Enhancing employment services for people with severe mental illness: the challenge of the Australian service environment

OBJECTIVES: Comparatively few people with severe mental illness are employed despite evidence that many people within this group wish to obtain, can obtain and sustain employment, and that employment can contribute to recovery. This investigation aimed to: (i) describe the current policy and service environment within which people with severe mental illness receive employment services; (ii) identify evidence-based practices that improve employment outcomes for people with severe mental illness; (iii) determine the extent to which the current Australian policy environment is consistent with the implementation of evidence-based employment services for people with severe mental illness; and (iv) identify methods and priorities for enhancing employment services for Australians with severe mental illness through implementation of evidence-based practices. METHOD: Current Australian practices were identified, having reference to policy and legal documents, funding body requirements and anecdotal reports. Evidence-based employment services for people with severe mental illness were identified through examination of published reviews and the results of recent controlled trials. RESULTS: Current policy settings support the provision of employment services for people with severe mental illness separate from clinical services. Recent studies have identified integration of clinical and employment services as a major factor in the effectiveness of employment services. This is usually achieved through co-location of employment and mental health services. CONCLUSIONS: Optimal evidence-based employment services are needed by Australians with severe mental illness. Providing optimal services is a challenge in the current policy environment. Service integration may be achieved through enhanced intersectoral links between employment and mental health service providers as well as by co-locating employment specialists within a mental health care setting.     

Immunoelectron microscopic analysis of a novel carbohydrate differentiation antigen (CDA-3C2) in the developing rat olfactory and otic systems

A carbohydrate differentiation antigen (CDA-3C2) exhibits a highly specific and restricted pattern of expression during rat embryogenesis. In the periphery of the embryo, this antigen is associated transiently with the lateral ectoderm but is retained only in the olfactory and otic epithelium throughout morphogenesis. At the light microscopic level, CDA-3C2 immunoreactivity appears mostly along cell periphery and in the extracellular matrix. The aim of the present study was to determine the specific cellular and subcellular distribution of CDA-3C2 in vivo in order to identify potential sites of cellular and tissue function of the antigen during embryogenesis. There was a strikingly similar subcellular distribution of CDA-3C2 in the developing otic and olfactory systems, found mostly along cell membranes, microvillar projections and acellular secretions of the epithelium. Mature sensory components of the epithelia were not immunoreactive, whereas supportive cells and their secreted structures were densely stained. The highly coincident nature of CDA-3C2 in both sensory epithelia suggests that this carbohydrate epitope, and possibly its carrier macromolecule, participate in a morphogenetic function common to these two sensory epithelia. © Wiley-Liss, Inc.     

Transforming growth factor-alpha induces sex-specific neurochemical imbalance in the stress- and memory-associated brain structures

Transforming growth factor-alpha (TGFalpha) is a well-known regulator of many developmental processes. However, its role in adult nervous system is yet unclear. Studies have shown that TGFalpha can regulate stress and memory behavior in adult mice. When TGFalpha is reduced in Waved-1 (Wa-1) mutant mice, the stress response and memory are impaired predominantly in males and only after puberty. To determine the neurochemical changes resulting from the reduced TGFalpha levels that could explain the reported behavioral outcomes, biogenic amine and amino acid levels were determined in the brain regions associated with stress and memory. Interestingly, sex-specific alterations in neurochemical levels were detected, including elevated noradrenaline and reduced glutamate levels in striatum of Wa-1 males, increased noradrenaline and reduced serotonin metabolite levels in hippocampus of Wa-1 females, reduced serotonin metabolite levels in cortex and amygdala of Wa-1 females, and reduced noradrenaline, dopamine, serotonin, glutamate and glycine levels in hypothalamus of Wa-1 females compared to their respective controls. Increased dopamine turnover in cortex and reduced dopamine and serotonin turnover in amygdala were observed in both male and female Wa-1 mice. The data indicate sex-specific alterations of specific neurochemicals as a result of reduced TGFalpha expression, which may underlie sex-dependent stress response and memory impairment in Wa-1 mice.     

Whole-body clearance kinetics and external dosimetry of 131I-3F8 monoclonal antibody for radioimmunotherapy of neuroblastoma

The purpose of this retrospective study was to evaluate the whole-body clearance kinetics of I-3F8 monoclonal antibody, an anti-ganglioside 2 antibody, used in the treatment of pediatric patients with late-stage neuroblastoma (NB). Serial whole-body dose rate measurements were obtained on pediatric patients participating in phase I dose escalation studies of therapeutic I-3F8. Whole-body retention fractions were derived and fit for each treatment to exponential curves to determine both the effective half-lives and corresponding clearance fractions. 27 patients were administered I-3F8 over the course of cyclical administrations with a median administered activity of 2.5 GBq (range, 1-8.14 GBq), typically every 2-4 d for up to 9 treatment cycles. Based on whole-body dose rate measurements, there was a large variability in the calculated mono-exponential clearance effective half-life time, with a mean of 26.4 h (range, 12.4-45.5 h). The data from a subset of 12 treatments were fit to a bi-exponential curve with a rapid clearance component mean effective half-time of 16.9 h (range, 4.3-26 h) and a slower clearance component mean effective half-time of 65.5 h (range, 16.9-136 h). The use of whole-body dose rate measurements, obtained for patient-release and other radiation safety considerations, can be useful in estimating whole-body clearance kinetics for photon emitting radionuclide labeled mAbs and other therapeutic radiopharmaceuticals. In the case of I-3F8 for pediatric NB therapy, the demonstrated variability in effective half-time suggests the need for patient-specific tracer dosimetry for both optimization of treatment and radiation safety precaution decision-making.     

