Review of Australia's funding commitments for suicide prevention from 2021-22 to 2026-27.

Objective Examine the distribution of funding for suicide prevention in Australia from 2021-22 to 2026-27. Methods Government websites were reviewed to locate budget documents related to suicide prevention funding. Information was extracted on the program/service to be funded, and the funder entity, duration, and year allocation. Extracted data was reviewed to identify commonly targeted sub-populations. Results The majority of suicide prevention-related funding was allocated to aftercare for persons who have attempted suicide, consistent with the effectiveness of these services, followed by programs targeting the general population. Little funding was allocated to other specific sub-populations, such as young people and Aboriginal and Torres Strait Islander peoples. The amount of funding allocated to suicide prevention varied across jurisdictions, which is only partially explained by suicide rates. Conclusions There is a need for greater investment in care for specific sub-populations who are at higher risk of suicide. This study provides a baseline for comparing future investments in suicide prevention in Australia.

Using the National Mental Health Service Planning Framework to inform integrated regional planning: a case study in Tasmania, Australia.

BACKGROUND: The aim of this study was to demonstrate the application of a needs-based mental health service planning model in Tasmania, Australia to identify indicative directions for future service development that ensure the equitable provision of mental health services across the State. METHODS: The activity and capacity of Tasmania's 2018-19 mental health services were compared to estimates of required care by: (1) generating estimates of required care using the National Mental Health Service Planning Framework (NMHSPF); (2) collating administrative mental health services data; (3) aligning administrative data to the NMHSPF; and (4) comparing aligned administrative data and NMHSPF estimates to identify priority areas for service development. Findings were contextualised using information about service location, population demographics, and upcoming service development. RESULTS: Bed-based services capacity reached 85% of the NMHSPF estimate. However, access to certain bed types was inequitable across regional areas. Access to jurisdictional clinical ambulatory team-based services was lowest in the South, while overall full-time equivalent staff capacity reached 58% of the NMHSPF estimate. Access to Primary Health Tasmania (PHT) primary care services was highest in the North West; access to Medicare services was highest in the South. Collectively, activity across primary care (PHT, headspace and Medicare) reached 43% of the NMHSPF estimate. Over half of Community Managed Mental Health Support Services were state-wide services. CONCLUSIONS: This study demonstrates the application of a needs-based planning model for mental health services. Findings revealed service priority areas across Tasmania and highlight considerations for needs-based planning.

Analysis of data items and gaps in Australia's national mental health services activity and capacity data collections for integrated regional service planning.

Background: Services data are an important source of information for policymakers and planners. In Australia, significant work has been undertaken to develop and implement collections of mental health services data. Given this level of investment, it is important that collected data are fit for purpose. Objective: This study aimed to: (1) identify existing national mandated and best endeavours collections of mental health services activity (e.g. occasions of service) and capacity (e.g. full-time equivalent staff) data in Australia; and (2) review the content of identified data collections to determine opportunities for data development. Method: A grey literature search was conducted to identify data collections. Where available, metadata and/or data were analysed. Results: Twenty data collections were identified. For services that received funding via multiple funding streams, data were often captured across several collections corresponding with each funder. There was significant variability in the content and format of collections. Unlike other service sectors, there is no national, mandated collection for psychosocial support services. Some collections have limited utility as they do not include key activity data; others do not include descriptive variables like service type. Workforce data are often not collected, and where data are collected, they are often not comprehensive. Conclusion: Findings are an important source of information for policymakers and planners who use services data to inform priorities. Implications: This study provides recommendations for data development, including mandating standardised reporting for psychosocial supports, filling workforce data gaps, streamlining data collections and including key missing data items in some collections.

A review of excluded groups and non-response in population-based mental health surveys from high-income countries.

National mental health surveys play a critical role in determining the prevalence of mental disorders in a population and informing service planning. However, current surveys have important limitations, including the exclusion of key vulnerable groups and increasing rates of non-response. This review aims to synthesise information on excluded and undersampled groups in national mental health surveys. We conducted a targeted review of nationally representative adult mental health surveys performed between 2005 and 2019 in high-income OECD countries. Sixteen surveys met our inclusion criteria. The response rate for included surveys ranged between 36.3% and 80.0%. The most frequently excluded groups included people who were homeless, people in hospitals or health facilities and people in correctional facilities. Males and young people were the most commonly underrepresented groups among respondents. Attempts to collect data from non-responders and excluded populations were limited, but suggest that mental health status differs among some of these cohorts. The exclusion of key vulnerable groups and high rates of non-response have important implications for interpreting and using the results of national mental health surveys. Targeted supplementary surveys of excluded or hard-to-reach populations, more inclusive sampling methodologies, and strategies aimed at improving response rates should be considered to strengthen the accuracy and usefulness of survey findings.

