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Introduction: Transition from primary school to high school can be a time of significant stress for young people. Social connection may mitigate the stress experienced by young people, yet their play activities, which are a key source of connection and friendship, have not been examined. The aim of the study was to capture the play behaviours of children in outdoor school environments. Methods: Children's play behaviours in their final year of primary school and those in their first year of high school were captured using a standardised tool (Tool for Observing Play Outdoors). Observations occurred in school outdoor environments during break times in the South Australian autumn of 2021. Frequencies and types of play were compared between year levels using descriptive statistics and contingency tables. Data were collected from four schools (two metropolitan and two regional), which were all from a similar level on the Index of Educational Disadvantage. Four observation sessions were held at each school. Results: Parents of 42 (16 girls) primary school students and 85 (33 girls) high school students gave permission for their children to participate. Physical play was the most frequent activity observed in both primary school and high school followed by expressive play. Year level was significantly associated with the type of play engaged in. Conclusion: Findings demonstrate children in the first year of high school continue to engage in physical and social play albeit less than those in the final year of primary school. Further research is needed to determine whether the physical and social environment or onset of puberty is more influential on changes in children's play. [ABSTRACT FROM AUTHOR]

Simple Summary: Horse sports are popular worldwide, providing spectator enjoyment, benefiting human health, and contributing substantially to national economies. Training and management practices used to care for sporthorses are generally based on tradition rather than science; this combined with the high-risk nature of equestrian activities led to the public questioning if sporthorse health and welfare are being compromised. To understand better how sporthorses are being managed, experts, actively involved with national and international horse sports (dressage, showjumping, and eventing) were consulted across four rounds of a Delphi study. This approach allowed participants to interact to reach a point where everyone agreed on core areas (or domains) that they felt were essential to sporthorse management. Five areas were rated as essential: training management, competition management, young horse management, health status and veterinary management, and the horse–human relationship. Stable and environmental management, and welfare assessment were rated as important but not essential, as most experts felt that these areas were already managed well. Experts called for increased education and research to support riders, trainers, and federations. A welfare charter and evidence-based guidelines to inform management practices were advised to ensure sporthorses have a good life and to safeguard the future of equestrian sports. The public is increasingly questioning equestrianism's social license to operate. While the focus historically centered on horseracing, increased scrutiny is now being placed on how dressage, showjumping, and eventing are addressing equine management and welfare concerns. Nominated equestrian federation and equestrian organization experts (n = 104) directly involved in international and/or national-level horse sports took part in a four-stage, iterative Delphi to obtain consensus on what factors should be considered essential to manage sporthorse health and welfare. Five core domains were agreed as essential: training management, competition management, young horse management, health status and veterinary management, and the horse–human relationship. Two further domains: stable and environmental management, and welfare assessment were rated as important but not essential, as most respondents felt that these areas were already managed well. Participants felt increased education and guidance combined with further policy development and regulation are needed to support stakeholders to optimize sporthorse management. An appetite to engage with research to generate evidence that promotes sporthorse welfare was evident. The development of a sporthorse welfare charter and evidence-based guidelines to inform the management and monitoring of sporthorses' health and welfare are recommended to provide horses with a good life and to safeguard the future of equestrian sports. [ABSTRACT FROM AUTHOR]

In the past decade, numerous ethical frameworks have been developed to support public health decision‐making in challenging areas. Before the COVID‐19 pandemic began, members of the authorship team were involved in research programmes, in which the development of ethical frameworks was planned, to guide (a) the use of new technologies for emerging infectious disease surveillance; and (b) the allocation of scarce supplies of pandemic influenza vaccine. However, as the pandemic evolved, significant practical challenges emerged that led to our questioning the value of these frameworks. We now believe that a normative instrument, such as a framework, cannot adequately or reliably provide the ethical guidance that needs to be incorporated into public health decision‐making during natural disasters or infectious disease emergencies. Recently it has been suggested that there are potentially more dynamic, flexible, and effective ways to navigate decisions involving complex considerations entailed in policies and practices during a public health emergency. In this paper, we first outline the key functions of a public health ethics framework, before describing why we believe it would not be fit for purpose during a crisis. We end by considering whether proposed alternative methods to promote ethical public health decision‐making goals have the potential to meet these objectives. [ABSTRACT FROM AUTHOR]

This article explores how complaint investigations undertaken by health ombudsman contribute to the improvement of the healthcare system. Using a qualitative case-study approach, semi-structured interviews were conducted with participants form the Scottish Public Services Ombudsman (SPSO) and three health boards within its jurisdiction. Health board participants were frustrated by complaints process used by the SPSO, in particular the lack of communication during an SPSO investigation especially when there were differences in clinical judgment. Using Braithwaite's typologies of motivational postures and Hertogh's models of administrative control it was found that a sense of capitulation was the primary determinant in ensuring health board compliance with SPSO recommendations and that the relationship between SPSO and health boards was predominantly coercive in nature. For the SPSO to be more effective in contributing to system improvement requires it to review its role and means of conducting complaint investigations. [ABSTRACT FROM AUTHOR]

