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Low response rates to postal surveys potentially bias study results. We used three approaches to determine why 46 per cent of a sample were non-responders, and to analyse any potential bias. Labour force data, telephone interviews with a number of non-responders and trend examination showed that our study sample was no different to the known nursing population, that there were few differences between responders and non-responders and that there were no trends in differences between early and late responders respectively. Results suggest 'intenders', or potential responders who do not complete and return the survey, are a key factor in non-response in surveys on nurses. Analysis for response bias increases confidence in the interpretations and conclusions of any study and should therefore become standard survey practice. [ABSTRACT FROM AUTHOR]

AIM: To examine the determinants of generalist nurses' therapeutic attitude to patients who use illicit drugs, and to model workforce development initiatives. BACKGROUND: Individuals who use illicit drugs rely heavily on healthcare in emergency departments and inpatient hospital wards. Little is known about the determinants of generalist nurses' therapeutic attitude to provide care, therefore limiting our understanding of the important issues for workforce development. DESIGN: The study was a cross-sectional survey of registrants on the Australian Capital Territory Nurses Registration Roll 2002 (N = 3241, 50% response rate). The associations between variables and nurses' therapeutic attitude were examined by multi-variable linear regression analysis. METHOD: Nurses' therapeutic attitude was assessed using a modified version of the Alcohol and Alcohol Problems Perception Questionnaire. Personal characteristics, attitudes to illicit drugs and professional practice variables such as drug and alcohol education, experience with the patient group and role support were examined using a mix of standardised and new questions. RESULTS: Professional practice variables explained 53% of the variation of nurses' therapeutic attitude, the most important being role support. Although a negative attitude to illicit drugs had a statistically significant association with therapeutic attitude, it added less than 1% to the variation explained. Personal characteristics showed no association. CONCLUSIONS: Generalist nurses struggle to provide care to this patient group. Role support was found to be the strongest driver of nurses' therapeutic attitude, and workplace illicit drug education was only useful in combination with high role support. RELEVANCE TO CLINICAL PRACTICE: Nurses' caring role with patients who use illicit drugs is complex and demanding. Nursing workforce development must focus on increasing nurses' role support, in terms of appropriately skilled staff readily available for consultation and advice. Support for nurses, in the form of evidence-based practice standards and appropriate time allocation, is also important. [ABSTRACT FROM AUTHOR]

Why are employed women at increased risk for upper limb musculoskeletal disorders and what can this tell us about the way work and family life shape health? Despite increases in women's labour force participation, gender differences in work-related health conditions have received little research attention. This appears be the first study to examine why employed women are much more likely than men to experience upper body musculoskeletal disorders. A mailed self-report survey gathered data from 737 Australian Public Service employees (73% women). The majority of respondents were clerical workers (73%). Eighty one per cent reported some upper body symptoms; of these, 20% reported severe and continuous upper body pain. Upper body musculoskeletal symptoms were more prevalent and more severe among women. The gender difference in symptom severity was explained by risk factors at work (repetitive work, poor ergonomic equipment), and at home (having less opportunity to relax and exercise outside of work). Parenthood exacerbated this gender difference, with mothers reporting the least time to relax or exercise. There was no suggestion that women were more vulnerable than men to pain, nor was there evidence of systematic confounding between perceptions of work conditions and reported health status. Changes in the nature of work mean that more and more employees, especially women, use computers for significant parts of their workday. The sex-segregation of women into sedentary, repetitive and routine work, and the persisting gender imbalance in domestic work are interlinking factors that explain gender differences in musculoskeletal disorders. [ABSTRACT FROM AUTHOR]

