Jayne Lucke

Smart drugs "as common as coffee": media hype about neuroenhancement.

Background The use of prescription drugs to improve cognitive functioning in normal persons –“neuroenhancement” – has gained recent attention from bioethicists and neuroscientists. Enthusiasts claim that the practice is widespread and increasing, and has many potential benefits; however recent evidence provides weak support for these claims. In this study we explored how the newsprint media portrays neuroenhancement. Aims We conducted an empirical study of media reporting of neuroenhancement to explore: media portrayals of the prevalence of neuroenhancement; the types of evidence used by the media to support claims about its prevalence; and, the possible benefits and risks of neuroenhancement mentioned in these media articles. Methods Using the Factiva database, we found 142 newspaper articles about the non-medical use prescription drugs for neuroenhancement for the period 2008-2010. We conducted a thematic content analysis of how articles portrayed the prevalence of neuroenhancement; what type of evidence they used in support; and, the potential benefits and risks/side-effects of neuroenhancement that were mentioned. Results 87% of media articles mentioned the prevalence of neuroenhancement, and 94% portrayed it as common, increasing or both. 66% referred to the academic literature to support these claims and 44% either named an author or a journal. 95% of articles mentioned at least one possible benefit of using prescription drugs for neuroenhancement, but only 58% mentioned any risks/side effects. 15% questioned the evidence for efficacy of prescription drugs to produce benefits to users. Conclusions News media articles mentioned the possible benefits of using drugs for neuroenhancement more than the potential risks/side effects, and the main source for media claims that neuroenhancement is common and increasingly widespread has been reports from the academic literature that provide weak support for this claim. We urge journalists and researchers to be cautious in their portrayal of the non-medical use of drugs for neuroenhancement.

Transitions into informal caregiving and out of paid employment of women in their 50s.

Data from the Australian Longitudinal Study on Womens Health were used to study the order of events leading to informal caregiving and changes in labour force participation in mid-aged women, taking into account health and socioeconomic status. This analysis included 9857 women who responded to the third (2001) and fourth (2004) surveys and provided data for the caring and employment variables used. Caring was defined as providing care for an ill, frail or disabled person at least 7h/wk. Between 2001 and 2004, the proportion of women caring increased from 12 to 14%. Paid employment participation decreased from 67 to 62% in 2004. Logistic regression model results show that taking up caring between 2001 and 2004 was not statistically significantly associated with employment status in 2001. Among women who took up caring, however, hours spent in paid employment in 2001 was negatively associated with hours spent caring in 2004. Amongst women working in 2001, taking up caring between 2001 and 2004 was associated with reduced participation in paid employment. In conclusion, among mid-aged women, transitions into caregiving were irrespective of time spent in paid employment, but were followed by a decrease in labour force participation. Policies could aim to support continuing labour force participation during caregiving by creating flexible working arrangements; re-employment programs could support women who quit work in getting back to paid employment after a period of caregiving.

Circulating interleukin‐6 concentration and cognitive decline in old age: the PROSPER study

Inflammation is involved in the pathogenesis of cardiovascular disease and cognitive decline. Interleukin‐6 (IL‐6) has a role in cardiovascular disease, but the association of IL‐6 concentration and the functional IL‐6 ‐174 polymorphism with cognitive decline has not been demonstrated unequivocally. The objective of this study was to investigate the associations between both high concentration of IL‐6 and the ‐174 promoter polymorphism, and increased cognitive decline in old age.

Deflating the Neuroenhancement Bubble

This article questions the evidence base for some commonly accepted assumptions among bioethicists about the prevalence of neuroenhancement among college students and the degree to which putative neuroenhancers in fact enhance cognitive functioning. We argue that the evidence on the prevalence of stimulant drug use does not support bioethicists’ claims that neuroenhancement use of these drugs is widespread; that the evidence that putatively enhancing pharmaceuticals are truly neuroenhancing is much weaker than often supposed; that bioethicists have underestimated the challenges in assessing the safety and efficacy of putative neuroenhancers; and that the assumption that neuroenhancement is a novel development has deflected attention from historical experiences with other putatively enhancing pharmaceutical drugs such as cocaine and the amphetamines.

Continuation rates and reasons for removal among Implanon users accessing two family planning clinics in Queensland, Australia.

BACKGROUND This study examined demographic profile, continuation rates and reasons for removal among Implanon users accessing two family planning clinics in Queensland, Australia. STUDY DESIGN A retrospective chart audit of 976 women who attended for implant insertion over a 3-year period between May 2001 and May 2004. RESULTS Continuation rates showed that at 6 months after insertion, 94% of women continued, 74% continued at 1 year and 50% continued at 2 years. Metropolitan women were more likely than rural women to discontinue use because of dissatisfaction with bleeding patterns. Cox regression analysis showed that those attending the regional clinic experienced significantly shorter time to removal. CONCLUSIONS Implanon continuation rates and reasons for removal differ between clinics in metropolitan and rural locations. A cooling-off period did not affect the likelihood of continuation with Implanon. Preinsertion counselling should emphasize potential changes in bleeding patterns.

