An investigation of differences in crash characteristics between males and females involved in a fatigue-related crash or close call event

There is consensus among community and road safety agencies that driver fatigue is a major road safety issue and it is well known that excessive fatigue is linked with an increased risk of a motor vehicle crash. Previous research has implicated a wide variety of factors involved in fatigue-related crashes and the effects of these various factors in regard to crash risk can be interpreted as causal (i.e. alcohol and/or drugs may induce fatigue states) or additive (e.g. where a lack of sleep is combined with alcohol). As such, the purpose of this investigation was to examine self-report data to determine whether there are any differences in the prevalence, crash characteristics, and travel patterns of males and females involved in a fatigue-related crash or close call event. Such research is important to understand how fatigue related incidents occur within the typical driving patterns of men and women and it provides a starting point in order to explore if males and females experience and understand the risk of diving when tired in the same way. A representative sample of (N = 1,600) residents living in the Australian Capital Territory (ACT) and New South Wales (NSW), Australia, were surveyed regarding their experience of fatigue and their involvement in fatigue-related crashes and close call incidents. Results revealed that over 35% of participants reported having had a close call or crash due to driving when tired in the five years prior to the study being conducted. In addition, the results obtained revealed a number of interesting characteristics that provide preliminary evidence that gender differences do exist when examining the prevalence, crash characteristics, and travel patterns of males and females involved in a fatigue-related crash or close call event. It is argued that the results obtained can provide particularly useful information for the refinement and further development of appropriate countermeasures that better target this complex issue.

AITPM Email Newsletter Volume 0911, November 2009 : President's Message

President’s Report Hello fellow AITPM members, It is interesting to follow the news at present, where transport costs are getting a significant airing. Treasury Secretary Dr Ken Henry has enunciated something Australians may have considered extremely radical just a few years back, but in the present time appears to quite a few to be a realistic alternative. That being a rethink of the way we are charged for using our vehicles. It appears that serious consideration is being given to congestion charging, perhaps in place at least to some extent, of fuel excise. As a transport professional I am pleased that the debate has elevated to the national level, and would look forward that AITPM might contribute appropriately to it. As a motorist though, I naturally have my concerns about being hit in the hip pocket. Not that I actually drive during congested periods very much. I am fortunate to live five minutes either side of two well serviced bus corridors, one of which will eventually become a busway, and work in the central business district, which is hub from all spokes in Brisbane. As such, bus and foot are my preferred commute modes. Ah but I should not gloat, as my smart card fare is about to increase by 20 percent in the New Year! And if the newspapers are to be believed, further substantial increments are proposed over the coming few years. This is reported to recoup some more of the costs of actually providing the quality public transport system that we enjoy in our region. So I expect it will be very interesting to see how transport economics will play out in reality in the coming few years, and how governments cater to Australians who either cannot afford substantial increases in transport costs or have no viable alternatives to those facilities whose costs will increase. The 2010 AITPM National Conference, “What’s New?”, still has the opportunity for authors to submit an abstract for consideration so please consider how you might contribute to the event. Best regards to all, Jon Bunker

An exploration of knowledge management and intellectual capital in a nonprofit organisation context

