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Polypharmacy is a term used to describe an individual's use of multiple medications. At present, there is no single established criterion for polypharmacy. However, researchers tend to operationalize it as [...], OBJECTIVES: Natural health products (NHP) are increasingly being used to supplement prescription medications (PM) and over-the-counter (OTC) products. The objective of this study was to examine patterns of overall health product use and how these patterns are associated with social and health factors. METHODS: We used direct health measures data from the Canada Health Measures Survey (CHMS) Cycle 1.0 (2007/2009) to examine recent product use among adults aged 18-79 years (n = 3,721). Latent class analyses were used to detect use (propensity) and intensity of use among users of all three product types. Associations between social and health covariates and product patterns were examined using linear and multinomial logit regression procedures. RESULTS: Three latent classes of health product use were identified. The largest (43%) was characterized by a high probability of PM and NHP but not OTC use. Class two (37%), in contrast, had a low probability of using any of the three health products. Class three (20%) had a high probability of PM and OTC but not NHP use. Age, gender, immigrant status, household size, co-morbidity, perceived health status, and having a regular doctor were associated with these patterns of use. Analyses of intensity of product use among users revealed seven distinct classes; these were differentiated by age, household size, co-morbidity and weight (BMI status). CONCLUSION: If defining polypharmacy or polyherbacy is based simply on number of health products used, then for Canadians under age 80 neither practice appeared to be widespread. More work needs to be done to define the "poly" in polypharmacy and polyherbacy. This will inform the conversation on appropriate product use, particularly given that about one half of Canadians used medications and NHPs concurrently. KEY WORDS: Polypharmacy; over-the-counter drugs; dietary supplements; nonprescription drugs OBJECTIFS: Les produits de sante naturels (PSN) sont de plus en plus utilises comme supplements aux medicaments d'ordonnance (MO) et aux produits en vente libre (VL). L'objectif de cette etude etait d'examiner les patrons d'usage de l'ensemble des produits de sante et comment ces patrons sont associes a des facteurs sociaux et sanitaires. METHODES: Nous avons utilise les donnees du cycle 1.0 (2007-2009) de l'Enquete canadienne sur les mesures de la sante (ECMS) afin d'examiner l'usage recent de produits chez les adultes ages de 18 a 79 ans (n = 3721). Des analyses de classes latentes ont ete utilisees pour detecter l'usage (propension) et l'intensite de l'usage chez les utilisateurs des trois types de produits. Les associations entre les covariables sociales et sanitaires et les patrons d'usage des produits ont ete examinees a l'aide d'analyses de regression logistique lineaire et multinomiale. RESULTATS: Trois classes latentes d'usage des produits de sante ont ete identifiees. La plus grande classe (43 %) etait caracterisee par une forte probabilite d'usage de MO et de PSN mais pas de VL. Par contre, la 2e classe (37 %) avait une faible probabilite d'utiliser l'un ou l'autre des trois produits de sante. La 3e classe (20 %) avait une forte probabilite d'utiliser les MO et les VL mais pas les PSN. L'age, le genre, le statut d'immigrant, la taille du menage, la comorbidite, l'etat de sante percue, et le fait d'avoir un medecin regulier etaient associes avec ces patrons d'usage. L'analyse de l'intensite d'usage des produits chez les utilisateurs a permis d'identifier sept classes distinctes; celles-ci variaient selon l'age, la taille du menage, la comorbidite et le poids (indice de masse corporelle). CONCLUSION: Si la definition de la polypharmacie et de la polyherbacie est basee seulement sur le nombre de produits consommes, alors aucune des deux pratiques ne semble repandue chez les Canadiens de moins de 80 ans. Plus de travaux sont necessaires pour definir la " poly " dans la polypharmacie et la polyherbacie. Ceci alimentera la discussion sur l'usage approprie des produits, surtout qu'environ la moitie des Canadiens consomment des medicaments et des PSN en meme temps. MOTS CLES: polypharmacie; medicaments en vente libre; supplements dietetiques; medicaments sans ordonnance

ALCOHOL AND INJURY are associated (National Institute on Alcohol Abuse and Alcoholism, 2000), but the relative contributions of short- and long-term alcohol exposures remain unclear. Few studies have measured both. [...], Objective: This study investigated the relationship between alcohol and the risk of acute injury, examining both short-term (drinking over a few hours) and long-term exposures (past-month hazardous drinking and current alcohol use disorders). Method: The study was a case-crossover and population-based case-control study. Cases (N = 2,517; 1,432 men) were injured patients recruited from all three emergency departments in Boone County, Missouri. Each case's alcohol consumption in the 6 hours prior to injury was compared to his or her consumption the day before in a case-crossover analysis. Community controls (N = 1,856; 948 men) were recruited by telephone and matched to cases by age, gender, day of week and hour. Case-control analyses examined recent alcohol consumption (past 6 hours), past-month hazardous drinking and past-year alcohol use disorders. Results: The odds ratios (ORs) for injury associated with short-term alcohol exposure were similar, whether cases were compared with themselves (case-crossover analyses) or with others (case-control analyses). After 1 or 2 drinks in a 6-hour interval, the ORs were 1.8 (95% confidence interval [CI]: 1.3-2.6) and 1.5 (0.96-2.2), respectively. Similar dose-response curves were seen in the two comparisons, with ORs of 6.2 and 3.7, respectively, after 3 or 4 drinks and 9.5 and 13.5 after 5 or 6 drinks. For past-month hazardous drinking, the OR was 1.7 (95% CI: 1.2-2.3). Current alcohol dependence was associated with injury (OR = 1.9; 95% CI: 1.5-2.6), but alcohol abuse was not (OR = 0.9; 95% CI: 0.8-1.1). Conclusions: Alcohol's effect on injury risk is related more strongly to acute exposure than to measures of long-term exposure. The risk is significant even at low levels of consumption. (J. Stud. Alcohol 64: 358-366, 2003)

A Canadian study shows that reference pricing of ACE inhibitors will not necessarily make patients stop using ACE inhibitors. Instead, they simply switch to a cheaper ACE inhibitor. Reference pricing means that a standard reimbursement fee is set for a class of drugs. If the drug is equal to or less than the fee, insurance will cover the entire fee. If it is more, the patient must pay the difference.