ORCID Profile
0000-0001-6998-6419
Current Organisation
University of Adelaide
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Publisher: SAGE Publications
Date: 12-2016
Abstract: Despite ideals of equality and “racial democracy,” high levels of social inequality persist in contemporary Brazil. In addition, while the majority of the Brazilian population acknowledges the persistence of racism, high proportions of socially disadvantaged groups do not regard themselves as victims of discrimination. This study seeks to shed light on this issue by investigating the processes through which in iduals come to interpret their experiences of mistreatment as discrimination. We ask: (1) How frequently do respondents perceive being treated differently due to a variety of social statuses alone and in combination? and (2) What factors are associated with respondents interpreting this differential treatment as “discrimination”? Data come from an ongoing cohort investigation, which included a representative s le of adults living in the urban area of Florianópolis. Results show that 45 percent of respondents experienced mistreatment and attributed it to two or more factors, such as social class, age, gender, and race. Perceptions of mistreatment based on social class were positively correlated with perceived mistreatment due to gender, place of residence, weight, race, and the way one dresses. Regression analyses revealed that interpreting differential treatment as stemming from multiple social statuses was the strongest predictor of respondents classifying their mistreatment as discrimination. Our findings highlight the importance of disentangling perceptions of mistreatment from perceptions of discrimination and show that the relationship between the two is structured in large part by the ways in which in iduals interpret their experiences at the intersection of multiple inequalities.
Publisher: Wiley
Date: 10-10-2023
DOI: 10.1111/DAR.13561
Abstract: We aimed to explore trends and sociodemographic patterns in benzodiazepine (BZD) (by half-life) and Z-drugs prescribing in Australian general practice. This open cohort study used de-identified electronic health records of 1.4 million patients (50,812,413 consultations) from 402 Australian practices (MedicineInsight 2011-2018). Annual prescribing frequency and changes over time were estimated according to sex, age, socioeconomic position and rurality. Between 2011 and 2018, the prescribing of very short-acting BZD increased from 0.10 to 0.29 per 1000 consultations (average annual change +17.2% [95% CI 9.6 25.3]), while it declined for short-intermediate (from 38.5 to 26.6 per 1000 consultations annual change -5.1% [95% CI -5.6 -4.5]), long-acting BZD (from 24.1 to 21.6 per 1000 consultation annual change -1.5% [95% CI -2.2 -0.8]) and Z-drugs (from 4.6 to 4.0 per 1000 consultations annual change -1.9% [95% CI -3.0 -0.7]). Short-intermediate-acting BZD prescribing was three times more frequent among women aged 65+ years than younger women, and long-acting BZD three-to-four times more likely among younger than older men. Z-drugs prescribing was higher among women aged 45-64 years than younger or older females. Short-intermediate- and long-acting BZD were more likely prescribed for patients from more disadvantaged areas, and Z-drugs in more advantaged areas. There were no disparities by rurality. Although most BZD and Z-drugs prescriptions declined over time, short-intermediate BZD prescriptions remained higher among older women and long-acting BZD more frequent among younger men, especially for those living in more disadvantaged areas. Targeted interventions could reduce the prescribing of BZD and Z-drugs in these groups.
