Patient attitudes towards analgesia and their openness to non-pharmacological methods such as acupuncture in the emergency department

Aims: To investigate patient attitudes to analgesia, opioids and non-pharmacological analgesia including acupuncture, in the ED. Methods: ED patients with pain were surveyed regarding: pain scores, satisfaction, addiction concern, non-pharmacological methods of pain relief, and acupuncture. Data were analysed using logistic regression. Results: Of 196 adult patients, 52.8% were ‘very satisfied’ with analgesia. Most patients (84.7%) would accept non-pharmacological methods including acupuncture (68.9%) and 78.6% were not concerned about addiction. Satisfaction was associated with male gender, and ‘adequate analgesia’ but not with opioids. Conclusion: Most patients were generally satisfied with ED analgesia and were open to non-pharmacologic analgesia including acupuncture

Elevated serum homocysteine levels have differential gender-specific associations with motor and cognitive states in Parkinson’s disease

Background: Studies attempting to elucidate an association between homocysteine and symptom progression in Parkinson’s disease (PD) have had largely discrepant findings. This study aimed to investigate elevated serum homocysteine levels and symptom progression in a cohort of PD patients. Methods: Serum homocysteine, folate, and vitamin B12 levels were measured in 205 people with PD and 78 age-matched healthy controls. People with Parkinson’s disease underwent a battery of clinical assessments to evaluate symptom severity, including motor (MDS-UPDRS) and cognitive (ACE-R) assessments. Multivariate generalized linear models were created, controlling for confounding variables, and were used to determine whether serum markers are associated with various symptom outcome measures. Results; People with Parkinson’s disease displayed significantly elevated homocysteine levels (p\u3c0.001), but not folate or vitamin B12 levels, when compared to healthy controls. A significant positive correlation between homocysteine and MDS-UPDRS III score was identified in males with Parkinson’s disease (rs=0.319, p\u3c0.001), but not in females, whereas a significant negative correlation between homocysteine levels and total ACE-R score was observed in females with Parkinson’s disease (rs=−0.449, p\u3c0.001), but not in males. Multivariate general linear models confirmed that homocysteine was significantly predictive of MDS-UPDRSIII score in male patients (p = 0.004) and predictive of total ACE-R score in female patients (p = 0.021). Conclusion: Elevated serum homocysteine levels are associated with a greater motor impairment in males with Parkinson’s disease and poorer cognitive performance in females with Parkinson’s disease. Our gender specific findings may help to explain previous discrepancies in the literature surrounding the utility of homocysteine as a biomarker in PD

Opportunistic screening for chlamydia in young men

Background: Information on prevalence of genital Chlamydia trachomatis in young men attending Australian general practices is scarce. Objective: We aimed to estimate the prevalence of chlamydia in this group; establish behaviours associated with infection, and evaluate general practitioner follow up of positive cases. Methods: Sexually active men (aged 15–29 years) attending 10 general practices in Perth, Western Australia, were tested for chlamydia and completed a self report questionnaire concerning sexual practices and symptoms. Results: Prevalence of chlamydia was 3.7% (95% CI: 2–6%, n=14/383). High rates of risky sexual practices were observed in both chlamydia positive and negative participants. The association between chlamydia status and risky sexual practices however, was not statistically significant. Treatment and notification of positive cases were usually undertaken, but GPs did not always check that patients had contacted sexual partners. Conclusion: We found little relationship between reported sexual behaviour and chlamydia infection in young men. It may be appropriate to offer screening to all at risk individuals

