Housing, health and master planning: rules of engagement.

OBJECTIVES: Knowledge about health focussed policy collaboration to date has been either tactical or technical. This article focusses on both technical and tactical issues to describe the experience of cross-sectoral collaboration between health and housing stakeholders across the life of a housing master plan, including but not limited to a health impact assessment (HIA). STUDY DESIGN: A single explanatory case study of collaboration on a master plan to regenerate a deprived housing estate in Western Sydney was developed to explain why and how the collaboration worked or did not work. METHODS: Data collection included stakeholder interviews, document review, and reflections by the health team. Following a realist approach, data was analysed against established public policy theory dimensions. RESULTS: Tactically we did not know what we were doing. Despite our technical knowledge and skills with health focussed processes, particularly HIA, we failed to appreciate complexities inherent in master planning. This limited our ability to provide information at the right points. Eventually however the HIA did provide substantive connections between the master plan and health. We use our analysis to develop technical and tactical rules of engagement for future cross-sectoral collaboration. CONCLUSIONS: This case study from the field provides insight for future health focussed policy collaboration. We demonstrate the technical and tactical requirements for future intersectoral policy and planning collaborations, including HIAs, with the housing sector on master planning. The experience also suggested how HIAs can be conducted flexibly alongside policy development rather than at a specific point after a policy is drafted.

Isolation of bacterial strains able to metabolize lignin from screening of environmental samples.

AIMS: To develop a method to detect bacteria from environmental samples that are able to metabolize lignin. METHODS AND RESULTS: A previously developed UV-vis assay method for lignin degradation activity has been developed for use as a spray assay on agar plates. Nine mesophilic strains were isolated using this method from woodland soil incubated in enrichment cultures containing wheat straw lignocellulose: four Microbacterium isolates, two Micrococcus isolates, Rhodococcus erythropolis (all Actinobacteria) and two Ochrobactrum isolates (Alphaproteobacteria). Three thermotolerant isolates were isolated from the same screening method applied at 45°C to samples of composted wheat straw from solid-state fermentation: Thermobifida fusca and two isolates related to uncharacterized species of Rhizobiales and Sphingobacterium (Bacteroidetes), the latter strain showing tenfold higher lignin degradation activity than other isolates. The isolated strains were able to depolymerize samples of size-fractionated high molecular weight and low molecular weight Kraft lignin, and produced low molecular weight metabolites oxalic acid and protocatechuic acid from incubations containing wheat straw lignocellulose. CONCLUSIONS: A new method for the isolation of bacteria able to metabolize lignin has been developed, which has been used to identify 12 bacterial isolates from environmental sources. The majority of isolates cluster into the Actinobacteria and the Alphaproteobacteria. SIGNIFICANCE AND IMPACT OF THE STUDY: Lignin-degrading bacterial strains could be used to convert lignin-containing feedstocks into renewable chemicals and to identify new bacterial lignin-degrading enzymes.

Aminoindanes--the next wave of 'legal highs'?

Due to its closed ring system, 2-aminoindane is a conformationally rigid analogue of amphetamine. Internet websites offering synthetic compounds as 'research chemicals' have recently been advertising 5,6-methylenedioxy-2-aminoindane (MDAI), 5, 6-methylenedioxy-N-methyl-2-aminoindane (MDMAI), 5-iodo-2-aminoindane (5-IAI), and 5-methoxy-6-methyl-2-aminoindane (MMAI). The chemistry, pharmacology, and toxicological aspects of this new class of psychoactive substances are reviewed, as these could become the next wave of 'legal highs'.

Parental perspectives on caring for a child with chronic kidney disease: an in-depth interview study.

BACKGROUND: Children diagnosed with chronic kidney disease (CKD) depend on their parents for complex, continuous and intensive support. The study aimed to explore the experiences of parents who have children with CKD. METHODS: Parents of 20 children with CKD, recruited from two paediatric hospitals in Australia, participated in an in-depth interview, qualitative study. RESULTS: Four major themes were identified: (1) absorbing the clinical environment: parents struggled to accept the diagnosis and permanence of CKD, felt traumatized watching their child undergo invasive clinical procedures, battled to meet appointments, negotiated with staff for their child's needs and felt disempowered; (2) medicalizing parenting: parents became caregivers, a role which was stressful, exhausting and overwhelming. Dialysis was unrelenting and consumed the time, thoughts and energy of parents who felt at fault if their child developed infections and other complications. Parents struggled with their child's psychological problems and episodic aggressive behaviour; (3) disrupting family norms: CKD caused spousal tension, sibling neglect and influenced family planning; (4) coping strategies and support structures: Parents depended on support from their health care providers and valued meeting and learning from other parents of CKD children. Parents also expressed information needs and suggested methods of communicating information. CONCLUSIONS: Despite facing profound and pervasive difficulties, parents strived to fulfil their dual parental and health care provider responsibilities. Parents appear to need better support structures to help them cope with the difficulties encountered during all stages of their child's illness.