In recent years, practitioners and researchers alike have turned their attention to knowledge management (KM) in order to increase organisational performance (OP). As a result, many different approaches and strategies have been investigated and suggested for how knowledge should be managed to make organisations more effective and efficient. However, most research has been undertaken in the for-profit sector, with only a few studies focusing on the benefits nonprofit organisations might gain by managing knowledge. This study broadly investigates the impact of knowledge management on the organisational performance of nonprofit organisations. Organisational performance can be evaluated through either financial or non-financial measurements. In order to evaluate knowledge management and organisational performance, non-financial measurements are argued to be more suitable given that knowledge is an intangible asset which often cannot be expressed through financial indicators. Non-financial measurement concepts of performance such as the balanced scorecard or the concept of Intellectual Capital (IC) are well accepted and used within the for-profit and nonprofit sectors to evaluate organisational performance. This study utilised the concept of IC as the method to evaluate KM and OP in the context of nonprofit organisations due to the close link between KM and IC: Indeed, KM is concerned with managing the KM processes of creating, storing, sharing and applying knowledge and the organisational KM infrastructure such as organisational culture or organisational structure to support these processes. On the other hand, IC measures the knowledge stocks in different ontological levels: at the individual level (human capital), at the group level (relational capital) and at the organisational level (structural capital). In other words, IC measures the value of the knowledge which has been managed through KM. As KM encompasses the different KM processes and the KM infrastructure facilitating these processes, previous research has investigated the relationship between KM infrastructure and KM processes. Organisational culture, organisational structure and the level of IT support have been identified as the main factors of the KM infrastructure influencing the KM processes of creating, storing, sharing and applying knowledge. Other research has focused on the link between KM and OP or organisational effectiveness. Based on existing literature, a theoretical model was developed to enable the investigation of the relation between KM (encompassing KM infrastructure and KM processes) and IC. The model assumes an association between KM infrastructure and KM processes, as well as an association between KM processes and the various levels of IC (human capital, structural capital and relational capital). As a result, five research questions (RQ) with respect to the various factors of the KM infrastructure as well as with respect to the relationship between KM infrastructure and IC were raised and included into the research model: RQ 1 Do nonprofit organisations which have a Hierarchy culture have a stronger IT support than nonprofit organisations which have an Adhocracy culture? RQ 2 Do nonprofit organisations which have a centralised organisational structure have a stronger IT support than nonprofit organisations which have decentralised organisational structure? RQ 3 Do nonprofit organisations which have a stronger IT support have a higher value of Human Capital than nonprofit organisations which have a less strong IT support? RQ 4 Do nonprofit organisations which have a stronger IT support have a higher value of Structural Capital than nonprofit organisations which have a less strong IT support? RQ 5 Do nonprofit organisations which have a stronger IT support have a higher value of Relational Capital than nonprofit organisations which have a less strong IT support? In order to investigate the research questions, measurements for IC were developed which were linked to the main KM processes. The final KM/IC model contained four items for evaluating human capital, five items for evaluating structural capital and four items for evaluating relational capital. The research questions were investigated through empirical research using a case study approach with the focus on two nonprofit organisations providing trade promotions services through local offices worldwide. Data for the investigation of the assumptions were collected via qualitative as well as quantitative research methods. The qualitative study included interviews with representatives of the two participating organisations as well as in-depth document research. The purpose of the qualitative study was to investigate the factors of the KM infrastructure (organisational culture, organisational structure, IT support) of the organisations and how these factors were related to each other. On the other hand, the quantitative study was carried out through an online-survey amongst staff of the various local offices. The purpose of the quantitative study was to investigate which impact the level of IT support, as the main instrument of the KM infrastructure, had on IC. Overall several key themes were found as a result of the study: • Knowledge Management and Intellectual Capital were complementary with each other, which should be expressed through measurements of IC based on KM processes. • The various factors of the KM infrastructure (organisational culture, organisational structure and level of IT support) are interdependent. • IT was a primary instrument through which the different KM processes (creating, storing, sharing and applying knowledge) were performed. • A high level of IT support was evident when participants reported higher level of IC (human capital, structural capital and relational capital). The study supported previous research in the field of KM and replicated the findings from other case studies in this area. The study also contributed to theory by placing the KM research within the nonprofit context and analysing the linkage between KM and IC. From the managerial perspective, the findings gave clear indications that would allow interested parties, such as nonprofit managers or consultants to understand more about the implications of KM on OP and to use this knowledge for implementing efficient and effective KM strategies within their organisations.

