Anxiety, post-traumatic stress disorder and depression in Korean War veterans 50 years after the war.

BACKGROUND: There has been no comprehensive investigation of psychological health in Australia's Korean War veteran population, and few researchers are investigating the health of coalition Korean War veterans into old age. AIMS: To investigate the association between war service, anxiety, post-traumatic stress disorder (PTSD) and depression in Australia's 7525 surviving male Korean War veterans and a community comparison group. METHOD: A survey was conducted using a self-report postal questionnaire which included the PTSD Checklist, the Hospital Anxiety and Depression scale and the Combat Exposure Scale. RESULTS: Post-traumatic stress disorder (OR 6.63, P<0.001), anxiety (OR 5.74, P<0.001) and depression (OR 5.45, P<0.001) were more prevalent in veterans than in the comparison group. These disorders were strongly associated with heavy combat and low rank. CONCLUSIONS: Effective intervention is necessary to reduce the considerable psychological morbidity experienced by Korean War veterans. Attention to risk factors and early intervention will be necessary to prevent similar long-term psychological morbidity in veterans of more recent conflicts.

Changing GPs' antibiotic prescribing: a randomised controlled trial.

A randomised controlled trial involving 54 general practitioners (GPs) was conducted in Canberra, Australian Capital Territory from September 1997 to November 1999. In the first year of the study, 24 GPs, who constituted the active arm of the intervention group, were involved in the consideration of evidence and the development and implementation of a set of clinical guidelines for the treatment of acute respiratory infections. These guidelines were then endorsed in a meeting together with specialist colleagues. In the second year of the study the group of GPs who had been acting as controls, received a moderate intervention consisting of a brief educational event and distribution of the locally developed guidelines. We obtained data from January 1997 to December 1999 from the Health Insurance Commission on prescribing rates for 40 of the doctors in the study. The rate of prescribing was calculated as the number of antibiotic prescriptions per 100 Medicare services. The average yearly prescribing decreased significantly in the intensive intervention group and increased in the moderate intervention group, (p=0.026). A mixed effects longitudinal time series model was fitted to the data to account for seasonal variation of antibiotic prescribing and trends over time. The intensive intervention group significantly reduced their antibiotic prescribing over time compared to the moderate intervention group, (p<0.001). This study has shown that an intensive intervention in which general practitioners were actively engaged in development and consideration of the evidence base for the guidelines resulted in a significant fall in general antibiotic prescribing.

Effect of beta lactam antibiotic use in children on pneumococcal resistance to penicillin: prospective cohort study.

OBJECTIVE: To examine the relation between use of antibiotics in a cohort of preschool children and nasal carriage of resistant strains of pneumococcus. DESIGN AND PARTICIPANTS: Prospective cohort study over two years of 461 children aged under 4 years living in Canberra, Australia. MAIN OUTCOME MEASURES: Use of drugs, respiratory symptoms, and visits to doctors were documented in a daily diary by parents of the children during 25 months of observation. Isolates of pneumococci, which were cultured from nasal swabs collected approximately six monthly, were tested for antibiotic resistance. RESULTS: From the four swab collections 631 positive pneumococcal isolates from 461 children were found, of which 13.6% were resistant to penicillin. Presence of penicillin resistant pneumococci was significantly associated with children's use of a beta lactam antibiotic in the two months before each swab collection (odds ratio 2.03 (95% confidence interval 1.15 to 3.56, P=0.01)). The odds ratio of the association remained >1 (though did not reach significance at the 0.05 level) for use in the six months before swab collection. The association was seen in children who received only penicillin or only cephalosporin antibiotics in that period. The odds ratio was 4.67 (1.29 to 17.09, P=0.02) in children who had received both types of beta lactam in the two months before their nasal swab. The modelled odds of carrying penicillin resistant pneumococcus was 4% higher for each additional day of use of beta lactam antibiotics in the six months before swab collection. CONCLUSIONS: Reduction in beta lactam use could quickly reduce the carriage rates of penicillin resistant pneumococci in early childhood. In view of the propensity of these organisms to be spread among children in the community, the prevalence of penicillin resistant organisms may fall as a consequence.