Integrating early intervention for borderline personality disorder and mood disorders

Borderline personality disorder (BPD) has been demonstrated to be a reliable and valid construct in young people (adolescents and young adults). Both borderline- and mood-related psychopathology become clinically apparent from puberty through to young adulthood, frequently co-occur, can reinforce one another, and can be difficult to differentiate clinically. This Gordian knot of overlapping clinical features, common risk factors, and precursors to both BPD and mood disorders complicates clinical assessment, prevention, and treatment. Regardless of whether an individual crosses an arbitrary diagnostic threshold, a considerable proportion of young people with borderline- and mood-related psychopathology will develop significant and persistent functional, vocational, and interpersonal impairment and disability during this critical risk and developmental period. There is a clear need for early intervention, but spurious diagnostic certainty risks stigma, misapplication of diagnostic labels, inappropriate treatment, and unfavorable outcomes. This article aims to integrate early intervention for BPD and mood disorders in the clinical context of developmental and phenomenological change and evolution. "Clinical staging," similar to disease staging in general medicine, is presented as a pragmatic, heuristic, and trans-diagnostic framework to guide prevention and intervention. It acknowledges that the early stages of these disorders cannot be disentangled sufficiently to allow for disorder-specific preventive measures and early interventions. Clinical staging defines an individual's location along the continuum of the evolving temporal course of a disorder. Such staging aids differentiation of early or milder clinical phenomena from those that accompany illness progression and chronicity, and suggests the application of appropriate and proportionate intervention strategies.

Creatine supplementation and riluzole treatment provide similar beneficial effects in copper, zinc superoxide dismutase (G93A) transgenic mice

This study investigated the effects of riluzole (Ril), creatine (Cr) and a combination of these treatments on the onset and progression of clinical signs and neuropathology in an animal model of familial amyotrophic lateral sclerosis, the G93A transgenic mouse (n=13–17 per group). The onset of clinical signs was delayed (P<0.05) by about 12 days in all treatment groups compared with control; however, no differences occurred between treatments. All animals were killed at 199 days of age. At the end of the experimental period the severity of clinical signs was less (P<0.05) with all treatments compared with control. Again no differences between treatments were observed. The treatments had no effect on the number of neurons in ventral horns of the lumbar region of the spinal cord. Transgenic mice ingesting Cr displayed elevated (P<0.05) total Cr levels in cerebral hemispheres (5%) and spinal cord (8%), but not skeletal muscles. These data demonstrate that treatment with Ril and Cr were both effective in delaying disease onset and clinical disability. To the age of killing, no additional benefit was conferred by co-administration of Ril and Cr.

Understanding parental motivators and barriers to uptake of child poison safety strategies: a qualitative study

Objectives: To develop an understanding of factors acting as barriers and motivators to parental uptake of child poison safety strategies.

Design: A qualitative study involving semistructured interviews and focus groups. A grounded theory approach was used for the collection and analysis of data.

Participants: Sixty five parents of children under 5 years of age, some of whom had experienced an unintentional child poisoning incident.

Results: A range of knowledge based, environmental, and behavioral barriers to comprehensive parental uptake of poison safety practices were identified. As a result there tended to be only partial implementation of safety initiatives in the home. Selection of safety practices was often guided by the interests and behaviors of the child. This made the child vulnerable to changes in the home environment, inadequate supervision, and/or shifts in their own behavior and developmental ability. Personal or vicarious exposure of a parent to a child poisoning incident was a significant motivator for parental review of safety practices.

Conclusion: Environmental measures targeting child resistant containers, warning labels, and lockable poisons cupboards will support parents’ efforts to maintain poison safety. Additional education campaigns using stories of actual poisoning incidents may help to increase awareness of risk and encourage increased uptake.

