Kevin D. Murphy

Interferon therapy for condylomata acuminata.

Current therapy for condylomata acuminata (genital warts) is not consistently effective. Therefore, we conducted a randomized, double-blind trial to compare interferon alpha-2b with placebo in the treatment of this disorder. Our rationale was that interferon has both antiproliferative and antiviral properties. The placebo or interferon (1 X 10(6) IU) was injected directly into one to three warts three times weekly for three weeks. The injections were well tolerated by both groups of patients. The side effects of fever, chills, myalgia, headache, fatigue, and leukopenia occurred more commonly in the interferon group than in the placebo group, but such effects rarely disrupted daily routines. Only 13 of 296 patients (4 percent) discontinued therapy because of side effects (11 in the interferon group and 2 in the placebo group). Twenty-six other patients were excluded from analysis because of a loss to follow-up or other deviations from protocol, thus leaving 257 patients in the final evaluation. At one week after the completion of therapy, interferon had produced a large and significantly greater reduction in mean wart area (a 62.4 percent decrease), as compared with placebo (a 1.2 percent increase in mean area) (P less than 0.001). At the conclusion of the study (13 weeks after the completion of therapy), the mean wart area was still decreased 39.9 percent below the initial size in the interferon group, whereas it had increased by 46 percent over base-line measurements in the placebo group (P less than 0.001). At the same time, all treated warts had completely cleared in 36 percent of the interferon recipients and in 17 percent of the placebo recipients (P less than 0.001), whereas treated warts progressed in 13 percent of the interferon recipients and in 50 percent of the placebo recipients (P less than 0.001). We conclude that injection of interferon alpha-2b directly into genital warts appears to be an effective and fairly well-tolerated form of therapy.

Substance use in young persons in Ireland, a systematic review.

Adolescence is a time of physical and mental development when small changes can impact on the rest of a persons life. Substance use in this crucial period can have long-lasting consequences for the individual and for society. The prevalence of substance use in young people is an area of concern for policy makers and health workers. This systematic review looked at prevalence for four substances: alcohol, tobacco, cannabis, and benzodiazepines, across the Republic of Ireland for persons between the ages of 13 and 24, and compared usage between 2000 and 2012. Eighteen articles were included in the review. It was seen that tobacco, alcohol, and cannabis use has fallen in the lifetime and previous month use. The level of benzodiazepine use has remained similar in the period of study. Future work should redress the imbalance in substance use research that sees the majority of researchers looking at a few substances while little work is done on the others.

Benzodiazepine use among young attendees of an Irish substance treatment center.

Objective:To describe the demographic characteristics of those service users attending Matt Talbot Services, and their current and past substance use, and to explore the use of benzodiazepines among this group. Method:There were 198 service users who attended a substance misuse treatment center in Cork, Ireland, between January 2005 and August 2011. Results:Benzodiazepines had ever been used by 51.0%, and of these, 55.8% were regular benzodiazepine users. The mean age of first use was 14.9 ± 1.4 years. Regular users of benzodiazepines were regular users of significantly more substances (3, interquartile range [IQR] = 2-3) when compared with nonregular benzodiazepine users (1, IQR = 1-2). Regular benzodiazepine users showed more behavioral signs (12, IQR = 10-14) than nonregular users (9, IQR = 7-12). Physical signs were significantly different between regular (8, IQR = 6-11) and nonregular (5, IQR = 3-10) users. Conclusions:The effects of benzodiazepine misuse affect the individual, their family, and society as a whole through hospitalization, substance treatment, and crime. Identifying regular benzodiazepine users can help reduce the burden of benzodiazepines.

You don't feel: The experience of youth benzodiazepine misuse in Ireland.

ABSTRACT There are negative effects to inappropriate use of benzodiazepines, yet the percentage of young people in Ireland experimenting with benzodiazepines has increased. There is a paucity of research about why Irish young people misuse benzodiazepines. In this study, people between 18 and 25 years attending substance misuse services in the south of Ireland (N = 13) were interviewed in a semi-structured style between June 2012 and April 2013. Content analysis was performed. The main motivations for benzodiazepine misuse were to self-regulate negative emotions and to induce dissociation from their environment. Interviewees also described the consequences of benzodiazepine misuse, such as disengagement from family relationships and other protective environments such as school and sports clubs. The consequences of chronic misuse were discussed, such as the compulsion to take more benzodiazepines despite experiencing severe side-effects. The incidence of paradoxical aggression on benzodiazepines is also explored. Education about benzodiazepines and their risks to young people, families, and the public may reduce benzodiazepine misuse. Future research on the role of trauma and mental health in young people’s substance misuse is needed.

Analysis of service-users attending Matt Talbot Services (MTS) from 2007-2010.

Background and objectives: User fees, also termed ‘cash and carry’, is the preferred approach used in the delivery of healthcare in many third world countries who have limited funds allocated to health services. The WHO has advised that this inequitable method creates many barriers for the poor to access healthcare services, where there are often many competing day-to-day necessities and therefore choices are made based on intuitive trades-offs. However, some of the third world nations have taken a stance against the use of user fees, by introducing social healthcare to the masses. Ghana is one of many to implement this system in 2005 by setting up the National Health Insurance Scheme (NHIS) run by the National Health Insurance Agency (NHIA). The NHIS is aimed at the pro-poor, the most vulnerable group to access primary healthcare. The aim of the study was therefore to evaluate the progress of the scheme from the perspectives of the main stakeholders. Setting and methods: A semi structured interview was conducted to evaluate service providers and decision makers with regards to their daily involvement and management of the scheme. In addition the HUI2 questionnaire was distributed to patients aged 18–70 in the greater Accra region to measure their current health states. Main outcome measure: The interview demonstrated that the scheme was a good initiative in providing coverage to all, in particular the poor and those in rural areas, Results: Despite the scheme being a good initiative all responders mentioned that there were many discrepancies with regards to the repayment system of the scheme and further improvements were needed, as well as more responsibility to the service providers. The HUI2 demonstrated that the mean utility scores of the patients HRQoL showed the NHIS members had a higher utility score of 0.96 versus 0.95 of the non members, with an overall mean of 0.94 for all respondents suggesting very good health. Conclusion: The findings indicate that further improvements are needed in the scheme, NHIA have made recommendations of improvement to the current structure and the financing of the scheme to curb fraud on claims and expenditure. Disclosure of interest: None declared.41st ESCP symposium on clinical pharmacy: personalised and safe therapy Barcelona, Spain. 29–31 October 2012 Published online: 2 August 2013 Springer Science+Business Media Dordrecht 2013 Oral communications I

A survey of service-users attending Matt Talbot Services (MTS) during 2009 and their use of alcohol.

ESCP 40th International Symposium on Clinical Pharmacy. Clinical Pharmacy: Connecting Care and Outcomes Dublin Ireland, 19–21 October 2011 Clinical pharmacokineticsActivities of hospital pharmacies (PUI) are multiple: dispensing, patient education, risk mapping, or risk management. Transverse and integrated into the overall management of patient, they require the establishment of a systemic approach of safety.