The health society: importance of the new policy proposal by the EU Commission on health and consumer affairs.
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BACKGROUND AND PURPOSE: Physical therapists strive to promote children's motor function and the parents' abilities to interact with their children, thus aiming to positively influence the parent-child relationship. This study examined a model for provision of home-based physical therapy within the context of motor play on mother-child interactions and motor behaviors of children. SUBJECTS: The subjects were 38 mothers and their children with motor delay, aged 6 to 34 months (mean = 18.8, SD = 7.2), who were receiving center-based early intervention. METHOD: Children were ranked by motor development, using the Bayley Motor Scale, and assigned to either an experimental or control group. The experimental group received five home-based sessions of physical therapy. Conventional physical therapy strategies were incorporated into interactive play activities between mothers and their children. Both groups continued to receive their centered-based services. Mother-child interactions were videotaped before and after intervention and were analyzed using a modification of the response-class matrix. RESULTS: The mothers in the experimental group demonstrated an increase in appropriate holding of their children, whereas mothers in the control group demonstrated a decrease. The mothers in the experimental group became more directive, thus controlling their children's behavior, but they were not less positive or more negative when interacting with their children. CONCLUSION AND DISCUSSION: The integration of conventional physical therapy within the context of interactive play was well received and may promote generalization of motor skills during play without interfering with positive mother-child interactions.
BACKGROUND: Children often say they have problems with their toilets in school. Educationalists and health workers need to be aware of potential difficulties, to try and improve these facilities for school children. The objective of this study was to assess the perception children have of the toilet facilities in their schools and whether or not this influences their use of them. METHODS: An interviewer-administered questionnaire was given to children attending community audiology clinics and their parents. RESULTS: Eighty-seven children from 65 schools were surveyed. Poorly maintained and unhygienic facilities were described to which access was restricted. A significant proportion of children were bullied or teased. Forty per cent would never open their bowels using the toilets in school. CONCLUSION: The same standards for toilet facilities in the workplace should apply to schools. Substandard facilities may contribute to the suppression of the 'call to stool', leading to chronic constipation. Infectious illnesses may be more easily spread.
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Help-seeking patterns and satisfaction with care were described by 641 women with eating disorders participating in a national magazine survey. Between 60.6% and 92.9% of respondents in three diagnostic groups sought professional treatment. Professional treatments most often entered were individual psychotherapy (52.9%), behavioral therapy (28.0%), group therapy (24.6%), and nutritional therapy (18.6%). Treatments were generally seen as helping "a little." Only bulimic anorexia nervosa respondents perceived any interventions to be more harmful than helpful, specifically Overeaters Anonymous and self-help groups, both nonprofessional interventions. Caregivers selected as "experts" regarding eating disorders were rated as more efficacious than others, helping "a little" to "somewhat."
This paper describes the reliability and validity of 10 easily administered and scored self-report measures of physicians' humanistic attitudes, values, and behaviors. This research also provides evidence that evaluations of physicians' humanistic behavior made by their outpatients, and non-physician staff with whom they worked, and the faculty physicians supervising them on inpatient ward rotations were positively and significantly correlated with one another. The potential usefulness of a multi-modal approach in evaluating humanistic physician attributes in which self-report measures are combined with direct feedback from all of those who interact with physicians is discussed.
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The effects of stress-reducing intervention in emergency department suturing were evaluated by comparing children receiving intervention from child life staff, with two control groups who did not receive intervention, control A at a pediatric hospital and control B at a general hospital. The following measures were obtained: observable anxiety during the procedure; the child's self-report of anxiety, self-report of pain, postemergency visit behavior, and anxiety about a return visit; the parent's overall rating of satisfaction with care given and the parent's feelings of anxiety. Children and parents in the intervention group received emotional support and information concerning the medical procedure, and were taught appropriate coping strategies. Measures were obtained across three age groups (four to six years, seven to 10 years, 11 to 14 years) divided by sex; site of cut (face or body), and extent of injury (five or fewer sutures, six or more sutures). Intervention had its greatest influence on 11- to 14-year-olds with a facial injury requiring six or more sutures. Children in the intervention group expressed fewer fears than children in the general hospital control group. Parents of children who received intervention reported a significantly higher degree of satisfaction with the overall care given in the emergency department.
Good home health and institutional care alternatives are important for the care of aging patients. The physician's assistance is crucial in helping family and patients decide on the optimal level of care. Knowledge of the patient's medical status, family and patient resources and preferences, cost factors, and the patient's functional status will make the physician an effective counselor for elderly patients and their families faced with deciding between nursing home and home care.
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A questionnaire survey of 50 patients treated by behavior therapy or short-term, analytically oriented psychotherapy revealed that both groups, as well as those patients who improved the most, placed a high value on insight, the patient-therapist relationship, catharsis, and trust. The findings suggest that behavior therapy patients tend to place more emphasis than do their therapists on factors that have traditionally been thought important in analytic psychotherapy.
