Not taking annual leave: what could it cost Australia?

Australians work longer hours than all other OECD nations and generally do not use all their leave entitlement. According to National Occupational Health and Safety Commission (NOHSC) figures, workplace accidents and disease may cost the Australian economy $37 billion. However, this figure may be an underestimate. This is because the costs of workplace stress are not included in these figures. It has been established that organisations that do not overwork their employees and offer hours of work that are more sociable tend to be more productive. It has also been established that taking holidays over a period of 20 days or more is helpful in reducing workplace and other stress. This paper considers these issues and suggests an agenda for future research to increase our understanding of the importance of taking annual leave for a holiday to workers and the Australian economy. The findings of this research suggest both policy makers and employee relations practitioners need to consider the importance of work-family balance, health economics and employee wellbeing

Mental health treatment: Reaching more kids

Background: Nearly 70% of children who are in need of specialized mental health services do not access them. We set out to identify effective self-delivered interventions as a way to help bridge the gap between those in need and those being serviced. Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating self-delivered treatments. After applying our rigorous inclusion criteria, we accepted five RCTs evaluating five treatment interventions. Results: Three self-directed family interventions reduced anxiety diagnoses and symptoms for school age children. One self-directed parenting intervention reduced ADHD diagnoses for school age children. Additionally, one self-directed youth invention reduced depression symptoms for adolescents. Conclusions: Strong research evidence supports the use of self-directed treatments to address three common childhood mental disorders. Greater use of these interventions can expand the number of children who are reached with effective treatments

Helping children cope with trauma

Background: Experiencing adverse experiences during childhood can lead to the development of mental disorders. We therefore set out to identify that effectively help children who have experienced trauma. Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating prevention interventions for children after serious adverse experiences. After applying our rigorous inclusion criteria, we accepted five RCTs – evaluating three psychosocial interventions delivered to children who had been maltreated, and one medication for children who had sustained physical injuries. Results: It’s My Turn Now, Fostering Healthy Futures, and Multisystemic Therapy showed benefits for children who had a history of maltreatment, including reducing symptoms of mental disorders. In contrast, Propranolol failed to show benefit for children who had sustained injuries. Conclusions: Preventing childhood adversities wherever possible is crucial and recognizes children’s rights to safety. Yet it is possible to prevent mental health symptoms from developing even after children have experienced serious adversity

Psychosis: Is prevention possible?

Background: Controversy persists about whether or not it is possible to prevent psychotic disorders. We set out to identify if there were any effective interventions that prevent psychosis among youth. Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating prevention interventions. After applying our rigorous inclusion criteria, we accepted three RCTs –  evaluating one supplement and two psychosocial interventions with youth found to be at high-risk for psychosis. Results: Omega-3 polyunsaturated fatty acid (PUFA) supplements reduced psychosis diagnoses and symptoms use and improved overall functioning over six years follow-up. Two other interventions – Auditory Cognitive Training and Family-Focused Treatment – did not produce significant benefits post-intervention. Conclusions: More studies are needed to replicate results for PUFAs. As well, additional research is needed to develop psychosocial interventions that may help high-risk youth. Given the high burdens and costs associated with psychosis, prevention remains an important goal for youth and families

Treating posttraumatic stress disorder in children

Background: Posttraumatic stress disorder (PTSD) affects approximately 0.1% of children who have been exposed to serious adversities. We therefore set out to identify effective interventions for treating childhood PTSD. Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating treatment interventions for children who had diagnosed with PTSD. After applying our rigorous inclusion criteria, we accepted five RCTs – evaluating three psychosocial interventions and one medication. Results: Prolonged Exposure for Adolescents and KIDNET, both based on cognitive-behavioural therapy (CBT), showed significant benefits for children, including reduction of PTSD diagnoses, symptoms, and overall functioning compared to controls. In contrast, D-cycloserine failed to show benefit for children compared to controls. In a head-to-head trial, Eye Movement Desensitization and Reprocessing (EMDR) and CBT both reduced PTSD diagnoses and symptoms, with EMDR outperforming CBT in reducing diagnoses by parent-report at one-year follow-up. Conclusions: Preventing childhood adversities is priority. But when a child develops PTSD, access to effective treatment is crucial. CBT was effective in reducing diagnoses and/or symptoms across four RCTs in our systematic review.&nbsp

