Respect, interaction, immediacy and the role community plays in registering an organ donation decision.

BACKGROUND: Registering a donation decision is fundamental to increasing the number of people who donate the organs and tissues essential for transplantation, but the number of registered organ donors is insufficient to meet this demand. Most people in Australia support organ donation, but only a third have registered their decision on the Australian Organ Donor Register (AODR). We addressed this paradox by investigating how feelings of community, engendered through an ethic of hospitality and care and a non-proselytizing dialogue about organ donation, facilitated the decision to register. METHODS: An Immediate Registration Opportunity was set up in a large public hospital in NSW, Australia. The public was approached and invited to engage in an open, respectful dialogic interaction that met people where their beliefs were and allowed their concerns and fears about donation to be discussed. This included a survey that measured positive and negative beliefs about organ donation, mood, atmosphere, and feelings of community coupled with an on-the-spot opportunity to register their donation decision. RESULTS: Over four days, we interacted with 357 participants; 75.5% (210) of eligible-to-register participants registered on the AODR. Generalized Structural Equation Modelling highlighted that as connection to community increased, so did the salience of positive beliefs about organ donation. Positive beliefs, in turn, were negatively correlated with negative beliefs about donation and, as the strength of negative beliefs decreased, the probability of registration on the AODR increased. Participants who registered on the AODR reported stronger connection to the broader community than participants who did not register. CONCLUSION: A respectful non-judgmental interaction that allows beliefs and concerns about organ donation to be discussed, coupled with an immediate opportunity to register, encouraged registration. Within this framework, feelings of belonging to a community were a key determinant that enabled many to make the decision to register.

Respect, Interaction, and Immediacy: Addressing the Challenges Associated With the Different Religious and Cultural Approaches to Organ Donation in Australia.

Australia is a multicultural society of just over 25 million people, with approximately 310 different ancestries, 300 languages, and 150 religions. This diversity suggests that Australia's people might hold a multiplicity of beliefs regarding organ donation. Research shows that most people in Australia have a strong, positive perception of organ donation; they believe that organ donation helps others and benefits society. However, the current rate of 21.6 donors per million population is below expectations and below the demand for organs needed for transplantation. This has led us to ask whether donation consent rates are differentiated by religious and cultural affiliation. We present a case study of New South Wales, Australia, to address this issue. New South Wales is the most populous state in Australia and is also religiously and culturally diverse. Donation consent data (2016-2019) by ethnicity and by religion show that donation consent rates have improved but not across all groups. Initiatives to increase awareness and support for organ and tissue donation among culturally and linguistically diverse and Aboriginal and Torres Strait Islander communities are discussed. Research is also presented that investigates whether registration rates on the Australian Organ Donor Register can be increased and the implications of this for increasing consent for donation. This research underscores the importance of respecting the diversity of beliefs held regarding organ donation, both positive and negative; offering all people a face-to-face interaction opportunity to consider their beliefs about organ donation, ask questions, and raise concerns without judgment; and providing people with an immediate opportunity to register their donation decision on the Australian Organ Donor Register. The challenges associated with adopting these initiatives are considered along with the role of religious and cultural leaders within the context of organ donation and registration; the unspoken concerns of cultural and religious groups are also addressed. In conclusion, we propose that the rich diversity of Australian society is more of a backdrop than a barrier to organ donation.

Income and employment equity of graduates with and without disabilities.

BACKGROUND: Among Organisation for Economic Co-operation and Development [OECD] countries, Australians with disabilities are most at risk of experiencing poverty. Employment equity is essential for wellbeing, health and social inclusion. Reported differences in income level between people with and without disabilities vary widely between 0 to 47% depending on productivity assumptions. Contradictory to these assumptions, empirical research has demonstrated that people with disabilities often have equivalent skills, superior loyalty and lower absentee rates. OBJECTIVE: To investigate if there is a significant difference in the annual remuneration, hours worked and age-related career trajectory of graduates with and without disabilities. METHODS: Descriptive statistics and regression analysis were used to identify employment equity between graduates with and without disabilities in the 2011 Australian Census. RESULTS: Graduates with disabilities received a mean weekly income that was 53% of the income of graduates without disabilities and 85% of the mean hourly income. Female graduates with disabilities received the lowest mean income of all subgroups at 35% of the mean weekly income of male graduates without disabilitiesCONCLUSION:This corroborates previous research that reports people with disabilities have difficulty obtaining employment, experience insecure employment and have fewer career and promotional opportunities. The income gaps were significantly greater than gaps previously reported.

