Metropolitan Brisbane Research Articles

Subjective reasons why immigrant patients attend the emergency department.

BackgroundSome patients visit a hospital’s emergency department (ED) for reasons other than an urgent medical condition. There is evidence that this practice may differ among patients from different backgrounds. The objective of this study was to examine the reasons why patients from a non-English speaking background (NESB) and patients with an English speaking background but not born in Australia (ESB-NBA) visit the ED, as compared to patients from English-speaking backgrounds but born in Australia (ESB-BA).MethodsA cross-sectional survey was conducted at the ED of a tertiary hospital in metropolitan Brisbane, Queensland, Australia. Over a four-month period patients who were assigned an Australasian Triage Scale score of 3, 4 or 5 were surveyed. Pearson chi-square test and multivariate logistic regression analyses were performed to examine the differences between the ESB and NESB patients’ reported reasons for attending the ED.ResultsA total of 828 patients participated in this study. Compared to ESB-BA patients NESB patients were less likely to consider contacting a general practitioner (GP) before attending the ED (Odds Ratios (OR) 0.6 (95% Confidence Interval (CI) 0.4–0.8, p < .05) While ESB-NBA were more likely to consider contacting a GP 1.7 (1.1–2.5, p < .05). Both the NESB patients and the ESB-NBA patients were far more likely than ESB-BA patients to report that they had visited the ED either because they do not have a GP (OR 7.9, 95% CI 4.7–13.4, p < .001) and 2.2 (95% CI 1.1–4.4, p < .05) respectively and less likely to think that the ED could deal with their problem better than a GP (OR 0.5 (95% CI 0.3–0.8, p < .05) and 0.7 (0.3–0.9, p < .05) respectively. The NESB patients also thought it would take too long to make an appointment to consult a GP (OR 6.2, 95% CI 3.7–10.4, p < 0.001).ConclusionsNESB patients were the least likely to consider contacting a GP before attending hospital EDs. Educational interventions may help direct NESB people to the appropriate health services and therefore reduce the burden on tertiary hospitals ED.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-015-0031-8) contains supplementary material, which is available to authorized users.

Spatial Planning and High-Speed Broadband: Australia's National Broadband Network and Metropolitan Planning

The Australian government is constructing a National Broadband Network (NBN), which at an estimated cost of $43 billion will be Australia's largest ever infrastructure project. The NBN, if its full benefits are to be realized, raises a number of important, but largely unexplored, questions for planning. This paper investigates the implications of the NBN for Australian metropolitan planning focusing on the question of how these plans will exploit the NBN to improve urban outcomes. The paper examines the Sydney, Melbourne and Brisbane metropolitan areas and analyses the strategies shaping the future of these regions during the rollout and implementation of the NBN. This comparative analysis reveals similarities across these three metropolitan areas in their weak stance towards the NBN. Some key findings include: (1) a segregation of infrastructure planning and metropolitan planning; (2) a lack of consistency between different policies within each metropolitan area and (3) policy gaps regarding the role of telecommunications at the metropolitan level. Considering the number of governments worldwide that are making large investments in high-speed broadband, this paper addresses policy issues that will impact upon metropolitan planning well beyond the borders of Australia.

Greening the Commute: Assessing the Impact of the Eleanor Schonell ‘Green’ Bridge on Travel to the University of Queensland, Australia

The ability of targeted infrastructure to effect change in travel behaviour is axiomatic in transport planning but rarely does the opportunity arise to directly quantify the impacts of infrastructure on the travel behaviour of a discrete urban population. This article explores the impact of the Eleanor Schonell ‘Green’ Bridge on the travel and residential distribution of staff and students of the University of Queensland (UQ) St Lucia Campus, one of the largest daily traffic generators in the Brisbane metropolitan region. We examine the volume and modal split of trips to and from the campus prior to and post construction of the bridge in 2006. We then explore shifts in the residential distribution of staff and students over the same period according to the accessibility and socio-economic status of the neighbourhoods in which they are resident. We show that opening of the bridge was followed by a measurable improvement in transport sustainability at the campus, as well as a significant redistribution of staff and students across the metropolitan area.

