Showing papers by "Australian Catholic University published in 2013"

Primer on the metabolic bone diseases and disorders of mineral metabolism

Abstract: Book file PDF easily for everyone and every device. You can download and read online Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition file PDF Book only if you are registered here. And also you can download or read online all Book PDF file that related with Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition book. Happy reading Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition Bookeveryone. Download file Free Book PDF Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition at Complete PDF Library. This Book have some digital formats such us :paperbook, ebook, kindle, epub, fb2 and another formats. Here is The Complete PDF Book Library. It's free to register here to get Book file PDF Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition.

Understanding performance deficits in developmental coordination disorder: a meta-analysis of recent research

Abstract: Aim Developmental coordination disorder (DCD) is a significant disorder of childhood, characterized by core difficulties in learning fine and/or gross motor skills, and the attendant psychosocial problems. The aim of the meta-analysis presented here (the first on DCD since 1998) was to summarize trends in the literature over the past 14 years and to identify and describe the main motor control and cognitive deficits that best discriminate children with DCD from those without. Method A systematic review of the literature published between January 1997 and August 2011 was conducted. All available journal papers reporting a comparison between a group of children with DCD and a group of typically developing children on behavioural measures were included. Results One hundred and twenty-nine studies yielded 1785 effect sizes based on a total of 2797 children with DCD and 3407 typically developing children. Across all outcome measures, a moderate to large effect size was found, suggesting a generalized performance deficit in children with DCD. The pattern of deficits suggested several areas of pronounced difficulty, including internal (forward) modelling, rhythmic coordination, executive function, gait and postural control, catching and interceptive action, and aspects of sensoriperceptual function. Interpretation The results suggest that the predictive control of action may be a fundamental disruption in DCD, along with the ability to develop stable coordination patterns. Implications for theory development and intervention are discussed.

Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta-analysis.

Abstract: Aim The aim of this study was to review systematically evidence about the efficacy of motor interventions for children with developmental coordination disorder (DCD), and to quantify treatment effects using meta-analysis. Method Included were all studies published between 1995 and 2011 that described a systematic review, (randomized) clinical trial, or crossover design about the effect of motor intervention in children with DCD. Studies were compared on four components: design, methodological quality, intervention components, and efficacy. Twenty-six studies met the inclusion criteria for the review. Interventions were coded under four types: (1) task-oriented intervention, (2) traditional physical therapy and occupational therapy, (3) process-oriented therapies, and (4) chemical supplements. For the meta-analysis, effect sizes were available for 20 studies and their magnitude (weighted Cohen’s d [dw]) was compared across training types. Results The overall effect size across all intervention studies was dw=0.56. A comparison between classes of intervention showed strong effects for task-oriented intervention (dw=0.89) and physical and occupational therapies (dw=0.83), whereas that for process-oriented intervention was weak (dw=0.12). Of the chemical supplements, treatment with methylphenidate was researched in three studies (dw=0.79) and supplementation of fatty acids plus vitamin E in one study (no effect). The post hoc comparison between treatment types showed that the effect size of the task-oriented approach was significantly higher than the process-oriented intervention (p=0.01) and comparison (p=0.006). No significant difference in the magnitude of effect size between traditional physical and occupational therapy approaches and any of the other interventions emerged. Interpretation In general, intervention is shown to produce benefit for the motor performance of children with DCD, over and above no intervention. However, approaches from a task-oriented perspective yield stronger effects. Process-oriented approaches are not recommended for improving motor performance in DCD, whereas the evidence for chemical supplements for children with DCD is currently insufficient for a recommendation.

‘I call it the blame and shame disease’: a qualitative study about perceptions of social stigma surrounding type 2 diabetes