Utilizing a Hospital-based Setting to Increase Organ Donor Registrations.

BACKGROUND: Shortages of organs for transplantation are a concern for many countries. In Australia's "opt-in" system, people register their donation decision on the Australian Organ Donor Register (AODR) in their own time, yet <30% of the population have done so. Consent registrations are honored by the next-of-kin in 90% of cases, so increasing registrations will increase donated organs for transplantation. This study investigated the efficacy of offering an immediate registration opportunity in 2 hospitals, and the role that beliefs about organ donation play in registration behavior. METHODS: An immediate registration opportunity was offered at a public and a private hospital in New South Wales, Australia. Participants (N = 168) categorized as medical/healthcare (eg, doctor and nurse) and nonhealthcare (eg, teacher and chef) completed a measure of beliefs about organ donation, were encouraged to discuss their fears and concerns about organ donation, and given an immediate opportunity to register on the AODR. RESULTS: A total of 81.5% of medical/healthcare participants who were eligible registered, and 71.5% of all eligible participants registered on the spot. Beliefs about the negative consequences of donation and concerns over the medical care given to potential donors predicted (non)registration. Medical/healthcare participants reported lower levels of fears and concerns than nonhealthcare participants. Although both groups reported strong positive beliefs about donation, these did not predict registration. CONCLUSIONS: Offering an immediate registration opportunity in 2 hospitals notably increased the number of registrations on the AODR, suggesting this is a strategy that could potentially increase registrations in opt-in donation systems.

Metal and metalloid concentrations in the tissues of dusky Carcharhinus obscurus, sandbar C. plumbeus and white Carcharodon carcharias sharks from south-eastern Australian waters, and the implications for human consumption.

Shark fisheries have expanded due to increased demand for shark products. As long-lived apex predators, sharks are susceptible to bioaccumulation of metals and metalloids, and biomagnification of some such as Hg, primarily through diet. This may have negative health implications for human consumers. Concentrations of Hg, As, Cd, Cu, Fe, Se and Zn were analysed in muscle, liver and fin fibres (ceratotrichia) from dusky Carcharhinus obscurus, sandbar Carcharhinus plumbeus, and white Carcharodon carcharias sharks from south-eastern Australian waters. Concentrations of analytes were generally higher in liver than in muscle and lowest in fin fibres. Muscle tissue concentrations of Hg were significantly correlated with total length, and >50% of sampled individuals had concentrations above Food Standards Australia New Zealand's maximum limit (1 mg kg(-1) ww). Arsenic concentrations were also of concern, particularly in fins. Results warrant further investigation to accurately assess health risks for regular consumption of shark products.

Saccadic eye movements as indicators of cognitive function in older adults.

Older adults appear to have greater difficulty ignoring distractions during day-to-day activities than younger adults. To assess these effects of age, the ability of adults aged between 50 and 80 years to ignore distracting stimuli was measured using the antisaccade and oculomotor capture tasks. In the antisaccade task, observers are instructed to look away from a visual cue, whereas in the oculomotor capture task, observers are instructed to look toward a colored singleton in the presence of a concurrent onset distractor. Index scores of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were compared with capture errors, and with prosaccade errors on the antisaccade task. A higher percentage of capture errors were made on the oculomotor capture tasks by the older members of the cohort compared to the younger members. There was a weak relationship between the attention index and capture errors, but the visuospatial/constructional index was the strongest predictor of prosaccade error rate in the antisaccade task. The saccade reaction times (SRTs) of correct initial saccades in the oculomotor capture task were poorly correlated with age, and with the neurospsychological tests, but prosaccade SRTs in both tasks moderately correlated with antisaccade error rate. These results were interpreted in terms of a competitive integration (or race) model. Any variable that reduces the strength of the top-down neural signal to produce a voluntary saccade, or that increases saccade speed, will enhance the likelihood that a reflexive saccade to a stimulus with an abrupt onset will occur.