Publisher: SAGE Publications
Date: 28-12-2021
DOI: 10.1177/00048674211067720
Abstract: To examine trends in prescribing psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018. A retrospective cohort study examined prescriptions written by general practitioners using MedicineInsight, a large Australian primary care database, covering approximately 9% of all general practitioner practices. Numbers of patients receiving prescriptions for five main classes of psychotropics (antipsychotics, antidepressants, attention deficit hyperactivity disorder medications, anxiolytics, and hypnotics/sedatives [including benzodiazepines and Z-drugs, but excluding melatonin]) were examined annually by age-group (0–4, 5–9, 10–14, 15–18 years). Melatonin was analysed separately. The number of patients prescribed any psychotropic increased from 25.6 to 36.2 per 1000 in iduals from 2011 to 2018 (average annual increase +4.5%, 95% confidence interval [4.1%, 4.9%] overall +41.4%). Among the five main classes, the largest annual increase was for attention deficit hyperactivity disorder medications (+9.6%, 95% confidence interval [8.8%, 10.5%] overall +95.8%), followed by antipsychotics (+6.2%, 95% confidence interval [5.0%, 7.3%] overall +62.8%) and antidepressants (+4.5%, 95% confidence interval [4.0%, 5.0%] overall +42.8%). Hypnotic/sedative prescribing decreased on average 6.5% per year (95% confidence interval [–8.0%, –5.0%] overall −40.2%). Anxiolytic prescribing remained steady. Melatonin prescriptions showed the highest increase of all (+24.7%, 95% confidence interval [23.7%, 25.8%] overall +606.7%). The largest annual increase in antipsychotic, antidepressant or attention deficit hyperactivity disorder medication prescribing occurred in 10- to 14-year-olds (+7.5%, +6.5% and +10.4%, respectively). The largest point prevalence occurred in 2018 among 15- to 18-year-olds, with 98.5 per 1000 prescribed antidepressants. Antidepressants were more frequently prescribed to females antipsychotics, attention deficit hyperactivity disorder medications and melatonin more often to males. The most prescribed antipsychotics were risperidone ( years) and quetiapine (15- to 18-year-olds). Fluoxetine was the most prescribed antidepressant in those aged 5+ years and amitriptyline in 0- to 4-year-olds. General practitioner prescribing of melatonin, antipsychotics, antidepressants and attention deficit hyperactivity disorder medications to under-19-year-olds increased markedly from 2011 to 2018. Although benzodiazepine and Z-drug prescriptions declined, this was offset by a substantial increase in melatonin prescribing.
Publisher: Elsevier BV
Date: 05-2022
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.VACCINE.2019.06.057
Abstract: To assess influenza immunisation rates and coverage in adult patients from Australian general practice and identify whether practice or patients' characteristics are associated with vaccination uptake. Open cohort study. 550 Australian general practices included in the MedicineInsight database. Patients aged 18+ years who had at least one consultation during influenza season between 2015 and 2017. Two s les were considered: (1) 'active' patients (at least three consultations in any two consecutive years) and (2) 'every year' patients (at least one consultation per year). Influenza vaccination rates per 1,000 consultations and coverage (% vaccinated among those who consulted) from 2015 to 2017. Between 2015 and 2017 the influenza vaccine rate changed from 57.4 to 51.7 and 67.0 per 1,000 consultations, while correspondent values for coverage were 29.3%, 25.2% and 27.6% (in 'active' patients). Vaccine coverage was at least 30% higher in inner regional areas, among patients aged 65+ years or those with comorbidities. Similar associations were found among 'every year' patients, but average coverage across the three years was higher (41% vs 27%). Aboriginal and Torres Strait Islander people, either with or without comorbidity, showed a vaccine coverage 10-30% higher than non-Indigenous people for those aged less than 65 years (p-value for interaction < 0.001). MedicineInsight data is a useful and low-cost method to monitor influenza immunisation coverage. Independent of the s le used, vaccination coverage among Indigenous people or patients with comorbidities could be improved. Targeted strategies for high-risk groups need to be developed.
Publisher: Springer Science and Business Media LLC
Date: 10-05-2015
Publisher: BMJ
Date: 04-2019
DOI: 10.1136/BMJOPEN-2018-026396
Abstract: To investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing. Open cohort study. A representative s le of 550 Australian general practices contributing data to the MedicineInsight programme. 4 228 149 patients of all age groups who had at least one consultation between 2015 and 2017. Median age was 37 years (Interquartile range: 21–57), 54.4% women, 16.4% aged ≥65 years, 2.2% Aboriginal or Torres Strait Islander, 17.6% had a chronic disease and 18.1% a mental health condition. ILI consultation rates (per 1000 consultations) were calculated using all ILI diagnoses for all clinical encounters with a general practitioner between 2015 and 2017. Antiviral and antibiotic prescribing for ILI cases were investigated and logistic regression models adjusted for practice and patient characteristics used to analyse associations. ILI consultation rates in 2017 were higher than in previous years. Antiviral prescribing increased from 20.6% in 2015, to 23.7 in 2016 and 29.7% in 2017, while antibiotic prescribing decreased from 30.3% to 28.0% and 26.7%, respectively (p .05 in both cases). Practices located in high socioeconomic areas had higher ILI consultation rates (4.3 vs 2.5 per 1000 consultations, p .05), antibiotic (30.7% vs 23.4%, p .05) and antiviral (34.2% vs 13.5%, p .05) prescribing than those in lower socioeconomic areas. The coexistence of chronic or mental health conditions was associated with lower ILI consultation rates, higher antibiotic use, but not with antiviral prescribing. However, those with chronic respiratory conditions had a higher frequency of antibiotic and antiviral prescribing in 2017 than in iduals with other comorbidities. Although the apparent decline in antibiotic prescribing for ILI is welcome, the increase in antiviral use may not be targeting those at high risk of complications from infection.
