Safety first: Beliefs of older peers supplying alcohol to underage friends.

ISSUE ADDRESSED: Underage drinkers most commonly source alcohol from older peers. However, few studies have examined older peers' supply-related beliefs and motivations. METHODS: A sample of 270 risky drinkers aged 18-19 years were interviewed in Australia where the legal purchase age is 18. They were asked about their provision to underage friends, awareness of secondary supply legislation (intended to prohibit such supply) and 24 psycho-legal beliefs around supply. RESULTS: Half (49%) provided alcohol to a 16- to 17-year-old friend to drink at a party they were both attending at least twice a year. Three-quarters reported provision was okay so long as the recipient(s) were in a safe environment, and 46% reported "everyone gives alcohol to teenagers if they are in a safe environment." There was significantly higher agreement that "my friends would think I was mean if I did not give alcohol to a friend under the age of 18" (37%), compared to "my friends would think I was uncool if I did not give alcohol to a friend under the age of 18" (26%). Two thirds (69%) felt more responsible for an underage friend's safety if they provided the alcohol. A multivariate logistic regression revealed supply was more likely if the supplier: was aged 18 compared to 19 (95% CI OR: 1.57, 4.84), male (1.06, 3.27), of a higher SES quintile (1.08, 1.80) and believed alcohol supply to minors was morally acceptable (1.01, 1.33) and normal (1.04, 1.38). Knowledge of regulatory strategies (68%) designed to prevent supply to minors, and their perceived deterrent value did not significantly impact supply. CONCLUSIONS: Supply of alcohol to underage peers was perceived as morally and socially acceptable in a group of 18- to 19-year-old risky drinkers. SO WHAT?: Opportunities include harm reduction initiatives that prioritise caring responsibilities towards friends, as opposed to relying on external enforcement measures alone.

Alcohol supply as a favour for a friend: Scenarios of alcohol supply to younger friends and siblings.

ISSUES ADDRESSED: Adolescents under the legal purchase age primarily source their alcohol through social networks. This study assessed the provision context from the perspective of both underage recipients and their suppliers who were older peers and siblings. METHODS: Interviewer-administered surveys were conducted with 590 risky-drinking (50 g alcohol per session, at least monthly) adolescents. Participants of legal purchase age (18- to 19-year-olds; n = 269) reported their provision to 16- to 17-year-olds under eight scenarios. Those aged 14-17 (n = 321) reported receipt of alcohol under the same scenarios plus two parental supply contexts. RESULTS: Purchase-age participants reported supply: to an underage friend (67%), an acquaintance (44%) or a sibling (16%) to drink at the same party; to a friend (43%) or sibling (20%) to take to another party (20%) and to a stranger near a bottle shop (5%). Supply to a friend at the same party was more likely if money was exchanged (60% vs 40%; P < 0.001). Almost all (98%) 14- to 17-year-olds reported receiving alcohol from an adult (including 36% from a parent for consumption away from the parent), with a similar pattern of receipt scenarios as those reported by the 18- to 19-year-olds. CONCLUSIONS: Provision of alcohol was more frequent with a friend than a sibling or stranger, in close environmental proximity, and if money was exchanged. SO WHAT?: As supply may be sensitive to monetary considerations, the incidence of underage receipt may be affected by community-wide pricing measures. Traditional alcohol availability regulations should be supplemented by strategies relating to the social nature of supply and demand.

Comparison of Government and Non-Government Alcohol and Other Drug (AOD) Treatment Service Delivery for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community.

BACKGROUND: Lesbian, gay, bisexual, and transgender (LGBT) populations are more likely to misuse alcohol and other drugs (AOD), compared to the general population. However, LGBT engagement with AOD treatment is often precluded by insensitivity and misunderstanding of LGBT issues. These treatment barriers may be a consequence of either worker attitudes, organizational factors or a combination of both. Few studies have compared service context as an impediment to AOD treatment. OBJECTIVES: This pilot study sought to examine and compare staff attitudes, knowledge and awareness of LGBT issues in two state-wide AOD services within Australia. One organization was a government service, whilst the other was faith based. METHODS: A cross-sectional study of a convenience sample (N = 130) of workers employed in a state-wide government AOD service (n = 65), and a state-wide non-government service (n = 65) was conducted. Participants self-completed a questionnaire comprising tools previously used to assess staff attitudes, knowledge and awareness of LGBT issues. RESULTS: Few significant differences in attitudes and awareness of LGBT issues between government and non-government respondents were found. Nearly all respondents were supportive of LGBT persons irrespective of organizational context, with a small number of negative views. Although most respondents demonstrated awareness of organizational policies and practices relating to LGBT clients, many were "unsure" or "neutral" of what these might be. CONCLUSION: It is confirming that the majority of staff report supportive attitudes towards LGBT clients. Findings suggest that organizations need to continue to take leadership to strengthen organizational training and capacity to deliver LGBT friendly AOD treatment practices.