Improving services for people with a psychotic disorder and problematic substance use: a multifaceted approach to project evaluation.

OBJECTIVE: The objective of this study was to conduct a multifaceted formative evaluation of the Central Sydney Area Health Service (CSAHS) Psychosis and Substance Use Project. METHOD: Four evaluative methods were used: (i) description and interpretation of the Project's documented processes and outcomes; (ii) a benchmark comparison of the Project processes and outcomes against three of the 11 National Standards for Mental Health Services; (iii) a survey of the Project's key stakeholders; and (iv) interviews with 12 purposefully sampled key informants. RESULTS: The Project achieved its aim to develop a strategy to improve services for people with comorbid psychosis and problematic substance use. Three of the five Project objectives were fully achieved: examination of current clinical services, development of a clinical services plan, and development of a staff education programme. The Project partially achieved two objectives: development of an information system, and a research agenda. The Project and CSAHS performed well when measured against three of the National Mental Health Standards. Project participants perceived the Project to have been successful and worth continuing, identified some shortcomings and made recommendations for the second phase. CONCLUSIONS: The participatory approach to the Project and the evaluation was successful. With some improvements the Project is worth continuing into a second phase. A multifaceted approach and qualitative research methods are useful for formative evaluation of health service programmes.

Divisions of population health: quantum leap forward or rearranging the deckchairs?

OBJECTIVES: To describe the reasons for the formation of divisions of population health in NSW, their functional units, how they might be evaluated, and some future challenges; to stimulate critical appraisal of the divisions. METHODS: Personal observation; review of documentation and organisational charts. RESULTS: Area health services (AHSs) were established in NSW in 1986; there are now 17. Divisions of population health attempt to overcome the marginalisation and fragmentation that often characterise population health workers within AHSs. Divisions aim to strengthen an AHS's capacity to meet its legislated responsibility to protect and promote the health of the local population. Each of the 13 divisions established since 1994 contains a different mix of services. Public health, health promotion and health services planning units are most commonly included in divisions. Formal evaluations of organisational structures are not common in health services. Evaluations of divisions of population health should focus on their success at creating organisational structures and processes which are conducive to the implementation of population health strategies; improving health outcomes; and improving the personal, social and environmental preconditions for health. CONCLUSIONS: Establishing divisions of population health has highlighted the lack of evidence regarding the effectiveness of different organisational structures for delivering population health services. IMPLICATIONS: Greater effort is needed to evaluate existing organisational structures and to develop and implement optimal structures for population health services.

Industrial atmospheric pollution, historical land use patterns and mortality.

BACKGROUND: The measurement of atmospheric pollution for epidemiological studies is problematic. This study presents a new proxy measure of atmospheric pollution of industrial origin and uses it to determine, at electoral ward level, the relationship between atmospheric pollution and all-cause mortality. METHODS: All-cause Standardized Mortality Ratios (SMR), all ages, and for persons under 65 years for the period 1984-1988, proportions of land in each ward utilized by industrial works (the proxy for atmospheric pollution) and levels of socioeconomic deprivation of the ward residents were compared in 104 electoral wards. RESULTS: The all-age SMR in the 22 wards containing the largest proportions of industrial land (113) was 9.7 per cent higher than the SMR (103) in the 60 wards with no industrial land. The under 65 years SMR in the 22 highly industrialized wards (120) was 22.4 per cent higher than the SMR (98) in the wards with no industrial land. After matching the levels of deprivation, the all-age SMR in the 15 wards containing over 10 per cent industrial land (116) was significantly higher than the SMR in 15 wards containing no industrial land (108); corresponding figures for the under 65 years SMR were 135 and 118. CONCLUSIONS: A greater proportion of industrial land in a ward is associated with a higher mortality of the ward residents, even after controlling for the level of socio-economic deprivation of the residents. The association between deprivation and mortality is stronger than the association between atmospheric pollution and mortality. There is an urgent need for better measures of atmospheric pollution which are usable in epidemiological studies.