How have the selective serotonin reuptake inhibitor antidepressants affected suicide mortality

OBJECTIVE We review evidence on two claims that have been made about the effects of selective serotonin reuptake inhibitor (SSRI) antidepressants; that they have: (i) decreased suicide rates in the population; and (ii) increased suicide rates in some individuals early in treatment. METHOD We critically review evidence in the English-speaking peer-reviewed medical literature on: (i) meta-analyses of randomized controlled trials (RCTs) of SSRIs; (ii) observational studies of suicide risk in patients prescribed SSRIs and other antidepressants; and (iii) ecological studies of correlations between population use of SSRI use and population suicide rates. RESULTS The largest and most recent meta-analyses of RCTs of SSRIs have found suggestive evidence that SSRIs increase suicidal ideation early in treatment compared with placebo. Observational studies have found an increased risk of self-harm within 9 days of an antidepressant drug being prescribed but the risk has been similar for the older tricyclic antidepressants and the SSRIs. Ecological studies in developed countries have found either that suicide rates have declined as SSRI use has increased, or have found no relationship between suicide rates and increased SSRI use. CONCLUSIONS Meta-analyses of RCTs suggest that SSRIs increase suicide ideation compared with placebo but the observational studies suggest that SSRIs do not increase suicide risk more than older antidepressants. If SSRIs increase suicide risk in some patients, the number of additional deaths is very small because ecological studies have generally found that suicide mortality has declined (or at least not increased) as SSRI use has increased.

Depression: an emotional obstacle to seeking medical advice for infertility.

OBJECTIVE To investigate the mental and general health of infertile women who had not sought medical advice for their recognized infertility and were therefore not represented in clinical populations. DESIGN Longitudinal cohort study. SETTING Population based. PATIENT(S) Participants in the Australian Longitudinal Study on Womens Health aged 28-33 years in 2006 who had ever tried to conceive or had been pregnant (n = 5,936). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Infertility, not seeking medical advice. RESULT(S) Compared with fertile women (n = 4,905), infertile women (n = 1,031) had higher odds of self-reported depression (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.01-1.43), endometriosis (5.43, 4.01-7.36), polycystic ovary syndrome (9.52, 7.30-12.41), irregular periods (1.99, 1.68-2.36), type II diabetes (4.70, 1.79-12.37), or gestational diabetes (1.66, 1.12-2.46). Compared with infertile women who sought medical advice (n = 728), those who had not sought medical advice (n = 303) had higher odds of self-reported depression (1.67, 1.18-2.37), other mental health problems (3.14, 1.14-8.64), urinary tract infections (1.67, 1.12-2.49), heavy periods (1.63, 1.16-2.29), or a cancer diagnosis (11.33, 2.57-49.89). Infertile women who had or had not sought medical advice had similar odds of reporting an anxiety disorder or anxiety-related symptoms. CONCLUSION(S) Women with self-reported depression were unlikely to have sought medical advice for infertility. Depression and depressive symptoms may be barriers to seeking medical advice for infertility.

Determinants of condom use by Australian Secondary School students

PURPOSE To identify factors that are associated with condom use to aid in the understanding of how to change the behavior of those young people who have sex without using condoms. METHODS The article reports data from 932 sexually active grade 10-12 students from a sample of 72 public secondary schools in seven Australian states and territories. The data were collected using a cross-sectional, self-report questionnaire. RESULTS Boys were more likely than girls to report that a condom was used the last time they had sex. For boys and girls, communication with a partner about avoiding infection with HIV/STDs, the belief that more peers use condoms, and a higher perceived risk of becoming infected with HIV/STDs were associated with using a condom, as was lower knowledge of STDs. The use of oral contraception and the unavailability of condoms were reported by the students as prominent reasons for non-use of condoms. Number of sexual partners in the past year and type of relationship with partner on the most recent occasion were not associated with condom use. CONCLUSIONS Adolescents are more concerned with unwanted pregnancy than with disease prevention. School students more at risk are not more likely to take the necessary precautions to protect themselves from HIV/STDs.

Recruiting Online: Lessons From a Longitudinal Survey of Contraception and Pregnancy Intentions of Young Australian Women

Recruitment of young people for epidemiologic research remains challenging, with marked decreases in the effectiveness of face-to-face, mail, and telephone recruitment methods. We report on the implementation and feasibility of an innovative and flexible approach used to recruit participants for a longitudinal cohort study about contraceptive use and pregnancy (the Contraceptive Use, Pregnancy Intention, and Decisions (CUPID) Study). Australian women aged 18-23 years were recruited using a range of online, networking, and offline methods, including social media (primarily Facebook (Facebook Inc., Menlo Park, California; http://www.facebook.com)), face-to-face events, distribution of promotional material, and media releases. Over the course of the 1-year recruitment period (beginning in September 2012), a total of 3,795 eligible women were recruited to complete the online survey, at a cost of approximately A

Infertility, medical advice and treatment with fertility hormones and/or in vitro fertilisation: a population perspective from the Australian Longitudinal Study on Women's Health

11 per participant. This sample was found to be broadly representative of the Australian population of women aged 18-23 years in terms of demographic characteristics, with the exception of an overrepresentation of tertiary-educated women (88.7% compared with 72.6%). This study demonstrated that although current recruitment strategies are required to be innovative and flexible in order to engage young people in epidemiologic research, representative samples can be achieved online at reasonable cost.