Comparison of the structure of adolescent problem behavior in the United States and Australia

Some extant theory and empirical research suggests that youth problem behaviors, such as substance abuse and delinquency, reflect a single underlying dimension of behavior, whereas others suggest there are several different dimensions. Few studies have examined potential international differences in the structure of problem behavior, where cultural and policy differences may create more variation in behavior and different structures. This study explored the structure of problem behavior in two representative samples of youth (ages 12-17) from Maine and Oregon in the United States (N = 33,066) and Victoria, Australia (N = 8,500). The authors examined the degree to which data from the two countries produce similar model structures using indicators of problem behavior. Results show that the data are best represented by two factors, substance use and delinquency, and there appear to be more similarities than differences in the models across countries. Implications for understanding problem behavior across cultural and developmental groups and practical and policy implications are discussed.

2001 Volvo Award winner in clinical studies : effects of a media campaign on back pain beliefs and its potential influence on management of low back pain in general practice

Study Design. Quasi-experimental, nonrandomized, nonequivalent, parallel group-controlled study involving before and after telephone surveys of the general population and postal surveys of general practitioners was conducted, with an adjacent state used as a control group.


Objectives. To evaluate the effectiveness of a population-based intervention designed to alter beliefs about back pain, influence medical management, and reduce disability and workers’ compensation–related costs.


Summary of Background Data. A multimedia campaign begun during 1997 in Victoria, Australia, positively advised patients with back pain to stay active and exercise, not to rest for prolonged periods, and to remain at work.


Methods. The campaign’s impact on population beliefs about back pain and fear-avoidance beliefs was measured in telephone surveys, and the effect of the campaign on the potential management of low back pain by general practitioners was assessed by eliciting their likely approach to two hypothetical scenarios in mailed surveys. Demographically identical population groups in Victoria and the control state, New South Wales, were surveyed at three times: before, during, and after intervention in Victoria.


Results. The studies were completed by 4730 individuals in the general population and 2556 general practitioners. There were large statistically significant improvements in back pain beliefs over time in Victoria (mean scores on the Back Beliefs Questionnaire, 26.5, 28.4, and 29.7), but not in New South Wales (26.3, 26.2, and 26.3, respectively). Among those who reported back pain during the previous year, fear-avoidance beliefs about physical activity improved significantly in Victoria (mean scores on the Fear-Avoidance Beliefs Questionnaire for physical activity, 14, 12.5, and 11.6), but not in New South Wales (13.3, 13.6, and 12.7, respectively). General practitioners in Victoria reported significant improvements over time in beliefs about back pain management, as compared with their interstate colleagues. There were statistically significant interactions between state and time for 7 of 10 responses on management of acute low back pain, and for 6 of 10 responses on management of subacute low back pain.


Conclusion. A population-based strategy of providing positive messages about back pain improves the beliefs of the general population and general practitioners about back pain and appears to influence medical management.

The breast cancer related burden of morbidity and mortality in six European coutries

Background: The burden of breast cancer expressed in Disability Adjusted Life Years (DALYs) was compared for six European countries and its sensitivity to different sources of variation examined. Methods: DALYs were calculated using country-specific epidemiological data and European Disability Weights. Epidemiological data for 1996 were obtained for Denmark, England and Wales, France, the Netherlands, Spain and Sweden. Disability weights were empirically derived. Results:  Denmark and the Netherlands lost the largest number of DALYs (approximately 1100 DALYs per 100,000 women). They were followed by England (87% of the Danish burden), France (72%), Sweden (68%) and Spain (67%). 70 to 80% of the burden was caused by mortality. Cross-national variation in disease epidemiology was the largest source of variation in the burden of breast cancer. Variation in disability weights and uncertainty in epidemiological data had smaller effects. Conclusion: To compare the burden of breast cancer and most other types of cancer mortality rates provide sufficient information.

Vibrant, oppositional culture : the media and Australian political culture, 1880-1910

The notion that Australia has an entrenched “utilitarian political culture” has predominated in representations of political life and political culture in this country. Ostensibly, political life has been characterised above all by materialism and pragmatism, largely devoid of meaningful debate over ideas. There has, however, been a growing recognition that Australian political culture has been richer, more complex and less settled than commonly believed.

