The stability of correlates of labour force activity.

OBJECTIVE: To investigate the stability of correlates of labour force activity among people with affective and anxiety disorders, compared with healthy adults, between 1998 and 2003. METHOD: Secondary analyses of multi-stage probability samples of community residents (n(1998)=37,580 and n(2003)=36,088) obtained from repeat administrations of an Australian population survey. RESULTS: Proportionally, fewer people with affective or anxiety disorders were employed compared with well controls. Extent of employment restrictions, sex, age left school, country of birth, age and educational attainment were strong correlates of labour force participation and current employment. These effects were stable despite improved labour market conditions in 2003. CONCLUSION: These results can inform decisions about access to substantial forms of employment assistance. Subgroups of people with anxiety and depression, with severe employment restrictions, low education, low language proficiency, aged 15-24 years, or aged 55 years or more, may require greater access to substantial employment assistance.

The incidence and prevalence of schizophrenia varies with latitude.

OBJECTIVE: The aim of this study was to examine the association between latitude and the incidence and prevalence of schizophrenia based on two recently published systematic reviews. METHOD: The analyses were based on 353 incidence rates (from 68 studies) and 258 prevalence estimates (from 94 studies). Exact latitude values were used for cities, and geocentroid values for other sites. Based on three equal latitude bands, we compared the frequency measures of schizophrenia for persons, males and females when adjusted for within-study variation. RESULTS: Prevalence estimates from sites in the high-latitude band were significantly higher when compared with lower bands for persons, males and females. Incidence rates were positively associated with absolute latitude for males, but neither for females nor persons. CONCLUSION: Variables that have latitude gradients warrant closer inspection in schizophrenia epidemiology.

Labour force activity by people with depression and anxiety disorders: a population-level second-order analysis.

OBJECTIVE: To identify the population-level first- and second-order effects among candidate correlates of labour force activity by people with ICD-10 depression and anxiety disorders. METHOD: Australian Bureau of Statistics multistage sampling strategies obtained a household sample of 37,580 individuals. Analyses were conducted using multiple binary logistic regression. RESULTS: The impact of depression and anxiety on labour force activity depended on the extent of employment restrictions, age and country of birth. Background second-order effects help explain labour force participation and employment in the wider and predominantly healthy community. A significantly greater proportion of those receiving mental health treatment for anxiety and depression were not in the labour force. CONCLUSION: These second-order effects reveal the substantial impact of depression and anxiety disorders on labour force activity across the working life. Those with more severe employment restrictions appear to need more intensive and continuous forms of assistance.

A cohort study of early neurological consultation by telemedicine on the care of neurological inpatients.

OBJECTIVES: To find out the effect of early neurological consultation using a real time video link on the care of patients with neurological symptoms admitted to hospitals without neurologists on site. METHODS: A cohort study was performed in two small rural hospitals: Tyrone County Hospital (TCH), Omagh, and Erne Hospital, Enniskillen. All patients over 12 years of age who had been admitted because of neurological symptoms, over a 24 week period, to either hospital were studied. Patients admitted to TCH, in addition to receiving usual care, were offered a neurological consultation with a neurologist 120 km away at the Neurology Department of the Royal Victoria Hospital, Belfast, using a real time video link. The main outcome measure was length of hospital stay; change of diagnosis, mortality at 3 months, inpatient investigation, and transfer rate and use of healthcare resources within 3 months of admission were also studied. RESULTS: Hospital stay was significantly shorter for those admitted to TCH (hazard ratio 1.13; approximate 95% CI 1.003 to 1.282; p = 0.045). No patients diagnosed by the neurologist using the video link subsequently had their diagnosis changed at follow up. There was no difference in overall mortality between the groups. There were no differences in the use of inpatient hospital resources and medical services in the follow up period between TCH and Erne patients. CONCLUSIONS: Early neurological assessment reduces hospital stay for patients with neurological conditions outside of neurological centres. This can be achieved safely at a distance using a real time video link.

Delineating disability, labour force participation and employment restrictions among persons with psychosis.

OBJECTIVE: To delineate at a population level: activity restrictions, labour market participation, educational attainment, employment restrictions and employment characteristics of persons with psychosis compared with healthy non-disabled persons. METHOD: Confidentialized data files were provided by the Australian Bureau of Statistics. The data were collected in a national survey titled "Survey of Disability, Ageing and Carers, Australia 1998". Multi-stage sampling strategies obtained a probability sample of 42 664 individuals. Trained interviewers using ICD-10 computer-assisted interviews identified household residents with psychosis. RESULTS: Among householders with psychosis aged 15-64 years, 75.2% were non-participants in the labour market, 21.1% were employed and 3.7% were looking for work. Completing school years 10 and 11, and vocational training, appeared to offer an employment advantage. CONCLUSION: Persons with psychotic disorders have low rates of labour force participation and may benefit from greater participation in educational and vocational services. Implications for policy development are discussed.

