Screening for risk of later mental health problems : a longitudinal study

Purpose: This is one of the first studies to report that the Achenbach internalising scales were much more effective at identifying those with current comorbid depression and anxiety, rather than individual mood disorder. Introduction: The Achenbach behaviour checklists (YSR,YASR) are widely used, low cost screening tools used to assess problem behaviour. Several studies report good association between the checklists and psychiatric diagnoses; although with varying degrees of agreement. Most are cross-sectional studies involving adolescents referred to mental health services; few are in large community-based studies. This study examined the usefulness of the Achenbach internalising scales in the primary screening (both predictive and concurrent)for depression and anxiety. Methods: The sample was 2400 young adults from an Australian population-based prospective birth cohort study. The association between the empirical anxiety and depression scales were individually assessed against DSM-IV depression and anxiety diagnoses. Odds ratios and diagnostic efficiency tests report the findings. Results: Adolescents with internalising symptoms were twice (OR 2.3, 95%CI 1.7 to 3.1) as likely to be diagnosed with later DSM-IV depression. YASR internalising scale predicted DSM-IV mood disorders (depression OR = 6.9, 95% CI 5.0–9.5; anxiety OR = 5.1, 95% CI 3.8–6.7) in the previous 12 months. The internalising scales were much more effective at identifying those with comorbid depression and anxiety. Conclusions: Adolescence and early adulthood are key risk periods for the onset of anxiety and depression. This study found that young people with internalising behaviour problems were more likely to have comorbid depression and anxiety DSM-IV disorder.

The New Lawyer

This text is designed to implement the Threshold Learning Outcomes (TLOs) for law in the first year, and to incorporate Sally Kift’s First Year Curriculum principles: http://tls.vu.edu.au/portal/site/trans/Resources/KiftTransitonPedagogySixPrinciples_16Nov09.pdf This is a learning-centered text book intentionally designed for first year students and written by experts in legal education and the first year experience. It is written in a tone and style that engages and communicates effectively with first year law students, without compromising its rigour. It provides students with opportunities to contextualise and make sense of their learning by connecting that learning with what they already know, and with current contemporary issues and affairs. This work is designed to ease students through the transition from a diverse variety of backgrounds (such as high school, work or other disciplines) to the first year of law. It provides practical guidance about adjusting to law school and to university. Students are asked to regularly reflect upon why they are studying law. The book also prepares law students for success in their latter year studies in law by ensuring that they are equipped with the necessary threshold concepts and foundational skills to do well: for example, research skills (particularly, online research skills), reasoning skills, written communication skills, negotiation skills, and self-management skills. A range of practical tips on studying law are provided throughout the book. The work also asks students to engage with developing an emergent sense of professional identity – including what it means to ‘think like a lawyer’. In supporting the students to engage with the concept of professional identity, the work begins a process of preparing students for transition from law school to legal practice. This is achieved by providing explanations of how the material being presented relates to the practice of law, as well as practical information relating to employability skills as a new graduate. This work has a number of learning and teaching objectives to enhance the quality of student learning in their first year of law by engaging, motivating and supporting that learning. First, the work is designed to engage first year students with their legal education and with a future sense of professional identity. It does this through its: • Dynamic writing style • Engaging format • Inclusion of contemporary issues and events • Flowcharts, checklists, mind-maps, tables and timelines • Inclusion of real-world problems and dilemmas. Second, the text motivates student learning by promoting active learning. It does this by: • Demonstrating, and asking students to practice, what they need to do – that is, the work is not simply focussed on telling students what they need to know • Including regular self-directed learning exercises throughout each chapter, such as practical exercises for the development of important foundational legal skills • Including exercises that promote student collaboration, and that require students to apply their learning to practical situations, and • Incorporating a range of interesting active thinking points and research activities. Third, the book supports student learning by encouraging reflective learning and independent learning. It does this by including: • Specific content on how to be a reflective practitioner and an independent learner • Exercises that require students to engage in independent learning, particularly in relation to legal research skill development • Exercises requiring students to reflect upon what they have learned, and encouraging students to keep a reflective learning journal • Exercises requiring students to reflect upon their own views and beliefs • Reflection on whether students have achieved the learning objectives articulated at the beginning of the chapter. The work also: • Demonstrates respect for student experiences, views, opinions and values • Acknowledges student diversity • Recognises the importance of being globally minded law students and lawyers • Supports law teachers in using the work in their classrooms through the provision of comprehensive teaching materials.

