Better outcomes in mental health care: impact of different models of psychological service provision on patient outcomes.

Objective: One hundred and eight Access to Allied Psychological Services projects have been funded under Australia's Better Outcomes in Mental Health Care programme since July 2001. All projects are run by Divisions of General Practice and enable general practitioners (GPs) to refer patients to allied health professionals for evidence-based care. They differ in the models they use to retain, locate and direct referrals to their allied health professionals.

Optimal shift duration and sequence: recommended approach for short-term emergency response activations for public health and emergency management.

Since September 11, 2001, and the consequent restructuring of the US preparedness and response activities, public health workers are increasingly called on to activate a temporary round-the-clock staffing schedule. These workers may have to make key decisions that could significantly impact the health and safety of the public. The unique physiological demands of rotational shift work and night shift work have the potential to negatively impact decisionmaking ability.

Function and localization within rostral prefrontal cortex (area 10).

We propose that rostral prefrontal cortex (PFC; approximating area 10) supports a cognitive system that facilitates either stimulus-oriented (SO) or stimulus-independent (SI) attending. SO attending is the behaviour required to concentrate on current sensory input, whereas SI attending is the mental processing that accompanies self-generated or self-maintained thought. Regions of medial area 10 support processes related to the former, whilst areas of lateral area 10 support processes that enable the latter.

Bovine lineage-specific gamma delta (gammadelta) T cell GD3.5 antibody cross-reacts with cell surface antigens on ovine and caprine lymphocytes.

A specifically defined function for gammadelta T cells is still a topic of intense debate. Thus, there is great importance in the identification of lineage-specific markers that characterize these cells. Early studies describe a family of lineage-specific cell-surface molecules on ruminant gammadelta T cells called WC1.

Differential involvement of regions of rostral prefrontal cortex (Brodmann area 10) in time- and event-based prospective memory.

Rostral prefrontal cortex (approximating Brodmann area 10) has been shown repeatedly to have a role in the maintenance and realization of delayed intentions that are triggered by event cues (i.e., event-based prospective memory).

Factors in the selection of patients for conditional release from their first psychiatric hospitalization.

Objective: This study examined a sample of patients in Victoria, Australia, to identify factors in selection for conditional release from an initial hospitalization that occurred within 30 days of entry into the mental health system.

Methods: Data were from the Victorian Psychiatric Case Register. All patients first hospitalized and conditionally released between 1990 and 2000 were identified (N=8,879), and three comparison groups were created.

Effect of conditional release from hospitalization on mortality risk.

Objectives: This study considered the protective value provided by conditional release. It assessed the contribution of conditional release to mortality risk among patients with mental disorders severe enough to require psychiatric hospitalization during a mental health treatment span of 13.5 years in Victoria, Australia.

Conditional release: a less restrictive alternative to hospitalization?

Objective: This study examined conditional release--that is, involuntary outpatient commitment orders upon release from hospitalization--as a least restrictive alternative to psychiatric hospitalization in Victoria, Australia.

Methods: Records were obtained from the Victorian Psychiatric Case Register for patients who experienced psychiatric hospitalization: between 1990 and 2000 a total of 8,879 patients were given conditional release and 16,094 were not.

Results: Compared with the group that was hospitalized but did not receive a conditional release, the group that received a conditional release was more likely to have more prior hospitalizations of greater than average duration.

The utility of extended outpatient civil commitment.

Objective: This study considers three hypotheses regarding the impact of extended involuntary outpatient commitment orders on services utilization.

Method: Service utilization of Victorian Psychiatric Case Register (VPCR) patients with extended (> or =180 day) outpatient commitment orders was compared to that of a diagnostically-matched treatment compliant group with similarly extended (> or =180 day) periods of outpatient care (N=1182)--the former receiving care during their extended episode on an involuntary basis while the latter participated in care voluntarily. Pre/post first extended episode mental health service utilization was compared via paired t tests with individuals as their own controls.

Extended outpatient civil commitment and treatment utilization.

Objective: This study considers four hypotheses regarding the impact of extended involuntary outpatient commitment orders on services utilization.

Method: All Victorian Psychiatric Case Register (VPCR) patients who had extended (180+ day) outpatient commitment orders in the nine year study period and a matched treatment compliant comparison group with extended periods of outpatient care (N = 1182), both with at least two years of post-episode experience, were evaluated. Pre/post episode utilization was compared via paired t tests with individuals as their own controls.

Substance misuse in first-episode psychosis: 15-month prospective follow-up study.

Background: Well-designed prospective studies of substance misuse in first-episode psychosis can improve our understanding of the risks associated with comorbid substance misuse and psychosis.

Aims: To examine the potential effects of substance misuse on in-patient admission and remission and relapse of positive symptoms in first-episode psychosis.

