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Normal peer models and autistic children's learning.

Present research and legislation regarding mainstreaming autistic children into normal classrooms have raised the importance of studying whether autistic children can benefit from observing normal peer models. The present investigation systematically assessed whether autistic children's learning of discrimination tasks could be improved if they observed normal children perform the tasks correctly. In the context of a multiple baseline design, four autistic children worked on five discrimination tasks that their teachers reported were posing difficulty. Throughout the baseline condition the children evidenced very low levels of correct responding on all five tasks. In the subsequent treatment condition, when normal peers modeled correct responses, the autistic children's correct responding increased dramatically. In each case, the peer modeling procedure produced rapid achievement of the acquisition which was maintained after the peer models were removed. These results are discussed in relation to issues concerning observational learning and in relation to the implications for mainstreaming autistic children into normal classrooms.

Autistic Disorder↗

Building true capacity: indigenous models for indigenous communities.

Within the past 2 decades, community capacity building and community empowerment have emerged as key strategies for reducing health disparities and promoting public health. As with other strategies and best practices, these concepts have been brought to indigenous (American Indian and Alaska Native) communities primarily by mainstream researchers and practitioners. Mainstream models and their resultant programs, however, often have limited application in meeting the needs and realities of indigenous populations. Tribes are increasingly taking control of their local health care services. It is time for indigenous people not only to develop tribal programs but also to define and integrate the underlying theoretical and cultural frameworks for public health application.

Community Participation↗

Hydrolysis and fermentation of activated sludge to enhance biological phosphorus removal.

The conventional mainstream enhanced biological phosphorus removal (EBPR) process depends on the quality of the raw incoming wastewater. An alternative sidestream EBPR process is presented, where the substrates for storage by the polyphosphate accumulating organisms (PAOs) instead come from hydrolysis of the return activated sludge. This process is studied in full-scale at two treatment plants and quantified by means of phosphorus release rates and readily biodegradable COD (RBCOD) accumulation rates. It was seen that not only was a significant amount of RBCOD stored by PAOs but an approximately equal amount was accumulated in the sidestream hydrolysis tank and made available for the subsequent nitrogen removal process. The phosphorus release of the sludge with and without addition of different substrates was furthermore studied in laboratory scale. The study showed that the process is promising and in a number of cases will have significant advantages compared with the conventional mainstream EBPR

Denmark↗

Economic boundaries of health policy: factors influencing 1993-1994 reform proposals.

This article offers a theoretical framework for understanding the crisis of U.S. health care system and the mainstream debate on restructuring health care financing and delivery subsystems. The author argues that the crisis of the health care system is a cause and a consequence of the long cycle of structural changes in the U.S. economy since World War II. The article distinguishes between the level and the rate of growth of health care expenditures. It is possible to moderate the level of health care expenditure by adopting measures in the direction indicated by the historical experience of other advanced capitalist economies. However, in the long term the rate of growth of health care costs will exceed the rate of growth of gross domestic product, thus any attempt to limit it will result in deterioration in the quantity and quality of health care services. The 1993-1994 mainstream debate is revisited to show how these proposals were a part of the overall effort to resolve the long-term problems of the U.S. economy. The defeat of the Clinton plan was due to its concerns with efficiency of the health care system in the face of the demand by a majority of the U.S. capitalist class to cut costs.

Canada↗

Learning disabled boys' performance and self-assessments on physical fitness tests.

30 learning disabled boys drawn from a segregated private school for learning disabled children and 22 from a public school mainstream program and 22 nondisabled boys performed two physical fitness tests, sit-ups and shuttle run in one of two conditions. While normal achievers performed significantly better on one of the tests, there were no differences between the two samples of learning disabled youngsters. However, students' comparisons of their performance with classmates' indicated that learning disabled youngsters in the private school ranked themselves more favorably than those in mainstream classrooms.

Adolescent↗

Social distance and behavioral attributes of developmentally handicapped and normal children.

