Polypharmacy and drug-drug interactions among older and younger male prisoners in Switzerland.

PURPOSE: The purpose of this paper is to determine the prevalence of polypharmacy and drug-drug interactions (DDIs) in older and younger prisoners, and compared if age group is associated with risks of polypharmacy and DDIs. DESIGN/METHODOLOGY/APPROACH: For 380 prisoners from Switzerland (190 were 49 years and younger; 190 were 50 years and older), data concerning their medication use were gathered. MediQ identified if interactions of two or more substances could lead to potentially adverse DDI. Data were analysed using descriptive statistics and generalised linear mixed models. FINDINGS: On average, older prisoners took 3.8 medications, while younger prisoners took 2.1 medications. Number of medications taken on one reference day was higher by a factor of 2.4 for older prisoners when compared to younger prisoners (p = 0.002). The odds of polypharmacy was significantly higher for older than for younger prisoners (>=5 medications: odds ratio = 5.52, p = 0.035). Age group analysis indicated that for potentially adverse DDI there was no significant difference (odds ratio = 0.94; p = 0.879). However, when controlling for the number of medication, the risk of adverse DDI was higher in younger than older prisoners, but the result was not significant. ORIGINALITY/VALUE: Older prisoners are at a higher risk of polypharmacy but their risk for potentially adverse DDI is not significantly different from that of younger prisoners. Special clinical attention must be given to older prisoners who are at risk for polypharmacy. Careful medication management is also important for younger prisoners who are at risk of very complex drug therapies.

Prescription of pain medication in prisons: A comparative analysis of younger and older male prisoners.

PURPOSE: In prison populations, treating pain is particularly challenging, especially for the growing number of older prisoners. The objective was to find out about prevalence, frequency, and types of pain medications prescribed to older prisoners (≥50 years) in comparison with younger prisoners (<50 years). METHODS: Data were collected in Switzerland as part of a study on ageing prisoners' health. Fifteen prisons (out of 26 of the total eligible population) agreed to take part, and data from medical records of 190 older and 190 younger male prisoners were analysed. Descriptive statistics on pain medication prescriptions (excluding drugs used in opioid dependence) were carried out and differences between the 2 age groups tested for statistical significance. RESULTS: More than half of younger and older prisoners were prescribed pain medication during the past 180 days, while 10% of younger and 15% of older prisoners were prescribed pain medication on a daily basis. Nonsteroidal anti-inflammatory drugs and "other analgesics and antipyretics" were most frequently prescribed. Significantly (P < .05), more younger than older prisoners were prescribed NSAIDs and drugs to treat muscle skeletal pain. Tramadol was the opioid most often prescribed. CONCLUSIONS: This is the first empirical study investigating prescriptions of pain medication in Swiss prisoners on a national level. It shows that nonopioid pain medication is an important part of health care provision inside prison, while there are only few prescriptions of strong opioids. Research is needed to investigate whether the standard set by the principle of equivalence is met regarding treatment of pain in prison.

Can routine data from prisoners' files be used to estimate prevalence rates of illicit drug use among prisoners?

OBJECTIVES: The paper examines whether routine data from prisoners' files is a useful basis to estimate prevalence rates of illicit drug use among prisoners. METHODS: Medico-legal files of 190 younger (20-49 years) and 190 older (50-75 years) male prisoners from 13 prisons in Switzerland were analysed. Indications of illicit drug use were extracted based on recorded legal measures, notes from health care professionals, diagnoses related to the use of illicit substances, prescribed medications, other treatment indicators, and results from mandatory drug tests in prison. RESULTS: Estimated lifetime prevalence of illicit drug use based on those indicators is 50.0% for younger and 24.2% for older prisoners. Current cannabis use is an estimated 10.0% and current cocaine, opioids, or other drug use 4.7% for younger prisoners. Among older prisoners, prevalence of current cannabis use is an estimated 3.2% and of other drug use 0.5%. CONCLUSIONS: The paper concludes that analysing routine data is a reasonable alternative to surveys if prisoners' files are kept more complete and concise and if data is collected for no other purpose than to benefit prisoners' health.

Contextual determinants of alcohol consumption changes and preventive alcohol policies: a 12-country European study in progress.

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and 2008 are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.

Revising the Cannabis Use Disorders Identification Test (CUDIT) by means of Item Response Theory.