Abstract: Objectives: While health-related stigma has been the subject of considerable research in other conditions (obesity and HIV/AIDS), it has not received substantial attention in diabetes. The aim of the current study was to explore the social experiences of Australian adults living with type 2 diabetes mellitus (T2DM), with a particular focus on the perception and experience of diabetes-related stigma. Design: A qualitative study using semistructured interviews, which were audio recorded, transcribed and subject to thematic analysis. Setting: This study was conducted in non-clinical settings in metropolitan and regional areas in the Australian state of Victoria. Participants were recruited primarily through the state consumer organisation representing people with diabetes. Participants: All adults aged ≥18 years with T2DM living in Victoria were eligible to take part. Twenty-five adults with T2DM participated (12 women; median age 61 years; median diabetes duration 5 years). Results: A total of 21 (84%) participants indicated that they believed T2DM was stigmatised, or reported evidence of stigmatisation. Specific themes about the experience of stigma were feeling blamed by others for causing their own condition, being subject to negative stereotyping, being discriminated against or having restricted opportunities in life. Other themes focused on sources of stigma, which included the media, healthcare professionals, friends, family and colleagues. Themes relating to the consequences of this stigma were also evident, including participants’ unwillingness to disclose their condition to others and psychological distress. Participants believed that people with type 1 diabetes do not experience similar stigmatisation. Conclusions: Our study found evidence of people with T2DM experiencing and perceiving diabetesrelated social stigma. Further research is needed to explore ways to measure and minimise diabetes-related stigma at the individual and societal levels, and also to explore perceptions and experiences of stigma in people with type 1 diabetes.

Social stigma in diabetes : a framework to understand a growing problem for an increasing epidemic.

Abstract: A comprehensive understanding of the social and psychological impact of diabetes mellitus is important for informing policy and practice. One potentially significant, yet under-researched, issue is the social stigma surrounding diabetes. This narrative review draws on literature about health-related stigma in diabetes and other chronic conditions in order to develop a framework for understanding diabetes-related stigma. Our review of the literature found that people who do not have diabetes assume that diabetes is not a stigmatized condition. In contrast, people with diabetes report that stigma is a significant concern to them, experienced across many life domains, e.g., in the workplace, in relationships. The experience of diabetes-related stigma has a significant negative impact on many aspects of psychological well-being and may also result in sub-optimal clinical outcomes for people with diabetes. We propose a framework that highlights the causes (attitudes of blame, feelings of fear and disgust, and the felt need to enforce social norms and avoid disease), experiences (being judged, rejected, and discriminated against), and consequences (e.g., distress, poorer psychological well-being, and sub-optimal self-care) of diabetes-related stigma and also identifies potential mitigating strategies to reduce diabetes-related stigma and/or enhance coping and resilience amongst people with diabetes. The systematic investigation of the experiences, causes, and consequences of diabetes-related stigma is an urgent research priority.

Reliability and validity of ultrasound measurements of muscle fascicle length and pennation in humans: a systematic review

Abstract: Ultrasound imaging is widely used to measure architectural features of human skeletal muscles in vivo. We systematically reviewed studies of the reliability and validity of two-dimensional ultrasound measurement of muscle fascicle lengths or pennation angles in human skeletal muscles. A comprehensive search was conducted in June 2011. Thirty-six reliability studies and six validity studies met the inclusion criteria. Data from these studies indicate that ultrasound measurements of muscle fascicle lengths are reliable across a broad range of experimental conditions [intraclass correlation coefficient (ICC) and r values were always > 0.6, and coefficient of variation values were always 0.5 and coefficient of variation values were always 0.7) under certain conditions, such as when large limb muscles are imaged in a relaxed state and the limb or joint remains stationary. Future studies on validity should consider ways to test for the validity of two-dimensional ultrasound imaging in contracted or moving muscles and the best method of probe alignment.

Screening, referral and treatment for depression in patients with coronary heart disease.

Abstract: In 2003, the National Heart Foundation of Australia position statement on "stress" and heart disease found that depression was an important risk factor for coronary heart disease (CHD). This 2013 statement updates the evidence on depression (mild, moderate and severe) in patients with CHD, and provides guidance for health professionals on screening and treatment for depression in patients with CHD. The prevalence of depression is high in patients with CHD and it has a significant impact on the patient's quality of life and adherence to therapy, and an independent effect on prognosis. Rates of major depressive disorder of around 15% have been reported in patients after myocardial infarction or coronary artery bypass grafting. To provide the best possible care, it is important to recognise depression in patients with CHD. Routine screening for depression in all patients with CHD is indicated at first presentation, and again at the next follow-up appointment. A follow-up screen should occur 2-3 months after a CHD event. Screening should then be considered on a yearly basis, as for any other major risk factor for CHD. A simple tool for initial screening, such as the Patient Health Questionnaire-2 (PHQ-2) or the short-form Cardiac Depression Scale (CDS), can be incorporated into usual clinical practice with minimum interference, and may increase uptake of screening. Patients with positive screening results may need further evaluation. Appropriate treatment should be commenced, and the patient monitored. If screening is followed by comprehensive care, depression outcomes are likely to be improved. Patients with CHD and depression respond to cognitive behaviour therapy, collaborative care, exercise and some drug therapies in a similar way to the general population. However, tricyclic antidepressant drugs may worsen CHD outcomes and should be avoided. Coordination of care between health care providers is essential for optimal outcomes for patients. The benefits of treating depression include improved quality of life, improved adherence to other therapies and, potentially, improved CHD outcomes.