The study aimed to identify the range of buprenorphine doses required to comfortably alleviate symptoms in patients undergoing inpatient heroin withdrawal using a symptom-triggered titration dosing regime, and to identify the patient characteristics that impact upon the buprenorphine dose requirements. The study was conducted in two Australian inpatient withdrawal units, recruiting 63 dependent, injecting heroin users with no recent methadone treatment, dependence on other drugs, or other active medical or psychiatric conditions. In a single (patient) blinded case series, placebo or 2 mg sublingual buprenorphine tablets was administered four times a day according to severity of withdrawal (assessed with Subjective Opiate Withdrawal Scale). Up to 16 mg buprenorphine was available over the first 4 days of the admission, up to 8 mg on day 5, and placebo continued until day 6. Thirty-two subjects completed the dosing regime, with mean (+/-S.D.) daily doses of 3.8+/-2.8 on day 1, 5.8+/-3.2 on day 2, 4.8+/-3.3 on day 3, 2.3+/-2.6 on day 4, 0.8+/-1.3 on day 5, and a total dose of 17.4+/-9.7. Higher buprenorphine doses were required by those patients with more severe psychosocial dysfunction, women, those with more frequent heroin use, and those with more severe dependence on heroin at intake. A dosing regime using sublingual buprenorphine tablets for short inpatient heroin withdrawal is proposed. [ABSTRACT FROM AUTHOR]

Existing evidence for the efficacy of diamorphine treatment of heroin dependence is presented, focusing first on ‘gold standard’ randomised controlled trials and then on other forms of evidence. The evidence strongly suggests that diamorphine treatment may be of some value and that further trials are warranted. Nevertheless, there are a range of risks associated with diamorphine trials and these are also discussed. It is recommended that: extensive trialling of the efficacy, safety and cost-effectiveness of diamorphine should be undertaken trials should be conducted to the highest scientific standards, but the standards should be realistic the risks associated with diamorphine prescribing must be taken seriously and included in trial planning and evaluation competing moral positions about diamorphine prescribing should be spelt out and debated; and diamorphine prescription should be viewed as only one of a number of treatment options and should be investigated as part of a pluralist approach to the treatment of heroin dependence. [ABSTRACT FROM AUTHOR]

A proposal for a trial to provide heroin to dependent users in a controlled manner is currently being considered in the Australian Capital Territory. The political background to this proposal is outlined, as is the current 'drug scene'. A Stage 1 examination found that a trial of controlled provision of heroin is feasible in principle and recommended a further stage (Stage 2) of feasibility investigations to explore the practicalities. The results of the Stage 1 investigations and the proposals for Stage 2 are incorporated into discussion about three important issues: the feasibility research process, the therapeutic relationship, and social control. These considerations have wider applicability, both for treatment services for illegal drug users generally and for informing drug policy debates. Much can be learnt from the feasibility considerations, whether or not a trial of the controlled provision of heroin eventuates in Australia. [ABSTRACT FROM AUTHOR]

Ethanol (0.25-1 gm/kg body weight; IP) did not significantly alter shock-induced fighting, regardless of whether it was administered to both rats or to only one rat of the pair. Higher doses tended to decrease shock-induced fighting. Ethanol (0.25-2 gm/kg body weight' IP) also did not induce "nonkiller" rats to kill mice and only high doses (1.5 and 2 gm/kg body weight) decreased the incidence of muricide in "killer" rats. The depressant effects of ethanol on both shock-induced fighting and muricide appeared to result from drug-induced ataxia rather than from a direct effect of ethanol on aggressive behavior. [ABSTRACT FROM AUTHOR]

Health impact assessment (HIA) and comparative risk assessment (CRA) are important tools with which governments and communities can compare and integrate different sources of information about various health impacts into a single framework for policy-makers and planners. Both tools have strengths that may be combined usefully when conducting comprehensive assessments of decisions that affect complex health issues, such as the health risks and impacts of transport policy and planning activities. As yet, however, HIA and CRA have not been applied widely to the area of transport. We draw on the limited experience of the application of these tools in the context of road transport to explore how comparative assessment of transport risks can contribute to HIA of transport policies.