Gambling Attitudes and Beliefs Predict Attentional Bias in Non-problem Gamblers.

Problem gambling has been identified as a public health concern in Australia, and a considerable proportion of regular gamblers may be at risk of developing gambling related problems. Attentional bias to salient cues has been observed in substance addictions, and to some extent, in problem gamblers. This bias appears to be indicative of an increase in sensitisation to salient cues as a result of continued reforcement of a related behaviour. To test for an attentional bias to gambling-related stimuli in non-problem gamblers, the relationships between gambling frequency, gambling attitudes and beliefs (GABS-23), and attentional bias were investigated. Participants (N = 38) viewed simultaneous pairs of gambling-related and neutral images and performed a dot probe task, during which their eye-movements were recorded. This enabled both direct and indirect measures of attentional bias to be obtained. Gambling frequency and GABS-23 scores predicted both direct and indirect measures of a bias in the maintenance of attention to gambling cues. No bias in attentional engagement was found. These results suggest that regular gamblers who have not yet developed any related problems show signs of sensitisation to gambling cues and may be at risk of progressing further towards problem gambling.

How well do patients understand written instructions?: health literacy assessment in rural and urban rheumatology outpatients.

The aim of this study was to assess health literacy (word recognition and comprehension) in patients at a rural rheumatology practice and to compare this to health literacy levels in patients from an urban rheumatology practice.Inclusion criteria for this cross-sectional study were as follows: ≥18-year-old patients at a rural rheumatology practice (Mid-North Coast Arthritis Clinic, Coffs Harbour, Australia) and an urban Sydney rheumatology practice (Combined Rheumatology Practice, Kogarah, Australia). Exclusion criteria were as follows: ill-health precluding participation; poor vision/hearing, non-English primary language. Word recognition was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). Comprehension was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Practical comprehension and numeracy were assessed by asking patients to follow prescribing instructions for 5 common rheumatology medications.At the rural practice (Mid-North Coast Arthritis Clinic), 124/160 patients agreed to participate (F:M 83:41, mean age 60.3 ±â€Š12.2) whereas the corresponding number at the urban practice (Combined Rheumatology Practice) was 99/119 (F:M 69:30, mean age 60.7 ±â€Š17.5). Urban patients were more likely to be born overseas, speak another language at home, and be employed. There was no difference in REALM or TOFHLA scores between the 2 sites, and so data were pooled. REALM scores indicated 15% (33/223) of patients had a reading level ≤Grade 8 whereas 8% (18/223) had marginal or inadequate functional health literacy as assessed by the TOFHLA. Dosing instructions for ibuprofen and methotrexate were incorrectly understood by 32% (72/223) and 21% (46/223) of patients, respectively.Up to 15% of rural and urban patients had low health literacy and <1/3 of patients incorrectly followed dosing instructions for common rheumatology drugs.There was no significant difference in word recognition, functional health literacy, and numeracy between rural and urban rheumatology patients.

Prosaccade errors in the antisaccade task: differences between corrected and uncorrected errors and links to neuropsychological tests.

The relations among spatial memory, Stroop-like colour-word subtests, and errors on antisaccade and memory-guided saccadic eye-movement trials for older and younger adults were tested. Two types of errors in the antisaccade task were identified: short latency prosaccade errors that were immediately corrected and longer latency uncorrected prosaccade errors. The age groups did not differ on percentages of either corrected or uncorrected errors, but the latency and time to correct prosaccade errors were shorter for younger than older adults. Uncorrected prosaccade errors correlated significantly with spatial memory accuracy and errors on the colour-word subtests, but neither of these neuropsychological indices correlated with corrected prosaccade errors. These findings suggest that uncorrected prosaccade errors may be a result of cognitive factors involving a failure to maintain the goal of the antisaccade task in working memory. In contrast, corrected errors may be a consequence of a fixation system involving an initial failure to inhibit a reflexive prosaccade but with active goal maintenance enabling correction to take place.

Effect of nicotine on saccadic eye movement latencies in non-smokers.

OBJECTIVE: Recently, saccadic eye movement tasks have been used to assess the effects of nicotine on higher cognitive processes, including inhibitory control. Saccadic task switching methods suggest that there is prolonged inhibition of the saccadic eye movement system following antisaccade trials. The objective of this research was to examine effects of nicotine on inhibition using saccadic task switching paradigms. METHODS: Nicotine and placebo lozenges were administered on separate days to 40 non-smokers who performed prosaccade and antisaccade tasks. In addition, participants performed a series of trials in which prosaccade and antisaccade tasks were switched. Eye movement latencies were recorded. RESULTS: Participants responded significantly faster for the nicotine condition than for the placebo condition. A switch benefit was observed for only placebo antisaccade trials, in that latencies of repetition trials were significantly longer than those of switch trials. In addition, an analysis of the repetition trials showed an interaction between saccade type and sequence position for the placebo condition, but not the nicotine condition. CONCLUSION: Inhibition persists after antisaccade trials in a switching paradigm, but that the duration of this inhibition is reduced by nicotine.

Smooth-pursuit eye movement and directional motion-contrast sensitivity in schizophrenia.

Although the occurrence of visual processing and eye-movement disorders in schizophrenia have been widely recognized, their relationship with the symptoms of schizophrenia is less well understood. In two experiments the relationship between directional-motion processing and smooth-pursuit eye movement was investigated in normal observers and in groups with positive and negative symptoms in schizophrenia. The first experiment measured linear smooth-pursuit eye movement at six target velocities from 5.0 to 30.0 degrees s(-1) and the second experiment measured directional motion-contrast sensitivity at three spatial (1.0, 4.0 and 8.0 c/deg) and five temporal (0.75, 3.0, 6.0, 12.0 and 18.0 Hz) frequencies in the same groups of observers. No significant differences were found between the control and positive-symptom group in directional motion-contrast sensitivity and smooth-pursuit eye movements. In comparison, a relationship was found between a significant reduction in directional motion-contrast sensitivity and significantly reduced smooth-pursuit eye movement in the negative-symptom group and serves to further cleave the distinction between positive and negative symptoms in schizophrenia. The relationship between visual motion processing and pursuit eye movement in the negative-symptom group was explained by a disorder in directional motion processing that fails to fully engage the pursuit eye movement system and reduces smooth pursuit eye-velocity gain.

Balancing hospital and community treatment: effectiveness of an extended-hours community mental health team in a semi-rural region of australia.

OBJECTIVE: To examine the effectiveness of the introduction of a community mental health team on consumer psychosocial outcomes. DESIGN: Longitudinal panel design. SETTING: District general hospital in a semi-rural region of Australia. NUMBERS: Two matched groups (n = 37 in each group) MAIN OUTCOME MEASURE: These included: Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), Rosenberg Self-Esteem, Life Skills Profile as well as self-report. RESULTS: The study found that the introduction of the new service resulted in few significant differences in consumer outcomes. CONCLUSIONS: The paper argues that because the state was the only specialist mental health service provider and it was unable to offer assertive community treatment, hospital care remained central. Evidence that a substantial proportion of consumers and carers preferred hospital to community care is placed against this background. The paper argues that in regions like these, where community-based services are likely to remain underdeveloped, it may be best to maintain quality hospital services and to target community services more precisely on what is achievable rather than developing community services at the expense of hospital care. WHAT IS ALREADY KNOWN: Studies on the efficacy of assertive community treatment suggest that it can lead to improved consumer outcomes. However, these studies are usually in urban settings and involve experimental teams. In many rural and regional areas community treatment teams offer standard rather than assertive community care. It is therefore important to investigate the effectiveness of community treatment teams in rural and regional Australia. WHAT THIS STUDY ADDS: This study suggests that in rural and regional areas characterised by limited resources, it is too much to expect community treatment teams to have a measurable impact on consumer outcomes. In these settings hospital care remains at the heart of the service. This means that regions such as these need to focus their community services on what is achievable given the level of resources and social ecology. For example, they may need to consider offering either crisis intervention or rehabilitation services and to rely on innovations, such as telehealth or strategic alliances with other service providers to fill the gap.