Publisher: FapUNIFESP (SciELO)
Date: 10-2012
DOI: 10.1590/S0034-89102012000500010
Abstract: OBJECTIVE: To examine the association between tooth loss and general and central obesity among adults. METHODS: Population-based cross-sectional study with 1,720 adults aged 20 to 59 years from Florianópolis, Southern Brazil. Home interviews were performed and anthropometric measures were taken. Information on sociodemographic data, self-reported diabetes, self-reported number of teeth, central obesity (waist circumference [WC] 88 cm in women and 102 cm in men) and general obesity (body mass index [BMI] ≥ 30 kg/m²) was collected. We used multivariable Poisson regression models to assess the association between general and central obesity and tooth loss after controlling for confounders. We also performed simple and multiple linear regressions by using BMI and WC as continuous variables. Interaction between age and tooth loss was also assessed. RESULTS: The mean BMI was 25.9 kg/m² (95%CI 25.6 .2) in men and 25.4 kg/m2 (95%CI 25.0 .7) in women. The mean WC was 79.3 cm (95%CI 78.4 .1) in men and 88.4 cm (95%CI 87.6 .2) in women. A positive association was found between the presence of less than 10 teeth in at least one arch and increased mean BMI and WC after adjusting for education level, self-reported diabetes, gender and monthly per capita income. However, this association was lost when the variable age was included in the model. The prevalence of general obesity was 50% higher in those with less than 10 teeth in at least one arch when compared with those with 10 or more teeth in both arches after adjusting for education level, self-reported diabetes and monthly per capita family income. However, the statistical significance was lost after controlling for age. CONCLUSIONS: Obesity was associated with number of teeth, though it depended on the participants' age groups.
Publisher: Hindawi Limited
Date: 23-03-2022
DOI: 10.1155/2022/1566408
Abstract: Aims. To investigate the epidemiology of diabetes diagnosis and screening in Australian general practice. Methods. Cross-sectional study using electronic health records of 1,522,622 patients aged 18+ years attending 544 Australian general practices (MedicineInsight database). The prevalence of diagnosed diabetes and diabetes screening was explored using all recorded diagnoses, laboratory results, and prescriptions between 2016 and 2018. Their relationship with patient sociodemographic and clinical characteristics was also investigated. Results. Overall, 7.5% (95% CI 7.3, 7.8) of adults had diabetes diagnosis, 0.7% (95% CI 0.6, 0.7) prediabetes, and 0.3% (95% CI 0.3, 0.3) unrecorded diabetes rediabetes (elevated glucose levels without a recorded diagnosis). Patients with unrecorded diabetes rediabetes had clinical characteristics similar to those with recorded diabetes, except for a lower prevalence of overweight/obesity (55.5% and 69.9%, respectively). Dyslipidaemia was 1.8 times higher (36.2% vs. 19.7%), and hypertension was 15% more likely (38.6% vs. 33.8%) among patients with prediabetes than with diabetes. Diabetes screening (last three years) among people at high risk of diabetes was 55.2% (95% CI 52.7, 57.7), with lower rates among young or elderly males. Conclusions. Unrecorded diabetes rediabetes is infrequent in Australian general practice, but prediabetes diagnosis was also lower than expected. Diabetes screening among high-risk in iduals can be improved, especially in men, to enhance earlier diabetes diagnosis and management.
