuous demands for high quality care, greater access to health care services, and containment of health care costs, pharmacists will likely acquire greater responsibilities in direct patient care.

Aim: To examine prospectively over a period of 4 years the profile of cannabis dependence and the risk of specific dependence criteria in a community sample of adolescents. Methods: A representative community sample of 2446 young adults aged 14–24 years at baseline was followed up over a period of 4 years. Frequency of use measures and of criteria for DSM-IV dependence were assessed by standardized diagnostic interview measures (CIDI). To explore the nature of this association, frequency of use and concomitant use of other psychoactive substances was considered. Results: 30% of the sample were cannabis users. Among all users 35% met at least one dependence criterion. Most frequently reported dependence criteria among all users were withdrawal (17%), tolerance (15%), loss of control (14%) and continued use despite a health problem (13%). Even without concomitant use of other illicit drugs, 22% of low frequency users and 81% of high frequency users met at least one dependence criterion. Symptom patterns were similar in high and low frequency users. The occurrence of a dependence syndrome or of specific dependence criteria could not be attributed to the use of other illicit drugs or to comorbid nicotine and alcohol dependence. Conclusions: Regular cannabis use in adolescence is associated with the development of a dependence syndrome. This association cannot be explained by the concomitant use of other illicit substances or by comorbid nicotine and alcohol dependence.

Asthma affects nearly two and a half million people in Canada. In Saskatchewan, the prevalence of asthma has increased across all age groups since 1981. Current literature indicates that the purchase of all asthma medications increased in the last 20 years both province and nationwide. Since the early 1990s, the Canadian Consensus Guidelines (CCG) for the treatment of asthma recommended increasing the use of inhaled corticosteroids as a mainstay for controlling asthma symptoms. The CCG have also encouraged decreasing the use of short-acting, inhaled beta2-agonist medication. <p>The objective of this descriptive epidemiological study was to investigate asthma medication prescribing at the individual level among physician-diagnosed asthma patients, aged 0 to 64 years, in Saskatchewan from January 1, 1991 to December 31, 2000. Saskatchewan residents covered under the provincial health insurance plan who received a physicians diagnosis of asthma, identified each calendar year, were included in the study (296,430 asthma patients in total). <p> Nearly 80.0% of this asthma population purchased at least one asthma medication in each calendar year. From 1991 to 2000, users and the mean number of prescriptions of short-acting beta2-agonists decreased slightly. The proportion of users and mean number prescriptions per year of inhaled corticosteroids increased. The highest mean numbers of prescriptions and users of inhaled corticosteroids were among the 0-4 year olds. <p>Short-acting beta2-agonists, inhaled corticosteroids, and oral corticosteroids were the most popular medications. Users of theophyllines and cromoglycates decreased. The 15-34 year old males showed the greatest "inappropriate" use as high users of short-acting beta2-agonists and low users of inhaled corticosteroids. <p>There was increasing compliance with the CCG over the ten years. The combination of beta2-agonists with inhaled corticosteroids usurped beta2-agonist monotherapy as the most popular form of asthma therapy by the year 2000. Users of combination therapy increased from 19% to 38.7%, while users of beta2-agonists alone decreased from 34.5% to 23.1%. <p>From 1996 to 2000, the monthly number of both short-acting beta2-agonists and inhaled corticosteroids prescriptions decreased for all users in July and August. Peak increases in the number of short-acting beta2-agonist prescriptions, for children under 15, occurred in September. For adults, peak increases occurred in December for both medications. <p>These study results will enhance the understanding of asthma medication use among children and adults and will help healthcare professionals develop new treatment programs for the management of asthma.

<p>HIV poses considerable social and health challenges in South Africa, particularly among young people aged 15-24. Research indicates a strong link between risky sexual behaviour and alcohol and illicit drugs. In the Western Cape drug-related behaviours is a growing concern among young people because of relatively high prevalence rates of drug abuse, particularly methamphetamine. Previous South African studies have tended to focused on the link between substance use and risky sexual behaviour among commercial sex workers. The theoretical approach of this study is the information motivation behavioural skills model. Participants were selected using non-probability sampling of 279 first year students registered for Psychology I at the University of the Western Cape. This study employed a quantitative research approach using a survey design. Results: Forty-six percent of students do not believe that the use of illicit drugs has an impact on a person&rsquo / s sexual behavior. However, the findings also showed that only 45% of students believed that there was a difference between illicit drug users correctly using condoms when compared to non-users. Data was analysed using descriptive and inferential statistics. Conclusion: Prevention is our best and most effective means of decreasing risk-taking behaviours associated with HIV infection. Information is the first line of intervention that is necessary to reduce risk-taking behaviours / however prevention strategies and interventions of risk-taking behaviours should aim to increase motivation and help young people integrate information in a way that it is personally relatable. This is vital to address the inconsistencies between perceptions of risk and the realities of risk-taking behaviour.</p>