Advance Care Planning in palliative care : a systematic literature review of the contextual factors influencing its uptake 2008-2012

Background: Advance Care Planning is an iterative process of discussion, decision-making and documentation about end-of-life care. Advance Care Planning is highly relevant in palliative care due to intersecting clinical needs. To enhance the implementation of Advance Care Planning, the contextual factors influencing its uptake need to be better understood. Aim: To identify the contextual factors influencing the uptake of Advance Care Planning in palliative care as published between January 2008 and December 2012. Methods: Databases were systematically searched for studies about Advance Care Planning in palliative care published between January 2008 and December 2012. This yielded 27 eligible studies, which were appraised using National Institute of Health and Care Excellence Quality Appraisal Checklists. Iterative thematic synthesis was used to group results. Results: Factors associated with greater uptake included older age, a college degree, a diagnosis of cancer, greater functional impairment, being white, greater understanding of poor prognosis and receiving or working in specialist palliative care. Barriers included having non-malignant diagnoses, having dependent children, being African American, and uncertainty about Advance Care Planning and its legal status. Individuals’ previous illness experiences, preferences and attitudes also influenced their participation. Conclusion: Factors influencing the uptake of Advance Care Planning in palliative care are complex and multifaceted reflecting the diverse and often competing needs of patients, health professionals, legislature and health systems. Large population-based studies of palliative care patients are required to develop the sound theoretical and empirical foundation needed to improve uptake of Advance Care Planning in this setting.

Preventing infections following caesarean section

Surgical site infections following caesarean section are a serious and costly adverse event for Australian hospitals. In the United Kingdom, 9% of women are diagnosed with a surgical site infection following caesarean section either in hospital or post-discharge (Wloch et al 2012, Ward et al 2008). Additional staff time, pharmaceuticals and health supplies, and increased length of stay or readmission to hospital are often required (Henman et al 2012). Part of my PhD investigated the economics of preventing post-caesarean infection. This paper summarises a review of relevant infection prevention strategies. Administering antibiotic prophylaxis 15 to 60 minutes pre-incision, rather than post cordclamping, is probably the most important infection prevention strategy for caesarean section (Smaill and Gyte2010, Liu et al 2013, Dahlke et al 2013). However the timing of antibiotic administration is reportedly inconsistent in Australian hospitals. Clinicians may be taking advice from the influential, but out-dated RANZCOG and United States Centers for Disease Control and Prevention guidelines (Royal Australian and New Zealand College of Obstetricians and Gynaecologists 2011, Mangram et al 1999). A number of other important international clinical guidelines, including Australia's NHMRC guidelines, recommend universal prophylactic antibiotics pre-incision for caesarean section (National Health and Medical Research Council 2010, National Collaborating Centre for Women's and Children's Health 2008, Anderson et al 2008, National Collaborating Centre for Women's and Children's Health 2011, Bratzler et al 2013, American College of Obstetricians and Gynecologists 2011a, Antibiotic Expert Group 2010). We need to ensure women receive preincision antibiotic prophylaxis, particularly as nurses and midwives play a significant role in managing an infection that may result from sub-optimal practice. It is acknowledged more explicitly now that nurses and midwives can influence prescribing and administration of antibiotics through informal approaches (Edwards et al 2011). Methods such as surgical safety checklists are a more formal way for nurses and midwives to ensure that antibiotics are administered pre-incision (American College of Obstetricians and Gynecologists 2011 b). Nurses and midwives can also be directly responsible for other infection prevention strategies such as instructing women to not remove pubic hair in the month before the expected date of delivery and wound management education (Ng et al 2013). Potentially more costly but effective strategies include using a Chlorhexidine-gluconate (CHG) sponge preoperatively (in addition to the usual operating room skin preparation) and vaginal cleansing with a povidone-iodine solution (Riley et al 2012, Rauk 2010, Haas, Morgan, and Contreras 2013).

Challenging the myth of an "epidemic" of common mental disorders : trends in the global prevalence of anxiety and depression between 1990 and 2010

Background Anxiety disorders and major depressive disorder (MDD) are common and disabling mental disorders. This paper aims to test the hypothesis that common mental disorders have become more prevalent over the past two decades. Methods We conducted a systematic review of prevalence, remission, duration, and excess mortality studies for anxiety disorders and MDD and then used a Bayesian meta-regression approach to estimate point prevalence for 1990, 2005, and 2010. We also conducted a post-hoc search for studies that used the General Health Questionnaire (GHQ) as a measure of psychological distress and tested for trends to present a qualitative comparison of study findings. Results This study found no evidence for an increased prevalence of anxiety disorders or MDD. While the crude number of cases increased by 36%, this was explained by population growth and changing age structures. Point prevalence of anxiety disorders was estimated at 3.8% (3.6-4.1%) in 1990 and 4.0% (3.7-4.2%) in 2010. The prevalence of MDD was unchanged at 4.4% in 1990 (4.2-4.7%) and 2010 (4.1-4.7%). However, 8 of the 11 GHQ studies found a significant increase in psychological distress over time. Conclusions The perceived "epidemic" of common mental disorders is most likely explained by the increasing numbers of affected patients driven by increasing population sizes. Additional factors that may explain this perception include the higher rates of psychological distress as measured using symptom checklists, greater public awareness, and the use of terms such as anxiety and depression in a context where they do not represent clinical disorders.

