Identifying respiratory events and artifacts using oscillatory impedance measurement in aPAP therapy.

Constant positive airway pressure (cPAP) is the predominant noninvasive therapy for the obstructive sleep apnea syndrome (OSAS). The average pressure thereby applied can be reduced by online-identification of respiratory events. Oscillatory impedance measurement as an indicator for airway patency can identify central and obstructive apneas and hypopneas. Our goal was to reduce the sensors needed, to auto-calibrate the signals to each individual patient and to rule out patient induced artifacts.

The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being.

OBJECTIVE: To identify the prevalence of three mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder), the prevalence of mental health problems, the health-related quality of life of those with problems, and patterns of service utilisation of those with and without mental health problems, among 4-17-year-olds in Australia. To identify rates of health-risk behaviours among adolescents with mental health problems. METHOD: The mental disorders were assessed using the parent-version of the Diagnostic Interview Schedule for Children Version IV. Parents completed the Child Behaviour Checklist to identify mental health problems and standard questionnaires to assess health-related quality of life and service use. The Youth Risk Behaviour Questionnaire completed by adolescents was employed to identify health-risk behaviours. RESULTS: Fourteen percent of children and adolescents were identified as having mental health problems. Many of those with mental health problems had problems in other areas of their lives and were at increased risk for suicidal behaviour. Only 25% of those with mental health problems had attended a professional service during the six months prior to the survey. CONCLUSION: Child and adolescent mental health problems are an important public health problem in Australia. The appropriate balance between funding provided for clinical interventions focusing on individual children and families and funding for interventions that focus on populations, requires careful study. The latter are an essential component of any strategy to reduce mental health problems as the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help. Clinical and population health interventions must take into account the comorbid problems experienced by children with mental disorders.

Validity of DSM-IVADHD subtypes in a nationally representative sample of Australian children and adolescents.

OBJECTIVE: To examine the discriminant validity of DSM-IV attention-deficit/hyperactivity disorder (ADHD) subtypes in a nationally representative sample of Australian youths. METHOD: The Diagnostic Interview Schedule for Children, including the symptom-specific impairment questions, was administered to 3,597 parents of children aged 6 to 17 years (response rate = 70%). Parents also completed questionnaires assessing children's emotional and behavioral problems and quality of life. RESULTS: Current DSM-IVADHD prevalence was 7.5% (6.8% with impairment) with inattentive types being more common than hyperactive-impulsive and combined types. ADHD was more prevalent among young males and was linked to social adversity, particularly for combined types. Compared with non-ADHD controls, all three ADHD subtypes were rated as having more emotional and behavioral problems and lower psychosocial quality of life, with combined types consistently rated the most impaired. Combined types received higher ratings than hyperactive-impulsive and inattentive types on externalizing behavior problems, disruption to family activities, and symptom-specific impairments with schoolwork and peer-related activities. Inattentive types were rated as having lower self-esteem, more social and school-related problems, but fewer externalizing problems than hyperactive-impulsive types. CONCLUSION: These findings support the view of DSM-IVADHD subtypes as distinct clinical entities with impairments in multiple domains.

The National Survey of Mental Health and Wellbeing: the child and adolescent component.

OBJECTIVE: This paper describes the Child and Adolescent Component of the National Survey of Mental Health and Wellbeing. METHOD: The aims of the study, critical decisions in planning for the study, progress to date and key issues which influenced the course of the study are described. RESULTS: The Child and Adolescent Component of the National Survey of Mental Health and Wellbeing is the largest study of child and adolescent mental health conducted in Australia and one of the few national studies to be conducted in the world. Results from the study will provide the first national picture of child and adolescent mental health in Australia. CONCLUSIONS: Large-scale epidemiological studies have the potential to provide considerable information about the mental health of children and adolescents. However, having a clear set of aims, ensuring that the scope of the study remains within manageable proportions and paying careful attention to the details of fieldwork are essential to ensure that high-quality data is obtained in such studies.

An Australian study of adolescents with cystic fibrosis: perceived supportive and nonsupportive behaviors from families and friends and psychological adjustment.