Urban birth and migrant status as risk factors for psychosis: an Australian case-control study.

BACKGROUND: Urban birth and migrant status have been identified as risk factors for psychosis in North American and European studies. The aim of this study was to explore these variables in an Australian case-control study. METHOD: Country of birth of subjects and their parents, and place of birth of Australian-born subjects, were examined in individuals with psychosis drawn from a prevalence study (n = 310) and well controls recruited from the same catchment area (n = 303). RESULTS: Migrant status was associated with a significantly decreased odds of having a psychotic disorder. For those born in Australia, neither migrant status of parents nor urban birth was associated with having a psychotic disorder. CONCLUSIONS: The lack of effect for urban birth and second-generation migrant status may help generate candidate environmental risk factors that operate in Europe but not in Australia.

The perceived utility of six selected measures of consumer outcomes proposed for routine use in Australian mental health services.

OBJECTIVE: This paper aims to assess the utility of six measures of consumer outcomes: the Behaviour and Symptom Identification Scale, the Mental Health Inventory (MHI), the Medical Outcomes Study 36-Item Short-Form Survey, the Health of the Nation Outcome Scales, the Life Skills Profile (LSP) and the Role Functioning Scale previously recommended for the routine assessment in Australian mental health services. METHOD: Consumers and service providers were invited through focus group discussions and surveys to describe the perceived utility of these selected measures. RESULTS: All six measures were rated favourably. The qualitative and quantitative findings suggest that the MHI elicited the most positive results of the consumer measures. No observer-rated scale was clearly preferred. CONCLUSION: The qualitative feedback obtained indicated that process and context issues may be as important to the successful use of routine instruments for the measurement of consumer outcomes in clinical practice as the choice of instrument.

Seasonality of first admissions for schizophrenia in the Southern Hemisphere.

Northern Hemisphere studies of first admissions for schizophrenia have shown an excess of summer admissions (June, July and August) compared to other times of the year. The within-year fluctuations in first admissions could be related to meteorological factors that fluctuate between seasons (e.g. temperature, photoperiod) and/or social factors (e.g. holidays, religious events). If meteorological factors were primarily responsible for the fluctuation, then Southern Hemisphere studies should find excess first admissions in December, January and February. This paper presents the first season of first admission study of schizophrenia in the Southern Hemisphere. The month and year of first admission for schizophrenia (ICD 8/9) for 4487 male and 3252 female, Australian-born individuals were extracted from a Queensland mental health register. Spectral analysis showed a strong annual periodicity of first admissions for males with the peak in August (Southern Hemisphere winter) and a trough in the summer months (December to February). The pattern for females also displayed annual periodicity. These results correspond to the Northern Hemisphere reports of excess of schizophrenia first admissions in terms of the month of the year but not the season of excess. Further work is needed in order to clarify the impact of latitude and meteorological factors on the month of first admission for schizophrenia.

Mail-order pharmacy. Teaching your patients to use it safely.

People of all ages are discovering the convenience and savings of mail-order pharmacy use. On the surface, this option seems like a commonsense way to save money on healthcare, but the use of mail-order pharmacy among the elderly may increase the risk of unintentional medication noncompliance. This article discusses the advantages and risks of using this service and presents guidelines that can maximize the safety of mail-order pharmacy.

Infants born to narcotic dependent mothers: physical growth patterns in the first 12 months of life.

OBJECTIVES: To describe the physical growth patterns of infants born to narcotic dependent mothers (INDM) over a 12 months period and, if possible, to relate the growth to drug taking patterns during pregnancy. METHODOLOGY: The growth of a cohort of 43 INDM was measured during the first 12 months of life. Weight and length measurements were compared with percentile charts and converted to Z scores. Questionnaire data about drug taking practices, demographic variables and the neonatal period (including withdrawal scores) were obtained. RESULTS: Twenty-four (55.8%) of INDM had evidence of neonatal drug withdrawal requiring treatment with phenobarbitone. At birth, Z scores for weight and length indicated relative intrauterine growth retardation. By 12 months, there had been some catch up growth, but Z scores for weight and length were still below zero. Persistent weight retardation at 12 months was correlated with methadone dosage during pregnancy, but not the need for phenobarbitone therapy. CONCLUSIONS: The growth patterns of INDM in the first 12 months of life indicated that at birth there was evidence of intrauterine growth retardation, but by 12 months the growth was little different from the rest of the community. There appears to be some influence of narcotic agents taken while pregnant on subsequent growth of INDM.

Reverse transcription-polymerase chain reaction detection of collagen transcripts in healing human wounds.