Publisher: Wiley
Date: 24-06-2020
DOI: 10.1111/IRV.12774
Publisher: Wiley
Date: 31-05-2017
DOI: 10.1111/OBR.12564
Abstract: While the impact of interpersonal discrimination on mental health is well established, its effects on physical health outcomes have not been fully elucidated. This study systematically reviewed the literature on the prospective association between interpersonal discrimination and markers of adiposity. Medline, Web of Science, Scopus, PsycInfo, SciELO, LILACS, Google Scholar, Capes/Brazil and ProQuest databases were used to retrieve relevant information in November 2016. The results from the 10 studies that met the inclusion criteria support an association between interpersonal self-reported discrimination and the outcomes. In general, the most consistent findings were for weight and body mass index (BMI) among women, i.e. high levels of self-reported discrimination were related to increased weight and BMI. Waist circumference (WC) showed a similar pattern of association with discrimination, in a positive direction, but an inverted U-shaped association was also found. Despite a few inverse associations between discrimination and markers of adiposity, none of the associations were statistically significant. Overall, markers of adiposity were consistently associated with discrimination, mainly through direct and nonlinear associations. This review provides evidence that self-reported discrimination can play an important role in weight, BMI and WC changes.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Jornal de Pediatria
Date: 04-08-2009
DOI: 10.2223/JPED.1917
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.JINF.2022.01.011
Abstract: To evaluate the impact of the National Herpes Zoster (zoster) Immunisation Program in Australia on zoster incidence. Ecological analysis of zoster incidence related to timing of implementation of the national program in vaccine-targeted (70-79 years) and non-targeted age groups (60-69 and 80-89 years) during January 2013-December 2018 was estimated using interrupted time-series analyses. Prior to program commencement (Jan 2013-Oct 2016) in patients aged 60-69, 70-79 and 80-89 years, incidence was mostly stable averaging respectively 7.2, 9.6 and 10.8 per 1000 person-years. In the two years following program commencement, incidence fell steadily in those aged 70-79 years, with an estimated decrease of 2.25 (95% CI: 1.34, 3.17) per 1000 person-years per year, with women having a greater decrease than men (2.83 versus 1.68, p-interaction<0.01). In the two non-vaccine-program-targeted groups there was no evidence of reduction in zoster incidence: 60-69 years, 0.46 (95% CI: -0.46, 1.38) and 80-89 years, 0.11 (95% CI: -1.64, 1.87). Two years after implementation, an estimated 7000 zoster cases were prevented through the national program. With known waning vaccine efficacy, continued surveillance is needed to ensure these early reductions in incidence are sustained.
Publisher: FapUNIFESP (SciELO)
Date: 06-2010
DOI: 10.1590/S1519-38292010000200005
Abstract: OBJETIVOS: verificar a associação entre o Índice de Massa Corporal (IMC) de escolares de 7 a 14 anos e dos respectivos pais. MÉTODOS: estudo transversal com 886 escolares de quatro escolas de Florianópolis, SC. Diagnóstico antropométrico dos escolares e dos pais definido, respectivamente, a partir do IMC para idade de acordo com Centers for Disease Control and Prevention e dos pontos de corte da Organização Mundial da Saúde. A associação entre o IMC dos pais e dos escolares foi estimada por meio da razão de prevalência (RP) com intervalo de confiança (IC) de 95% e teste qui-quadrado com valor de significância de p 0,05. RESULTADOS: identificou-se prevalência de sobrepeso/obesidade mais elevada em meninos (29,9%) quando comparada a de meninas (17,7%) (p ,001). Observou-se relação estatisticamente significante entre o IMC de escolares do sexo feminino com o IMC das mães (RP=1,63 IC95%=1,1-3,0 p=0,02) e dos pais (RP=1,78 IC95%= 1,1-3,5 p=0,01). Nos escolares do sexo masculino a associação observada não foi estatisticamente significante. CONCLUSÕES: identificou-se que a prevalência do sobrepeso ou obesidade é 1,63 vezes maior, entre as meninas, quando a mãe também apresenta esse distúrbio e 1,78 vezes maior quando o pai o apresenta, em comparação a mães e pais eutróficos ou de baixo peso.
