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Objective: To describe the economic and cost considerations of mobile X‐ray services (MXS) in residential aged care facilities (RACFs), according to stakeholders (involved in residents' healthcare), residents living in RACFs and informal carers (ICs) of residents. Methods: Semistructured interviews were conducted with 20 residents and 27 ICs recruited from six RACFs across metropolitan Adelaide (South Australia, Australia), and 22 stakeholders, on their perspectives of using MXS in RACFs. Data relating to economic and cost considerations were extracted and analysed using thematic analysis. Results: Residents' mean age was 85 years, 60% were women and 40% had experienced an MXS in the last 12 months. Most ICs were daughters (70%) and wives (11%) and 30% had a family member who had experienced an MXS in the last 12 months. Stakeholders included RACF staff, GPs, a hospital avoidance program clinician, paramedics, emergency department clinicians, MXS radiographers and manager, and a radiologist. Four themes were presented: (1) business considerations, where private providers found it necessary to charge residents a co‐payment to deliver MXS; (2) cost and payment process as a potential barrier to using MXS, with varied willingness and ability to pay for an MXS co‐payment, and equity concerns; (3) overcoming cost and payment barriers, with staff and consumers sometimes using strategies to overcome cost barriers; and (4) perceived cost benefits of MXS to the healthcare system, residents and ICs. Conclusions: Mobile X‐ray services providers charge residents an upfront co‐payment for business viability, which can be a barrier to some residents wishing to access MXS. [ABSTRACT FROM AUTHOR]

Abstract: Communities in Australia's Murray‐Darling Basin face the challenge of trying to achieve social, economic, and environmental sustainability; but experience entrenched conflict about the best way to achieve a sustainable future, especially for small rural communities. Integral ecology is a philosophical concept that seeks to address community, economic, social, and environmental sustainability simultaneously. Its inclusive processes are designed to reduce stakeholder conflict. However, to date the application of the integral ecology concept has been largely qualitative in nature. This study developed a quantitative integral ecology framework, and applied this framework to a case study of the Riverina, in the Murray‐Darling Basin. Seventy‐seven community‐focused initiatives were assessed, ranked, and quantified. The majority of the community‐focused ranked initiatives did not exhibit all aspects of integral ecology. Initiatives typically prioritized either (1) economic and community development or (2) environmental health; rarely both together. The integral ecology framework developed here enables recommendations on future community initiatives and may provide a pathway for community leaders and other policy‐makers to more readily apply integral ecology objectives. Further research refining the framework's operationalization, application and implementation to a wider‐scale may enhance communities' capacity to develop and grow sustainably. [ABSTRACT FROM AUTHOR]

Aim: Suicidal behaviours (suicide attempts and suicides) are common among individuals experiencing, or having recently experienced, a firstepisode psychosis (FEP). Current interventions for suicidal behaviours are crisis driven and focused on hospital admission of patients at imminent risk of ending their lives. This paper aims to describe ideas for universal, selective and indicated strategies that may complement existing practices to suicide risk management in first-episode patients. Methods: Key findings from the Suicidal Behaviours in FEP Project were used to develop suggested interventions. The project examined the temporal course of suicide risk, common characteristics of suicidal behaviours and predictors of suicidal behaviours in 699 patients with FEP. Results: Key findings included: (i) 12% of FEP cohort engaged in suicidal behaviours during treatment (up to 3 years); (ii) first month of treatment conferred the highest suicide risk; (iii) 64% of suicidal behaviours were overdoses, usually on antipsychotics; (iv) 20% of suicidal behaviours occurred on psychiatric units and all involved hanging/strangulation; (v) most suicidal behaviours were impulsive, precipitated by psychosocial stressors and with serious intent; and (vi) proximal non-suicidal self-injurious behaviour and proximal negative life events were the strongest predictors. Conclusion: Comprehensive approach by mental health services to prevention of suicidal behaviours among first-episode patients could be facilitated by: delineating safe quantities of prescribed medications available to outpatients; regular audits of fixtures on inpatient units; enhancing risk recognition by family members; routinely monitoring suicide risk levels; developing crisis cards with all new FEP patients to facilitate help seeking during distress; and skills training programs targeting distress tolerance, interpersonal effectiveness and problem-solving. [ABSTRACT FROM AUTHOR]