Buprenorphine is safe and effective for short-term ambulatory heroin withdrawal. Compared to clonidine and other symptomatic medications, buprenorphine was associated with greater retention, less heroin use and less discomfort during withdrawal. People receiving buprenorphine had significantly greater retention, less heroin use and less withdrawal discomfort compared with clonidine. The intervention was provided for an extended period, and the sample size was large, providing sufficient power.

Purpose: To determine if the timing for requesting signed permission to access personal health services utilization records affects authorization or survey response rates.Methods: A screening question about in-principle willingness to permit access to personal health services utilization records was included in a mail-based survey of two Australian female samples (n = 292). Half of the surveys for each sample also included a separate form to be signed to approve access. For the other half the form was not included, but an authorization form was sent subsequently.Results: Around 30% of participants signed the authorization form and there was no significant difference between the randomized groups [ relative risk (RR) = 0.95, 95% confidence interval (CI) = 0.72-1.25). However, the response rate to the postal survey was significantly higher for the group who received the form after returning the questionnaire (60% compared to 46%; RR = 1.31, 95% CI = 1.06-1.62).Conclusions: A two-staged approach, with a time lag between seeking in principle permission to access personal health services utilization records and requesting signed authorization, does not affect authorization rates. In addition, it results in a significantly higher survey response rate than if an authorization form is included with the survey. [ABSTRACT FROM AUTHOR]

BACKGROUND: Agent-based simulation models can be used to explore the impact of policy and practice on drug use and related consequences. In a linked paper (Perez et al., 2011), we described SimAmph, an agent-based simulation model for exploring the use of psychostimulants and related harm amongst young Australians. METHODS: In this paper, we use the model to simulate the impact of two policy scenarios on engagement in drug use and experience of drug-related harm: (i) the use of passive-alert detection (PAD) dogs by police at public venues and (ii) the introduction of a mass-media drug prevention campaign. RESULTS: The findings of the first simulation suggest that only very high rates of detection by PAD dogs reduce the intensity of drug use, and that this decrease is driven mainly by a four-fold increase in negative health consequences as detection rates rise. In the second simulation, our modelling showed that the mass-media prevention campaign had little effect on the behaviour and experience of heavier drug users. However, it led to reductions in the prevalence of health-related conditions amongst moderate drug users and prevented them from becoming heavier users. CONCLUSION: Agent-based modelling has great potential as a tool for exploring the reciprocal relationships between environments and individuals, and for highlighting how intended changes in one domain of a system may produce unintended consequences in other domains. The exploration of these linkages is important in an environment as complex as the drug policy and intervention arena. [ABSTRACT FROM AUTHOR]

BACKGROUND: Computer simulations provide a useful tool for bringing together diverse sources of information in order to increase understanding of the complex aetiology of drug use and related harm, and to inform the development of effective policies. In this paper, we describe SimAmph, an agent-based simulation model for exploring how individual perceptions, peer influences and subcultural settings shape the use of psychostimulants and related harm amongst young Australians. METHODS: We present the conceptual architecture underpinning SimAmph, the assumptions we made in building it, the outcomes of sensitivity analysis of key model parameters and the results obtained when we modelled a baseline scenario. RESULTS: SimAmph's core behavioural algorithm is able to produce social patterns of partying and recreational drug use that approximate those found in an Australian national population survey. We also discuss the limitations involved in running closed-system simulations and how the model could be refined to include the social, as well as health, consequences of drug use. CONCLUSION: SimAmph provides a useful tool for integrating diverse data and exploring drug policy scenarios. Its integrated approach goes some way towards overcoming the compartmentalisation that characterises existing data, and its structure, parameters and values can be modified as new data and understandings emerge. In a companion paper (Dray et al., 2011), we use the model outlined here to explore the possible consequences of two policy scenarios. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe the circumstances surrounding recent heroin overdose among a sample of heroin overdose survivors and the links to their knowledge of overdose risk. METHODS: A cross-sectional survey of 257 recent non-fatal heroin overdose survivors was undertaken to examine self-reported knowledge of overdose risk reduction strategies, behaviour in the 12 h prior to overdose and attributions of overdose causation. RESULTS: Most of the overdoses occurred in public spaces as a result of heroin use within 5 min of purchasing the drug. A substantial number of overdoses occurred with no one else present and/or involved the concomitant use of other drugs. While knowledge of at least one overdose prevention strategy was reported by 90% of the sample, less then half of the sample knew any single strategy. Furthermore knowledge of the dangers of mixing benzodiazepines and/or alcohol with heroin was associated with an increased likelihood of such mixing being reported prior to overdose. CONCLUSIONS: While heroin users can articulate knowledge of key overdose risk reduction strategies, this knowledge was not generally associated with a reduction in risk behaviours but was in some cases associated with increased reports of overdose risk behaviours. Further research is required in order to better understand this paradoxical effect, focussing on risk reduction education amenable to the social contexts in which heroin use takes place. [ABSTRACT FROM AUTHOR]

