Persistence and subtype stability of ADHD among substance use disorder treatment seekers

OBJECTIVE: To examine ADHD symptom persistence and subtype stability among substance use disorder (SUD) treatment seekers. METHOD: In all, 1,276 adult SUD treatment seekers were assessed for childhood and adult ADHD using Conners' Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; CAADID). A total of 290 (22.7%) participants met CAADID criteria for childhood ADHD and comprise the current study sample. RESULTS: Childhood ADHD persisted into adulthood in 72.8% (n = 211) of cases. ADHD persistence was significantly associated with a family history of ADHD, and the presence of conduct disorder and antisocial personality disorder. The combined subtype was the most stable into adulthood (78.6%) and this stability was significantly associated with conduct disorder and past treatment of ADHD. CONCLUSION: ADHD is highly prevalent and persistent among SUD treatment seekers and is associated with the more severe phenotype that is also less likely to remit. Routine screening and follow-up assessment for ADHD is indicated to enhance treatment management and outcomes.

The Post-Anaesthesia N-acetylcysteine Cognitive Evaluation (PANACEA) trial: study protocol for a randomised controlled trial

BACKGROUND: Some degree of cognitive decline after surgery occurs in as many as one quarter of elderly surgical patients, and this decline is associated with increased morbidity and mortality. Cognition may be affected across a range of domains, including memory, psychomotor skills, and executive function. Whilst the exact mechanisms of cognitive change after surgery are not precisely known, oxidative stress and subsequent neuroinflammation have been implicated. N-acetylcysteine (NAC) acts via multiple interrelated mechanisms to influence oxidative homeostasis, neuronal transmission, and inflammation. NAC has been shown to reduce oxidative stress and inflammation in both human and animal models. There is clinical evidence to suggest that NAC may be beneficial in preventing the cognitive decline associated with both acute physiological insults and dementia-related disorders. To date, no trials have examined perioperative NAC as a potential moderator of postoperative cognitive changes in the noncardiac surgery setting.

METHODS AND DESIGN: This is a single-centre, randomised, double-blind, placebo-controlled clinical trial, with a between-group, repeated-measures, longitudinal design. The study will recruit 370 noncardiac surgical patients at the University Hospital Geelong, aged 60 years or older. Participants are randomly assigned to receive either NAC or placebo (1:1 ratio), and groups are stratified by age and surgery type. Participants undergo a series of neuropsychological tests prior to surgery, 7 days, 3 months, and 12 months post surgery. It is hypothesised that the perioperative administration of NAC will reduce the degree of postoperative cognitive changes at early and long-term follow-up, as measured by changes on individual measures of the neurocognitive battery, when compared with placebo. Serum samples are taken on the day of surgery and on day 2 post surgery to quantitate any changes in levels of biomarkers of inflammation and oxidative stress.

DISCUSSION: The PANACEA trial aims to examine the potential efficacy of perioperative NAC to reduce the severity of postoperative cognitive dysfunction in an elderly, noncardiac surgery population. This is an entirely novel approach to the prevention of postoperative cognitive dysfunction and will have high impact and translatable outcomes if NAC is found to be beneficial.

Garlic (Allium sativum): diet based therapy of 21st century-a review

Functional and nutraceutical foods provide an opportunity to improve one's health by reducing health care costs and to support economic development in rural communities. For this reason, various phyto-based functional foods are becoming popular worldwide owing to number of evidences for their safer therapeutic applications. Garlic (Allium sativum L.,) is an essential vegetable that has been widely utilized as seasoning, flavoring, culinary and in herbal remedies. The consumption of traditional plants especially garlic has progressively increased worldwide because of their great effectiveness, fewer side effects and relatively low cost. Garlic is well known to contain an array of phytochemicals. These bioactive molecules are playing pivotal role in maintaining human health and having potential to reduce various ailments. It has distinct nutritional profile with special reference to its various bioactive components that can be used in different diet based therapies to cure various life-style related disorders. The present review is an attempt to explore the functional/nutraceutical role of garlic against various threats including dyslipidemia and hyperglycemia, cardiovascular disorders, antioxidant capacity and carcinogenic perspectives.

Victoria’s banning notice provisions: parliamentary, procedural and individual vulnerabilities

Purpose Alcohol-related disorder in Australia’s night-time economy has precipitated an expanding regulatory and legislative framework. A key feature is the growth of police-imposed discretionary justice, one example of which are Victoria’s banning provisions. Banning notices are imposed on-the-spot, may be issued pre-emptively, but permit no right of independent appeal. However, there has been little analysis of the enactment, implementation or use of police-imposed banning provisions. The paper aims to discuss these issues.

