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The constant changing health care system has made it imperative for occupational therapists (OTs) to examine the effectiveness of treatment interventions with children. Few studies exist examining play as the desired outcome of the intervention. Previous studies in occupational therapy (OT) have focused on the motor aspects of play in children (Anderson, Hinojosa & Strauch, 1987; Florey, 1981; Morrison, Bundy, & Fisher, 1991). In these studies, the researchers hypothesize that improving motor skills will improve play skills in children. OTs frequently evaluate play using the Preschool Play Scale (PPS) (Bledsoe & Shephard, 1982; Knox, 1997) which provides a developmental age for play skills. Therapists also use developmental assessments designed to examine the skills used during play (Bundy, 1991). Skills used in play are important but fail to look at a child's approach or attitude during play. A child's approach to activities of play is termed "playfulness" (Bundy, 1997). The Test of Playfulness (TOP) (Bundy, 1997) was developed to measure this construct. The TOP provides information that can assist therapists working with children in designing measurable playfulness goals. This study examined the playfulness of four children who received OT intervention specifically designed to improve play behaviors in comparison to four children who did not receive this intervention. The results provide therapists with information and insight for treating children with play deficits. This information will help therapists design effective treatment to increase playfulness in children.

This paper argues that analysis of the process of acquiring an international education in a multicultural environment requires examination of the structural aspects of the process. It also requires identification of the critical variables that are active and influential during the experience. In order to achieve this purpose, the construction of personal identity, the functioning of groups, and behaviour inside the classroom are examined, and a model is developed to visually represent the process

This study aimed to assess the feasibility of a home-based exercise programme and examine the effects on the healing rates of venous leg ulcers. A 12-week randomised controlled trial was conducted investigating the effects of an exercise intervention compared to a usual care group. Participants in both groups (n = 13) had active venous ulceration and were treated in a metropolitan hospital outpatients clinic in Australia. Data were collected on recruitment from medical records, clinical assessment and questionnaires. Follow-up data on progress in healing and treatments were collected fortnightly for 12 weeks. Calf muscle pump function data were collected at baseline and 12 weeks from recruitment. Range of ankle motion data were collected at baseline, 6 and 12 weeks from recruitment. This pilot study indicated that the intervention was feasible. Clinical significance was observed in the intervention group with a 32% greater decrease in ulcer size (P = 0·34) than the usual care group, and a 10% (P = 0·74) improvement in the number of participants healed in the intervention group compared to the usual care group. Significant differences between groups over time were observed in calf muscle pump function parameters [ejection fraction (P = 0·05), residual volume fraction (P = 0·04)] and range of ankle motion (P = 0·01). This pilot study is one of the first to examine and measure clinical healing rates for participants involved in a home-based progressive resistance exercise programme. Further research is warranted with a larger multi-site study.

In 1997 the status of Hong Kong will change. It will cease being a colony of the United Kingdom and become a Special Administrative Region of the People's Republic of China. The article attempts to demonstrate that, due to historical, economic and cultural factors, the task of achieving appropriate change in Hong Kong education to prepare for this event is problematic and highly complex. This suggestion, however, is not that the education system will not be affected by the events surrounding ‘1997’, for the relationship between education and social change is profoundly reciprocal. Hong Kong's society and education system will interact and change because of the events of this and the next decades.

Objectives: It is standard practice to use lignocaine gel during male urethral catheterization. However, it is commonly believed that topical anaesthetic confers no benefit during female catheterization hence lubricating gel alone is more commonly used. The present study aimed to determine whether lignocaine gel decreased pain compared with water-based lubricating gel for female urethral catheterization in the ED. Methods: This randomized double-blinded study was carried out at two Sydney hospitals – an urban district inner western hospital and a south-western major trauma centre. A convenience sample of 62 alert, cooperative adult female ED patients provided written informed consent. The indications for, and technique of catheterization, were at the discretion of the clinical staff. Pre- and immediate post-procedure pain was scored by the patient on a 100 mm Visual Analogue Scale (VAS). The primary outcome was the difference in VAS scores (post- minus pre-procedure) in millimetres. Values for each group were expressed as medians and interquartile ranges, statistical significance determined using the Mann–Whitney U-test. Results: The groups were well matched for age, indication for catheterization, pre-procedural pain score, catheter size and the number of catheterization attempts. Patients receiving lignocaine gel had a significantly lower median procedural pain score than patients receiving lubricating gel (6 mm vs 33 mm, P = 0.007). Conclusions: Lignocaine gel substantially reduces the procedural pain of female urethral catheterization by comparison with use of a water-based lubricating gel.

