Estradiol for treatment-resistant schizophrenia: a large-scale randomized-controlled trial in women of child-bearing age

Many women with schizophrenia remain symptomatic despite optimal use of current therapies. While previous studies suggest that adjunctive oestrogen therapy might be effective, large-scale clinical trials are required before clinical applications are possible. This study is the first large-scale randomized-controlled trial in women with treatment-resistant schizophrenia. This Definitive Oestrogen Patch Trial was an 8-week, three-arm, double-blind, randomized-controlled trial conducted between 2006 and 2011. The 183 female participants were aged between 18 and 45 (mean=35 years), with schizophrenia or schizoaffective disorder and ongoing symptoms of psychosis (Positive and Negative Syndrome Scale, PANSS score>60) despite a stable dose of antipsychotic medication for at least 4 weeks. Mean duration of illness was more than 10 years. Participants received transdermal estradiol 200 μg, transdermal estradiol 100 μg or an identical placebo patch. For the 180 women who completed the study, the a priori outcome measure was the change in PANSS score measured at baseline and days 7, 14, 28 and 56. Cognition was assessed at baseline and day 56 using the Repeatable Battery of Neuropsychological Status. Data were analysed using latent growth curve modelling. Both estradiol groups had greater decreases in PANSS positive, general and total symptoms compared with the placebo group (P<0.01), with a greater effect seen for 200 μg than 100 μg estradiol. The largest effect size was for the positive subscale of PANSS in the estradiol 200 μg treatment group (effect size 0.44, P<0.01). This study shows estradiol is an effective and clinically significant adjunctive therapy for women with treatment-resistant schizophrenia, particularly for positive symptoms.Molecular Psychiatry advance online publication, 15 April 2014; doi:10.1038/mp.2014.33.

Australasian nutrition research for prevention and management of child obesity: innovation and progress in the last decade.

The Food and Nutrition stream of Australasian Child and Adolescent Obesity Research Network (ACAORN) aims to improve the quality of dietary methodologies and the reporting of dietary intake within Australasian child obesity research (http://www.acaorn.org.au/streams/nutrition/).

Optimal second best taxation of addictive goods in dynamic general equilibrium: a revenue raising perspective

In this paper we derive conditions under which optimal tax rates for addictive goods exceed tax rates for non-addictive consumption goods within a rational addiction framework where exogenous government spending cannot be financed with lump sum taxes. We reexamine classic results on optimal commodity taxation and find a rich set of new findings. Two dynamic effects exist. First, households anticipating higher future addictive tax rates reduce current addictive consumption, so they will be less addicted when the tax rate increases. Therefore, addictive tax revenue falls prior to the tax increase. Surprisingly, the optimal tax rate on addictive goods is generally decreasing in the strength of tolerance, since strong tolerance strengthens this tax anticipation effect. Second, high current tax rates on addictive goods make households less addicted in the future, affecting all future tax revenues in a way which depends on how elasticities are changing over time. Classic results on uniform commodity taxation emerge as special cases when elasticities are constant and the addiction function is homogeneous of degree one. Finally, we also study features of addictive goods such as complementarity to leisure that, while not directly related to the definition of addiction, are nonetheless properties many addictive goods display.

Estradiol for treatment-resistant schizophrenia: a large-scale randomized-controlled trial in women of child-bearing age

Many women with schizophrenia remain symptomatic despite optimal use of current therapies. While previous studies suggest that adjunctive oestrogen therapy might be effective, large-scale clinical trials are required before clinical applications are possible. This study is the first large-scale randomized-controlled trial in women with treatment-resistant schizophrenia. This Definitive Oestrogen Patch Trial was an 8-week, three-arm, double-blind, randomized-controlled trial conducted between 2006 and 2011. The 183 female participants were aged between 18 and 45 (mean=35 years), with schizophrenia or schizoaffective disorder and ongoing symptoms of psychosis (Positive and Negative Syndrome Scale, PANSS score>60) despite a stable dose of antipsychotic medication for at least 4 weeks. Mean duration of illness was more than 10 years. Participants received transdermal estradiol 200 μg, transdermal estradiol 100 μg or an identical placebo patch. For the 180 women who completed the study, the a priori outcome measure was the change in PANSS score measured at baseline and days 7, 14, 28 and 56. Cognition was assessed at baseline and day 56 using the Repeatable Battery of Neuropsychological Status. Data were analysed using latent growth curve modelling. Both estradiol groups had greater decreases in PANSS positive, general and total symptoms compared with the placebo group (P<0.01), with a greater effect seen for 200 μg than 100 μg estradiol. The largest effect size was for the positive subscale of PANSS in the estradiol 200 μg treatment group (effect size 0.44, P<0.01). This study shows estradiol is an effective and clinically significant adjunctive therapy for women with treatment-resistant schizophrenia, particularly for positive symptoms.

