Risk and protective factors for depressive symptomatology among a community sample of adolescents and young adults

Objectives: The study explores the risk and protective factors for current depressive symptomatology in a large community sample of 15-to-24-year-olds. Methods: The study was designed as a cross-sectional household survey, which used telephone recruitment followed by an anonymous self-report postal questionnaire. The final sample included 3,082 adolescents and young adults from Queensland, Australia. Results: The vast majority of measured risk and protective factors were associated with current depressive symptomatology. Key risk factors included high levels of neuroticism, perceived problems with parents, sexual abuse, relationship breakups, educational failure and sexual identity conflict. A different profile of protective factors was evident for each of these high-risk groups. Of particular note was the importance of well-developed intrapersonal skills as protective for both males and females. The significance of social connectedness as a protective factor for the males overall and across a range of high-risk groups was a central finding. Conclusions and implications: The implications of these findings in relation to a range of mental health promotion and mental illness prevention and early intervention initiatives are discussed. Supported initiatives include parenting programs that consider the realities of modern families, increasing community awareness of the impact on young people of the breakdown of their intimate relationships, initiatives in educational settings and workplaces to increase tolerance of gay/lesbian and bisexual lifestyles and the enhancement of social connectedness.

Factors influencing PRN medication use in nursing homes

Objective: To identify determinants of PRN ( as needed) drug use in nursing homes. Decisions about the use of these medications are made expressly by nursing home staff when general medical practitioners (GPs) prescribe medications for PRN use. Method: Cross-sectional drug use data were collected during a 7-day window from 13 Australian nursing homes. Information was collected on the size, staffing-mix, number of visiting GPs, number of medication rounds, and mortality rates in each nursing home. Resident specific measures collected included age, gender, length of stay, recent hospitalisation and care needs. Main outcome measures: The number of PRN orders prescribed per resident and the number of PRN doses given per week averaged over the number of PRN medications given at all in the seven-day period. Results: Approximately 35% of medications were prescribed for PRN use. Higher PRN use was found for residents with the lower care needs, recent hospitalisation and more frequent doses of regularly scheduled medications. With increasing length of stay, PRN medication orders initially increased then declined but the number of doses given declined from admission. While some resident-specific characteristics did influence PRN drug use, the key determinant for PRN medication orders was the specific nursing home in which a resident lived. Resident age and gender were not determinants of PRN drug use. Conclusion: The determinants of PRN drug use suggest that interventions to optimize PRN medications should target the care of individual residents, prescribing and the nursing home processes and policies that govern PRN drug use.

Factors affecting student attitudes toward flexible online learning in management education

In response to recent technological advances and the trend toward flexible learning in education, the authors examined the factors affecting student satisfaction with flexible online learning. The authors identified 2 key student attributes of student satisfaction: (a) positive perceptions of technology in terms of ease of access and use of online flexible learning material and (b) autonomous and innovative learning styles. The authors derived measures of perceptions of technology from research on the Technology Acceptance Model and used locus of control and innovative attitude as indicators of an autonomous and innovative learning mode. First-year students undertaking an introductory management course completed surveys at the beginning (n = 248) and at the end (n = 256) of course work. The authors analyzed the data by using structural equation modeling. Results suggest that student satisfaction is influenced by positive perceptions toward technology and an autonomous learning mode.

Medication management at home: medication-related risk factors associated with poor health outcomes

Background: some patients may have medication-related risk factors only identified by home visits, but the extent to which those risk factors are associated with poor health outcomes remains unclear. Objective: to determine the association between medication-related risk factors and poor patient health outcomes from observations in the patients' homes. Design: cross-sectional study. Setting: patients' homes. Subjects: 204 general practice patients living in their own homes and at risk of medication-related poor health outcomes. Methods: medications and medication-related risk factors were identified in the patients' homes by community pharmacists and general practitioners (GPs). The medication-related risk factors were examined as determinants of patients' self-reported health related quality of life (SF-36) and their medication use, as well as physicians' impression of patient adverse drug events and health status. Results: key medication-related risk factors associated with poor health outcomes included: Lack of any medication administration routine, therapeutic duplication, hoarding, confusion between generic and trade names, multiple prescribers, discontinued medication repeats retained and multiple storage locations. Older age and female gender were associated with some poorer health outcomes. In addition, expired medication and poor adherence were also associated with poor health outcomes, however, not independently. Conclusion: the findings support the theory that polypharmacy and medication-related risk factors as a result of polypharmacy are correlated to poor health outcomes.

Technical and economic factors in applying the enhanced coalbed methane recovery process

Geological sequestration of CO2 is a technically feasible and potentially economic option for significantly and safely reducing greenhouse gas emissions, with CO2 injection already practiced in Canada and the USA to enhance crude oil production. The Enhanced Coalbed Methane (ECBM) process is seen as the next most economical sequestration options. The authors estimate an incremental methane recovery factor from 20% to 50%, depending on coal rank and seam depth. Others have estimated the potential to increase worldwide CBM production, utilising ECBM, by 18 Trillion cubic meters, while simultaneously sequestering 345 Giga tonnes of CO2. This paper presents technical and economic factors to consider for developing a commercial ECBM project. Technical factors include: geostructural and hydrogeological issues, geochemical reactions, stressed and competitive sorption, counter-diffusion, effective and relative 4-D coal permeability and methane recovery levels. Key economic factors are injectant acquisition price, sale price of methane and the level of carbon credits.