Context: This paper reports on a qualitative study looking at the perceptions of clients who use drugs and are on low income. Research suggests that counselling services can experience difficulties in reaching and retaining such clients, and outcomes of counselling can be disappointing. Aim: To learn from clients who had engaged in counselling for over six months what difference it had made to their lives. Method: Grounded theory methodology was used to analyse semi-structured interviews with six participants. Findings: Findings included changes in the clients' internal world, their connectedness with society, their familiarity with counselling, and their perception of the relationship with the counsellor. Factors within the counselling process which helped and hindered change were identified. The study documents how participants were able to use counselling to improve their lives. [ABSTRACT FROM AUTHOR]

To support curriculum and policy, a midwest city school district assessed the association of selected categories of nutrition and physical activity (NUTR/PA) behaviors, fitness measures, and body mass index (BMI) with academic performance (AP) for 800 sixth graders. Students completed an adapted Youth Risk Behavior Surveillance Survey (NUTR/PA behaviors), fitness assessments (mile run, curl-ups, push-ups, height, and weight) with results matched to standardized scores (Measures of Academic Progress [MAP]), meal price status, and gender. Differences in mean MAP scores (math and reading) were compared by selected categories of each variable utilizing 1-way analysis of variance. Associations were determined by stepwise multiple regression utilizing mean MAP scores (for math and for reading) as the dependent variable and NUTR/PA behaviors, fitness, and BMI categories as independent variables. Significance was set at α = 0.05. Higher MAP math scores were associated with NUTR (more milk and breakfast; less 100% fruit juice and sweetened beverages [SB]) and PA (increased vigorous PA and sports teams; reduced television), and fitness (higher mile run performance). Higher MAP reading scores were associated with NUTR (fewer SB) and PA (increased vigorous PA, reduced television). Regression analysis indicated about 11.1% of the variation in the mean MAP math scores and 6.7% of the mean MAP reading scores could be accounted for by selected NUTR/PA behaviors, fitness, meal price status, and gender. Many positive NUTR/PA behaviors and fitness measures were associated with higher MAP scores supporting the school district focus on healthy lifestyles. Additional factors, including meal price status and gender, contribute to AP. [ABSTRACT FROM AUTHOR]

In Australia, it is commonplace for tertiary mental health care to be provided in large regional centres or metropolitan cities. Rural and remote consumers must be transferred long distances, and this inevitably results in difficulties with the integration of their care between primary and tertiary settings. Because of the need to address these issues, and improve the transfer process, a research project was commissioned by a national government department to be conducted in South Australia. The aim of the project was to document the experiences of mental health consumers travelling from the country to the city for acute care and to make policy recommendations to improve transitions of care. Six purposively sampled case studies were conducted collecting data through semistructured interviews with consumers, country professional and occupational groups and tertiary providers. Data were analysed to produce themes for consumers, and country and tertiary mental healthcare providers. The study found that consumers saw transfer to the city for mental health care as beneficial in spite of the challenges of being transferred over long distances, while being very unwell, and of being separated from family and friends. Country care providers noted that the disjointed nature of the mental health system caused problems with key aspects of transfer of care including transport and information flow, and achieving integration between the primary and tertiary settings. Improving transfer of care involves overcoming the systemic barriers to integration and moving to a primary care-led model of care. The distance consultation and liaison model provided by the Rural and Remote Mental Health Services, the major tertiary provider of services for country consumers, uses a primary care-led approach and was highly regarded by research participants. Extending the use of this model to other primary mental healthcare providers and tertiary facilities will improve transfer of care. [ABSTRACT FROM AUTHOR]

