Medicine & Health

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Now showing 1 - 10 of 56
  • (2012) Sunderland, Matthew; Slade, Tim; Andrews, Gavin
    Journal Article
    Diagnostic instruments must be relatively free from respondent burden and cost effective to administer whilst remaining faithful to the psychiatric nomenclature. It seems logical to develop short form alternatives to rather lengthy and complicated diagnostic interviews to facilitate large scale data collection. The current study examines one method, signal detection theory, for developing a short form interview based on the Composite International Diagnostic Interview version 3.0. The method was able to retain the smallest number of items to predict a lifetime and 30 day DSM-IV diagnosis for ten disorders. Concordance analyses between the full form and the short form modules, demonstrated an excellent level of agreement in the whole sample and various subsamples of the Australian population as well as in an international comparison sample of the U.S. population. The good concordance between the long form and the short form demonstrates the ability of signal detection theory to assist in the development of valid short forms, which could replace lengthy diagnostic interviews when the aim is to reduce respondent burden and overall research costs.

  • (2012) Williams, Alishia
    Journal Article
    Compulsive buying (CB) is not only associated with impulse control disorders and specific domains of impulsivity, but is also highly comorbid with negative affect and depression, making it a candidate disorder to be characterised by poor emotion regulation. Despite emerging research supporting an association between distress tolerance and disorders of dysregulated behaviour, no study has investigated distress tolerance in the context of CB. The aim of the current study was to explore the relationship between CB and four specific domains of distress tolerance (appraisal, tolerance, absorption, regulation) and experiential avoidance. In a community-recruited sample of compulsive buyers (n = 47) and healthy controls (n = 38), CB was significantly associated with each of the domains of distress tolerance (Distress Tolerance Scale). Furthermore, CB was associated with greater experiential avoidance (Acceptance and Action Questionnaire), which was in turn associated with each domain of distress tolerance. Analysis of variance demonstrated significant group differences in all measures. Nonparametric bootstrapping analysis revealed that general psychopathology, impulsivity, and experiential avoidance could not fully account for the relationship between distress tolerance and CB severity. Results suggest that distress tolerance and experiential avoidance may represent therapeutic targets in CB. Limitations and future directions are discussed.

  • (2012) Thompson, Rachel
    Conference Paper
    Critical thinking is an inherent element of the troublesome and metacognitive nature of the threshold concept as defined by Meyer and Land (2003; 2005) and also has been examined as a threshold concept in its own right, for instance within information research. Furthermore, research on the interdisciplinary nature of critical thinking highlights the importance of learning these skills within a specific discipline area in order to enable later transference to other disciplines (Entwistle, 2008; Perkins and Salamon, 1992). Thus, criticality appears to be key to academic disciplinary development and existence. Barnett (1997) takes this further and champions a more holistic view, namely that graduates should aim to become critical practitioners; a state of being he believes is necessary for students and indeed academics to achieve their full potential within the world. However, various social-cultural pressures (such as accrediting professional bodies) exert a strong influence on how students learn criticality in higher education. In this paper, I will argue that critical thinking is a major interdisciplinary threshold concept in its own right and hence can be defined as and at the same time be defining of a threshold concept. Furthermore, using a sociological perspective, I will explore the dynamics that influence a graduate’s learning path to becoming a critical practitioner and in particular, analyse the relationship between critical thinking and power within the higher education system. Consequently, I will show how this system creates and frames threshold concepts that in turn define the substance and boundaries of the disciplines, which, in their turn act to restrict the extent to which students control and extend their mastery of criticality, thus inhibiting the very skill that education claims to value above all others.

  • (2013) Treloar, Carla; Rance, Jake; Grebely, Jason; Dore, Gregory
    Journal Article
    Internationally, there are ongoing efforts to increase access to hepatitis C (HCV) assessment and treatment to counter a generally low uptake of treatment among people with a history of injecting drug use. The aim of this qualitative study was to examine client and staff attitudes towards and experience of co-location of HCV and opioid substitution treatment (OST) services. METHODS: In-depth interviews were conducted with 57 clients and 19 staff from four NSW clinics participating in the Australian ETHOS study. RESULTS: Client and staff participants typically welcomed integrated treatment, citing issues of convenience, reduced travel time and costs, persistent cues to engagement and immediacy of access to care. Positive attitudes towards the initiative were expressed even by clients who had not engaged with HCV care. Providing co-located care largely avoided the negative, stigmatising or discriminatory experiences that participants reported encountering in settings less familiar with people who use drugs. A minority of client participants expressed concerns about the lack of privacy and/or confidentiality available in the co-located model, preferring to seek HCV care elsewhere. CONCLUSIONS: The co-location of HCV care in OST clinics was welcomed by the large majority of participants in this study. Besides issues of convenience, the appeal of the co-located service centred on the familiarity of existing relationships between clients and staff in the OST setting. While some clients remained distrustful of OST and chose not to take up HCV care in this setting, the co-located treatment model was overwhelmingly successful amongst both client and staff participants.