Modeling the cost effectiveness of child care policy changes in the U.S.

INTRODUCTION: Child care facilities influence diet and physical activity, making them ideal obesity prevention settings. The purpose of this study is to quantify the health and economic impacts of a multi-component regulatory obesity policy intervention in licensed U.S. child care facilities. METHODS: Two-year costs and BMI changes resulting from changes in beverage, physical activity, and screen time regulations affecting a cohort of up to 6.5 million preschool-aged children attending child care facilities were estimated in 2014 using published data. A Markov cohort model simulated the intervention's impact on changes in the U.S. population from 2015 to 2025, including short-term BMI effects and 10-year healthcare expenditures. Future outcomes were discounted at 3% annually. Probabilistic sensitivity analyses simulated 95% uncertainty intervals (UIs) around outcomes. RESULTS: Regulatory changes would lead children to watch less TV, get more minutes of moderate and vigorous physical activity, and consume fewer sugar-sweetened beverages. Within the 6.5 million eligible population, national implementation could reach 3.69 million children, cost $4.82 million in the first year, and result in 0.0186 fewer BMI units (95% UI=0.00592 kg/m(2), 0.0434 kg/m(2)) per eligible child at a cost of $57.80 per BMI unit avoided. Over 10 years, these effects would result in net healthcare cost savings of $51.6 (95% UI=$14.2, $134) million. The intervention is 94.7% likely to be cost saving by 2025. CONCLUSIONS: Changing child care regulations could have a small but meaningful impact on short-term BMI at low cost. If effects are maintained for 10 years, obesity-related healthcare cost savings are likely.

The effect of victim age on police authorisation of charges in cases of child sexual abuse

In the study, a cohort of 440 child sexual abuse cases were used to model the effect of victim age on police authorisation of charges. Linear and quadratic effects of age were modelled in a logistic regression that controlled for case characteristics and evidence. The quadratic effect of victim age was strengthened when control variables were included in the model and the linear effect of age was not significant in the final model. The results indicated that cases involving victims in middle childhood had a higher proportion of suspects charged than cases involving victims in early childhood and adolescence. Possible mediators of the relationship between victim age and charges were explored and it was found that cases with older victims had a higher prevalence of extra-familial abuse and suspect confessions, and these factors had a positive effect on the proportion of suspects charged. Possible explanations for the quadratic effect of victim age and mediation are discussed.

Mothers' experiences of child support: qualitative research and opportunities for policy insight

Child support is one of the defining and under-studied elements of single mothering in contemporary Australia. However, the Australian Child Support Scheme is marked by high levels of debt and unreliable, partial and non-payment, which exacerbate mothers' financial insecurity. Most Australian child support research has focused on the amounts and outcomes of payments. Little is known about how and why mothers and fathers make the child support decisions they do. In this paper, we synthesise data from three interview studies with mothers who were due to receive child support to assess whether they experienced the system as intended. We compare the experience of child support policy 'on the books' with its experience by mothers 'on the ground'. A qualitative approach to mothers' experiences of child support highlights the social meaning of that money and the importance of understanding its transfer and use as embedded in social relations.

‘It should be a big responsibility’: Separated low-income mothers’ evaluation of child support arrangements and the conduct of fathers

The Australian Child Support Scheme was established as a means of ensuring adequate financial support for children of separated parents. However, within the financial transfer of child support exist notions of ‘trust’ and ‘fairness’ based on parents navigating their changed relationship post-separation. Previous research has explored the assessment and outcomes of child support for both payee and payer parents, however little attention has been given to how women evaluate the assessment and outcomes of child support. As such, this research aimed to explore payee mothers’ evaluation of their child support experiences based on the value of their child support assessment and the extent to which these payments were received. Following the methods of constructivist grounded theory, in-depth interviews were conducted with 20 low-income single mothers. Analysis revealed that payee mothers evaluated child support based on the moral assumptions and the rationalities they perceived were underlying payer fathers’ child support compliance. While payee mothers desired arrangements that reflected joint parental financial responsibility, in reality many experienced problematic child support payments, which may ultimately undermine payee parents’ confidence in the Child Support Scheme.

How parents manage the risk of child sexual abuse: a grounded theory

The aim of this study is to understand how parents manage the risk of child sexual abuse, including prevention as well as early intervention and detection strategies. Using a social constructivist theoretical foundation and grounded theory methods, qualitative in-depth interviews were conducted with Australian parents between 2006 and 2008. Based on the data, a balance theory was developed, which explains how parents attempt to balance the type of information given to children in order to protect their children from sexual abuse without scaring them as well as how parents manage sexual boundary crossing incidents experienced by their children in the context of complex social relationships. Implications for prevention programs as well as reporting of child sexual abuse are discussed.

