bluuebunny/crossref_metadata_2025_split huggingface dataset:
BRIEF THERAPY FOR CHILDREN’S MENTAL HEALTH PROBLEMS: OUTCOMES IN A RURAL SETTING
Authors: Allison Stephen , Roeger Leigh , Dadds Vikki , Martin Graham 
Published: March 2003

ABSTRACTIn rural areas where specialist services are not readily accessible, there are practical advantages to providing short courses of therapy for children’s mental health problems. Fifty‐five parents from a rural area in South Australia completed questionnaires before and 3 months after receiving brief, family‐orientated therapy from a child and adolescent mental health service. Clinically, these families were assessed as being suitable for brief therapy because the children had moderately severe emotional and behavioural problems and the families were not severely dysfunctional. The screening process sought to exclude more serious and complex presentations so those families were not included in the current study. Questionnaires measuring the severity of children’s mental health problems (Child Behavior Checklist) and the degree of family dysfunction (Family Assessment Device general functioning subscale) suggested that, on average, the sample met these entry criteria. The follow‐up evaluation after brief therapy found significant overall improvement in the Child Behavior Checklist scores, however some children continued to show substantial difficulties. Parents’ satisfaction with therapy was related to these scores after treatment. The results suggest that brief therapy was appropriate for most of the families and that routine follow‐up could help determine those who might benefit from further assistance.
Lacrimal gland abscess: Two case reports
Authors: McNab Alan A 
Published: March 2003

Background: Bacterial dacryoadenitis is rare and suppuration leading to abscess formation within the lacrimal gland has been very rarely reported in the antibiotic era. Methods: The medical records and investigation results, including computed tomography (CT), of two patients with lacrimal gland abscess were reviewed. Results: Two cases of lacrimal gland abscess, one a 28‐year‐old male and the other a 64‐year‐old female, are described. Both demonstrated a characteristic low‐density area within an enlarged lacrimal gland on CT. The first case had been treated with antibiotics and the abscess, when drained, was sterile. The second case settled spontaneously. Neither patient suffered any sequelae of dry eye. Conclusions: Although rare, lacrimal gland abscess may still occur and may require surgical drainage if spontaneous resolution does not occur.
Posterior uveitis in Hodgkin’s disease
Authors: Towler H , De La Fuente M , Lightman S 
Published: March 2003

Purpose: To describe the features of posterior uveitis in patients who either developed or were known to have, biopsy‐proven Hodgkin’s disease (HD). Methods: Four patients were identified who were attending the uveitis clinic. Their charts were reviewed retrospectively and information on their HD was obtained from other hospitals where necessary. Their case histories are presented. Results: Two patients presented with uveitis prior to the diagnosis of HD and in the other two, the HD was thought to be in remission. The commonest ocular signs were of vitritis and discrete, white, chorioretinal lesions. No difference in the ocular findings were apparent between those who had a known diagnosis of HD and the those that did not. Conclusions: HD can occur in the eye and can mimic posterior uveitis. In two of the patients, the uveitis preceded the diagnosis of HD and at the time of presentation all investigations were normal. No specific diagnostic features were apparent, though three of the patients had vitritis and chorioretinal lesions.
Psychiatrists' Recommendations for Improving Bicultural Training and Maori Mental Health Services: A New Zealand survey
Authors: Johnstone Kelly , Read John 
Published: March 2003