Digital play in the early years: a contextual response to the problem of integrating technologies and play-based pedagogies in the early childhood curriculum

Abstract: In many countries technologies are still not fully integrated with perspectives on play-based learning in early childhood education. This is evidenced in international curriculum documents that continue to separate descriptions of play as a basis for learning from the use of technologies as learning outcomes for young children. Meanwhile, technologies continue to be rapidly interfaced with digital media, and in particular, provide a platform for young children's consumption of popular culture. Understanding children's play is this newly emerging context provides one way of thinking about how best to bridge the gap between pedagogical understandings of play and young children's experiences with digital technologies, digital media and their consumption of popular culture. This article examines the emerging context using ideas drawn from cultural historical theory, the sociology of consumption and the sociology of childhood to explore children's contemporary play experiences. It is suggested that a contextua...

Altitude training and haemoglobin mass from the optimised carbon monoxide rebreathing method determined by a meta-analysis

Abstract: Objective To characterise the time course of changes in haemoglobin mass (Hbmass) in response to altitude exposure Methods This meta-analysis uses raw data from 17 studies that used carbon monoxide rebreathing to determine Hbmass prealtitude, during altitude and postaltitude Seven studies were classic altitude training, eight were live high train low (LHTL) and two mixed classic and LHTL Separate linear-mixed models were fitted to the data from the 17 studies and the resultant estimates of the effects of altitude used in a random effects meta-analysis to obtain an overall estimate of the effect of altitude, with separate analyses during altitude and postaltitude In addition, within-subject differences from the prealtitude phase for altitude participant and all the data on control participants were used to estimate the analytical SD The ‘true’ between-subject response to altitude was estimated from the within-subject differences on altitude participants, between the prealtitude and during-altitude phases, together with the estimated analytical SD Results During-altitude Hbmass was estimated to increase by ∼11%/100 h for LHTL and classic altitude Postaltitude Hbmass was estimated to be 33% higher than prealtitude values for up to 20 days The withinsubject SD was constant at ∼2% for up to 7 days between observations, indicative of analytical error A 95% prediction interval for the ‘true’ response of an athlete exposed to 300 h of altitude was estimated to be 11–6% Conclusions Camps as short as 2 weeks of classic and LHTL altitude will quite likely increase Hbmass and most athletes can expect benefit

Influence of Neuromuscular Fatigue on Accelerometer Load in Elite Australian Football Players

Abstract: Purpose: To determine the impact of neuromuscular fatigue (NMF) assessed from variables obtained during a countermovement jump on exercise intensity measured with triaxial accelerometers (load per minute [LPM]) and the association between LPM and measures of running activity in elite Australian Football. Methods: Seventeen elite Australian Football players performed the Yo-Yo Intermittent Recovery Test level 2 (Yo-Yo IR2) and provided a baseline measure of NMF (flight time:contraction time [FT:CT]) from a countermovement jump before the season. Weekly samples of FT:CT, coaches’ rating of performance (votes), LPM, and percent contribution of the 3 vectors from the accelerometers in addition to high-speed-running meters per minute at >15 km/h and total distance relative to playing time (m/min) from matches were collected. Samples were divided into fatigued and nonfatigued groups based on reductions in FT:CT. Percent contributions of vectors to LPM were assessed to determine the likelihood of a meaningful di...