Background: Physical activity benefits physical and mental health. However, limited research investigates if physical activity can improve outcomes from the grieving process following the death of a parent. Methods: Semi-structured interviews were conducted with 14 individuals (n = 8 female; age M = 31.2 years), who had experienced the death of a parent when they were aged between 10 and 24 years old, using retrospective recall. Data were analysed inductively using thematic analysis. Results: Six themes were identified. Physical activity was seen as; 1) 'Therapeutic'; providing an 2) 'Emotional Outlet' and created a strong sense of 3) 'Social Support'. Alongside it 4) 'Builds Confidence', and led to 5) 'Finding Yourself' and 6) 'Improved Health and wellbeing' (physical and psychological). Conclusion: Physical activity has the potential to provide positive experiences following a parental bereavement. It can provide a sense of freedom and was seen to alleviate grief outcomes, build resilience, enable social support and create a stronger sense of self. Bereavement support services for young people who have experienced death of a parent should consider physical activity as a viable intervention to support the grieving process. [ABSTRACT FROM AUTHOR]

In their 2010 book, Lorna Weir and Eric Mykhalovskiy conceptualised the role of vigilance in unknown and emerging infectious disease threats. Theirs is a macro-level account which draws on empirical data to describe vigilance as a set of technical and political arrangements that govern collection, analysis, interpretation and communication of data as it pertains to unknown threats. In this paper we expand their work to detail a conceptual analysis of the role of vigilance at the micro-level during periods of high infectious disease threat. Our data are daily press conferences and associated non-discursive tools in New South Wales (NSW), Australia during times of heightened COVID-19 risk. This paper is a conceptual analysis that draws on theories of vigilance and related concepts to show how a key aspect of vigilance is making previously unseen threats visible or present. Communications formulated and encouraged three types of vigilance as a set of governing relations: institutional or authority-based; individual outward-facing; and individual inward-facing. We also describe the relationship between vigilance and related concepts that are used in response to anticipated public threats. Authority based vigilance involved contact tracing and policing of movement and behaviours. In individual outward facing vigilance people were asked to be alert to, analyse, and react to risk in their immediate environment. Inward facing vigilance required people to gather and react to information about their own behaviours and within their own bodies. There was a relationship between different types of vigilance; as risk increased and authority-based vigilance was less successful in containing the spread of infection, individual vigilance had a stronger role to play. This extension of vigilance at the micro-level sees some of the same unintended consequences as Weir and Mykhalovskiy describe at the global level, particularly in how burdens are inequitably distributed and experienced. • Citizens became an arm of vigilance apparatus during COVID-19 pandemic in Australia. • Vigilance was authority-based; individual outward facing; individual inward facing. • Disadvantaged populations carried higher vigilance burden. • Earlier conceptions of vigilance in infectious disease emergencies are extended. [ABSTRACT FROM AUTHOR]

Introduction: Patients with gastroparesis (Gp) have symptoms with or without a cyclic pattern. This retrospective study evaluates differences in cyclic vs. non-cyclic symptoms of Gp by analyzing mucosal electrogastrogram (mEG), familial dysautonomias, and response to gastric stimulation. Methods: 37 patients with drug refractory Gp, 7 male and 30 female, with a mean age of 41.4 years, were studied. 18 had diabetes mellitus, 25 had cyclic (Cyc), and 12 had a non-cyclic (NoCyc) pattern of symptoms. Patients underwent temporary mucosal gastric stimulator (tGES) placement, which was done as a trial before permanent stimulator (GES) placement. Electrogastrogram (EGG) by mucosal (mEG) measures, including frequency, amplitude, and frequency-amplitude ratio (FAR), were pre- and post-tGES. Patients' history of personal and familial dysautonomias, quality of life, and symptom scores were recorded. Baseline vs. follow-ups were compared by paired t tests and McNemar's tests. T tests contrasted symptom scores, gastric emptying tests (GET), and mEG measures, while chi-squared tests deciphered comorbidity differences between two groups and univariate and multivariate analyses. Results: There were significantly more patients with diabetes in the Cyc group vs. the NoCyc group. Using a 1 point in symptom outcome, 18 patients did not improve and 19 did improve with tGES. Using univariable analysis, with the cyclic pattern as a predictor, patients exhibiting a cyclic pattern had an odds ratio of 0.22 (95% CI 0.05–0.81, p = 0.054) for achieving an improvement of at least one unit in vomiting at follow-up from baseline. The mucosal electrogastrogram frequency to amplitude ratio (FAR) for the "not Improved" group was 19.6 [3.5, 33.6], whereas, for the "Improved" group, it was 54.3 [25.6, 72.5] with a p-value of 0.049. For multivariate logistic regression, accounting for sex and age squared, patients exhibiting a cyclic pattern had an adjusted odds ratio (OR) of 0.16 (95% CI 0.03–0.81, p = 0.027) for achieving an improvement of at least one unit in vomiting at follow-up from baseline. The two groups had no significant differences in the personal or inherited history of investigated familial patterns. Conclusion: This study shows differences in Gp patients with Cyc vs. NoCyc symptoms in several areas. Larger studies are needed to elicit further differences between the two groups about cycles of symptoms, EGG, findings, familial patterns, and response to mucosal GES. [ABSTRACT FROM AUTHOR]

