Medical School

This paper presents findings from a study which investigated young people's ICT use and the capacity of service providers to utilise these technologies in their practice. The results suggest that ICT may be an important resource for mental health promotion, particularly in relation to engaging young people. It was found that young people who experience marginalisation access and engage with ICT although the quality of the access available to them is often limited. The findings also suggest that there is a pressing need to provide training for service providers to increase their capacity to use ICT.

The growth of the internet and related technologies such as mobile phones, digital film and photography in the last decade has seen a substantial shift in the way young people communicate and share information. The role that information and communication technologies (ICT) may play and the impact they may have on the mental health and wellbeing of young people is not well understood and there are gaps in the evidence base surrounding the efficacy of mental health promotion and prevention initiatives that utilise technology. The Bridging the Digital Divide Project examines the potential use of ICT to promote social connectedness and civic engagement in young people experiencing marginalisation. This paper provides an overview of the project rationale and presents preliminary research that explores the barriers and enablers to implementing an ICT based project designed to promote civic engagement and social connectedness with young people experiencing marginalisation.

Objective: Inspire and partners have built an evidence base examining the role technology can play in supporting the mental health and wellbeing of young people at increased risk of developing mental health diffi culties. This paper explores these fi ndings collectively and considers how to best use information communication technologies (ICT) to meet the mental health needs of diverse young people aged 14 -25.

Considerable investment over the last decade in strategies to improve mental health and wellbeing in Australia has seen a notable increase in the availability and awareness of youth-specifi c mental health services as well as an increase in mental health literacy among young people. However, national statistics do not refl ect a corresponding increase in help-seeking behaviour among young people. There is limited understanding of how services can promote effective help-seeking in young people -particularly those young people experiencing marginalisation or high levels of psychological distress. In this paper we examine the potential for online mental health services to address the persistent challenge of facilitating help-seeking in young people. This paper presents fi ndings from a study of young people's use of the online service, ReachOut.com, to examine if and how the service promotes help-seeking. We fi nd that ReachOut.com effectively engages young people -particularly those who are experiencing high levels of psychological distress and supports young people to become service ready. Targeted strategies for young men and other hard-to-reach groups as well as further integration with on and offl ine clinical services are likely to strengthen and systematise the role of ReachOut.com as a gateway service, supporting young people to seek professional support.

Aims:  To evaluate the Australian Paediatric Surveillance Unit (APSU).Methods:  We used criteria recommended by the Centres for Disease Control and Prevention (CDC) for evaluating surveillance systems and reviewed productivity, response rates, completeness of the mailing list and impacts of APSU studies. Anonymous evaluation questionnaires were sent to 1260 reporting clinicians, 42 researchers and 86 public health professionals to seek their feedback as users of the APSU.Results:  APSU provides national epidemiological and clinical data about rare childhood conditions that inform public health policy and clinical practice. Between 2000 and 2007, APSU data were disseminated in 106 journal articles, 207 scientific presentations and 85 media items. Of paediatricians and paediatric sub-specialists actively practicing in Australia and listed as Fellows of the Royal Australasian College of Physicians, 92% participate in APSU surveillance. An average 96% of monthly report cards were returned per annum since 2000. Sensitivity of case ascertainment was difficult to calculate for many conditions because alternative sources of ascertainment do not exist. Evaluation questionnaires were returned by 818 (65%) reporting clinicians, who believe APSU is valuable for generating knowledge 665 (81%), identifying research priorities 635 (78%), guiding clinical practice 572 (70%) and informing public health policy 575 (70%). Similar responses were received from researchers and public health professionals.Conclusions:  The APSU fulfils its objectives and meets relevant CDC criteria for usefulness, simplicity, acceptability and representativeness, sensitivity and timeliness of data quality. However, stability is threatened by lack of continuing core funding. APSU is highly productive and valued by child health clinicians, researchers and public health professionals.

Australia requires a national plan, similar to plans developed internationally, to address the impacts of rare diseases on individuals, the community and health services. Rare diseases often present in childhood, many are chronic, some life threatening and others associated with significant disability. However, diagnosis is often delayed, because of lack of knowledge and experience of health professionals and uncertainty about where to refer. Specialised health services are frequently lacking and specific therapies are often not available, partly because of lack of research funding directed towards rare diseases. A national plan would facilitate a coordinated response to service development, carer support, and health professional and community education, and would promote research and advocacy for affected children and their families.