20 behavioral attributes predicting social distance were examined among 101 junior high school students in six classrooms. The sample included 8 developmentally handicapped students, of whom at least one of each was mainstreamed into each classroom. Subjects were predominantly white, middle-class, suburban midwesterners. A sociometric nomination measure was used to obtain behavioral attribute profiles of the students which were then used to predict a psychometric measure of social distance. Handicapped students were not more socially distant than their normal peers. Factor analysis of the 20 behavioral attributes yielded four factors, three of which were significant predictors of classroom social distance, accounting for better than half the variance in social distance. These were described as Incompetent/Unassertive, Positive/Active/Assertive, and Passive/Unassertive. Social rejection in mainstreamed classrooms is more a function of perceived behavioral attributes than the label developmentally handicapped.

Adolescent↗

Friendship skills in children with specific language impairment.

An investigation into friendship skills of pre-school children with specific language impairment was carried out in both mainstream and specialist play settings. Significant differences in onlooker behaviour were found suggesting that the children benefited from observation and information-processing time within their mainstream play setting. The amount of solitary play behaviour found within the specialist setting supported these findings. Conclusions are drawn for inclusive education and collaborative practice.

Child, Preschool↗

Integrative oncology: complementary therapies for pain, anxiety, and mood disturbance.

Many people with cancer experience pain, anxiety, and mood disturbance. Conventional treatments do not always satisfactorily relieve these symptoms, and some patients may not be able to tolerate their side effects. Complementary therapies such as acupuncture, mind-body techniques, massage, and other methods can help relieve symptoms and improve physical and mental well-being. Self-hypnosis and relaxation techniques help reduce procedural pain. Acupuncture is well documented to relieve chronic cancer pain. Massage and meditation improve anxiety and other symptoms of distress. Many dietary supplements contain biologically active constituents with effects on mood. However, not all complementary therapies are appropriate or useful, and even helpful complementary modalities may not be optimal under some circumstances. Situations when precaution is indicated include acute onset of symptoms and severe symptoms, which require immediate mainstream intervention. Dietary supplements are associated with serious negative consequences under some circumstances. The authors summarize the research on these modalities and discuss the rationale, expectation, and necessary precautions involved with combining complementary therapies and mainstream care. Practical clinical issues are addressed.

Anxiety Disorders↗

Cutting edge: Rapid recovery of NKT cells upon institution of highly active antiretroviral therapy for HIV-1 infection.

CD1d-restricted NKT cells play important regulatory roles in various immune responses and are rapidly and selectively depleted upon infection with HIV-1. The cause of this selective depletion is incompletely understood, although it is in part due to the high susceptibility of CD4+ NKT cells to direct infection and subsequent cell death by HIV-1. Here, we demonstrate that highly active antiretroviral therapy (HAART) results in the rapid recovery of predominantly CD4(-) NKT cells with kinetics that are strikingly similar to those of mainstream T cells. As it is well known that the early recovery of mainstream T cells in response to HAART is due to their redistribution from tissues to the circulation, our data suggest that the selective depletion of circulating NKT cells is likely due to a combination of cell death and tissue sequestration and indicates that HAART can improve immune functions by reconstituting both conventional T cells and immunoregulatory NKT cells.

Adult↗

Current trends in the integration and reimbursement of complementary and alternative medicine by managed care, insurance carriers, and hospital providers.

OBJECTIVES: To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services offered by hospitals. METHODS: A literature review and information search was conducted to determine which insurers had special policies for CAM and which hospitals were offering CAM. Telephone interviews were conducted with a definitive sample of 18 insurers and a representative subsample of seven hospitals. RESULTS: A majority of the insurers interviewed offered some coverage for the following: nutrition counseling, biofeedback, psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy, and physical therapy. Twelve insurers said that market demand was their primary motivation for covering CAM. Factors determining whether insurers would offer coverage for additional therapies included potential cost-effectiveness based on consumer interest, demonstrable clinical efficacy, and state mandates. Some hospitals are also responding to consumer interest in CAM, although hospitals can only offer CAM therapies for which local, licensed practitioners are available. Among the most common obstacles listed to incorporating CAM into mainstream health care were lack of research on efficacy, economics, ignorance about CAM, provider competition and division, and lack of standards of practice. CONCLUSIONS: Consumer demand for CAM is motivating more insurers and hospitals to assess the benefits of incorporating CAM. Outcomes studies for both allopathic and CAM therapies are needed to help create a health care system based upon treatments that work, whether they are mainstream, complementary, or alternative.

Complementary Therapies↗

The diabetes health care of Aboriginal people in South Australia (Part 1).