An outcomes approach to population health at the local level in NSW: practical problems and potential solutions.

While a health outcomes approach has the potential to improve the health status of Australians as well as health service efficiency, such a policy will be successful only if practice at the local level follows suit. This paper briefly reviews the health outcomes approach and describes how the Central Sydney Area Health Service has established a Needs Assessment & Health Outcomes Unit to help improve health outcomes. The paper discusses issues in working with population health outcomes at the local level, such as the usefulness and limitations of routinely collected data for planning and managing health services, problems of small area data, gaps in the documentation of national health goals and targets, problems of attribution of improved outcomes to specific interventions, and definition of responsibilities for action at the local level. It offers some potential solutions relevant at the local level.

Validity and reliability of trends in suicide statistics.

For a number of reasons, suicide is under-reported and the reliability of official rates is subject to error through variations in defining and reporting cases, the kind of inaccuracy encountered when ascertaining cases in studies of mortality from any cause. Nevertheless, the evidence from studies designed to see whether these sources of error invalidate the differences reported between cultural and social groups indicates that they are of a random nature, at least to an extent that allows epidemiologists to compare rates between countries and districts within them, between demographic groups, and over periods of time. The accuracy and hence the value of official suicide statistics has been questioned in recent years to an extent that has led some authorities to dismiss their usefulness in epidemiological research. In England and Wales, a decision as to whether an unexpected or violent death is a suicide or not is normally made at a coroner's inquest; similar, but by no means identical procedures are followed in other developed countries. Cases defined and ascertained in this way are the usual source of national suicide statistics. Indeed, it may be claimed that the medical and post-mortem inquiry together with the evidence of witnesses on the psychological and social circumstances relating to the act, entail a more thorough investigation into this cause of death than is usual in compiling the statistics of deaths from other causes. Consider by contrast the General Registrar Office enquiry into the accuracy of reporting other causes of death (1). When, for example, deaths from cancer of the lung are registered before holding a post-mortem and the cause of death is later checked by a pathologist, the net error is about 16%. The conclusions drawn from official cancer statistics, however, are not seriously questioned. It is thus reasonable to expect suicide statistics, despite inaccuracies, also to be of heuristic value particularly as over-reporting is negligible, and it is only under-reporting, not a matter in dispute, that need be considered. Studies of under-reporting of suicide include those done in England and Wales (2), Scotland (3), and in Ireland where McCarthy & Walsh (4) examined coroners' case records in Dublin using clinical criteria to assess the probability of suicide. Though their revised rate was considerably higher than the official one, the Irish rate is still exceptionally low when compared with other countries. Barraclough (5) confirmed by other means that the adjusted rate was still half that of England.(ABSTRACT TRUNCATED AT 400 WORDS)

Estimating suicide risk among attempted suicides: I. The development of new clinical scales.

A discriminant function analysis was carried out to separate a sample of 75 suicides from a sample of 146 attempted suicides, on which comprehensive clinical and social data were recorded on an identical schedule. Two sets of discriminating items (with 18 and 6 variables) correctly classified 91 per cent and 83 per cent of the two samples in their respective groups. The results provide a basis for examining the usefulness of these variables as predictors of future suicide in people who have attempted suicide.

The accuracy of officially reported suicide statistics for purposes of epidemiological research.

Suicide is underreported for a number of reasons and the reliability of the official rates is subject to error from variation in defining and reporting cases--the kind of inaccuracies encountered when ascertaining cases in studies of mortality from any cause. Nevertheless, the evidence from studies designed to see whether these sources of error invalidate the differences reported between cultural and social groups indicate that they are randomised, at least to an extent that allows epidemiologists to compare rates between countries and districts within them, between demographic groups, and over time.

An Ultrasound technique for the measurement of tardive dyskinesia.

A simple and portable ultrasound system, using a transducer attached to a pair of spectacles, to measure disorders of facial movement is described and applied to the measurement of tardive dyskinesia. Product-moment coefficients of correlation for the split-half and test-retest assessments of reliability in 20 patients were 0.96 and 0.93 respectively. Concurrent validity was confirmed by assessing the consistency between ultrasound scores and time-sampled scores based on video films (Pearson r = 0.86). Serial measurements of tardive dyskinesia over five months revealed striking individual consistency.