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PubMedDate not supplied

Mortality in children admitted to Port Moresby General Hospital: how can we improve our hospital outcomes?

A detailed audit, part retrospective and part prospective, of deaths occurring in children admitted to the children's wards of the Port Moresby General Hospital over a 12-month period was made. 238 children died out of the 4898 admitted, an overall case fatality rate of 4.9%, with a monthly range of 3.7%-9.6%. The proportion of deaths approximated the proportion of admissions in each age group. 92% of the children had a weight of less than 80% of the standard weight for age and 30% weighed less than 60% of the standard weight for age. 24 (11%) of the deaths occurred within the first 6 hours of admission, 39 (17%) within the first 12 hours and 58 (26%) within the first 24 hours. 89 children (40%) died more than one week after admission. Pneumonia, meningitis, measles and septicaemia were the four leading certified causes of death and paediatric AIDS was the fifth. Less than half of the deceased children were appropriately immunized for their age. 27 deaths (12%) were assessed as preventable. 150 (67%) were classified as from treatable causes but unavoidable, 18 (8%) from untreatable causes, 22 (10%) of undetermined cause and 34 (15%) avoidable. The factors associated with avoidable deaths were delayed treatment (20 children), inadequate treatment (8 children), incorrect treatment (1 child) and others (5 children). Infant and child mortality could be reduced by general measures such as improving community nutrition and immunization status and improving care-seeking behaviour. Hospital-related measures to reduce mortality include improving the accuracy and effectiveness of triage and provision of adequate staffing levels and bed space. Periodic in-depth audit is necessary to assess quality of patient care, to identify problems and to point towards their solution. Accurate recordkeeping is essential for appropriate audit and planning.

Cause of Death↗

PubMed1995

[Closure of large psychiatric hospitals in England: evaluation by the TAPS project--a review of the literature].

The TAPS study evaluates the closure of two Greater London mental hospitals. Beginning in 1985, one-year and five-year follow-up compared successive cohorts of long-stay patients discharged to the community (leavers) with groups of matched long-stay patients who stayed in hospital. Some psychopathological symptoms improved in discharged patients, some did not. Mortality, patient vagrancy and delinquent behaviour did not increase in leavers. Patient autonomy, social networks and patient satisfaction favoured out-patient provision of care as compared to continuing in-patient care.

Community Mental Health Services↗

PubMed2003

The comparative energetics and growth strategies of sympatric Antarctic and subantarctic fur seal pups at Iles Crozet.

The period of maternal dependence is a time during which mammalian infants must optimise both their growth and the development of behavioural skills in order to successfully meet the demands of independent living. The rate and duration of maternal provisioning, post-weaning food availability and climatic conditions are all factors likely to influence the growth strategies of infants. While numerous studies have documented differences in growth strategies at high taxonomic levels, few have investigated those of closely related species inhabiting similar environments. The present study examined the body composition, metabolism and indices of physiological development in pups of Antarctic fur seals (Arctocephalus gazella) and subantarctic fur seals (Arctocephalus tropicalis), congeneric species with different weaning ages (4 months and 10 months, respectively), during their overlap in lactation at a sympatric breeding site in the Iles Crozet. Body lipid reserves in pre-moult pups were significantly greater (t28=2.73, P<0.01) in subantarctic (26%) than Antarctic fur seals (22%). Antarctic fur seal pups, however, had significantly higher (t26=3.82, P<0.001) in-air resting metabolic rates (RMR; 17.1 +/- 0.6 ml O2 kg(-1) min(-1)) than subantarctic fur seal pups (14.1 +/- 0.5 ml O2 kg(-1) min(-1)). While in-water standard metabolic rate (SMR; 22.9 +/- 2.5 ml O2 kg(-1) min(-1)) was greater than in-air RMR for Antarctic fur seal pups (t9=2.59, P<0.03), there were no significant differences between in-air RMR and in-water SMR for subantarctic fur seal pups (t12=0.82, P>0.4), although this is unlikely to reflect a greater ability for pre-moult pups of the latter species to thermoregulate in water. Pup daily energy expenditure was also significantly greater (t27=2.36, P<0.03) in Antarctic fur seals (638 +/- 33 kJ kg(-1) day(-1)) than in subantarctic fur seals (533 +/- 33 kJ kg(-1) day(-1)), which corroborates observations that pups of the former species spend considerably more time actively learning to swim and dive. Consistent with this observation is the finding that blood oxygen storage capacity was significantly greater (t9=2.81, P<0.03) in Antarctic (11.5%) than subantarctic fur seal (8.9%) pups. These results suggest that, compared with subantarctic fur seals, Antarctic fur seal pups adopt a strategy of faster lean growth and physiological development, coupled with greater amounts of metabolically expensive behavioural activity, in order to acquire the necessary foraging skills in time for their younger weaning age.

