Search

Objective: For 3 decades, studies have reported that the usual sequence of drug initiation is licit drugs, then cannabis, and then other illicit drugs. This article describes the prevalence of violations of this sequence, the predictors of violations, and the relationship between violations and the onset of alcohol or drug dependence. Method: The New Zealand Mental Health Survey is a nationally representative sample with 12,992 face-to-face interviews carried out in 2003-2004. The response rate was 73.3%. The World Health Organization Composite International Diagnostic Interview (CIDI 3.0) was used in the survey. Reports of the age at first use were obtained for alcohol and drugs but not for smoking. Results: Violations of the usual sequence of drug initiation were uncommon in the population (2.6%). Use of other illicit drugs before cannabis was the main violation, found in 2.3% of alcohol users, 3.0% of cannabis users, 8.6% of cocaine users, and 16.7% of those who had used other illicit drugs. Use of other illicit drugs before cannabis was more predominant in younger cohorts and those with more early-onset internalizing disorders. Violations had little association with the development of dependence in users when other important predictors such as age at onset of use and the number of illicit drugs used were taken into account. Internalizing disorders and early-onset bipolar disorder also predicted dependence. Conclusions: In New Zealand, violations of the gateway sequence are not common and they are not markers of progression to dependence., NUMEROUS STUDIES OF THE SEQUENCE of drug use initiation have shown that tobacco and alcohol are the first drugs used, followed by cannabis, and then by other drugs (Ellickson et [...]

The policy of compulsive competitive tendering for support services in the National Health Service may be considered a success because it has reduced costs, despite the intitial costs of establishing the system and making redundancies. Changes in working practices led to increased productivity and costs were reduced by cutting wages and conditions of service. In some cases the NHS has found it difficult to interest outside firms in bidding for a contract, or could provide the service more cheaply in-house.

Objective: The aim of the present study was to compare two versions of the Kessler 10-item scale (K10), as measures of population mental health status in New Zealand. Method: A nationwide household survey of residents aged ≥16 years was carried out between 2003 and 2004. The World Mental Health Composite International Diagnostic Interview (CIDI 3.0) was used to obtain DSM-IV diagnoses. Serious mental illness (SMI) was defined as for the World Mental Health Surveys Initiative and the USA National Comorbidity Survey Replication. Participants were randomly assigned to receive the ‘past month’ K10 or the ‘worst month in the past 12 months’ K10. There were 12 992 completed interviews; 7435 included the K10. The overall response rate was 73.3%. Receiver operator characteristic (ROC) curves were used to examine the ability of both K10 versions to discriminate between CIDI 3.0 cases and non-cases, and to predict SMI. Results: Scores on both versions of the K10 were higher for female subjects, younger people, people with fewer educational qualifications, people with lower household income and people resident in more socioeconomically deprived areas. Both versions of the K10 were effective in discriminating between CIDI 3.0 cases and non-cases for anxiety disorder, mood disorders and any study disorder. The worst month in the past 12 months K10 is a more effective predictor than the past 1 month K10 of SMI (area under the curve: 0.89 vs 0.80). Conclusions: Either version of the K10 could be used in repeated health surveys to monitor the mental health status of the New Zealand population and to derive proxy prevalence estimates for SMI. The worst month in the past 12 months K10 may be the preferred version in such surveys, because it is a better predictor of SMI than the past month K10 and also has a more logical relationship to 12 month disorder and 12 month service use. [ABSTRACT FROM AUTHOR]