Pathways for adaptive and integrated disaster resilience

Abstract: The world is experiencing more frequent, deadly and costly disasters. Disasters are increasingly uncertain and complex due to rapid environmental and socio-economic changes occurring at multiple scales. Understanding the causes and impacts of disasters requires comprehensive, systematic and multi-disciplinary analysis. This paper introduces recent multidisciplinary work on resilience, disaster risk reduction (DRR), climate change adaptation (CCA) and adaptive governance and then proposes a new and innovative framework for adaptive and integrated disaster resilience (AIDR). AIDR is defined as the ability of nations and communities to build resilience in an integrated manner and strengthen mechanisms to build system adaptiveness. AIDR provides the ability to face complexities and uncertainties by designing institutional processes that function across sectors and scales, to engage multiple stakeholders and to promote social learning. Based on the review of existing academic and non-academic literature, we identify seven pathways to achieve AIDR. These pathways are a conceptual tool to support scholars, policy makers and practitioners to better integrate existing DRR strategies with CCA and more general development concerns. They describe institutional strategies that are aimed at dealing with complexities and uncertainties by integrating DRR, CCA and development; strengthening polycentric governance; fostering collaborations; improving knowledge and information; enabling institutional learning; self-organisation and networking; and provision of disaster risk finance and insurance. We also examine the implications of these pathways for Indonesia, one of the most vulnerable countries to natural hazards and climate change impacts. Our findings suggest that there is an urgent need to commit more resources to and strengthen multi-stakeholder collaboration at the local level. We also argue for placing the community at the centre of an integrated and adaptive approach to DRR and CCA.

The effect of pharmacist-provided non-dispensing services on patient outcomes, health service utilisation and costs in low- and middle-income countries.

Abstract: Background The role of pharmacists has expanded beyond dispensing and packaging over the past two decades, and now includes ensuring rational use of drugs, improving clinical outcomes and promoting health status by working with the public and other healthcare professionals. Objectives To examine the effect of pharmacist-provided non-dispensing services on patient outcomes, health service utilisation and costs in low- and middle-income countries. Search methods Studies were identified by electronically searching the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (February 2010), MEDLINE (1949 to February 2010), Scopus (1960 to March 2010) and International Pharmaceutical Abstracts (1970 to January 2010) databases. An update of this review is currently ongoing. The search was re-run September 2012 and the potentially relevant studies are awaiting classification. Selection criteria Randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted time series analyses comparing 1. pharmacist-provided non-dispensing services targeted at patients versus (a) the same services provided by other healthcare professionals, (b) the same services provided by untrained health workers, and (c) usual care; and 2. pharmacist-provided non-dispensing services targeted at healthcare professionals versus (a) the same services provided by other healthcare professionals, (b) the same services provided by untrained health workers, and (c) usual care in low- and middle-income countries. The research sites must have been located in low or middle income countries according to World Bank Group 2009 at the time of the study, regardless of the location or the origin of the researchers. Data collection and analysis Two authors independently reviewed studies for inclusion in the review. Two review authors independently extracted data for each study. Risk of bias of the included studies was also assessed independently by two authors. Main results Twelve studies comparing pharmacist-provided services versus usual care were included in this review. Of the 12 studies, seven were from lower middle income countries and five were from upper middle income countries. Eleven studies examined pharmacist-provided services targeted at patients and one study evaluated pharmacist interventions targeted at healthcare professionals. Pharmacist-provided services targeting patients resulted in a small improvement of clinical outcomes such as blood pressure (-25 mm Hg/-6 mm Hg and -4.56 mm Hg/-2.45 mm Hg), blood glucose (-39.84 mg/dl and -16.16 mg/dl), blood cholesterol (-25.7 mg/dl)/ triglyceride levels (-80.1 mg/dl) and asthma outcomes (peak expiratory flow rate 1.76 l/min). Moreover, there was a small improvement in the quality of life, although four studies did not report the effect size explicitly. Health service utilisation, such as rate of hospitalisation and general practice and emergency room visits, was also found to be reduced by the patient targeted pharmacist-provided services. A single study examined the effect of patient targeted pharmacist interventions on medical expenses and the cost was found to be reduced. A single study that examined pharmacist services that targeted healthcare professionals demonstrated a very small impact on asthma symptom scores. No studies assessing the impact of pharmacist-provided non-dispensing services that targeted healthcare professionals reported health service utilisation and cost outcomes. Overall, five studies did not adequately report the numerical data for outcomes but instead reported qualitative statements about results, which prevented an estimation of the effect size. Studies for the comparison of patient targeted services provided by pharmacists versus the same services provided by other healthcare professionals or untrained healthcare workers were not found. Similarly, studies for the comparison of healthcare professional targeted services provided by pharmacists versus the same services provided by other healthcare professionals or untrained healthcare workers were not found. Authors' conclusions Pharmacist-provided services that target patients may improve clinical outcomes such as management of high glucose levels among diabetic patients, management of blood pressure and cholesterol levels and may improve the quality of life of patients with chronic conditions such as diabetes, hypertension and asthma. Pharmacist services may reduce health service utilisation such as visits to general practitioners and hospitalisation rates. We are uncertain about the effect of educational sessions by pharmacists for healthcare professionals due to the imprecision of a single study included in this review. Similarly, conclusions could not be drawn for health service utilisation and costs due to lack of evidence on interventions delivered by pharmacists to healthcare professionals. These results were heterogenous in the types of outcomes measured, clinical conditions and approaches to measurement of outcomes, and require cautious interpretation. All eligible studies were from middle income countries and the results may not be applicable to low income countries.