PT136 Review of thrombolysis outcomes for acute ST elevation Myocardial Infarction (STEMI) in rural versus greater metropolitan Brisbane area

PT136 Review of thrombolysis outcomes for acute ST elevation Myocardial Infarction (STEMI) in rural versus greater metropolitan Brisbane area

School Children’s Personal Exposure to Ultrafine Particles in the Urban Environment

There has been considerable scientific interest in personal exposure to ultrafine particles (UFP). In this study, the inhaled particle surface area doses and dose relative intensities in the tracheobronchial and alveolar regions of lungs were calculated using measured 24-h UFP time series of school children personal exposures. Bayesian hierarchical modeling was used to determine mean doses and dose intensities for the various microenvironments. Analysis of measured personal exposures for 137 participating children from 25 schools in the Brisbane Metropolitan Area showed similar trends for all participating children. Bayesian regression modeling was performed to calculate the daily proportion of children's total doses in different microenvironments. The proportion of total daily alveolar doses for home, school, commuting, and other were 55.3%, 35.3%, 4.5%, and 5.0%, respectively, with the home microenvironment contributing a majority of children's total daily dose. Children's mean indoor dose was never higher than the outdoor's at any of the schools, indicating there were no persistent indoor particle sources in the classrooms during the measurements. Outdoor activities, eating/cooking at home, and commuting were the three activities with the highest dose intensities. Children's exposure during school hours was more strongly influenced by urban background particles than traffic near the school.

Health related quality of life across the perinatal period among Australian women

To investigate the significant features in health-related quality of life and to examine the changes over time during the perinatal period. Health-related quality of life during the perinatal period is significant for women. Screening or surveillance during the perinatal period is inconsistent and often not part of continued assessment. Prospective. Setting involved antenatal clinics at three public hospitals in metropolitan Brisbane, Australia. A total of 363 participants out of a cohort of 605 women completed all items of the Short Form-12 Health Survey in late pregnancy and again at 6 and 12 weeks postpartum. There was a significant difference across the three perinatal time periods in all the health-related quality-of-life subscales. Significant improvements were noted from late pregnancy to 6 weeks following childbirth and again at 12 weeks particularly in physical health, role physical, bodily pain, vitality, role emotional and mental health. Even when confounding variables such as maternal ages, partner status, parity, delivery type and ethnicity were introduced, significant improvements were noted. Maternal distress significantly related to almost all quality-of-life factors over time even when all possible confounding factors were controlled. Significant changes occur in health-related quality of life across the perinatal period. All dimensions of health-related quality of life except for social functioning and maternal distress showed marked improvement following childbirth. During this period, maternal distress was negatively related to health-related quality of life. Nurses need to be mindful of the broader view of health as encompassed in health-related quality-of-life measures and the potential these have for alerting health professionals when providing care. More rigorous health assessment for mothers at risk is useful so that appropriate support and follow-up can be given.

Outcomes for Antenatally Diagnosed Hypoplasia of the Left Ventricle

Aim: To investigate parental decisions associated with the antenatal diagnosis of hypoplasia of the left ventricle spectrum (HLV), and intermediate-term outcome. Methods: A cohort study was performed on all families with a foetal diagnosis of HLV. Assessment was performed at the sole tertiary cardiac feto-maternal service for Queensland from 2008 to 2012. Demographic data, incidence of termination of pregnancy, and post-natal survival outcomes were recorded. Results: HLV was diagnosed (using standardised foetal echocardiographic criteria) in 81 pregnancies. Sixty-two (76.5%) had HLHS (aortic ± mitral atresia), with the remainder having HLV variants. Three (3.7%) foetuses had chromosomal abnormalities. Median gestation at initial tertiary assessment was 21 weeks (range 16–36 weeks). Thirty-eight (46.9%) families were not from metropolitan Brisbane. Forty-five (55.8%) families elected termination of pregnancy. Seventeen (21%) families elected palliative care following delivery. Nineteen (23.5%) infants diagnosed antenatally were referred for surgery, and 14 (73.7%) were referred to RCH, Melbourne. There was no significant variation in antenatal and postnatal diagnosis. Sixteen (84.2%) had Norwood operations, two (10.5%) had bi-ventricular repairs and one (5.3%) is awaiting delivery. Fourteen (77.7%) surgically treated infants are alive at a median follow-up of 21 months (range 1–57 months). One patient has undergone a Fontan operation. Overall this represents an 82.7% intermediate loss (elective termination, palliative care and operative mortality) for foetuses following antenatal diagnosis of HLV. Conclusion: In our unit, foetal diagnosis of HLV is associated with a high probability of death, noting that the majority of mortality was in non-surgical cases.