Progress in the study on Chlamydia trachomatis in young men

In January 2007 the Primary Health Care Research and Evaluation Unit at Notre Dame commenced a study to determine the frequency of Chlamydia trachomatis (symptomatic and asymptomatic) presentations in an at-risk group of the Australian male population attending general practitioners. Assessment of appropriate follow-up care by GP will also be determined. Target population: Males aged 15-29 years presenting to their GP (in 7 Metropolitan and outer Metropolitan Suburbs of Perth, Western Australia) for routine examination are being targeted. Sample size: Based on a prevalence of 6% (Vajdic et al, 2005: Sexual Health 2:169-183) and a precision measure of 2%, a sample size of 542 participants would be required to ensure (CI 95%) that the study estimate is representative of the population estimate. We envisage recruiting 600 participants. Study design: Information on risk taking behaviour is collected by self administered questionnaire from consenting participants. In addition, a 25ml sample of first stream urine is collected for chlamydia testing by PCR. There is no further study-related follow-up for participants. Those with positive test results are contacted and managed by the GP as per standard WA Department of Health Guidelines for managing sexually transmitted infections. General practitioners will be contacted by the researchers to assess their level of follow-up care through a brief questionnaire. Recruitment commenced in early February. At the time of submission of this abstract (March) fifteen participants have been recruited. Preliminary data will be presented. The authors will discuss their experience of undertaking clinical research in the area of sexual health in general practice. The study will provide information on the prevalence of chlamydia. It will also serve to increase awareness of chlamydia infection and inform policy on the effectiveness of education in primary health care

Retirement intentions of general practitioners aged 45–65 years

Objective: To ascertain the retirement intentions of a cohort of Australian general practitioners. Design and setting: Postal questionnaire survey of members of four Divisions of General Practice in Western Australia, sent out November 2007 – January 2008. Participants: A sample of 178 GPs aged 45–65 years. Main outcome measures: Intention to work in general practice until retirement; reasons for retiring before age 65 years; factors that might encourage working beyond chosen retirement age; and perceived obstacles to working in general practice. Results: 63% of GPs intended to work to at least age 65 years, with men more likely to retire early. Of 63 GPs intending to retire early, 46% gave pressure of work, exhaustion and burnout as reasons for early retirement. Better remuneration, better staffing levels and more general support were incentives to continue working for 46% of the 64 GPs who responded to the question about incentives, and more flexible working hours, part-time work and reduced workload for 41%. Of 169 participants, 65% gave increasing bureaucracy, poor job satisfaction and disillusionment with the medical system or Medicare as obstacles to working in general practice in Australia, whereas workforce shortage, increasing patient demands and diminishing lifestyle through overwork were obstacles named by 48%. Conclusion: Many GPs are planning to retire early, reflecting an emerging trend among professionals and society generally. Declining job satisfaction, falling workforce numbers, excessive workload and increasing bureaucracy were recurrent concerns of older WA GPs considering premature retirement

Assessing long term outcomes of men with prostate cancer-a data linkage study

The study aims to follow-up a cohort of men who either present with or are diagnosed by their general practitioner (GP) with prostate cancer. Subsequent morbidity and mortality will be used to assess if treatment/detection by the GP has positive impact

Dopaminergic challenges in social anxiety disorder: evidence for dopamine D\u3csub\u3e3\u3c/sub\u3e desensitisation following successful treatment with serotonergic antidepressants

Serotonergic antidepressants (SSRIs) are first-line treatments for social anxiety disorder [SAnD], though there is evidence of dopaminergic system dysfunction. Twenty subjects with DSM-IV SAnD, untreated (n = 10) and SSRI-remitted DSM-IV SAnD (n = 10), were administered a single dose of 1) a dopamine agonist (pramipexole 0.5 mg) and 2) a dopamine antagonist (sulpiride 400 mg), followed by anxiogenic challenges (verbal tasks and autobiographical scripts) in a double-blind crossover design, the two test days being one week apart. Anxiety symptoms were measured by self-reported changes in Visual Analogue Scales, specific SAnD scales and anxiety questionnaires. Plasma levels of prolactin were obtained. Untreated SAnD subjects experienced significant increases in anxiety symptoms following behavioural challenges after either sulpiride or pramipexole. Following remission with SSRIs, the socially anxiogenic effect of behavioural provocation was significantly attenuated under pramipexole, whereas under sulpiride effects remained significantly elevated. There appears to be instability of the dopamine system under behavioural stress in social anxiety subjects that is only partly rectified by successful treatment with an SSRI, which may induce a desensitisation of postsynaptic dopamine D3 receptors