The influence of moral disengagement, morally based self-esteem, age, and gender on traditional bullying and cyberbullying

Abstract: The current study investigated moral disengagement, morally based self-esteem, age, and gender as predictors of traditional bullying and cyberbullying. The participants were 210 Australian school students aged 12 to 15, evenly split between males and females. Salient predictors of traditional bullying were overall moral disengagement, and the specific practices of moral justification and diffusion of responsibility. Furthermore, overall moral disengagement and the specific practices of diffusion of responsibility and attribution of blame predicted cyberbullying. Morally based self-esteem did not influence either form of bullying. Age predicted cyberbullying, with a greater tendency for older students to bully than younger students, while gender predicted involvement in traditional bullying, with boys more likely to bully than girls. Implications for antibullying interventions in schools are suggested.

Screening for mild cognitive impairment in patients with heart failure: Montreal Cognitive Assessment versus Mini Mental State Exam

Abstract: Background Cognitive impairments occur frequently in patients with chronic heart failure (CHF), resulting in worse health outcomes than expected. These impairments can remain undetected unless specifically screened. There are limited sensitive screening measures available in nursing practice to identify mild cognitive impairment (MCI). Aim To compare the Montreal Cognitive Assessment (MoCA) with the Mini Mental State Exam (MMSE) in screening for MCI in CHF patients. Methods The MMSE and MoCA were administered to 93 hospitalized CHF patients (70±11 years), without a history of neurocognitive problems. Patients with low MoCA scores ( Results Statistically more patients had low MoCA scores compared with low MMSE scores (66 vs. 30, p=0.02). The MoCA classified 38 (41%) patients as cognitively impaired that were not classified by the MMSE. A significantly low level of agreement was found (κ=0.25, p=0.001) between the MMSE and MoCA in identifying patients with scores suggestive of MCI. More task errors were observed on the MoCA cognitive domains compared with the MMSE cognitive domains. In 68% of patients with low cognitive scores, visuospatial task errors were observed on tasks from the MoCA compared with 22% on a similar task of the MMSE. Conclusion The MoCA, a screening tool for MCI, identified subtle but potentially clinically relevant cognitive dysfunctions with greater frequency than MMSE.

Influence of the Opposing Team on the Physical Demands of Elite Rugby League Match Play

Abstract: This study investigated the influence of playing standard, and winning and losing on the physical demands of elite rugby league match play. Twenty-two elite rugby league players participated in this study. Global positioning system data were collected during 16 rugby league matches. Players covered significantly greater (p ≤ 0.05) absolute and relative distance at high speeds when playing against Bottom 4 teams than when competing against Top 4 teams. The total distance per minute of match play and relative distance at low speeds were greater when matches were won. In addition, a greater absolute and relative number of maximal accelerations and repeated high-intensity effort bouts were performed when players were competing in winning teams than in losing teams. The mean and maximum number of efforts in a repeated high-intensity effort bout was also higher in winning teams, although the recovery between efforts was shorter in losing teams. Moderate (7?17 points) and large (-18 points) winning margins were associated with greater relative distances covered and distances covered at low speeds than small winning margins. No meaningful differences were found in the physical demands between small, moderate, and large losing margins. The results of this study demonstrate that the physical demands of rugby league are greater when winning than losing, and when competing against lower ranked teams. Furthermore, larger winning margins are associated with greater physical demands than small and moderate winning margins, with these physical demands, in turn, greater than losing margins of any magnitude. These findings suggest that the competitive advantage of successful elite rugby league teams is closely linked to their ability to maintain a higher playing intensity than their less successful counterparts.

Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care - an integrative review.