Although type 2 diabetes is a recognised health priority in South Australia, Aboriginal people with diabetes do not utilise the mainstream diabetes health services on a regular basis for health care. This means that Aboriginal clients have the potential to develop diabetes-related problems and, furthermore, are not in a position to make informed decisions about health care issues. This lack of client empowerment is contrary to the goals of contemporary diabetes health care and, as a result, Aboriginal clients suffer the consequences of ineffective management with a compromised lifestyle. To identify how this situation might be improved, a qualitative study funded by Diabetes Australia was undertaken in South Australia. The overall goal was, firstly, to identify the reasons why Aboriginal people with diabetes do not attend mainstream health agencies on a regular basis and secondly, if possible, to improve attendance. Thus, Aboriginal health professionals (n = 43) were recruited from the 8 statistical divisions of South Australia and interviewed about Aboriginal diabetes health care issues. In Part 1 of this series, the research findings indicated the beliefs and attitudes held by clients about diabetes, their lack of knowledge about management issues, their responses to diabetes, the effects of diabetes on their lifestyle and the strategies that diabetes health professionals used to help their clients deal with diabetes health issues. In Part 2 the research findings indicated the importance of the Aboriginal health worker to the successful diabetes management of Aboriginal clients, the constraints that affect the delivery of diabetes health care and the recommendations made by health professionals to improve the standard of diabetes health services.

Australia↗

The diabetes health care of Aboriginal people in South Australia (Part 2).

Although type 2 diabetes is a recognised health priority in South Australia, Aboriginal people with diabetes do not utilise the mainstream diabetes health services on a regular basis for health care. This means that Aboriginal clients have the potential to develop diabetes-related problems and, furthermore, are not in a position to make informed decisions about health care issues. This lack of client empowerment is contrary to the goals of contemporary diabetes health care and, as a result, Aboriginal clients suffer the consequences of ineffective management with a compromised lifestyle. To identify how this situation might be improved, a qualitative study funded by Diabetes Australia was undertaken in South Australia. The overall goal was, firstly, to identify the reasons why Aboriginal people with diabetes do not attend mainstream health agencies on a regular basis and secondly, if possible, to improve attendance. Thus, Aboriginal health professionals (n = 43) were recruited from the 8 statistical divisions of South Australia and interviewed about Aboriginal diabetes health care issues. In Part 1 of this series, the research findings indicated the beliefs and attitudes held by clients about diabetes, their lack of knowledge about management issues, their responses to diabetes, the effects of diabetes on their lifestyle and the strategies that diabetes health professionals used to help their clients deal with diabetes health issues. In Part 2 the research findings indicated the importance of the Aboriginal health worker to the successful diabetes management of Aboriginal clients, the constraints that affect the delivery of diabetes health care and the recommendations made by health professionals to improve the standard of diabetes health services.

Australia↗

Moving toward culturally sensitive services for Indigenous people: a non-Indigenous mental health nursing perspective.

Indigenous psychiatric morbidity, whilst culturally different in presentation to white communities has been suggested to run at a mean prevalence rate of 13.5% of the major disorders found in non-Indigenous communities. This paper discusses the socio-political and cross cultural issues to do with mental health for Australian Indigenous from a non-Indigenous perspective. The paper is particularly concerned with the effects of racism on Indigenous mental health and how racism effectively limits Indigenous people from full participation in the pluralist mainstream. Racism has been seen to be a major contributor to mental illness. The scope of this paper addresses the issue of transforming mainstream culture as well as highlighting the need for protection, participation and collaborative involvement in mental health service delivery.

Attitude of Health Personnel↗

Use of complementary and alternative medicines by patients with chronic obstructive pulmonary disease.