PURPOSE: To identify and compare perceived supportive and nonsupportive behaviors exhibited by family members and friends toward adolescents with cystic fibrosis (CF), and to examine the relationships between supportive and nonsupportive behaviors and adolescents' psychological adjustment. METHOD: Participants were 35 adolescents with CF attending the Women's and Children's Hospital in South Australia. Perceived supportive and nonsupportive behaviors were assessed using an adapted version of the Chronic Disease Support Interview. The psychological adjustment of the adolescents was assessed using the Youth Self Report Form. Repeated-measures analyses of variance were performed to compare the support provided by family members and friends. Multiple regression analyses assessed the contribution of supportive and nonsupportive behaviors for the prediction of psychological adjustment. RESULTS: Family members provided more tangible support than friends who, conversely, provided more companionship support. Overall, family members scored higher than friends on ratings for supportive behaviors. No differences were observed between family members and friends on ratings for nonsupportive behaviors. Rating of nonsupportive behaviors for family members was found to be the strongest predictor of psychological adjustment. CONCLUSIONS: Family members and friends provide different types of support. Family members provide more tangible help with treatment tasks and adolescents provide more companionship. Overall, this study demonstrated the importance of addressing nonsupportive as well as supportive behaviors when investigating the impact of support on the psychological adjustment of adolescents with a chronic illness.

Social skills training for primary school children: a 1-year follow-up study.

OBJECTIVE: To evaluate the effectiveness of the Rochester Social Problem Solving Program to reduce emotional and behavioural problems amongst primary school children. METHODOLOGY: Children in years 3 and 4 at primary school were assessed prior to receiving the program, immediately after the program and 1 year after the program. At each assessment, the functioning of the children who received the program was compared to the functioning of children enrolled in years 3 and 4 at a comparable school who did not receive the program. RESULTS: The program improved the ability of children to cope with potentially difficult social situations. However, the program did not reduce the prevalence of teacher-reported or mother-reported childhood emotional and behavioural problems. CONCLUSIONS: School-based social skills programs may be more effective in reducing childhood emotional and behavioural problems if they include components which focus specifically on childhood behaviour problems as well as components focusing on social skills and peer relationships.

Assessment of peer relationships in children with asthma.

Identified peer relationships in children with chronic illnesses as an important but neglected, research area. This study compared 21 children with asthma, ages 8-13, with 21 matched classroom controls on a number of measures of peer relationship adjustment, including both self-report and peer-report items. Overall, the children with asthma had peer relationships that were equivalent to those of their classmates, although they were seen as being sicker and missing more school. However, those children who experienced more hospitalizations were less preferred as playmates, perceived as more sensitive-isolated, and felt more lonely. Implications for intervention are considered, and the notion of asthma severity and its measurement is also discussed.

Health consequences of employment and unemployment: longitudinal evidence for young men and women.

This study examines the impact of employment and unemployment on psychological health and well-being, as measured by the General Health Questionnaire (GHQ). Using longitudinal data, it traces health changes over time for a variety of groups and through a variety of labour market experiences: during sustained employment and unemployment, in the transition from school to employment and unemployment, and as people move between employment and unemployment and between satisfying and unsatisfying jobs. The results show that employed people report significantly lower levels of health disorder than students and the unemployed. These differences are largely unaffected by demographic attributes, living arrangements, socioeconomic status or immediate labour market experiences, and can be attributed to employment status itself rather than predisposing health differences. However, the health consequences of employment and unemployment are directly contingent upon quality of work. As a result, the highest levels of health risk are found amongst dissatisfied workers and the lowest levels amongst satisfied workers. In between these two extremes lie employed people neither satisfied nor dissatisfied with their jobs, unemployed people irrespective of duration, and students. These results indicate that what happens in the workplace has even more impact on a person's health than success or failure in finding a job and keeping it.

Multidimensional properties of the General Health Questionnaire.

This analysis re-examines the factor structure of the 12-item GHQ for a large Australian sample of young people. It shows that oblique factor rotation better approaches the criterion of simple structure, and allows separate components of the GHQ to be identified and measured using factor scores. When the performance of these separate factors is compared with composite Likert scores, it is found that they do not behave uniformly in response to outside variables, both in cross-sectional and longitudinal analyses. These results suggest that there are advantages to be gained by using the multidimensional properties of the GHQ as well as a single severity score. The additional information this yields can provide new insights into the nature of psychiatric impairment within and between samples.

Work satisfaction, unionism and militancy amongst nurses.

In recent years there has been a substantial increase in attitudinal and industrial militancy amongst nurses. This paper examines some of the factors associated with this change, in the context of the 50-day strike by Victorian nurses in late 1986. Using data collected from 125 nurses in a large public hospital in Melbourne, it is shown that dissatisfaction with the levels of autonomy, pay and intrinsic work rewards were of greatest concern to nurses at that time, and contributed to their growing unrest and attitudinal militancy. This suggests that measures such as professionalisation and salary restructuring may help to alleviate some of the grievances of nurses, but are unlikely to resolve other important issues that contribute to their discontent.