Behavioural responses vary significantly within the Reptile Class when stressed, fearful or frustrated, making it very difficult to observe or measure their emotional state. Reptiles are not commonly seen in general veterinary practice which can mean that suitable accommodation is not always available, and as there is a huge variation in a reptile's ability, or lack of, to signal changes in emotional state, it can be challenging for veterinary nurses to identify and address the stress response. The veterinary practice can reduce negative behavioural responses by managing transportation, sampling and handling methods to improve the patient experience. This article refers to reptile species commonly kept as companion animals in the UK, including snakes, lizards and tortoises, which may be presented for veterinary treatment. It also examines possible routes to the identification of Reptile species as suitable pets, and indeed the suitability of Reptiles as pets at all. [ABSTRACT FROM AUTHOR]

Vaccination plays an important role in pandemic planning and response. The possibility of developing an effective vaccine for a novel pandemic virus is not assured. However, as we have seen with SARS-CoV-2 vaccine development, with sufficient resources and global focus, successful outcomes can be achieved in a relatively short period. However even when vaccine is available it will initially be scarce. When one becomes available, how should it be distributed? In this paper we explicate how ethical thinking that is carefully attuned to context is essential to decisions about how we should conduct vaccination in a pandemic where demand exceeds supply. We focus on two key issues. First, setting the aims for a pandemic vaccination programme. Second, thinking about the means of delivering a chosen aim. We outline how pandemic vaccine distribution strategies can be implemented with distinct aims, e.g. protecting groups at greater risk of harm, saving the most lives, or ensuring societal benefit. Each aim will result in a focus on a different priority population and each strategy will have a different benefit-harm profile. Once we have decided our aim, we still have choices to make about delivery. We may achieve at least some ends via direct or indirect strategies. Such policy decisions are not merely technical, but necessarily involve ethics. One important general issue is that such planning decisions about distribution will always be made under conditions of uncertainty about vaccine safety and effectiveness. However, planning how to distribute vaccine for SARS-CoV-2 is even harder because we understand relatively little about the virus, transmission, and its immunological impact in the short and long term. [ABSTRACT FROM AUTHOR]

To explore longer-term health-related quality of life (HRQoL) and participation outcomes and goals of children and young people (CYP) with acquired brain injuries (ABI) and their families in a region of the UK and the impact of the COVID-19 pandemic. Cross-sectional survey of (5-18 CYP) and their parent-carers 12–43 months following ABI. Included measures of HRQoL, participation, family function and parental wellbeing and demographic and free text questions. Ninety-five responses (30% response) were received. 67% of CYP were at risk of impaired HRQoL, 72% had severely impaired participation. 53% of parent-carers reported reduced HRQoL and family functioning, 37% of parent-carers screened positive for anxiety/depression. Relationships exist between CYP participation and HRQoL and parental HRQoL and family functioning. Goals were overwhelmingly activity and participation focused. Participants described the global impact of an ABI on the CYP and family as well as the additional impact of the COVID-19 pandemic on CYP and family wellbeing. ABI significantly impacts CYP participation and both CYP and parent-carer wellbeing in the long-term, potentially further impacted by the COVID-19 pandemic. Rehabilitation interventions should address both participation and the psychological wellbeing of CYP with ABI and their parent-carers. [ABSTRACT FROM AUTHOR]

This article argues that an analytic framework based on participation is useful for analysing consumer experiences of alternative dispute resolution (ADR), providing a complementary approach to analyses drawing on procedural justice theory. The argument is developed by applying McKeever's 'ladder of legal participation' (LLP)1 to a qualitative data set consisting of interviews with United Kingdom consumers. The article concludes that applying the LLP in the consumer ADR context results in novel empirical and theoretical insights. Empirically, it demonstrates that – even in low‐value and transactional disputes – consumers expect high levels of participation from ADR. Theoretically, it argues that the LLP complements existing approaches by providing an unifying lens through which to study consumer experiences by emphasizing the importance of participation, not only as a process value but also in shaping outcomes highlighting the distinction between genuine and tokenistic provision of ADR. [ABSTRACT FROM AUTHOR]

In Australia, the growing assisted reproductive technologies (ART) industry has recently received some public criticism. Much of this criticism centres on the concern that doctors are increasingly motivated by profit, rather than patient interests. These concerns appear to suggest that the growing business of ART generates conflicts of interest (COI) for clinicians. While media reports may be rhetorically compelling, claims that ART practice is distorted by COI must be supported by empirical evidence. This preliminary study sought to engage with people involved with the ART industry and map out their concerns related to COI in ART. A small convenience sample of eight professionals was interviewed. Here, we present the major themes uncovered, including a richer understanding of the 'interests' of various parties involved in Australian ART. We then propose a strategy for how this topic could be constructively explored. [ABSTRACT FROM AUTHOR]