OBJECTIVES: To investigate complementary and alternative medicine (CAM) use by patients with chronic obstructive pulmonary disease (COPD) and to explore their beliefs about CAM. DESIGN AND PARTICIPANTS: Cross-sectional study of 173 patients with moderate to severe COPD, and in depth interviews with a purposive sample of 28 patients. SETTING: Ambulatory care. MAIN OUTCOME MEASURES: Use of CAM; beliefs about the value of CAM. RESULTS: 71 patients (41%) claimed to be using some form of CAM. Most commonly used were multivitamins and minerals, and garlic was the most commonly used herbal preparation. Patients reported that advertisements and people with prior experience of using CAM were their major sources of information. Extent of knowledge about CAM, degree of faith in CAM and personal attitudes influenced decisions to try CAM. Patients used CAM to promote general wellbeing, to counteract drug side effects, to compensate for dietary deficiencies and to ameliorate their disease. Efficacy appeared less important to users than safety. CAM practitioners were regarded as more convincing, informative, considerate and available compared with mainstream health professionals. CONCLUSIONS: Communication between patients and mainstream health professionals about CAM use could be improved by health professionals being more accepting of CAM use and having some basic knowledge about commonly used CAM preparations.

Aged↗

The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?

In alternative medicine, the main question regarding placebo has been whether a given therapy has more than a placebo effect. Just as mainstream medicine ignores the clinical significance of its own placebo effect, the placebo effect of unconventional medicine is disregarded except for polemics. This essay looks at the placebo effect of alternative medicine as a distinct entity. This is done by reviewing current knowledge about the placebo effect and how it may pertain to alternative medicine. The term placebo effect is taken to mean not only the narrow effect of a dummy intervention but also the broad array of nonspecific effects in the patient-physician relationship, including attention; compassionate care; and the modulation of expectations, anxiety, and self-awareness. Five components of the placebo effect--patient, practitioner, patient-practitioner interaction, nature of the illness, and treatment and setting--are examined. Therapeutic patterns that heighten placebo effects are especially prominent in unconventional healing, and it seems possible that the unique drama of this realm may have "enhanced" placebo effects in particular conditions. Ultimately, only prospective trials directly comparing the placebo effects of unconventional and mainstream medicine can provide reliable evidence to support such claims. Nonetheless, the possibility of enhanced placebo effects raises complex conundrums. Can an alternative ritual with only nonspecific psychosocial effects have more positive health outcomes than a proven, specific conventional treatment? What makes therapy legitimate, positive clinical outcomes or culturally acceptable methods of attainment? Who decides?

Anxiety↗

Assessing the validity of published randomized controlled trials in podiatric medical journals.

The purposes of this study were to develop an instrument to assess the validity of randomized controlled trials and to report on the differences in the validity of randomized controlled trials between two podiatric medical journals and a mainstream medical journal. The study demonstrated that after adequate training, there can be agreement among reviewers evaluating the quality of published randomized controlled trials using an established instrument and guidelines. The results of the study indicate that randomized controlled trials published in podiatric medical journals are less credible than those published in a mainstream medical journal.

Humans↗

Why medical research needs a new specialty of 'pure medical science'.

Sciences tend to go through boom and bust phases. Following decades of rapid expansion, medical science is now due for a collapse in overall funding. Furthermore, there has been a decline in the rate of therapeutic innovation, with fewer significant breakthroughs and little progress in several major areas of medicine such as oncology, psychiatry and autoimmune disorders. Mainstream medical research has gradually evolved into a form similar to industrial research and development (R&D), aiming at steady, reliable, predictable progress by ringing minor variations on existing approaches. Where this risk-averse approach is failing, a more speculative strategy is indicated. A new research specialty of 'pure medical science' would aim to seek radical new theories, technologies and therapies, and subject these to professional evaluation to the point where they can be applied in practice by more mainstream 'applied' medical scientists. A specialty of 'pure medical science' might be launched by financial support from patrons who wish to be associated with an elite new medical research discipline.

Biomedical Research↗

Unconventional therapies vie for professional acceptance.

A five-part documentary entitled "Healing and the Mind," which aired on PBS-TV stations nationwide February 22-24, explored the roles of thoughts and emotions in illness and health. It also raised some interesting questions regarding the relationship between mainstream Western medicine and alternative forms of therapies that are considered by most to be outside the mainstream. The Moyers documentary is reviewed by Frank Sabatino in the February 20 issue of Hospitals magazine (pp. 66-72). A companion volume to the PBS series, also titled Healing and the Mind, has been published (1993, New York City, Doubleday, $25). The TV series is but one of a number of events that signal a growing awareness and interest in alternative approaches to medicine, and the relationship between those who support these approaches and those in the bioethics field will most likely become entwined, as the following articles show.

Attitude to Health↗