Cannabis use among adolescents and young adults has become a major public health challenge. Several European countries are currently developing short screening instruments to identify 'problematic' forms of cannabis use in general population surveys. One such instrument is the Cannabis Use Disorders Identification Test (CUDIT), a 10-item questionnaire based on the Alcohol Use Disorders Identification Test. Previous research found that some CUDIT items did not perform well psychometrically. In the interests of improving the psychometric properties of the CUDIT, this study replaces the poorly performing items with new items that specifically address cannabis use. Analyses are based on a sub-sample of 558 recent cannabis users from a representative population sample of 5722 individuals (aged 13-32) who were surveyed in the 2007 Swiss Cannabis Monitoring Study. Four new items were added to the original CUDIT. Psychometric properties of all 14 items, as well as the dimensionality of the supplemented CUDIT were then examined using Item Response Theory. Results indicate the unidimensionality of CUDIT and an improvement in its psychometric performance when three original items (usual hours being stoned; injuries; guilt) are replaced by new ones (motives for using cannabis; missing out leisure time activities; difficulties at work/school). However, improvements were limited to cannabis users with a high problem score. For epidemiological purposes, any further revision of CUDIT should therefore include a greater number of 'easier' items.

Leisure time activities that predict initiation, progression and reduction of cannabis use: a prospective, population-based panel survey.

INTRODUCTION AND AIMS: Frequent cannabis consumption can lead to severe physical and mental harm. As cannabis is often consumed in leisure time, this study aimed at identifying differences in leisure time activities that predicted the severity of cannabis use. DESIGN AND METHODS: In a prospective population-based survey on cannabis use a cohort of 5025 subjects aged 13-29 years were assessed by telephone interview and followed up 3 years later. Different leisure time activities and the persons (e.g. partner, friend, sibling) the activities were spent with were analysed for the initiation, progression and reduction/cessation of cannabis use over time using multinomial and ordered logistical regression models. RESULTS: The persons the leisure time was spent with at baseline led to a higher probability of initiation and progression of cannabis use over time than the type of leisure time activity. There also was a tendency for tobacco use to increase during the progression phase and to remain high after a reduction/cessation of cannabis use. DISCUSSION AND CONCLUSIONS: The influence of persons the leisure time was spent with was of higher relevance to most phases of cannabis use than the type of leisure time activity.

Interrelationships of adolescent physical activity, screen-based sedentary behaviour, and social and psychological health.

OBJECTIVES: To examine how adolescent physical activity (PA) and screen-based media sedentary behaviours (SBM) relate to psychological and social health and identify cross-national differences in these relationships. METHODS: Associations were examined in five regions using two Health Behaviour in School-Aged Children (HBSC) countries from each. RESULTS: Self-reported psychological and social health indices such as self-image, perceived health status, and Life Satisfaction were positively related to PA in all five regions but, with a few exceptions, negatively related to SBM. Negative health indices such as health complaints and tobacco use were negatively related to PA but, with exceptions, positively related to SBM. Significant regional differences were present. CONCLUSIONS: Regional differences in correlates of PA and SBM suggest cultural differences in potential effects of PA and SBM and the need to tailor school and public health efforts to the different meanings of PA and SBM for positive and negative health consequences.

[Quitting hash. The readiness for behaviour change among cannabis users in Switzerland]. / Mit Kiffen aufhören. Die Bereitschaft zur Verhaltensänderung bei Cannabisgebrauchenden in der Schweiz.

OBJECTIVES: The study aims to identify factors that are associated with the willingness of adolescents and young adults to modify their cannabis use. It is hypothesized that frequency of use, cannabis-related problems and age of onset are associated with their willingness to change. METHODS: In 2004, a survey on cannabis use was conducted among 13 to 29 year-olds living in Switzerland. Of the 5025 participants 593 had taken cannabis during the past six months. They were then asked about their willingness to change. Three groups of users were compared: those not willing to change, those considering change, and those determined to change. Pearson Chi-square-tests and logistic regressions were performed to test the hypotheses. RESULTS: Experience of problems motivates users to start thinking about changing their behavior. Frequent use and early onset are associated with young people not making the transition from considering changing behavior to resolving to do so. CONCLUSIONS: The need to perceive problematic use as a first step towards change and the inhibiting effect of dependence-related factors on the transition from consideration to determination calls for tailored intervention approaches that are matched to the willingness to change.