Estimating demand for mental health care among Australian children and adolescents: Findings from the Young Minds Matter survey.

OBJECTIVE: Mental health service use by individuals without a diagnosed mental disorder is sometimes termed 'met un-need'. However, provision of services for this group may be necessary to provide appropriate assessment, referral and early intervention. This study quantified child and adolescent use of, and perceived need for, mental health services to inform population-level service planning. METHODS: Young people in Australia's Young Minds Matter survey (n = 5837, 5-17 years), were categorised into four 'need' groups: (1) 12-month mental disorder diagnosis; (2) remitted for more than 12 months (or experiencing a condition not surveyed); (3) 12-month subthreshold mental health problem; and (4) no indication of need for help (i.e. did not meet the requirements of the first three categories). Service demand (use of, or perceived need for, a mental health service) and number of sessions received were estimated for each, separately for children (5-11 years) and adolescents (12-17 years). RESULTS: Some 20.1% (95% CI: [18.6, 21.7]) of children and 32.3% (95% CI: [30.5, 34.2]) of adolescents expressed a demand for mental health services in the past year. Service demand decreased across the need groups. Perceived need without service use was higher among those with a 12-month subthreshold mental health problem (13.8/20.2%) than those who had experienced a mental health problem that had remitted for more than 12 months (or were experiencing a condition not surveyed) (9.3/12.6%). In addition, 23.6% of children and 24.6% of adolescents with a demand for mental health services were classified as experiencing no indication of need for help. CONCLUSIONS: This study quantified the number of children and adolescents in Australia who are likely to require mental health services. Findings suggest that not everyone in this group who has an expressed service demand meets diagnostic thresholds, but among those who do, service demand is higher.

A New Stepping-Stone on the Path to Mathematics Success for DHH Learners.

Coeditors of a special issue of the American Annals of the Deaf on mathematics instruction in deaf education, the authors provide a context for the five featured articles. First, the authors establish the importance of mathematics. They then give a historical account of previously related "stepping-stones." Beginning at 1990, the authors follow key events in the field that have led to the special issue. They summarize each article, highlighting three common themes: deaf and hard of hearing (DHH) persons as distinct and capable mathematics learners, the significance of conceptual understanding of mathematics concepts, and the role of language as a key component of mathematics instruction and learning. The authors conclude with a call for further research that recognizes the heterogeneity of DHH learners.

Counting Differently: Assessing Mathematics Achievement of Signing Deaf and Hard of Hearing Children Through a Unique Lens.

Limited studies exist that connect using signed language with mathematics performance of deaf and hard of hearing children. In the present study, the authors examined 257 participants and compared their results on the Northwest Evaluation Association: Measures of Academic Progress (NWEA MAP) to their results on an assessment of American Sign Language (ASL) skills. It was found that better ASL skills tended to result in better MAP performance. These results are moderated by factors such as age, gender, parental hearing status, and learning disability identification.

COVID-19 Patient Management in Outpatient Setting: A Population-Based Study from Southern Italy.

Evidence on treatments for early-stage COVID-19 in outpatient setting is sparse. We explored the pattern of use of drugs prescribed for COVID-19 outpatients' management in Southern Italy in the period February 2020-January 2021. This population-based cohort study was conducted using COVID-19 surveillance registry from Caserta Local Health Unit, which was linked to claims databases from the same catchment area. The date of SARS-CoV-2 infection diagnosis was the index date (ID). We evaluated demographic and clinical characteristics of the study drug users and the pattern of use of drugs prescribed for outpatient COVID-19 management. Overall, 40,030 patients were included in the analyses, with a median (IQR) age of 44 (27-58) years. More than half of the included patients were asymptomatic at the ID. Overall, during the study period, 720 (1.8%) patients died due to COVID-19. Azithromycin and glucocorticoids were the most frequently prescribed drugs, while oxygen was the less frequently prescribed therapy. The cumulative rate of recovery from COVID-19 was 84.2% at 30 days from ID and it was lower among older patients. In this study we documented that the drug prescribing patterns for COVID-19 treatment in an outpatient setting from Southern Italy was not supported from current evidence on beneficial therapies for early treatment of COVID-19, thus highlighting the need to implement strategies for improving appropriate drug prescribing in general practice.

Beta-blocker choice and exchangeability in patients with heart failure and chronic obstructive pulmonary disease: an Italian register-based cohort study.