Refinement and revalidation of the demoralization scale: The DS-II-external validity.

BACKGROUND: The recently refined Demoralization Scale-II (DS-II) is a 16-item, self-report measure of demoralization. Its 2 factors-Meaning and Purpose and Distress and Coping Ability-demonstrate sound internal validity, including item fit, unidimensionality, internal consistency, and test-retest reliability. The convergent and discriminant validity of the DS-II with various measures is reported here. METHODS: Patients who had cancer or other progressive diseases and were receiving palliative care (n = 211) completed a battery of questionnaires, including the DS-II and measures of symptom burden, quality of life, depression, and attitudes toward the end of life. Spearman ρ correlations were determined to assess convergent validity. Mann-Whitney U tests with calculated effect sizes were used to examine discriminant validity and establish the minimal clinically important difference (MCID). Cross-tabulation frequencies with chi-square analyses were used to examine discriminant validity with major depression. RESULTS: The DS-II demonstrated convergent validity with measures of psychological distress, quality of life, and attitudes toward the end of life. It also demonstrated discriminant validity, as the DS-II differentiated patients who had different functional performance levels and high/low symptoms, with a difference of 2 points between groups on the DS-II considered clinically meaningful. Furthermore, discriminant validity was demonstrated, as comorbidity with depression was not observed at moderate levels of demoralization. CONCLUSIONS: The DS-II has sound psychometric properties and is an appropriate measure of demoralization. Given its structural simplicity and brevity, it is likely to be a useful tool in meaning-centered therapies. Cancer 2016;122:2260-7. © 2016 American Cancer Society.

Refinement and revalidation of the demoralization scale: The DS-II-internal validity.

BACKGROUND: The Demoralization Scale (DS) was initially validated in 2004 to enable the measurement of demoralization in patients with advanced cancer. Subsequent shortcomings indicated the need for psychometric strengthening. Here, the authors report on the refinement and revalidation of the DS to form the DS-II, specifically reporting the scale's internal validity. METHODS: Patients with cancer or other progressive diseases who were receiving palliative care (n = 211) completed a revised version of the 24-item DS and a measure of symptom burden (the Memorial Symptom Assessment Scale). Exploratory factor analysis and Rasch modeling were used to evaluate, modify, and revalidate the scale, providing information about dimensionality, suitability of response format, item fit, item bias, and item difficulty. Test-retest reliability was examined for 58 symptomatically stable patients at a 5-day follow-up. RESULTS: Exploratory factor analysis supported a 22-item, 2-component model. Separate Rasch modeling of each component resulted in collapsing the response option categories and removing 3 items from each component. Both final 8-item subscales met Rasch model expectations and were appropriate to sum as a 16-item total score. The DS-II demonstrated internal consistency and test-retest reliability (Meaning and Purpose subscale: α = .84; intraclass correlation [ICC] = 0.68; Distress and Coping Ability subscale: α = .82; ICC = 0.82; total DS: α = .89; ICC = 0.80). CONCLUSIONS: The DS-II is a 3-point response, self-report scale comprising 16 items and 2 subscales. Given its revalidation, psychometric strengthening, and simplification, the DS-II is an improved and more practical measure of demoralization for research and clinical use. External validation of the DS-II will be reported subsequently. Cancer 2016;122:2251-9. © 2016 American Cancer Society.

Addressing inequities in alcohol consumption and related harms.