Relationship between Social Support and Quality of Life in Childbearing Women during the Perinatal Period

To explore demographic and social support predictors of health-related quality of life (HRQoL) (mental and physical) for childbearing women in the perinatal period. Longitudinal. Three public hospitals in metropolitan Brisbane, Australia. Four hundred seventy-three (473) women recruited at 36 weeks of pregnancy, and 6 and 12 weeks following childbirth. The Short Form-12 (SF-12) Version 2 Health Survey was used to measure the mental and physical domains of HRQoL. Social support was measured using the Maternal Social Support Scale (MSSS). Mean scores for the mental and physical domains of HRQoL were lower than population norms. Social support was found to be a significant and consistent predictor of higher HRQoL scores, particularly in the physical domain at 12 weeks following child birth and mental domain during the perinatal period. The relationship between social support and HRQoL was found to be independent of other factors including education, length of relationship with partner, age, parity, and antenatal visit. The only other significant predictor was length of relationship with partner in the mental domain at 36 weeks of pregnancy. Social support is a significant and consistent predictor of a mother's HRQoL during the perinatal period. Nurses and midwives need to assess social support, rather than making assumptions based on demographic factors.

Helicobacter pylori infection and the risks of Barrett's oesophagus: A population‐based case–control study

Infection with Helicobacter pylori is associated with significantly reduced risks of oesophageal adenocarcinoma; however, few studies have examined the association between H. pylori and Barrett's oesophagus (BO), the precursor lesion. We explored the relationship between H. pylori infection and BO and sought to identify potential modifiers. We compared the prevalence of positive H. pylori serology among 217 adults with simple BO (without dysplasia), 95 with dysplastic BO and 398 population controls sourced from the metropolitan Brisbane area. We determined H. pylori serostatus using enzyme-linked immunosorbent assay. To estimate relative risks, we calculated odds ratios (OR) and 95% confidence intervals (CI) using multivariable logistic regression in the entire sample and stratified by factors known to cause BO. The prevalence of H. pylori seropositivity was 12%, 3%, and 18%, respectively, among patients with simple BO, dysplastic BO and population controls. BO patients were significantly less likely to have antibodies for H. pylori (Simple BO: OR = 0.51, 95% CI: 0.30-0.86; Dysplastic BO: OR = 0.10, 95% CI: 0.03-0.33) than population controls. For simple BO, the association was diminished after adjustment for frequency of gastro-oesophageal reflux (GOR) symptoms. Adjustment for frequency of GOR symptoms did not substantially alter the observed effect for dysplastic BO. Although there was some variation in the magnitude of risk estimates across strata of age, sex, GOR symptoms and use of proton pump inhibitors or H2-receptor antagonists, the differences were uniformly nonsignificant. Helicobacter pylori infection is inversely associated with BO, and our findings suggest that decreased acid load is not the only mechanism underlying the H. pylori protective effect.

Q fever seroprevalence in metropolitan samples is similar to rural/remote samples in Queensland, Australia

Q fever is a vaccine preventable disease; however, despite this, high notification numbers are still recorded annually in Australia. We investigated the seroprevalence of Coxiella burnetii, the Q fever agent, in a Queensland sample population. Notification data (N = 6425) from 1984-2008 were collated, identifying high risk areas of Q fever exposure. Of these 177 were recorded in children. Serum samples were collected from Queensland and screened using both an immunoflourescence assay at 1:10 dilution and a commercially available ELISA kit. Results were collated based on age, geographical location and sex. From 1988 Queensland samples screened, 103 were identified as Q fever IgG-positive, giving a seroprevalence of 5.2% (95% CI 4.3-6.2%). Seroprevalence in the rural/remote population was 5.3% (95% CI 4.6-6.6%), and the metropolitan Brisbane population, which is considered not at risk, was 5.0% (95% CI 3.7-6.7%). Sixty-three seropositive males and 40 females were identified, along with an increase in seropositivity with increasing age. The seropositivity of children was 1.3% (95% CI 0.7-2.3%) from 844 samples. We have shown that both metropolitan and paediatric populations which are considered low risk of Coxiella exposure have surprisingly high seropositivity. These emerging groups require further investigation and consideration for the introduction of preventive measures.