Clinical guidelines suggest that for patients with heart failure and concurrent chronic obstructive pulmonary disease (COPD), metoprolol/bisoprolol/nebivolol should be preferred over carvedilol. However, studies suggest a high proportion of carvedilol usage that remains unexplained. Therefore, we aimed to investigate the predictors of carvedilol choice in patients with heart failure and COPD that were naïve to carvedilol or metoprolol/bisoprolol/nebivolol. Caserta Local Health Unit databases (Italy) were used as data sources. Age, sex, chronic/acute comorbidities, and co-medications were included in a logistic regression model to assess predictors of carvedilol choice. Chronic comorbidities include those defined in the Elixhauser comorbidity index and all hospitalizations within two years prior to the first beta-blocker prescription. Comedications include all redeemed prescriptions within one year prior to the beta-blocker prescription. Kernel density estimations were used to assess the overlap in propensity and preference scores distributions for receiving carvedilol and thereby potential beta-blocker exchangeability. Totally, 10091 patients composed the study population; 2011 were exposed to carvedilol. The overlapping of propensity scores distributions was 57%. Accordingly, the exchangeability was not reached. Atrioventricular block (Odds Ratio, OR 8.20; 95% Confidence Interval, 95% CI 1.30-51.80), cerebrovascular thrombosis (OR 7.06; 95% CI 1.14-43.68), chronic kidney disease (OR 4.32; 95% CI 1.16-16.02), and acute heart failure (OR 1.97; 95% CI 1.28-3.03) hospitalizations were statistically significantly associated with carvedilol choice. Analogously, human insulin (OR 3.00; 95% CI 1.24-7.24), fondaparinux (OR 2.47; 95% CI 1.17-5.21) or strontium ranelate (OR 2.03; 95% CI 1.06-3.90) redeemed prescriptions. In conclusion, this study suggests the absence of beta-blockers exchangeability and a preferential choice of carvedilol in patients with heart failure, COPD and concurrent chronic kidney disease, atrioventricular block, cerebrovascular thrombosis, acute heart failure or redeeming human insulin, fondaparinux or strontium ranelate prescriptions. Therefore, it suggests that choice of prescribing carvedilol over metoprolol/bisoprolol/nebivolol is driven by differences in comorbidities and co-treatments.

Usability of American Sign Language Videos for Presenting Mathematics Assessment Content.

There is considerable interest in determining whether high-quality American Sign Language videos can be used as an accommodation in tests of mathematics at both K-12 and postsecondary levels; and in learning more about the usability (e.g., comprehensibility) of ASL videos with two different types of signers - avatar (animated figure) and human. The researchers describe the results of administering each of nine pre-college mathematics items in both avatar and human versions to each of 31 Deaf participants with high school and post-high school backgrounds. This study differed from earlier studies by obliging the participants to rely on the ASL videos to answer the items. While participants preferred the human version over the avatar version (apparently due largely to the better expressiveness and fluency of the human), there was no discernible relationship between mathematics performance and signed version.

Indications of newer and older anti-epileptic drug use: findings from a southern Italian general practice setting from 2005-2011.

AIMS: The aim of the study was to analyze the prescribing pattern of both newer and older AEDs. METHODS: A population of almost 150 000 individuals registered with 123 general practitioners was included in this study. Patients who received at least one AED prescription over 2005-2011 were identified. The 1 year prevalence and cumulative incidence of AED use, by drug class and individual drug, were calculated over the study period. Potential predictors of starting therapy with newer AEDs were also investigated. RESULTS: The prevalence of use per 1000 inhabitants of older AEDs increased from 10.7 (95% CI10.1, 11.2) in 2005 to 13.0 (95% CI12.4, 13.6) in 2011, while the incidence remained stable. Newer AED incidence decreased from 9.4 (95% CI 8.9, 9.9) in 2005 to 7.0 (95% CI 6.6, 7.5) in 2011, with a peak of 15.5 (95% CI 14.8, 16.1) in 2006. Phenobarbital and valproic acid were the most commonly prescribed AEDs as starting therapy for epilepsy. Gabapentin and pregabalin accounted for most new pain-related prescriptions, while valproic acid and lamotrigine were increasingly used for mood disorders. Female gender (OR 1.36, 95% CI 1.20, 1.53), age ranging between 45-54 years (OR 1.39, 95% CI 1.16, 1.66) and pain as an indication (OR 16.7, 95% CI, 13.1, 21.2) were associated with newer AEDs starting therapy. CONCLUSIONS: Older AEDs were mainly used for epileptic and mood disorders, while newer drugs were preferred for neuropathic pain. Gender, age, indication of use and year of starting therapy influenced the choice of AED type. The decrease of newer AED use during 2007 is probably related to the restricted reimbursement criteria for gabapentin and pregabalin.

