Pathway to clozapine use:a comparison between a patient cohort from New Zealand and a cohort from the United Kingdom

Background and Objective: Clozapine has been available since the early 1990s. Studies continue to demonstrate its superior efficacy in treatment-resistant schizophrenia. Despite this, numerous studies show under-utilisation, delayed access and reluctance by psychiatrists to prescribe clozapine. This retrospective cross-sectional study compared the prescribing of clozapine in two adult cohorts under the care of large public mental health services in Auckland (New Zealand) and Birmingham (United Kingdom) on 31 March 2007. Method: Time from first presentation to clozapine initiation, prior antipsychotics trialled and antipsychotic co-prescribing were compared. Data included demographics, psychiatric diagnosis, co-morbid conditions, year of first presentation, admissions and pharmacological treatment (clozapine dose, start date, prior antipsychotics, co-prescribed antipsychotic). Results: Overall, 664 people were prescribed clozapine (402 Auckland; 262 Birmingham); mean daily dose of 384 mg (Auckland) and 429 mg (Birmingham). 53 % presented after 1990 and the average duration of time before starting clozapine was significantly longer in the Birmingham cohort (6.5 vs. 5.3 years) but this reduced in both cohorts to a 1-year mean in those presenting within the last 3 years. The average number of antipsychotics trialled pre-clozapine for those presenting since 1990 was significantly higher in the Birmingham cohort (4.3 vs. 3.1) but in both cohorts this similarly reduced in those presenting within the last 3 years. Antipsychotic co-prescribing was significantly higher in the Birmingham cohort (22.9 vs. 10.7 %). Conclusions: There is evidence that access to clozapine has improved over time in both cohorts, with a reduction in the duration between presentation and initiation of clozapine and number of different antipsychotics trialled pre-clozapine. These are very positive findings in terms of optimising outcomes with clozapine and are possibly due to the impact of guideline recommendations, increasing clinician, consumer and carer knowledge, and experience with clozapine and funding changes. © 2014 Springer International Publishing.

Norm-based comparison of SF -12 physical and mental health scale scores for a sample of employees of Broward County

In the new health paradigm, the connotation of health has extended beyond the measures of morbidity and mortality to include wellness and quality of life. Comprehensive assessments of health go beyond traditional biological indicators to include measures of physical and mental health status, social role-functioning, and general health perceptions. To meet these challenges, tools for assessment and outcome evaluation are being designed to collect information about functioning and well-being from the individual's point of view.^ The purpose of this study was to profile the physical and mental health status of a sample of county government employees against U.S. population norms. A second purpose of the study was to determine if significant relationships existed between respondent characteristics and personal health practices, lifestyle and other health how the tools and methods used in this investigation can be used to guide program development and facilitate monitoring of health promotion initiatives.^ The SF-12 Health Survey (Ware, Kosinski, & Keller, 1995), a validated measure of health status, was administered to a convenience sample of 450 employees attending one of nine health fairs at an urban worksite. The instrument has been utilized nationally which enabled a comparative analysis of findings of this study with national results.^ Results from this study demonstrated that several respondent characteristics and personal health practices were associated with a greater percentage of physical and/or mental scale scores that were significantly "worse" or significantly "better" than the general population. Respondent characteristics that were significantly related to the SF-12 physical and/or mental health scale scores were gender, age, education, ethnicity, and income status. Personal health practices that were significantly related to SF-12 physical and/or mental scale scores were frequency of vigorous exercise, presence of chronic illness, being at one's prescribed height and weight, eating breakfast, smoking and drinking status. This study provides an illustration of the methods used to analyze and interpret SF-12 Health Survey data, using norm-based interpretation guidelines which are useful for purposes of program development and collecting information on health at the community level. ^

The Hindu-Jewish relationship and the significance of dialogue : participants' reflections on the 2007 and 2008 Hindu-Jewish summits at New Delhi and Jerusalem

The purpose of this study was to determine whether or not new and significant developments for the Hindu and Jewish faiths, and the relationship that exists between them, can be demonstrated from the results of the Hindu-Jewish Leadership Summits of 2007 and 2008 in Delhi and Jerusalem. I argue that new and significant developments can be observed with this Hindu-Jewish encounter with regards to official rulings of Halacha (Jewish law), proper understandings of sacred symbols of Hinduism, and even improved Islamic-Jewish relations. After analyzing the approaches, themes, and unique framework found within this encounter, it is clear that the Hindu-Jewish leadership summits mark new and significant developments in inter-religious dialogue between the two traditions, culminating in the redefinition of Hinduism as a monotheistic religion.

Those Who Belong and Those Who Don’t: Physical and Mental Borders in Europe

Europe promotes migration and mobility but new or ‘different’ Europeans are still stigmatised and marginalised in our societies. Today, neither refugee status nor citizenship can tear down the mental borders between people who inhabit the same cities or neighbourhoods. Sociology professor Nira Yuval-Davis writes about the meaning of borders, and how they make us differentiate between ‘us’ and ‘the other’ in our daily lives.

The Impact of Education and Socioeconomic and Occupational Conditions on Self-Perceived and Mental Health Inequalities Among Immigrants and Native Workers in Spain

There is limited evidence on the influence of social determinants on the self-perceived and mental health of immigrants settled at least 8 years in Spain. The aim of this study was to examine differences between workers related to migrant-status, self-perceived and mental health, and to assess their relationship to occupational conditions, educational level and occupational social class, stratified by sex. Using data from the Spanish National Health Survey of 2011/12, we computed prevalence, odds ratios and explicative fractions. Mental (OR 2.02; CI 1.39–2.93) and self-perceived health (OR 2.64; CI 1.77–3.93) were poorer for immigrant women compared to natives. Occupational social class variable contributes 25 % to self-perceived health OR in immigrant women. Settled immigrant women workers are a vulnerable group in Spain.