Aims: To trial two novel methods of recruiting people who experience non-fatal heroin overdose through the ambulance service.Setting: Melbourne and Sydney, Australia.Methods: In Melbourne potential participants were given numbered contact cards by ambulance paramedics after revival, while in Sydney potential participants were approached after revival by a researcher who travelled with ambulance paramedics to the overdose scene.Results: In Melbourne 281 cards were distributed during the period 1 June 1998-31 December 1998 and a subsequent contact rate of 24% was achieved with 14% attending a subsequent interview. In Sydney there were 170 initial contacts of which 139 (82%) answered a series of questions asked at the scene (the remainder either ineligible or incapable of answering questions) with 48 (35%) also attending for follow-up interviews.Conclusions: Recruitment through contact with ambulance services is a novel method of recruiting heroin users for research into non-fatal heroin overdose with advantages over other methods of sampling for research on non-fatal heroin overdose. [ABSTRACT FROM AUTHOR]

Urgent sustainability challenges require effective leadership for inter- and trans-disciplinary (ITD) institutions. Based on the diverse experiences of 20 ITD institutional leaders and specific case studies, this article distills key lessons learned from multiple pathways to building successful programs. The lessons reflect both the successes and failures our group has experienced, to suggest how to cultivate appropriate and effective leadership, and generate the resources necessary for leading ITD programs. We present two contrasting pathways toward ITD organizations: one is to establish a new organization and the other is to merge existing organizations. We illustrate how both benefit from a real-world focus, with multiple examples of trajectories of ITD organizations. Our diverse international experiences demonstrate ways to cultivate appropriate leadership qualities and skills, especially the ability to create and foster vision beyond the status quo; collaborative leadership and partnerships; shared culture; communications to multiple audiences; appropriate monitoring and evaluation; and perseverance. We identified five kinds of resources for success: (1) intellectual resources; (2) institutional policies; (3) financial resources; (4) physical infrastructure; and (5) governing boards. We provide illustrations based on our extensive experience in supporting success and learning from failure, and provide a framework that articulates the major facets of leadership in inter- and trans-disciplinary organizations: learning, supporting, sharing, and training., (© Springer Japan KK, part of Springer Nature 2020.)

Introduction and Aims: Researchers are often frustrated by their inability to influence policy. We describe models of policy-making to provide new insights and a more realistic assessment of research impacts on policy., Design and Methods: We describe five prominent models of policy-making and illustrate them with examples from the alcohol and drugs field, before drawing lessons for researchers., Results: Policy-making is a complex and messy process, with different models describing different elements. We start with the incrementalist model, which highlights small amendments to policy, as occurs in school-based drug education. A technical/rational approach then outlines the key steps in a policy process from identification of problems and their causes, through to examination and choice of response options, and subsequent implementation and evaluation. There is a clear role for research, as we illustrate with the introduction of new medications, but this model largely ignores the dominant political aspects of policy-making. Such political aspects include the influence of interest groups, and we describe models about power and pressure groups, as well as advocacy coalitions, and the challenges they pose for researchers. These are illustrated with reference to the alcohol industry, and interest group conflicts in establishing a Medically Supervised Injecting Centre. Finally, we describe the multiple streams framework, which alerts researchers to 'windows of opportunity', and we show how these were effectively exploited in policy for cannabis law reform in Western Australia., Discussion and Conclusions: Understanding models of policy-making can help researchers maximise the uptake of their work and advance evidence-informed policy.