Social determinants, or the conditions in which individuals are born, grow, live, work and age, can result in inequities in health and well-being. However, to-date little research has examined alcohol use and alcohol-related problems from an inequities and social determinants perspective. This study reviewed the evidence base regarding inequities in alcohol consumption and alcohol-related health outcomes in Australia and identified promising approaches for promoting health equity. Fair Foundations: the VicHealth framework for health equity was used as an organizing schema. The review found that social determinants can strongly influence inequities in alcohol consumption and related harms. In general, lower socioeconomic groups experience more harm than wealthier groups with the same level of alcohol consumption. While Australia has implemented numerous alcohol-related interventions and policies, most do not explicitly aim to reduce inequities, and some may inadvertently exacerbate existing inequities. Interventions with the greatest potential to decrease inequities in alcohol consumption and alcohol-related harms include town planning, zoning and licensing to prevent disproportionate clustering of outlets in disadvantaged areas; interventions targeting licensed venues; and interventions targeting vulnerable populations. Interventions that may worsen inequities include national guidelines, technological interventions and public drinking bans. There is a need for further research into the best methods for reducing inequities in alcohol consumption and related harms.

Cannabis use and quality of life of adolescents and young adults: findings from an Australian birth cohort.

Cannabis is generally used to enhance mood (quality of life), but it is not known whether it has this effect in the medium to longer term. Little is currently known about the temporal sequence between cannabis use and the quality of life (QOL). Data are taken from a prospective longitudinal study of pregnant women recruited at their first antenatal visit in Brisbane, Australia. Offspring data from the follow-ups with 14-year-olds and 21-year-olds are used here. Indicators of QOL, happiness, and satisfaction at 14 years are considered as predictors of subsequent cannabis use. The association between cannabis use and QOL at 21 years, adjusting for prior QOL (14 years), is also examined. Socio-demographic characteristics were included as potential confounders relevant to QOL assessments. In this cohort, lower QOL in the early teenage years predicted subsequent onset of cannabis use in young adulthood. After adjustment for socio-demographic characteristics and for QOL pre-cannabis use, participants who used cannabis more frequently had a lower QOL at the 21-years follow-up. Frequent use of cannabis does not appear to enhance the user's QOL and appears to be associated with a reduced QOL into young adulthood.

The sources of pharmaceuticals for problematic users of benzodiazepines and prescription opioids.

OBJECTIVES: To describe benzodiazepine and prescription opioid use by clients of drug treatment services and the sources of pharmaceuticals they use. DESIGN: Structured face-to-face interviews on unsanctioned use of benzodiazepines and prescription opioids were conducted between January and July 2008. PARTICIPANTS: Convenience sample of treatment entrants who reported regular (an average of ≥ 4 days per week) and unsanctioned use of benzodiazepines and/or prescription opioids over the 4 weeks before treatment entry. SETTING: Drug treatment services in Victoria, Queensland, Western Australia and Tasmania. MAIN OUTCOME MEASURES: Participant demographics, characteristics of recent substance use, substance use trajectories, and sources of pharmaceuticals. RESULTS: Two hundred and four treatment entrants were interviewed. Prescription opioids were predominantly obtained from non-prescribed sources (78%, 84/108). In contrast, medical practitioners were the main source for benzodiazepines (78%, 113/144). Forging of prescriptions was extremely uncommon. A mean duration of 6.3 years (SD, 6.6 years) for benzodiazepines and 4.4 years (SD, 5.7 years) for prescription opioids was reported between first use and problematic use--a substantial window for intervention. CONCLUSIONS: Medical practitioners are an important source of misused pharmaceuticals, but they are not the main source of prescription opioids. This has implications for prescription drug monitoring in Australia: current plans (to monitor only Schedule 8 benzodiazepines and prescription opioids) may have limited effects on prescription opioid users who use non-prescribed sources, and the omission of most benzodiazepines from monitoring programs may represent a lost opportunity for reducing unsanctioned use of benzodiazepines and associated harm.

Quality of life of people who inject drugs: characteristics and comparisons with other population samples.

PURPOSE: To assess the quality of life (QOL) of persons who inject drugs. METHODS: Some 483 current injecting drug users visiting a large NSP over a 2-week period in October 2009 were interviewed using a structured questionnaire. QOL was measured using the WHOQOL-BREF. Data were collected on age, gender, injecting patterns, current drug treatment status and hepatitis C status. Participant QOL profiles were compared to published domain scores for a range of other population groups. RESULTS: People who inject drugs (PWID) experience a very poor QOL irrespective of socio-demographic characteristics, injecting patterns, hepatitis C sero-status and drug treatment status. Sample participants (PWID) experience a QOL below that experienced by many population groups in the community affected by disabling chronic illnesses. CONCLUSIONS: Injecting drug use is associated with a poor QOL. Some PWID may be self-medicating for chronic non-malignant pain, and it is likely that these people had a low QOL prior to the decision to inject. Despite this caveat, it remains likely that injecting drug use does little to enhance the QOL of the user.