Animals↗

PubMed1983

Changes in body weight and food-related behaviour induced by destruction of the ventral or dorsal noradrenergic bundle in the rat.

Three experiments contrasted the effects of 6-hydroxydopamine-induced lesions of the ventral noradrenergic and dorsal noradrenergic projections, predominantly to hypothalamus and cortex, respectively, upon body weight changes and food-related behaviour in the rat. In general, ventral noradrenergic bundle lesions enhanced weight gain and these effects were exaggerated by the provision of palatable cheese to the standard chow diet. In contrast, lesions of the dorsal noradrenergic bundle produced minor changes in body weight. Associated with the effects of ventral noradrenergic bundle lesions were hyperphagia, enhanced suppression of intake of food adulterated with quinine, (at high concentration), a small attenuation of food neophobia, and enhanced acquisition, but not performance, of the eating response to tail-pinch stimulation. These ventral noradrenergic bundle lesions failed to alter basal activity levels, amphetamine anorexia or the diurnal pattern of eating or activity. In contrast, lesions of the dorsal noradrenergic bundle did not produce either hyperphagia or enhanced rejection of food adulterated with quinine. However, there was a strong attenuation of food neophobia and a retarded acquisition (but unimpaired performance) of eating in response to tail-pinch stimulation. The results are discussed in connection with previous studies of ventral and dorsal noradrenergic bundle lesions, with the effects of ventromedial hypothalamic lesions and with the underlying behavioural and physiological processes that mediate these contrasting effects of different neuroanatomical patterns of central noradrenaline depletion.

Animals↗

PubMed2000

Male size does not affect territorial behaviour and life history traits in a sphecid wasp.

The optimum maternal investment per offspring is determined by the relationship between the investment per offspring and offspring fitness. In the European beewolf, Philanthus triangulum, a solitary mass-provisioning sphecid wasp, offspring size correlates with the amount of provisions. We investigated whether the reproductive success of adult males depends on body size in a way that would influence the allocation of parental investment. Since the mating success of P. triangulum males cannot be determined by observation in the field, we assessed the influence of male size on characteristics of their territories, territorial behaviour and life history traits. Territory size was weakly correlated with male size, but a measure of territory quality (number of female nests in the vicinity) was independent of male size. Neither the duration of ownership nor the intensity of scent marking was correlated with male size. Territory owners were slightly smaller than nonterritorial males. The absolute amount of fat was positively correlated with size but, owing to allometric relationships, the energetic equivalent of the fat store appeared to be independent of size. Life span was not significantly influenced by body size under four different conditions (with and without food in the laboratory, in an outdoor flight cage and in the field). We discuss the discrepancy between these results and other studies that have mostly reported advantages to large males. We suggest that in noncontact male-male interactions, as seen in the European beewolf, body size might not be the key determinant for success in contests. We conclude that there is no evidence for a strong size dependence of male reproductive success. Thus the reproductive success of male progeny probably does not depend on parental investment in a way that would influence the investment allocation of females. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed1993

Strain among nurses and their emotional reactions during 1 year of systematic clinical supervision combined with the implementation of individualized care in dementia nursing.

This study aimed at exploring nurses' views of the characteristics of severely demented patients, the difficulties these characteristics produced and the emotional reactions they evoked during the provision of care. Also, it aimed at exploring any changes in these aspects during a year of regular systematic clinical supervision combined with the implementation of individualized care at an experimental ward (EW) (n = 19) and at a control ward (CW) (n = 19). Data were collected by means of the Strain in Nursing Care scale, assessing the presence of certain characteristics in the patients, and how difficult each characteristic can be to handle. The Emotional Reactions in Nursing Care scale was also used, assessing 18 pairs of emotions. The analysis showed that agitation, not being responsive and unruly behaviour were the most common features while emptiness and agony turned out to be the most difficult problems to handle in the provision of care. Feelings of defeat and dissociation were reported to be almost as common as feelings of control and association. The EW nurses saw the patients as significantly more responsive, and victims of nihilation to a lesser degree and also patients' willfulness and emptiness was significantly easier to handle during the year of intervention. There were no significant changes on the CW. The mean values improved significantly in several aspects on the EW in comparison to the CW; patients seen as victims of nihilation, easier to handle agony, obediency, willfulness, evaluation and improved feelings of devotion and beneficence in the nurses. Thus the intervention seemed to improve the nurse-patient relationship and to decrease the experience of strain in the nurses.

