Preparing interdisciplinary leadership for a sustainable future.

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.

Are drug detection dogs and mass-media campaigns likely to be effective policy responses to psychostimulant use and related harm? Results from an agent-based simulation model.

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.

SimAmph: an agent-based simulation model for exploring the use of psychostimulants and related harm amongst young Australians.

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.

Models of policy-making and their relevance for drug research.

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.

A research routine to assess bias introduced by low response rates in postal surveys.

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.

Extending drug ethno-epidemiology using agent-based modelling.

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.

Improving nurses' therapeutic attitude to patients who use illicit drugs: workplace drug and alcohol education is not enough.

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.

Fast-tracking implementation through trial design: the case of buprenorphine treatment in Victoria.

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.

The determinants of nurses' therapeutic attitude to patients who use illicit drugs and implications for workforce development.

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.

Effective drug policy: a new approach demonstrated in the Drug Policy Modelling Program.

The aim of this paper is to describe a new comprehensive approach to studying illicit drug policy - one that integrates evidence, disciplinary approaches, drug use behaviours and policy making processes. The methods described here include systematic reviews of the evidence, studies of the ways in which policy decision-making actually occurs, and the use of modelling approaches that can explicate the multi-dimensional nature of drug policy responses and their dynamic interactions. The approach described has the potential to facilitate new drug policy that would not have been possible or apparent through the sole study of one aspect of drug policy, such as the evidence-base or the political context or the economics of drug markets.

When is a little knowledge dangerous? Circumstances of recent heroin overdose and links to knowledge of overdose risk factors.

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.

Transient changes in behaviour lead to heroin overdose: results from a case-crossover study of non-fatal overdose.

Background And Aims: Heroin overdose is a serious consequence of heroin use and one of the leading causes of premature death and illness in Australia. Despite considerable research effort little is known about the effects of transient changes in heroin user behaviour and the links to overdose. This research is the first to use a suitable methodology to allow such ephemeral changes and their effects on non-fatal heroin overdose to be examined.

Aged care services for indigenous people in the Australian Capital Territory and surrounds: analysing needs and implementing change.

Objective: To ascertain and meet current and anticipated needs for residential care and other services by older Indigenous people in the Australian Capital Territory (ACT) and region.

Methods: With advice from a reference group, qualitative and quantitative data were gathered from 98 older (45 years and over) Indigenous people in the ACT and region during 1999/2000. Indigenous and non-Indigenous researchers worked closely throughout all phases of the research.

What can the Swiss and Dutch trials tell us about the potential risks associated with heroin prescribing?

Following on from last edition's Harm Reduction Digest on drug consumption facilities this Digest investigates what can be learnt from the Swiss and Dutch trials of heroin prescribing about the unintended consequences of this controversial intervention to reduce heroin-related harm. The authors of the paper bring considerable experience in the implementation and evaluation of such schemes in Europe and their consideration in Australia. The paper systematically addresses concerns about heroin prescribing and suggests further research to respond to some unanswered questions.

Implementing buprenorphine treatment in community settings in Australia: experiences from the Buprenorphine Implementation Trial.

Buprenorphine was registered in Australia as a maintenance and detoxification agent for the management of opioid dependence in November, 2000, and became widely available in August, 2001. This paper provides an overview of key developments in the introduction of buprenorphine treatment in Australia, with an emphasis upon the delivery of services in community-based (primary care) settings. A central study in this work was the Buprenorphine Implementation Trial (BIT), a randomized, controlled trial comparing buprenorphine and methadone maintenance treatment delivered under naturalistic conditions by specialist and community-based service providers (general practitioners and community pharmacists) in 139 subjects across nineteen treatment sites.

Women, work and musculoskeletal health.

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).

Disturbingly low levels of contraception among women living with hepatitis C.

Objective: To describe the prevalence of contraception among a sample of women with hepatitis C (HCV), compare it with contraceptive use among Australian women generally, and look for associations between contraception and sample characteristics.

Method: Women who self-identified as living with HCV were recruited through a wide range of non-clinical and clinical sites in the Australian Capital Territory (ACT) and Victoria to complete a self-administered questionnaire.

Results: Seventy-five per cent of distributed questionnaires were completed and returned.

The injection of methadone syrup in New South Wales: patterns of use and increased harm after partial banning of injecting equipment.

Objective: To describe methadone injectors and the risk practices associated with injecting methadone in New South Wales, Australia. To assess the impact on injecting drug use and risk behaviour of the withdrawal of methadone injecting equipment from government-funded needle and syringe programs.

Method: Cross-sectional survey, conducted in 1999, of 206 people who had injected methadone at least once in the previous month.

A randomized trial comparing levo-alpha acetylmethadol with methadone maintenance for patients in primary care settings in Australia.

Aims: The present study aimed to compare the efficacy of levo-alpha-acetylmethadol (LAAM) and methadone, as measured by retention in treatment and heroin use, in a randomized trial conducted under naturalistic conditions.

Setting: This study is the first randomized trial comparing LAAM with methadone in the primary care setting. Participants were recruited through 29 medical practitioners working in specialist and generalist settings in Australia.

Comparative assessment of transport risks--how it can contribute to health impact assessment of transport policies.

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.

Buprenorphine dosing regime for inpatient heroin withdrawal: a symptom-triggered dose titration study.

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).