Objective: In the context of Maori being over-represented as clients, and under-represented as professionals in New Zealand's mental health system, this study ascertained the beliefs of New Zealand's psychiatrists about issues pertaining to Maori mental health. The overriding objective was to gather recommendations as to how to improve bicultural training and mental health services for Maori. Method: A questionnaire involving closed and open-ended questions was sent to 335 New Zealand psychiatrists. Results: Of the 247 psychiatrists (74%) responding, 40% believed their training had prepared them to work effectively with Maori. Recommendations for improving training focused on the need for greater understanding of Maori perspectives of well-being. Recommendations for improving mental health services for Maori highlighted the need for more Maori professionals and for Maori-run services. No psychiatrists thought that pakeha clinicians should not work with Maori clients, but the majority (70%) recognised the need to consult with Maori staff when doing so. Twenty-eight psychiatrists (11.3%), all male, New Zealand born, and with 10 or more years clinical experience, believed that Maori were biologically or genetically more predisposed than others to mental illness. Several respondents offered other racist comments. Conclusions: The high response rate and the many positive recommendations suggest a high level of constructive interest in these issues among psychiatrists. Comparisons with a simultaneous survey of psychologists are made. It is hoped that the recommendations might inform those responsible for training programs and for providing or purchasing mental health services.
The Trajectory of Psychiatric Disorders in Young People with Intellectual Disabilities
Authors: Tonge Bruce , Einfeld Stewart 
Published: March 2003

Objective: This study addresses the question of how prevalence and patterns of psychiatric disorder change from childhood to adolescence in young people with intellectual disability (ID). Method: A representative epidemiological sample of 582 young people with ID aged 4–19 years was surveyed in 1991–1992 and again in 1995–1996. The main measure of psychiatric disturbance was the developmental behaviour checklist (DBC), a 96 item parent/carer completed questionnaire with robust psychometric properties which provided an overall score, 6 subscale or syndrome measures of psychiatric disturbance and determined caseness. Results: The findings confirmed that about 40% of young people with ID had psychiatric disorders which persisted over 4 years. Clinically significant change in symptoms with either deterioration or improvement occurred in around 14% of the sample. Conclusion: Psychiatric disorder is 3–4 times more prevalent in young people with ID than in the general population. Less than 10% of these young people receive specialist services for a problem which is numerically as large as schizophrenia.
Successful Treatment of Behavioural Problems in Dementia Using a Cholinesterase Inhibitor: The Ethical Questions
Authors: Coulson Brett S , Coulson Brett S , Fenner Stephen G , Almeida Osvaldo P 
Published: March 2003

Objective: To review the effect of cholinesterase inhibitors on the behavioural and neuropsychiatric symptoms of dementia and discuss the current clinical guidelines for the prescription of cholinesterase inhibitors in Australia. Method: This paper reports the case of a patient with clinical diagnosis of dementia with lewy bodies (DLB) who was referred to an old age psychiatry service for the treatment of severe visual hallucinations and behavioural problems. Results: Pharmacological treatment with olanzapine produced marked parkinsonism, agitation and confusion. A cholinesterase inhibitor, donepezil, was introduced. The introduction of donepezil was associated with cognitive improvement (mini-mental state examination [MMSE] increased from 23 to 27) and complete remission of behavioural symptoms. Conclusion: That cholinesterase inhibitors may have a role in the management of behavioural symptoms of dementia and the current Australian PBS guidelines for prescribing cholinesterase inhibitors are clinically restrictive. This has clinical and ethical implications that need to be addressed by consumers, the medical community and regulating authorities.
First-Episode Mania: A Neglected Priority for Early Intervention
Authors: Conus Philippe , Conus Philippe , Mcgorry Patrick D 
Published: March 2003

Objective: While first-episode (FE) psychosis has become an important field of research, FE affective psychoses, and mania in particular, have been relatively neglected. This paper summarizes current knowledge about FE mania and explores the potential for early intervention. Method: The main computerized psychiatric literature databases were accessed. Results: When functional as well as symptomatic variables are considered, the outcome of mania is not as good as was formerly believed, a characteristic which is already present from the first episode. Various factors (lower socio-economic status, younger age at onset of illness, poor adherence to treatment, presence of comorbidity) have been identified as possible predictors of poor outcome. The prognostic value of the presence of psychotic symptoms and their congruence to mood, as well as the diagnostic subgroup, is less well established. This literature review also reveals striking similarities between manic and schizophreniform first episodes. Poor functional outcome in a significant proportion of patients following the first episode, high risk of suicide, high prevalence of comorbid diagnoses, worse outcome with a younger age at onset and with longer delay until treatment is initiated, and finally early presence of neuro-anatomical changes, are observed in both syndromes. Conclusions: This pattern justifies the development of early intervention strategies for FE manic patients and supports more exploratory research to identify prodromal symptoms, which might ultimately lead to even earlier focus on preventive interventions.
Changes in the Rate of Diagnosis of Major Depression in Adolescents Following Routine Use of a Depression Rating Scale
Authors: Rey Joseph M , Grayson David , Mojarrad Tayebeh , Walter Garry 
Published: March 2003