The aim of this study was to analyse the expression of COl1A1, COl1A2 and COl3A1 in 6 mm diameter punch biopsies obtained from human wounds. Total RNA was isolated from biopsies taken from Sacrococcygeal pilonidal sinus excision cavities at weekly intervals between surgery and clinical closure. cDNAs were generated from the RNA using reverse transcriptase and polymerase chain reaction (PCR) amplifications performed with oligonucleotide primer pairs specific for regions of the COl1A1, COl1A2 and COl3A1 genes. The expression of these three genes was demonstrated throughout the course of healing on 36 biopsies taken from nine patients between surgery and clinical closure. Amplification bands demonstrated on cDNAs generated from 6 mm diameter biopsies were comparable in intensity and specificity with those generated from 50 mg excised scar tissue and cultured fibroblasts. The RT-PCR technique described here allows the rapid 'routine' detection of specific gene expression in 6 mm biopsies obtained from healing wounds.

Pterygium recurrence time.

PURPOSE: To define the amount of time necessary to follow patients after pterygium removal to identify a recurrence. METHODS: The authors reviewed patients who supposedly had a recurrence of their pterygium and analyzed the records to determine the duration of these recurrences. RESULTS: One hundred sixty-one known pterygium recurrences were identified from records. Those patients with frequent follow-up in whom recurrence could be determined to within 1 month were in group A, and those in whom the time of recurrence was indefinite were in group B. For patients in group A, there was an average time to the first recurrence of 123 +/- 113 days, with second and third recurrences at 97 +/- 58 and 67 +/- 47 days, respectively. Survival curve analysis showed that there was a 50% chance that there would be a recurrence within the first 120 days, and there was a 97% chance there would be a recurrence within 12 months of its removal. CONCLUSION: This suggests that a 1-year follow-up time is likely to identify a recurrence.

From the Journals.

Enhancing wound healing in animals with interferon Kératinocyte allografts for chronic venous leg ulcers Integrin receptors and RGD sequences in healing Nutrition in patients with spinal cord injuries Vitamin C deficiency and pressure sores.

A SAS Macro for Jackknifing the Results of Discriminant Analyses.

In discriminant analysis, the correlations between the variables and the discriminant functions, structure coefficients, are used in interpretation. Rules of thumb are used to set a cut-off value. It would be useful for structure coefficients to be at least statistically significantly different from zero before being used in an interpretation. Unfortunately, there are no formulas for the standard error of structure coefficients. However, the jackknife procedure can be applied to produce an estimate of the standard error. A SAS macro procedure for performing a jackknife analysis on structure coefficients is described together with issues and caveats on its use in multivariate methods.

From the Journals.

The effects of adenosine nucleotides on the repair process Problems in tissue repair response The prevalence of lower-limb ulceration The development of tissue engineering Ontogenesis of the basement membrane.

Pain intensity measurement in chronic low back pain.

This study investigated the psychometric properties of eight pain intensity measures used with chronic low back pain patients. All measures were similar in terms of scale distribution and rates of incorrect responses, with all scales apart from the Pain Rating Index significantly correlated. Principal axis factoring of data from 92 patients indicated the presence of one general factor on which all pain intensity measures except the Pain Rating Index loaded. The 101-point Numeric Rating Scale and the Box Scale had the strongest relationship, with loadings of 0.90. The Numeric Rating Scale and the Box Scale appear to be the scales of choice for the measurement of pain intensity in the low back pain patient.

What 'makes' a good doctor?

The relation between gender, personality, school scores, grades at medical school and eventual achievement as a medical practitioner 8 years after qualifying has been explored by path analysis in a cohort of medical students. Factor analysis of data derived from a questionnaire identified a significant factor accounting for 75% of the common variance of the professional achievement scores. Standardized path coefficients were computed to indicate the relative importance of the causal factors to postgraduate achievement. Gender played an important role at many levels. For example it was apparent that many of our women graduates were seriously disadvantaged in their professional careers. Of the school subjects, chemistry was a surprising long-term predictor of postgraduate achievement. Academic achievement during medical school training, particularly in the final year, was a significant predictor, while personality attributes made their contribution to one or other aspect of achievement at earlier stages in training but made little additional direct contribution to postgraduate performance.

Population growth and predation interference between two species of predatory phytoseiid mites (Acarina: Phytoseiidae) in interactive systems.

Populations of two species of phytoseiid mite predators, Phytoseiulus persimilis Athias-Henriot and Amblyseius degenerans (Berlese), feeding on a tetranychid prey, Tetranychus pacificus McGregor, were allowed to grow separately as well as together on bush lima bean (Phaseolus lunatus Var.) arenas in the laboratory. The population plateau attained by P. persimilis was nearly 5 times higher than that for A. degenerans when each species was on separate leaf arenas. When they were on the same arena, P. persimilis was outcompeted by A. degenerans after about 70 days of population growth. When dispersal to other arenas was necessary for the predators to find prey in another experiment, P. persimilis survived well but not A. degenerans. The mechanisms underlying species displacement were explored further. The differential mortality of immature predators at different developmental stages due to interspecific predation was concluded to be responsible for the population decline of P. persimilis, and the decline of A. degenerans in another experiment was attributed to its sedentary tendency regardless of prey distribution and to the lack of alternative food sources in the system. The implications to biological control of mutual predation between predator species is discussed briefly.