Publisher: FapUNIFESP (SciELO)
Date: 02-2012
DOI: 10.1590/S0102-311X2012000200008
Abstract: To assess the association of parents' nutritional status, and dietary and sociodemographic factors with overweight/obesity in schoolchildren in Florianópolis Island, Santa Catarina State, Brazil, this cross-sectional epidemiological study examined 2,826 schoolchildren 7 to 14 years old, classified according to body mass index curves for age and sex recommended by the International Obesity Task Force. Data were analyzed using Poisson regression. The final model showed overweight/obesity in boys associated directly with father's educational level, mother's age, and parents' nutritional status, and inversely with mother's educational level, and number of daily meals. Among girls, it associated directly with parents' nutritional status and the schoolchildren's age, and inversely with consumption of risk foods. The variables that associated with overweight/obesity differed between the sexes, except parents' nutritional status. Boys and girls with both parents overweight or obese were, respectively, 80% and 150% more likely to exhibit the same diagnosis, indicating the need for interventions that include the family environment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-01-2021
Publisher: FapUNIFESP (SciELO)
Date: 09-2012
DOI: 10.1590/S1415-790X2012000300018
Abstract: OBJETIVO: Estimar a prevalência de sobrepeso/obesidade em escolares e investigar sua associação com o estado nutricional dos pais, fatores sociodemográficos e de consumo alimentar. MÉTODO: Estudo transversal realizado com 1.223 escolares de 7 a 10 anos de Florianópolis, SC. Foram coletados dados socioeconômicos e medidas antropométricas autorreferidas dos pais, e medidas antropométricas diretas e de consumo alimentar do dia anterior dos escolares. O diagnóstico nutricional dos escolares foi definido a partir do Índice de Massa Corporal (IMC) para idade e sexo de acordo com dados de referência da Organização Mundial de Saúde (2007) e o dos pais segundo os pontos de corte do IMC também da Organização Mundial de Saúde (1995). Realizou-se análise bivariada e multivariada por meio da regressão de Poisson. RESULTADOS: Prevalência de sobrepeso/obesidade de 36,2% nos meninos e 32,7% nas meninas. Nos pais e mães a prevalência foi de, respectivamente, 56,3% e 27,5%. Dos fatores investigados, no modelo final permaneceram associados ao sobrepeso/obesidade nos escolares o estado nutricional das mães (p = 0,001) e dos pais (p = 0,050). A prevalência de sobrepeso/obesidade foi 1,58 vezes maior em escolares com mães e 1,41 vezes maior em escolares com pais com sobrepeso/obesidade, quando comparados a mães e pais sem o problema. CONCLUSÃO: Observou-se elevada prevalência de sobrepeso/obesidade nos escolares, e esta se associou ao estado nutricional de pais e mães. Isso evidencia a necessidade de ações de prevenção do ganho excessivo de peso ainda na infância que atuem também no ambiente familiar do escolar, a fim de reduzir a obesidade neste grupo populacional.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Wiley
Date: 17-12-2022
DOI: 10.1002/PRP2.896
Abstract: Despite reducing benzodiazepine prescribing, benzodiazepine‐involving deaths have substantially increased in Australia. This study aimed to explore patterns in long‐term prescribing of medications (benzodiazepine and z‐drugs [BZD]) used for sleep‐issues/insomnia in Australia to better understand these changes. Open cohort study using de‐identified electronic health records of 1 414 593 adult patients regularly attending 404 Australian general practices from 2011 to 2018 (MedicineInsight). We used logistic regression adjusted for patient and practice characteristics to (1) estimate long‐term BZD prescribing prevalence (≥3 prescriptions in 6 months) and the associated sociodemographic factors, and (2) Poisson regression to compute annual changes in prescribing rates. Long‐term BZD prescribing changed from 4.4% in 2011 to 5.8% in 2015, remaining relatively stable until 2018 (annual increase +2.5% [95% CI +2.0% +3.0%]). Long‐term BZD prescribing in any year was up to six times more likely in elderly rather than in younger patients and 30%–43% more prevalent in females, or patients living in or attending a practice located in more disadvantaged areas. The increase was more pronounced among males, adults aged 35–49 years, and in iduals living in advantaged areas. The median duration among incident cases decreased from 1183 to 322 days between 2011 and 2017, and was up to 197 days longer among elderly females than males. Despite a slight increase and recent stability in long‐term BZD prescribing, the higher rates and durations among elderly patients, women, or those living in more disadvantaged areas are concerning and highlights the need for interventions that reduce the potential harms of long‐term BZD use in vulnerable groups.