Aim: With a number of qualified community practitioner nurse prescribers (CPNPs) not prescribing, this research aimed to understand what influences this behaviour. Design: A qualitative research design. Methods: Semi‐structured interviews, based on the theoretical domains framework (TDF) were conducted with 20 CPNPs. Data collection took place between March‐July 2018 and continued until data saturation was reached. Results: Nine themes inductively explained prescribing behaviour: 1) 'Knowledge and experience'; 2) 'Consultation and communication skills'; 3) 'Professional confidence and identity'; 4) 'Wanting the best outcome'; 5) 'NHS versus patient cost'; 6) 'Emotion‐led decisions'; 7) 'Time allocation'; 8) 'Formulary access' and 9) 'Supporting environment for patient‐centred care'. Themes were then deductively mapped to the TDF and COM‐B. Conclusion: There is an ongoing need to support community practitioner nurse prescribers' 'Capability' to prescribe in terms of knowledge and aquired skills; 'Opportunity' to make prescribing easier, such as access to a wider and up to date nurse formulary alongside effective clinical support; and 'Motivation' to feel confident in prescribing behaviour, highlighting positive patient outcomes while reducing perceived issues such as cost and non‐adherence. Impact: Findings show that Capability, Opportunity and Motivation all influence the decision to prescribe. Those responsible for professional regulation and training should ensure community practitioner nurse prescribers have access to the relevant knowledge, skills and formulary to facilitate their prescribing behaviour. Professional confidence and identity as a prescriber should be encouraged, with acknowledgment of influences such as cost and emotion. An environment that allows for patient‐centred care and the best outcome should be supported, this may mean increasing time allocated to consultations. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This paper reports on the findings from 6 focus groups conducted with Australian medical students. The focus groups sought students' perspectives on how the influence of commercial interests on medical practice and education could be managed. Method: We conducted 6 focus groups with medical students in New South Wales, Australia. Participants were recruited via student‐run medical society and faculty e‐mail lists. Forty‐nine students from 6 medical schools in New South Wales participated. The research team reflected on the extent to which students uncritically appealed to science in the abstract as a management solution for conflicts of interest. Data analysis was largely inductive, looking for uses of scientific terminology, EBM, and appeals to “science” in the management of COI and applied theoretical analyses of scientism. Results: The students in our study suggested that science and evidence‐based medicine, rather than ethics or professionalism, were the best tools to deal with undue influence and bias. This paper uses philosophy of science literature to critically examine these scientistic appeals to science and EBM as a means of managing the influence of pharmaceutical reps and commercial interests. We argue that a scientistic style of reasoning is reinforced through medical curricula and that students need to be made aware of the epistemological assumptions that underpin science, medicine, and EBM to address the ethical challenges associated with commercialised health care. Conclusion: More work is needed to structure medical curricula to reflect the complexities of practice and realities of science. However, curricula change alone will not sufficiently address issues associated with commercial interests in medicine. For real change to occur, there needs to be a broader social and professional debate about the ways in which medicine and industry interact, and structural changes that restrict or mitigate commercial influences in educational, research, and policy settings. [ABSTRACT FROM AUTHOR]

Over the past decade ‘social egg freezing’ has emerged as a technology of hope that purports to empower women by enabling them to continue their careers or find the right partner without the fear of jeopardising their fertility. This technology has been promoted and celebrated by fertility companies, bioethicists, clinicians, and multi-national corporations such as Apple and Facebook. While critical questions have been raised, they tend to focus on ethical and legal issues, such as informed consent and patient autonomy. This paper uses Foucault’s notion ofdispositifas analytic lens to examine the entanglement of the commercial arrangements of fertility companies, the discursive use of hope in promoting these services, and effects on professional medical care. Drawing on socio-political analyses of hope, this paper examines the potential financial conflicts of interest facing clinicians and the way discourses of hope might mask problematic financial relations and lack of evidence of effectiveness. [ABSTRACT FROM AUTHOR]

Context Conflicts of interest (CoIs) are considered to be ubiquitous in health care and biomedicine. The disclosure of relevant interests is a first step in managing conflicts, although its usefulness is contested. Although several countries have mandated the public disclosure of doctors' financial relationships with the pharmaceutical industry, little is known about medical students' understanding of mandatory public disclosure. Methods Six 90-minute focus groups were conducted with medical students in New South Wales, Australia. Participants ranged from first- to final-year students. Students were asked about their understanding and experiences of CoIs and, more specifically, for their views on and experiences of disclosure in medical education, mandatory disclosure and public registers. Qualitative data analysis was based on a framework approach. Results Participants were generally not supportive of mandatory public disclosure of financial relationships with industry, principally because of concerns about privacy, control over disclosure, and others' (mis)interpretations of disclosures. Further, they did not know how to assess the disclosures presented to them as part of their medical education and described a wide range of reactions to disclosed information. Conclusions This study suggests that students are currently not well prepared for mandatory public disclosure of CoIs. The subsequent discussion draws on Bourdieu's doxa to highlight assumptions of altruism in medicine, assumptions that are potentially in tension with recent events that have exposed doctors to moral scrutiny by the public. Medical students could be better prepared for future obligations by encouraging disclosures, and contextualising and helping students to interpret them. Disclosure as a box-ticking exercise is unlikely to achieve goals implied by transparency, but a more reflective approach may assist both scrutinisers and the scrutinised. [ABSTRACT FROM AUTHOR]

