An international survey of EEG use in the neonatal intensive care unit.

OBJECTIVE: To examine the extent of EEG monitoring in neonatal intensive care units (NICUs), and to survey the level of experience and training of those using it. STUDY DESIGN: A web-based survey, the link to which was circulated via e-mail, personal contact, specialist societies and professional groups. Survey data were exported to SPSS for analysis. RESULTS: In total 210 surveys were analysed; 124 from Europe, 54 from the US. Ninety percent of respondents had access to either EEG or aEEG monitoring; 51% had both. EEG was mainly interpreted by neurophysiologists (72%) whereas aEEG was usually interpreted by neonatologists (80%). Only 9% of respondents reported that they felt 'very confident' in their ability to interpret aEEG/EEG with 31% reporting that they were 'not confident'. Half had received no formal training in EEG. CONCLUSION: Both aEEG and conventional EEG were used extensively in the NICUs surveyed for this study. Most of the survey respondents were not confident in their ability to interpret EEGs despite the fact that they used monitoring routinely. There is an urgent need for a structured and appropriately targeted training programme in EEG methodologies and EEG interpretation for neonatal intensive care unit staff.

Metabolic control and quality-of-life self-assessment in adolescents with IDDM.

OBJECTIVE: To examine the relation between metabolic control and self-assessed quality of life in adolescents with IDDM. RESEARCH DESIGN AND METHODS: The Diabetes Quality of Life (DQOL) questionnaire for youths was given to 69 subjects with IDDM aged 10-20 years at the time of their outpatient visit. Subjects with IDDM of < 1 year's duration or with documented psychotic disorder or mental retardation were excluded. Metabolic control was assessed by the mean HbA1c during the preceding year (long-term), by a single HbA1c at the time of the visit (short-term), and by the number of acute events related to IDDM in the preceding year. RESULTS: The DQOL score correlated with mean HbA1c (beta = 6.13, R2 = 0.22, P = 0.0122) and single HbA1c (beta = 3.94, R2 = 0.18, P = 0.05). Self-health assessment was the best predictor of DQOL score (beta = -44.42, R2 = 0.45, P < 0.0001). The Worries subscale score on DQOL correlated with the occurrence of acute events (beta = 6.97, R2 = 0.2, P = 0.006), but did not correlate with either HbA1c level. Correlations of mean HbA1c with the predictors were stronger than the correlations of single HbA1c with the same predictors. CONCLUSIONS: Metabolic control and quality of life are two important outcomes of IDDM care. In our study, adolescents in better metabolic control report better quality of life. Both components need to be addressed in developing successful diabetes treatment strategies for adolescents with IDDM.

Association between psychiatric disorders and the progression of tobacco use behaviors.

OBJECTIVE: To examine the progression of tobacco use and the patterns of comorbidity of tobacco use and psychiatric disorders. METHOD: The authors conducted analyses of prospective and retrospective reports, collected from 1988 to 1998, of a sample of high- and low-risk youths identified on the basis of the presence or absence of a parental history of substance abuse or dependence. RESULTS: A parental history of substance use disorders was associated with regular tobacco use and nicotine dependence, but not with experimentation for all youths. Individual and composite psychiatric diagnoses were strongly associated with nicotine dependence, but not with regular use or experimentation. While the presence of an affective disorder and drug abuse/dependence generally increased the risk for co-occurring nicotine dependence, analyses based on the temporal onset of disorders showed that it was the initiation of alcohol or drug use that predicted the progression to nicotine dependence. For low-risk youths, oppositional defiant disorder was the single psychiatric risk factor that predicted the transition to nicotine dependence. CONCLUSIONS: This study adds to the accumulating evidence that has implicated comorbid psychiatric disorders in the etiology and subsequent course of nicotine dependence. In addition, family history may represent an important indicator of an increased risk for nicotine dependence.

An Australian profile on the use of cocaine.