Design/methodology/approach This paper draws upon a detailed examination of the record of parliamentary debate of the banning notice legislation to document how the provisions, and their embedded procedural vulnerabilities, were legitimised. In addition, an analysis of Victoria Police data informs consideration of the ongoing scrutiny of the police power to ban.

FindingsThe absolute discretion afforded to police officers, and a lack of effective oversight, has created the potential for the disproportionate and discriminatory implementation of Victoria’s banning notice powers. The findings highlight procedural vulnerabilities within the provisions, and concern regarding the particular risk of banning notices for vulnerable recipients.

Research limitations/implications The nature of Victoria’s banning provisions created the circumstances for their inequitable imposition, but public scrutiny of their use and effect is limited. Omissions and deficiencies in the published data restricts meaningful analysis of how banning works in practice.

Originality/value The research underpinning this paper was the first detailed examination of the implementation and ongoing scrutiny of Victoria’s banning notice provisions. The findings presented in this paper highlight key procedural vulnerabilities resulting from the passage of the legislation and the absence of effective oversight.

Upholding whose right? Discretionary police powers to punish, collective 'pre-victimisation and the dilution of individual rights

This article uses the example of Victoria’s alcohol-related banning notice provisions to explore the changing conception of balance within criminal justice processes. Despite the formalisation of individual rights within measures such as Victoria’s Charter of Human Rights and Responsibilities Act 2006, the discretionary power of the police to issue on-the-spot punishments in response to actual or potential criminal behaviour has increased steadily. A key driver, evident across the parliamentary debates of the banning legislation, is a presumed need to protect the broader community of potential victims. As a result, the individual rights of those accused (but not necessarily convicted) of undesirable behaviours are increasingly subordinated to the pre-emptive protection of the law-abiding majority. This shift embodies a largely unsubstantiated notion of collective pre-victimisation. Significantly, despite the expectations of Victoria’s Charter, measures such as banning notices have been enacted with insufficient evidence of the underlying collective risk, of their likely effectiveness and without meaningful ongoing scrutiny. The motto of Victoria Police – Uphold the Right –appears to belie a growing uncertainty over whose rights should be upheld and how.

FASD: From isolation to inclusion in Australian schools.

This research investigated pedagogical approaches required for the successful inclusion of children and young people living with Fetal Alcohol Spectrum Disorders. The research applied an Indigenist constructivist qualitative method working with one school community. The development of a National Framework for Achieving Inclusion for Australian Students with FASD demands urgent policy and support for educators to meet the complex learning needs of students with FASD.

Key stakeholder perspectives of drink restrictions in Newcastle, Australia

Background: The problems associated with alcohol consumption in or around licensed premises in the nighttime economy are extensive. One intervention designed to address these problems is drink restrictions. The aim of the current study is to gain different key stakeholder perspectives on drink restriction interventions, including their ability to reduce alcohol-related harms. Method: This study involves an analysis of key stakeholder perspectives on the introduction of drink restrictions. Interviews were conducted with 23 key stakeholders, including venue licencees, security, and police from Newcastle, Australia. Drink restrictions, including limits on shots and umber of drinks, were part of a mandatory set of interventions, which were implemented as a result of legislative change in New South Wales. As such, key stakeholders were able to provide insight into the implementation and practicality of the restrictions. All interviews were analyzed using thematic analysis.Results: Overall, key stakeholders were mixed in their support for drink restrictions, particularly because of the issues associated with customer preloading and practicality of enforcement. Stakeholders remained unconvinced of the impact of the restrictions on reducing harm. Conclusions: Key stakeholders believe that drink restrictions would almost certainly be more likely to reduce alcohol-related harm in the nighttime economy as part of a larger intervention. However, it is unclear how much impact they have as a standalone harm reduction measure.

The disparity between human rights policy and parliamentary practice in Australia : a Victorian case study

Over the past decade alcohol-related violence in and around licensed premises has given rise to significant legislative, regulatory and operational policing developments. In Australia, the State of Victoria introduced police-imposed banning notices as part of a range of provisions and new powers targeting alcohol-related disorderly behaviour. Banning notices exemplify a broader shift towards discretionary, pre-emptive, regulatory, summary justice which circumvents the criminal law, dilutes individual rights, and reconfigures expectations of balance in the administration of justice. The legal principles upon which banning notices are based and the way in which they were enacted by the Victorian Parliament challenge both the purpose and specific requirements of Victoria’s Charter of Human Rights and Responsibilities Act 2006. Detailed analysis of the application of the Charter compliance processes to the banning notice provisions point to a notable disparity between the expectations of formal human rights policy and the reality of substantive practice. The broader effect of such a disconnect is potentially significant, but has been largely opaque to meaningful scrutiny.