Method of symptom assessment influences cognitive, affective and somatic post-concussion-like symptom base rates

Primary objective: To investigate whether assessment method influences the type of post-concussion-like symptoms. Methods and procedures: Participants were 73 Australian undergraduate students (Mage = 24.14, SD = 8.84; 75.3% female) with no history of mild traumatic brain injury (mTBI). Participants reported symptoms experienced over the previous 2 weeks in response to an open-ended question (free report), mock interview and standardized checklist (British Columbia Post-concussion Symptom Inventory; BC-PSI). Main outcomes and results: In the free report and checklist conditions, cognitive symptoms were reported significantly less frequently than affective (free report: p < 0.001; checklist: p < 0.001) or somatic symptoms (free report: p < 0.001; checklist: p = 0.004). However, in the mock structured interview condition, cognitive and somatic symptoms were reported significantly less frequently than affective symptoms (both p < 0.001). No participants reported at least one symptom from all three domains when assessed by free report, whereas most participants did so when symptoms were assessed by a mock structured interview (75%) or checklist (90%). Conclusions: Previous studies have shown that the method used to assess symptoms affects the number reported. This study shows that the assessment method also affects the type of reported symptoms.

Bridging the gap: Exploring the barriers to using economic evidence in healthcare decision making and strategies for improving uptake

Evidence from economic evaluations is often not used to inform healthcare policy despite being well regarded by policy makers and physicians. This article employs the accessibility and acceptability framework to review the barriers to using evidence from economic evaluation in healthcare policy and the strategies used to overcome these barriers. Economic evaluations are often inaccessible to policymakers due to the absence of relevant economic evaluations, the time and cost required to conduct and interpret economic evaluations, and lack of expertise to evaluate quality and interpret results. Consistently reported factors that limit the translation of findings from economic evaluations into healthcare policy include poor quality of research informing economic evaluations, assumptions used in economic modelling, conflicts of interest, difficulties in transferring resources between sectors, negative attitudes to healthcare rationing, and the absence of equity considerations. Strategies to overcome these barriers have been suggested in the literature, including training, structured abstract databases, rapid evaluation, reporting checklists for journals, and considering factors other than cost effectiveness in economic evaluations, such as equity or budget impact. The factors that prevent or encourage decision makers to use evidence from economic evaluations have been identified, but the relative importance of these factors to decision makers is uncertain.

Development of an evidence-based symptom checklist for symptoms of recurrence in women with endometrial cancer

Objective Women treated for endometrial cancer currently commonly attend clinic-based follow-up examinations for up to five years. This is based on little evidence and alternative models need to be investigated. This study aimed to identify currently available symptom checklists, determine the comprehensiveness of identified checklists, and generate an updated list of symptoms potentially associated with a recurrence of endometrial cancer for future testing within a prospective study. Methods/materials We conducted a systematic review of the literature extracting; routine follow-up schedules; proportion of patients with symptomatic or asymptomatic recurrence; symptoms of recurrence; prevalence of these symptoms at recurrence. Results Overall, three previous checklists, and 12 retrospective studies were identified meeting the selection criteria. The average rate of recurrence across the studies was 13% (range 3%-19%). The proportion of patients identified with a symptomatic recurrence varied widely (overall average 67%;range 41% to 91%). The most commonly reported symptoms were vaginal bleeding (25%), pain [not further described] (16%) and abdominal pain and/or discomfort and swelling (15%) which combined, represented 56% of the total reported symptoms. The three previous checklists listed 14 and this review identified an additional 24 symptoms (e.g. vaginal discharge, leg pain, constipation, headache and self-detected mass) not previously identified. Conclusion The newly developed symptom checklist expands previous ones, by an additional 24 symptoms. It will be used in a prospective cohort study to assess whether it is sensitive and specific enough to identify recurrence compared to current standard follow-up examinations.

