Substance misuse in patients with schizophrenia: epidemiology and management

Substance misuse in individuals with schizophrenia is very common, especially in young men, in communities where use is frequent and in people receiving inpatient treatment. Problematic use occurs at very low intake levels, so that most affected people are not physically dependent (with the exception of nicotine). People with schizophrenia and substance misuse have poorer symptomatic and functional outcomes than those with schizophrenia alone. Unless there is routine screening, substance misuse is often missed in assessments. Service systems tend to be separated, with poor inter-communication, and affected patients are often excluded from services because of their comorbidity. However, effective management of these disorders requires a fully integrated approach because of the close inter-relationship of the disorders. Use of atypical antipsychotics may be especially important in this population because of growing evidence (especially on clozapine and risperidone) that nicotine smoking, alcohol misuse and possibly some other substance misuse is reduced. Several pharmacotherapies for substance misuse can be used safely in people with schizophrenia, but the evidence base is small and guidelines for their use are necessarily derived from experience in the general population.

Expert review of an approach to functional capacity evaluation

Functional capacity evaluation (FCE) is a widely used tool in work rehabilitation, despite the limited examination of the soundness of its measurement properties. This paper outlines the development of a new approach to FCE, the GAPP FCE, and reports on the findings of an expert review of aspects of its content validity and technical adequacy and how it meets established test criteria. Five expert occupational therapists reviewed the materials of the GAPP FCE then completed a questionnaire related to the content validity, technical adequacy and safety, reliability, validity, practicality and utility of the GAPP FCE. The experts gave support to most aspects of these criteria. The main issue identified by the review was related to interpretation and extrapolation of the FCE results for return to work. This and other issues are discussed in relation to recent developments in FCE and plans for future development of the GAPP FCE.

Patients' interactions with health providers - A linguistic category model approach

Two studies investigated interactions between health providers and patients, using Semin and Fiedler's linguistic category model. In Study 1 the linguistic category model was used to examine perceptions of the levels of linguistic intergroup bias in descriptions of conversations with health professionals in hospitals. Results indicated a favourable linguistic bias toward health professionals in satisfactory conversations but low levels of linguistic intergroup bias in unsatisfactory conversations. In Study 2, the language of patients and health professionals in videotaped interactions was examined for levels of linguistic intergroup bias. Interpersonally salient interactions showed less linguistic intergroup bias than did intergroup ones. Results also indicate that health professionals have high levels of control in all types of medical encounters with patients. Nevertheless, the extent to which patients are able to interact with health professionals as individuals, rather than only as professionals is a key determinant of satisfaction with the interaction.

Service quality and consumers' experience: Towards an interpretive approach

As marketers and researchers we understand quality from the consumer's perspective, and throughout contemporary service quality literature there is an emphasis on what the consumer is looking for, or at least that is the intention. Through examining the underlying assumptions of dominant service quality theories, an implicit dualistic ontology is highlighted (where subject and object are considered independent) and argued to effectively negate the said necessary consumer orientation. This fundamental assumption is discussed, as are the implications, following a critical review of dominant service quality models. Consequently, we propose an alternative approach to service quality research that aims towards a more genuine understanding of the consumer's perspective on quality experienced within a service context. Essentially, contemporary service quality research is suggested to be limited in its inherent third-person perspective and the interpretive, specifically phenomenographic, approach put forward here is suggested as a means of achieving a first-person perspective on service quality.

The Building Partnerships Program: An Approach to Community-based Learning for Medical Students in Australia

The Building Partnerships Program at the University of Queensland, Australia seeks to address the dual challenge of preparing doctors who are responsive to the community while providing a meaningful context for social sciences learning. Through partnerships with a diverse range of community agencies, the program offers students opportunities to gain non-clinical perspectives on health and illness through structured learning activities including: family visits; community agency visits and attachments; and interview training. Students learn first-hand about psychosocial influences on health and how people manage health problems on a day-to-day basis. They also gain insights into the work of community agencies and how they as future doctors might work in partnership with them to enhance patient care. We outline the main components of the program, identify challenges and successes from student and community agency perspectives, and consider areas that invite further development.

