Review of "Comorbidity, disability and the need for treatment for DSM-IV psychiatric disorders in an insured population"

Background: This study presents estimates of 12 month and current prevalences of DSM-IV disorders, and the related comor-bidity, disability and service utilization, derived from a national probability sample in Australia. Methods: The DSM-IV psychiatric disorders among persons aged 18 and over in the Australian population were assessed with data collected by lay interviewers using the Composite International Diagnostic Interview, other screening interviews and measures of disability and service utilization. The response rate was 78.1% and the final sample size was 10,641 adults. Results: Close to 20% reported at least one twelve month disorder and 13% a disorder current within the past 30 days. ICD-10 diagnoses were also derived, DSM-IV was the more conservative classification whether or not the new clinical significance criteria was applied. Major depression, any personality disorder, and alcohol dependence were the three most common twelve month disorders, generalized anxiety disorder replaced alcohol dependence as the third most common current disorder. The sexes has similar rates of any disorder, but women had higher rates of affective and anxiety disorders, men higher rates of substance use disorders. Prevalence of most disorders declined with age and education, and were lower among those employed or married. Respondents whose symptoms met criteria for three or more disorders in the past year had greatly increased rates of disability and of mental health consultations. The affective and somatoform disorders were associated with the highest rates of disability. Only 36% of people with a mental disorder this year had consulted for a mental problem, and most had seen a general practitioner. We identified those with a current disorder who were disabled or multiply comorbid - only half had consulted and of those who had not, more than half said they did not need treatment. Conclusions: The 12 month prevalence was lower than reported in the US National Comorbidity Survey but method factors might account for this. The relationships between prevalence and demographic variables, and between comorbidity, disability and service utilization were similar to those found in the US survey. Australia has a national health insurance scheme with total coverage and access to medical help is available to all, commonly at little or no cost. We identify the high rate of not consulting among those with a current disorder, and additional disability or multiple comorbidity, as an important public health problem. Kessler argued for more research on barriers to professional help seeking. This report reinforces his conclusion and shows that economic barriers are not the dominant issue.

The effects of the Cannabis Expiation Notice System on the prevalence of cannabis use in South Australia: evidence from the National Drug Strategy Household Surveys 1985-95

This study sought to examine the impact of the Cannabis Expiation Notice (CEN) scheme on the prevalence of lifetime and weekly cannabis use in South Australia. Data from five National Drug Strategy Household Surveys between 1985 and 1995 were examined to test for differences in trends in self-reported: (1) lifetime cannabis use; and (2) current weekly cannabis use, after controlling for age and gender, between South Australia and the other states and territories. Between 1985 and 1995, rates of lifetime cannabis use increased in SA from 26% to 36%. There were also significant increases in Victoria (from 26% to 32%), Tasmania (from 21% to 33%) and New South Wales (from 26% to 33%). The increase in South Australia was significantly greater than the average increase throughout the rest of Australia, but the other Australian states differed in their rates of change. Victoria and Tasmania had similar rates of increase to South Australia; New South Wales, Queensland and Western Australia showed lower rates of increase; and the Northern Territory and the Australian Capital Territory had high rates that did not change during the period. There was no statistically significant difference between SA and the rest of Australia in the rate of increase in weekly cannabis use. While there was a greater increase in self- reported lifetime cannabis use in South Australia between 1985 and 1995 than in the average of the other Australian jurisdictions it is unlikely that this increase is due to the CEN system, because similar increases occurred in Tasmania and Victoria (where there was no change in the legal status of cannabis use), and there was no increase in the rate of weekly cannabis use in South Australia over the same period.