Conflicts of interest ( COI) are considered ubiquitous in many healthcare arrangements,1 but there is disagreement on how COI should be defined, whether non-financial conflicts deserve attention and the relationship between COI and harm. We conducted a study of Australian healthcare professionals and students to gain a better understanding of the way that COI are understood in practice. In this paper, we outline an empirically derived taxonomy of the understanding of, and attitudes towards, COI. We carried out 25 semistructured interviews with clinicians working in several fields across Australia and held six focus group discussions with medical students in New South Wales. Interviewees and focus groups followed similar question routes investigating participants' understanding of COI and views of management. All data were compared and analysed using a matrix of pre-determined questions. There were, broadly, two views of COI: that COI were potentially harmful and morally compromising and another that saw COI as less serious and easily managed through existing structures. Definitions of COI varied widely and were both financial and non-financial. Causes of COI were, variously, systemic, individual and/or relational. Some participants associated COI with moral wrongdoing, and a variety of potential harms was identified. Views on how COI should be managed were similarly varied. We found considerable heterogeneity in how COI are understood in practice. This has implications for management systems that are currently in place, and we suggest a more sophisticated system for considering and mitigating COI. [ABSTRACT FROM AUTHOR]

This paper aims to interrogate the potential and challenges in interdisciplinary working across disciplinary boundaries by examining a longitudinal partnership designed to research student experiences of digital technologies in undergraduate medicine established by the authors of this paper (one from Education and the other from Medical Education). The paper is situated in current methodological trends including the changing value of replicability and evidence-based methods and increases in qualitative and mixed methods studies in medical education, whilst education research has seen growing encouragement for randomized controlled trials and large-scale quantitative studies. A critical analysis of the partnership interactions is framed by Holland’s positional and imagined identities, negotiated across ‘figured’ worlds and the concept of epistemic games that guide knowledge construction. We consider social, political and cultural challenges; and how ‘in-between’ sites of knowledge were established where the academic identity of each was shaped by engaging with the other and new theoretical, methodological and ethical understandings were co-constructed. The paper concludes that despite the ongoing challenges, ‘bottom-up’ partnerships can contribute to a growth in interdisciplinarity which might itself be understood as a boundary object. Interdisciplinarity necessitates improvisation and boundary crossing and can, therefore, always be considered a matter of negotiation, creativity and collaboration. [ABSTRACT FROM AUTHOR]

Equestrianism is popular worldwide, with millions of horses and riders participating in competitive horse sports and non-competitive leisure riding. Riders have a duty of care or responsibility for their horses and should aim to optimise their health and welfare. Despite this, limited research has explored the effectiveness and impact of equitation practice, equine management and training techniques on equine performance and welfare. The International Society for Equitation Science promotes enhanced equine welfare through an objective and evidence based approach to equine management and training, via education and research. This review explores the impact of the rider on equitation practice and how rider education could inform equine management and training regimens to promote health, welfare and performance. The experience of the rider will influence their riding capabilities, decision-making and their horse’s ridden performance. Matching the personality and experience of horses and riders can create a positive partnership. Riding is a physical activity; therefore rider fitness can also influence the horse’s performance and physical capacity. An unbalanced rider will not be able to give clear and consistent aids to the horse therefore affecting their behaviour when ridden. The horse will have to adapt their locomotion to account for the moving weight of the unbalanced rider which increases the physiological demands of exercise. Psychological influences can also change the way a rider interacts with their horse. Therefore the informed rider will ensure they are physically and psychologically prepared to ride. Decision making is a key part of rider responsibility. Riders, owners and keepers of horses will determine training and management regimens, which should be designed to support the workload expected of the horse. Similarly, riders should be capable of identifying potential risks of injury and be able to recognise pain and the physical representation of injury in the horse. Such knowledge should then be applied to adapt management and exercise regimes accordingly. To safeguard the horse, the responsible rider needs to be educated and informed, to make them aware of the impact of decisions they make, on their equine partner. Further research within equitation science is required to build an evidence base to support the development of educated and responsible riders. The horse-rider relationship is complex. The inability of the horse to verbalise its emotions and pain places significant responsibility on the rider to ensure that the animal’s health and welfare is optimised through informed management and riding. The responsible rider should exert a positive impact upon the horse and the partnership, applying scientific principles when training and managing their horse to promote health, welfare and performance to achieve a positive horse-rider relationship. [ABSTRACT FROM AUTHOR]

Variation in equine hoof conformation between farriery interventions lacks research, despite associations with distal limb injuries. This study aimed to determine linear and angular hoof variations pre- and post-farriery within a four to six week shoeing/trimming interval. Seventeen hoof and distal limb measurements were drawn from lateral and anterior digital photographs from 26 horses pre- and post-farriery. Most lateral view variables changed significantly. Reductions of the dorsal wall, and weight bearing and coronary band lengths resulted in an increased vertical orientation of the hoof. The increased dorsal hoof wall angle, heel angle, and heel height illustrated this further, improving dorsopalmar alignment. Mediolateral measurements of coronary band and weight bearing lengths reduced, whilst medial and lateral wall lengths from the 2D images increased, indicating an increased vertical hoof alignment. Additionally, dorsopalmar balance improved. However, the results demonstrated that a four to six week interval is sufficient for a palmer shift in the centre of pressure, increasing the loading on acutely inclined heels, altering DIP angulation, and increasing the load on susceptible structures (e.g., DDFT). Mediolateral variable asymmetries suit the lateral hoof landing and unrollment pattern of the foot during landing. The results support regular (four to six week) farriery intervals for the optimal prevention of excess loading of palmar limb structures, reducing long-term injury risks through cumulative, excessive loading. [ABSTRACT FROM AUTHOR]