Disclosures of harming others during their most recent drinking session: Findings from a large national study of heavy-drinking adolescents.

INTRODUCTION: The extant Alcohol's Harms to Others (AHTO) literature is largely comprised of reports from victims. We investigated AHTO from perpetrators' perspectives, including how harms were associated with individual characteristics, and alcohol quantities consumed during the perpetration incident. METHODS: Participants (N = 2932) were 14-19 years old, recruited primarily through social media and screened as risky drinkers. They completed face-to-face (n = 594) or self-administered (n = 2338) surveys. They self-reported whether during their last risky drinking session (LRDS) they had perpetrated any verbal abuse, physical abuse or property damage. A multinomial logistic regression examined whether nine factors were associated with perpetrating zero, one or 2+ categories of AHTO. RESULTS: Eleven percent (n = 323) reported perpetrating at least one form of AHTO (7.5% verbal, 1.9% physical and 4.6% property). Perpetration of AHTO at LRDS was uniquely associated with: younger age, male gender, experiences of childhood physical punishment, greater perpetration incident-specific drinking, concurrent illicit drug use, and less frequent use of safety strategies while drinking in the past 12 months. Controlling for the other variables, an increase of six Australian standard drinks (60 g of alcohol) increased the odds of perpetration by 15% [95% confidence interval (CI) adjusted odds ratio (AOR) 1.08, 1.23], and an increase of 15 Australian standard drinks increased the odds by 42% (95% CI AOR 1.20, 1.69). DISCUSSION AND CONCLUSIONS: Individual characteristics, larger quantities of alcohol consumed, and a disinclination to practice harm reduction amplified risk of AHTO perpetration. This has implications for health promotion and risk prevention/reduction strategies.

Women's use of nonprescribed methods to induce labor: a brief report.

BACKGROUND: Sometimes pregnant women take it on themselves to hasten labor to alleviate the discomforts of pregnancy. This study sought to identify how frequently women attempt to induce labor through nonprescribed methods, and what factors are associated with the use of such methods. METHODS: Surveys were distributed to postpartum women who had delivered at a Midwestern academic hospital. Women were asked what methods they had used to induce labor on their own, where they heard about these methods, and whether they had discussed it with their physician. Information about demographics and mode and timing of delivery was also collected. RESULTS: Of the 201 women who responded, 99 (49.3%) did not try to induce labor themselves, whereas 102 (50.7%) used some type of nonprescribed method to induce labor. The most common method was walking (43.3%), followed by intercourse (22.9%), ingesting of spicy food (10.9%), and nipple stimulation (7.5%). Very few respondents used laxatives, heavy exercise, masturbation, acupuncture, or herbal preparations to induce labor. Women who used any nonprescribed method to induce labor were younger, had a lower parity, greater gestational age, and were more likely to have had a vaginal birth. CONCLUSIONS: A substantial portion of women used nonprescribed methods to induce labor, often without discussing them with a physician. Maternity caregivers may want to inquire about such issues, especially where interventions may do more harm than good.

Commercial sexual practices before and after legalization in Australia.

The nature of sex work changes over time for many reasons. In recent decades around the world, there has been movement toward legalization and control of sex economies. Studies of the possible impact of legalization mainly have focused on sexually transmitted infections and violence, with little attention to change in the diversity of sexual services provided. This study examined the practices of sex workers before and after legalization of prostitution. Cross-sectional surveys of comparable samples of female sex workers were conducted in 1991 (N = 200, aged 16-46 years) and 2003 (N = 247, aged 18-57 years) in Queensland, Australia, spanning a period of major change in regulation of the local industry. In 2003, male clients at brothels and private sole operators (N = 161; aged 19-72 years) were also interviewed. Over time, there was a clear increase in the provision of "exotic" sexual services, including bondage and discipline, submission, fantasy, use of sex toys, golden showers, fisting, and lesbian double acts, while "traditional" services mostly remained at similar levels (with substantial decrease in oral sex without a condom). Based on comparisons of self-reports of clients and workers, the demand for anal intercourse, anal play, and urination during sex apparently exceeded supply, especially in licensed brothels. Within this population, legalization of sex work coincided with a substantial increase in diversity of services, but it appears that in the regulated working environments, clients who prefer high risk practices might not dictate what is available to them.