Publisher: FapUNIFESP (SciELO)
Date: 2015
DOI: 10.1590/S0034-8910.2015049005590
Abstract: OBJECTIVE To analyze if differences according to gender exists in the association between tooth loss and obesity among older adults. METHODS We analyzed data on 1,704 older adults (60 years and over) from the baseline of a prospective cohort study conducted in Florianopolis, SC, Southern Brazil. Multivariable logistic regression models were used to assess the association between tooth loss and general and central obesity after adjustment for confounders (age, gender, skin color, educational attainment, income, smoking, physical activity, use of dentures, hypertension, and diabetes). Linear regressions were also assessed with body mass index and waist circumference as continuous outcomes. Interaction between gender and tooth loss was further assessed. RESULTS Overall mean body mass index was 28.0 kg/m2. Mean waist circumference was 96.8 cm for males and 92.6 cm for females. Increasing tooth loss was positively associated with increased body mass index and waist circumference after adjustment for confounders. Edentates had 1.4 (95%CI 1.1 .9) times higher odds of being centrally obese than in iduals with a higher number of teeth however, the association lost significance after adjustment for confounders. In comparison with edentate males, edentate females presented a twofold higher adjusted prevalence of general and central obesity. In the joint effects model, edentate females had a 3.8 (95%CI 2.2 .6) times higher odds to be centrally obese in comparison with males with more than 10 teeth present in both the arches. Similarly, females with less than 10 teeth in at least one arch had a 2.7 (95%CI 1.6 .4) times higher odds ratio of having central obesity in comparison with males with more than 10 teeth present in both the arches. CONCLUSIONS Central obesity was more prevalent than general obesity among the older adults. We did not observe any association between general obesity and tooth loss. The association between central obesity and tooth loss depends on gender – females with tooth loss had greater probability of being obese.
Publisher: Universidade de Sao Paulo, Agencia USP de Gestao da Informacao Academica (AGUIA)
Date: 27-11-2017
DOI: 10.11606/S1518-8787.2017051006776
Abstract: OBJECTIVE: To describe the s le plan, operational aspects, and strategies used in the 2009/2010 and 2013/2014 EpiFloripa Aging Study. METHODS: The EpiFloripa Aging is a population-based longitudinal study with 1,705 older adults (60 years or more) living in the municipality of Florianópolis, State of Santa Catarina, Brazil, in 2009/2010 (baseline). The research was conducted with a face-to-face interviews, organized into blocks of identification, socioeconomic, mental health, health and life habits, global functionality, falls, physical activity, morbidities, use of health services, use of medications, food, oral health, and violence, evaluated in the first (2009/2010) and in the second wave (2013/2014). Additionally, in the second wave, we investigated the issue of discrimination and quality of life. RESULTS: The response rate of the first wave was 89.2% (n = 1,705). The baseline s le, with predominance of women (63.9%), was similar to the 2010 Census regarding age for women and slightly different for younger men. In the second wave, 1,197 participants were interviewed (response rate of 70.3%). Follow-up losses were only observed for the variable age group (p = 0.003), and predominantly for those aged 80 years or more. Mortality data linkage and active search for participants were used as a follow-up strategies. CONCLUSIONS: This study used strategies that were able to help locate the participants and maintain adherence, which ensured a good response rate during investigations.
