Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis.

BACKGROUND: There are insufficient data from nationwide surveys on the prevalence of specific psychotic disorders and associated co-morbidities. METHOD: The 2010 Australian national psychosis survey used a two-phase design to draw a representative sample of adults aged 18-64 years with psychotic disorders in contact with public treatment services from an estimated resident population of 1 464 923 adults. This paper is based on data from 1642 participants with an International Classification of Diseases (ICD)-10 psychotic disorder. Its aim is to present estimates of treated prevalence and lifetime morbid risk of psychosis, and to describe the cognitive, physical health and substance use profiles of participants. RESULTS: The 1-month treated prevalence of psychotic disorders was 3.10 cases per 1000 population aged 18-64 years, not accounting for people solely accessing primary care services; lifetime morbid risk was 3.45 per 1000. Mean premorbid intelligence quotient was approximately 0.5 s.d.s below the population mean; current cognitive ability (measured with a digit symbol coding task) was 1.6 s.d.s below the population mean. For both cognitive tests, higher scores were significantly associated with better independent functioning. The prevalence of the metabolic syndrome was high, affecting 60.8% of participants, and pervasive across diagnostic groups. Of the participants, two-thirds (65.9%) were current smokers, 47.4% were obese and 32.4% were sedentary. Of the participants, half (49.8%) had a lifetime history of alcohol abuse/dependence and 50.8% lifetime cannabis abuse/dependence. CONCLUSIONS: Our findings highlight the need for comprehensive, integrative models of recovery to maximize the potential for good health and quality of life for people with psychotic illness.

Prospective study of early bereavement on psychological and behavioural cardiac risk factors.

BACKGROUND: Increasing evidence supports the role of emotional stress in the onset of cardiovascular disease. Although bereavement is a major emotional stress with both acute and more long-term features, the mechanism of its association with cardiovascular risk is not well understood, in particular because of limited studies of acute bereavement. The aim of the study was to identify psychological and behavioural changes in acute bereavement and potential modifiers of these changes. METHODS: Bereaved (n= 62) and non-bereaved individuals (n= 50) were evaluated within 2 weeks and at 6 months following loss using the Centre for Epidemiologic Studies -- Depression, Spielberger State Anxiety and Anger, Social Support Questionnaire and changes in appetite, cigarette and alcohol consumption, cortisol and lipids. RESULTS: Compared with non-bereaved, acutely bereaved had increased symptoms of depression (26.7 +/- 1.7 vs 5.9 +/- 0.7, P < 0.001), anxiety (47.4 +/- 2.0 vs 28.2 +/- 1.4, P < 0.001) and anger (median 16.0 vs 15.0, P < 0.001). Greater depressive symptoms were associated with being unprepared for the death, decreased sleep duration and younger age. Acutely, bereaved slept less than non-bereaved (5.8 +/- 0.2 vs 7.2 +/- 0.2 h, P < 0.001). Reduced sleep time was associated with increased anger and depression and decreased satisfaction with social support. Compared with the non-bereaved, the acutely bereaved had higher cortisol (median 306 vs 266, P= 0.003), reduced appetite (P < 0.001) and lower total cholesterol (median 4.9 vs 5.4, P= 0.006) and low-density lipoprotein (median 2.4 vs 2.9, P < 0.001). CONCLUSION: These results offer insight into the psychological, behavioural and physical changes that may contribute to cardiovascular risk in bereavement.

Daytime sleepiness and sleep habits of Australian workers.

Excessive daytime sleepiness in the general community is a newly recognized problem about which there is little standardized information. Our aim was to measure the levels of daytime sleepiness and the prevalence of excessive daytime sleepiness in a sample of Australian workers and to relate that to their self-reported sleep habits at night and to their age, sex, and obesity. Sixty-five percent of all 507 employees working during the day for a branch of an Australian corporation answered a sleep questionnaire and the Epworth sleepiness scale (ESS) anonymously. Normal sleepers, without any evidence of a sleep disorder, had ESS scores between 0 and 10, with a mean of 4.6 +/- 2.8 (standard deviation). They were clearly separated from the "sleepy" patients suffering from narcolepsy or idiopathic hypersomnia whose ESS scores were in the range 12-24, as described previously. ESS scores > 10 were taken to represent excessive daytime sleepiness, the prevalence of which was 10.9%. This was not related significantly to age (22-59 years), sex, obesity, or the use of hypnotic drugs but was related significantly but weakly to sleep-disordered breathing (frequency of snoring and apneas), the presence of insomnia, and reduced time spent in bed (insufficient sleep).

Comments on "A critical review of epidemiologic studies of radiofrequency exposure and human cancers".

Comments on Elwood's article: A critical review of epidemiologic studies of radiofrequency exposure and human cancers. Environ Health Perspect 107(suppl 1):155-168 (1999).

Implanted medical devices in workers exposed to radio-frequency radiation.

This paper discusses the management of radio-frequency radiation workers who have implanted medical devices which may be adversely affected by such radiation fields. The implants include orthopedic devices, cardiac pacemakers, and cochlear implants, but exclude dental work. The effect of radio-frequency radiation on the devices may be to increase heat load and/or produce signal interference. The mechanics of interaction are outlined and protocols for managing cases are described. The implications for safety standards are discussed.

