The health of children in immigration detention: how does Australia compare?

We live in an age when the number of refugees worldwide is increasing. All of them have suffered physically or emotionally to a varying degree in their country of origin. The transit to a country of resettlement is fraught with further difficulties or the risk of death. This article explores the different approach taken to the management of this issue by Denmark and Iceland, in comparison to that of Australia. In particular, the different approaches to health care for children and their families are identified. The management of these issues by Denmark and Iceland would appear to be a model to follow. Outcomes of the different managements have not been assessed.

A preliminary case series on the use of quetiapine for posttraumatic stress disorder in juveniles within a youth detention center

Juveniles within the youth justice system have high rates of psychiatric morbidity, including posttraumatic stress disorder (PTSD). This case series describes 6 young people aged 15 to 17 years within a youth detention center who met the criteria for PTSD and reported an improvement in symptoms after 6 weeks of treatment with low-dose quetiapine. The primary outcome measure used was the Traumatic Symptom Checklist in Children. The dose of quetiapine ranged from 50 to 200 mg/d; T scores for PTSD symptoms decreased from 75 (SD, +/- 5.2; range, 68-82) to 54 (SD: +/- 7.4; range, 43-62) (P <= 0.01). Significant improvements in symptoms of dissociation (P <= 0.01), anxiety (P < 0.01), depression (P < 0.01).. and anger (P < 0.05) were also noted over the 6-week evaluation period. Low-dose quetiapine was tolerated well, with no persisting side effects or adverse events. Nighttime sedation was reported, although this was viewed as beneficial. All young people opted to continue with treatment after the assessment period. This preliminary case series suggests that juveniles in detention who have PTSD may benefit from treatment with quetiapine. Caution is needed in interpreting these findings. Both larger open-label and blinded trials are war-ranted to define the use of quetiapine in the treatment of PTSD in the adolescent forensic population.

Working with involuntary clients: Perceptions and experiences of outreach social workers in Hong Kong

The outreach social work service is one of the dominant youth work approaches in dealing with delinquents and youths 'at-risk' in Hong Kong. Yet this approach presents particular challenges. Outreach social workers usually play an active role in initiating and establishing contacts with young people, yet young people are reluctant to engage with the outreach social workers and are resistant towards therapeutic change. To date, little is known about what strategies and techniques are most effective in dealing with client resistance in this context. The aims of this paper are to gain a better understanding of the common resistant behaviours that outreach social workers usually encounter in their day-to-day practice, and to investigate how the outreach social workers respond to their clients' resistance with reference to case examples given in the in-depth interviews. The findings of this study provide evidence that whilst client resistance is common in the outreach social work setting, social workers' patience as well as sensitivity are essential in resolving resistance and building up a rapport with clients.

Involuntary glottal closure during inspiration in muscle tension dysphonia

Objective/Hypothesis: The purpose of this study was to examine respiratory function in a group of patients with muscle tension dysphonia (MTD) Design: Cross-sectional analytical study. Methods: Participants included 15 people with a diagnosis of MTD referred to speech pathology for management of their voice disorder, fiberoptic evidence of glottal or supraglottic constriction during phonation with or without posterior chink, or bowing combined and deviation in perceptual voice quality. A second group of 15 participants with no history of voice disorder served as healthy controls,. Baseline pulmonary function test measures included forced expiratory volume in the first second (FEV1), FVC, FEF25 to 75, FIF50, FEV1/FVC, ratio and FEF50/FIF50 ratio. Hypertonic saline challenge test measures included FEV1 and FIF50 after provocation, close response slope, and provocation dose. Results: Compared with healthy controls, participants with MTD demonstrated a higher prevalence of glottal constriction during inspiration after provocation with nebulized hypertonic saline as demonstrated by a reduction in FIF50 after the hypertonic saline challenge. There was no significant difference between the MTD and healthy control groups in baseline pulmonary function testing. Participants with MTD demonstrated a higher prevalence than healthy controls of abnormal glottic closure during inspiration similar to paradoxical vocal fold movement (PVFM). This suggests that they either had previously undiagnosed coexisting PVFM or that the condition of MTD could be expanded to include descriptions of aberrant glottic function during respiration. This study enhances the understanding of PVFM and MTD by combining research advances made in the fields of otolaryngology and respiratory medicine.

Minister for Immigration and Multicultural and Indigenous Affairs v Al Masri

The case of Minister for Immigration and Multicultural and Indigenous Affairs v Al Masri examines the legality of the continued, and possibly indefinite, detention of an asylum seeker - in determining whether mandatory detention was in fact 'mandatory', and legally so, the Federal Court had to examine the complexity between statute, the Constitution and fundamental rights and freedoms at stake.

How adolescents cope with bullying

Bullying is a stressful event for adolescents at school and was the fourth most common reason for calls to Kids Help Line in 2002. This study sought to examine coping styles used by students affected by bullying in Years 8 and 10 attending three Queensland high schools. Eighty-eight students completed the Bully Survey containing questions about bullying experiences and the way they coped in those situations. No year level differences were found in terms of the type of bullying experienced or the way in which students coped with these experiences. A significant interaction was found between duration of bullying and perceived control for the proportional use of disengagement coping (i.e., denial, avoidance and wishful thinking strategies). A significant simple main effect was found between perceived stressfulness and proportional use of involuntary engagement coping (i.e., rumination, intrusive thoughts, emotional arousal, physiological arousal and impulsive actions). Implications of these findings for schools are discussed.