[Evaluation of therapeutical appropriateness in psychiatric treatment of schizophrenia, by integrating computer data records with clinical audit results]. / Valutazione dell'appropriatezza prescrittiva in psichiatria: un progetto di clinical audit nella ASL di Caserta.

AIM: The aim is to evaluate prescriptive patterns of atypical antipsychotic drugs for the treatment of schizophrenia in the LHU Caserta in 2011-2013, and to indicate potentially inappropriate therapy; to plan or schedule corrective/preventive activities to support the continuous improvement of health services. METHODS: Retrospective cohort study, based on integration of health records and clinical audit. The study was performed in the following steps: data retrieval and analysis; comparison of data with international literature; editing of the Diagnostic-Therapeutic Path. The analysis was performed by using the administrative database of drug prescriptions and treatment plans in the SANIARP portal, a web platform available to specialist facilities and private and public pharmacies of LHU Caserta. The subject of our analysis was to gain information about the diagnosis and treatment of users of atypical antipsychotics in the LHU of Caserta in the years 2011-2013. RESULTS: We identified 2,768 patients with at least one prescription of atypical antipsychotics and diagnosis coded in the study period. Schizophrenia is the most frequent diagnosis (31.1%) and the most common drug in use is olanzapine (29.1%). About 70% of schizophrenics were on monotherapy with no change in drug, 23.6% were under polytherapy and 7.9% made a switch. DISCUSSION AND CONCLUSION: Our findings were a starting point for editing Diagnostic and Therapeutic Paths aimed at raising the awareness of the scientific community about the appropriateness of diagnosis and treatment in schizophrenia. Pharmacological treatment of schizophrenia should be focused on improving the overall quality of life aimed at remission and possible recovery, although difficult.

Pattern of statin use in southern italian primary care: can prescription databases be used for monitoring long-term adherence to the treatment?

OBJECTIVES: We sought to evaluate the prescribing pattern of statins according to national and regional health policy interventions and to assess specifically the adherence to the therapy in outpatient setting in Southern Italy. METHODS: A population-based study was performed on persons ≥15 years old, living in the catchment area of Caserta (Southern Italy), and registered in Arianna database between 2004 and 2010. Prevalence and incidence of new treatments with statins were calculated for each year and stratified by drug. Adherence to therapy was measured by Medication Possession Ratio. Sub-analyses by individual compound and type of cardiovascular prevention were performed. RESULTS: From 2004 to 2010, the one-year prevalence of statin use increased from 44.9/1,000 inhabitants to 79.8/1,000, respectively, consistently with the incidence of new use from 16.2/1,000 to 19.5/1,000, except a slight decrease after criteria reimbursement revision on 2005 (13.3/1,000). The incidence of new treatments decreased for atorvastatin, and increased for simvastatin over the study years. Overall, 43% of new users were still highly adherent to the treatment (MPR≥80%) after six months, while 26% after 4-years of follow-up. As compared with highly adherent patients, the probability to be non-adherent (MPR≤25%) at 4-years of follow-up was 26% higher for women than for men (full adj. odds ratio: 1.26; 95% CI: 1.10-1.45), and 64% higher in patients who started on primary rather than on secondary prevention (1.64; 1.29-2.07). CONCLUSIONS: Prevalence and incidence of statin use increased consistently with health policy interventions. Only one-fourth of patients who newly initiated a statin were adherent to the treatment after 4-year of follow-up. Since the benefits of statins in terms of cardiovascular outcome and costs are associated with their chronic use, the identification of patient-related predictors of non-adherence such as gender, primary prevention could be suitable for physicians to improve the patients' compliance.

Technology use among adults who are deaf and hard of hearing: a national survey.

As society becomes increasingly more dependent on technology, information regarding the use, preference, and accessibility of commonly used devices and services among individuals who are deaf and hard of hearing (DHH) is crucial. Developing technologies that are functional and appropriately accessible allows persons who are DHH to fully participate in society, education, and business while also providing opportunities for personal and professional advancement. Although a few international studies have addressed the technology use of individuals who are DHH, none exist that focus on the needs, preferences, and accessibility of current Internet- and mobile-based technologies. Consequently, a national survey was conducted in the United States to determine the preference, frequency of use, and accessibility of various technologies (hardware, software, Web sites) by adults who are DHH and living in the United States. Findings indicate frequent use of smartphones and personal computers, specifically for text-based communication and web surfing, and little use of Teletypewriter/Telecommunications Device for the Deaf. Web site feature preferences include pictures and text, and captions over signed translations. Some results varied by demographics.