This paper examines the experience in late nineteenth and early twentieth century Australia, focussing on the role of the media in tandem with a burgeoning reading public as integral elements of a vibrant oppositional culture. Here, a passion for knowledge and self-improvement combined with a strong sense that cultivation of the mind was intrinsic to goals of moral, political and social development existed. The print media was centrally important in catering to and stimulating the interests, outlooks and aspirations of a diverse community of readers. Radical papers and journals jostled for attention alongside the mainstream press, supported by a spreading carpet of Mechanics Institutes and Schools of Arts, bookshops stocking a vast array of titles, and a comparatively large and increasingly professionalised literary-artistic intelligentsia.

Many different publics were being engaged and indeed constituted, from the very pragmatic to the strongly idealistic; from anarchists through to conservatives; from the strongly nationalistic through to those deeply loyal to God and Empire. Moreover, potentially quite complex patterns of understanding and attachment were being stimulated during this time. Taking clearer account of the media’s contribution to intellectual and literary pursuits during this period increases our understanding of the diverse and often contradictory traditions that have been part of Australian political culture.

Need and options for teaching global health

A conceptual and developmental approach to teaching global health is presented. We outline the differences between international health (traditionally, the connections between nation-states, typically ‘the west’ and ‘the rest’) and global health (a value-driven systems approach). We see a need for curriculum development in the area of global health, and describe how the health and tertiary education landscape in Melbourne (Australia) would be fertile ground for such a new programme. We illustrate our conceptual and strategic curriculum development efforts with local and international partners, and the outcome suggests we would be able to offer a Master of Global Health programme with two majors: an international health one (more disease oriented), and a global one (focused more on sustainability and political economy issues).

Re-placing gender? Reflections on 15 years of gender, place and culture

This article reflects on Gender, Place and Culture (GPC) from 1994 to mid-2008, to highlight some of the key subjects and debates which have been delimited and progressed within its pages. Launched simultaneously with the cultural turn in human geography, GPC proceeded to raise important questions about identity and difference, effectively reflecting but also driving a number of transformative intellectual and political agendas. This reflection will focus on three interrelated sites of such activity: empirical, theoretical and political. Empirically, numerous articles have examined the ways gender is lived, in and across spaces and these have been enlivened by approaches highlighting masculinities, sexualities and embodiment. Theoretically these subjects have been informed by post-colonial and post-structural frameworks, directing discussion towards multiple identities, reflexivity, research practice, performativity, material cultures, positionality and the nature of academic knowledge. In addition, GPC has registered progressive political concerns for justice and equality, though the nature and extent of its political import has been legitimately questioned from without and within the pages of the journal. The resolution of the many dilemmas associated with the ways gender is lived, thought about and practiced has not always been successful in the pages of GPC, and the ongoing reality of Anglo-American dominance, the persistence of women's inequality and the tension between discursive and political activism, remains. However, in re-placing gender over the last 15 years, GPC has been a journal of serious and path-breaking scholarship which has further legitimized the value of feminist geography.

Tourism and recreation in natural environments : an empirical analysis of visitor satisfaction

A trend in tourism patterns is the desire by tourists to spend more time enjoying unspoilt, natural environments. Leisure experiences in parks can provide many benefits which include promoting positive emotional, intellectual and social experiences which result in high levels of wellness in communities with long-term benefits. However, the resultant growing number of national park visitors has created a need for effective and efficient decision suppOli tools to assist park managers to administer resources, assess planning decisions, cater for an increased range of users, avoid user conflicts and minimise negative impacts on the environment. The aim of this paper is to determine the extent to which manageable variables predict park visitor satisfaction, and in so doing develop a better understanding of park visitors and their leisure experiences in parks. This study is based on a sample of 11,387 face to face interviews at 34 major parks in Victoria, Australia. The study uses cluster analysis, factor analysis and structural equation modelling to develop a segmentation approach to model and analyse visitor satisfaction. Seven well differentiated segments have been developed; constructs relating to park visitation have also been produced. The study highlights that different combinations of park facilities and resources are important in determining the satisfaction of park visitors from different segments.

