Residents who took many different types of medications, as well as residents starting a new BZD/antipsychotics were at greatly increased risk of falling. These are high risk groups where increased monitoring or adjustments to drug regimens could lead to prevention of falls.

Reports of corticosteroid-induced adverse psychiatric effects began to appear in the literature soon after the introduction of these medications in the 1950s. Unfortunately, early studies relied on informal classification and measurement procedures and tended to utilise nonspecific descriptive terminology (such as steroid psychosis'). A growing number of contemporary investigations have begun to address these problems. However, the literature remains surprisingly undeveloped from a pharmacoepidemiological perspective, consisting largely of case reports and case series. The objective of this review is to summarise published data concerning corticosteroid-induced adverse psychiatric effects. A clinical perspective will be adopted since opportunities to minimise the impact of corticosteroid-induced adverse effects tend to present themselves most readily within the sphere of clinical management. Some of the psychiatric adverse effects of corticosteroids are mild, and not necessarily clinically significant. However, several serious psychiatric syndromes can be caused by corticosteroids: substance-induced mood disorders (with depressive, manic and mixed features), substance-induced psychotic disorders and delirium. While certain clinical groups may be at greater risk of corticosteroid-induced adverse psychiatric effects, corticosteroid-induced psychiatric toxicity is remarkably unpredictable. The literature regarding prevention and treatment of corticosteroid-induced adverse psychiatric effects is poorly developed. As a result, the emphasis of this review is on clinical and epidemiological evidence linking specific adverse effects to corticosteroid medications. However, clinical reports do provide some practical guidance for prevention and treatment, and these are summarised as well. A variety of pharmacological strategies for treatment and prevention have been proposed. Education and support also appear to be important, and perhaps neglected.

The objectives of this prospective study were to calculate incidence rates for fall-related hospitalization, to compare the effect of risk factors among benzodiazepine (BZD) users and unexposed controls, and to examine variations in risks according to length of time following a BZD prescription. Data were derived from Saskatchewan Health linked data bases, leading to information on 468 hospitalizations for injury due to falls among a study population of 321422. Incidence rates per 10000 within 28 days of the prescription fill date were 26.2, 12.1 and 9.0 for BZD sedative users, BZD tranquillizer users and for unexposed controls, respectively. Incidence rates increased with age, and were higher for women than for men. Results from multivariate logistic regression models also showed a greater risk of falling for BZD users but the odds ratio was higher for men than for women. A history of treatment for alcohol abuse was a very strong risk factor for falls among both men (odds ratio, 10.7) and women (odds ratio, 4.3). The highest risk of serious injury due to falls was within 15 days of filling the prescription, with an odds ratio of 3.6 for BZD sedatives and 2.6 for BZD tranquillizers. Risk decreased with further increase of time after the BZD fill date. For the individual BZD, flurazepam and triazolam showed the highest increase in risk with odds ratios of 3.4 and 2.7, respectively, while oxazepam, lorazepam and diazepam showed odds ratios of 2.2, 2.0 and 1.8 (all odds ratios mentioned are statistically significant at p< 0.05).

Recommendations for benzodiazepine (BZD) use suggest durations of no more than a few weeks, but studies report use for months, years, or even decades. This article examines the who (who are long-term users), why (why do they use BZD), what (what are patterns of long-term use) and how (how do they compare to all BZD users). The study population is from the National Population Health Survey in Canada which interviewed respondents four times at two-year intervals, asking about specific drugs use as well as demographic, lifestyle and health-related questions. Long-term BZD use was defined as BZD use for two successive cycles. Four percent of the Canadian population used BZD at any one time, half of whom also reported use in the previous cycle. Benzodiazepine users were more likely to be female, elderly, smokers, to prefer speaking a language other than English, to have insurance coverage for medication, and to have completed high school education. Almost none of these determinants predicted long-term use. Persons reporting BZD use in 2000 had an odds ratio (OR) of 38.6 for also using BZD in 1998, were more likely to use antidepressants (OR=8.5) and suffer from conditions such as poor health, stress, and pain. Most of these determinants had no association with long-term use or if they did at a considerably lower OR. Of the 395 BZD users in 2000, almost 48.4% also used BZD in the previous cycle and 17% in all three previous cycles. Benzodiazepine use in any previous cycle made BZD use in 2000 more likely, with use determined by how recent and the frequency of reported use, culminating in a very high OR of 83.3 for use in all three previous cycles. Continued use for any of the individual BZD tended to be largely for the same BZD. We conclude that: (1) the overriding determinant for BZD use was that of previous use; and (2) long-term use was not determined by the same factors as overall use, which is significant in developing approaches to dealing with long-term BZD use.

Although overall incidence rates have shown a decline, absolute numbers of new colorectal cancer cases have increased. While men have higher colorectal cancer rates, women have similar numbers and screening should target both equally. Over the years, colorectal cancer subsites are showing a rightward shift, i.e. an increase in proximal subsites, but a leftward shift in male/female ratios, i.e. a greater decrease for the more distal subsites in females. The lower rates for women for distal cancer are compatible with a degree of hormonal protection based on oral contraceptive and hormone replacement therapy. Colorectal cancer will continue to be a considerable public health problem in the foreseeable future.