Sexual activity predicts continued pessary use

OBJECTIVE: The purpose of this study was to determine which clinical variables predict continued pessary use. STUDY DESIGN: After IRB approval, charts of consecutive women at Loyola Women's Pelvic Medicine Center who bought a pessary from August 2000 to December 2002 were reviewed. Demographic information, length of pessary use, and reason for pessary discontinuation were recorded. Current pessary "users" were compared with "nonusers" (women who stopped wearing the pessary during the study period). RESULTS: Of the 136 study women, 82 (60%) were "users," and 54 (40%) were "nonusers." Women who were sexually active were more likely to continue pessary use (beta=2.204, P=.021). This was true regardless of indication for pessary placement. Women with prolapse were more likely than women with incontinence to continue with long-term pessary use (beta=2.031, P=.049). No other demographic characteristics predicted continued pessary use. CONCLUSION: Long-term pessary use is acceptable to sexually active women. Women being treated for pelvic organ prolapse are more likely to continue pessary use than women being treated for urinary incontinence. Additionally, the majority of women (60%) who accept a pessary for prolapse or urinary incontinence continue this treatment.     

Society for the Social History of Medicine: Medicine and the emergence of modern warfare

Medicine and War

War and Public Health Edited by Barry S. Levy and Victor W. Sidel Oxford University Press in co‐operation with the American Public Health Association, 1997, 412 pp., £42.50, ISBN 0–19–510814–0

The Plague Makers: The Secret World of Biological Warfare By Wendy Barnaby Vision Paperbacks, London, 1997, 202 pp., £9.99, ISBN 1–901250–04–0

Plutonium and Highly Enriched Uranium 1996 World Inventories, Capabilities, and Policies By David Albright, Frans Berkhout, and William Walker SIPRI/Oxford University Press, Oxford, 1997, 502 + xxxii pp., £40.00, ISBN 0–19–828009–2.

Moruroa and Us By Pieter de Vries and Han Seur Centre de Documentation et de Recherche sur la Paix et les Conflits, Lyon, 1997, 224pp., Frs 152.05 inc. p&;p, ISBN 2–9508291–5–5, (available from CDRPC, BP 1027, 69201 Lyon, France).

Caring

Agency, Health and Social Survival: The Ecopolitics of Rival Psychologies By Caroline New Taylor and Francis, London, 1996, 184 pp., £39.00, ISBN 0–7484–0246–2 hbk., £12.95, 0–7484–024–0 pbk.

Who Cares? True Stories of the NHS Reforms By Peter Bruggen Jon Carpenter, Cbarlbury, Oxon, 1997, 314 pp., £12.00, ISBN 1–897766–32–7.

Sacred Journeys By Jennifer Westwood with forward by Martin Palmer Gaia Books, London, 1997, 223 pp., £14.99, ISBN 1–85675 ‐004–3.     

Does ‘Sports Massage’ Have a Role in Sports Medicine?

More and more athletes are turning to massage, apparently in hopes of gaining a winning edge. But although research does not support claims that massage improves performance, it can offer athletes some physiological and psychological benefits.     

Patients and families experiences with video telehealth in rural/remote communities in Northern Canada

Aim. To explore patients’ and families’ experiences with video telehealth consultations as a method of health care delivery in rural/ remote communities in Northern Canada. Background. Accessing health services in isolated populations where human resources and infrastructure are constrained by vast geographical landmasses poses challenges and opportunities for nurses, health care providers, patients and families. Design. A qualitative approach was adopted with a purposeful sample of 10 patients and four family members representative of nine communities. Method. Selection criteria included patients receiving telehealth visits for a minimum of a year and willing to share their experiences. Data were collected during the winter of 2006 using semi‐structured video taped interviews and analysed using a qualitative thematic content analysis. Results. Patients and families experiences of their telehealth visits centered on three key themes: lessening the burden (costs of travel, accommodations, lost wages, lost time and physical limitations), maximising supports (access to family, friends, familiar home environment, nurses and other care providers), tailoring specific e‐health systems to enhance patient and family needs. Conclusion. The benefits of telehealth extend not only to patients and families but are linked to benefits for providers as well as the health care system. Relevance to clinical practice. This study indicates that video telehealth is an effective mechanism for delivering nursing and other health services to rural/remote communities and can impact positively on the quality of health care. The integration of telehealth practice can enhance the coordination, organisation and implementation of health care services.     

A comparison of general and age-specific factors associated with political behavior

Abstract

Sociological research has focused on relationships between status, participation, efficacy, and political behavior with less attention to the influence of discontinuity in life circumstances on political activity. In contrast, gerontologists have explored the implications of age-specific and life change factors for political orientations but conflicting hypotheses have been derived. On suggests that discontinuity will decrease political activity while the other contends that discontinuity will politicize individuals This study compares the relative contribution of life change and age-specific factors, demographic characteristics, and efficacy to voting and political interest. Data were collected by personal interviews with a random sample of 169 inner and women 65 or over. Voting and political interest had somewhat different antecedents, but participation in multi-age groups and efficacy increased both while age-paded participation decreased political activity. Discontinuity, in general, had less effect on political behavior than empathic characteristics and efficacy.