Wastewater epidemiology is an emerging discipline that requires collaborative research involving analytical chemists, drug epidemiologists, and wastewater engineers. Wastewater epidemiology involves the sampling and quantitative analysis of raw wastewaters from communities for illicit drugs and their metabolites. Mass loads (mass per day) and per capita (mg per day per person) are then calculated from concentrations and indicate the approximate quantity of illicit drugs used and excreted by the community. Limitations to wastewater epidemiology include that the population served by wastewater treatment plants within a day and between days is not well known. In addition, biodegradation of illicit drugs during transit in sewers may affect the concentration and mass flows that reach wastewater treatment plants. This thesis describes a series of studies conducted by an international collaboration between scientists and engineers from the United States and Switzerland to answer these two limitations. The experimental approaches for these studies used included high-frequency wastewater sampling strategies, the use of creatinine as a human urinary biomarker, as well as the use of unique locations as test sites including an open community, a prison in the state of Oregon, and a 5 km section of sewer in Zürich Switzerland. In Chapter 2, the diurnal study on the mass flows of illicit drugs or metabolites was formed over four days in a municipality with a population of approximately 55,000 people. The diurnal trends in illicit substances vary by substance. The high (g/day) mass flows of caffeine, methamphetamine, and creatinine indicate that lower-frequency sampling (approximately one sample per h) may representatively capture the use and excretion of these substances. However, lower and episodic mass flows of cocaine and its primary human metabolite, benzoylecgonine, indicate that higher-frequency is needed to accurately assess the use of the cocaine within the municipality. Normalization of illicit substances to creatinine gave between-day trends in illicit and legal substances that differed from non-normalized trends. Resident use of cocaine and methamphetamine were indicated by normalized mass flows that increased during early morning hours while commuters are largely absent from the community. Chapter 3 describes a series of experiments conducted at an Oregon state prison. The prison setting provided a unique opportunity to study a nearly-fixed population of individuals and their corresponding mass flows of illicit substances, the number of doses per person consumed, as well as an opportunity to quantify the level of agreement between numbers of individuals and the measured mass flows of creatinine. Methamphetamine use was more prevalent than cocaine/benzoylecgonine in the prison over the one month study in which single daily (24 h) composite samples of wastewater were collected. The hypothesis that the mass flows of methamphetamine and cocaine would be lower on days on which random urinalysis testing (RUA) is typically conducted by the prison (Monday-Thursday) was rejected. While the mass flows (mg/d) of methamphetamine were less than those for a nearby open community, the number of estimated doses per person was higher for the prison population. A higher number of positive RUA results were obtained for methamphetamine while none were positive for cocaine, which is consistent with the data obtained from wastewater. The hourly (diurnal) trend in methamphetamine mass loads indicated continual methamphetamine use/excretion inside the prison while cocaine and benzoylecgonine were detected in five hourly composite samples. Use of methamphetamine and cocaine by inmates could not be unambiguously distinguished from that of non-inmates (employees and visitors). The observed diurnal trends in creatinine mass loads were similar to those of an open community and are indicative of the general pattern of human wakefulness/activity. Predicted creatinine mass loads based on the total prison (inmates + non-inmates) were in good agreement with the measured mass loads, which indicates the potential use of creatinine as a quantitative population indicator. Additional research on the biodegradability of creatinine is needed because the prison setting was deliberately selected to minimize the potential for creatinine biodegradation. Chapter 4 addresses the data gap that exists on illicit drug transformation during in situ transit in sewers. The rates of in situ biodegradation have not yet been determined for conditions that are relevant to sewers, which include low to variable oxygen concentrations, the presence of a biofilm, and temperatures ≤ 20 °C. For this reason, two tracer tests were conducted in a 5 km stretch of sewer located near Zürich, Switzerland. The stable-isotope forms (deuterated) of cocaine and benzoylecgonine were injected into flowing wastewater and three locations up to 5 km downstream were sampled over time. Breakthrough curves were constructed from measurements of cocaine-d3 and benzoylecgonine-d3 concentration with time. The area under the curve (mass) was determined by integrating concentration over time. Benzoylecgonine-d3 was present in the injectate that should have only contained cocaine-d3; because the benzoylecgonine-d3 formation prior to injection is not known. The injected mass of cocaine-d3 did not decline over the 5 km distance. The observed mass of cocaine-d3 at 5 km was 10% greater than at 500 m, which indicates that the transformation of cocaine was not significant over the 1.5 h experiment. At 5 km downgradient, the apparent mass of benzoylecgonine-d3 had increased by 35% over that observed at 500 m. However, the apparent increase in benzoylecgonine-d3 mass was not accompanied by a corresponding loss of cocaine-d3. While uncertainty is apparent in the increase of both cocaine-d3 and benzoylecgonine-d3, the ratio of cocaine-d3/benzoylecgonine-d3 is subject only to analytical error because any errors associated with sampling and the integration of masses cancel out. The ratio of cocaine-d3/benzoylecgonine-d3 declined from 2.98 in the injectate to 1.66 at Location 3, which indicated a greater increase in benzoylecgonine-d3 relative to cocaine over the 5 km distance. Due to the benzoylecgonine-d3 that was present in the injectate, any biodegradation of cocaine-c3 to form benzoylecgonine-d3 could not be unambiguously distinguished. During the second tracer test in which benzoylecgonine-d3 was injected, the mass of benzoylecgonine-d3 did not significantly decline, which suggests that the apparent loss of benzoylecgonine-d3 during the cocaine-d3 test cannot be attributed to in-situ biodegradation. Overall, while uncertainty exists about the integrated masses for cocaine-d3 and benzoylecgonine-d3, the 5 km distance was too short in order to observe a significant loss of cocaine-d3 and formation of benzoylecgonine-d3. Recommendations for future research include conducting analysis on the injectate solution to ensure that only cocaine-d3 is introduced so that any formation of benzoylecgonine-d3 is readily apparent and quantifiable. In addition, the tracer tests should be repeated in a longer section of sewer to increase the residence time beyond 1.5 hr and degradation products of benzoylecgonine-d3 should be monitored including ecgonine and ecgonine methyl ester. / Graduation date: 2013 / Access restricted to the OSU Community at author's request from Jan. 7, 2013 - Jan. 7, 2014