The Math Gap: a description of the mathematics performance of preschool-aged deaf/hard-of-hearing children.

Over decades and across grade levels, deaf/hard-of-hearing (d/hh) student performance in mathematics has shown a gap in achievement. It is unclear, however, exactly when this gap begins to emerge and in what areas. This study describes preschool d/hh children's knowledge of early mathematics concepts. Both standardized and nonstandardized measures were used to assess understanding in number, geometry, measurement, problem solving, and patterns, reasoning and algebra. Results present strong evidence that d/hh students' difficulty in mathematics may begin prior to the start of formal schooling. Findings also show areas of strength (geometry) and weakness (problem solving and measurement) for these children. Evidence of poor foundational performance may relate to later academic achievement.

An intervention for early mathematical success: outcomes from the hybrid version of the Building Math Readiness Parents as Partners (MRPP) project.

The Building Math Readiness in Young Deaf/Hard-of- Hearing Children: Parents as Partners (MRPP) Project works with parents to increase the understanding of foundational mathematics concepts in their preschool deaf/hard-of-hearing (d/hh) children in preparation for formal mathematics education. A multiple-case/single-unit case study incorporating descriptive statistics and grounded theory analysis was conducted on the hybrid version of the intervention. Results showed productive changes in parental behaviors indicating a possible positive effect on parent knowledge, recognition, and mediation of early matthematics concepts with their young d/hh children.

Deaf and hard of hearing students' problem-solving strategies with signed arithmetic story problems.

The use of problem-solving strategies by 59 deaf and hard of hearing children, grades K-3, was investigated. The children were asked to solve 9 arithmetic story problems presented to them in American Sign Language. The researchers found that while the children used the same general types of strategies that are used by hearing children (i.e., modeling, counting, and fact-based strategies), they showed an overwhelming use of counting strategies for all types of problems and at all ages. This difference may have its roots in language or instruction (or in both), and calls attention to the need for conceptual rather than procedural mathematics instruction for deaf and hard of hearing students.

Factors predicting recall of mathematics terms by deaf students: implications for teaching.

In this study of deaf high school students, imagery and familiarity were found to be the best predictors of geometry word recall, whereas neither concreteness nor signability of the terms was a significant predictor variable. Recall of high imagery terms was significantly better than for low imagery terms, and the same result was found for high- over low-familiarity and signability. Concrete terms were recalled significantly better than abstract terms. Geometry terms that could be represented with single signs were recalled significantly better than those that are usually fingerspelled or those represented by compound signs. Teachers with degrees and/or certification in mathematics had significantly higher self-ratings for the strongest predictor variables, imagery (visualization), and familiarity, as compared with those without such formal training. Based on these findings, implications for mathematics instruction, teacher education, and research are provided.

The relative difficulty of signed arithmetic story problems for primary level deaf and hard-of-hearing students.

This study determines the relative difficulty and associated strategy use of arithmetic (addition and subtraction) story problems when presented in American Sign Language to primary level (K-3) deaf and hard-of-hearing students. Results showed that deaf and hard-of-hearing students may consider and respond to arithmetic story problems differently than their hearing peers, with the critical dimension in problem difficulty being based on the operation typically used to solve the problem, not the story within the problem. The types of strategies used by the students supported the order of problem difficulty. The visual-spatial nature of the problem presentation appeared not to assist the deaf and hard-of-hearing students in solving the problems. Factors that may have contributed to this pattern of problem difficulty are discussed so that educators can better align mathematics instruction to the thinking of the deaf child.

Discrete mathematics in deaf education: a survey of teachers' knowledge and use.

The study documents what deaf education teachers know about discrete mathematics topics and determines if these topics are present in the mathematics curriculum. Survey data were collected from 290 mathematics teachers at center and public school programs serving a minimum of 120 students with hearing loss, grades K-8 or K-12, in the United States. Findings indicate that deaf education teachers are familiar with many discrete mathematics topics but do not include them in instruction because they consider the concepts too complicated for their students. Also, regardless of familiarity level, deaf education teachers are not familiar with discrete mathematics terminology; nor is their mathematics teaching structured to provide opportunities to apply the real-world-oriented activities used in discrete mathematics instruction. Findings emphasize the need for higher expectations of students with hearing loss, and for reform in mathematics curriculum and instruction within deaf education.