Heterogeneity of admission history among patients with bipolar disorder.

BACKGROUND: Patients on a first admission for bipolar disorder often have a history of other psychiatric diagnoses for previous admissions. AIMS: The current study examines the time course and diagnoses of psychiatric admissions prior and subsequent to a first hospitalisation for a diagnosis of bipolar disorder. METHOD: The prior admission histories (over the period 1965-1989) of 1167 patients who had been hospitalised in state mental health facilities with their first admission with diagnosis of bipolar disorder between 1983 and 1989 were examined. RESULTS: A total of 542 (46.4%) patients had at least one previous hospitalisation with a psychiatric diagnosis other than bipolar disorder. Two prominent groups emerged; one group which had primarily a history of prior admissions with diagnoses of depression over 1-3 years, and a second which mainly had previous admissions for schizophrenia, over a period longer than for those with a primarily depressive history. The group with a history of schizophrenia was significantly younger and had a greater number of admissions prior to the first bipolar disorder diagnosis than the depression group. LIMITATIONS: This was a record-based study which did not examine cases which were not hospitalised. CONCLUSIONS: There appeared to be three distinct patterns of prior presentations in those patients admitted with a diagnosis of bipolar disorder.

A comparison of patient clinical and social outcomes before and after the introduction of an extended-hours community mental health team.

OBJECTIVE: The aim of this study was to assess the effectiveness of the addition of standard community treatment to a hospital-based service in a regional district of Australia. METHOD: The study was a naturalistic investigation of a routine clinical service and utilized a longitudinal panel design. Two matched groups of seriously mentally ill patients were recruited,one before the addition of the community mental health team (CMHT)and one after. Each sample was followed up for one year using a semistructured questionnaire and instruments including the Brief Psychiatric Rating Scale, the Global Assessment Scale, the Life Skills Profile and the Rosenberg Self-Esteem Scale as well as hospital records. RESULTS: Patients in both groups showed similar patterns of improvements. Although the aims of the new service included reducing in-patient utilization and improving social functioning,there were few significant differences between the two groups. While the number of admissions and length of stay were lower in the post-CMHTsample most were admitted rather than treated in their homes by the CMHT. CONCLUSION: The study concludes that better outcomes might have been achieved if the aims of the CMHT had been limited to either crisis or rehabilitation interventions, but not both. More attention needs to be paid to the service context in which model programmes are introduced so that new developments can be more closely tailored to the realities of what is likely to be achievable.

Psychiatric and social outcomes of a rural district general hospital in the 1990s.

This study investigates the psychiatric and social outcomes of treatment by the psychiatric unit of a district general hospital in a semirural region of Australia. The study is a naturalistic investigation of a routine clinical service, and utilizes a longitudinal panel design. Repeat interviews at admission, 1 month and 1 year later were conducted with all consenting respondents (n = 57) with a diagnosis of schizophrenia, bipolar disorder or related condition, as well as with their nominated relatives. Patients showed significant improvements on clinical measures (P < 0.001) and a high rate of continuation of medication. Most measures of social functioning showed improvement although few were statistically significant. Patients and relative satisfaction was high. Relative worry showed significant improvement in the first month (P < 0.05). There was a high rate of readmission (31 patients) and mean days in hospital were also high at 43 days. These results suggest that basic district general hospital care, operating under both budgetary restrictions and the difficulties associated with recruiting staff can nonetheless provide a credible service. However, the results fall short of what research tells us can be achieved when services are adequately funded and more specifically targeted to meet patient needs.