Asthma affects nearly two and a half million people in Canada. In Saskatchewan, the prevalence of asthma has increased across all age groups since 1981. Current literature indicates that the purchase of all asthma medications increased in the last 20 years both province and nationwide. Since the early 1990s, the Canadian Consensus Guidelines (CCG) for the treatment of asthma recommended increasing the use of inhaled corticosteroids as a mainstay for controlling asthma symptoms. The CCG have also encouraged decreasing the use of short-acting, inhaled beta2-agonist medication. <p>The objective of this descriptive epidemiological study was to investigate asthma medication prescribing at the individual level among physician-diagnosed asthma patients, aged 0 to 64 years, in Saskatchewan from January 1, 1991 to December 31, 2000. Saskatchewan residents covered under the provincial health insurance plan who received a physicians diagnosis of asthma, identified each calendar year, were included in the study (296,430 asthma patients in total). <p> Nearly 80.0% of this asthma population purchased at least one asthma medication in each calendar year. From 1991 to 2000, users and the mean number of prescriptions of short-acting beta2-agonists decreased slightly. The proportion of users and mean number prescriptions per year of inhaled corticosteroids increased. The highest mean numbers of prescriptions and users of inhaled corticosteroids were among the 0-4 year olds. <p>Short-acting beta2-agonists, inhaled corticosteroids, and oral corticosteroids were the most popular medications. Users of theophyllines and cromoglycates decreased. The 15-34 year old males showed the greatest "inappropriate" use as high users of short-acting beta2-agonists and low users of inhaled corticosteroids. <p>There was increasing compliance with the CCG over the ten years. The combination of beta2-agonists with inhaled corticosteroids usurped beta2-agonist monotherapy as the most popular form of asthma therapy by the year 2000. Users of combination therapy increased from 19% to 38.7%, while users of beta2-agonists alone decreased from 34.5% to 23.1%. <p>From 1996 to 2000, the monthly number of both short-acting beta2-agonists and inhaled corticosteroids prescriptions decreased for all users in July and August. Peak increases in the number of short-acting beta2-agonist prescriptions, for children under 15, occurred in September. For adults, peak increases occurred in December for both medications. <p>These study results will enhance the understanding of asthma medication use among children and adults and will help healthcare professionals develop new treatment programs for the management of asthma.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences