Trends in calls to a state poisons centre and presentation to emergency departments for intentional antidepressant overdose in Victoria, Australia.

OBJECTIVE: To describe the rates and trends of emergency department presentations and calls to a state poisons centre for antidepressant overdose. METHODS: A retrospective cohort study utilising the Victorian Emergency Minimum Dataset and Victorian Poisons Information Centre call registry between January 2009 and December 2018 was conducted. This captured all presentations to Victorian emergency departments and calls to the Victorian Poisons Information Centre. Any intentional overdose involving an antidepressant was included. Annual rates of emergency department presentations and calls per 100,000 persons and 100,000 prescriptions for antidepressants overall and individual antidepressant classes, in addition to age-group-specific rates, were reported. RESULTS: A total of 3650 presentations to emergency department and 7096 calls to the poisons centre were included. No changes were seen in overall emergency department presentation rates when controlled for population or prescription numbers, but large and significant increases were seen for younger age groups. The 10-14- and 15-19-year age groups had average annual increases of 13.1% (95% CI = [6.5%, 19.7%], p < 0.001) and 7.2% (95% CI = [2.8%, 11.5%], p < 0.001) per 100,000 persons, respectively. Increases were seen in overall annual call rates of 6.7% (95% CI = [5.2%, 8.1%], p < 0.001) per 100,000 persons and 7.5% (95% CI = [4.9%, 10.1%], p < 0.001) per 100,000 prescriptions. CONCLUSION: Overall, emergency department presentation rates remained stable during the study period. Overall poisons centre call rates increased moderately. However, when examining younger persons, large increases were seen in both emergency department presentations and poison centre call rates. These findings highlight the need for future interventions to mitigate against intentional overdose in younger populations.

Comparison of Stimulant-Related Presentations to Victorian Emergency Departments Pre-pandemic and During the COVID-19 Pandemic.

Introduction Victoria, Australia, holds the unenviable record for the longest number of lockdown days in the world (262 days) and some of the most rigid restrictions. The purpose of this study was to determine whether changes in harmful drug use occurred during the pandemic by comparing stimulant-related presentations to Victorian emergency departments before and during the COVID-19 pandemic. Methods A retrospective analysis of data from the Victorian Injury Surveillance Unit was undertaken for two time periods, March 2019 to September 2019 and March 2020 to September 2020. Results The proportion of people presenting to an ED who used methylamphetamine/methamphetamine/amphetamine significantly increased from 2019 to 2020. Conversely, there was a significant reduction in ED presentations among people who used 3,4-methylenedioxy​methamphetamine (MDMA) and ecstasy during the study period. Conclusions COVID-19-related restrictions can affect mental health due to depression, or anxiety, particularly if people also experience loss of employment and income. In addition, mental health issues may affect substance use, including increased frequency of use and dose. This has implications for policy and planning during a pandemic and may be overlooked as the focus is on planning and resources for patients with COVID-19.

Improving injury surveillance data quality: a study based on hospitals contributing to the Victorian Emergency Minimum Dataset.

OBJECTIVE: In this paper, we describe the design and baseline data of a study aimed at improving injury surveillance data quality of hospitals contributing to the Victorian Emergency Minimum Dataset (VEMD). METHODS: The sequential study phases include a baseline analysis of data quality, direct engagement and communication with each of the emergency department (ED) hospital sites, collection of survey and interview data and ongoing monitoring. RESULTS: In 2019/20, there were 371,683 injury-related ED presentations recorded in the VEMD. Percentage unspecified, the indicator of (poor) data quality, was lowest for 'body region' (2.7%) and 'injury type' (7.4%), and highest for 'activity when injured' (29.4%). In the latter, contributing hospitals ranged from 3.0-99.9% unspecified. The 'description of event' variable had a mean word count of 10; 16/38 hospitals had a narrative word count of <5. CONCLUSIONS: Baseline hospital injury surveillance data vary vastly in data quality, leaving much room for improvement and justifying intervention as described. IMPLICATIONS FOR PUBLIC HEALTH: Hospital engagement and feedback described in this study is expected to have a marked effect on data quality from 2021 onwards. This will ensure that Victorian injury surveillance data can fulfil their purpose to accurately inform injury prevention policy and practice.

Pharmaceutical opioid poisonings in Victoria, Australia: Rates and characteristics of a decade of emergency department presentations among nine pharmaceutical opioids.

BACKGROUND AND AIMS: Pharmaceutical opioids are a significant contributor to the global 'opioid crisis', yet few studies have comprehensively distinguished between opioid types. We measured whether a range of common pharmaceutical opioids varied in their contribution to the rates and characteristics of harm in a population-wide indicator of non-fatal overdose. DESIGN: Retrospective observational study of emergency department (ED) patient care records in the Victorian Emergency Minimum Data set (VEMD), July 2009 to June 2019. SETTING: Victoria, Australia. CASES: ED presentations for non-fatal overdose related to pharmaceutical opioid use (n = 5403), where the specific pharmaceutical opioid was documented. MEASUREMENTS: We compared harms across the nine individual pharmaceutical opioids most commonly sold, and considered where multiple opioids contributed to the overdose. We calculated supply-adjusted rates of ED presentations using Poisson regression and used multinomial logistic regression to compare demographic and clinical characteristics of presentations among nine distinct pharmaceutical opioids and a 10th category where multiple opioids were documented for the presentation. FINDINGS: There were wide differences, up to 27-fold, between supply-adjusted rates of overdose. When considering presentations with sole opioids, the highest supply-adjusted overdose rates [per 100 000 oral morphine equivalents (OME); 95% confidence interval (CI)] were for codeine (OME = 0.078, 95% CI = 0.073-0.08) and oxycodone (OME =0.029, 95% CI = 0.027-0.030) and the lowest were for tapentadol (OME = 0.004, 95% CI = 0.003-0.006) and fentanyl (OME = 0.003, 95% CI = 0.002-0.004). These rates appeared related to availability rather than opioid potency. Most (62%) poisonings involved females. Codeine, oxycodone and tramadol were associated with younger presentations (respectively, 59.5%, 41.7% and 49.8% of presentations were 12-34 years old), and intentional self-harm (respectively 65.2%, 50.6%, and 52.8% of presentations). Relative to morphine, fentanyl [ 0.32 relative risk ratio (RRR)] and methadone ( 0.58 RRR) presentations were less likely to be coded as self-harm. Relative to morphine-buprenorphine, codeine, oxycodone and tramadol presentations were significantly more likely to be associated with the less urgent triage categories (respectively 2.18, 1.80, 1.52, 1.65 RRR). CONCLUSIONS: In Victoria, Australia, rates and characteristics of emergency department presentations for pharmaceutical opioids show distinct variations by opioid type.

Comparing rates and characteristics of emergency department presentations related to pharmaceutical opioid poisoning in Australia: a study protocol for a retrospective observational study.

INTRODUCTION AND AIMS: Pharmaceutical opioids are an important contributor to the global 'opioid crisis', and are implicated in 70% of Australia's opioid-related mortality. However, there have been few studies which consider the relative contribution of different pharmaceutical opioids to harm.We aim to compare commonly used pharmaceutical opioids in terms of (1) rates of harm, and (2) demographic and clinical characteristics associated with that harm. METHOD AND ANALYSIS: Observational study of emergency department presentations for non-fatal poisoning related to pharmaceutical opioid use. Data from 2009 to 2019 will be extracted from the Victorian Emergency Minimum Dataset which contains data from public hospitals with dedicated emergency departments in Victoria, Australia's second most populous state. A combination of free-text and International Classification of Diseases 10th Revision codes will be used to identify relevant cases, with manual screening of each case to confirm relevance. We will calculate supply-adjusted rates of presentations using Poisson regression for all pharmaceutical opioid cases identified, separately for nine commonly prescribed pharmaceutical opioids (buprenorphine, codeine, fentanyl, methadone, morphine, oxycodone, oxycodone-naloxone, tapentadol, tramadol), and for a multiple opioid category. We will use multinomial logistic regression to compare demographic and clinical characteristics, such as triage category, across opioid types. ETHICS AND DISSEMINATION: This work is conducted under approval 21427 from the Monash University Human Research Ethics Committee for ongoing injury surveillance. As per conditions of approval, cells of <5 will not be reported, though zeroes will be preserved. We will present project findings in a peer-reviewed journal article as well as at relevant scientific conferences.

Recent trends in heroin and pharmaceutical opioid-related harms in Victoria, Australia up to 2018.

AIMS: To characterize the trajectory in the years leading up to 2018 in pharmaceutical opioid and heroin morbidity in Victoria, Australia, and to assess the effect on that trajectory of reformulation of oxycodone to a form that could not be easily snorted or injected. DESIGN: Interrupted time-series analyses of population-level data before versus after reformulation of oxycodone, stratified by sex. SETTING: Victoria, Australia. PARTICIPANTS: The population of Victoria aged 12+ years. MEASUREMENTS: Ambulance patient care and emergency department (ED) records were examined using both fixed-code and free-text fields, with each record manually cleaned and checked by trained coders. These were used to derive the output variables providing an index of harm: rates of opioid-related ambulance attendances and ED attendances for pharmaceutical opioids and heroin. The input variable was pre- versus post-oxycodone reformulation. FINDINGS: There were 30 045 opioid-related ambulance attendances from January 2012 to October 2018 (54% heroin-related), and 10 113 ED attendances from July 2008 to June 2018 (39% heroin-related). There was an increase in the rate (events per 100 000 people per year) of all opioid ED attendances from 2008 to 2018 [increase = 0.063; 95% confidence interval (CI) = 0.049, 0.078]. Pharmaceutical opioid ED attendances decreased from 2014 onwards (slope change = -0.083; 95% CI = -0.108, -0.059). Heroin-related ED attendances increased from 2014 to 2018; 11 324 heroin-related ambulance attendances and 1980 ED attendances were observed from April 2014 to June 2018, compared with the respective estimates of 8176, and 1661 had the pre-April 2014 trend continued (ambulance slope change = 0.296, 95% CI = 0.104, 0.489; ED slope change = 0.026, 95% CI = 0.005, 0.046). The inflection point of 2014 coincided with the re-formulation of oxycodone. CONCLUSION: In Victoria, Australia, there appears to have been a trend starting around mid-2014 of increasing heroin-related harm, and a flattening of the increase or a decrease of harms relating to pharmaceutical opioids. These changes may, in part, reflect reformulation of oxycodone to reduce the extent to which it can be injected or snorted.

Translation strategies, contradiction, and the theory of social representations: Why discussing needles may improve blood donor retention.

Retaining blood donors is a cost-effective way of ensuring a safe blood supply, yet despite the plethora of research, only 5.1% of the eligible population in Australia donate blood and 40% of these do not make a second donation. We offer an alternative to traditional approaches by conceptualizing blood donation within social representations theory as socially derived symbolic knowledge with a specific focus on cognitive polyphasia and Guimelli's (1998) normative and functional dimensions. An online survey, completed by 703 residents from NSW Australia, comprised a blood donation word association task, Likert-style questions constructed from previous word association data and contextualized blood donation statements. Individual difference scaling analysis revealed all donor groups (including non-donors) associated blood donation with a few central, albeit contradictory ideas/beliefs. Exploratory factor analysis and confirmatory factor analysis performed on a split data set of the Likert-style items reiterated this finding. Interpreted through Guimelli's dichotomy, all donor groups were aware of these contradictory normative and functional ideas/beliefs but when explicitly asked, it was the functional aspect that differentiated the groups. We argue the key to retaining donors is understanding the interdependence between how blood donation is socially understood at the societal level of discourse and donor behaviour. Translational strategies for recruitment and retention are discussed.

Donating blood for research: a potential method for enhancing customer satisfaction of permanently deferred blood donors.

BACKGROUND: Each year, a large number of individuals in Australia are deferred from donating blood. A deferral may have a negative impact on donor satisfaction and subsequent word-of-mouth communication. The Australian Red Cross Blood Service (the Blood Service) is, therefore, investigating options for managing service interactions with deferred donors to maintain positive relationships. While public research institutes in Australia have established independent research donor registries, other countries provide programmes allowing deferred donors to donate blood for research via blood collection agencies. This study examined attitudes towards donating blood for research use in a sample of permanently deferred Australian donors. MATERIALS AND METHODS: Donors permanently deferred because of a risk of variant Creutzfeldt-Jakob disease (n=449) completed a postal survey that examined attitudes towards research donation. RESULTS: The majority of participants were interested in donating blood for research (96%), and joining a registry of research donors (93%). Participants preferred to donate for transfusion or clinical research, and were willing to travel large distances. Results indicated that positive attitudes towards the Blood Service would be extended if the opportunity to donate blood was provided. These findings indicate a desire for continued engagement with the Blood Service despite deferral. DISCUSSION: Donating blood for research is a potential way of maintaining positive relationships with permanently deferred donors which also benefits the health research community. Through maintaining positive relationships with deferred donors, positive word-of-mouth activity can be stimulated. Further work is needed to determine the feasibility of implementing research donation through the Blood Service in Australia.

Frequent whole blood donors: understanding this population and predictors of lapse.

BACKGROUND: Frequent blood donors are an important resource as they contribute many donations over their lifetime. The aim of this research was to develop a demographic profile of Australian frequent whole blood donors and to determine predictors of lapse within this group. STUDY DESIGN AND METHODS: Routinely collected data were used to profile individuals who had donated whole blood frequently (three or more times) between December 2010 and November 2011. Two segments were identified: 1) existing donors who had donated before December 2010 and 2) new donors who had not donated before December 2010. Donation records were followed to the end of December 2013 to examine retention. RESULTS: A total of 90,867 donated frequently between December 2010 and November 2011. The group was composed of slightly more men (51.4%), was typically of middle socioeconomic status, and many were employed in skilled trades such as a builder or a plumber (21.3%). Existing donors (n = 81,762) were significantly older, more likely to be male, and more likely to have a D- blood type compared to the smaller group of new donors (n = 9105). For both segments, being older and male and having a D- blood type increased the likelihood of return in the follow-up period. Deferrals and adverse events had negative impacts on retention for both groups. CONCLUSIONS: This study highlights specific factors that blood collection agencies may focus on to support continued donation among frequent donors.

Improving first-time donor attendance rates through the use of enhanced donor preparation materials.

BACKGROUND: Many nondonors are positive about blood donation and this motivates booking an appointment to donate. However, as their appointment approaches barriers to donating-such as anxiety-may become salient and deter attendance. Building on research of France and colleagues demonstrating the positive effect of enhanced preparation materials on donor recruitment, this study sought to determine whether these materials could effectively boost first donation appointment attendance. STUDY DESIGN AND METHODS: A field study comprising a 3 (brochure: none, e-mail, hard copy) × 2 (national call center [NCC] contact: none, call) between-subjects design was conducted with 3646 nondonors who had scheduled their first appointment. Participants in the brochure conditions received either a hard copy or an e-mailed link to electronic materials modeled on the donor preparation research of France and colleagues. Participants in the NCC call condition also received a call scripted in line with these preparation materials. The key outcome was new donor attendance rate. RESULTS: Although first-appointment attendance rates were high in the control (no additional contact) condition at 85.07% of those not canceling in advance, dual exposure to the preparation materials through a NCC call and an electronic brochure boosted attendance. The relative risk of attending in the NCC call and electronic brochure condition was 1.0836 (95% confidence interval, 1.0352-1.1343; p = 0.0006), with attendance 8.36% higher than in the control. This gain in attendance came at a relative increase in recruitment costs of 2%. CONCLUSION: The use of tailored communication to address new donors' concerns and prepare them for donating bolsters attendance rates.

The psychological impact of a specialist referral and telephone intervention on male cancer patients: a randomised controlled trial.

OBJECTIVE: To examine the psychological impact of a referral and telephone intervention, involving information and support, among men with colorectal cancer (CRC) and prostate cancer. METHODS: 571 newly diagnosed male CRC (N=182) and prostate (N=389) cancer patients were block-randomised into three arms. In the two intervention arms, the specialist actively referred men to a Cancer Helpline. In Active Referral--4 outcalls, men received calls from the Helpline within 1 week of diagnosis, and at 6 weeks, 3 months and 6 months post-diagnosis. In Active Referral--1 outcall, men received one call within 1 week of diagnosis. In the control arm, Passive Referral, patients were referred to the Helpline, with contact at their initiative. Participants completed scales measuring cancer-specific distress, anxiety and depression at study entry, then 4, 7 and 12 months post-diagnosis. Random effects regression models compared rates of change in these outcomes between study arms. RESULTS: At the first outcall, over 85% of participants in both intervention arms discussed treatment management and psychological/emotional issues. Among the Active Referral--4 outcalls arm, over 80% of participants discussed psychological/emotional issues at each call. Mean changes over time in cancer-specific distress, anxiety and depression were similar between study arms. CONCLUSION: Although men were willing to discuss psychosocial issues via the telephone, we found no psychological impact. Further research is required to determine whether the intervention is more effective for patients who do not have psychosocial support or have unmet information needs.

Can population-based tobacco-control policies change smoking behaviors of adolescents from all socio-economic groups? Findings from Australia: 1987-2005.

OBJECTIVE: To examine whether socio-economic status (SES) was associated with changes in smoking prevalence among Australian adolescents during three phases of tobacco-control activity between 1987 and 2005. METHODS: Triennial cross-sectional national studies of representative random samples of secondary students aged 12-17 years have been conducted since 1987. Numbers range from 19,203 in 1987 to 29,853 in 1996. Self-report anonymous surveys assessed cigarette use in the past month, week (current), and on at least three of the previous seven days (committed). Students' residential postcode was collected and the Index of Relative Socio-Economic Disadvantage (IRSD) associated with each postcode determined SES quartiles. RESULTS: Between 1987 and 2005, smoking prevalence decreased in all SES groups. Tobacco-control activity level was associated with changes in smoking prevalence and whether changes were consistent across SES groups. In a period of low tobacco-control funding (1992-1996) and activity, smoking prevalence increased among 12- to 15-year-olds, the increase being greatest among low SES students. In a period of high tobacco-control activity (1997-2005) smoking decreased and reductions were generally consistent across SES groups. CONCLUSIONS: Well-funded, population-based tobacco-control programs can be effective in reducing smoking among students from all SES groups.

Australian adolescents' sun protection behavior: who are we kidding?

PURPOSE: To examine the influence of tan preference and skin type on sun protection behaviors of Australian adolescents. METHODS: The Australian Secondary School Alcohol and Drug Questionnaires were conducted in 1993, 1996, 1999 and 2002 among randomly selected students aged 12--17. Schools were randomly selected from each education sector in each state. The self-administered questionnaire contained questions about tan preferences, skin type and usual SunSmart behavior (use of sunscreen, hats and covering clothing). RESULTS: The routine use of SunSmart behavior was low in all survey years. There was a significant decrease over time in the proportion of students who practiced SunSmart behavior, with prevalence rates lower in 2002 than in any other survey year (males: p<0.01 and females: p<0.01). As desire for a tan increased, routine practice of SunSmart behaviors decreased. Across the four survey periods, male (p<0.01) and female (p<0.01) students who preferred no tan were significantly more likely to practice SunSmart behavior than students who preferred any sort of tan. Across the four survey years, male (p<0.01) and female (p<0.01) students with skin that 'just burns' were most likely to routinely practice SunSmart behavior. CONCLUSIONS: Sun protection practices among adolescents have continued to decline significantly over time. Future educational programs require an innovative approach to modify adolescent behaviors in relation to sun exposure and sun protection.

Can home smoking restrictions influence adolescents' smoking behaviors if their parents and friends smoke?

Research suggests that the presence of a total ban on smoking in the home is associated with a reduced likelihood of tobacco experimentation among adolescents. While the influence of parental smoking on this association is examined in this work, no study has examined the influence of friends' smoking behavior. In this study, we use data from a statewide survey of students (n=4125) from the Australian State of Victoria to examine the association between home smoking bans and stage of smoking uptake after controlling for parental smoking and smoking among friends. Logistic regression revealed that students residing in homes with a total ban on smoking were least likely to be susceptible to smoking or to have experimented with smoking. While there was an interaction between parental smoking status and home bans on smoking uptake stage, indicating that the effect of home bans was strongest when neither parent smoked, there was no interaction between home bans and friends' smoking. The results suggest that home smoking bans reduce the likelihood of an adolescent trying tobacco regardless of their friends' smoking behavior. By adopting strong home smoking bans, parents can reduce some of the influence friends' smoking can have on the smoking behavior of their adolescent.

Prevalence of health promotion policies in sports clubs in Victoria, Australia.

In recent years, some health agencies offered sponsorship to sporting associations to promote healthy environments by encouraging clubs to develop health-related policies. However, the extent to which these sponsorship contracts reach their stated aims is of concern. This study aimed to quantify levels of policy development and practice in sports clubs for each of five key health areas, namely smoke-free facilities, sun protection, healthy catering, responsible serving of alcohol and sports injury prevention. Representatives from 932 Victorian sports clubs were contacted by telephone with 640 clubs (69%) participating in the survey. Results suggested that the establishment of written policies on the key health areas by sports clubs varied widely by affiliated sport and health area: 70% of all clubs with bar facilities had written policies on responsible serving of alcohol, ranging from 58% of tennis clubs to 100% of diving and surfing clubs. In contrast, approximately one-third of sports clubs had a smoke-free policy, with 36% of tennis, 28% of country football and 28% of men's cricket clubs having policy. Moreover, 34% of clubs overall had established sun protection policy, whereas clubs competing outside during summer months, [diving (86%) and life-saving (81%)] were most likely to have a written sun protection policy. Injury prevention policies were established in 30% of sports clubs, and were most common among football (56%), diving (43%) and life-saving (41%). This study suggests that policy development for health promotion can be achieved in sports clubs when it is well supported by health agencies and consideration is given to the appropriateness of the specific behaviours to be encouraged for a given sport. Communication between associations and clubs needs to be monitored by health agencies to ensure support and resources for policy development to reach the club level.

Women's satisfaction with their breast prosthesis: what determines a quality prosthesis?

The aim of this study is to determine what factors constitute a quality prosthesis and ascertain which factors affect prosthesis satisfaction. Sixty-four women who received full funding for their prosthesis and 38 women who received their hospital's usual funding were recruited. Women rated the information provided about breast prostheses very highly, with 85% reporting that it was "very good" or "excellent." Satisfaction was significantly associated with how well the prosthesis fit (1 week, p = .001; 3 months, p = .01), level of comfort (3 months, p=.005), and appearance of the prosthesis when worn (6 months, p = .001). Quality was significantly associated with how well it fit (1 week, p = .001; 3 months, p = .001), how natural it felt (1 week, p = .001; 6 months, p = .01), the weight of the prosthesis (3 months, p = .003), and appearance when worn (6 months, p = .03). The results will be used to improve women's access to a quality prosthesis.

Sun exposure and sun protection behaviours among Australian adolescents: trends over time.

BACKGROUND: This study compared the sun exposure and sun protection behaviours of adolescent students between 1993 and 1999. METHODS: Schools from all Australian states and the two territories participated in each of the 1993, 1996, and 1999 surveys and a sample of students from years 7 to 12 were surveyed. In each of the states and territories a random sample of schools was selected within each education sector (government, Catholic, independent). The questionnaire was a self-completed booklet with questions about sunburn history during the previous summer, tan preferences, skin-type, and usual reported behaviour. Data from a total of 78,032 students were available for analysis. RESULTS: From 1993 to 1999 there was a significant increase in the number of students reporting sunburn during the previous summer (chi(2) = 225.77, df = 2, P < 0.01). However, the percentage of students who preferred no tan at all increased over the same period (chi(2) = 184.47, df = 2, P < 0.01). The percentage of students who usually or always wore clothing that covered most of their body decreased between 1993 and 1999 (chi(2) = 20.46, df = 2, P < 0.01); the percentage of students usually or always wearing maximum protection sunscreen decreased over time (chi(2) = 27.71, df = 2, P < 0.01). Staying in the shade increased from 1993 (26%) to 1996 (32%) but decreased slightly in 1999 (30%). Across all survey years, only 11% of students routinely followed all three protective behaviours of wearing a hat, sunscreen, and clothes that cover the body. CONCLUSIONS: Sun protection practices among adolescents are still below optimal levels. Future educational programs require innovative approaches that aims to change attitudes toward tanning as being healthy and attractive and modify adolescent behaviours in relation to sun exposure.