Method: The study was a prospective 15-month follow-up investigation of 103 patients with first-episode psychosis recruited from three mental health services.

Do adults in contact with Australia's public sector mental health services get better?

This paper describes the outcomes of episodes of care for adults in public sector mental health services across Australia, with a view to informing the debate on service quality. Health of the Nation Outcome Scales (HoNOS) change scores and effect sizes were calculated for 14,659 acute inpatient episodes and 23,692 community episodes. The results showed that people in contact with public sector mental health services generally do get better, although the magnitude of improvement depends on the setting and episode type.

Human error and time of occurrence in hazardous material events in mining and manufacturing.

Human error has played a role in several large-scale hazardous materials events. To assess how human error and time of occurrence may have contributed to acute chemical releases, data from the Hazardous Substances Emergency Events Surveillance (HSEES) system for 1996-2003 were analyzed. Analyses were restricted to events in mining or manufacturing where human error was a contributing factor.

Models of psychological service provision under Australia's Better Outcomes in Mental Health Care program.

The Access to Allied Psychological Services component of Australia's Better Outcomes in Mental Health Care program enables eligible general practitioners to refer consumers to allied health professionals for affordable, evidence-based mental health care, via 108 projects conducted by Divisions of General Practice. The current study profiled the models of service delivery across these projects, and examined whether particular models were associated with differential levels of access to services. We found: 76% of projects were retaining their allied health professionals under contract, 28% via direct employment, and 7% some other way; Allied health professionals were providing services from GPs' rooms in 63% of projects, from their own rooms in 63%, from a third location in 42%; and The referral mechanism of choice was direct referral in 51% of projects, a voucher system in 27%, a brokerage system in 24%, and a register system in 25%.

Functional specialization within rostral prefrontal cortex (area 10): a meta-analysis.

One of the least well understood regions of the human brain is rostral prefrontal cortex, approximating Brodmann's area 10. Here, we investigate the possibility that there are functional subdivisions within this region by conducting a meta-analysis of 104 functional neuroimaging studies (using positron emission tomography/functional magnetic resonance imaging). Studies involving working memory and episodic memory retrieval were disproportionately associated with lateral activations, whereas studies involving mentalizing (i.

Discriminating imagined from perceived information engages brain areas implicated in schizophrenia.

Some of the symptoms of schizophrenia may reflect a difficulty discriminating between information that was perceived from the outside world and information that was imagined. This study used fMRI to examine the brain regions associated with this reality monitoring ability in healthy volunteers, who recollected whether information had previously been perceived or imagined, or whether information had been presented on the left or right of a monitor screen. Recent studies have suggested that schizophrenia may be associated particularly with dysfunction in medial anterior prefrontal cortex, thalamus, and cerebellum.

Do community treatment orders for mental illness reduce readmission to hospital? An epidemiological study.

Background: It has been suggested that community treatment orders (CTOs) will prevent readmission to hospital, but controlled studies have been inconclusive. We aimed to test the hypothesis that hospital discharges made subject to CTOs are associated with a reduced risk of readmission. The use of such a measure is likely to change after its introduction as clinicians acquire familiarity with it, and we also tested the hypothesis that the characteristics of patients subject to CTOs changed over time in the first decade of their use in Victoria, Australia.

Developing a New Zealand casemix classification for mental health services.

This study aimed to develop a casemix classification of characteristics of New Zealand mental health services users. Over a six month period, patient information, staff time and service costs were collected from 8 district health boards. This information was analysed seeking the classification of service user characteristics which best predicted the cost drivers of the services provided.

Increased health care utilization and increased antiretroviral use in HIV-infected individuals with mental health disorders.

Objectives: The aims of the study were to describe the prevalence and associations of mental health disorder (MHD) among a cohort of HIV-infected patients attending the Victorian HIV/AIDS Service between 1984 and 2000, and to examine whether antiretroviral therapy use or mortality was influenced by MHD (defined as a record of service provision by psychiatric services on the Victorian Psychiatric Case Register). It was hypothesized that HIV-positive individuals with MHD would have poorer treatment outcomes, reduced responses to highly active antiretroviral therapy (HAART) and increased mortality compared with those without MHD.

Methods: This is a retrospective cohort of 2981 individuals (73% of the Victorian population diagnosed with HIV infection) captured on an HIV database which was electronically matched with the public Victorian Psychiatric Case Register (VPCR) (accounting for 95% of public system psychiatry service provision).

The case for the development and use of "ecologically valid" measures of executive function in experimental and clinical neuropsychology.

This article considers the scientific process whereby new and better clinical tests of executive function might be developed, and what form they might take. We argue that many of the traditional tests of executive function most commonly in use (e.g.