Objective: Because major depression in adolescents often goes undiagnosed, it is useful to establish whether clinicians’ rates of making this diagnosis in a specialist adolescent mental health service change when a self-rating depression scale is routinely administered. Method: A retrospective, naturalistic study examining the rate of diagnosis of major depression in a mental health service between 1993 and 1997. The intervention was the administration of the Center for Epidemiological Studies Depression Scale (CES-D) prior to initial assessment from September 1995 onwards. The proportion of clinical diagnoses of DSM-III-R or DSM-IV major depression was the outcome measure. Age, gender, ratings of depression and other confounding variables were used to control for changes in patient population over time. Results: One thousand three hundred and ten adolescents aged 12 to 17 years assessed between 1993 and 1997 were included. After taking into account potential confounders, diagnosis of major depression was 2.8 times (95% confidence interval 1.8, 4.3) as likely when the CES-D was in use. Increase was more marked when adolescents were more disturbed overall. There was no evidence suggesting this was due to changes in diagnostic practices or in the patient population. Conclusion: Availability to clinicians of a self-rating depression scale completed prior to assessment was associated with an increase in the frequency of diagnosis of depression in a specialist mental health service for adolescents.
Delayed-Onset Posttraumatic Stress Disorder: A Prospective Evaluation
Authors: Bryant Richard A , Harvey Allison G 
Published: March 2003

Objective: Delayed onset posttraumatic stress disorder (PTSD) refers to PTSD that develops at least 6 months after the traumatic event. This study aimed to index the features of patients who develop delayed-onset PTSD. Method: This study investigated delayed onset PTSD by prospectively assessing 103 motor vehicle accident survivors within 1 month of the motor vehicle accident for acute stress disorder, and subsequently assessing them for PTSD 6 months post-accident, and 2 years post-accident. Patients were initially assessed for symptoms of traumatic stress, anxiety, depression, and resting heart rate. Results: Five patients displayed PTSD 2 years post-trauma without meeting PTSD criteria 6 months posttrauma. Delayed onset cases were characterized by elevated psychopathology scores and resting heart rate levels within the initial month and elevated psychopathology 6 months posttrauma. Conclusions: These findings suggest that cases of delayed onset PTSD suffer subsyndromal levels of posttraumatic stress prior to the diagnosis of PTSD. These findings challenge the notion of PTSD developing after a period without symptoms.
The Written Report in Consultation–Liaison Psychiatry: A Proposed Schema
Authors: Alexander Timothy , Bloch Sidney 
Published: March 2003

Objective: The consultation–liaison psychiatry (CLP) written report serves several crucial functions; it therefore needs to be presented in a meaningful format to its readers. Surprisingly little has been written about its optimal nature. Our aim is to offer a schema which promotes effective communication. Methods: We have reviewed pertinent literature, consulted with CLP colleagues and convened a focus group that a number of them attended. Results: The core functions of the CLP report are to offer the referrer (and other relevant professionals) key comprehensible findings, recommendations for treatment and advice for follow up. Additional purposes are educational, archival and medico-legal. Our schema contains eight sections: Who is the patient? Why you referred the patient to us at this particular time? What did we find? Who are the patient's family and other supports? How do we understand these findings? What do we recommend regarding management? What further clinical developments have ensued? and What do we recommend regarding psychosocial follow-up? We provide guidelines concerning the content of each section and illustrate the use of the schema with two clinical cases. Conclusions: The functions of the CLP report are not satisfied through conventional psychiatric-history note taking. Our related yet different framework is inclined to be a more effective means to convey necessary clinical data and treatment recommendations.
Distributing Mental Health Care Resources: Strategic Implications from The National Survey of Mental Health and Wellbeing
Authors: Meadows Graham , Burgess Philip , Bobevski Irene 
Published: March 2003