Modulation of the SHBG signalling axis

Sex hormone-binding globulin (SHBG) is a homodimeric plasma glycoprotein that is the major sex steroid carrier-protein in the bloodstream and functions also as a key regulator of steroid bioavailability within target tissues, such as the prostate. Additionally, SHBG binds to prostatic cell membranes via the putative and unidentified SHBG receptor (RSHBG), activating a signal transduction pathway implicated in stimulating both proliferation and expression of prostate specific antigen (PSA) in prostate cell lines in vitro. A yeast-two hybrid assay suggested an interaction between SHBG and kallikrein-related protease (KLK) 4, which is a serine protease implicated in the progression of prostate cancer. The potential interaction between these two proteins was investigated in this PhD thesis to determine whether SHBG is a proteolytic substrate of KLK4 and other members of the KLK family including KLK3/PSA, KLK7 and KLK14. Furthermore, the effects from SHBG proteolytic degradation on SHBG-regulated steroid bioavailability and the activation of the putative RSHBG signal transduction pathway were examined in the LNCaP prostate cancer cell line. SHBG was found to be a proteolytic substrate of the trypsin-like KLK4 and KLK14 in vitro, yielding several proteolysis fragments. Both chymotrypsin-like PSA and KLK7 displayed insignificant proteolytic activity against SHBG. The kinetic parameters of SHBG proteolysis by KLK4 and KLK14 demonstrate a strong enzyme-substrate binding capacity, possessing a Km of 1.2 ± 0.7 µM and 2.1 ± 0.6 µM respectively. The catalytic efficiencies (kcat/Km) of KLK4 and KLK14 proteolysis of SHBG were 1.6 x 104 M-1s-1 and 3.8 x 104 M-1s-1 respectively, which were comparable to parameters previously reported for peptide substrates. N-terminal sequencing of the fragments revealed cleavage near the junction of the N- and C-terminal laminin globulin-like (G-like) domains of SHBG, resulting in the division of the two globulins and ultimately the full degradation of these fragments by KLK4 and KLK14 over time. Proteolytic fragments that may retain steroid binding were rapidly degraded by both proteases, while fragments containing residues beyond the steroid binding pocket were less degraded over the same period of time. Degradation of SHBG was inhibited by the divalent metal cations calcium and zinc for KLK4, and calcium, zinc and magnesium for KLK14. The human secreted serine protease inhibitors (serpins), α1-antitrypsin and α2-antiplasmin, inhibited KLK4 and KLK14 proteolysis of SHBG; α1-antichymotrypsin inhibited KLK4 but not KLK14 activity. The inhibition by these serpins was comparable and in some cases more effective than general trypsin protease inhibitors such as aprotinin and phenylmethanesulfonyl fluoride (PMSF). The binding of 5α-dihydrotestosterone (DHT) to SHBG modulated interactions with KLK4 and KLK14. Steroid-free SHBG was more readily digested by both enzymes than DHT-bound SHBG. Moreover, a binding interaction exists between SHBG and pro-KLK4 and pro-KLK14, with DHT strengthening the binding to pro-KLK4 only. The inhibition of androgen uptake by cultured prostate cancer cells, mediated by SHBG steroid-binding, was examined to assess whether SHBG proteolysis by KLK4 and KLK14 modulated this process. Proteolytic digestion eliminated the ability of SHBG to inhibit the uptake of DHT from conditioned media into LNCaP cells. Therefore, the proteolysis of SHBG by KLK4 and KLK14 increased steroid bioavailability in vitro, leading to an increased uptake of androgens by prostate cancer cells. Interestingly, different transcriptional responses of PSA and KLK2, which are androgen-regulated genes, to DHT-bounsd SHBG treatment were observed between low and high passage number LNCaP cells (lpLNCaP and hpLNCaP respectively). HpLNCaP cells treated with DHT-bound SHBG demonstrated a significant synergistic upregulation of PSA and KLK2 above DHT or SHBG treatment alone, which is similar to previously reported downstream responses from RSHBG-mediated signaling activation. As this result was not seen in lpLNCaP cells, only hpLNCaP cells were further investigated to examine the modulation of potential RSHBG activity by KLK4 and KLK14 proteolysis of SHBG. Contrary to reported results, no increase in intracellular cAMP was observed in hpLNCaP cells when treated with SHBG in the presence and absence of either DHT or estradiol. As a result, the modulation of RSHBG-mediated signaling activation could not be determined. Finally, the identification of the RSHBG from both breast (MCF-7) and prostate cancer (LNCaP) cell lines was attempted. Fluorescently labeled peptides corresponding to the putative receptor binding domain (RBD) of SHBG were shown to be internalized by MCF-7 cells. Crosslinking of the RBD peptide to the cell surfaces of both MCF-7 and LNCaP cells, demonstrated the interaction of the peptide with several targets. These targets were then captured using RBD peptides synthesized onto a hydrophilic scaffold and analysed by mass spectrometry. The samples captured by the RBD peptide returned statistically significantly matches for cytokeratin 8, 18 and 19 as well as microtubule-actin crosslinking factor 1, which may indicate a novel interaction between SHBG and these proteins, but ultimately failed to detect a membrane receptor potentially responsible for the putative RSHBG-mediated signaling. This PhD project has reported the proteolytic processing of SHBG by two members of the kallikrein family, KLK4 and KLK14. The effect of SHBG proteolysis by KLK4 and KLK14 on RSHBG-mediated signaling activation was unable to be determined as the reported signal transduction pathway was not activated after treatment with SHBG, in combination with either DHT or estradiol. However, the digestion of SHBG by these two proteases positively regulated androgen bioavailability to prostate cancer cells in vitro. The increased uptake of androgens is deleterious in prostate cancer due to the promotion of proliferation, metastasis, invasion and the inhibition of apoptosis. The increased bioavailability of androgens, from SHBG proteolysis by KLK4 and KLK14, may therefore promote both carcinogenesis and progression of prostate cancer. Finally, this information may contribute to the development of therapeutic treatment strategies for prostate cancer by inhibiting the proteolysis of SHBG, by KLK4 and KLK14, to prevent the increased uptake of androgens by hormone-dependent cancerous tissues.