Adaptation, Psychological↗

PubMed2001

Homicide and schizophrenia: maybe treatment does have a preventive effect.

BACKGROUND: Persons with schizophrenia have been found to be at increased risk for homicide as compared with the general population. The increased risk may be associated with the implementation of the policy of deinstitutionalization. METHOD: Persons with schizophrenia who had committed or attempted homicide in the German state of Hessen from 1992 to 1996 and in the Federal Republic of Germany from 1955 to 1964 were compared. RESULTS: Schizophrenia increased the risk of homicide 16.6 times (95% CI 11.2-24.5) in the recent cohort and 12.7 times (95% CI 11.2-14.3) in the older cohort. These odds ratios are not statistically different. The lack of appropriate services for chronic high-risk patients and the non-use of mental health services by first episode, acutely psychotic patients were associated with homicide. CONCLUSION: There has been no increase in the risk of homicide among persons with schizophrenia since the implementation of the policy of deinstitutionalization. The examination of the recent period suggests that the provision of specialized long-term care to persons with schizophrenia who are at high risk for violent behaviour and the use of mental health services by acutely psychotic persons may reduce the risk of homicide.

Journal Article↗

PubMed2000

Sex-dependent risk taking in the collared flycatcher, Ficedula albicollis, when exposed to a predator at the nestling stage.

An increased mortality rate is a cost of parental care, and can be high during the provisioning phase of altricial nestlings. When a parent stops feeding the nestlings temporarily after seeing a predator, it can reduce its own predation risk, but the suspension of parental care may also reduce its offspring's chances of surviving. We modelled this situation by exposing a stuffed sparrowhawk near collared flycatcher nests and removing it when both parents had seen it. We measured the time (return time) between the removal and when each parent entered the nestbox. The parents' risk taking and the return time are assumed to be inversely related. We studied which brood variables the parents take into account when deciding how much risk they are willing to take during the provisioning period. Males took more risk for older and better-quality nestlings and earlier broods. The females' behaviour was opposite to that of the males: they took significantly less risk for older and better-quality offspring and visited the nestbox later for earlier broods. The males' behaviour supported the reproductive value hypothesis, that risk taking is related to brood value and survival chances, whereas the females' behaviour supported the harm to offspring hypothesis, that risk taking is related to the broods' vulnerability. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed1997

Mental disorders and problematic behaviours in people with intellectual disability: future directions for research.

In recent years there has been a major growth of interest in the field of mental health and intellectual disability. This article outlines some of the issues that will be important to address in the coming years. The issues discussed include: the interaction of biological and environmental factors in the aetiology of behavioural and psychiatric disorders; diagnosis and classification; epidemiology; dementia; recognition of mental illness in the community; treatment; service provision; and training.

Conduct Disorder↗

PubMed2005

Factors influencing nurse supervisor competence: a critical incident analysis study.

AIM: The aim of the study was to identify factors related to critical incidents that influence the competence of nurse supervisors. BACKGROUND: Nurse supervisors require considerable competence in order to help supervisees to reflect on their clinical work and to interpret the needs of the patient. METHOD: A qualitative approach involving the critical incident technique was used. Critical incidents were collected by means of self-reports from 25 nurse supervisors. FINDINGS: Two main areas emerged: a professional and a personal stance. The professional stance described the nurse supervisors' awareness of the importance of creating a secure learning environment and facilitating reflection. The supervisors structured the material and created awareness of fundamental nursing values. The second main area, personal stance, described the nurse supervisors' behaviour when they gave the participating nurses the opportunity to work through the experiences gained in the daily provision of nursing care. Although they experienced lack of self-assurance during the supervision session, they also expressed security regarding their own performance as nurse supervisors. CONCLUSIONS: Nurse supervisors need to include more nursing theory and focus on the nursing process as well as being aware of their own shortcomings and resources. One way for the supervisor to scrutinize his/her actions is to discuss and examine them with a more experienced nurse supervisor colleague.