Background: The Youth Risk Behavior Survey (YRBS) was used by a city school district (∼11,000 students) in the upper Midwest to monitor trends for nutrition and physical activity (PA) behaviors both within and between years and to compare with national 2003 data. Methods: Independent random samples were obtained in 1999 (387 middle school [MS] and 931 high school [HS]), in 2001 (322 MS and 367 HS), and in 2003 (658 MS and 1026 HS). A two-sample test of proportions was used. Results: Within each survey year, a higher proportion of MS compared to HS reported positive behaviors with some exceptions: (1) an increased proportion of HS having daily physical education (PE) and (2) a reduced proportion of HS reporting media time. Within 2003, a lower proportion of district females compared to males (MS and HS) reported participation in many measured behaviors. District trends overtime indicated a reduced proportion: (1) drinking milk (MS and HS), (2) eating breakfast (HS), and (3) watching television (MS). Trends overtime indicated an increased proportion: (1) using computers for fun (MS and HS), (2) participating in moderate PA (MS), and (3) daily PE (HS). District HS compared to national (2003) indicated a higher proportion: (1) drinking milk, (2) getting moderate PA, and (3) taking daily PE. District HS compared to national indicated a lower proportion: (1) at risk of overweight, (2) overweight, and (3) watching television. Conclusions: Analysis of district YRBS trends provides both a database for informed decisions by the school district and an assessment model for other districts. [ABSTRACT FROM AUTHOR]

Objective: Reductions in cannabis use have been observed during the first year following treatment entry for first-episode psychosis (FEP), but there is little indication of the pattern of cannabis and substance misuse generally in the very early course of treatment. Methods: Patterns of cannabis and other substance use (including alcohol) were examined prospectively among 130 FEP patients assessed at treatment entry and again at early follow up (median 9 weeks 4 days). Differences between cannabis users and non-users at both time-points were compared on descriptive features, psychopathology, social functioning and functional disability. Results: Of 72 patients using cannabis at treatment entry, 29 (40.3%)were abstinent at follow up. Notably, almost half (41%) of those cannabis users who were abstaining at follow up had been using on a daily or multiple daily basis. Among 58 individuals abstinent at treatment entry, 11 (19%) had commenced cannabis use at follow up. There were no significant differences between cannabis users and non-users on any psychopathology measure at treatment entry, however, those using cannabis at early follow up scored significantly higher than non-users on general psychopathology and positive symptomatology, and lower on health functioning. Conclusions: This study demonstrates significant fluctuation in cannabis use in the context of receiving specialist treatment for FEP, and suggests that a substantial proportion of young patients are contemplating changing harmful patterns of use in this critical early phase. [ABSTRACT FROM AUTHOR]

This paper draws on a consultation with 200 stakeholders about a mental health plan in the most remote region of South Australia to discuss primary mental healthcare improvement strategies. In rural and remote environments, a lack of services means that it is more difficult to deal with a mental illness or provide assistance for circumstantial life problems. The authors’ consultations revealed difficulties with service access, acceptability and teamwork. They also found that the availability of local human service workers leads to their use as first-level mental health contacts, but these workers are neither skilled nor supported for this. These difficulties will require attention to the boundaries between different service providers which can otherwise create inflexibility and service gaps. The regional mental health plan that is being rolled out will develop collaboration through regional interagency task groups, networking groups for local human service workers and the position of a regional mental health coordinator in order to overcome these difficulties and to operationalise service partnerships. [ABSTRACT FROM AUTHOR]

Objectives. Cognitively oriented psychotherapy for early psychosis (COPE) is aimed at facilitating the adjustment of the person, and at preventing or alleviating secondary morbidity in the wake of the first psychotic episode. Design. A total of 80 people participated in the initial trial and completed assessments on a range of outcome measures. Post-treatment assessment results from a non-randomized controlled trial of COPE have been previously reported. The present paper describes the results obtained from 51 patients who attended a follow-up assessment 1 year subsequent to the end-of-treatment assessment. Method. The 51 patients formed three groups: (1) those who were offered and accepted COPE; (2) those who were offered COPE but refused it, and continued to receive other services from the Early Psychosis Prevention and Intervention Centre (EPPIC) (refusal subjects); and (3) those who were offered neither COPE nor any other continuing treatment from EPPIC (control subjects). Results. At 1-year follow-up, there was only one significant difference and this was between the COPE and refusal groups on the Integration/Sealing Over (I/SO) measure (p = .008). End-of-treatment differences were mostly sustained over the 1- year follow-up period. When the complete sample of 80 was considered, there were no differences between the three groups in terms of hospital admissions, community episodes, or time taken to first in-patient re-admission. Conclusions. The study was weakened by the poor follow-up rates in the two control groups. This reduced power to detect differences between groups on the seven major measures. However, the relapse data gathered on the complete set of 80 patients were discouraging and suggest that the present formulation of COPE does not confer any advantage to those patients receiving the therapy over those not receiving the therapy. [ABSTRACT FROM AUTHOR]