Helping young people with psychosis

Background: Psychotic disorders are associated with a high degree of impairment making early intervention crucial for youth. We therefore set out to identify effective psychosis interventions for young people. Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating treatment interventions. After applying our rigorous inclusion criteria, we accepted eight RCTs – evaluating five different medications and three psychosocial interventions. Results: Aripiprazole and olanzapine showed benefits in two trials each, although both led to adverse events that require close monitoring. Cognitive Remediation Therapy, Computer-Assisted Cognitive Remediation and the Think Program showed secondary benefits of improved cognitive skills and reduced emergency room visits which can be helpful when used along with antipsychotic medications. Conclusions: Antipsychotics should be used prudently, after careful assessment and diagnosis, and psychosocial interventions should be offered as well. Further research is needed on early interventions to help young people with psychosis

Trouble at the top: The construction of a tenant identity in the governance of social housing organizations

The project of citizen governance has transformed the social housing sector in England where 20,000 tenants now sit as directors on the boards of housing associations, but the entrance of social housing tenants to the boardroom has aroused opposition from the chief executives of housing companies and triggered regulatory intervention from government inspectors. This paper investigates the cause of these tensions through a theoretical framework drawn from the work of feminist philosopher Judith Butler. It interprets housing governance as an identificatory project with the power to constitute tenant directors as regulated subjects, and presents evidence to suggest that this project of identity fails to completely enclose its subject, allowing tenant directors to engage in ‘identity work’ that threatens the supposed unity of the board. The paper charts the development of antagonism and political tension in the board rooms of housing companies to present an innovative account of the construction and contestation of identities in housing governance

Temozolomide for high grade glioma

This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2013, Issue 4. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.BACKGROUND: High grade glioma (HGG) is an aggressive form of brain cancer. Treatment of HGG usually entails biopsy, or resection if safe, followed by radiotherapy. Temozolomide is a novel oral chemotherapy drug that penetrates into the brain and purportedly has a low incidence of adverse events. OBJECTIVES: To assess whether temozolomide has any advantage for treating HGG in either primary or recurrent disease settings. SEARCH METHODS: The following databases were searched: CENTRAL (Issue 10, 2012), MEDLINE, EMBASE, Science Citation Index, Physician Data Query and the Meta-Register of Controlled Trials in October, 2012. Reference lists of identified studies were searched. The Journal of Neuro-Oncology and Neuro-oncology were handsearched from 1999 to 2012 including conference abstracts. We contacted neuro-oncologists regarding ongoing and unpublished trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) where the interventions were the use of temozolomide during primary therapy or for recurrent disease. Comparisons included no chemotherapy, non-temozolomide chemotherapy or different dosing schedules of temozolomide. Patients included those of all ages with histologically proven HGG. DATA COLLECTION AND ANALYSIS: Two review authors undertook the quality assessment and data extraction. Outcome measures included: overall survival (OS); progression-free survival (PFS); quality of life (QoL); and adverse events. MAIN RESULTS: For primary therapy three RCTs were identified, enrolling a total of 745 patients, that investigated temozolomide in combination with radiotherapy versus radiotherapy alone for glioblastoma multiforme (GBM). Temozolomide increased OS (hazard ratio (HR) 0.60, 95% confidence interval (CI) 0.46 to 0.79, P value 0.0003) and increased PFS (HR 0.63, 95% CI 0.43 to 0.92, P value 0.02), when compared with radiotherapy alone, although these benefits only appear to emerge when therapy is given in both concomitant and adjuvant phases of treatment. A single RCT found that temozolomide did not have a statistically significant effect on QoL. Risk of haematological complications, fatigue and infections were increased with temozolomide.In recurrent HGG, two RCTs enrolling 672 patients in total found that temozolomide did not increase OS compared to standard chemotherapy (HR 0.9, 95% CI 0.76 to 1.06, P value 0.2) but it did increase PFS in a subgroup analysis of grade IV GBM tumours (HR 0.68, 95% CI 0.51 to 0.90, P value 0.008). Adverse events were similar between arms.In the elderly, 2 RCTs of 664 patients found OS and PFS was similar with temozolomide alone versus radiotherapy alone. QoL did not appear to differ between arms in a single trial but certain adverse events were significantly more common with temozolomide. AUTHORS' CONCLUSIONS: Temozolomide when given in both concomitant and adjuvant phases is an effective primary therapy in GBM compared to radiotherapy alone. It prolongs survival and delays progression without impacting on QoL but it does increase early adverse events. In recurrent GBM, temozolomide compared with standard chemotherapy improves time-to-progression (TTP) and may have benefits on QoL without increasing adverse events but it does not improve overall. In the elderly, temozolomide alone appears comparable to radiotherapy in terms of OS and PFS but with a higher instance of adverse events. Update of Cochrane Database Syst Rev. 2008;(4):CD007415