Pterygium and Rate of Dysplasia in Surgical Specimens

Purpose: To determine the rate of ocular surface squamous neoplasia in all pterygium specimens in a 2-year period at a single tertiary hospital in metropolitan Brisbane. Secondary outcomes measured included the percentage of tissue samples undergoing histological analysis and the clinical suspicion of dysplastic change. Method: Retrospective chart review was undertaken for all pterygium surgery performed between the period of January 2009 and October 2010 at the Princess Alexandra Hospital in Brisbane. The rate of ocular surface squamous neoplasia, number of specimens sent for histopathology analysis, and clinical suspicion of dysplastic changes at initial review was recorded. Results: One hundred and five out of 166 pterygia removed were sent for histological analysis, and 14 out of 105 (13.3%) showed ocular surface squamous neoplasia. Age, gender and side of surgery were not significantly different between patients with histologically normal and OSSN specimens. Conclusion: Our results showed a much higher rate ocular surface squamous neoplasia in pterygium patients than otherwise suspected based on clinical examination. This finding suggests the need for routine submission of all pterygium specimens for histopathology analysis, so appropriate post-operative treatment and follow up can be instituted.

Planning Volunteer Responses to Low-Volume Mass Gatherings: Do Event Characteristics Predict Patient Workload?

Workforce planning for first aid and medical coverage of mass gatherings is hampered by limited research. In particular, the characteristics and likely presentation patterns of low-volume mass gatherings of between several hundred to several thousand people are poorly described in the existing literature. This study was conducted to: 1. Describe key patient and event characteristics of medical presentations at a series of mass gatherings, including events smaller than those previously described in the literature; 2. Determine whether event type and event size affect the mean number of patients presenting for treatment per event, and specifically, whether the 1:2,000 deployment rule used by St John Ambulance Australia is appropriate; and 3. Identify factors that are predictive of injury at mass gatherings. A retrospective, observational, case-series design was used to examine all cases treated by two Divisions of St John Ambulance (Queensland) in the greater metropolitan Brisbane region over a three-year period (01 January 2002-31 December 2004). Data were obtained from routinely collected patient treatment forms completed by St John officers at the time of treatment. Event-related data (e.g., weather, event size) were obtained from event forms designed for this study. Outcome measures include: total and average number of patient presentations for each event; event type; and event size category. Descriptive analyses were conducted using chi-square tests, and mean presentations per event and event type were investigated using Kruskal-Wallis tests. Logistic regression analyses were used to identify variables independently associated with injury presentation (compared with non-injury presentations). Over the three-year study period, St John Ambulance officers treated 705 patients over 156 separate events. The mean number of patients who presented with any medical condition at small events (less than or equal to 2,000 attendees) did not differ significantly from that of large (>2,000 attendees) events (4.44 vs. 4.67, F = 0.72, df = 1, 154, p = 0.79). Logistic regression analyses indicated that presentation with an injury compared with non-injury was independently associated with male gender, winter season, and sporting events, even after adjusting for relevant variables. In this study of low-volume mass gatherings, a similar number of patients sought medical treatment at small (<2,000 patrons) and large (>2,000 patrons) events. This demonstrates that for low-volume mass gatherings, planning based solely on anticipated event size may be flawed, and could lead to inappropriate levels of first-aid coverage. This study also highlights the importance of considering other factors, such as event type and patient characteristics, when determining appropriate first-aid resourcing for low-volume events. Additionally, identification of factors predictive of injury presentations at mass gatherings has the potential to significantly enhance the ability of event coordinators to plan effective prevention strategies and response capability for these events.

The experience of socially isolated older people in accessing and navigating the health care system

Objective: This article reports findings from a study exploring the challenges experienced by socially isolated and unwell older people as they attempted to access the health care system. Understanding the specific issues confronting these individuals would inform the development of more appropriate models of community‑based aged care. Design: A longitudinal qualitative, interpretive study using a case study approach with indepth interviewing. Setting: This study was conducted in metropolitan Brisbane, with frail older people who were accessed via their GP service. Participants: Six participants who met pre‑determined selection criteria were recruited to this longitudinal study, and interviewed twice over a six month period. Findings: Fear emerged as a common experience embracing aspects of daily life such as depletion of social networks, being dependent on others, loss of mobility and diminishing ability to drive. Inadequate or unreliable public transport resulted in extended waiting times to attend medical appointments. Conclusions: Despite efforts to address the specific issues of frail older people living independently, this study highlights the suffering experienced by those who are socially isolated and lack the knowledge, skills, physical wellbeing and support to locate and access relevant health services.