The effectiveness of using a simple ARIA based geographical classification to identify road crash patterns in rural and urban areas of Queensland

Research has noted a ‘pronounced pattern of increase with increasing remoteness' of death rates in road crashes. However, crash characteristics by remoteness are not commonly or consistently reported, with definitions of rural and urban often relying on proxy representations such as prevailing speed limit. The current paper seeks to evaluate the efficacy of the Accessibility / Remoteness Index of Australia (ARIA+) to identifying trends in road crashes. ARIA+ does not rely on road-specific measures and uses distances to populated centres to attribute a score to an area, which can in turn be grouped into 5 classifications of increasing remoteness. The current paper uses applications of these classifications at the broad level of Australian Bureau of Statistics' Statistical Local Areas, thus avoiding precise crash locating or dedicated mapping software. Analyses used Queensland road crash database details for all 31,346 crashes resulting in a fatality or hospitalisation occurring between 1st July, 2001 and 30th June 2006 inclusive. Results showed that this simplified application of ARIA+ aligned with previous definitions such as speed limit, while also providing further delineation. Differences in crash contributing factors were noted with increasing remoteness such as a greater representation of alcohol and ‘excessive speed for circumstances.' Other factors such as the predominance of younger drivers in crashes differed little by remoteness classification. The results are discussed in terms of the utility of remoteness as a graduated rather than binary (rural/urban) construct and the potential for combining ARIA crash data with census and hospital datasets.

Friends looking out for friends as an intervention strategy for young adults' risky driving

Young adults are at the greatest risk of experiences road trauma disproportionately to those in other age groups. While the influence of peers is commonly associated with motor vehicle crashes and injury few studies examine whether their influence can be positive. In particular friends may be able to actively intervene to reduce the likelihood of risky driving (e.g. speeding, drink driving or drug driving) and alcohol use. The aim of this paper is to conduct a systematic review on intervening in risky driving behaviour including the situations in which it is likely or unlikely to occur, factors associated with individuals who might or report having intervened and any evaluated programs that make use of such strategies. In addition a study was conducted with 247 first year university students (32% males) to examine whether young adults report engaging in protective behaviour with their peers in South-east Queensland. In particular, if they intervene if their friends are about to drive after drinking, drive after taking illicit drugs or when speeding. It examines any differences in reported likelihood of discouraging such illegal and dangerous behaviour (in the past 12 months prior to the survey). Findings showed that young adults (17-25 years) did indeed report protective behaviour in relation to friends’ drink driving, drug driving, speeding and binge drinking. Conclusions will be drawn regarding important considerations in developing positive strategies and advertising campaigns that encourage positive behaviours (e.g. ‘don’t let mates drink and drive’).

The status of Australian nurse practitioners : the first national census

A five-section questionnaire was mailed to all 234 authorised Australian nurse practitioners in late 2007. An 85% response rate was achieved (202 responses). Respondents had a mean age of 47.0 years and 84.2% were women. Only 145 nurse practitioners (72% of respondents) reported being employed in Australia at the time of the census. Emergency nurse practitioners were the most commonly employed nationally (26.9%). Nearly one third of employed nurse practitioners reported that they were still awaiting approval to prescribe medications despite this being a core legislated skill. Over 70% stated that lack of Medicare provider numbers and lack of authority to prescribe through the Pharmaceut ical Benef its Scheme was extremely limiting to their practice. These findings are consistent with the international literature describing establishment of reformative