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BACKGROUND: Bacille Calmette-Guérin (BCG) vaccine is given to Canadian Aboriginal neonates in selected communities. Severe reactions and deaths associated with BCG have been reported among infants born with immunodeficiency syndromes. The main objective of this study was to estimate threshold values for severe combined immunodeficiency (SCID) incidence, above which BCG is associated with greater risk than benefit. METHODS: A Markov model was developed to simulate the natural histories of tuberculosis (TB) and SCID in children from birth to 14 years. The annual risk of tuberculous infection (ARI) and SCID incidence were varied in analyses. The model compared a scenario of no vaccination to intervention with BCG. Appropriate variability and uncertainty analyses were conducted. Outcomes included TB incidence and quality-adjusted life years (QALYs). RESULTS: In sensitivity analyses, QALYs were lower among vaccinated infants if the ARI was 0.1% and the rate of SCID was higher than 4.2 per 100,000. Assuming an ARI of 1%, this threshold increased to 41 per 100,000. In uncertainty analyses (Monte Carlo simulations) which assumed an ARI of 0.1%, QALYs were not significantly increased by BCG unless SCID incidence is 0. With this ARI, QALYs were significantly decreased among vaccinated children if SCID incidence exceeds 23 per 100,000. BCG is associated with a significant increase in QALYs if the ARI is 1%, and SCID incidence is below 5 per 100,000. CONCLUSION: The possibility that Canadian Aboriginal children are at increased risk for SCID has serious implications for continued BCG use in this population. In this context, enhanced TB Control--including early detection and treatment of infection--may be a safer, more effective alternative.
BACKGROUND: Medical training is increasingly occurring in the ambulatory setting for final year medical students and residents. This study looks to identify if gender, school, level of training, or specialty affects learner's (final year medical students and residents) preferred site characteristics and preceptor behaviours for learning in the ambulatory setting. METHODS: All final year medical students and residents at the five medical schools in Ontario (N = 3471) were surveyed about the site characteristics and preceptor behaviours most enhancing their learning in the ambulatory setting. Preferred site characteristics and preceptor behaviours were rank ordered. Factor analysis grouped the site characteristics and preceptor behaviours into themes which were then correlated with gender, school, level of training, and specialty. RESULTS: Having an adequate number and variety of patients while being supervised by enthusiastic preceptors who give feedback and are willing to discuss their reasoning processes and delegate responsibility are site characteristics and preceptor behaviours valued by almost all learners. Some teaching strategies recently suggested to improve efficiency in the ambulatory teaching setting, such as structuring the interview for the student and teaching and reviewing the case in front of the patient, were found not to be valued by learners. There was a striking degree of similarity in what was valued by all learners but there were also some educationally significant differences, particularly between learners at different levels and in different specialties. Key findings between the different levels include preceptor interaction being most important for medical students as opposed to residents who most value issues pertaining to patient logistics. Learning resources are less valued early and late in training. Teaching and having the case reviewed in front of the patient becomes increasingly less valued as learners advance in their training. As one approaches the end of ones' training office management instruction becomes increasingly valued. Differences between specialties pertain most to the type of practice residents will ultimately end up in (ie: office based specialties particularly valuing instruction in office management and health care system interaction). CONCLUSIONS: Preceptors need to be aware of, and make efforts to provide, teaching strategies such as feedback and discussing clinical reasoning, that learners have identified as being helpful for learning. If strategies identified as not being valued for learning, such as teaching in front of the patient, must continue it will be important to explore the barriers they present to learning. Although what all learners want from their preceptors and clinic settings to enhance their learning is remarkably similar, being aware of the educationally significant differences, particularly for learners at different levels and in different specialties, will enhance teaching in the ambulatory setting.
We evaluated the effectiveness of SleepTight in the management of infant colic. SleepTight is a device that vibrates the infant's crib to simulate the action of a car traveling at 55 mph. A multiple baseline design across 6 infants was used. Data were collected on infant crying, parental use of SleepTight, and parental satisfaction. The application of SleepTight was associated with reduction in crying in 4 of the 6 infants. These outcome data notwithstanding, consideration of reported nonrecording of severe episodes and mixed reports of satisfaction suggests that SleepTight may not be a viable means of managing infant colic.
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The purpose of the present study was to investigate the relative importance of adolescents' attitude toward an act (the degree to which the person had a favorable or unfavorable evaluation or appraisal of the act's behavior in question), perceived norm, and perceived behavioral control in predicting Taiwanese adolescents' intention to purchase the merchandise of a celebrity when they had different levels of celebrity adoration. The present results showed that the relative strengths of attitude toward the act and the perception of behavioral control in predicting purchase intention toward the merchandise of a celebrity were stronger for adolescents in the celebrity adoration group than for adolescents in the celebrity nonadoration group. On the other hand, the relative importance of the perceived norm in predicting the attitude toward the act and the purchase intention was stronger for adolescents in the celebrity nonadoration group than for adolescents in the celebrity adoration group.
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