bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rural-Urban Differences in Reasons for Living
Authors: Mclaren Suzanne , Hopes Lisa M. 
Published: March 2003

Objective: The suicide rate in Australia is cause for concern, especially the increase in attempted and completed suicides in rural and regional locations. The present study examined reasons for choosing not to commit suicide as a function of residential location. Method: The study involved 655 Victorian residents from four population-based strata; urban, regional city, regional town, and rural. Results: Results from the Reasons for Living Inventory revealed significant differences as a function of residential location. Overall, residents in rural locations reported having significantly more to live for than their urban counterparts. Further analysis of six reasons for living (child, family, moral, social, coping and death-related concerns) showed a pattern whereby residents in rural locations reported having the most to live for, followed by regional residents, and urban residents who reported having the least to live for. Conclusions: These findings are in contrast to increase of suicide rates in rural areas, and highlight the need for a greater understanding of the mechanisms underlying suicidal behaviour.
Barriers to Optimal Care for Patients with Coexisting Substance Use and Mental Health Disorders
Authors: Todd Fraser C. , Douglas Sellman J. , Robertson Paul J. 
Published: March 2003

Objective: This paper describes qualitative research that was carried out as part of a project aimed at drawing up a series of guidelines for the assessment and management for people with coexisting substance use and mental health disorders, or dual diagnosis [ 1 ]. Method: A core consultation team of 14 experts with experience in the areas of both substance use and mental health in New Zealand was established to advise on the development of eight clinical scenarios. The clinical scenarios were selected to highlight a range of real life issues in the treatment of people with coexisting substance use and mental health disorders and were presented at 12 focus groups around New Zealand. The 261 participants of the focus groups were asked to comment on what was optimal management for each of the scenarios and to identify barriers to optimal care in their region. Written notes were analysed for recurring and strongly stated themes and these comprise the results of the study. Results: While there was marked regional variation in treatment approaches and service structures, many of the barriers to optimal care that were identified were common to all regions. The results are considered under the headings of systems issues, clinical issues and attitudes. Conclusions: A wide variety of barriers that impede the delivery of optimal care have been identified. These range from the attitudes of individual clinicians to the structure of the systems within which they work. A system of key principles and processes for organizing treatment in a way which helps overcome these barriers is proposed.
Mental Health of Adolescents in Custody: The Use of the ‘Adolescent Psychopathology Scale’ in a Tasmanian Context
Authors: Bickel Rosie , Campbell Alistair 
Published: March 2003

Objective: To investigate the incidence of mental health problems based on the DSM-IV [ 1 ] among adolescents in custody in Tasmania, using the Adolescent Psychopathology Scale (APS) [ 2 ]. Methods: The APS was administered to 50 adolescents admitted consecutively to a youth detention centre in Tasmania, Australia, using a structured interview format. Results: In this sample 46% scored positively for a mood disorder, 36% for posttraumatic stress disorder (PTSD), and 32% for an anxiety disorder excluding PTSD. Conclusions: Tasmania is no exception to the rule that adolescents in custody have a high proportion of mental health problems. This study confirmed findings of previous studies that detained adolescents had a roughly equivalent level of mental health problems as young people referred to mental health services and five times more than adolescents in the community. Therefore, all detained adolescents should be assessed for mental health problems as their risk is equivalent to that of young people referred to mental health services in the community. Youth detention centres are able to provide significant opportunities for individual therapy and group programmes for young people with mental health problems. However, to achieve a realization of this potential, detention facilities need to develop philosophies and procedures, which facilitate the development of therapeutic, as opposed to ‘punishing’, environments.
A Profile of Regional Psychiatry Publishing: Home and Away
Authors: Parker Gordon , Parker Kay 
Published: March 2003

Objective: Previous reports have profiled Australian psychiatry publishing in high-ranking international journals over the last two decades. An audit of selected high ranking and regional psychiatric journals was therefore undertaken to obtain a current profile of Australasian publishing. Methods: Journals were selected on the basis of impact factors for the year 2000, with the top five regional, generalist and specialist journals being selected, and with publication numbers over a two-year period (1999–2000) compared with numbers from other major geographical regions. Results: Of the 4573 papers identified in the 15 journals, Australasian authors contributed 269 to the regional journals (with two-thirds in the Australian and New Zealand Journal of Psychiatry), 47 to the generalist journals (with two-thirds in Psychological Medicine) and very few (23) to the specialist journals. Representation in the so-called ‘dominant four’ international journals has increased since the 1986–1989 audit. When analysis was made of the ‘top nine’ international journals, the Australasian representation rate was a low 1.8% and lower than most regions examined. Conclusions: If Australasian psychiatry is to advance its international presence, a greater representation rate in top-ranking international journals should be set as an objective.
Postdisaster Emotional Distress, Depression and Event-Related Variables: Findings Across Child and Adolescent Developmental Stages
Authors: Mcdermott Brett M. , Palmer Lyle J. 
Published: March 2003