Modelling of different measures for improving removal in a stormwater pond

The effect of retrofitting an existing pond on removal efficiency and hydraulic performance was modelled using the commercial software Mike21 and compartmental modelling. The Mike21 model had previously been calibrated on the studied pond. Installation of baffles, the addition of culverts under a causeway and removal of an existing island were all studied as possible improvement measures in the pond. The subsequent effect on hydraulic performance and removal of. suspended solids was then evaluated. Copper, cadmium, BOD, nitrogen and phosphorus removal were,also investigated for that specific improvement measure showing the best results. Outcomes of this study reveal that all measures increase the removal efficiency of suspended solids. The hydraulic efficiency is improved for all cases, except for the case where the island is removed. Compartmental modelling was also used to evaluate hydraulic performance and facilitated a better understanding of the way each of the different measures affected the flow pattern and performance. It was concluded that the installation of baffles is the best of the studied measures resulting in a reduction in the annual load on the receiving lake by approximately 8,000 kg of suspended solids (25% reduction of the annual load), 2 kg of copper (10% reduction of the annual load) and 600 kg of BOD (10% reduction of the annual load).

Neural pathways mediating bilateral interactions between the upper limbs

The ease with which we perform tasks such as opening the lid of a jar, in which the two hands execute quite different actions, belies the fact that there is a strong tendency for the movements of the upper limbs to be drawn systematically towards one another. Mirror movements, involuntary contractions during intended unilateral engagement of the opposite limb, are considered pathological, as they occur in association with specific disorders of the CNS. Yet they are also observed frequently in normally developing children, and motor irradiation, an increase in the excitability of the (opposite) homologous motor pathways when unimanual movements are performed, is a robust feature of the mature motor system. The systematic nature of the interactions that occur between the upper limbs has also given rise to the expectation that functional improvements in the control of a paretic limb may occur when movements are performed in a bimanual context. In spite of the ubiquitous nature of these phenomena, there is remarkably little consensus concerning the neural basis of their mediation. In the present review, consideration is given to the putative roles of uncrossed corticofugal fibers, branched bilateral corticomotoroneuronal projections, and segmental networks. The potential for bilateral interactions to occur in various brain regions including the primary motor cortex, the supplementary motor area, non-primary motor areas, the basal ganglia, and the cerebellum is also explored. This information may provide principled bases upon which to evaluate and develop task and deficit-specific programs of movement rehabilitation and therapy. (c) 2005 Elsevier B.V. All rights reserved.

Are the changes in postural control associated with low back pain caused by pain interference?

Background: Voluntary limb movements are associated with involuntary and automatic postural adjustments of the trunk muscles. These postural adjustments occur prior to movement and prevent unwanted perturbation of the trunk. In low back pain, postural adjustments of the trunk muscles are altered such that the deep trunk muscles are consistently delayed and the superficial trunk muscles are sometimes augmented. This alteration of postural adjustments may reflect disruption of normal postural control imparted by reduced central nervous system resources available during pain, so-called pain interference, or reflect adoption of an alternate postural adjustment strategy. Methods: We aimed to clarify this by recording electromyographic activity of the upper (obliquus extemus) and lower (transversus abdominis/obliquus internus) abdominal muscles during voluntary arm movements that were coupled with painful cutaneous stimulation at the low back. If the effect of pain on postural adjustments is caused by pain interference, it should be greatest at the onset of the stimulus, should habituate with repeated exposure, and be absent immediately when the threat of pain is removed. Sixteen patients performed 30 forward movements of the right arm in response to a visual cue (control). Seventy trials were then conducted in which arm movement was coupled with pain (pain trials) and then a further 70 trials were conducted without the pain stimulus (no pain trials). Results: There was a gradual and increasing delay of transversus abdominis/obliquus internus electromyograph and augmentation of obliquus externus during the pain trials, both of which gradually returned to control values during the no pain trials. Conclusion: The results suggest that altered postural adjustments of the trunk muscles during pain are not caused by pain interference but are likely to reflect development and adoption of an alternate postural adjustment strategy, which may serve to limit the amplitude and velocity of trunk excursion caused by arm movement.

Technologizing inhumanity: A discursive practice

A political interview intended to justify refugee detention in Australia is analysed using an interdisciplinary critical discourse method. Barthesian semiotic theory in which the 'Other' is the foundation of national myth provides a context for a close textual analysis using Hallidayan linguistics. The lexico-grammatical analysis identifies features associated with processes (verbs), grammatical metaphors, and nominals. Essentially, the effect is to blunt agency and distance the speaker, but, more importantly, create a classificatory system that allows humans to be treated in certain ways according to bureaucratic procedures. The discursive strategy is labelled technologizing the inhumane because it objectifies the subjective, turning profound human issues into technical issues. Analysed discursively, the interview reveals how discursive control is established and how democracy is represented as impeding the orderly procedure of 'objective' procedures.