Management and organisational barriers in the acquisition of computer usage skills by mature age workers

To investigate workplace cultures in the acquisition of computer usage skills by mature age workers. Data were gathered through focus groups conducted at job network centres in the Greater Brisbane metropolitan region. Participants who took part were a mixture of workers and job-seekers. The results suggest that mature age workers can be exposed to inappropriate computer training practices and age-insensitive attitudes towards those with low base computer skills. There is a need for managers to be observant of ageist attitudes in the work place and to develop age-sensitive strategies to help mature age workers learn computer usage skills. Mature age workers also need to develop skills in ways which are practical and meaningful to their work.

Randomised controlled trial of a secondary prevention program for myocardial infarction patients ('ProActive Heart'): study protocol. Secondary prevention program for myocardial infarction patients.

BackgroundCoronary heart disease (CHD) is a significant cause of health and economic burden. Secondary prevention programs play a pivotal role in the treatment and management of those affected by CHD although participation rates are poor due to patient, provider, health system and societal-level barriers. As such, there is a need to develop innovative secondary prevention programs to address the treatment gap. Telephone-delivered care is convenient, flexible and has been shown to improve behavioural and clinical outcomes following myocardial infarction (MI). This paper presents the design of a randomised controlled trial to evaluate the efficacy of a six-month telephone-delivered secondary prevention program for MI patients (ProActive Heart).Methods550 adult MI patients have been recruited over a 14 month period (December 2007 to January 2009) through two Brisbane metropolitan hospitals, and randomised to an intervention or control group (n = 225 per group). The intervention commences within two weeks of hospital discharge delivered by study-trained health professionals ('health coaches') during up to 10 × 30 minute scripted telephone health coaching sessions. Participants also receive a ProActive Heart handbook and an educational resource to use during the health coaching sessions. The intervention focuses on appropriate modification of CHD risk factors, compliance with pharmacological management, and management of psychosocial issues. Data collection occurs at baseline or prior to commencement of the intervention (Time 1), six months follow-up or the completion of the intervention (Time 2), and at 12 months follow-up for longer term outcomes (Time 3). Primary outcome measures include quality of life (Short Form-36) and physical activity (Active Australia Survey). A cost-effective analysis of the costs and outcomes for patients in the intervention and control groups is being conducted from the perspective of health care costs to the government.DiscussionThe results of this study will provide valuable new information about an innovative telephone-delivered cost-effective secondary prevention program for MI patients.Trial Registration NumberACTRN12607000595415

Spatial Foraging Behavior and Use of an Urban Landscape by a Fast-Flying Bat, the MolossidTadarida australis

Insectivorous bats require different resources for diurnal roosting and nocturnal feeding, and sound conservation planning requires knowledge of both. However, ranging behavior and habitat use by foraging bats are poorly known, especially within urban ecosystems. We studied foraging flight behavior and use of an urban landscape by 14 white-striped free-tailed bats (Tadarida australis) in metropolitan Brisbane, Australia. Each evening, the bats emerged from day-roosts in tree-hollows and commuted rapidly to a feeding area (median travel speed 42.9 km/h, based on net distances moved during 10–20 min). Within 30 min from emergence their travel speed was greatly reduced (median 6.7 km/h) to a level that remained similar throughout subsequent hours while they foraged. Day-roosts were widely dispersed across the urban landscape, but foraging bats mostly restricted their movements to a localized area of a few kilometers diameter. This area was closer to a communal roost, visited periodically by all bats, than to their day-roosts (median distance from foraging bats to the communal roost 2.5 km; to their day-roosts 6.2 km). The bats showed a significant preference for foraging above floodplain habitat, and did not prefer to feed above remnant forest. T. australis appears tolerant of deforestation and capable of persisting in urban landscapes, provided that roost trees are protected. However, it remains unknown whether a sustained availability of aerial prey depends on floodplains remaining undeveloped.