This article draws on an empirical investigation of how Australia's cervical screening program came to be the way it is. The study was carried out using grounded theory methodology and primarily uses interviews with experts involved in establishing, updating or administering the program. We found strong differences in experts' normative evaluations of the program and beliefs about optimal ways of achieving the same basic outcome: a reduction in morbidity and mortality caused by invasive cervical cancer. Our analysis demonstrates how variations in values and preferences associated with key concepts underpinning public health such as benefit, harm and burden led to different perspectives on the purpose of an organized cervical screening program. These variations were largely driven by different bases of professional experience. Differently conceived purposes in turn led to conflict over how the program should be operationalized. Following Frith's model of empirical bioethics, the results of the study both draw on and inform the existing public health and screening ethics literature. [ABSTRACT FROM AUTHOR]

Chemotherapy is a commonly integrated treatment option within human and animal oncology regimes. Limited research has investigated pet owners' treatment decision-making in animals diagnosed with malignant neoplasia. Dog and cat owners were asked to complete an online questionnaire to elucidate factors which are key to the decision making process. Seventy-eight respondents completed the questionnaire in full. Fifty-eight percent of pet owners would not elect to treat pets with chemotherapy due to the negative impact of the associated side effects. Seventy-two percent of respondents over estimated pet survival time post chemotherapy, indicating a general perception that it would lead to remission or a cure. Vomiting was considered an acceptable side effect but inappetence, weight loss and depression were considered unacceptable. Owners did expect animals' to be less active, sleep more and play less, but common side effects were not rated as acceptable despite the potential benefits of chemotherapy. Based on the results, veterinary teams involved with oncology consultations should establish if clients have prior experience of cancer treatments and their expectations of survival time. Quality of life assessments should also be implemented during initial oncology consultations and conducted regularly during chemotherapy courses to inform client decision making and to safe guard animal welfare. [ABSTRACT FROM AUTHOR]

This paper proposes a model for designing consumer dispute resolution (CDR) mechanisms (including conciliation, adjudication, arbitration and ombuds schemes). This field has expanded significantly in recent years, replacing courts as the primary forum of dispute resolution in some areas of consumer-to-business activity. This expansion has been ad hoc, with a lack of consistency in the design of CDR mechanisms and in the overall shape of the CDR landscape. In light of the recent implementation of the EU's Directive on Consumer Alternative Dispute Resolution and Regulation on Consumer Online Dispute Resolution, Dispute System Design (DSD) requires urgent attention to ensure that the design of future mechanisms is based on coherent principles. A failure to address this issue risks undermining the legitimacy of state-sanctioned dispute resolution. The model described in this paper proposes a systematic approach and aims to: synthesise existing DSD models; apply the concepts of DSD to the field of CDR; and provide a framework that may be of use in other disputing contexts. [ABSTRACT FROM AUTHOR]

The United Kingdom's four children's commissioners, established under separate legislation for Wales, Northern Ireland, Scotland and England, are amongst the best known of the public institutions created since the beginning of devolved government in 1999. Like many such offices around the world, they are the result of domestic political and social processes as well as the influence of the requirements of international human rights treaties, specifically the United Nations Convention on the Rights of the Child. Different processes in the four countries have produced differing remits and emphases, but each commissioner is in part a response to concerns about the vulnerability of children in difficult circumstances. The commissioners' activities include vigilance over the access of such children to support, in particular support for getting their voices heard. The commissioners have also developed prominence on the international stage as independent children's rights institutions and all have been active in promoting children's participation in social accountability for human rights implementation. This article explains the commissioners' different roles and remits and examines ways in which they contribute to accountability for human rights implementation in the political, administrative, legislative, judicial and social spheres. It concludes by suggesting that their status as both "children's champion" and independent children's rights institutions is likely to assure their long-term endurance in the still-evolving process of constitutional change in the UK. [ABSTRACT FROM AUTHOR]

Cancer screening is an important component of prevention and early detection in public health and clinical medicine. The evidence for cancer screening, however, is often contentious. A description and explanation of disagreements over the evidence for cervical, breast, and prostate screening may assist physicians, policymakers, and citizens faced with screening decisions and suggest directions for future screening research. There are particular issues to be aware of in the evidence base for each form of screening, which are summarized in this paper. Five tensions explain existing conflicts over the evidence: (1) data from differing contexts may not be comparable; (2) screening technologies affect evidence quality, and thus evidence must evolve with changing technologies; (3) the quality of evidence of benefit varies, and the implications are contested; (4) evidence about harm is relatively new, there are gaps in that evidence, and there is disagreement over what it means; and (5) evidence about outcomes is often poorly communicated. The following principles will assist people to evaluate and use the evidence: (1) attend closely to transferability; (2) consider the influence of technologies on the evidence base; (3) query the design of meta-analyses; (4) ensure harms are defined and measured; and (5) improve risk communication practices. More fundamentally, there is a need to question the purpose of cancer screening and the values that inform that purpose, recognizing that different stakeholders may value different things. If implemented, these strategies will improve the production and interpretation of the methodologically challenging and always-growing evidence for and against cancer screening. [ABSTRACT FROM AUTHOR]