Adult↗

PubMed1975

Voluntary lithium intake, antidotal thirst' and concurrent behavior of rats.

1 Voluntary intake of various pair combinations of fluids (100 mM, 10 mM LiC1, 10 mM NaC1, water) and body weight was measured daily in rats. 2 More lithium was consumed when water was available. 3 When offered a lithium-sodium choice the rats did not consume significantly more saline than water on the previous trial. While saline consumption increased over the two days, lithium decreased slightly. 4 Following the lithium-only trial, water and saline were provided. Marked polydipsia was observed on the first day and the rats drank more water than saline. On the second day there was a significant drop in saline intake while water consumption returned to baseline levels. 5 Behavioural measurements overall confirmed the depressant effect of lithium: decreased ambulation and rearing and increased time spent immobile/grooming. 6 These findings are discussed with reference to lithium toxicity, which may be a comfounding variable in studies concerned with the effects of this salt on the behavior of laboratory rodents. Behavioural irritability such as aggression reported in situations using long-term lithium treatment may be reduced by provision for voluntary saline consumption.

Animals↗

PubMed1990

[Changes in the concept of minimal brain dysfunction in modern diagnostic classification and its manifestation in our theory and practice].

The purpose of the investigation was to give an account of changes in the concept of minimal brain dysfunction and deduce certain recommendations for professional and social practice. The authors describe the development of consensus regarding the problem of impaired activities and behaviour during childhood based on probable damage of the central nervous system. Analysis of the 8th, 9th and 10th decennial revision of the International Classification of Diseases and DSM III revealed a trend of increasing specification of clinical entities included in the complex of minimal brain dysfunctions. Diagnostic systems are focused on syndromological classification according to specific functions, reduced or impaired by the disorder. Contemporary diagnosis is to an increasing extent based on behavioural signs disorders. The analogous development in Czechoslovak practice is demonstrated on frequency analysis of articles in professional periodicals. It is apparent that social needs emphasize in particular early diagnosis of disorders of school skills. The result of the analysis is evidence of continuous overlapping of specific diagnostic units based on common symptoms (such as mental retardation, developmental disorders, hyperkinetic disorders and behavioural disorders). The authors discuss the problem of comorbidity of the complex of minimal brain dysfunctions and recommend provisions in diagnostic practice. Hypothetically pathogenetic models of the outcome of actual forms of different brain dysfunctions into specific risks or disorders in adult age are proposed.

Attention Deficit Disorder with Hyperactivity↗

PubMed2004

The effects of warnings and an educational brochure on computer working posture: a test of the C-HIP model in the context of RSI-relevant behaviour.

This study tested whether warnings can result in a better working posture with respect to RSI prevention compared with an educational brochure. By using a warning, the information provision on how to prevent RSI can be shorter and only interrupts with the task at hand for a short time. Five conditions were created to compare the effects on position adjustments of a warning displayed on the computer screen, a warning hanging on the wall, an educational brochure, a neutral interruption on the computer screen, and no intervention. Systematic observations of respondents' working postures showed that the computer warning led to significantly more correct position adjustments than the educational brochure and the two control situations, whereas the wall warning condition did not differ significantly from all other conditions. Questionnaires were used to study whether the number of position adjustments in the conditions could be explained by Wogalter's communication-human information processing (C-HIP) model. The questionnaire data suggest that the effect of the computer warning is caused by heightened attention for this type of intervention. The other stages of the C-HIP model--knowledge, attitude change, and motivation--might not be necessary in this situation in the explanation of behavioural changes. The conclusion is that warnings may be able to successfully replace educational brochures to produce behavioural changes.

Adult↗

PubMedDate not supplied

Epidemiology of neurodevelopmental disorders in children.

The epidemiology of mental and behavioural disorders is considered in comparison with spina bifida, chromosomal anomalies and brain tumours. Descriptive epidemiology is important not only in assessing the frequency of neurodevelopmental disorders, thereby aiding planning of service provision, but also because variations by geographical area, over time, and by personal characteristics provide clues regarding etiology. The value of the latter application is exemplified by research on spina bifida and other neural tube defects (NTDs). The descriptive epidemiology of mental and behavioural disorders has been less investigated. The descriptive epidemiology of NTDs suggested that diet might be of etiological importance. Analytical epidemiologic investigation proceeded by testing dietary hypotheses in case-control and cohort studies. Subsequently, folate supplementation was shown to reduce recurrence risk in a randomized controlled trial. The analytical epidemiology of other neurodevelopmental disorders is less well understood. Study design issues are discussed in relation to mental and behavioural disorders.

