Search

Objective: Individual placement and support (IPS) has shown consistently better outcomes on competitive employment for patients with severe mental illness than traditional vocational rehabilitation. The evidence for efficacy originates from few countries, and generalization to different countries has been questioned. This has delayed implementation of IPS and led to requests for country-specific RCTs. This meta-analysis examines if evidence for IPS efficacy can be generalized between rather different countries., Methods: A systematic search was conducted according to PRISMA guidelines to identify RCTs. Overall efficacy was established by meta-analysis. The generalizability of IPS efficacy between countries was analysed by random-effects meta-regression, employing country- and date-specific contextual data obtained from the OECD and the World Bank., Results: The systematic review identified 27 RCTs. Employment rates are more than doubled in IPS compared with standard vocational rehabilitation (RR 2.07 95% CI 1.82-2.35). The efficacy of IPS was marginally moderated by strong legal protection against dismissals. It was not moderated by regulation of temporary employment, generosity of disability benefits, type of integration policies, GDP, unemployment rate or employment rate for those with low education., Conclusions: The evidence for efficacy of IPS is very strong. The efficacy of IPS can be generalized between countries., (© 2019 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.)

The Obligatory Continuing Medical Education (CME) programme of the Royal Australian College of Obstetricians and Gynaecologists (RACOG) which is linked to time-limited certification has now been in operation for over a decade. Its somewhat unique features have attracted widespread interest both nationally and internationally and may be seen as part of an international movement towards obligatory CME in Western Medicine. However, the programme should also be seen as just a part of the educational responses necessary as the medical profession moves into the 1990s, particularly for those of us in the discipline of Obstetrics and Gynaecology. This paper reviews the increasing pressures from within the profession and from the community towards the obligatory CME concepts pioneered by the RACOG, but suggests that the challenges that have been faced in this area in the past although significant, are much less than those which will be faced in the 1990's, as the discipline addresses the challenges of educating obstetricians in the third phase of Continuing Medical Education--education in managing the environment in which our discipline is practised.

As difined in the first part of these papers, the distribution of MS does not really correlate well with broad geoclimatic factors. Specifically there is little evidence for a direct correlation with latitude, and such correlations, to be meaningful, need to consider longitude as well. At latitude 40 degrees north, for example, MS is high frequency in America, medium in Europe, and low in Asia. Accordingly the world-wide distribution of MS is best regarded as comprising three bands or zones of high medium, and low risk or frequency as delineated here. All the high and medium regions are at present found in Europe or in areas colonized by Europeans. It seems likely then that MS originated in western Europe and has spread from there to the United States and Canada as well as to New Zealand and Australia. The disorder may well have "taken" also in South Africa and Hawaii, but at considerably lower levels. Further attention to the character and timing of the depresion of this disease may well provide clues vital to determining its cause.

This paper and the one that preceded it1 have traced the development of the design and use of negative pressure ventilators from their origins in the early nineteenth century to the present day. Their maximum use was in the nineteen-forties and the early fifties after which they were quite rapidly replaced in the treatment of acute respiratory disease by intermittent positive pressure ventilators-the turning point being the severe poliomyelitis epidemic in Copenhagen in 1952. Negative pressure ventilators, particularly cuirass ventilators, still have a place in the treatment of chronic respiratory disease.