National survey of the prevalence, incidence, primary care burden, and treatment of heart failure in Scotland

Objective: To examine the epidemiology, primary care burden, and treatment of heart failure in Scotland, UK. Design: Cross sectional data from primary care practices participating in the Scottish continuous morbidity recording scheme between 1 April 1999 and 31 March 2000. Setting: 53 primary care practices ( 307 741 patients). Subjects: 2186 adult patients with heart failure. Results: The prevalence of heart failure in Scotland was 7.1 in 1000, increasing with age to 90.1 in 1000 among patients greater than or equal to 85 years. The incidence of heart failure was 2.0 in 1000, increasing with age to 22.4 in 1000 among patients greater than or equal to 85 years. For older patients, consultation rates for heart failure equalled or exceeded those for angina and hypertension. Respiratory tract infection was the most common comorbidity leading to consultation. Among men, 23% were prescribed a beta blocker, 11% spironolactone, and 46% an angiotensin converting enzyme inhibitor. The corresponding figures for women were 20% (p = 0.29 versus men), 7% (p = 0.02), and 34% (p < 0.001). Among patients, 75 years 26% were prescribed a β blocker, 11% spironolactone, and 50% an angiotensin converting enzyme inhibitor. The corresponding figures for patients &GE; 75 years were 19% (p = 0.04 versus patients < 75), 7% (p = 0.04), and 33% (p < 0.001). Conclusions: Heart failure is a common condition, especially with advancing age. In the elderly, the community burden of heart failure is at least as great as that of angina or hypertension. The high rate of concomitant respiratory tract infection emphasises the need for strategies to immunise patients with heart failure against influenza and pneumococcal infection. Drugs proven to improve survival in heart failure are used less frequently for elderly patients and women.

A scheme for efficient quantum computation wtih linear optics

Quantum computers promise to increase greatly the efficiency of solving problems such as factoring large integers, combinatorial optimization and quantum physics simulation. One of the greatest challenges now is to implement the basic quantum-computational elements in a physical system and to demonstrate that they can be reliably and scalably controlled. One of the earliest proposals for quantum computation is based on implementing a quantum bit with two optical modes containing one photon. The proposal is appealing because of the ease with which photon interference can be observed. Until now, it suffered from the requirement for non-linear couplings between optical modes containing few photons. Here we show that efficient quantum computation is possible using only beam splitters, phase shifters, single photon sources and photo-detectors. Our methods exploit feedback from photo-detectors and are robust against errors from photon loss and detector inefficiency. The basic elements are accessible to experimental investigation with current technology.

A power system control scheme based on security visualisation in parameter space

Power system real time security assessment is one of the fundamental modules of the electricity markets. Typically, when a contingency occurs, it is required that security assessment and enhancement module shall be ready for action within about 20 minutes’ time to meet the real time requirement. The recent California black out again highlighted the importance of system security. This paper proposed an approach for power system security assessment and enhancement based on the information provided from the pre-defined system parameter space. The proposed scheme opens up an efficient way for real time security assessment and enhancement in a competitive electricity market for single contingency case

(FAB12_2_019) National identity at Arakawa & Gins’ Site of Reversible Destiny—Yoro, Japan

This paper examines the manipulation of forms of the traditional Japanese stroll garden at Site of Reversible Destiny, a tourist park designed by the New Yorkbased collaborators Shusaku Arakawa and Madeline Gins. Landscape and its representations are central to the construction of national identity in Japan since the cultural distinctiveness of the Japanese people has been argued to rest on their unique relationship to nature and the country’s idiosyncratic geography. The stroll garden of the larger estates and palaces of the Edo period (1615–1867) developed out of earlier temple gardens and most public parks in contemporary Japan are in the grounds of these historic sites or reproduce their forms.

