On- and off-label utilisation of antipsychotics in Australia (2000-2021): Retrospective analysis of two medication datasets.

OBJECTIVE: To determine antipsychotic utilisation patterns in Australian adults from 2005 to 2021, with a focus on on-label and off-label prescriptions. METHODS: We examined antipsychotic dispensing trends in adults from 2005 to 2021 using a 10% sample of the Pharmaceutical Benefits Scheme (PBS) dataset, which contains patient-level information on medicines dispensed throughout Australia. The lack of diagnostic information in PBS was substituted by analysing BEACH (Bettering the Evaluation And Care of Health) dataset, a cross-sectional national survey from 2000 to 2016, consisting of data from general practitioner-patient encounters. RESULTS: There were 5.6 million dispensings for 164,993 patients in PBS throughout this period; 69% patients had >1 dispensing, with a median of 6 per patient. Calculating the estimated period of exposure gave a total of 693,562 treatment episodes, with a median duration of 80 days. There were steady increases in both the incidence and prevalence of antipsychotic dispensings, mainly due to oral second-generation antipsychotics. The most commonly prescribed antipsychotics were quetiapine, olanzapine and risperidone, with a significant portion of patients receiving low-dose quetiapine without dose titration. Analysis of diagnostic indications from BEACH indicated that 27% of antipsychotic prescriptions were off-label for indications such as depression, dementia, anxiety and insomnia, at much lower prescribed daily dosages. CONCLUSION: The increasing prescribing and off-label use highlights concerns about chronic adverse effects caused by antipsychotics. The combined analysis of medication dispensings and the diagnostic indications for which they are prescribed is a novel approach and throws a spotlight on the need for additional monitoring of antipsychotics.

Hey Google! will New Zealand vote to legalise cannabis? Using Google Trends data to predict the outcome of the 2020 New Zealand cannabis referendum.

BACKGROUND: New Zealand held a referendum on the legalisation of recreational cannabis in October 2020. Polls preceding the referendum provided contrasting outcomes. We investigated whether internet search data from Google Trends could provide an alternative estimate of the referendum outcome. METHODS: We assessed various methods for accessing Google Trends data, downloading search probability data for google.com searches from New Zealand via trends.google.com, PyTrends and Google Trends Extended for Health. We used daily data for the three months prior to the final referendum date, and hourly data for the final week. We defined two smaller time frames each from daily and hourly data, allowing comparisons over the entire time frames, and progressively closer to the end. Using the selected keyword combination of 'cannabis referendum yes/no' we calculated the proportions of 'yes' and 'no' searches for each time frame/data source combination, aiming for a prediction within 2% of the final result. RESULTS: Data from different sources varied slightly. The method used to aggregate search probabilities over the selected time frame (mean/median) resulted in changes in the predicted outcome for hourly-, but not daily data. On 20 October we predicted the 'no' vote at 51.9%-55.4% for daily-, and 60% for hourly data when aggregated using the median, but only 49% for mean hourly data. Hourly data performed poorly at predicting the final 51.2% 'no' result, while predictions based on mean daily data for the full voting period provided the best prediction, differing by 0.1-0.2%. CONCLUSION: Predictions based on Google Trends data broadly agreed with polling predictions, but the exact method used affected the eventual prediction. While polls are subject to influence from methodological considerations (e.g., sampling), it is clear that Google Trends data can be used to make a prediction, but do not present a magic bullet solution to polling problems.

Iron-focussed nutritional status of mothers with children (6-59 months) in rural northern Ghana.

BACKGROUND: Anaemia, especially iron deficiency anemia, is an important cause of morbidity and mortality in African women and children. AIM: To assess the intake of nutrients related to iron and anaemia status among mothers in smallholder agrarian communities in Northern Ghana where anaemia is known to be endemic. SETTING: Tolon Kumbumgu district and Tamale Metropolis in Ghana. METHODS: A cross-sectional study was conducted among 161 mothers with children 6-59 months. Questionnaires on socio-demographics, household food security and production and food frequencies, and three 24-hour recalls were administered during structured interviews, and BMI was assessed. Dietary intakes were analysed with the Ghana Nutrient Database® (version 6.02). Nutrient intake was evaluated using the estimated average requirements and iron intakes using the probability method. RESULTS: Most mothers (91.9%) had low literacy and were subsistence farmers. The staple diet was homemade unrefined, unfortified maize meal, homemade unfortified oil (shea butter), and seasonal green leafy vegetables (mostly amaranth), butternut, tomatoes, onions and legumes. Inadequate intakes of vitamin A (in 9.9%), folate (in 46.6%) and vitamin B12 (in 98.8%) were observed, in combination with high fibre (47.8 ± 19.0 g/day) intakes and high tea consumption. If 10% iron bio-availability was assumed, 33.1% were estimated to have inadequate iron intake; if 5% iron bio-availability was assumed, 80.8% were estimated to have inadequate iron intakes. CONCLUSION: In these low socio-economic agrarian communities, mothers of infants are living on home produce and rarely consumed foods (fortified salt, cooking oil and wheat flour) from the national food fortification programmes intended to address anaemia and other micronutrient deficiencies.

A scoring framework for assessing anatomy competence of undergraduate preclinical students.

Recent higher education changes toward outcomes-based education emphasize competent learners, but a widely accepted definition of competence is still lacking. Although the importance of anatomy in health professions education is recognized, there is still uncertainty about what anatomical competence entails and how to assess it. This study aimed to provide a framework for assessing anatomical competence, using an anatomy competence score, for the anatomy course in the undergraduate medical learning program at the University of the Free State in South Africa. All assessments within the dissection program of two student groups (July 2012 to June 2014) were explored to determine the representation of the three competence domains: knowledge, skill and application in context. Student performance in the final objective structured practical examination (OSPE) was investigated for the three domains and the different body regions. Knowledge had ±50% representation in assessments and the different body regions (in final OSPE) for both groups, and skill and application represented ±25% each in both groups. The best average student performance was in the skill domain (64% and 67% for the respective groups). All domains showed good reliabilities (> 0.75) and student performance correlated well between the domains (P < 0.001). This study suggests a representation ratio of 2:1:1 between knowledge, skill and application (i.e., 50% knowledge and 25% skill and application respectively), for anatomical competence assessment. However, this ratio depends on the assessment type, the stage of the anatomy course and the institutional context. Nonetheless, it provides a guideline for ensuring that assessments address all competence domains. Anat Sci Educ 9: 319-329. © 2015 American Association of Anatomists.