Antigen-reactive CD4+ T cells expressing CD39 are more abundant in active TB than LTBI and are associated with production of the immunosuppressive cytokine IL-10. Modulating the effects of CD39 might enhance cellular immune responses against M. tuberculosis.

Objective The aim of this research was to explore the transition pathways of transition‐aged youth out of child and adolescent mental health services in Perth, Western Australia. A secondary aim was to identify factors that have some impact upon the transition process. Method Cases discharged from seven child and adolescent mental health community clinics in the Perth metropolitan area, from 1 June 2004 to 30 June 2013, at transition age (16–25 years of age), were examined retrospectively. Two hundred and forty‐five cases met the selection criteria and were reviewed on the Psychiatric Services Online Information System. Results Four specific pathways of referral and acceptance into an adult mental health service were identified: not referred, referred with immediate engagement, referred with delayed engagement, and referred with no engagement and not accepted. Principal discharge diagnosis, length of stay, and housing situation on discharge were all found to influence likelihood of referral. Only principal discharge diagnosis was found to influence successful acceptance into an adult mental health service. Conclusions The factors found to influence transition pathways in the present study were largely consistent with findings from the UK. Findings of the present research can assist clinicians to make more informed decisions when discussing transition with clients. More broadly, findings can be used by policy makers to support the formation and maintenance of transition protocols.

Objective: This study examined the relationships between appraisals of the physical environment with the subjective experience of consumers, and work satisfaction of clinicians, in Child and Adolescent Mental Health Services (CAMHS). Design, setting, and outcome measures: A survey of clinicians, parent/guardians, and child/adolescents was conducted across eight community CAMHS in Western Australia. Respondents evaluated the waiting room and therapy rooms on a number of environmental attributes, and factor analysis was carried out to confirm that these ratings loaded on an overall appraisal of the physical environment measure. This measure was thencorrelated with self-reported subjective experience of consumers, and overall work satisfaction of staff members. Results: Clinicians were found to be much more critical of the physical environment compared with consumers. Moderate associations were found between appraisal of the physical environment and subjective experience of consumers. A strong positive association was found between clinician appraisal of the physical environment and overall work satisfaction. Conclusions: The present study adds to the limited existing research arguing for the important role that the physical environment can have upon both consumer and staff experience in mental health settings. The present study provides empirical evidence to justify steps being taken to enhance the physical environment in mental health clinics. The inter-relationship between physical environment attributes suggests there is potential for managers to improve the overall perception of clinic space via relatively small actions (e.g., adding a nice piece of artwork). Abbreviations: CAMHS – Child and Adolescent Mental Health Services.

Objective:  The primary objective was to investigate the impact of shared versus individual office space on therapist appraisal of the work physical and social environment, and overall appraisal of working conditions. Method:  Therapists (n = 59) from Child and Adolescent Mental Health Services in Western Australia were surveyed about their appraisal of the social and physical work environment, in addition to their overall appraisal of working conditions. Results:  Compared to therapists with individual offices, therapists occupying shared office space reported lower appraisal of the work physical environment and lower overall appraisal of working conditions. No difference was found between groups for appraisal of the work social environment. Additionally, when statistically controlling for office space, both the appraisal of the social and physical environment made an independent contribution to the prediction of overall work satisfaction. Conclusion:  This research reveals that shared office space can negatively impact therapist appraisal of their work environment and reduce overall appraisal of working conditions. Additionally, results reveal the high importance of the physical environment for staff satisfaction in a mental health service.

BACKGROUND: Australia has a low incidence of TB and has committed to eliminating the disease. Identification of risk factors associated with TB is critical to achieving this goal.METHODS: We undertook a prospective cohort study involving persons receiving TB treatment in four Australian jurisdictions. Risk factors and their association with delayed treatment completion (treatment delayed by at least 1 month) were analysed using univariate analyses and multivariate logistic regression.RESULTS: Baseline surveys were completed for 402 persons with TB. Most (86.1%) were born overseas. Exposure to a person with TB was reported by 19.4%. Diabetes mellitus (10.2%), homelessness (9.2%), cigarette smoking (8.7%), excess alcohol consumption (6.0%) and mental illness (6.2%) were other common risk factors. At follow-up, 24.8% of patients had delayed treatment completion, which was associated with adverse events (34.1%, aOR 6.67, 95% CI 3.36–13.27), excess alcohol consumption (6.0%, aOR 21.94, 95% CI 6.03–79.85) and HIV co-infection (2.7%, aOR 8.10, 95% CI 1.16–56.60).CONCLUSIONS: We identified risk factors for TB and their association with delayed treatment completion, not all of which are routinely collected for surveillance purposes. Recognition of these risk factors should facilitate patient-centred care and assist Australia in reaching TB elimination.

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