Organised screening programmes have been remarkably successful in reducing incidence and mortality from cervical cancer, while opportunistic screening varies in its effectiveness. Experts recommend that cervical screening or HPV testing be carried out only in the context of an organised programme. We sought to answer the following study questions: What does it mean for a cervical screening programme to be organised? Is there a place for opportunistic screening (in an organised programme)? We reviewed 154 peer-reviewed papers on organised and opportunistic approaches to cervical screening published between 1970 and 2014 to understand how the term ‘organised’ is used, formally and in practice. We found that despite broad recognition of a prescriptive definition of organisation, in practice the meaning of organisation is much less clear. Our review revealed descriptions of organised programmes that differ significantly from prescribed norms and from each other, and a variety of ways that opportunistic and organised programmes intersect. We describe the breadth of the variation in cervical cancer screening programmes and examine the relationships and overlaps between organised and opportunistic screening. Implications emerging from the review include the need to better understand the breadth of organisation in practice, the drivers and impacts of opportunistic screening and the impact of opportunistic screening on population programme outcomes. Appreciation of the complexity of cervical screening programmes will benefit both screeners and women as programmes are changed to reflect a partially vaccinated population, new evidence and new technologies. [ABSTRACT FROM AUTHOR]

Aim To identify what aspects of health clinicians target when working with children with neurodisability, and which might be appropriate to assess the performance of health services. Method Health professionals were recruited through child development teams and professional societies in England. Professionals participated in four rounds of an online Delphi survey. Open questions were used to elicit aspects of health; these were coded using the WHO International Classification of Functioning, Disability and Health for Children and Youth. Then, participants were asked to rate their agreement with statements to prioritise outcomes identified. Results Responses to all four rounds were, respectively: 233/276 (84.4%), 232/286 (81.1%), 227/285 (79.6%) and 191/284 (67.3%). The key outcome domains identified were: mental health, confidence/emotional stability, anxiety/attention, sleep, pain, toileting, movement ability, manual ability, acquiring skills, communication, mobility, self-care, recreation and leisure. Participants rated both functioning and wellbeing in these aspects of health as equally important. Interpretation This Delphi survey identified nine key domains that provide a professional perspective on a core set of outcomes for evaluating services for children and young people with neurodisability. [ABSTRACT FROM AUTHOR]

Background UK medical students' confidence in their prescribing skills is low, and a significant proportion of prescriptions written by foundation year 1 (FY1) doctors contain errors. The Prescribing Safety Assessment ( PSA) is a new national examination aimed at ensuring prescribing competence in undergraduates, but few PSA-specific preparatory resources are available to students. Methods A needs analysis was performed and an online e-tutorial (Prepare for the PSA) was designed. The e-tutorial consists mainly of a practise exam that closely mirrors the format of the PSA itself. After completing each question the user receives personalised feedback, and is given the opportunity to further their knowledge using interactive learning activities. A facility for users to contribute their own questions is included, and the e-tutorial also explains the rationale underlying the PSA and directs users to further learning resources. Numerous attempts were made to encourage the use of the e-tutorial amongst UK medical students and educators. A total of 248 final-year students at a UK medical school were asked to evaluate the e-tutorial and rate their prescribing confidence before and after completing it. Results The response rate in the evaluation was 72.7-73.9 per cent. The results show that completing the e-tutorial is associated with highly significant (p < 0.0001) increases in confidence across all prescribing skills. Discussion Our e-tutorial is effective and meets the needs of medical students. Once the e-tutorial is disseminated more widely and is expanded by user-contributed questions, we hope that it will become established as a national platform for collaborative prescribing education. [ABSTRACT FROM AUTHOR]

Background: Clinical application of body composition (BC) measurements for individual children has been limited by lack of appropriate reference data. Objectives: (1) To compare fat mass (FM) and fat free mass (FFM) standard deviation scores (SDS) generated using new body composition reference data and obtained using simple measurement methods in healthy children and patients with those obtained using the reference 4-component (4-C) model; (2) To determine the extent to which scores from simple methods agree with those from the 4-C model in identification of abnormal body composition. Design: FM SDS were calculated for 4-C model, dual-energy X-ray absorptiometry (DXA; GE Lunar Prodigy), BMI and skinfold thicknesses (SFT); and FFM SDS for 4CM, DXA and bioelectrical impedance analysis (BIA; height2/Z)) in 927 subjects aged 3.8–22.0 y (211 healthy, 716 patients). Results: DXA was the most accurate method for both FM and FFM SDS in healthy subjects and patients (mean bias (limits of agreement) FM SDS 0.03 (±0.62); FFM SDS −0.04 (±0.72)), and provided best agreement with the 4-C model in identifying abnormal BC (SDS ≤−2 or ≥2). BMI and SFTs were reasonable predictors of abnormal FM SDS, but poor in providing an absolute value. BIA was comparable to DXA for FFM SDS and in identifying abnormal subjects. Conclusions: DXA may be used both for research and clinically to determine FM and FFM SDS. BIA may be used to assess FFM SDS in place of DXA. BMI and SFTs can be used to measure adiposity for groups but not individuals. The performance of simpler techniques in monitoring longitudinal BC changes requires investigation. Ultimately, the most appropriate method should be determined by its predictive value for clinical outcome. [ABSTRACT FROM AUTHOR]