The naming of child homicide offenders in England and Wales: the need for a change in law and practice

Judicial decisions about whether or not to publicly name child homicide offenders have long ani- mated debate in the United Kingdom and internationally. This article draws on case law and in- depth interviews conducted with members of the English criminal justice system to critically analyse the viability of current domestic legislation in the context of the UK’s international human rights obligations. The article identifies ambiguities surrounding the definition of ‘public interest’ in law; the merits of equating the naming of child offenders with open justice, accountability and transpar- ency; and the increasing sabotage of the principle of rehabilitation. By identifying the complexities of this contentious area of judicial discretion, this article highlights the need for a rights-based approach to decisions about publicly naming children in conflict with the law.

Australian prosecutors perceptions of the utility of child investigative interview protocols

Investigative interviews with alleged victims form the central plank of evidence in the prosecution of child sexual abuse. Despite interviewers being provided with a guiding framework, child sexual abuse cases are often not prosecuted because of poor-quality evidence. The purpose of this study was to elicit feedback from prosecutors about the structure and format of current interview protocols and the ways in which these could potentially be improved from an evidential perspective. Focus group discussions (ranging in length from 180 to 190 minutes) were conducted with 13 Crown prosecutors representing every jurisdiction of Australia. Thematic analysis of the focus group discussions revealed that prosecutors were supportive of the structure of interview protocols, however, concerns were raised about four of the interview elements. These elements were the oath and truth–lie competency test, the ground rules, the practice narrative and eliciting a disclosure. The prosecutors’ concerns and their implications for protocol developers and trainers are discussed.

Identifying the characteristics of child sexual abuse cases that exit the criminal justice system before the forensic interview

Most child sexual abuse cases do not result in conviction; rather, they result in attrition at an earlier point in the system. Although research has looked at case characteristics associated with attrition at later stages of the system (i.e. the laying of charges and prosecution stages), to date, no research has studied the case characteristics associated with attrition as soon as a report has been made to authorities. The aim of this study was to determine the case characteristics (child complainant, suspect and additional case characteristics) associated with attrition when a case first enters the criminal justice system before a forensic interview is conducted. All child sexual abuse incidents reported to police in one jurisdiction of Australia in 2011 were examined. Three case characteristics were found to predict attrition: previous disclosure, abuse frequency and the child complainant’s age. Specifically, cases were more likely to result in attrition when the child had not previously disclosed the abuse to an adult, the abuse was a single incident rather than repeated, and a curvilinear relationship was found for child age. Cases involving children aged 7–12 years were less likely to result in attrition than cases involving younger (0–6 years) and older (13–15 years) children. This information should assist professionals and researchers in developing interventions to reduce the attrition when necessary during this early stage of the criminal justice system.

Pathway to justice: Examining the attrition of child sexual abuse cases

The attrition of child sexual abuse cases from the criminal justice process was explored. Recommendations to prevent attrition included: more effective communication between stakeholders; enabling connections between children and adults to facilitate disclosures; introduction of peer support programs to prevent withdrawal; and educating children about sexual victimisation to reduce withdrawal.

Why all directors should be shareholders in the company: the case against "independence"

It is argued that the shift towards more 'independent' directors, in the wake of corporate collapses, is a fundamentally bad move, undermining the rights and powers of minority shareholders - entrenches a second-rate corporate governance model, separation of ownership and control, in company law - rather than suggest cosmetic reform in an attempt to address the problem, it is proposed that all directors must have significant interest in the company they serve - directors' self-interests and the best interests of the company become intertwined - this is a more effective way of tackling the problem of separation of ownership and control

Directors' duties to stakeholders : a reform proposal based on three false assumptions

The Corporations and Markets Advisory Committee has been asked to consider whether the duties of directors under the Corporations Act 2001 (Cth) should be broadened to require directors to take into account the interests of stakeholder groups other than shareholders when making corporate decisions. In this article, the author argues that the existing statutory duties of directors in Australia should remain unchanged. The existing duties of directors, in particular the overriding duty of directors to act in the best interests of the company, already accommodates consideration of stakeholder interests by directors if the decision is justifiable as being in the company's best interests. Furthermore, corporate culture and norms are moving towards embracing stakeholder engagement, again with the implicit recognition that integrating stakeholder considerations within the decision-making processes of companies is integral to achieving long-term sustainable growth.