Exploration of the comorbidity of alcohol use disorders and mental health disorders among inpatients presenting to all hospitals in New South Wales, Australia.

Alcohol is one of the most commonly used legal psychoactive substances, and its use often coexists with mental health disorders. This study explores the relationships between alcohol use and some common mental health disorders. Admissions to all New South Wales (NSW) hospitals were analyzed. The data were extracted from the NSW Department of Health Inpatient Statistics Data Collection for the period 1 July 2006 to 30 June 2007. Readmissions within 28 days were excluded. Data extraction and analyses were performed by using the SAS program. Chi-square tests and odds ratio were used to measure the association. Of the 1.8 million admissions, associations between alcohol use disorders and mental health disorders were strong (odds ratio 7.8 to 10.7, P < .001). A 33.8% of patients who used alcohol had at least 1 identifiable mental disorder. Higher comorbidity rates were observed for females (39.6%) and for those aged between 30 and 49 years. The most common mental disorders were anxiety disorders, bipolar affective disorders, major depressive disorders, personality disorders, schizophrenia, and severe stress disorders. Comorbidity with one of these mental disorders ranged from 1% to 17.6%, with significant associations (odds ratio 5.6 to 14.1). The average length of stay (ALOS) for alcohol use disorders were 6.4 days and the ALOS for the most common mental health admissions was 11.2 days. This study provides detailed information about the association between alcohol use and mental health disorders and extends our understanding of comorbidity presentations in inpatient admissions.

[Epidemiological survey on clonorchiasis sinensis in an endemic area of South Hunan Province].

OBJECTIVE: To make an epidemiological investigation on clonorchiasis sinensis and relevant factors in the south of Hunan Province. METHODS: One village from each of Lengshuitan District and Qiyang County was selected for the survey from November to December in 2006. Stool samples from villagers were collected and examined by modified Kato-Katz method. Questionnairing was performed for relevant knowledge and attitude among residents. The infection rate in animal reservoirs and intermediate hosts were detected. RESULTS: A total of 586 cases with Clonorchis sinensis infection were found from 777 people with a prevalence of 75.4%. The average egg density was 451 eggs per gram (EPG) feces. Light, moderate and heavy infections occupied 85.5% (501/586), 14.0% (82/586), and 0.5% (3/586) respectively. Prevalence in males and females was 76.9% (316/411) and 73.8% (270/366) respectively with no significant difference (chi2 = 1.013, P > 0.05). Infections were found in all age groups, with the highest prevalence in the group of 70 to 79 years (85.7%, 30/35). By occupations, the prevalence was 82.5% (447/542) in peasants, 79.3% (42/53) in doctors, 73.7% (28/38) in teachers, and 73.5% (25/34) in local cadres. The infection rate was 17.4% (29/167) and 7.4% (2/27) in Parafossarulus seriatulus and Alocinma longicornis, and 69.2% (9/13) and 5.3% (1/19) in Carassius auratus and Cyprinus carpios respectively. Adult worms were found in all 3 dogs dissected. Over 80% inhabitants did not know that this disease can be acquired by eating raw fish. 95.6% (153/160) of the farmers and 56.7% (349/616) of the students had a history of eating raw fish. The water was contaminated with C. sinensis eggs by using untreated feces as fertilizer for farming and by scrubbing pail latrines in the ponds. CONCLUSION: The prevalence of clonorchiasis in human population is high in Lengshuitan District and Qiyang County of Hunan Province. Eating raw fish and using untreated feces as fertilizer are the most important epidemiological factors of the disease.

Competencies for graduate curricula in health, medical and biomedical informatics: a framework.

The rapid emergence of programmes in health informatics, medical informatics and biomedical informatics implies a need for core curricula in these diverse disciplines. This study investigated the recommended competencies for health and medical informatics, aiming to develop a framework for use in curricular development. Current health and medical programmes around the world were analysed to assess how these competencies are reflected in current curricula and to identify new competencies. Several preferred skills and knowledge sets were identified and 40 programs were analysed. Diverse curricular designs were found in these programmes. Competencies such as research skills, knowledge in health information systems and methods for informatics/computer science were the most frequently taught. Knowledge or skills in interpersonal communications, social impact of IT on health, and data mining may represent important skills for future informaticians. The suggested framework and the data analysed may be important for developing a competency-based modular curriculum.

A qualitative study of GPs' views on modern genetics.

BACKGROUND: With rapid advances in genetics and increased public awareness of genetic testing for many hereditary diseases, the demand for genetic services may increase. We wondered how developments in genetics have impacted on general practice and the position general practitioners have taken in practising the new genetics. METHOD: A qualitative study using semi-structured interviews conducted during 2003-2004 with 15 GPs practising in Sydney (New South Wales) and the Australian Capital Territory. RESULTS: General practitioners reported that genetic services had minimal impact on their practice and the number of consultations related to genetic conditions was insignificant. They felt they were often not included in the 'referral loop' of such patients. Their knowledge of advances in genetics was limited. They were wary of the possible costs of testing and the time taken to provide genetic counselling. DISCUSSION: General practitioners' attitudes toward modern genetics seems to be disengaged, and they are ambivalent toward the role they now play, or will play, in genetic services.

Interleukin 12-augmented T cell proliferation of peripheral blood mononuclear cells from HIV-seropositive individuals is associated with interleukin 12 receptor beta 2 upregulation.