Consequences of maternal yolk testosterone for offspring development and survival : experimental test in a lizard

1. Hormone-mediated maternal effects and developmental plasticity are important sources of phenotypic variation, with potential consequences for trait evolution. Yet our understanding of the importance of maternal hormones for offspring fitness in natural populations is very limited, particularly in non-avian species.

2. We experimentally elevated yolk testosterone by injection of a physiological dose into eggs of the lizard Ctenophorus fordi Storr, to investigate its roles in offspring development, growth and survival.

3. Yolk testosterone did not influence incubation period, basic hatchling morphology or survival under natural conditions. However, there was evidence for increased growth in hatchlings from testosterone-treated eggs, suggesting that maternal hormones have potential fitness consequences in natural populations.

4. The positive effect of prenatal testosterone exposure on postnatal growth could represent a taxonomically widespread developmental mechanism that has evolved into an adaptive maternal effect in some taxa, but remains deleterious or selectively neutral in others.

5. A broader taxonomic perspective should increase our understanding of the role of physiological constraints in the evolution of endocrine maternal effects.

Neurodevelopmental effects of maternal nutritional status and exposure to methylmercury from eating fish during pregnancy

Fish contain nutrients that promote optimal brain growth and development but also contain methylmercury (MeHg) that can have toxic effects. The present study tested the hypothesis that the intake of selected nutrients in fish or measures of maternal nutritional status may represent important confounders when estimating the effects of prenatal methylmercury exposure on child development. The study took place in the Republic of Seychelles, an Indian Ocean archipelago where fish consumption is high. A longitudinal cohort study design was used. A total of 300 mothers were enrolled early in pregnancy. Nutrients considered to be important for brain development were measured during pregnancy along with prenatal MeHg exposure. The children were evaluated periodically to age 30 months. There were 229 children with complete outcome and covariate data for analysis. The primary endpoint was the Bayley Scales of Infant Development-II (BSID-II), administered at 9 and 30 months of age. Combinations of four secondary measures of infant cognition and memory were also given at 5, 9 and 25 months. Cohort mothers consumed an average of 537 g of fish (nine meals containing fish) per week. The average prenatal MeHg exposure was 5.9 ppm in maternal hair. The primary analysis examined the associations between MeHg, maternal nutritional measures and children's scores on the BSID-II and showed an adverse association between MeHg and the mean Psychomotor Developmental Index (PDI) score at 30 months. Secondary analyses of the association between the PDI and only MeHg alone or nutritional factors alone showed only a borderline significant association between MeHg and the PDI at 30 months and no associations with nutritional factors. One experimental measure at 5 months of age was positively associated with iodine status, but not prenatal MeHg exposure. These findings suggest a possible confounding role of maternal nutrition in studies examining associations between prenatal MeHg exposures and developmental outcomes in children.