Objective: Developmental approaches have not been widely used in child and adolescent posttraumatic stress disorder research, and little is known about developmental differences in response to postdisaster trauma. Our objective was to investigate postdisaster depression and emotional distress psychopathology across a broad child and adolescent developmental range. Method: Six months following a bushfire disaster, 2379 grade 4–12 school students completed an extensive self-report battery, which included the Impact of Event Scale and the Birleson Depression Inventory. Generalized linear models were constructed to model the effects of multiple covariates on continuous outcome measures of depression and emotional distress. Results: Significant independent predictors of persisting depressive symptoms were increased symptoms of emotional distress; increased symptoms of anxiety; evacuation experience; and school grade. Significant independent predictors of emotional distress were persisting depressive symptoms; perception of threat to self or to parents; evacuation experience; and school grade. Gender was not a significant predictor in either the depression or emotional distress multivariate models. Complex, non-linear relationships between depression, emotional distress and school grade were found. Conclusion: This study suggests that important developmental differences in postdisaster psychological responses exist across a broad spectrum of developmental stages in children.
Monitoring Consumer Satisfaction With Inpatient Service Delivery: The Inpatient Evaluation of Service Questionnaire
Authors: Meehan Thomas , Bergen Helen , Stedman Terry 
Published: March 2003

Objective: To report on the development, testing and psychometric properties of a brief consumer satisfaction measure for use with psychiatric inpatients. Method: Focus group discussions with inpatients were used to develop a pool of items related to satisfaction with hospital stay. A second cohort of 72 inpatients was invited to rate the 51 items that emerged for importance in contributing to satisfaction. Mean importance scores highlighted 20 items that were subsequently framed into neutrally worded statements. A draft questionnaire comprising these statements was introduced, on a trial basis, in a range of inpatient facilities. Results: Factor analysis of 356 completed questionnaires yielded three factors comprising a staff-patient alliance; doctor/treatment issues; and an environmental component. Psychometric properties include good response variability and high internal consistency. Conclusions: The Inpatient Evaluation of Service Questionnaire addresses many of the shortcomings of existing satisfaction measures. It was developed through extensive consumer involvement, it is simply worded, easy to score and appears to perform well with acute and rehabilitation inpatients.
Use of Antipsychotic Medications in Australia Between July 1995 and December 2001
Authors: Mond Jonathan , Morice Rodney , Owen Cathy , Korten Ailsa 
Published: March 2003

Objective: To examine trends in the use of oral conventional, depot and atypical antipsychotic medications in Australia between July 1995 and December 2001. Method: For each six-month interval between July 1995 and December 2001, prescription data obtained from the Health Insurance Commission of Australia were converted into a measure of drug utilization expressed as the number of defined daily doses per thousand population per day (DDDs/1000/day). Results: Between July 1995 and December 2001, use of atypical medications increased from an estimated 0.27 to an estimated 3.83 DDDs/1000/day. Use of oral conventional medications decreased from 1.76 to 0.91 DDDs/1000/day, while use of depot medications decreased from 1.38 to 0.96 DDDs/1000/day. During the latter half of 2001, atypical medications accounted for 67.3%, oral conventional medications for 16.0%, and depot medications for 16.7% of total prescriptions for antipsychotic medications dispensed through community pharmacies in Australia. The increased use of atypical medications was accounted for largely by a dramatic increase in the use of olanzapine. Between July 2001 and December 2001, prescriptions for olanzapine accounted for 65.0% of total prescriptions for atypical antipsychotic medications. Conclusions: The results of the present study confirm that atypical antipsychotic medications have replaced conventional medications as the first-line pharmacological treatment for psychotic illness in Australia. While this change in prescribing practice is gratifying, the overwhelming preference for the use of olanzapine among clinicians prescribing antipsychotic medication is surprising and is of some concern given the significant increases in body weight that can accompany long-term use of this medication.
The Association Between Depression and Isotretinoin Use in Acne
Authors: Hong Ng Chee , Schweitzer Isaac 
Published: March 2003

Objective: The association between isotretinoin and depression has received little attention in the psychiatric literature despite an increasing number of reports in medical journals. The purpose of this paper is to highlight this association, examine the possible link and review the clinical implications. Method: A critical review of the literature pertaining to depression in patients with acne who were treated with isotretinoin was conducted. Results and Conclusions: The causal relationship between isotretinoin therapy and depression has not been clearly established and needs further study. Isotretinoin is likely to have a positive psychological impact for the majority of patients who benefit from such a highly efficacious anti-acne treatment. However, it is important to recognize that depression can occur as an idiosyncratic side-effect that requires urgent and appropriate treatment. Therefore, having a low threshold for detection of this uncommon complication and early psychiatric referral to address both the depression and its contributing factors may prevent serious consequences.
IMPROVED PERCUTANEOUS INSERTION OF LONG‐TERM CENTRAL VENOUS CATHETERS IN CHILDREN: THE ‘SHRUG’ MANOEUVRE
Authors: Holland A. J. A. , Ford W. D. A. 
Published: March 2003