Choosing to have children or choosing to be childfree: Australian students' attitudes towards the decisions of heterosexual and lesbian women

Research has demonstrated that voluntarily childless heterosexual women, and lesbian women choosing to become mothers, are negatively stereotyped. However, there is little recent Australian research, and attitudes may have changed in line with changing family formation patterns. This study assessed young Australians' attitudes towards either a lesbian or a heterosexual woman who was planning, or not planning, to have children. One hundred and nineteen first year psychology students, and members of the general public, participated. The majority of participants were under 20, female, European Australian and single. Participants read a brief description of a woman who was variously described as having a male or a female partner, and as planning or not planning to have children. As expected, participants rated the heterosexual woman more favourably than the lesbian, and the woman wanting children more positively than the woman not wanting children. However, there was a trend for the lesbian woman planning to have children to be rated as happier, more mature and more individualistic than others. The legal and social implications associated with wanting to be a lesbian mother in Australia make motherhood a more difficult process for lesbian women than it does for heterosexual women, and may explain why lesbian women who have decided to take this difficult path are seen as happier and more mature, than women making more conventional life choices. While the predominantly young, female student sample limits the generality of the findings, they suggest that social attitudes towards female sexual orientation and women's childbirth decisions are changing.

Conditional release: A less restrictive alternative to hospitalization?

Objective: This study examined conditional release - that is, involuntary outpatient commitment orders upon release from hospitalization - as a least restrictive alternative to psychiatric hospitalization in Victoria, Australia. Methods: Records were obtained from the Victorian Psychiatric Case Register for patients who experienced psychiatric hospitalization: between 1990 and 2000 a total of 8,879 patients were given conditional release and 16,094 were not. Results: Compared with the group that was hospitalized but did not receive a conditional release, the group that received a conditional release was more likely to have more prior hospitalizations of greater than average duration. Patients with schizophrenia were more likely to be given conditional release. Patients given conditional release experienced a care pattern involving briefer inpatient episodes (8.3 fewer days per episode), more inpatient days, and longer duration of restrictive care - that is, combined inpatient and conditional release periods (5.1 more days per month in care). Conclusions: For patients at risk of long-term hospitalization, conditional release may help to shorten inpatient episodes by providing a least restrictive alternative to continued hospitalization. However, patients who were given conditional release doubled the amount of days they spent under restrictive care, compared with the amount of time they previously spent in the hospital before entering a period of combined inpatient and conditional release commitment. Additional oversight may have led to more frequent hospitalization. This consequence raises new questions regarding the possible benefits of such extended oversight and new challenges for release planning using conditional release as a least restrictive method of care.

Do community treatment orders for mental illness reduce readmission to hospital? - An epidemiological study

Background It has been suggested that community treatment orders (CTOs) will prevent readmission to hospital, but controlled studies have been inconclusive. We aimed to test the hypothesis that hospital discharges made subject to CTOs are associated with a reduced risk of readmission. The use of such a measure is likely to change after its introduction as clinicians acquire familiarity with it, and we also tested the hypothesis that the characteristics of patients subject to CTOs changed over time in the first decade of their use in Victoria, Australia. Method A database from Victoria, Australia (total population 4.8 million) was used. Cox proportional hazard models compared the hazard ratios of readmission to hospital before the end of the study period (1992-2000) for 16,216 discharges subject to a CTO and 112,211 not subject to a CTO. Results Community treatment orders used on discharge from a first admission to hospital were associated with a higher risk of readmission, but CTOs following subsequent admissions were associated with lower readmission risk. The risk also declined over the study period. Conclusions The effect of using a CTO depends on the patient's history. At a population level their introduction may not reduce readmission to hospital. Their impact may change over time.

Factors in the selection of patients for conditional release from their first psychiatric hospitalization

Objective: This study examined a sample of patients in Victoria, Australia, to identify factors in selection for conditional release from an initial hospitalization that occurred within 30 days of entry into the mental health system. Methods: Data were from the Victorian Psychiatric Case Register. All patients first hospitalized and conditionally released between 1990 and 2000 were identified (N = 8,879), and three comparison groups were created. Two groups were hospitalized within 30 days of entering the system: those who were given conditional release and those who were not. A third group was conditionally released from a hospitalization that occurred after or extended beyond 30 days after system entry. Logistic regression identified characteristics that distinguished the first group. Ordinary least-squares regression was used to evaluate the contribution of conditional release early in treatment to reducing inpatient episodes, inpatient days, days per episode, and inpatient days per 30 days in the system. Results: Conditional release early in treatment was used for 11 percent of the sample, or more than a third of those who were eligible for this intervention. Factors significantly associated with selection for early conditional release were those related to a better prognosis ( initial hospitalization at a later age and having greater than an 11th grade education), a lower likelihood of a diagnosis of dementia or schizophrenia, involuntary status at first inpatient admission, and greater community involvement ( being employed and being married). When the analyses controlled for these factors, use of conditional release early in treatment was significantly associated with a reduction in use of subsequent inpatient care.