Glow worms as a tourist attraction in Springbrook National Park: Visitor attitudes and economic issues

nsect-based tourism mainly caters to a niche market, but its popularity has been growing in recent years. Despite its popularity this form of tourism has remained under-researched and in a sense its contribution to the tourism industry has gone mostly unnoticed. This paper reports the results of a study undertaken on one form of popular insect-based tourism, namely glow worms. The study was undertaken in Springbrook National Park (Natural Bridge section) southeast Queensland, which has one of the largest glow worm colonies in Australia that attracts thousands of visitors each year. A study of this form of tourism is important and useful for several reasons. It is important to understand this hitherto under-studied tourism activity to determine the type of visitors, their socio-economic attributes, economic benefits to the local economy, visitors’ knowledge of glow worms, education imparted, visitor satisfaction of glow worm viewing and visitor attitudes for the introduction of a user fee system to view glow worms. An understanding of these issues could not only help to better manage this valuable biological resource, but can be used to develop the industry to cater to a growing number of visitors. Tourism in glow worms can potentially be used not only to educate the public on the threats affecting glow worms and their colonies, but could also be used to conserve them. Lessons learnt from glow worms as an attraction to Springbrook National Park can be used to better manage and further develop other existing and new glow worm sites in Australia and elsewhere for tourism. Furthermore, it could provide some guidance for the management and development of other forms of current insect-based tourism activities (eg. butterflies) and develop new tourism ventures based on species such as stick insects and jewel beetles for which Australia is well known (Reader’s Digest, 1997)

Effect of self-monitoring and national culture on follower perceptions of personal charisma and charismatic message

In this paper, a theory of charismatic relationships is examined with reference to the follower's personal characteristics. It is argued that a leader's charismatic message and personal charisma occupy different roles for individuals who vary in national culture and level of self-monitoring. In an empirical test of the theory, 387 undergraduates of Chinese and Australian cultural backgrounds completed self-monitoring and charismatic leadership instruments. High self-monitors placed more importance on personal charisma than the charismatic message. Chinese participants relied more than the Australians on the charismatic message, although this preference depended on self-monitoring orientation. These results indicate the influence of both individual-and cultural-level variables on leader-member relationships, and the need to consider these effects in future developments of a theory of charismatic leadership.

Women's health Australia: Recruitment for a national longitudinal cohort study

The Women's Health Australia (WHA) project is a longitudinal study of several cohorts of Australian women, which aims to examine the relationships between biological, psychological, social and lifestyle factors and women's physical health, emotional well-being, and their use of and satisfaction with health care. Using the Medicare database as a sampling frame (with oversampling of women from rural and remote areas), 106,000 women in the three age groups 18-23, 45-50 and 70-75 were sent an invitation to participate and a 24-page self-complete questionnaire. Reminder letters, a nation-wide publicity campaign, information brochures, a freecall number for inquiries, and the option of completing the questionnaire by telephone in English or in the respondent's own language, were used to encourage participation. Statutory regulations precluded telephone follow-up of non-respondents. Response rates were 41% (N = 14,792), 54% (N = 14,200) and 36% (N = 12,614) for the three age groups. Comparison with Australian census data indicated that the samples are reasonably representative of Australian women in these age groups, except fur a somewhat higher representation of women who are married or in a defacto relationship, and of women with post-school education. The most common reason for non-participation was lack of interest or time. Personal circumstances, objections to the questionnaire or specific items in it, and concerns about confidentiality were the other main reasons. Recruitment of three representative age-group cohorts of women, and the maintenance of these cohorts over a number of years, will provide a valuable opportunity to examine associations over time between aspects of women's lives and their physical and emotional health and well-being.

International tourists and road safety in Australia: developing a national research and management programme

Motor vehicle crashes are the leading cause of injury death for international tourists. This makes road safety an important issue for tourism authorities. Unfortunately, as it is in other areas of tourist health, the common response from the travel and tourism industry is to remain silent about this problem and to leave any mishaps in the hands of insurers. At the same time, but for different reasons, international tourists are not usually targeted for road safety initiatives by transport authorities. Given that there are considerable 'hidden' costs associated with international tourists and motor vehicle crashes, the topic should be of concern to both tourism and transport groups. This paper examines issues concerned with driving in unfamiliar surroundings for international visitors in Australia, and proposes a national research and management programme to guide policy and planning in the area. (C) 1999 Elsevier Science Ltd. All rights reserved.