Current management of transitional feeding issues in preterm neonates born in Queensland, Australia

Background: Many preterm neonates display difficulty establishing suck-feeding competence in the weeks following birth. Ineffective management of transitional feeding issues may cause patient complications, and can contribute to increased length of stay. Aims: Given that many neonatal nurseries appear to vary in their neonatal feeding management practices, the aim of this study was to investigate and document the routine level of support and intervention currently provided for preterm neonates with transitional feeding issues across the various level II (special care) nurseries (SCNs) in Queensland, Australia. Methods: A questionnaire was mailed to all Queensland SCNs in 2005 (n = 36). The questionnaire contained a series of closed-choice and short-answer questions designed to obtain information from each SCN regarding their current practices for managing transitional feeding issues in preterm neonates. Results were confirmed during a follow-up phone call. Results: Responses were obtained from 29 SCNs (80.6%). None of these nurseries reported having any formal, written policies regarding the management of transitional feeding issues in preterm neonates. Wide variations were reported in relation to the suck-feeding assessments and interventions used by staff within the various SCNs. Of the 29 nurseries, 4 (13.8%) reported using checklists or assessments to judge readiness for suck-feeds, and 5 (17.2%) reported using pulse oximetry to judge tolerance of suck-feeding attempts. Eighteen SCNs (62.1%) reported offering some form of active intervention to assist neonates with transitional feeding issues, with the most common intervention techniques reported being non-nutritive sucking during tube feeds, pre-feeding oral stimulation, and actively pacing suck-feeds. Twenty-two SCNs (75.4%) reported having access to a lactation consultant to assist mothers with breastfeeding issues. Conclusions: Differences were reported in the routine management of transitional feeding issues in preterm neonates across the various SCNs in Queensland. It is suggested that evidence based guidelines need to be developed, and that, in order to do this, further research studies are required to determine current best practice, as well as to answer remaining questions. © 2008 Elsevier Ireland Ltd. All rights reserved.

Nutrition in remote Aboriginal communities: Lessons from Mai Wiru and the Anangu Pitjantjatjara Yankunytjatjara Lands

Objective To examine the impact of efforts to improve nutrition on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands from 1986, especially in Mai Wiru stores. Methods Literature was searched in a systematic manner. In 2012, the store-turnover method was used to quantify dietary intake of the five APY communities that have a Mai Wiru (good food) store. Results were compared with those available from 1986. Prices of a standard market basket of basic foods, implementation of nutrition policy requirements and healthy food checklists were also assessed in all seven APY community stores from 2008 and compared with available data from 1986. Results Despite concerted efforts and achievements decreasing intake of sugar and increasing the availability and affordability of healthy foods, particularly fruit and vegetables, and consequent improvements in some nutrient indicators, the overall effect has been a decrease in diet quality as indicated primarily by the increased supply and proportion of energy intake from discretionary foods, particularly sugar-sweetened beverages, convenience meals and take-away foods. Conclusions The study findings reinforce the notion that, in the absence of supportive regulation and market intervention, adequate and sustained resources are required to improve nutrition and prevent diet-related chronic disease on the APY Lands. Implications This study also provides insights into food supply/security issues affecting other remote Aboriginal communities and wider Australia.

Psychiatric disturbances in children with intellectual disability : Prevalence, risk factors and assessment

Children with intellectual disability are at increased risk for emotional and behavioural problems, but many of these disturbances fail to be diagnosed. Structured checklists have been used to supplement the psychiatric assessment of children without intellectual disability, but for children with intellectual disability, only a few checklists are available. The aim of the study was to investigate psychiatric disturbances among children with intellectual disability: the prevalence, types and risk factors of psychiatric disturbances as well as the applicability of the Finnish translations of the Developmental Behaviour Checklist (DBC-P) and the Child Behavior Checklist (CBCL) in the assessment of psychopathology. The subjects comprised 155 children with intellectual disability, and data were obtained from case records and five questionnaires completed by the parents or other carers of the child. According to case records, a psychiatric disorder had previously been diagnosed in 11% of the children. Upon careful re-examination of case records, the total proportion of children with a psychiatric disorder increased to 33%. According to checklists, the frequency of probable psychiatric disorder was 34% by the DBC-P, and 43% by the CBCL. The most common diagnoses were pervasive developmental disorders and hyperkinetic disorders. The results support previous findings that compared with children without intellectual disability, the risk of psychiatric disturbances is 2-3-fold in children with intellectual disability. The risk of psychopathology was most significantly increased by moderate intellectual disability and low socio-economic status, and decreased by adaptive behaviour, language development, and socialisation as well as living with both biological parents. The results of the study suggest that both the DBC-P and the CBCL can be used to discriminate between children with intellectual disability with and without emotional or psychiatric disturbance. The DBC-P is suitable for children with any degree of intellectual disability, and the CBCL is suitable at least for children with mild intellectual disability. Because the problems of children with intellectual disability differ somewhat from those of children without intellectual disability, checklists designed specifically for children with intellectual disability are needed.