The health of female sex workers from three industry sectors in Queensland, Australia.

Previous studies have reported poor mental health amongst sex workers without distinguishing the context in which commercial sex is provided. This study describes the self-reported mental and physical health of female sex workers in three industry sectors in Queensland, Australia. In 2003, cross-sectional convenience sampling was used to collect data from 247 female sex workers working in licensed brothels (n=102), as private sole operators (n=103) and illegally (n=42). The average age was 32 years (range 18-57), with most participants being born either in Australia or New Zealand. Overall, there were few differences in the physical health of women from different industry sectors. Illegal (and predominantly street-based) sex workers were four times more likely to report poor mental health with some of this difference attributable to the particular social background of this group. Much of the increased levels of poor mental health among illegal sex workers were associated with more negative experiences before, and subsequent to entering the sex industry. These patterns were not seen among women from the legal industry sectors. This research suggests that illegal, street-based sex workers, from whom many previous results have been derived, may show patterns of disadvantage, and health outcomes not seen in sex workers from other industry sectors.

Operationalising the quality of life construct in studies of alcohol and drug residential rehabilitation programme clients: A systematic review.

INTRODUCTION AND AIMS: Quality of life (QOL) is increasingly recognised as an important treatment indicator in the alcohol and other drug (AOD) sector, particularly in treatment modalities providing 'whole of life programmes', such as residential rehabilitation. However, it is currently unclear how studies conducted in AOD residential rehabilitation settings have operationally defined and measured QOL. This study therefore aimed to determine current practices in defining and measuring the QOL of residential rehabilitation clients. DESIGN AND METHODS: A systematic review of studies examining the QOL of AOD residential rehabilitation clients was conducted. Potential studies published in English between 1990 and 2018 were identified through a search of electronic databases (e.g. PsycINFO and PubMed), search engines (Google Scholar) and article reference lists. RESULTS: The search identified a total of 1267 records, of which 16 met the inclusion criteria. Less than half of the included studies provided an operational definition of QOL. QOL was generally understood to be a subjective, multidimensional, client assessment construct. Twelve different instruments were used to assess QOL, of which two enabled clients to identify QOL dimensions important to themselves. DISCUSSION AND CONCLUSIONS: QOL has been inconsistently measured in studies of AOD residential rehabilitation clients. As a result, the comparability and validity of research in this field may be weakened. There is a need to develop a consensual operational definition of QOL, including a core set of domains relevant to and endorsed by residential rehabilitation clients. Appropriate tools to measure client QOL need to be identified and disseminated.

From eye rolls to punches: experiences of harm from others' drinking among risky-drinking adolescents across Australia.

OBJECTIVES: Exploration of experience of harms due to another person's drinking within a demographic particularly vulnerable to these consequences. Importance of study: Largest sampling of young Australian risky drinkers, who are underrepresented in general population surveys. The range of harms due to others' drinking reported here is more comprehensive than documented elsewhere. STUDY TYPE: Cross-sectional self-report survey. METHODS: Participants were 14-19 years old and screened as being within the riskiest-drinking 25% for their age cohort. The convenience sample of 3465 was recruited primarily by social media advertising. Face-to-face interviews were conducted in all eight Australian capital cities (n = 596), supplemented by online surveys (n = 2869). Past 12-month experience of 13 harms due to others' drinking was assessed by age, gender and perpetrator. RESULTS: Females were more likely to experience seven harms, mainly characterised by fear and harassment, including being harassed or bothered at a party or some other private setting (41% vs 34% of males, p < 0.001), being given unwanted sexual attention (71% vs 47%, p < 0.001) and being put in fear (33% vs 20%, p < 0.001). Males were more likely to experience three harms, characterised by aggression: being yelled at, criticised or verbally abused (38% vs 33% of females, p = 0.002), being pushed or shoved (42% vs 28%, p < 0.001) and being physically hurt (17% vs 11%, p < 0.001). Teenagers of a legal alcohol-purchase age were more likely to experience harassment in public settings (49% vs 32-34%, p < 0.001) and unwanted sexual attention (66% vs 51-59%, p < 0.001) compared with younger teenagers. Seven of the harms studied were more likely (p < 0.01) to be perpetrated by people the respondents knew, and five (those associated with fear and aggression) were more likely to be perpetrated by strangers. CONCLUSION: Young people who are risky drinkers commonly experience multiple harms from others' drinking. Many of these alcohol harms to others are reported here for the first time, as previous studies of adolescent drinking have focused almost exclusively on the harms young people have experienced from their own drinking. This refocusing on the harms caused by the drinking of others may prompt greater community concern and concomitant calls for better alcohol regulation.