ABSTRACTThe present study sought to understand the rural and remote influences on people’s identification of, and response to, mental health problems. Twenty-two key informants living in northern and western South Australia were interviewed. They included mental health and generalist health professionals, other human service workers and mental health consumers. Three themes are reported here: reluctance to acknowledge mental health problems and the avoidance of appropriate help; stigma and the avoidance of mental health services; and the influence of rural and remote circumstances. Most informants considered that many mental health problems were amenable to help from generalist workers, with backup support from mental health specialists. Informants thought this intervention to be appropriate because a common view of mental health problems as ‘insanity’ and a culture of self-reliance created a reluctance to seek help from a mental health specialist. These themes need to be taken into account when designing mental health interventions for rural and remote communities. [ABSTRACT FROM AUTHOR]

This study investigated the personality disorders of 21 recent-onset Bipolar Disorder patients using the revised Millon Clinical Multiaxial Inventory (MCMI-II; Millon, 1987). Personality disorder assessments, conducted after patients' clinical symptoms had settled, indicated that 17 patients received at least one MCMI-II personality disorder diagnosis with a trend toward multiple diagnoses. Narcissistic, Antisocial, and Histrionic personality disorders were diagnosed most frequently and were the scales most elevated. Schizoid and Compulsive personality disorders were the scales least elevated. Diagnostic concordance between the MCMI-II and the Structured Interview for DSM-III Personality (SIDP; Pfohl, Stangl, & Zimmerman, 1983) was poor; the MCMI-II made more multiple diagnoses. Implications of the discrepanices between these instruments and suggestions for future research are discussed. [ABSTRACT FROM AUTHOR]

Background: Foam cell formation by intimal smooth muscle cells (SMCs) inhibits the elaboration of extracellular matrix, which is detrimental to plaque stabilization. In the present study, we examined the lipoproteins and receptors involved in human SMC foam cell formation and investigated the ability of 24(S),25-epoxycholesterol [24(S),25-EC], an oxysterol agonist of the liver X receptor, to attenuate SMC foam cell formation., Methods and Results: Incubation of human internal thoracic SMCs with atherogenic lipoproteins demonstrated that low-density lipoprotein (LDL), but not oxidized or acetylated LDL, was the primary lipoprotein taken up, resulting in marked cholesteryl ester deposition (6-fold vs 1.8-fold; P<0.05; n=4). Exposure of SMCs to exogenous or endogenously synthesized 24(S),25-EC attenuated LDL uptake (-90% and -47% respectively; P<0.05; n=3) through decreased sterol regulatory element-binding protein-2 expression (-30% and -17%, respectively; P<0.001; n=3), decreased LDL receptor expression (-75% and -40%, respectively; P<0.05; n=3) and increased liver X receptor-mediated myosin regulatory light chain interacting protein expression (7- and 3-fold, respectively; P<0.05; n=4). Furthermore, exogenous 24(S),25-EC increased adenosine triphosphate-binding cassettes A1- and G1-mediated cholesterol efflux to apolipoprotein AI (1.9-fold; P<0.001; n=5) and high-density lipoprotein(3) (1.3-fold; P<0.05; n=5). 24(S),25-EC, unlike a nonsteroidal liver X receptor agonist, T0901317, did not stimulate sterol regulatory element-binding protein-1c-mediated fatty acid synthesis or triglyceride accumulation. 24(S),25-EC preserved the assembly of fibronectin and type I collagen by SMCs., Conclusions: The oxysterol 24(S),25-EC prevented foam cell formation in human SMCs by attenuation of LDL receptor-mediated LDL uptake and stimulation of cholesterol efflux, restoring the elaboration of extracellular matrix. In contrast to T0901317, 24(S),25-EC prevented the development of a triglyceride-rich foam cell phenotype. (J Am Heart Assoc. 2012;1:e000810 doi: 10.1161/JAHA.112.000810.).