Aims: To show how the inclusion of agent-based modelling improved the integration of ethno-epidemiological data in a study of psychostimulant use and related harms among young Australians., Methods: Agent-based modelling, ethnographic fieldwork, in-depth interviews and epidemiological surveys., Setting: Melbourne, Perth and Sydney, Australia., Participants: Club drug users in Melbourne, recreational drug users in Perth and street-based injecting drug users in Sydney. Participants were aged 18-30 years and reported monthly or more frequent psychostimulant use., Findings: Agent-based modelling provided a specific focus for structured discussion about integrating ethnographic and epidemiological methods and data. The modelling process was underpinned by collective and incremental design principles, and produced 'SimAmph', a data-driven model of social and environmental agents and the relationships between them. Using SimAmph, we were able to test the probable impact of ecstasy pill-testing on the prevalence of harms--a potentially important tool for policy development. The study also navigated a range of challenges, including the need to manage epistemological differences, changes in the collective design process and modelling focus, the differences between injecting and non-injecting samples and concerns over the dissemination of modelling outcomes., Conclusions: Agent-based modelling was used to integrate ethno-epidemiological data on psychostimulant use, and to test the probable impact of a specific intervention on the prevalence of drug-related harms. It also established a framework for collaboration between research disciplines that emphasizes the synthesis of diverse data types in order to generate new knowledge relevant to the reduction of drug-related harms.

This study examines the impact of workplace drug and alcohol education on nurses' therapeutic attitude to patients who use illicit drugs. It builds on a study of the generalist nursing workforce in the Australian Capital Territory in 2003, which showed that the interaction of role support with workplace drug and alcohol education facilitated nurses' therapeutic attitude. This paper explores this interaction in detail, showing that workplace education has no independent association with therapeutic attitude and that an effect from education only occurs when nurses have at least a moderate level of role support. Nursing workforce development needs to focus on strategies that provide role support for nurses as they work with this clinically challenging patient group. Without the ready availability of someone in the nurse's clinical field to advise and assist them, efforts to increase nurses' knowledge and skills are wasted.

Objectives: We investigated how a randomised controlled trial (RCT) could be designed to incorporate features known or thought likely to enhance the uptake of the new treatment into clinical practice post-trial., Method and Results: Between 1999 and 2001, we trialled buprenorphine treatment for heroin dependence in community settings throughout Victoria, using 28 experienced methadone prescribers and 34 pharmacists across 19 sites. In this case study, we describe how we incorporated seven features considered important in treatment uptake: skilled and experienced practitioners, government and policy support, incentives to prescribe the new treatment, specialist support services, clinical guidelines, training programs and patient involvement and information. We also present information showing that uptake of buprenorphine treatment was substantially boosted in Victoria compared with other Australian jurisdictions immediately after the trial in 2001 and that this increase was sustained until at least 2006., Conclusion: While we cannot prove that our trial design was responsible for the increased uptake of buprenorphine treatment in Victoria, we do show that design has been a neglected aspect of clinical trials in terms of enhancing post-trial uptake of the treatment being tested., Implications: Those interested in closing the 'know-do' gap between research and practice may wish to further explore this very promising lead. Imaginative linking of features known to enhance treatment uptake to pressing research questions may lead to new information on efficacy, as well as getting valuable drugs into the treatment system more rapidly.