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First do no harm’ is a fine principle; however, most medicines worth using have side effects, so it’s important that the prescriber can assess the risk/benefit ratio. This chapter provides examples of good advice (e.g. not to use NSAIDs in renal or liver impairment), overly cautious advice that may be flouted (e.g. cephalosporins in pencillin allergic patients) and advice that may appear overly cautious but should still be followed as there is a safer alternative (e.g.metformin in renal failure).
Epidural analgesia is a safe and effective method of providing pain relief before, during and after a surgical procedure, or for patients with chronic pain, using a combination of local anaesthetic and opioids. The choice of agent, contraindications and complications of epidural analgesia are discussed, and the reader is also provided with top tips for prescribing epidurals.
There is little research on factors associated with alcohol consumption among Puerto Ricans living in the USA; thus the aim of the present study was to examine alcohol intake patterns, and factors associated with drinking categories, in a cohort of Puerto Rican adults in Massachusetts.
Design
Cross-sectional study. Descriptive and polytomous logistic regression analyses were used to identify factors associated with drinking patterns, stratified by gender.
Setting
Greater Boston area, MA, USA.
Subjects
Puerto Rican adults (n 1292), aged 45–75 years.
Results
Eight per cent of men and 39 % of women were lifetime abstainers; 40 % of men and 25 % of women were former drinkers; 31 % of men and 27 % of women were moderate drinkers; and 21 % of men and 8 % of women were heavy drinkers. Thirty-five per cent of participants reported drinking alcohol while taking medications with alcohol contraindications. After multivariable adjustment, young men were less likely than older men to be moderate drinkers. Among women, higher BMI, age, lower income and lower psychological acculturation were associated with abstention; age and lower perceived emotional support were associated with increased likelihood of former drinking; and women without v. with diabetes were more likely to be heavy drinkers.
Conclusions
High prevalence of chronic disease, heavy drinking and alcohol use while taking medications with alcohol contraindications suggest an urgent need for better screening and interventions tailored to this rapidly growing Hispanic national subgroup. As heavy drinking appears to increase with acculturation for women, public health initiatives are needed to support appropriate alcohol use.
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