Economic constraint and modes of consumption of addictive goods.

BACKGROUND: To see how economic recession, or, more generally, how increased economic constraint amongst drug users may impact their behaviour regarding the mode of drug consumption. METHODS: The theoretical framework is the theory of rational addiction - drug users are considered to be rational and well-informed about the way they use drugs and the consequences of using them. Surveys in the specialist literature dealing with the potential changes in the economic context of drugs users, and with the mechanisms of the bioavailability of psychoactive substances are examined in order to highlight one of the strategies drug users can implement to circumvent economic problems - namely a change in the mode of administration. An examination of ethnographic studies and French data are also used to test our assumptions. RESULTS: Changes in the mode of drug consumption can be the result of a maximization behaviour. Injection is the most effective way to reach a maximum bioavailability of substances. There is evidence in favour of the hypothesis that in times of economic recession, when the economic resources of drug users can decrease, they may prefer injection to other modes of administration in order to maximize the effect of what they have purchased. CONCLUSION: In times of economic recession, harm reduction policy has to be reinforced as injection behaviour can increase. As a result, economic and social policies should be an integral consideration for health policy issues.

Outcomes in older patients after surgical treatment for hip fracture: a new approach to characterise the link between readmissions and the surgical stay.

BACKGROUND: in older patients, there is a high risk of hospital readmission within the first year after surgery for hip fracture, due to complications following treatment or to the evolution of prior comorbid conditions. OBJECTIVES: to identify factors associated with readmissions related to the index surgical stay. DESIGN: retrospective cohort study. SETTING: administrative claims databases. SUBJECTS: patients over 75 surgically treated for hip fracture in Paris area. METHODS: we analysed all admissions in 2005, and tracked for 1-year readmissions. First readmissions (FRs) were classified as related or unrelated to the index stay, according to rules defined a priori. We analysed the association between patient characteristics and the FR. RESULTS: among 5,709 patients, 32% had at least one readmission, 53% were FR related. Near 80% of related readmissions occurred within 3 months from discharge. Surgical conditions caused 47% of all related readmissions, and male gender, dementia, cancer or kidney diseases were independent risks factors. CONCLUSIONS: half of readmissions could be classified as related to the index stay and a great majority of these occurred early post discharge. Surgical conditions caused 47% of all related readmissions. Improvement in orthopedic-geriatric co-care is suitable to expect an impact on outcomes after surgery.