Objective: This paper considers mental health services resource distribution under the Australian second national mental health plan, with its direction to mental health services to be more inclusive of people with higher prevalence psychiatric disorders. We consider inequalities in mental health in Australia, and describe the performance of the composite census variable employed in the Victorian mental health funding distribution formula, the index of relative socioeconomic disadvantage (IRSED), in predicting disorder rates and perceived needs for care. Method: We review data sets generated through the National Survey of Mental Health and Wellbeing (NSMHWB) for their utility in development of resource distribution formulae. We present analyses from the 10 641 cases examined in the household survey to explore the role of the IRSED in predicting prevalence rates of anxiety, affective, substance misuse and other disorders, as well as perceived need for care. Results: Recent epidemiological studies provide some additional sources of data to guide resource distribution, although the available data sets are found not to be optimized for examination of this issue. Greater levels of socioeconomic disadvantage of areas are associated with increased rates of morbidity in metropolitan areas, with different patterns for different disorder groups. The influence of the IRSED is more complex outside the major cities. Conclusions: The descriptive epidemiological data now available, despite significant investment, are relatively crude instruments for this current purpose. The findings support the case for using the IRSED as a proxy indicator for morbidity for the high prevalence disorders, but only within metropolitan areas. This examination confirms the existence of significant inequalities in mental health between Australian urban areas with different socioeconomic characteristics.
THE ROLE OF PERITONEAL IMMUNITY AND THE TUMOUR‐BEARING STATE ON THE DEVELOPMENT OF WOUND AND PERITONEAL METASTASES AFTER LAPAROSCOPY
Authors: Mathew George , Watson David I. , Ellis Tanya S. , Jamieson Glyn G. , Rofe Allan M. 
Published: March 2003

Background: The effect of the tumour‐bearing state and alterations in peritoneal immune function on the incidence of port‐site and peritoneal metastases was investigated after laparoscopy with and without CO2 pneumoperitoneum. Methods: A suspension of viable adenocarcinoma cells was introduced into the left upper quadrant of the peritoneal cavity of syngeneic tumour‐bearing rats at laparotomy, laparoscopy with CO2, and gasless laparoscopy. Control rats did not have pre‐existing tumours. A group of non‐tumour‐bearing rats were also injected intraperitoneally with endotoxin 4 h before intraperitoneal tumour cell injection. Six days later the peritoneal cavity and surgical wounds were examined for macroscopic evidence of implanted tumour. Peritoneal macrophages were obtained from tumour‐bearing rats subjected to different laparoscopic procedures and the activation state measured following exposure to lipopolysaccharide in vitro. Results: In the control rats, tumour implantation in the surgical wounds and peritoneum was significantly greater in the rats that had undergone laparoscopy with CO2. The presence of a pre‐existing tumour was associated with increased tumour spread in all treatment groups and at most sites. Injection of endotoxin also resulted in increased tumour spread. Peritoneal macrophages from control and tumour‐bearing rats who underwent laparoscopy with CO2 produced significantly less TNF‐αin vitro, compared to gasless laparoscopy or laparotomy. Conclusions: Carbon dioxide insufflation enhances tumour spread and implantation. The underlying immune or metabolic status of the host, as influenced by the tumour‐bearing state or modification of the peritoneal environment, also has a marked independent effect on tumour spread and implantation. The immune and metabolic status of the peritoneum including the extent of macrophage activation is implicated in this effect.
SERUM LEVELS OF INSULIN‐LIKE GROWTH FACTOR BINDING PROTEIN‐3 IN BENIGN AND MALIGNANT BREAST DISEASE
Authors: Holdaway I. M. , Mason B. H. , Lethaby A. E. , Singh V. , Harman J. E. , Maccormick M. , Civil I. D 
Published: March 2003