Adult↗

PubMed2000

Male provisioning is negatively correlated with attempted extrapair copulation frequency in the stitchbird (or hihi).

In species with biparental care of offspring and high levels of extrapair parentage, paired males may suffer reduced fitness by investing in offspring that are not their own. In such instances, males are predicted to evolve some form of discrimination between kin and nonkin and vary investment accordingly. One simple form of discrimination is to follow behavioural cues to paternity. We investigated paternal contribution to chick rearing in a socially monogamous population of stitchbirds, Notiomystis cincta, with high levels of extrapair copulation (EPC) and extrapair paternity. The relative contribution of the male to chick provisioning was negatively correlated with attempted EPC frequency. Because the majority of EPC attempts are forced and conspicuous in stitchbirds they are an obvious cue for males to use. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed2006

Supplier-induced demand: reconsidering the theories and new Australian evidence.

This paper reconsiders the evidence and several of the key arguments associated with the theory of supplier-induced demand (SID). It proposes a new theory to explain how ethical behaviour is consistent with SID. The purpose of a theory of demand and one criterion for the evaluation of a theory is the provision of a plausible explanation for the observed variability in service use. We argue that Australian data are not easily explained by orthodox possible explanation. We also argue that, having revisited the theory of SID, the agency relationship between doctors and patients arises not simply because of asymmetrical information but from an asymmetrical ability and willingness to exercise judgement in the face of uncertainty. It is also argued that the incomplete demand shift that must occur following an increase in the doctor supply is readily explained by the dynamics of market adjustment when market information is incomplete and there is non-collusive professional (and ethical) behaviour by doctors. Empirical evidence of SID from six Australian data sets is presented and discussed. It is argued that these are more easily explained by SID than by conventional demand side variables. We conclude that once the uncertainty of medical decision making and the complexity of medical judgements are taken into account, SID is a more plausible theory of patient and doctor behaviour than the orthodox model of demand and supply. More importantly, SID provides a satisfactory explanation of the observed pattern and change in the demand for Australian medical services, which are not easily explained in the absence of SID.

Australia↗

PubMed2003

Cognitive behaviour therapy of acute stress disorder: a four-year follow-up.

The aim of this study was to index the long-term benefits of early provision of cognitive behavior therapy to trauma survivors with acute stress disorder. Civilian trauma survivors (n = 80) with acute stress disorder were randomly allocated to either cognitive behavior therapy (CBT) or supportive counseling (SC) - 69 completed treatment, and 41 were assessed four years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician Administered PTSD Scale. Two CBT patients (8%) and four SC patients (25%) met PTSD criteria at four-year follow-up. Patients who received CBT reported less intense PTSD symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. These findings suggest that early provision of CBT in the initial month after trauma has long-term benefits for people who are at risk of developing PTSD.

Adult↗

PubMed1998

Towards the equitably efficient and transparently decidable use of public funds in the deep blue millennium.

Health economists concerned about the efficiency and equity of health care provision have focused their attention and evaluations on programmes and interventions at a population or group level. Clinicians, including those seeking to improve the quality of care by making it more evidence-based, see their task as using their clinical judgment to make the best use of the resources available to them as a result of policy decisions The existence of significant incoherence between the two (or more) levels is increasingly recognized, but clinical guidelines, the only current response, are analytically inadequate to the task of reducing it. 'Clinical Guidance Trees', on the other hand, not only have the potential to bridge the policy-clinical gap but also provide the means by which public funds can be allocated to individual patients on the basis of a societally determined willingness to pay per incremental unit of benefit. This paper aims to stimulate debate about a system in which all public funds are allocated on the basis of patient specific cost-effectiveness analyses, conducted on the basis of sociopolitically determined parameters (including equity weightings), but individualized 'quality of life' measures. The system, seeking to maximize 'equificiency', would do away with the increasingly unsustainable division between public and private sector provision and remove many expensive layers of health care decision making. While it would have many problems (including strategic behaviour various by parties), these need to be considered in the light of the problems of all alternative systems, including those of the status quo.

Decision Trees↗