The Use of Group Therapy as a Means of Facilitating Cognitive–Behavioural Instruction for Adolescents With Disruptive Behaviour

AbstractThis article reports on the findings of an action research enquiry examining the efficacy of group therapy as a means of facilitating cognitive–behavioural instruction for students who exhibit disruptive behaviours. A curriculum comprising the key tenets of cognitive–behaviour modification was developed and taught over a 9-week period to a group of 12 Year 7 adolescent students selected from a primary school in the Brisbane metropolitan district, Queensland, Australia. Six of the participants for the investigation were identified as ‘at-risk’ of engaging in disruptive behaviours based on extensive observations from members of the school administration team. The remaining students served as role models of prosocial behaviours throughout the intervention. Each session incorporated group discussions and physical challenges that were formulated to facilitate investigation of key concepts of cognitive– behavioural therapy. The findings that emerged from the investigation provide support for the use of group therapy for this form of intervention.

The nature and predictors of stroke knowledge amongst at risk elderly persons in Brisbane, Australia

Purpose. The aim of the study was to investigate the nature, extent, and predictors of stroke knowledge amongst people at risk of stroke.Method. A total of 273 questionnaires were distributed to three types of sites in metropolitan Brisbane (retirement villages, senior citizens and bowls clubs), and this strategy yielded a response rate of 37%. Of the surveys returned, 75 were retained in this study on the basis that: (a) participants met our criteria for being at risk of stroke (i.e., they reported one or more modifiable stroke risk factor, such as hypertension), and (b) they returned a completed Stroke Knowledge Test (SKT).Results. Descriptive analyses revealed the overall level of stroke knowledge in this group was fair (approximately 50% of SKT items answered correctly, on average). SKT performance trends showed that participants did not have misconceptions about stroke but that more than 50% of the sample did not know the answer to seven out of 20 SKT items. Some overlap was identified regarding the issues about which participants in this and other previously researched groups admit they lack knowledge, such as the extent of increased stroke risk associated with smoking; however, the number of knowledge gaps identified in this sample was almost double that reported previously amongst stroke survivors and the general community. Analyses undertaken to explore determinants of stroke knowledge revealed age and education but not risk factor variables as significant predictors.Conclusion. Overall, findings suggest that it is presently difficult to predict an individual's understanding of stroke and that there is a need to increase stroke education, especially if this can address issues that people at risk of stroke admit they do not understand.

Measuring the Ability of School Children with a History of Otitis Media to Understand Everyday Speech

The present study compared the ability of school-aged children with and without a history of otitis media (OM) to understand everyday speech in noise using the University of Queensland Understanding of Everyday Speech Test (UQUEST). Participants were 484 children (246 boys, 238 girls) attending Grade 3 (272, mean age = 8.25 yr., SD = 0.43) and Grade 4 (212, mean age = 9.28 yr., SD = 0.41) at 19 primary schools in Brisbane metropolitan and Sunshine Coast schools. Children selected for inclusion were native speakers of English with normal hearing on the day of testing and had no reported physical or behavioral impairments. The children were divided into three groups according to the number of episodes of OM since birth. The results showed no significant differences in speech scores across the participant groups. However, a significant difference in mean speech scores was found across the grades and the noise conditions. Although children with a history of OM performed equally well at a group level when compared to the controls, they exhibited a large range of abilities in speech comprehension within the same group.

Comparing primary heroin and primary amphetamine users’ knowledge of withdrawal and treatment options in inner metropolitan Brisbane, Australia

The present study compared knowledge of withdrawal and treatment services among twelve primary heroin injectors (PHIs) and fourteen primary amphetamine injectors (PAIs). Assessment of knowledge about withdrawal and treatment was made using the Withdrawal Knowledge Questionnaire (WKQ). Results showed that, on average, knowledge about withdrawal differed depending on the drug used. Specifically, regular amphetamine users knew less about withdrawal from amphetamine, than regular heroin users knew about withdrawal from heroin. In addition, amphetamine users appeared to underestimate the likely length of amphetamine withdrawal. There was no difference between regular amphetamine and regular heroin users’ knowledge of available treatment services, such that both groups knew where to seek assistance for detoxification and rehabilitation. However, both user groups shared some important misconceptions about withdrawal. This suggests a clear need for improved dissemination of educational resources, emphasizing the length and severity of amphetamine withdrawal and the risks associated with excessive self-medication of withdrawal symptoms.