Objective: To estimate the lifetime prevalence and projected lifetime risk at age 75 years of DSM-IV disorders in New Zealand. Method: A nationwide face-to-face household survey carried out in 2003–2004. A fully structured diagnostic interview, the World Health Organization Composite International Diagnostic Interview (CIDI 3.0), was used. There were 12 992 completed interviews from participants aged 16 years and over. The overall response rate was 73.3%. In this paper, the outcomes reported are lifetime prevalence and projected lifetime risk at age 75 years. Results: The lifetime prevalence of any disorder was 39.5%. The lifetime prevalences for disorder groups were: anxiety disorders, 24.9%; mood disorders, 20.2%; substance use disorders, 12.3%; and eating disorders, 1.7%. The prevalences for all disorders were higher in the younger age groups. Females had higher prevalences of anxiety, mood and eating disorders compared with males; males had higher prevalences of substance use disorders. The estimated projected lifetime risk of any disorder at age 75 years was 46.6% with the median age of onset being 18 years. Adjustment for age, sex, education and household income did not remove all differences between Māori and the composite other ethnic group in the risk of disorder (hazard ratio = 1.1–1.4). After adjustment, hazard ratios for Pacific people ranged from 0.8 to 2.5. Conclusions: These results confirm those of other studies: mental disorders are relatively common and tend to have early onset. Females are more likely to experience anxiety, mood and eating disorders than males, who experience more substance use disorders. Adjustment for socioeconomic factors and demography does not explain all ethnic differences, although remaining differences are small relative to cohort and even sex differences. [ABSTRACT FROM AUTHOR]

Background In randomized trials there may be no overriding reason whether or not to have a placebo control. Purpose We assessed the effects of an open trial design (no placebo and people know what tablets they are given) compared with a blinded, placebo-controlled design on recruitment, compliance and retention within a randomized trial of secondary osteoporotic fracture prevention. Methods We undertook a randomized controlled comparison nested within a placebo-controlled trial of nutritional supplementation amongst people aged 70 years or over who had previously sustained a fracture, recruited in a UK teaching hospital. Randomization was 2 : 1 in favour of the blinded, placebo-controlled trial design. Results From 180 eligible participants randomized to receive information based on the open trial design, 134 (74.4%) consented to take part, compared with 233 (65.1%) of 358 people randomized to the blinded, placebo-controlled design (difference 9.4%, 95% confidence interval 1.3–17.4%). Reluctance to take a placebo and the desire to know tablet allocation were reasons given for not taking part in the blinded, placebo-controlled design. There was no significant difference in tablet compliance. Open trial participants were more likely to remain in the trial for one year (difference 13.9%, 95% confidence interval 3.1–24.6%), mainly reflecting the high retention of the open trial no tablet group compared to the open trial tablet group (difference 23.6%, 95% confidence interval 11.9–35.2%). The odds ratio for reporting an adverse event in the open trial compared to the blinded, placebo-controlled design was 0.64 (95% confidence interval 0.28–1.49), and for reporting a fracture was 0.81 (0.36–1.85). Conclusions We conclude that using an open trial design may enhance participant recruitment and retention and thus improve generalizability and statistical power, but withdrawal rates may differ between the study allocations and may threaten the internal validity of the trial. [ABSTRACT FROM AUTHOR]

Focuses on a study which provided a profile of disorders and disabilities in the older population. Setting and design of the study; Results; Conclusion.

Objective: The aim of the present study was to compare two versions of the Kessler 10-item scale (K10), as measures of population mental health status in New Zealand., Method: A nationwide household survey of residents aged > or = 16 years was carried out between 2003 and 2004. The World Mental Health Composite International Diagnostic Interview (CIDI 3.0) was used to obtain DSM-IV diagnoses. Serious mental illness (SMI) was defined as for the World Mental Health Surveys Initiative and the USA National Comorbidity Survey Replication. Participants were randomly assigned to receive the 'past month' K10 or the 'worst month in the past 12 months' K10. There were 12 992 completed interviews; 7435 included the K10. The overall response rate was 73.3%. Receiver operator characteristic (ROC) curves were used to examine the ability of both K10 versions to discriminate between CIDI 3.0 cases and non-cases, and to predict SMI., Results: Scores on both versions of the K10 were higher for female subjects, younger people, people with fewer educational qualifications, people with lower household income and people resident in more socioeconomically deprived areas. Both versions of the K10 were effective in discriminating between CIDI 3.0 cases and non-cases for anxiety disorder, mood disorders and any study disorder. The worst month in the past 12 months K10 is a more effective predictor than the past 1 month K10 of SMI (area under the curve: 0.89 vs 0.80)., Conclusions: Either version of the K10 could be used in repeated health surveys to monitor the mental health status of the New Zealand population and to derive proxy prevalence estimates for SMI. The worst month in the past 12 months K10 may be the preferred version in such surveys, because it is a better predictor of SMI than the past month K10 and also has a more logical relationship to 12 month disorder and 12 month service use.