Characteristics and service use of NSW Quitline callers with and without mental health conditions

IntroductionSmoking rates remain higher for people with a mental health condition compared to the general population and contribute to greater chronic disease burden and premature mortality. Quitline services offer telephone-based smoking cessation support to the public and have been shown to be effective. There is limited research exploring the characteristics of smokers with a mental health condition who use the Quitline or the impacts of using the service on their smoking behaviors.MethodsThis observational study aimed to compare demographic and smoking related characteristics, service use and quit attempts of callers to the New South Wales Quitline (2016–2018) with and without a mental health condition (N = 4,219).ResultsAt baseline, 40% of callers reported a current mental health condition. Desire to quit smoking was similar for both groups, however participants with a mental health condition had higher nicotine dependency and had made more quit attempts prior to engaging with the service. During program enrolment, quit attempts and 24 hours smoke free periods were similar, however participants with a mental health condition engaged in a greater number of calls and over a longer period with Quitline compared to those without.DiscussionThe findings suggest Quitline efficacy for people with a mental health condition in making a quit attempt for at least 24 h. Increasing the use of Quitline services and understanding service use for this critical group of smokers will increase the likelihood that their quit attempts are transformed into sustained periods of smoking abstinence. Future research should explore whether tailoring of Quitline service provision for people with mental health conditions may increase the likelihood of quit success

The Effectiveness and Cost of an Intervention to Increase the Provision of Preventive Care in Community Mental Health Services: Protocol for a Cluster-Randomized Controlled Trial.

Preventive care to address chronic disease risk behaviours is infrequently provided by community mental health services. In this cluster-randomised controlled trial, 12 community mental health services in 3 Local Health Districts in New South Wales, Australia, will be randomised to either an intervention group (implementing a new model of providing preventive care) or a control group (usual care). The model of care comprises three components: (1) a dedicated 'healthy choices' consultation offered by a 'healthy choices' clinician; (2) embedding information regarding risk factors into clients' care plans; and (3) the continuation of preventive care by mental health clinicians in ongoing consultations. Evidence-based implementation strategies will support the model implementation, which will be tailored by being co-developed with service managers and clinicians. The primary outcomes are client-reported receipt of: (1) an assessment of chronic disease risks (tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol use and physical inactivity); (2) brief advice regarding relevant risk behaviours; and (3) referral to at least one behaviour change support. Resources to develop and implement the intervention will be captured to enable an assessment of cost effectiveness and affordability. The findings will inform the development of future service delivery initiatives to achieve guideline- and policy-concordant preventive care delivery

Systematic review and meta-analysis of the provision of preventive care for modifiable chronic disease risk behaviours by mental health services

People with mental illness experience increased chronic disease burden, contributed to by a greater prevalence of modifiable chronic disease risk behaviours. Policies recommend mental health services provide preventive care for such risk behaviours. Provision of such care has not previously been synthesised. This review assessed the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Four databases were searched from 2006 to 2017. Eligible studies were observational quantitative study designs conducted in mental health services, where preventive care was provided to clients for tobacco smoking, harmful alcohol consumption, inadequate nutrition, or inadequate physical activity. Two reviewers independently screened studies, conducted data extraction and critical appraisal. Results were pooled as proportions of clients receiving or clinicians providing preventive care using random effects meta-analyses, by risk behaviour and preventive care element (ask/assess, advise, assist, arrange). Subgroup analyses were conducted by mental health service type (inpatient, outpatient, other/multiple). Narrative synthesis was used where meta-analysis was not possible. Thirty-eight studies were included with 26 amenable to meta-analyses. Analyses revealed that rates of assessment were highest for smoking (78%, 95% confidence interval [CI]:59%–96%) and lowest for nutrition (17%, 95% CI:1%–35%); with variable rates of care provision for all behaviours, care elements, and across service types, with substantial heterogeneity across analyses. Findings indicated suboptimal and variable provision of preventive care for modifiable chronic disease risk behaviours in mental health services, but should be considered with caution due to the very low quality of cumulative evidence

Rates of retention of persons with a mental health disorder in outpatient smoking cessation and reduction trials, and associated factors: Protocol for a systematic review and meta-analysis

Introduction Smoking among persons with a mental health disorder is associated with inequitable health, social and economic burden. Randomised controlled trials (RCTs) are considered the gold standard design for the assessment of healthcare intervention efficacy/effectiveness. However, many RCTs of smoking interventions for persons with a mental health disorder lack rigour due to low participant retention. No systematic review has pooled retention rates in randomised trials of smoking interventions for persons with a mental health disorder or explored associated factors. The aims of the systematic review will therefore be to: (1) summarise overall rates of participant retention in smoking cessation and reduction trials involving persons with a mental health disorder (including for experimental and control groups separately) and (2) determine if retention rates vary according to participant, environmental, researcher and study factors. Methods and analysis PsycINFO, EMBASE, MEDLINE, CENTRAL and The Cochrane Tobacco Addiction Review Group Specialised Register will be searched for reports of RCTs of outpatient smoking cessation or reduction interventions for adults with a mental health disorder. The search terms will include MeSH terms and free text words, and there will be no language or date restrictions. All databases will be searched from inception to present. Data will be analysed using the Mantel-Haenszel fixed-effect model, and where substantial heterogeneity (I2 >50%) is detected, DerSimonian & Laird inverse-variance random effects model. Pooled estimates and 95% CIs will be calculated for overall participant retention rates and for intervention and control trial arms separately. Associations between participant retention and participant, environmental, researcher and study factors will be assessed via subgroup analyses and, where sufficient data are obtained, meta-regression. Ethics and dissemination This study does not require ethical approval. The findings of this review will be disseminated via publication in a peer-reviewed open access medical journal and presentations at international scientific meetings

Allocation, stress tolerance and carbon transport in plants: How does phloem physiology affect plant ecology?