  • (2012) Laube, Robyn; Govender, Sendhil; Colebatch, James
    Journal Article
    An impulsive acceleration stimulus, previously shown to activate vestibular afferents, was applied to the mastoid. Evoked EMG responses from the soleus muscles in healthy subjects (n = 10) and patients with bilateral vestibular dysfunction (n = 3) were recorded and compared with the effects of galvanic stimulation (GVS). Subjects were stimulated while having their eyes closed, head rotated and while tonically activating their soleus muscles. Rectified EMG responses were recorded from the leg contralateral to the direction of head rotation. Responses were characterised by triphasic potentials that consisted of short latency (SL), medium latency (ML) and long latency (LL) components beginning at (mean ± SD) 54.2 ± 4.8 ms, 88.4 ± 4.7 ms and 121 ± 7.1 ms respectively. Mean amplitudes across all conditions were 6.9 ± 3.2 % for the SL interval, 12.5 ± 6.8 % for ML interval, and 7.5 ± 4.1 % for the LL interval, compared to prestimulus values. Stimulus rise times of 14 and 20 ms evoked the largest ML amplitudes. GVS evoked biphasic responses (SL and ML) with similar latencies. Like GVS, the polarity of the initial interval was determined by the direction of head acceleration and the evoked EMG response was attenuated when subjects were seated. There was no significant EMG response evoked when subjects were stimulated using 500 Hz vibration or in patients with bilateral vestibular dysfunction. Our study demonstrates that a brief lateral acceleration, likely to activate the utricle, can evoke spinal responses with properties similar to those previously shown for vestibular activation by GVS. The triphasic nature of the responses may allow the nervous system to respond differently to short compared to long duration linear accelerations, consistent with their differing significance.

  • (2013) Marel, Christina; Mills, Katherine; Darke, Shane; Ross, Joanne; Slade, Tim; Burns, Lucy; Teesson, Maree
    Journal Article
    Background The link between heroin use and crime has been well established; however, there has been little opportunity to examine this relationship longitudinally. This study examines the relationship between static and dynamic predictors of criminal involvement, and the degree to which changes in dynamic risk factors moderate the risk of criminal involvement over time. Method Data was collected as part of the Australian Treatment Outcome Study, a 3-year longitudinal study of 615 people with heroin dependence conducted in Sydney, Australia. Past-month criminal involvement (property crime, drug dealing, fraud, violent crime), demographic, drug use and mental health characteristics were assessed at each interview. Results Criminal involvement was consistently and independently predicted by lack of wage/salary as a main source of income, (OR 2.17), meeting diagnostic criteria for anti-social personality disorder (OR 1.91) and major depression (OR 1.41), screening positive for borderline personality disorder (OR 1.47), male sex (OR 1.44), a criminal history (OR 1.33), greater severity of dependence (OR 1.21), more extensive heroin use (OR 1.09), and younger age (OR 0.96) over the 3-year period. Conclusions These findings provide strong evidence of the robust nature of the association between more extensive heroin use, severity of dependence, the co-occurrence of mental health conditions, and an individual’s capacity for employment, and criminal involvement. Interventions aimed at increasing an individual’s employability and improving mental health in particular, may reduce the risk of criminal involvement among people with heroin dependence.