OBJECTIVES: Population based-studies on Campylobacter infection have focused on age, gender, season and the level of urbanisation. The aim of this study was to determine the risk of infection in different ethnic groups resident in England. METHODS: Ethnicity-specific risk for Campylobacter infection were calculated using data on 6585 laboratory-confirmed cases from 18 health authorities in England. RESULTS. The Pakistani community was at greater risk of Campylobacter infection than the White community (Risk Ratio (RR) 1.71; exact 95% confidence interval (CI) 1.45-2.01). The Indian (RR 0.38; 95% CI 0.28-0.52) and Black (RR 0.30; 95% CI 0.21-0.44) communities were at lower risk than the White community. The risk in the Chinese community was no different from other ethnic groups (RR 1.21; 95% CI 0.74-1.98). Epidemiological differences between Pakistani and White cases were identified. CONCLUSIONS: The epidemiology of Campylobacter infection in England differs according to ethnic origin, and some ethnic groups appear to be at greater risk of infection than others. This has important implications for the development of effective disease control strategies and the design of epidemiological studies. Failure to take ethnicity into consideration might mask important risk factors for infection and limit understanding of disease transmission processes, enhancing inequality of access to preventative measures.

Information about a patient's health is recorded in order to provide for that patient's care. Most patients will not think about the other uses for their data and many assume that the information they provide will go no further than the health care professionals who have been caring for them. Information collected about patients is essential for developments in our understanding of health and health care. Most patients will be happy to allow their data to be used for these purposes, once this has been explained. Health care professionals have an obligation to ensure that patients know when identifiable data about them are to be used and to get their agreement about making disclosures. We know that this is not easily achieved; doctors, nurses and others providing care are already over-stretched. Patients may be anxious about their condition and treatment. They may not, for a variety of reasons, read leaflets or letters sent or given to them. This does not mean our obligations to respect patients by keeping them informed and seeking their agreement can be ignored. Openness about how health care professionals work and partnership with patients are essential to the continued trust of the public in the professions. The challenge is not to answer the question whether we need consent but rather how we can best obtain it.

Exercise and adequate self-management capacity may be important strategies in the management of venous leg ulcers. However, it remains unclear if exercise improves the healing rates of venous leg ulcers and if a self-management exercise program based on self-efficacy theory is well adhered to. This is a randomised controlled in adults with venous leg ulcers to determine the effectiveness of a self-efficacy based exercise intervention. Participants with venous leg ulcers are recruited from 3 clinical sites in Australia. After collection of baseline data, participants are randomised to either an intervention group or control group. The control group receive usual care, as recommended by evidence based guidelines. The intervention group receive an individualised program of calf muscle exercises and walking. The twelve week exercise program integrates multiple elements, including up to six telephone delivered behavioural coaching and goal setting sessions, supported by written materials, a pedometer and two follow-up booster calls if required. Participants are encouraged to seek social support among their friends, self-monitor their weekly steps and lower limb exercises. The control group are supported by a generic information sheet that the intervention group also receive encouraging lower limb exercises, a pedometer for self-management and phone calls at the same time points as the intervention group. The primary outcome is the healing rates of venous leg ulcers which are assessed at fortnightly clinic appointments. Secondary outcomes, assessed at baseline and 12 weeks: functional ability (range of ankle motion and Tinetti gait and balance score), quality of life and self-management scores. This study seeks to address a significant gap in current wound management practice by providing evidence for the effectiveness of a home-based exercise program for adults with venous leg ulcers. Theory-driven, evidence-based strategies that can improve an individual’s exercise self-efficacy and self-management capacity could have a significant impact in improving the management of people with venous leg ulcers. Information gained from this study will provide much needed information on management of this chronic disease to promote health and independence in this population. Australian New Zealand Clinical Trials Registry ACTRN12612000475842 .

Professor Gary Kielhofner died September 2, 2010, after a short battle with cancer. Dr. Kielhofner was a visionary who developed the Model of Human Occupation (MOHO) to better understand and help t...

Objective. To evaluate the effectiveness of a community-based arthritis education program conducted in a number of locations throughout the Sydney, Australia, metropolitan area. Methods. The program, based on earlier work, comprised 6 weekly sessions of 2.5 hours' duration. The study sample included 175 men and women with different types of arthritis, divided into intervention (n = 104) and control (n = 71) groups. Five outcome measures were selected to evaluate effectiveness of the program: pain perception, knowledge level, self-efficacy, disability index, and self-management behavior. Results. The results indicated that the program was effective in increasing knowledge level ( F[1,222] = 10.3, P = 0.001 at 6 weeks; F[1,108] = 7.8, P = 0.006 at 6 months), and a statistically significant difference was found in disability satisfaction 6 months after intervention ([F 1,98] = 5.9, P = 0.01), but no statistically significant difference was found in pain perception, self-efficacy, and disability index. Conclusion. This research supports some of the successful outcomes which follow an arthritis edu-cation program: increased knowledge level and increased disability satisfaction.

Cooper is mistaken in thinking that the principle of making the care of your patients your first concern does not apply to doctors when they are assessing benefits claimants on behalf of Atos.1 Our guidance is for all doctors, and …

Research involving people directly or indirectly is vital in improving care and reducing uncertainty for patients now and in the future, and improving the health of the population as a whole.