Cannabis use and misuse prevalence among people with psychosis

Background: Increasing attention has been given by researchers to cannabis use in individuals with psychosis. As psychoses are relatively low-prevalence disorders, research has been mostly been restricted to small-scale studies of treatment samples.The reported prevalence estimates obtained from these studies vary widely. Aims: To provide prevalence estimates based on larger samples and to examine sources of variability in prevalence estimates across studies. Method: Data from 53 studies of treatment samples and 5 epidemiological studies were analysed. Results: Based on treatment sample data, prevalence estimates were calculated for current use (23.0%), current misuse (11.3%),12-month use (29.2%),12-month misuse (18.8%), lifetime use (42.1%) and lifetime misuse (22.5%). Epidemiological studies consistently reported higher cannabis use and misuse prevalence in people with psychosis. Conclusions: The factor most consistently associated with increased odds of cannabis prevalence was specificity of diagnosis. Factors such as consumption patterns and study design merit further consideration.

Assessment in education : principles, policy and practice

The English examination system provides a market in which a limited number of providers are accredited to offer curriculum-based examinations in many subject areas and at several levels. The most significant are the General Certificate of Secondary Education (GCSE) and the General Certificate of Education, Advanced (A level). Because these examinations are used for high-stakes purposes, including higher education and employment selection for individuals and programme evaluation for institutions, it is desired that scores from various exams be ‘comparable’ in several respects: across syllabuses and examination boards within a subject area, across years, and even across subject areas. Just how to accomplish this goal has been a topic of continual research and debate for over 50 years, through many changes of examination and institutional structures. But ever year, tens of thousands of scores must be reported, and every year, users expect them to ‘be comparable’ and use them as if they are.

Burden of care and general health in families of patients with schizophrenia

Background: De-institutionalization of psychiatric patients has led to a greater emphasis on family management in the community, and family members are often overwhelmed by the demands that caring for a patient with schizophrenia involves. Most studies of family burden in schizophrenia have taken place in developed countries. The current study examined family burden and its correlates in a regional area of a medium income country in South America. Method: Sixty-five relatives of patients with schizophrenia who were attending a public mental health out-patient service in the province of Arica, Chile, were assessed on Spanish versions of the Zarit Caregiver Burden Scale and SF-36 Health Survey (SF-36). Results: Average levels of burden were very high, particularly for mothers, carers with less education, carers of younger patients and carers of patients with more hospitalisations in the previous 3 years. Kinship and number of recent hospitalisations retained unique predictive variance in a multiple regression. Burden was the strongest predictor of SF-36 subscales, and the prediction from burden remained significant after entry of other potential predictors. Conclusions: In common with families in developed countries, family members of schizophrenia patients in regional Chile reported high levels of burden and related functional and health impact. The study highlighted the support needs of carers in contexts with high rates of poverty and limited health and community resources.

Illegal pedestrian crossing at signalised intersections : Incidence and relative risk

Illegal pedestrian behaviour is common and is reported as a factor in many pedestrian crashes. Since walking is being promoted for its health and environmental benefits, minimisation of its associated risks is of interest. The risk associated with illegal road crossing is unclear, and better information would assist in setting a rationale for enforcement and priorities for public education. An observation survey of pedestrian behaviour was conducted at signalised intersections in the Brisbane CBD (Queensland, Australia) on typical workdays, using behavioural categories that were identifiable in police crash reports. The survey confirmed high levels of crossing against the lights, or close enough to the lights that they should legally have been used. Measures of exposure for crossing legally, against the lights, and close to the lights were generated by weighting the observation data. Relative risk ratios were calculated for these categories using crash data from the observation sites and adjacent midblocks. Crossing against the lights and crossing close to the lights both exhibited a crash risk per crossing event approximately eight times that of legal crossing at signalised intersections. The implications of these results for enforcement and education are discussed, along with the limitations of the study.