Development of a fully quantitative approach to the interpretation of stress echocardiography using radial and longitudinal myocardial velocities

Background: Tissue Doppler may be used to quantify regional left ventricular function but is limited by segmental variation of longitudinal velocity from base to apex and free to septal walls. We sought to overcome this by developing a composite of longitudinal and radial velocities. Methods and Results. We examined 82 unselected patients undergoing a standard dobutamine echocardiogram. Longitudinal velocity was obtained in the basal and mid segments of each wall using tissue Doppler in the apical views. Radial velocities were derived in the same segments using an automated border detection system and centerline method with regional chords grouped according to segment location and temporally averaged. In 25 patients at low probability of coronary disease, the pattern of regional variation in longitudinal velocity (higher in the septum) was the opposite of radial velocity (higher in the free wall) and the combination was homogenous. In 57 patients undergoing angiography, velocity in abnormal segments was less than normal segments using longitudinal (6.0 +/- 3.6 vs 9.0 +/- 2.2 cm/s, P = .01) and radial velocity (6.0 +/- 4.0 vs 8.0 +/- 3.9 cm/s, P = .02). However, the composite velocity permitted better separation of abnormal and normal segments (13.3 +/- 5.6 vs 17.5 +/- 4.2 cm/s, P = .001). There was no significant difference between the accuracy of this quantitative approach and expert visual wall motion analysis (81% vs 84%, P = .56). Conclusion: Regional variation of uni-dimensional myocardial velocities necessitates site-specific normal ranges, probably because of different fiber directions. Combined analysis of longitudinal and radial velocities allows the derivation of a composite velocity, which is homogenous in all segments and may allow better separation of normal and abnormal myocardium.

Bringing people back in: Grassroots approach to peace in Bosnia-Nerzegovina

Peacemaking in Bosnia-Herzegovina is a controversial subject that engaged the political energies of the international community for several years without resolution. While international efforts at peacemaking warrant a critique in their own right, the assumptions that lie behind popular perceptions of peacemaking must also be examined. This article explores the proposition that the promotion of multi-ethnic contact between Bosnian people is at least as important as elections or the reconstruction of political institutions. Indeed, the restoration and development of inter-ethnic relationships, especially at grassroots level, is essential for the establishment of sustainable peace. This article thus focuses on the roles of NGOs (Non-governmental organisations) active at the grassroots level in Bosnia, such as the Centre for Drama Education in Mostar, Project Firefly in Brcko, and the CARE Welcome Project in Sarajevo, which represent a grassroots form of peacemaking that incorporates local knowledge and understandings of the conflict within peace projects.

Up close and personal on physical education teachers' identity: Is conflict an issue?

Much of the research on teachers' work is informed by role theory, that assumes teachers' identity is largely ascribed. When there are inconsistencies in teachers' and others' expectations for different occupational roles such as physical education teacher and sports coach, 'role conflict' is said to occur. This stud), sought to investigate if role conflict was a major concern for Australian physical education teacher/coaches. Findings, informed by case studies with five teacher/coaches, challenge the assumption that moving between professional responsibilities causes role conflict. Rather, in moving across contexts, the physical education teachers managed inconsistencies in ways that resulted in positive and rawarding work experiences.

Extra-pair paternity and mate-guarding behaviour in the brown thornbill

We used multilocus DNA fingerprinting to assess parentage in the brown thornbill, Acanthiza pusilla, a socially monogamous Australian passerine. Extra-pair paternity was uncommon (6.2% of 178 offspring; 11.9% of 67 broods) and there was no evidence of intra-specific brood parasitism. Extra-pair paternity was limited because pairs spent more time together when females were fertile and males were able to evict intruding males before they could approach the female. Males were responsible for the close proximity of partners during the fertile period. Mate guarding therefore appears to be a male tactic aimed at preventing female infidelity rather than a cooperative behaviour of the pair aimed at preventing extra-pair copulations and/or female harassment. Females did not attempt to escape male guarding and were rarely observed to solicit copulations from intruding males. Nevertheless, females paired to smaller and younger males were more likely to cuckold their mates than females paired to larger and older males. This suggests that females may be more likely to seek or accept extra-pair matings when paired to small, young males or that old, large males are better at preventing their mates from engaging in extra-pair copulations. We found that male age but not male size influences mate-guarding behaviour. Older males tended to respond more aggressively to intruders. We therefore speculate that the relationship between male size/age and extra-pair paternity in brown thornbills may arise because female thornbills prefer large males as mates but are unable to express this preference as easily when paired to older males.

Application of a simplified method based on regular regime approach to determine the effective moisture diffusivity of mixture of low molecular weight sugars and maltodextrin during desorption

The binary diffusivities of water in low molecular weight sugars; fructose, sucrose and a high molecular weight carbohydrate; maltodextrin (DE 11) and the effective diffusivities of water in mixtures of these sugars (sucrose, glucose, fructose) and maltodextrin (DE 11) were determined using a simplified procedure based on the Regular Regime Approach. The effective diffusivity of these mixtures exhibited both the concentration and molecular weight dependence. Surface stickiness was observed in all samples during desorption, with fructose exhibiting the highest and maltodextrin the lowest. (C) 2002 Elsevier Science Ltd. All rights reserved.