The microbiome and mental health: looking back, moving forward with lessons from allergic diseases

Relationships between gastrointestinal viscera and human emotions have been documented by virtually all medical traditions known to date. The focus on this relationship has waxed and waned through the centuries, with noted surges in interest driven by cultural forces. Here we explore some of this history and the emerging trends in experimental and clinical research. In particular, we pay specific attention to how the hygiene hypothesis and emerging research on traditional dietary patterns has helped re-ignite interest in the use of microbes to support mental health. At present, the application of microbes and their structural parts as a means to positively influence mental health is an area filled with promise. However, there are many limitations within this new paradigm shift in neuropsychiatry. Impediments that could block translation of encouraging experimental studies include environmental forces that work toward dysbiosis, perhaps none more important than westernized dietary patterns. On the other hand, it is likely that specific dietary choices may amplify the value of future microbial-based therapeutics. Pre-clinical and clinical research involving microbiota and allergic disorders has predated recent work in psychiatry, an early start that provides valuable lessons. The microbiome is intimately connected to diet, nutrition, and other lifestyle variables; microbial-based psychopharmacology will need to consider this contextual application, otherwise the ceiling of clinical expectations will likely need to be lowered.

Third-sector discourses and the future of (un)employment : skilled labor, new technologies, and the meaning of work

In this paper we analyse a 600,000 word corpus comprised of policy statements produced within supranational, national, state and local legislatures about the nature and causes of(un)employment. We identify significant rhetorical and discursive features deployed by third sector (un)employment policy authors that function to extend their legislative grasp to encompass the most intimate aspects of human association.

Hypercapitalism: language, new media and social perceptions of value

Using examples from contemporary policy and business discourses, and exemplary historical texts dealing with the notion of value, I put forward an argument as to why a critical scholarship that draws on media history, language analysis, philosophy and political economy is necessary to understand the dynamics of what is being called 'the global knowledge economy'. I argue that the social changes associated with new modes of value determination are closely associated with new media forms.

Middle years teacher education : new programs and research directions

Teacher education programs focussing on the development of specialist teachers for 'the middle years' have proliferated in Australian universities in recent years. This paper provides some insights into middle years' teacher education programs at the University of Queensland, Edith Cowan and Flinders Universities with regard to their: philosophical underpinnings; specific educational context; scope and nature of the program. In addition, some of the research directions and efficacy strategies utilised in conjunction with the programs will be shared, along with some early findings from a longitudinal study in one of the programs. We propose that the pattern of programmatic growth heralds a new time for teacher education, and we speculate about the production of new kinds of teacher identities as graduates take their place in the profession.

A comparison of farmland returns in Australia, Canada, New Zealand and United States

Rural land is still a major property asset class and rural commodity production is an important domestic and export market in all economies. This paper carries out a comprehensive analysis of both rural production and land prices in four major rural production countries. The study compares rural property values in Unites States, Canada, Australia and New Zealand over a period 1990 to 2005 and analyzes and compares the capital return and total return performance for rural land in these four countries. The analysis allows a comparison of farm land returns for both a subsidised and non-subsidised farming policy to determine if levels of farm support result in variations in farm profitability and therefore farm land values.

Public awareness of ‘green’ residential property – an empirical survey based on data from New Zealand and Germany

Over the last few years more stringent environmental laws (e.g. the German “Energie¬ein-sparverordnung ENEV” - Energy Performance of Buildings Directive) and soaring energy prices has increased the need for the real estate industry to react and participate in overall energy reduction through efficient house construction and design, as well as upgrading the existing housing stock to be more energy efficient. Therefore the Property Economics Group at Queensland University of Technology in Australia and Nuertingen-Geislingen University in Germany are carrying out research in relation to sustainable housing construction and public awareness of “green” residential property. Part of this research is to gain an understanding of the level of knowledge and importance of these issues to the house buyer and to determine the importance of sustainable housing to the general public. The paper compares data from two different empirical studies; one of studies analyzes the situation in New Zealand, the other is focused on Germany.

Third space in cyberspace : Indigenous youth, new technologies and literacies

This chapter analyses the affordances and constraints of an online literacy program designed for Indigenous Australian youth through a partnership between the Indigenous community, university staff and local schools. The after-school program sought to build on the cultural resources and experiences of the young people through a dialogic process of planning, negotiating, implementing, reflecting, and renegotiating the program with participants and a range of stakeholders. In the majority of cases, students presented themselves as part of pervasive global popular cultures, often hot-linking their webpages to pop icons and local sports stars. Elders regarded their competency as a potential cultural tool and community resource.

Critical Systems Theory: A Political Economy of Language, Thought, and Technology

An emergent form of political economy, facilitated by information and communication technologies (ICTs), is widely propagated as the apotheosis of unmitigated social, economic, and technological progress. Meanwhile, throughout the world, social degradation and economic inequality are increasing logarithmically. Valued categories of thought are, axiomatically, the basic commodities of the “knowledge economy”. Language is its means of exchange. This paper proposes a sociolinguistic method with which to critically engage the hyperbole of the “Information Age”. The method is grounded in a systemic social theory that synthesises aspects of autopoiesis and Marxist political economy. A trade policy statement is analysed to exemplify the sociolinguistically created aberrations that are today most often construed as social and political determinants.