Objective To describe the quantity and type of school health services provided by nurses in Boston Public Schools. Setting In 2001, the 63 024 students enrolled predominantly belonged to minority groups (48% black, 28% Hispanic, and 9% Asian) and were eligible for a free or reduced-price lunch (71%). Main Outcome Measure Analysis of the 2001-2002 Boston Public Schools Health Services database. Results A total of 63 024 students generated 721 291 individual encounters with 93.5 full-time equivalent school nurses, including episodic care (57.8%), medication administration (31.5%), procedures (6.2%), and screening (5.1%). A total of 2420 students had an individual health care plan for the administration of medications and procedures during the school day. Students with individual health care plans averaged 117.9 encounters per year with school nurses, and students without averaged 7.2 encounters per year. Outcomes of encounters included school dismissal (3.0%); verbal communication with parents (10.6%), school staff (3.9%), and community agencies or health care providers (1.1%); and referral to a primary care provider (4.6%) or emergency services ( Conclusions Some school-age children receive a large amount of health care from school nurses in Boston Public Schools. We estimate that these children are 8 times more likely to see a school nurse than a pediatric health care provider. These school nurses were involved in the care of children with mental health and chronic health care needs. Despite the extensive amount of care, little is known about the efficacy of the care provided or the effect of these services on health care use.

The General Medical Council have agreed that part of a letter which they wrote to a member of the College containing their current policy on confidentiality can be published in the Psychiatric Bulletin. This letter was written in response to a specific enquiry.

Poor performance and fraudulent tactics in the automobile repair business consistently head the list of consumer complaints in the United States. Numerous studies have attempted to determine the extent of dishonest acts in auto repair work, but they have suffered from methodological difficulties. This paper is based on examination of 313 repair facilities to whom a battery was presented for testing. Characteristics of honest and dishonest facilities are compared; so too are the attitudes expressed by their managers. A weak association was found between honesty and the size of a business and between honesty and the dealer's view of the severity of punishment. The battery test is said to offer a notable opportunity for continuing and comparative studies of the work of auto repair facilities.

Government rosters of physicians suspended from the Medicare and Medicaid programs because of fraud and abuse indicate that psychiatrists form a disproportionately large segment of the total. Of the factors contributing to this situation, the most notable is that because psychiatrists charge for time rather than for services, they are more readily apprehended if they violate the rules. The authors speculate on whether in fact psychiatrists break the law more than physicians in other-specialties or whether the statistics are purely artifactual.

From the Public Policy Research Organization, University of California, Irvine, California. Supported by a grant from the National Institute of Justice, U.S. Department of Justice (82-1J-CX-0035). An earlier version of this paper was presented at the Meetings of the Academy of Criminal Justice Sciences, Chicago, IL, March 28, 1984. Address correspondence to: Henry N. Pontell, PhD, Program in Social Ecology, University of California, Irvine, CA 92717.

Objective: Exercise has the potential to offer a range of health benefits in addition to improving healing outcomes for people with venous leg ulcers (VLUs). However, despite evidence-based recommendations, most of these individuals do not engage in regular exercise. The aim of this study was to gain an understanding of the perspectives of adults with VLUs, in relation to exercise. Method: This was a qualitative design using semi-structured interviews and discussions. Ten participants with venous leg ulceration volunteered to participate. Recruitment was through a specialist wound clinic. Verbatim data were collected by an experienced moderator using a semi-structured guide. Data saturation was reached after three group discussions and two interviews. A random selection of transcripts was sent back to the participants for verification. Thematic content analysis was used to determine major themes and categories. Two transcripts were independently analysed, categories and themes independently developed, cross checked and found comparable. Remaining transcripts were analysed using the developed categories and codes. Results: Regardless of their current exercise routine, participants reported exercising before venous leg ulceration and expressed an interest in either becoming active or maintaining an active lifestyle. Overall, four themes emerged from the findings: i) participant understanding of the relationship between chronic venous insufficiency and exercise patterns; ii) fear of harm impacts upon positive beliefs and attitudes to exercise; iii) perceived factors limit exercise; and iv) structured management facilitates exercise. Conclusion: The value of exercise in improving outcomes in VLUs lies in its capacity to promote venous return and reduce the risk of secondary conditions in this population. Despite motivation and interest in being exercise active, people with VLUs report many obstacles. Further exploration of mechanisms that assist this patient population and promote understanding about management of barriers, coupled with promotion of enabling factors, is vital for improving their exercise participation. Declaration of interest: The authors declare that they have no competing interests.

From 1 January 1992 to 31 December 2000, 27 milkborne general outbreaks of infectious intestinal disease (IID) were reported to the Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC). These outbreaks represented a fraction (2%) of all outbreaks of foodborne origin (N = 1774) reported to CDSC, but were characterized by significant morbidity. Unpasteurized milk (52%) was the most commonly reported vehicle of infection in milkborne outbreaks, with milk sold as pasteurized accounting for the majority of the rest (37%). Salmonellas (37%), Vero cytotoxin-producing Escherichia coli (VTEC) O157 (33%) and campylobacters (26%) were the most commonly detected pathogens, and most outbreaks were linked to farms (67%). This report highlights the importance of VTEC O157 as a milkborne pathogen and the continued role of unpasteurized milk in human disease.