Youth mental health promotion in the Hunter region.

OBJECTIVE: To describe the work of the Hunter Institute of Mental Health, with special emphasis on its role in mental health promotion and prevention with adolescents. METHOD AND RESULTS: The Ottawa Charter for Health Promotion is used as a framework to describe the varied functions of this organisation. Four youth mental health promotion programs are given as examples of the Institute's work. Results of preliminary evaluation of the Youth Suicide Prevention - National University Curriculum Project are provided. CONCLUSION: The Hunter Institute of Mental Health, a self-funding unit of the Hunter Area Health Service, provides innovative health promotion programs as part of its role as a provider of mental health education and training. The model may be particularly applicable to mental health services in regional Australia.

A survey of suicide prevention curricula taught in Australian universities.

OBJECTIVE: The aim of this study was to survey Australian universities to determine the scope of suicide prevention curricula in a range of prevocational courses. METHOD: Coordinators of undergraduate and postgraduate university programs for medicine, nursing, psychology, social work, theology, education, pharmacy, law and journalism were asked to complete a survey instrument to determine whether specific knowledge, attitude and skills items were included in the course content. Additional information was sought concerning the dominant method of teaching. Data were compared by discipline. An arbitrary threshold of 70% of courses within each discipline responding positively to each survey item was established as an adequate level of penetrance of that item into prevocational programs. RESULTS: Overall, knowledge and attitudes related to suicide prevention are taught more comprehensively than are skills. Knowledge and attitude items are taught most comprehensively in medical and nursing schools, somewhat less in psychology, social work, and pharmacy, uncommonly in theology and education. Law and journalism courses currently include very little material related to suicide and suicide prevention. Skills relevant to the management of suicidal individuals and their families are taught most comprehensively in psychology, nursing and medical courses, with low penetrance into other courses. CONCLUSION: The greatest opportunity to increase exposure to knowledge and attitudes relevant to suicide prevention exists within education, theology, law and journalism courses. Programs directed to the development of interpersonal skills relevant to the management of suicidal individuals and their families could be introduced across the board.

Prisoners with diabetes: do they receive appropriate care?

This paper reports on a survey of the care delivered to people with diabetes in a small number of prisons, focusing on diets and the availability of diabetic clinics.

Information management and technology in England's large acute NHS hospitals. National strategy versus local reality.

Discusses the NHS Executive's information management and technology (IM&T) strategy and its relationship to the 1991 reforms. Examines the recommendation for large acute hospitals to adopt integrated hospital information support systems (HISS). Reports that a recent census of these hospitals, undertaken by the authors, suggests that the implementation of the strategy's recommendations has been slow at the local level. Attempts to diagnose the factors that are impeding implementation, using the evidence provided by the census. Identifies four main problem areas: the lack of success of past IM&T initiatives undermines confidence in the current strategy; the strategy is poorly aligned with other policy initiatives; the legacy of discrete, proprietary information systems within hospitals makes the creation of an integrative information environment difficult to accomplish without massive investment in new systems; and there are implicit contradictions between the following: the absence of a comprehensive post-implementation evaluation of the economic, technological and cultural feasibility of HISS at any of the three HISS pilot sites; the strategy's advocacy of HISS as the way forward for large acute hospitals; the requirement for a comprehensive business case to support any substantial investment in IM&T. Concludes that a massive rethink of policy is required, with a much greater emphasis on research, development and independent evaluation.

The structured interview as a tool for predicting premature withdrawal from medical school.

A 1:1 matched case-control study was carried out to assess whether comments written about a candidate during a semi-structured interview can identify students likely to withdraw from a medical course better than global numerical scores. Fifty-nine students who withdrew from the undergraduate medical course at the University of Newcastle prior to completion were matched for sex, year and mode of entry into the course, prior academic qualifications and age at entry, with 59 students who had not discontinued or been excluded from the course. No significant differences were found between the numerical scores allocated for personal attributes to students who later withdrew from the course and those who continued. However, students who withdrew had statistically significantly more negative comments made about them at interview with respect to their supportive and encouraging behaviour (p = 0.04) and their motivation to become doctors (p = 0.05). Although no other comparisons reached statistical significance, students who withdrew consistently received more negative comments and fewer positive comments than their continuing peers. A stepwise logistic regression procedure identified the number of negative comments made by interviewers about a candidate on their supportive and encouraging behaviour as the only statistically significant predictor of later withdrawal (odds ratio 1.65 95% confidence interval 1.01-2.70).

A new technique of open amputation: use of the rolled flap.

In patients with extensive skin, soft tissue or bone loss and chronic osteomyelitis, or vascular disease, one feature in common is a source of potential infection in that limb. An amputation is often advisable but primary closure frequently results in complications. The above described method of open amputation enables us to retain the optimum bone length and skin flaps without basing the level of the amputation upon the apparent proximal level of normal skin. This method is expecially useful in the acutely traumatized and unsalvagable limb with gross contamination, and can produce early primary healing.