Interleukin 12 (IL-12) production is believed to be impaired in individuals with HIV infection and this impairment manifests early in disease, when the CD4(+) cell counts are within normal values. The reduced antigen-specific and mitogen-stimulated T cell-proliferative responses that occur in HIV infection can be corrected by the addition of recombinant human interleukin 12 (rhIL-12). As the IL-12 receptor (IL-12R) is central to the IL-12 signaling pathway, we examined whether the augmentation of antigen-specific proliferation of HIV(+) peripheral blood mononuclear cells (PBMCs) related to altered IL-12R expression. rhIL-12 augmented antigen-specific proliferation of HIV(+) PBMCs but not of HIV(-) PBMCs. Examination of resting PBMCs from HIV(+) and HIV(-) donors showed that neither of these populations expressed IL-12R beta 1 or IL-12R beta 2 chains on their cell surface as detected by flow cytometry. However, examination of mRNA showed that both IL-12R beta 1 and IL-12R beta 2 mRNAs were markedly reduced in HIV(+) PBMCs when compared with HIV(-) PBMCs. After mitogen activation there was an increase in IL-12R beta 1 expression on the cell surface of HIV(+) and HIV(-) PBMCs and this level was not altered by coculture with rhIL-12 or interferon gamma (IFN-gamma). However, coculture of phytohemagglutinin (PHA)-activated HIV(+) or HIV(-) PBMCs with rhIL-12 (but not IFN-gamma) increased IL-12R beta 2 expression on the cell surface of both populations. Examination at the message level showed a correction of IL-12R beta 1 to normal levels with activation that was further enhanced by rhIL-12 coculture for both the HIV(+) and HIV(-) PBMCs. However, although the level of IL-12R beta 2 for the HIV(+) PBMCs was normalized by PHA, rhIL-12 caused a further augmentation. This information provides a strong link between IL-12R upregulation, and the significant improvement in antigen-specific HIV-proliferative responses seen with the addition of rhIL-12. It also reveals that the dysfunction in IL-12R expression seen in cells from HIV(+) patients occurs at the transcriptional level. In addition, we provide further evidence that IL-12R beta 1 and IL-12R beta 2 regulation in human PBMCs is independent of IFN-gamma.

Creating informed consumers and achieving shared decision making.

BACKGROUND: The internet has become a powerful tool to disseminate health information and there are millions of people accessing this free information for a second medical opinion. Consumers seeking information from this resource are more responsible for their own health. However, the quality of health information on the internet varies and there is no simple instrument that can effectively evaluate its quality. OBJECTIVE: This paper reviews recent studies on the validity of instruments or guidelines developed for evaluating health information. It describes government initiatives around the world in establishing quality health information and proposes an alternative way of empowering consumers with reliable health information. It emphasises the importance of the role of primary family physicians in this consumer education process. DISCUSSION: The debate over the quality of health information on the internet and the attempt to use instruments to evaluate the quality of web information are discussed. The relationship between family physicians and consumer informations in this information age is also addressed.

Comorbidity of mental disorders and alcohol- and drug-use disorders: analysis of New South Wales inpatient data.

INTRODUCTION AND AIMS: Alcohol- and other drug-use disorders have been found to be associated with mental disorders, however, complete characteristics of these comorbid mental disorders are not completely clear in early population based studies. This study aimed to explore the extent and profiles of comorbid mental disorders with alcohol- and other drug-use disorders using a large inpatient dataset. METHODS: The data source was the New South Wales (NSW) Inpatient Statistic Data Collection which collects the clinical data of hospital admissions in NSW, Australia. The data were coded using the International Classification of Diseases-10th Revision (ICD-10). The data were from 1 July 2005 to 30 June 2006 the Australian financial year and statistical analysis was performed using SAS. RESULTS: Of 1 592 156 patients admitted, 91 510 (6%) had at least one mental disorder diagnosis and 18 283 (1.1%) had at least one alcohol- or other drug-related diagnosis. Of these patients, an overall 9.6% had dual diagnoses. Comorbidity was nearly five times higher in alcohol- and other drug-use disorders than in mental health disorders (52.4% vs. 10.5%). Comorbidity was higher in males than females (12% vs. 7.1%) and was the most common in patients aged from 20 to 49 regardless of sex. There was a significantly increased risk of developing a comorbid condition in all age groups above 10 years. The most common mental health disorders were major depressive disorders, followed by dementia, anxiety and severe stress. Alcohol-use disorder was the most common diagnosis, followed by cannabis and opioids. DISCUSSION AND CONCLUSION: This study shows the characteristics of comorbid mental and alcohol- or other drug-use disorders. The study extends our understanding of issues addressed in previous population studies.

Clinical patterns of obstructive sleep apnea and its comorbid conditions: a data mining approach.

OBJECTIVES: Obstructive sleep apnea often results in a wide range of comorbid conditions. Although some conditions have been clearly identified as comorbid, a full clinical pattern of associated diseases has not been systematically documented. This research aimed to reveal the full pattern of comorbid conditions associated with OSA by employing a data mining technique. METHODS: A large data repository (the New South Wales inpatient Data Collection) collected between 1999 and 2004 was mined, and all clinical diagnoses were coded with ICD-10-AM codes. RESULTS: A total of 60,197 cases (4% of total records) were identified as related to OSA (72.2% males, 27.8% females). OSA occurrence showed 2 peaks at 0-4 years and 55-59 years. A strikingly low occurrence was observed for the adolescent years. Conditions comorbid with OSA in adults by descending frequency were essential hypertension, obesity, hypercholesterolemia, type 2 diabetes, past or current tobacco use, and ischemic heart conditions. Obesity and OSA showed a similar time course of onset, with a latent period of 5 years for hypertension and type 2 diabetes and 15 years for chronic ischemic heart conditions. Comorbid conditions were predominantly of the cardiovascular, endocrine/metabolic and respiratory systems. The data also indicated OSA patients are high users of health services. CONCLUSIONS: The data mining technique confirms the prevalence of the disease, describes the age distribution patterns and time courses of disease development from obesity and OSAto comorbid conditions, and implicates possible interrelationships among these conditions and high cost of treating OSA patients.