Paradoxically, rare diseases are common, collectively affecting 6-10% of the population and have a huge impact on patients and families, health services, clinicians and the wider community. Accurate data are required to inform clinical practice, government policy and health service planning. We recommend a national approach, similar to that adopted in the USA and Europe, to support research and promote advocacy and equitable access to services for children with rare diseases.

Aim:  To explore clinicians' perceptions of the value, usefulness and limitations of the Australian Paediatric Surveillance Unit (APSU) and obtain direct feedback regarding the surveillance mechanism and suggestions for improvement.Methods:  Anonymous postal survey of Australian paediatricians (n = 1260) in 2007.Results:  Of 1260 clinicians surveyed 818 (65%) responded, a similar proportion from all states/territories and specialties. Over half had participated in surveillance for >10 years. The majority (95%), believe APSU research is valuable, for generating knowledge (81%), identifying research needs (78%), facilitating collaborative research (75%), supporting education and advocacy (74%), guiding clinical practice (70%), informing future policy (70%) and evaluating current policy (68%). Of 458 respondents who had ever reported a case (90%) had no objection to providing de-identified clinical information; and about 75% said questionnaires were easy to complete; however, one third said clinical information requested was not always readily available. Most (680, 83%) respondents believed their contribution to the APSU was appropriately acknowledged and 20% said they had personally benefited from participation. The majority (90%) were willing to report immediately by email/fax/phone in an epidemiological emergency. Lack of time and resources was the most common limitation to participation identified by clinicians: some suggested on-line reporting would improve the ease and timeliness of reporting. Clinicians also suggested better use of the APSU website to disseminate results.Conclusion:  Clinicians acknowledged the APSU as valuable. Improving communication with clinicians, ensuring that information requested in questionnaires is relevant and available, and developing a secure web-based reporting system are future APSU priorities.

This study examines an alternative to a narrow locus-of-dysfunction cortical pathophysiology in schizophrenia, which in turn suggests a modified approach to the analysis of data from regional cerebral blood flow studies. The resuits provide qualified support for a model of impaired differentiation of cortical activity in schizophrenia. As an index of the differentiation of cortical fields, regional gradients of cortical blood flow were examined. Medicated patients (n = 15) failed to show the differentiation of networks in frontal areas during a verbal memory recognition task observed in normal comparison subjects (n = 15). Unmedicated patients (n = 15) at rest tended to lose normal lateralization and had increased gradients in the right frontal area compared with normal comparison subjects.

Post-traumatic cerebral vasospasm is being increasingly recognised as a possibly significant complication after head injury. To assess the relationship between post-traumatic subarachnoid haemorrhage (tSAH) and post-traumatic vasospasm, 63 patients with severe head injury (GCS 3–8) were studied. Forty-seven patients had cerebral contusion on the initial CT scan. In 25 of these (Group I) there were only contusions, while 22 (Group II) also had tSAH. All patients had daily measurements of blood flow velocity in the basal cerebral arteries using transcranial Doppler ultrasound (TCD). The incidence of vasospasm detected by TCD was significantly higher in Group II. Furthermore there were significantly fewer good outcomes (GOS 1 and 2) in this group. These results suggest that the presence of subarachnoid blood in patients with severe head injury is associated with a risk of vasospasm, and with poorer outcome.

Cerebral vasospasm is increasingly recognized as contributing to ischaemia after head injury. The reported incidence of post-traumatic vasospasm (PTV) varies between 10% and 90%, probably largely because of differences in patient selection, in definitions of vasospasm and in methods of detecting spasm. In severe head injury, based on studies with similar criteria, the incidence is approximately 40%. PTV is often associated with traumatic subarachnoid haemorrhage (tSAH), but has been reported without tSAH. These two factors are independently associated with poor outcome, but the direct links between tSAH, vasospasm and outcome are uncertain. There is evidence that calcium antagonists improve outcome in patients with head injury and tSAH; aminosteroids may also be effective here. Other strategies such as maintaining normocapnia and control of blood volume and pressure may also be useful. Further investigation of large cohorts is required to clarify fully the significance of PTV, its relationship with tSAH and outcome and possible treatment modalities.