Abstract: This integrative review synthesises research studies that have investigated the perceptions of nurse practitioners and medical practitioners working in primary health care. The aggregation of evidence on barriers and facilitators to working collaboratively and experiences about the processes of collaboration is of value to understand success factors and factors that impede collaborative working relationships. An integrative review, which used systematic review processes, was undertaken to summarise qualitative and quantitative studies published between 1990 and 2012. Databases searched were the Cochrane Library, the Joanna Briggs Institute Library, PubMed, Medline, CINAHL, Informit and ProQuest. Studies that met the inclusion criteria were assessed for quality. Study findings were extracted relating to a) barriers and facilitators to collaborative working and b) views and experiences about the process of collaboration. The findings were narratively synthesised, supported by tabulation. 27 studies conducted in seven different countries met the inclusion criteria. Content analysis identified a number of barriers and facilitators of collaboration between nurse practitioners and medical practitioners. By means of data comparison five themes were developed in relation to perceptions and understanding of collaboration. Nurse practitioners and medical practitioners have differing views on the essentials of collaboration and on supervision and autonomous nurse practitioner practice. Medical practitioners who have a working experience with NPs express more positive attitudes towards collaboration. Both professional groups report concerns and negative experiences with collaborative practice but also value certain advantages of collaboration. The review shows that working in collaboration is a slow progression. Exposure to working together helps to overcome professional hurdles, dispel concerns and provide clarity around roles and the meaning of collaboration of NPs and MPs. Guidelines on liability and better funding strategies are necessary to facilitate collaborative practice whether barriers lie in individual behaviours or in broader policies.

Physiological responses to an intensified period of rugby league competition.

Abstract: This study investigated the physiological responses to an intensified period of rugby league competition and the subsequent impact on match performance. The participants were 7 rugby league players competing in an international student tournament. The tournament involved three 80-minute games over a 5-day period, with 48 hours between each match. Baseline measures of upper and lower body neuromuscular functions via a plyometric press-up (PP) and countermovement jump (CMJ), respectively (peak power and peak force were measured), blood creatine kinase (CK), and perceptions of well-being were assessed with a questionnaire. These measures were repeated every morning of the competition; neuromuscular fatigue and CK were additionally assessed within 2 hours after the cessation of each game. During each match, player movements were recorded via global positioning system units. There were meaningful reductions in upper (effect size [ES] = -0.55) and lower body (ES = -0.73) neuromuscular functions, and perceptual well-being (ES = -1.56) and increases in blood CK (ES = 2.32) after game 1. These changes increased in magnitude as the competition progressed. There were large reductions in the relative distance covered in high-speed running (ES = -1.49) and maximal accelerations (ES = -0.85) during game 3. Additionally, moderate reductions in the percentage of successful tackles completed were observed during game 3 (ES = -0.59). Collectively, these results demonstrate that during an intensified period of rugby league competition, characterized by only 48 hours between matches, fatigue will accumulate. This cumulative fatigue may compromise high-intensity match activities such as high-speed running, accelerations, and tackling. Furthermore, CMJs and PPs appear to be sensitive measures for monitoring neuromuscular function in rugby league players.

Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain

Abstract: Background Physical conditioning as part of a return to work strategy aims to improve work status for workers on sick leave due to back pain. This is the second update of a Cochrane Review (originally titled 'Work conditioning, work hardening and functional restoration for workers with back and neck pain') first published in 2003, updated in 2010, and updated again in 2013. Objectives To assess the effectiveness of physical conditioning as part of a return to work strategy in reducing time lost from work and improving work status for workers with back pain. Further, to assess which aspects of physical conditioning are related to a faster return to work for workers with back pain. Search methods We searched the following databases to March 2012: CENTRAL, MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1982), PsycINFO (from 1967), and PEDro. Selection criteria Randomized controlled trials (RCTs) and cluster RCTs that studied workers with work disability related to back pain and who were included in physical conditioning programmes. Data collection and analysis Two review authors independently extracted data and assessed risk of bias. We used standard methodological procedures expected by The Cochrane Collaboration. Main results We included 41 articles reporting on 25 RCTs with 4404 participants. Risk of bias was low in 16 studies. Three studies involved workers with acute back pain, eight studies workers with subacute back pain, and 14 studies workers with chronic back pain. In 14 studies, physical conditioning as part of a return to work strategy was compared to usual care. The physical conditioning mostly consisted of graded activity with work-related exercises aimed at increasing back strength and flexibility, together with a set date for return to work. The programmes were divided into a light version with a maximum of five sessions, or an intense version with more than five sessions up to full time or as inpatient treatment. For acute back pain, there was low quality evidence that both light and intense physical conditioning programmes made little or no difference in sickness absence duration compared with care as usual at three to 12 months follow-up (3 studies with 340 workers). For subacute back pain, the evidence on the effectiveness of intense physical conditioning combined with care as usual compared to usual care alone was conflicting (four studies with 395 workers). However, subgroup analysis showed low quality evidence that if the intervention was executed at the workplace, or included a workplace visit, it may have reduced sickness absence duration at 12 months follow-up (3 studies with 283 workers; SMD -0.42, 95% CI -0.65 to -0.18). For chronic back pain, there was low quality evidence that physical conditioning as part of integrated care management in addition to usual care may have reduced sickness absence days compared to usual care at 12 months follow-up (1 study, 134 workers; SMD -4.42, 95% CI -5.06 to -3.79). What part of the integrated care management was most effective remained unclear. There was moderate quality evidence that intense physical conditioning probably reduced sickness absence duration only slightly compared with usual care at 12 months follow-up (5 studies, 1093 workers; SMD -0.23, 95% CI -0.42 to -0.03). Physical conditioning compared to exercise therapy showed conflicting results for workers with subacute and chronic back pain. Cognitive behavioural therapy was probably not superior to physical conditioning as an alternative or in addition to physical conditioning. Authors' conclusions The effectiveness of physical conditioning as part of a return to work strategy in reducing sick leave for workers with back pain, compared to usual care or exercise therapy, remains uncertain. For workers with acute back pain, physical conditioning may have no effect on sickness absence duration. There is conflicting evidence regarding the reduction of sickness absence duration with intense physical conditioning versus usual care for workers with subacute back pain. It may be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning programme effective. For workers with chronic back pain physical conditioning has a small effect on reducing sick leave compared to care as usual after 12 months follow-up. To what extent physical conditioning as part of integrated care management may alter the effect on sick leave for workers with chronic back pain needs further research.

Toward a Model for Early Childhood Environmental Education: Foregrounding, Developing, and Connecting Knowledge Through Play-Based Learning

Abstract: Environmental education represents a growing area of interest in early childhood education, especially since the inclusion of environmental principles and practices in the Australian Early Years Learning Framework. Traditionally, these two fields of education have been characterized by diverse pedagogical emphases. This article considers how teachers in particular see different types of pedagogical play, such as open-ended play, modeled play, and purposefully framed play as providing opportunities for young children and teachers to develop knowledge through experiences about environmental education in early childhood settings. As a result of findings based on our qualitative research study involving early childhood teachers and children, an emerging model for thinking about environmental education in early childhood is proposed as a way of integrating these pedagogical emphases traditionally associated with environmental and early childhood education. Avenues for future research associated with this model...

A survey-based study of knowledge of Alzheimer’s disease among health care staff

Abstract: Background: Continued aging of the population is expected to be accompanied by substantial increases in the number of people with dementia and in the number of health care staff required to care for them. Adequate knowledge about dementia among health care staff is important to the quality of care delivered to this vulnerable population. The purpose of this study was to assess knowledge about dementia across a range of health care staff in a regional health service district. Methods: Knowledge levels were investigated via the validated 30-item Alzheimer’s Disease Knowledge Scale (ADKS). All health service district staff with e-mail access were invited to participate in an online survey. Knowledge levels were compared across demographic categories, professional groups, and by whether the respondent had any professional or personal experience caring for someone with dementia. The effect of dementia-specific training or education on knowledge level was also evaluated. Results: A diverse staff group (N = 360), in terms of age, professional group (nursing, medicine, allied health, support staff) and work setting from a regional health service in Queensland, Australia responded. Overall knowledge about Alzheimer’s disease was of a generally moderate level with significant differences being observed by professional group and whether the respondent had any professional or personal experience caring for someone with dementia. Knowledge was lower for some of the specific content domains of the ADKS, especially those that were more medically-oriented, such as ‘risk factors’ and ‘course of the disease.’ Knowledge was higher for those who had experienced dementia-specific training, such as attendance at a series of relevant workshops. Conclusions: Specific deficits in dementia knowledge were identified among Australian health care staff, and the results suggest dementia-specific training might improve knowledge. As one piece of an overall plan to improve health care delivery to people with dementia, this research supports the role of introducing systematic dementia-specific education or training.