Guideline for the non-surgical management of hip and knee osteoarthritis

Introduction: Chronic disease is a major public health burden on Australian society. An increasing proportion of the population has risk factors for, or at least one, chronic disease, leading to increasing public health costs. Health service policy and delivery must not only address acute conditions, it must also effectively respond to the wide range of health and public service requirements of people with chronic illness.^1,2 Strong primary health care policy is an important foundation for a successful national health delivery system and long term management of public health, and is linked to practical outcomes including lower mortality, decreased hospitalisation and improved health outcomes.¹ National strategic health policy has recently given increased recognition to the importance of chronic disease management, with the Australian Federal Government endorsement of a number of initiatives for the prevention (or delay in onset), early detection and evidence based management of chronic disease, including osteoarthritis.^1,3
Chronic musculoskeletal conditions, including arthritis, account for over 4% of the national disease burden in terms of disability adjusted life years. Over 6 million Australians (almost one-third of the population) are estimated to have a chronic musculoskeletal disease; chronic musculoskeletal disease represents the main cause of long term pain and physical disability. In Australia, osteoarthritis is self reported by more than 1.4 million people (7.3% of the population4) and is the tenth most commonly managed problem in general practice.5 This number is set to rise as the elderly population grows. Osteoarthritis exerts a significant burden on the individual and the community through reduction in quality of life, diminished employment capacity and an increase in health care costs. For further details, refer to the Evidence to support the National Action Plan for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis: Opportunities to improve health-related quality of life and reduce the burden of disease and disability (2004).⁶
As such, federal government health policy has identified arthritis as a National Health Priority Area and adopted a number of initiatives aimed at decreasing the burden of chronic disease and disability; raising awareness of preventive disease factors; providing access to evidence based knowledge; and improving the overall management of arthritis within the community.4 In 2002, all Australian health ministers designated arthritis and musculoskeletal conditions as Australia’s seventh National Health Priority Area. In response, a National Action Plan was developed in 2004 by the National Arthritis and Musculoskeletal Conditions Advisory Group (NAMSCAG).6 The aim of this document was to provide a blueprint for national initiatives to improve the health related quality of life of people living with osteoarthritis, rheumatoid arthritis and osteoporosis; reduce the cost and prevalence of these conditions; and reduce the impact on individuals, their carers and their communities within Australia. The National Action Plan was developed to complement both the National Chronic Disease Strategy – which is broader – and the National Service Improvement Framework for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis, in addition to other national and state/ territory structures.

School innovation in science: improving science teaching and learning in Australian schools

School Innovation in Science is a major Victorian Government initiative that developed and validated a model whereby schools can improve their  science teaching and learning. The initiative was developed and rolled out to more than 400 schools over the period 2000-2004. A research team worked with 200+ primary and secondary schools over three years, supporting them in developing new initiatives in science, and monitoring the impact on school and classroom practice, and student outcomes. The research effort underpinning the development phase included the development and validation of a set of components describing effective teaching, the refinement of a school and teacher change strategy, the development of instruments to monitor teacher classroom practice and a variety of student outcomes, and the development of insights into the change process using questionnaires, observations, and interviews across four years. This paper describes the project and its major outcomes, and raises a number of issues concerning the nature of school and teacher change, pedagogy, school and community, and student learning, and the way these interact. A number of research issues are raised by the size and developmental nature of the project, the range of research methods, and the different audiences served by the research. The issue of sustainability of such system-wide change initiatives is discussed.

Differential calcineurin signalling activity and regeneration efficacy in diaphragm and limb muscles of dystrophic mdx mice

Calcineurin activity is essential for successful skeletal muscle regeneration in young mdx mice and in wild type mice following myotoxic injury and cryodamage. In mature myofibres of adult mdx mice, calcineurin stimulation can ameliorate the dystrophic pathology. The aim of this study was to test the hypothesis that the more severe dystrophic pathology of the diaphragm compared with hindlimb muscles of mdx mice could be attributed to aberrant calcineurin signalling and that due to ongoing regeneration calcineurin activity would be greater in muscles of adult mdx than wild type mice. Differences in markers of regeneration between tibialis anterior and diaphragm muscles were also characterised, to determine whether there was an association between regeneration efficacy and calcineurin activity in dystrophic muscles. In diaphragm muscles of adult mdx mice, the proportion of centrally nucleated fibres and developmental myosin heavy chain protein expression was lower and myogenin protein expression was higher than in tibialis anterior muscles. Calcineurin and activated NFATc1 protein content and calcineurin phosphatase activity were higher in muscles from mdx than wild type mice and calcineurin activation was greater in diaphragm than tibialis anterior muscles of mdx mice. Thus, despite greater calcineurin activity in diaphragm compared to hindlimb muscles, regeneration events downstream of myoblast differentiation and mediated by the injured myofibre were severely compromised.