Background: The insulin‐like growth factors IGF‐I and IGF‐II and their major binding protein IGFBP‐3 influence the growth of breast cancer cells in vitro. Some benign non‐breast tumours appear to be associated with increased serum IGFBP‐3 levels which would tend to reduce bioactive‐free IGF concentrations. The present study investigates whether this pattern also occurs in neoplastic breast disease. Methods: Serum IGF‐I, IGF‐II and IGFBP‐3 were measured by specific radioassay in 12 women with benign breast disease, 31 patients with breast cancer and in age‐matched controls. Results: The mean (± SD) serum IGFBP‐3 concentration was higher in benign breast disease (3.6 ± 0.7 mg/L) than in controls (2.7 ± 0.6 mg/L) or in breast cancer patients (2.7 ± 0.5 mg/L) (P = 0.001). Serum IGF‐I and IGF‐II levels were not significantly different among the groups. However, the index of free unbound IGF measured as the molar ratio of IGF‐I plus IGF‐II divided by IGFBP‐3 was significantly lower in benign breast disease than in the other subjects. Conclusions: Either the production or clearance of IGFBP‐3 is altered in benign breast disease so that there is less free IGF available to cells. This may serve to protect against malignant transformation in patients with benign breast disorders.
STERILIZATION OF HIV WITH IRRADIATION: RELEVANCE TO INFECTED BONE ALLOGRAFTS
Authors: Campbell D. G. , Li P. 
Published: March 2003

Background: Bone allograft banks commonly sterilize frozen bone by irradiation. The dose–response relationship for HIV is calculated and the dose required to inactivate the bioburden of virus that may be present in allograft bone is determined. Methods: A virus titre experiment is performed using irradiated frozen HIV. The virus is maintained on dry ice (approximately –70°C) and is exposed to a cobalt 60 source with 0–40 kGy irradiation at 5 kGy intervals. Lymphocyte cell cultures are exposed to serial dilutions of the irradiated virus. The virus titre is quantified by cytological changes of HIV infection and p24 immunofluorescence. Results: There is a linear relationship between the virus titre and the radiation dose delivered. The inactivation rate of irradiated virus was 0.1134 log10 tissue culture infective doses 50/mL per kGy (95% confidence intervals, 0.1248–0.1020). The irradiation dose required to inactivate the HIV bioburden in allograft bone is 35 kGy. The irradiation dose required to achieve a sterility assurance level of 10–6 is 89 kGy. This dose exceeds current recommendations for sterilizing medical products and the current practice of many bone banks. Conclusions: It is concluded that gamma irradiation should be disregarded as a significant virus inactivation method for bone allografts.
ATLS: ARE WE TRAINING THE WRONG PEOPLE?
Authors: Hughes Geoff , Price Andrew 
Published: March 2003

Background: Despite the evolution, expansion and popularity of emergency medicine as a medical specialty in the United Kingdom (UK), emergency departments are still primarily staffed by senior house officers (second and third year graduates), particularly at weekends and at night. Methods: A telephone and postal survey of Advanced Trauma Life Support (ATLS)® training completed by this cohort of doctors indicates that UK courses are failing to train adequate numbers. Results: It can thus be argued that ATLS is not being disseminated to the relevant grass‐roots of medical care, where it is likely to be of the most benefit. Conclusions: The present study discusses possible reasons for this and offers constructive solutions to the problem. Although the matters discussed in this study refer to UK medical practice, they may be of relevance and interest to Australasian practitioners. Is EMST in Australasia training the appropriate group of doctors?