Making the Most of Field Placement [3rd Ed.]

Overview Learn how to get the most from your placements with the aid of this user-friendly text. Making the Most of Field Placement offers a practice-based approach to teaching and learning during placement experiences. Written for both students and their supervisors, it follows the various stages of a placement from planning through to evaluation. The core practice issues and ideas that it discusses can be used for a wide range of fields including social work, welfare work, disability work, youth work, community work and other human services. Readers can follow through the chapters as a guide as the placement progresses or select specific chapters and exercises to enhance specific stages of the placement. Numerous examples, checklists and exercises provide practical ideas that help students and supervisors to positively engage with each stage of the field placement process.

A linear sequence of extant families and genera of lycophytes and ferns

Throughout the history of the classification of extant ferns (monilophytes) and lycophytes, familial and generic concepts have been in great flux. For the organisation of lycophytes and ferns in herbaria, books, checklists, indices and spore banks and on the internet, this poses a problem, and a standardized linear sequence of these plants is therefore in great need. We provide here a linear classification to the extant lycophytes and ferns based on current phylogenetic knowledge; this provides a standardized guide for organisation of fern collections into a more natural sequence. Two new families, Diplaziopsidaceae and Rhachidosoraceae, are here introduced.

Comportamiento prooxidante y antioxidante de hierbas aromáticas en queso

Los quesos de cabra, con mejores cualidades funcionales provienen de leche de cabras en pastoreo, esto obedece al mayor contenido de ácidos grasos ω-3 y ω-6 en una relación óptima para la salud, sumado a un menor contenido de grasa y colesterol. Saborizar quesos con especias, otorga beneficios sensoriales y saludables al producto. Las especias son usadas para realzar el flavor de los alimentos además presentan beneficios antioxidantes. Sin embargo, se reportaron evidencias del doble papel de los flavonoides como antioxidantes o prooxidantes en función de la concentración de uso. El objetivo del trabajo es evaluar el efecto de distintas concentraciones de especias aromáticas con capacidad antioxidante, frente a las reacciones de deterioro que ocurren en el almacenamiento de quesos de cabra. Se estudió la actividad antirradicalaria (AAR) de 18 especias. Para evaluar la actividad antioxidante (AA0) se usó la técnica de desaparición de un radical libre estable el 2,2-difenil-1-picril hidrazilo (DPPH) y se calculó la AAR porcentual. Definido el queso base estándar (control), se ensayaron tres variedades con especies, elegidas de entre las de mayor AAR (orégano, romero y tomillo) y se adicionaron con las concentraciones 0,4 – 1 % p/p. Estos, fueron madurados 30 días y almacenados 7 meses a 4 °C. Se analizaron cada 4 semanas. Se realizaron pruebas sensoriales de aceptabilidad con 60 consumidores de queso (condición), usando planillas, con escala hedónica. Se trabajó sobre los lípidos extraídos de los quesos. El rancidez y deterioro fueron evaluados con análisis de acidez; índice peróxido y sustancias reactivas al ácido TBA. Los resultados se compararon con el comportamiento sensorial del producto en el tiempo de almacenamiento. En los quesos adicionados al 1 %, la acidez se incrementó con el almacenamiento. El máximo valor corresponde al queso con orégano (3,72 % de ac. láctico a los 126 días). En el control, la acidez inicial fue inferior y alcanzó 1,05 g de ác. láctico % a los 166 días. El IP más alto corresponde a los quesos con orégano al 1% , resultado que se contrapone a la actividad antirradicalaria de esta especia. Al 0,4 %, tanto el IP como el número de TBA son menores en quesos adicionados, respecto del control. En los quesos de cabra analizados las especias agregadas al 1% ejercieron acción prooxidante, mientras que al ser agregadas al 0,4% la acción es antioxidante, lo que indica la importancia de la selección de concentraciones adecuadas.

Marine flora and fauna of the eastern United States Mollusca: Cephalopoda

The cephalopods found in neritic waters of the northeastern United States include myopsid and oegopsid squids, sepiolid squids, and octopods. A key with diagnostic illustrations is provided to aid in identification of the eleven species common in the neritic waters between Cape Hatteras and Nova Scotia; included also is information on two oceanic species that occur over the continental shelf in this area and that can be confused with similar-looking neritic species. Other sections comprise a glossary of taxonomic characters used for identification of these species, an annotated systematic checklist, and checklists of the 89 other oceanic species and 18 Carolinian and subtropical neritic species that might occur occasionally off the northeastern United States. (PDF file contains 30 pages.)