Publisher: Informa UK Limited
Date: 17-01-2020
Publisher: Royal College of General Practitioners
Date: 04-05-2021
Abstract: Despite an increase in the prevalence of sleep problems, few studies have investigated changes in the prescribing of drugs that are often used to manage insomnia. To explore changes in the pattern of benzodiazepine (BZD), Z-drug (zolpidem, zopiclone), and non-BZD prescriptions. Open-cohort study comprising 1 773 525 patients (55 903 294 consultations) who attended one of 404 Australian general practices at least three times in two consecutive years between 2011 and 2018. Data were extracted from MedicineInsight, a database of 662 general practices in Australia. Prescription rates per 1000 consultations, the proportion of repeat prescriptions above recommendations, and the proportion of prescriptions for patients with a recent (within 2 years) recorded diagnosis of insomnia were analysed using adjusted regression models. Rates of BZD, Z-drug, and non-BZD prescriptions were 56.6, 4.4, and 15.5 per 1000 consultations in 2011 and 41.8, 3.5, and 21.5 per 1000 consultations in 2018, respectively. Over the whole study period, temazepam represented 25.3% of the prescriptions and diazepam 21.9%. All BZD and zolpidem prescriptions declined over the whole study period (annual change varying from −1.4% to −10.8%), but non-BZD and zopiclone prescriptions increased in the same period (annual change 5.0% to 22.6%). Repeat prescriptions that exceeded recommended levels remained at % for all medications, except melatonin (64.5%), zolpidem (63.3%), zopiclone (31.4%), and alprazolam (13.3%). In 2018, % of Z-drug and melatonin prescriptions were for patients with insomnia. There was an annual increase of 0.8–5.9% in the proportion of prescriptions associated with a recently recorded diagnosis of insomnia. Overall, BZD prescriptions in Australia declined between 2011 and 2018. However, the prescription of some of these drugs increased for patients with a recently recorded diagnosis of insomnia. This is concerning because of the potential adverse effects of these medications and the risk of dependence.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Informa UK Limited
Date: 07-10-2020
Publisher: BMJ
Date: 04-2023
DOI: 10.1136/BMJOPEN-2022-069875
Abstract: This study investigated whether the monitoring and control of clinical parameters are better among patients with newly compared with past recorded diabetes diagnosis. Retrospective cohort study. MedicineInsight, a national general practice database in Australia. 101 875 ‘regular’ adults aged 18+ years with past recorded (2015–2016) and 9236 with newly recorded (2017) diabetes diagnosis. Two different groups of outcomes were assessed in 2018. The first group of outcomes was the proportion of patients with clinical parameters (ie, glycated haemoglobin A1c (HbA1c), blood pressure (BP), total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, estimated glomerular filtration rate and albumin-to-creatinine ratio) monitored at least once in 2018. The second group of outcomes were those related to diabetes control in 2018 (HbA1c ≤7.0%, (BP) ≤140/90 mm Hg, total cholesterol .0 mmol/L and LDL-C .0 mmol/L). Adjusted ORs (OR adj ) and adjusted probabilities (%) were obtained based on logistic regression models adjusted for practice variables and patients’ socio-demographic and clinical characteristics. The study included 111 111 patients (51.7% men mean age 65.3±15.0 years) with recorded diabetes diagnosis (11.0% of all 1 007 714 adults in the database). HbA1c was monitored in 39.2% (95% CI 36.9% to 41.6%) of patients with newly recorded and 45.2% (95% CI 42.6% to 47.8%) with past recorded diabetes (OR adj 0.78, 95% CI 0.73 to 0.82). HbA1c control was achieved by 78.4% (95% CI 76.7% to 80.0%) and 54.4% (95% CI 53.4% to 55.4%) of monitored patients with newly or past recorded diabetes, respectively (OR adj 3.11, 95% CI 2.82 to 3.39). Less than 20% of patients with newly or past recorded diabetes had their HbA1c, BP and total cholesterol levels controlled (OR adj 1.08, 95% CI 0.97 to 1.21). The monitoring of clinical parameters was lower among patients with newly than past recorded diabetes. However, diabetes control was similarly low in both groups, with only one in five monitored patients achieving control of all clinical parameters.
Publisher: Springer Science and Business Media LLC
Date: 16-11-2017
Publisher: FapUNIFESP (SciELO)
Date: 08-05-2014
No related grants have been discovered for Carla Bernardo.