Exercise for health : a breast cancer recovery program - quality of life benefits [Conference Abstract]

Introduction: Five-year survival from breast cancer in Australia is 87%. Hence, ensuring a good quality of life (QOL) has become a focal point of cancer research and clinical interest. Exercise during and after treatment has been identified as a potential strategy to optimise QOL of women diagnosed with breast cancer.----- Methods: Exercise for Health is a randomised controlled trial of an eight-month, exercise intervention delivered by Exercise Physiologists. An objective of this study was to assess the impact of the exercise program during and following treatment on QOL. Queensland women diagnosed with unilateral breast cancer in 2006/07 were eligible to participate. Those living in urban-Brisbane (n=194) were allocated to either the face-to-face exercise group, the telephone exercise group, or the usual-care group, and those living in rural Queensland (n=143) were allocated to the telephone exercise group or the usual-care group. QOL, as assessed by the Functional Assessment of Cancer Therapy-Breast (FACT-B+4) questionnaire, was measured at 4-6 weeks (pre-intervention), 6 months (mid-intervention) and 12 months (three months post-intervention) post-surgery.----- Results: Significant (P<0.01) increases in QOL were observed between pre-intervention and three months post-intervention 12 months post-surgery for all women. Women in the exercise groups experienced greater mean positive changes in QOL during this time (+10 points) compared with the usual-care groups (+5 to +7 points) after adjusting for baseline QOL. Although all groups experienced an overall increase in QOL, approximately 20% of urban and rural women in the usual-care groups reported a decline in QOL, compared with 10% of women in the exercise groups.----- Conclusions: This work highlights the potential importance of participating in physical activity to optimise QOL following a diagnosis of breast cancer. Results suggest that the telephone may be an effective medium for delivering exercise counselling to newly diagnosed breast cancer patients.

A brief motivational intervention for substance misuse in recent-onset psychosis

Substance misuse is common in early psychosis, and impacts negatively on outcomes. Little is known about effective interventions for this population. We report a pilot study of brief intervention for substance misuse in early psychosis (Start Over and Survive: SOS), comparing it with Standard Care (SC). Twenty-five in-patients aged 18-35 years with early psychosis and current misuse of non-opioid drugs were allocated randomly to conditions. Substance use and related problems were assessed at baseline, 6 weeks and 3, 6 and 12 months. Final assessments were blind to condition. All 13 SOS participants who proceeded to motivational interviewing reported less substance use at 6 months, compared with 58% (7/12) in SC alone. Effects were well maintained to 12 months. However, more SOS participants lived with a relative or partner, and this also was associated with better outcomes. Engagement remained challenging: 39% (16/41) declined participation and 38% (5/13) in SOS only received rapport building. Further research will increase sample size, and address both engagement and potential confounds.

Reasons for cannabis use in men with and without psychosis

Psychoses are relatively low prevalence disorders that have a disproportionately negative impact on individuals and society. Cannabis use is one factor that can exacerbate the negative consequences associated with psychotic disorders. Relatively few studies have examined the effects or reasons for using cannabis self-reported by individuals with psychosis. The present study is the first known to compare directly such factors in individuals with and without psychosis, within a single study. At baseline and follow-up participants with psychosis most commonly reported using cannabis for positive mood alteration (36% and 42%), coping with negative affect (27% and 29%) and for social activity reasons (38% and 29%). The control group most commonly reported using cannabis for relaxation (34% and 43%) and social activity reasons (49% and 51%). Participants with psychosis were less likely to report relaxation as the most important effect after use (27%) or expect it at follow-up (49%) compared to the control group (53% and 70%). In both groups, addiction and positive affect enhancement were the composite variable scores correlated most consistently with concurrent amount and frequency of use.

Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders

Objectives: To determine opinions and experiences of health professionals concerning the management of people with comorbid substance misuse and mental health disorders. Method: We conducted a survey of staff from mental health services and alcohol and drug services across Queensland. Survey items on problems and potential solutions had been generated by focus groups. Results: We analysed responses from 112 staff of alcohol and drug services and 380 mental health staff, representing a return of 79% and 42% respectively of the distributed surveys. One or more issues presented a substantial clinical management problem for 98% of respondents. Needs for increased facilities or services for dual disorder clients figured prominently. These included accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent dual diagnosis services and after-hours alcohol and drug consultations were also reported. Each of these issues raised substantial problems for over 70% of staff. Another set of problems involved coordination of client care across mental health and alcohol and drug services, including disputes over duty of care. Difficulties with intersectoral liaison were more pronounced for alcohol and drug staff than for mental health. A majority of survey respondents identified 13 solutions as practical. These included routine screening for dual diagnosis at intake, and a range of proposals for closer intersectoral communication such as exchanging client information, developing shared treatment plans, conducting joint case conferences and offering consultation facilities. Conclusions: A wide range of problems for the management of comorbid disorders were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing services.