Training to enhance partnerships between mental health professionals and family caregivers: a comparative study.

A training program for mental health staff was collaboratively developed and delivered by family caregivers and professionals. It addressed calls for less blaming attitudes toward families and increased contact between professionals and families. Two levels of training were compared. Twenty-seven staff members completed a 30-hour extended 12-week program. Eighty-two percent of all eligible staff from area teams attended a brief program involving three or six hours of training. Self-ratings of competence and attitudes toward families improved only for staff receiving extended training. Contacts with families increased for those in the extended program but not for all types of teams, suggesting that length of training and service type may limit the impact of training.

Infant feeding patterns.

The feeding patterns of 437 infants, aged less than 1 month to 12 months, were studied by interview and questionnaire in 11 Maternal Child Health Centres of the Melbourne City Council. Ninety-nine mothers had never breast fed, 146 breast fed for less than 5 months. The major additives to formula, drinks and to dummies were a wide range of sweetening agents including sucrose, honey, syrups, and vitamin C preparations. Some mothers tasted the drinks and food to adjust to their own taste. Older mothers consumed less sugar themselves and gave less to the child. Lone mothers used more additives than married ones. With the introduction of solid foods, salt or salt-containing preparations increased to form 60 per cent of the additives used. There was a trend to more sweetened additives in some ethnic groups. Most mothers were aware of the dental hazards of sugar.

Health aspects of radio-frequency radiation accidents. Part II: A proposed protocol for assessment of health effects in radio-frequency radiation accidents.

A protocol is proposed for the assessment of health effects following a radio-frequency radiation accident. The protocol is intended to ensure uniform recording of exposure and medical data. This should meet the requirements of the individuals exposed as well as contributing to scientific knowledge. Difficult aspects about the collection of exposure and medical data are discussed and the need to consider the feelings of the exposed individual(s) is emphasized.

Health aspects of radio-frequency radiation accidents. Part I: Assessment of health after a radio-frequency radiation accident.

The health aspects of an accident involving nine men exposed to 4.1 GHz radio-frequency radiation (RFR) is described. Two were exposed to levels of 4.6 mW/cm2 for up to 90 minutes, which exceeds the current Australian standard of 1 mW/cm2, while the other seven were exposed to lower levels. For staff in the high-exposure group, the dose rate was calculated for the whole body, skin, eyes, and pituitary. Comprehensive medical examinations were performed on all staff, including follow-up ophthalmological examinations over a period of nine months. Various abnormalities were found in all staff but, with the possible exception of hair loss, there was no consistent gradient of effect in the occurrence of abnormality between the groups. Various problems in conducting the investigation are discussed. It was concluded that the exposure had not resulted in harmful effects.

Occupational stress.

This paper briefly reviews some current trends in thinking about occupational stress. The most interesting recent work relates to: (1) quantification of the contribution 'stress' makes to (psychosomatic) illness; and (2) the trend to view work stress as a particular case of man trying to maintain harmony between various environmental demands and his ability to cope.

Management of radiofrequency radiation overexposures.

BACKGROUND: Radiofrequency radiation (RFR) has been in use for some time but is now proliferative with the burgeoning radiocommunications industry. OBJECTIVE: To inform the profession of the possible health effects from overexposure to radiofrequency radiation (RFR) and the clinical approach to cases. An introduction to the health effects of overexposure to RFR is given. A clinical approach to integrating the patient's symptoms and the circumstances of the exposure is given. Emergency treatment and ongoing care is outlined, and sources of expert advice given. CONCLUSION: Overexposure to RFR is a complex injury. Advice is given in this article for emergency care and planning ongoing care.

Health assessment for commercial driving. The general practitioners' role.

Death and injury rates associated with commercial vehicle driving are unacceptably high. Pre-existing medical conditions may contribute to road accidents and the National Road Transport Commission (NRTC) has developed a set of uniform guidelines, based on best available evidence, which might preclude at risk individuals from holding commercial licences. Standardised clinical examinations performed by general practitioners (GPs) will be used to assist regulatory authorities in their licensing procedures. This article sets out the process of development of the guidelines as well as the construction and use of a medical assessment form to be used by GPs in facilitating the licensing process in each State.

Recent advances in gastro-enteritis.

This paper briefly reviews new knowledge about the causes, consequences and control of gastro-enteritis. Various recently discovered viral and bacterial causes of gastro-enteritis are discussed and the possible role of prolonged gut infection in causing malabsorption and thus malnutrition, considered. The revival of interest in prevention by improved water supplies is discussed and the need to critically evaluate the relative importance of the quality and quantity of a water supply stressed. Some newer regimes for treating acute and chronic infections are also discussed.

Duovirus infection as a cause of infantile gastro-enteritis in Port Moresby.

A preliminary study of nine children under five years of age admitted to Port Moresby General Hospital with acute gastro-enteritis showed that five (56%) were excreting duovirus in their stools as shown by electron microscopy. Duovirus was not demonstrated in the stools of any of eight children with gastro-enteritis seen at Kainantu Health Centre.