Background: Surgical central venous access in children usually requires open exposure of the internal jugular vein or one of its tributaries. The percutaneous route has the potential advantages of a reduced rate of wound infection, superior cosmesis and reduced operating time. We report our modifications to the percutaneous approach that facilitate the application of this technique to children over the age of 12 months. Methods: The dilator and peel‐away sheath of the introducer set should be inserted into the subclavian vein under fluoroscopic control. Elevation of the ipsilateral shoulder assists passage of the peel‐away sheath and subsequently the catheter from the subclavian vein into the superior vena cava. Results: This technique has been used successfully to establish surgical central venous access in the majority of children at the Women’s and Children’s Hospital, Adelaide, South Australia, over a 3‐year period. Conclusions: With the modifications described this technique may be safely applied to the paediatric age group.
ROLE OF SELECTIVE INTRA‐OPERATIVE CHOLANGIOGRAPHY DURING CHOLECYSTECTOMY
Authors: Singh G. , Gupta P. C. , Sridar G. , Katariya R. N. 
Published: March 2003

Background: The use of routine intra‐operative cholangiography (IOC) remains controversial. This prospective study was carried out to determine whether to perform selective or routine IOC in patients undergoing cholecystectomy for gallstones. Methods: All consecutive patients undergoing open cholecystectomy over a 16‐month period were included in the present study. They were divided into two groups based on the absence (n = 79) or presence (n = 55) of indicators of choledocholithiasis. All patients were subjected to cholangiography. Each indicator, subsets of indicators and all indicators combined were evaluated for their ability to predict choledocholithiasis. Results: There would be only two missed stones (1.5%) if selective cholangiography was to be practised. Intra‐operative cholangiography had a positive predictive value of 100%. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of all the indicators combined were 93.5%, 84.6%, 74.5%, 97.5% and 88.0%, respectively. The best indicators in each subset were jaundice, common bile duct diameter as assessed by ultrasonography, and a palpable stone during surgery with NPV of 82.7%, 91.1% and 96.8%, respectively. Conclusion: Routine IOC during cholecystectomy is not essential for the prevention of retained stones. A combination of the various indicators of choledocholithiasis can be used to select patients for cholangiography.
Ultrasound‐assisted lipoplasty
Authors: Cooter Rodney , Babidge Wendy , Mutimer Keith , Wickham Peter , Robinson David , Kiroff George , Chapman Andrew , Maddern Guy 
Published: March 2003

Background: Ultrasound‐assisted lipoplasty (UAL) has been associated with particular types of complications and uncertain long‐term effects arising from interactions between ultrasonic energy and living tissue. The present review seeks to address these issues. Methods: Search strategy Three search strategies were devised to retrieve literature from Medline, Current Contents, Embase and Cochrane Library databases up until April 2000. Study selection Inclusion of papers was largely determined using a predetermined protocol. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials, case series or case reports. Data collection and analysis Thirty‐six papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding and chance. Other papers were also included to provide background material. Results: There was little high‐level evidence available comparing UAL and suction‐assisted lipoplasty (SAL), with no conclusive evidence that UAL has a safety benefit, although low‐quality evidence suggests that UAL is associated with reduced surgeon fatigue as well as increased operating times, slower aspiration rates and an increased learning curve. There is inadequate evidence to determine whether the theoretical potential for DNA damage from ultrasound is realized in the clinical setting. Conclusions: The evidence base for UAL is inadequate to determine the procedure’s safety and efficacy. The potential for DNA damage must be investigated with appropriate in vivo animal models. Recommendations for the safe use of UAL are discussed.
Metabolic and immunologic consequences of laparoscopy with helium or carbon dioxide insufflation: A randomized clinical study
Authors: Neuhaus Susan J. , Watson David I. , Ellis Tanya , Lafullarde Thierry , Jamieson Glyn G. , Russell W. John 
Published: March 2003