Data collected on cocaine in Australia in the mid to late 1980s, when law enforcement and treatment centres were concerned with possible increases in cocaine use, indicated a low prevalence of use. This article reports findings from the Australian component of the 1993-94 World Health Organization study entitled "Initiative on Cocaine", which provides an updated analysis of cocaine use patterns and consequences. The two components of this study were a "country profile" which summarized existing health, law enforcement and survey data on cocaine use from national, regional and city level records, and a key informant study which consisted of interviews with people from Sydney and Melbourne who were familiar with cocaine use through personal, professional and observational experience. Findings show that the prevalence of cocaine use has remained low among the general population in Australia (around 2%), and few people present to treatment services with primary cocaine problems or are arrested. However, the use of cocaine seems to have increased among inner Sydney injecting drug users. There have also been indications of larger police seizures of cocaine, reflecting a possible increase in availability. Recommendations are made to provide relevant interventions and continually monitor patterns of cocaine use, particularly among at-risk groups.

Substance use in high school students in New South Wales, Australia, in relation to language spoken at home.

PURPOSE: To examine for the first time adolescent substance use by ethnicity, given the high proportion of migrants from non-English-speaking countries in New South Wales, (NSW), Australia. METHODS: Data from four surveys of NSW secondary school students in 1983, 1986, 1989, and 1992 were used for this analysis. The prevalence of substance use by whether English was spoken at home was stratified by sex and age using data from the most recent survey year. Adjusted odds ratios and 95% confidence intervals were produced by simultaneous logistic regression, adjusting for sex, age group, and the interaction term of sex and age for each of these substances, and for each survey year separately. Data from 1989 and 1992 were pooled together to examine rates of substance use by ethnic subgroups which reflect migration patterns. RESULTS: The prevalence of smoking and alcohol and illicit drug use was consistently lower among NSW adolescents speaking a language other than English at home, compared with those speaking English at home in all survey years. Only the prevalence of solvent sniffing was higher among younger adolescents speaking a language other than English at home. Students from Southeast Asia showed consistently lower rates of usage of all substances compared to all other groups. CONCLUSIONS: There may be different opportunities for the prevention of adolescent substance use among native English speakers to be gained from non-English-speaking cultures.

Substance use and socio-demographic factors among aboriginal and Torres Strait Islander school students in New South Wales.

OBJECTIVE: To estimate prevalence rates of substance use and associated socio-demographic factors among Aboriginal and Torres Strait Islander (ATSI) secondary students. METHOD: This paper presents ATSI data from population-based school surveys conducted in 1996, 1992 and 1989 in New South Wales and replicates identical analysis using the three datasets. RESULTS: The proportion of ATSI students in each survey ranged from 2.5% to 3.8%. After adjusting for age, gender and socio-demographic factors, ATSI students were more likely to smoke cigarettes, and to have tried cannabis and other illicit substances. CONCLUSIONS: This study suggests that Aboriginal and Torres Strait Islander students were more susceptible to, and maintained a higher rate of, substance use than non-Aboriginal and Torres Strait Islander youth. Socio-demographic differences between Aboriginal and non-Aboriginal students in age, rural/urban status, living with both parents, reporting poor school performance, low parental supervision and high school absenteeism remained significantly associated with Aboriginal status and substance use. IMPLICATIONS: This is one of the first studies examining substance use in a large and representative sample of in-school ATSI youth. These results provide information useful for public health advocates, and require policy changes more likely to reduce substance use among ATSI youth.

Identification of nonlinear model of ankle joint dynamics during electrical stimulation of soleus.

The mechanical impedance of the ankle joint was estimated in two conditions: during submaximal surface electrical stimulation of the soleus muscle, and with no stimulation applied. Both neurologically intact (n = 5) and spinal cord injured subjects (n = 4) were used. The mechanical impedance was measured by applying angular step and constant velocity (13-100 degrees s-1) perturbations at 10 degrees to the ankle and measuring the resulting changes in torque. A five-element lumped model consisting of an inertial element, a parallel elastic element, and an elastic element in series with a viscous element and a pure tension generator produced a good fit for predicting the compliance characteristics of the ankle for both the relaxed and stimulated conditions. The elastic elements were piecewise linear with different values for the dorsiflexion and plantarflexion directions. The viscous element was velocity-dependent and it decreased in value as the velocity increased. The average torque error between the measured and model's response during soleus stimulation was 10.56% for the dorsiflexed and 11.93% for the plantarflexed perturbations. However, the average error was skewed by several subjects who had excessive error, due to volitional intervention or flexor withdrawal reflex. The average model error for the perturbations without stimulation was 7.12% for dorsiflexed and 5.58% for plantarflexed perturbations.

Determining appropriate models for joint control using surface electrical stimulation of soleus in spinal cord injury.

The mechanical impedance of the ankle joint during electrical stimulation of the soleus is studied by applying constant-velocity 10 degrees angular perturbations to the ankle and measuring the resultant torque. Both neurologically intact subjects and spinal cord injured subjects are tested. Lumped, piecewise linear models are developed to predict the torque from the measured displacement and acceleration signals. The commonly used second-order mass-spring-dashpot model fails to predict the changes in torque that occur following imposed movements. A five-element, directionally-dependent piecewise linear model is much better at predicting the measured responses for velocities up to 50 degrees s-1. Numerical least squared error identification techniques are used to estimate the model parameters for three neurologically intact and three spinal cord injured subjects. The average error between the model's response and the measured response across all subjects is 10.9%. There is some evidence that a velocity-dependent non-linear model could produce better results than the directionally-dependent piecewise linear model.

Biomechanical and reflex responses to joint perturbations during electrical stimulation of muscle: instrumentation and measurement techniques.

A test device is developed to measure ankle joint compliance and muscle activity when the ankle is subjected to perturbations in angular position (or torque) from bias positions achieved volitionally or via electrical stimulation. The ankle measurement system uses a pivoting footplate and is operable with the subject sitting or supine. A companion platform for the knee is developed that uses a rotary arm and attached leg brace and is operable with the subject's leg in the horizontal or vertical plane. The knee fixture's pivoting arm can slide to account for the cam-like movement of the knee during rotation. The devices use similar hardware and share common instrumentation and control. Precise torque or position perturbations are delivered by a computer-controlled torque motor to the ankle or knee. Angular displacement, torque, acceleration, knee fixture moment arm and electromyographic data are collected on analogue tape and simultaneously digitised and stored. A special stimulator/recording amplifier permits the recording of electromyographic signals from the stimulated muscle. Experimental data indicate that the ankle and knee devices, operated horizontally, are purely inertial systems. Sample ankle and knee joint responses to perturbations are presented.

Early warning indicators of changes in patterns of drug use in Australia.

This report examines potential sources for a data system to serve as an 'early' warning of changes in drug use in the community. The system would measure changes in drug use to allow the managers of drug and alcohol programmes to adapt their services to meet the changing needs of their clients. The topic was addressed by identifying the 'dimensions of drug use' relevant to early warning. Three criteria for inclusion in an early warning network were identified: timeliness, volume of data, and complementarity with other indicators. Each indicator was evaluated against the early warning criteria and dimensions of drug use issues. The result was a list of six indicators which could form an early warning network in Australia: a collection based on general hospital casualty reports, ambulance officer reports of drug overdoses, telephone advice service data, data from key informants, profiles of clients in drug dependence treatment centres and the users of needle exchange centres.

Compulsory treatment of alcoholism: the case against.

The need for compulsory detention in the management of alcohol-dependent persons is reviewed with a particular focus on legislation in New South Wales (NSW). It is argued that there is no justification for the severe loss of civil liberties in order to provide a general power of involuntary alcoholism treatment since such treatment is basically ineffective and in any case little treatment is actually given to those detained. The selective operation of the NSW Inebriates Act (in terms of class and race biases) is noted. The special circumstances of those who suffer severe alcohol-related brain damage and those who are in acute life-threatening circumstances are discussed. It is suggested that these cases are adequately covered by existing Mental Health and Guardianship legislation, obviating the need for special legislation such as an Inebriates Act.

Knowledge and use of alcohol and other drugs among Vietnamese-speaking migrants.

A survey of the Vietnamese community in Sydney was conducted in 1992 to determine whether it was at a higher or lower risk of drug-related harm than the general community. Data was collected on knowledge, attitudes and behaviour associated with alcohol and other drug use and compared with overall NSW figures. The sample of 341 Vietnamese-speakers aged 15-65 years was obtained by face-to-face interviews conducted in private households using a cluster sampling technique. Of the sample, 72% indicated they did not speak English well or at all. Recognition of tobacco and alcohol as drugs and the specific health and social problems associated with use was much lower among the Vietnamese-speakers than the general community. Compared with the general community (1991 NCADA Household Survey), reported use of tobacco on the day of the survey among Vietnamese-speakers was higher among men (37% versus 26%) but much lower among women (4% versus 22%). Reported use of other drugs such as alcohol, analgesics, minor tranquillizers and illicit drugs was lower than in the general community. It is recommended that the low level of knowledge of the health and social problems associated with tobacco and alcohol in particular should be addressed by community-based education programmes.

Characteristics of admissions to residential drug treatment agencies in New South Wales, 1988-92: I. Illicit drug problems.

The Clients at Residential Agencies (CARA) database of the New South Wales Drug and Alcohol Directorate was analysed for trends in admissions of clients with illicit drug problems over the years 1988-92. The mean age of admissions rose from 26.8 years to 27.9 years over the study period. There was a small increase in the proportion of male admissions to agencies (66.5% in 1988 to 69.9% in 1992). The proportion of admissions reporting opiates as their primary drug problem declined from 81% to 65%, while the proportion of admissions for stimulant problems doubled in that period (8% to 16%), as did those for cannabis (3.6% to 8.7%). There was a significant increase in the proportions of admissions who had drug problems of 10 or more years' standing (34.9-41.3%). The proportion of admissions that had never been in treatment decreased from 51% to 15% over the study period. Admissions with prior methadone experience rose from 37% to 69% between 1988 and 1992.

Characteristics of admissions to residential drug treatment agencies in New South Wales, 1988-92: II. Alcohol problems.

The Clients at Residential Agencies (CARA) database of the New South Wales Drug and Alcohol Directorate was analysed for trends in admissions of clients with alcohol problems over the years 1988-92. There were no changes in the mean age and sex ratio of admissions, with the treatment population in all years predominantly males in their mid-thirties. There was a decrease in the proportion of clients who were employed full-time (25.1-16.4%), and an increase in admissions with criminal histories (45.7-59.3%). More than half of admissions in all years had alcohol problems of greater then 10 years' standing. The percentage of people who had never been in treatment before decreased from 44.4% in 1988 to 18.7% in 1992.

A new string to our bow: the role of a self-evaluation approach for drug and alcohol services.

In Australia there is a wide range and diversity of services and programmes to address the problems associated with the use of alcohol and other drugs. As with many other spheres of social welfare, the effectiveness of individual programmes in addressing these problems remains largely unexamined. In response to the absence of evaluation activity at this level of service provision one state health body, the New South Wales Drug and Alcohol Directorate, has developed a project to promote programme evaluation for agencies providing drug and alcohol services in their jurisdictions. This paper provides a description of the project which involved the development of a "self-evaluation" method based on the comparison of programme objectives and actual outcomes. The implementation of this method involved the use of a resource kit, workshops conducted in each health area and region in New South Wales and individual consultation with service providers and drug and alcohol co-ordinators. The preliminary results of an evaluation of the project itself are also described. Evaluation activity has commenced in almost half the services participating in the workshops and participants reported a significant increase in knowledge and skills in evaluation. They also reported a decrease in anxiety about evaluation as a result of the workshops. The paper concludes by placing the project in the broader context of state and national strategic planning.

Policing pubs: what happens to crime?

The aim of this study was to test the effect of heightened police enforcement of the NSW Liquor and Registered Clubs Acts on overall criminal offences and, specifically, the number of assaults. Ten police patrols were included in the study. Five of these patrols were allocated to the experimental condition and five were allocated to the control condition. Beat police in the experimental controls conducted frequent but random visits to predesignated licensed premises over a 2-month period. Police in the control patrols maintained their normal duties. Numbers of offences in the experimental and control patrols were then compared for 2 months before the intervention, for the 2-month intervention phase and for 2 months post-intervention. Results of the study indicated a significant increase in the number of offences in the experimental patrols during the intervention phase. Reasons for this increase are discussed.

Illicit drug use by young people in sydney: results of a street intercept survey.

To complement existing institution-based drug use surveys, a street intercept survey of 581 young illicit drug users was conducted in Sydney, Australia. Patterns of use, reasons for use and awareness of the health risks associated with use were investigated. The most commonly used illicit drug type, after marijuana, was amphetamines. The least popular illicit drug was heroin. Most of the sample used occasionally, exhibiting a controlled pattern of use with a low prevalence of problems associated with use. Heroin users, in contrast, were often frequent users and reported a higher prevalence of associated problems. The majority of the sample reported excessive drinking patterns, indicating that the current policy of emphasis on alcohol misuse rather than illicit drug use amongst youth is appropriate.