  • (2012) Mills, Katherine; Teesson, Maree; Back, Sudie; Brady, Kathleen; Baker, Amanda; Hopwood, Sally; Sannibale, Claudia; Barrett, Emma; Merz, Sabine; Rosenfeld, Julia; Ewer, Philippa
    Journal Article
    Context: There is concern that exposure therapy, an evidence-based cognitive-behavioral treatment for posttraumatic stress disorder (PTSD), may be inappropriate for patients with co-occurring substance dependence (SD). Objective: To determine whether an integrated treatment for PTSD and SD, Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE), can achieve greater reductions in PTSD and SD symptom severity compared to treatment as usual (TAU) for SD. Design, Setting, and Patients: A randomized controlled trial of 103 participants who met DSM-IV-TR criteria for both PTSD and SD. Participants were recruited from 2007-2009 in Sydney, Australia, and randomized to one of two conditions. The treatment group received COPE plus TAU (COPE+TAU; n=55) and the control group received TAU alone (n=48). Outcomes were assessed at 9-months post-baseline, and interim measures collected at 6-weeks and 3-months post-baseline. Interventions: COPE consists of 13 individual 90-minute sessions (i.e., 19.5 hours) with a clinical psychologist. It represents an integration of existing evidence based manualized cognitive behavioral treatments for PTSD and SD, comprising psychoeducation, motivational enhancement, and cognitive behavioral therapy for PTSD and SD, including imaginal and in vivo exposure. Main outcome measures: Change in PTSD symptom severity as measured by the Clinician Administered PTSD Scale (CAPS; scale range 0-240), and change in severity of SD as measured by the number of dependence criteria met according to the Composite International Diagnostic Interview version 3.0 (CIDI; range 0-7), from baseline to 9-month follow-up. A change of 15 points on the CAPS scale and 1 dependence criteria on the CIDI were considered to be clinically significant. Results: From baseline to 9-month follow-up, significant reductions in PTSD symptom severity were found for both the treatment (mean difference -38.24, 95%CI: -47.93 - -28.54) and control group (mean difference -22.14, 95%CI: -30.33 - -13.95), however, the treatment group demonstrated a significantly greater reduction in PTSD symptom severity compared to the control group (mean difference -16.09, 95%CI: -29.00 to -3.19). No significant between group difference was found in relation to improvement in severity of SD (0.43 v 0.52; IRR 0.85, 95%CI: 0.60 - 1.21), nor were there any significant between group differences in relation to changes in substance use, depression or anxiety. Conclusions: Among patients with PTSD and SD, the combined use of COPE+TAU, compared with TAU alone, resulted in improvement in PTSD symptom severity without an increase in severity of SD. Trial registration: Registration number ISRCTN12908171; URL:

  • (2012) Handley, Tonelle; Inder, Kerry; Kelly, Brian; Lewin, Terry; Fitzgerald, Michael; Kay-Lambkin, Frances
    Journal Article

  • (2013) Apte, Minoti; Yang, Lu; Phillips, Phoebe; Xu, Zhihong; Kaplan, Warren; Cowley, Mark
    Journal Article
    Activated pancreatic stellate cells (PSCs) are responsible for the fibrotic matrix of chronic pancreatitis and pancreatic cancer. In vitro protocols examining PSC biology have usually involved PSCs cultured on plastic, a non-physiological surface. However, PSCs cultured on physiological matrices e.g. MatrigelTM (normal basement membrane) and collagen (fibrotic pancreas), may have distinctly different behaviours compared to cells cultured on plastic. Therefore, we aimed to i) compare PSC gene expression after culture on plastic, MatrigelTM and collagen I; ii) validate the gene array data for transgelin, the most highly dysregulated gene in PSCs grown on activating versus non-activating matrices, at mRNA and protein levels; iii) examine the role of transgelin in PSC function; and iv) assess transgelin expression in human chronic pancreatitis sections. Culture of PSCs on different matrices significantly affected their gene expression pattern. 146, 619 and 432 genes respectively were differentially expressed (p < 0.001) in PSCs cultured on collagen I vs MatrigelTM, MatrigelTM vs plastic and collagen I vs plastic. The highest fold change (12.5 fold upregulation) in gene expression in cells on collagen I vs MatrigelTM, was observed for transgelin (an actin stress fibre associated protein). Transgelin was significantly increased in activated PSCs versus quiescent PSCs. Silencing transgelin expression decreased PSC proliferation and also reduced platelet derived growth factor (PDGF)-induced PSC migration. Notably, transgelin was highly expressed in chronic pancreatitis in stromal areas and peri-acinar spaces but was absent in acinar cells. These findings suggest that transgelin is a potentially useful target protein to modulate PSC function so as to ameliorate pancreatic fibrosis.

  • (2012) Apte, Minoti; Pirola, Romano; Wilson, Jeremy; Reddy, Nageshwar
    Book Chapter
    The past decade has seen rapid advances in our understanding of the fibrogenic process in the pancreas mainly due to the elucidation of the biology of the cells that are critical to this process. However, it is also becoming increasingly clear that PSCs do not merely exist to regulate ECM turnover in health and disease, but may also have other important roles in the normal pancreas as immune cells and/or progenitor cells. In vitro and in vivo experimental studies have provided encouraging results in terms of developing therapeutic strategies to target PSCs in chronic pancreatitis and pancreatic cancer. The challenge that remains is to translate these findings to the clinical situation so as to improve the outcome for patients afflicted with these diseases.