Background: Previous studies using animal models have demonstrated that carbon dioxide (CO2) pneumoperitoneum during laparoscopy is associated with adverse physiological, metabolic, immunological and oncological effects, and many of these problems can be avoided by the use of helium insufflation. The present study was performed in patients to compare the effect of helium and CO2 insufflation on intraperitoneal markers of immunological and metabolic function. Methods: Eighteen patients undergoing elective upper gastrointestinal laparoscopic surgery were randomized to have insufflation achieved by using either helium (n = 8) or CO2 (n = 10) gas. Intraperitoneal pH was monitored continuously during surgery, and peritoneal macrophage function was determined by harvesting peritoneal macrophages at 5 min and 30 min after commencing laparoscopy, and then assessing their ability to produce tumour necrosis factor‐α (TNF‐α), and their phagocytic function. Results: Carbon dioxide laparoscopy was associated with a lower intraperitoneal pH at the commencement of laparoscopy, although this difference disappeared as surgery progressed. The production of TNF‐α was better preserved by CO2 laparoscopy, but the insufflation gas used did not affect macrophage phagocytosis. Patients undergoing helium laparoscopy required less postoperative analgesia. Conclusion: The choice of insufflation gas can affect intraperitoneal macrophage function in the clinical setting, and possibly acid–base balance. The present study suggested no immunological advantages for the clinical use of helium as an insufflation gas. The outcomes of the present study, however, are different to those obtained from previous laboratory studies and further research is needed to confirm this outcome.
The Safe Way to Early Intervention: An Account of the SAFE (Southern Area First Episode) Project
Authors: Welch Mark , Garland Graham 
Published: March 2003

“Early intervention and prevention in psychotic disorders is increasingly seen as having the potential to produce better outcomes for people who have developed these disorders.”[ 1 ] However, the operationalisation of this hypothesis is less clear, and the emphasis to date has been on specialised services within large metropolitan areas. This paper will describe an initiative in the provision of best possible care in early psychosis undertaken by Southern Area Health Service, NSW, a small predominantly rural service with few resources and a scattered and attenuated population. It will demonstrate how a mainstreamed early intervention program can be effective and efficient, providing it pays careful attention to partnerships in early identification, and the absorption into the health service culture of sound principles, practices and processes.
The Use of “Safe Cells” in The Management of Suicidal and Violent Prisoners
Authors: Corcos Christopher D. , Lewin Robert D. 
Published: March 2003

Objective: To survey psychiatrists' practice in the use of prison safe cells. Method: The experiences, views and working protocols of Australia and New Zealand forensic psychiatrists in relation to authorisation of placement of prison inmates in safe cells were sought via a postal questionnaire. Results: Despite a low response rate, most psychiatrists with clinical involvement in the area replied. There was a wide diversity of clinical practice, ethical standpoints, knowledge of and reference to practices in other parts of the world, and sense of priorities. Conclusion: There appears to be considerable ambivalence and some discomfort in the role that psychiatrists in Australia and New Zealand are asked to play in the placement of prisoners in safe cells.
Mental Health Literacy Study of General Practitioners: A Comparative Study in Singapore and Australia
Authors: Parker Gordon , Lee Cheng , Chen Helen , Kua Joshua , Loh Jennifer , Jorm Anthony F 
Published: March 2003

Objective: To compare responses to a mental health literacy survey by general practitioners in Singapore and Australia. Method: Cross-sectional surveys of general practitioners were undertaken in Australia in 1996 (n = 872) and in Singapore in 1999 (n = 264). Questionnaires provided vignettes of schizophrenia and depression, and sought responses to a range of information assessing mental health literacy. Results: The two groups returned generally similar responses, with high diagnostic accuracy and distinctly high agreement in judging the likely helpfulness of a range of resource people, activities and therapies. In addition to a few minor differences, the Singaporean practitioners tended to view outcome for the disorders more optimistically and to differentiate less in estimating outcome for the two disorders. Conclusions: Previous reports of the responses by the Australian general practitioners had generally shown their views to be consistent with mental health professionals and, on several important parameters, discordant with the views of the Australian general public. This report highlights distinct similarities in general practitioner responses across cultures.
Training Directors' and Registrars' Views on Research Training in Australasian Psychiatry
Authors: Andrews Leah , Coverdale John , Turbott Sarah 
Published: March 2003

Objective: To determine to what extent research skills are taught and how they are taught to psychiatrists-in-training across Australasia. Method: Anonymous mail-out survey of training directors and trainee representatives on local training committees. Results: The questionnaire was completed by 20 of 23 directors (response rate = 87%) who reported on 522 trainee psychiatrists. Formal seminars or lectures and journal clubs were the most commonly adopted methods of teaching (90% and 70% of programs respectively) while only two programs formally required trainees' participation in research. Epidemiologi-cal research methods, critical appraisal skills, ethical issues, and research design were the topics most commonly taught formally, and these were taught in 80% of programs or less. Only 33 (6.3%) trainees were involved in a research project that involved data collection. Conclusions: Research skills were rather uniformly taught. The results are discussed in relation to identified areas for improvement.