Despite the crucial role of carbon transport in whole plant physiology and its impact on plant-environment interactions and ecosystem function, relatively little research has tried to examine how phloem physiology impacts plant ecology. In this review, we highlight several areas of active research where inquiry into phloem physiology has increased our understanding of whole plant function and ecological processes. We consider how xylem-phloem interactions impact plant drought tolerance and reproduction, how phloem transport influences carbon allocation in trees and carbon cycling in ecosystems, and how phloem function mediates plant relations with insects, pests, microbes and symbiotes. We argue that in spite of challenges that exist in studying phloem physiology, it is critical that we consider the role of this dynamic vascular system when examining the relationship between plants and their biotic and abiotic environment

Changing practice: preventive care for chronic disease health risk behaviours in community mental health services

Research Doctorate - Doctor of Philosophy (PhD)People who have a mental illness have significantly greater mortality rates and a reduced life expectancy when compared to the general population, with a large proportion of excess mortality attributable to a higher prevalence of preventable chronic diseases. One contributor to the greater chronic disease burden is an increased prevalence of modifiable health risk behaviours, when compared to the general population, in particular, tobacco smoking, harmful alcohol consumption, inadequate nutrition, and inadequate physical activity. The provision of preventive care in mental health services is one approach to addressing such health risk behaviours among people with a mental illness, with community mental health services identified as a particularly appropriate setting for such care delivery. Despite this, there are evident gaps in the literature regarding the prevalence of health risk behaviours among people with a mental illness, the prevalence of preventive care provision in community mental health services, and the approaches required to increase the provision of such care in community mental health services. To address these evidence gaps, the broad aims of this thesis were to: 1) Identify the prevalence of, and client characteristics associated with, four chronic disease health risk behaviours (tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption, and inadequate physical activity) among clients of community mental health services. ; 2) Determine the prevalence of preventive care provision (assessment, brief advice, and referral) in community mental health services for these four health risk behaviours. ; 3) Explore factors that may be associated with the provision of preventive care for these four health risk behaviours. ; 4) Determine the effectiveness of a clinical practice change intervention in increasing community mental health clinicians’ provision of preventive care for these four health risk behaviours across a network of community mental health services. These four aims have been addressed through a series of studies, undertaken within a network of 19 community mental health services in a single local health district in New South Wales, Australia. These studies include: a cross-sectional survey of 558 clients of community mental health services; a cross-sectional survey of 151 community mental health service clinicians; and a multiple baseline intervention trial involving 19 community mental health services, evaluated through weekly surveys of clients of community mental health services over a three year period. The work encompassed in this thesis has contributed to advancing research in this field in a number of ways. Firstly, the findings include evidence among people with a broad range of mental disorders, of a high prevalence of risk for all four health risk behaviours (tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption, and inadequate physical activity), high interest in improving these behaviours, and high acceptability towards receiving preventive care to address them. Despite the high prevalence of health risk behaviours and high client interest, it was found that the provision of preventive care for these behaviours within community mental health services was sub-optimal, and a number of factors that may be associated with the provision of such care were identified. Finally, the clinical practice change intervention that was undertaken to increase the routine provision of preventive care in community mental health services was found to have limited effectiveness. Overall, this thesis has identified a need to increase the provision of preventive care to address the high prevalence of health risk behaviours among people with a mental illness, and has trialled a novel approach to increasing the provision of such care in community mental health services. Despite the limited effectiveness of the clinical practice change intervention, the findings of this thesis have provided important insight for future interventions. It is suggested that future research consider barriers identified throughout this thesis to better tailor an intervention to the specific context of community mental health services; consider utilising advances in the science of clinical practice change design; and explore alternative models of preventive care provision

Reshaping Spectatorship: Immersive and Distributed Aesthetics

Although discourses of immersive aesthetics and distributed aesthetics may evoke associations with different media, creative processes, modes of audience engagement and even political ideologies, artists using these aesthetics often share similar interests in transforming and enhancing notions of the body and perception through technological intervention. This paper undertakes a comparison between immersive and distributed aesthetics in relation to Virtual Reality (VR) and Networked Art (net.art), particularly networked installation art. It focuses on the ways in which both VR and networked installations immerse the viewer in states of perceptual and cognitive transition. Central to this article is the argument that VR and net.art are able to generate immersive experiences in the viewer by creating the sensation of being (tele-)present in an electronically mediated environment that is illusionistic and sometimes remote from the physical body of the participant. Furthermore, the immersive and distributed aesthetics generated by specific VR and net.art projects have revolutionary consequences for traditional aesthetic theories of spectatorship and art appreciation that assert the need for critical and physical distance