The effects of alcohol consumption, psychological distress and smoking status on emergency department presentations in New South Wales, Australia

BACKGROUND: Despite clear links between risky alcohol consumption, mental health problems and smoking with increased morbidity and mortality, there is inconclusive evidence about how these risk factors combine and if they are associated with increased attendance at emergency departments. This paper examines the population-level associations and interactions between alcohol consumption, psychological distress and smoking status with having presented to an emergency department in the last 12 months. METHODS: This study uses data from a representative sample of 34,974 participants aged 16 years and over from the New South Wales Population Health Survey, administered between 2002 and 2004. Statistical analysis included univariate statistics, cross-tabulations, and the estimation of prevalence rate ratios using Cox's proportional hazard regression model. RESULTS: Results show that high-risk alcohol consumption, high psychological distress and current smoking were all significantly and independently associated with a greater likelihood of presenting to an emergency department in the last year. Presenting to an emergency department was found to be three times more likely for women aged 30 to 59 years with all three risk factors and ten times more likely for women aged 60 years or more who reported high risk alcohol consumption and high psychological distress than women of these age groups without these risk factors. For persons aged 16 to 29 years, having high-risk alcohol consumption and being a current smoker doubles the risk of presenting to an emergency department. CONCLUSION: The combination of being a high-risk consumer of alcohol, having high psychological distress, and being a current smoker are associated with increased presentations to emergency departments, independent of age and sex. Further research is needed to enhance recognition of and intervention for these symptoms in an emergency department setting in order to improve patient health and reduce future re-presentations to emergency departments

Clinical analysis of screening and threshold visual field data for glaucoma detection

The value of clinical interpretation in differentiating between glaucomatous and normal fields from threshold (Humphrey Field Analyser) and screening (Henson CFS3000) measures was determined using a masked prospective experimental design. The visual field plots of 20 primary open-angled glaucoma (POAG) patients, 19 ocular hypertensive and 19 normotensive glaucoma suspects, and 21 age-matched normals measured with the Humphrey Field Analyser (Humphrey) and Henson CFS3000 (Henson) were catagorised by two experienced clinicians. Significant differences in interpretation of the field plots were demonstrated between the tow clinicians (chi-squares = 19.36; p<0.001). The sensitivity of clinical interpretation was shown to lie between 65 per cent and 90 per cent (dependant upon the individual clinician) for the Humphrey plots, but was as low as 40 per cent with the Henson plots. Specificity was, however, higher for the Henson overall, regardless of the clinician (between 90 per cent and 95 per cent) compared to the Humphrey (between 75 per cent and 100 per cent). These levels of sensitivity and specificity do not reach the levels reported when interpretation is based on the visual field indices alone. It was concluded that a screening instrument, such as the Henson, should only be employed for testing large unselected populations, in which the prevalence of glaucoma is low. Visual fields should not judged in isolation, but in conjunction with measures of optic nerve and nerve fiber layers integrity, intra-ocular pressure and family history

Lifetime suicide risk in major depression: sex and age determinants

Background: Recent work has demonstrated that the lifetime suicide risk for patients with DSM IV Major Depression cannot mathematically approximate the accepted figure of 15%. Gender and age significantly affect both the prevalence of major depression and suicide risk, Methods: Gender and age stratified calculations were made on the entire population of the USA in 1994 using a mathematical algorithm. Sex specific corrections for under-reporting were incorporated into the design. Results: The lifetime suicide risks for men and women were 7% and 1%, respectively. The combined risk was 3.4%. The male:female ratio for suicide risk in major depression was 10:1 for youths under 25, and 5.6:1 for adults. Conclusions: Suicide in major depression is predominantly a male problem, although complacency towards female sufferers is to be avoided. Diagnosis of major depression is of limited help in predicting suicide risk compared to case specific factors. The male experience of depression that leads to suicide is often not identified as a legitimate medical complaint by either sufferers or professionals. Increasing help-accessing by males is a priority. Clinical implications: Patients with a history of hospitalisation; comorbidity, especially for substance abuse; and who are male, require greater vigilance for suicide risk. It may be that for males che threshold for diagnosing and treating major depression needs to be lowered. Limitations: This research is based on a mathematical algorithm to approximate a life-long longitudinal study that identifies community cases of depression. Our findings therefore rely on the validity of the statistics used. Extrapolation is limited to populations with an actual suicide rate of 17/100,000 or less and a lifetime prevalence of major depression of 17% or more. (C) 1999 Elsevier Science B.V. All rights reserved