Automatic referral to cardiac rehabilitation.

The pervasive negative impact of cardiovascular disease in the United States is well documented. Although advances have been made, the campaign to reduce the occurrence, progression, and mortality continues. Determining evidence-based data is only half the battle. Implementing new and updated clinical guidelines into daily practice is a challenging task. Cardiac rehabilitation is an example of a proven intervention whose benefit is hindered through erratic implementation. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American College of Cardiology (ACC), and the American Heart Association (AHA) have responded to this problem by publishing the AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services. This new national guideline recommends automatic referral to cardiac rehabilitation for every eligible patient (performance measure A-1). This article offers guidance for the initiation of an automatic referral system, including individualizing your protocol with regard to electronic or paper-based order entry structures.

Insomnia and Regulation of Sleep-Wake Cycle With Drugs Among Adolescent Risky Drinkers.

STUDY OBJECTIVES: We aimed to explore symptoms of insomnia in a group of youths characterized as engaging in risky drinking, their use of drugs as sleep/ wake aids, and the relationships between alcohol and other drug use and insomnia. METHODS: Face-to-face interviews were conducted with 596 Australian 14 to 19-year-olds identified as engaging in regular risky drinking. They completed the Insomnia Severity Index and were assessed for recent alcohol and other drug use, including drugs used specifically as sleep aids or to stay awake. Alcohol-related problems, emotional distress, self-control, and working outside of traditional hours were also assessed using validated scales. RESULTS: More than one-third of the study participants (36%) reported moderate to very severe sleep-onset insomnia, and 39% screened positive for clinical insomnia using adolescent criteria. Three-fourths used drugs in the past 2 weeks to regulate their sleep cycle (65% used stimulants to stay awake, mainly caffeine, and 32% used a depressant to get to sleep, mainly cannabis). Regression analyses showed that after controlling for variables such as sex, emotional distress, self-control, alcohol use problems, and past 6-month illicit or non-prescribed drug use, those who used drugs specifically to get to sleep or to stay awake were 2.0 (P < .001) and 1.7 (P = .02) times more likely to report clinical insomnia, respectively. CONCLUSIONS: Insomnia was commonly reported in this community sample of adolescents characterized as engaging in risky drinking. Those with symptoms of insomnia appeared to be managing their sleep-related symptoms through alcohol and other drug use, which may have further exacerbated their sleep issues.

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.

Palliating symptoms other than pain.

BACKGROUND: Symptoms other than pain are a heavy burden for patients with either malignant or progressive nonmalignant disease and significantly reduce quality of life. OBJECTIVE: This article discusses the management of symptoms of malignant or progressive nonmalignant disease in the general practice setting. DISCUSSION: The approach to management of the symptoms of malignant or progressive nonmalignant disease is the same, regardless of the diagnosis. Management includes evaluation, treatment--depending on the underlying pathological mechanism, explanation for both the patient and their family, and ongoing review of goals of care.

Men, Work, and Mental Health: A Systematic Review of Depression in Male-dominated Industries and Occupations.

Among men, depression is often unrecognised and untreated. Men employed in male-dominated industries and occupations may be particularly vulnerable. However, efforts to develop tailored workplace interventions are hampered by lack of prevalence data. A systematic review of studies reporting prevalence rates for depression in male dominated workforce groups was undertaken. Studies were included if they were published between 1990 - June 2012 in English, examined adult workers in male-dominated industries or occupations (> 70% male workforce), and used clinically relevant indicators of depression. Twenty studies met these criteria. Prevalence of depression ranged from 0.0% to 28.0%. Five studies reported significantly lower prevalence rates for mental disorders among male-dominated workforce groups than comparison populations, while six reported significantly higher rates. Eight studies additionally found significantly higher levels of depression in male-dominated groups than comparable national data. Overall, the majority of studies found higher levels of depression among workers in male-dominated workforce groups. There is a need to address the mental health of workers in male-dominated groups. The workplace provides an important but often overlooked setting to develop tailored strategies for vulnerable groups.