This article is concerned with ways in which integration of the UNCRC within national legal systems can help support realisation of the objectives of the UNCRC. Whilst the UN Committee on the Rights of the Child rightly attaches importance to justiciability of the provisions of the Convention, equally important for many of the UNCRC's provisions are strong parliamentary and administrative mechanisms which do not depend on an individual claim of rights violation. Advantages of such mechanisms include greater opportunities for deliberative engagement and for measurement of impact on the lives of children. The article considers the proposed Rights of Children and Young People (Wales) Measure 2010 as a legislative model for such a mechanism. [ABSTRACT FROM AUTHOR]

Preparation of high quality personnel to provide educational services to students with disabilities living in rural areas is, at best, challenging. Findings from a comprehensive study concerning the status of the implementation of the Individuals with Disabilities Education Act (IDEA) in rural settings and the issues such implementation presents to teacher education programs in these areas are discussed. Members of the American Council on Rural Special Education (ACRES) participated in the study. Results indicated that strategies for enhancing personnel preparation, recruitment, and retention of individuals to institutions of higher education and K-12 schools in rural settings include distance learning, on-site professional development opportunities, salary incentives/increments, and benefits. Linking evaluation data to the general education curriculum and determining how the student's disabilities affect his/her progress in general education are issues for practitioners implementing IDEA in rural settings. Recommendations are provided for enhancing personnel preparation and service delivery based on the results. [ABSTRACT FROM AUTHOR]

Abstract: Background: Preterm infants are at risk of metabolic bone disease due to inadequate mineral intake with unknown consequences for later bone health. Objective: To test the hypotheses that (1) early diet programs peak bone mass and bone turnover; (2) human milk has a beneficial effect on these outcomes; (3) preterm subjects have reduced peak bone mass compared to population reference data. Design: 20 year follow-up of 202 subjects (43% male; 24% of survivors) who were born preterm and randomized to: (i) preterm formula versus banked breast milk or (ii) preterm versus term formula; as sole diet or supplement to maternal milk. Outcome measures were (i) anthropometry; (ii) hip, lumbar spine (LS) and whole body (WB) bone mineral content (BMC) and bone area (BA) measured using DXA; (iii) bone turnover markers. Results: Infant dietary randomization group did not influence peak bone mass or turnover. The proportion of human milk in the diet was significantly positively associated with WBBA and BMC. Subjects receiving >90% human milk had significantly higher WBBA (by 3.5%, p =0.01) and BMC (by 4.8%, p =0.03) than those receiving <10%. Compared to population data, subjects had significantly lower height SDS (−0.41 (SD 1.05)), higher BMI SDS (0.31 (1.33)) and lower LSBMD SDS (−0.29 (1.16)); height and bone mass deficits were greatest in those born SGA with birthweight <1250 g (height SDS −0.81 (0.95), LSBMD SDS −0.61 (1.3)). Conclusion: Infant dietary randomization group did not affect peak bone mass or turnover suggesting the observed reduced final height and LS bone mass, most marked in growth restricted subjects with the lowest birthweight, may not be related to sub-optimal early nutrition. The higher WB bone mass associated with human milk intake, despite its low nutrient content, may reflect non-nutritive factors in breast milk. These findings may have implications for later osteoporosis risk and require further investigation. [Copyright &y& Elsevier]

Background: Increased emphasis has been placed in pediatric residency programs on the identification and treatment of child mental health disorders. Description: An electronic record audit was developed to assess residents' behavioral health skills and optimize behavioral health training. Information from the electronic audit was used to provide feedback to preceptors, modify the training curriculum, and increase access to mental health referrals. Evaluation: The audit determined the frequency of detected mental health problems, types of disorders identified, use of screening instruments, and behavioral health interventions and/or referrals by pediatric residents over a 2-year period. However, measurement of the effectiveness of curriculum and training interventions was undetermined due to the evolving implementation of changes based on continuous audit findings. Conclusions: Recommendations for future use of this technique include establishing baseline skills and targeting specific areas for training and evaluation, providing feedback to residents, and tracking specific patients over time. [ABSTRACT FROM AUTHOR]

The paper examines conceptual barriers to incorporation of children’s rights – understood in the context of the European Convention for the Protection of Human Rights and Fundamental Freedoms 1950, the Human Rights Act 1998 and the United Nations Convention on the Rights of the Child 1989 – in the law of England and Wales. It identifies traditions in law and policy on children and young people, and competing political imperatives which militate against effective implementation of children’s rights to protection and provision, but suggests that participative rights pose fewer problems. It argues that the scope for further judicial development is limited in the absence of substantial changes in the legislative framework. It then examines rights-based reasoning in administrative practice and considers the impact here of ideological differences between the UK Government and the Welsh Assembly Government. It considers the scope for differential implementation within the evolving devolution settlement, and the potential impact of such difference on child law and practice in the ‘single jurisdiction’ of England and Wales. It concludes by arguing for greater attention to executive as well as legislative and judicial functions, and to extra-judicial mechanisms, for promoting rights-based decision making. [ABSTRACT FROM AUTHOR]

A standard guide was readministered to 42 primary care pediatricians after community interventions to assess changes in their behavioral health practices. Among the outcome findings: increased screening of young children (6 months to 5 years); attention deficit hyperactivity disorder continued to be the most frequent diagnosis, with a high level of diagnostic comfort and use of stimulants; decreased comfort in the diagnosis and treatment of depression, with a significant decline in use of selective serotonin reuptake inhibitors; nearly all continued to offer nonmedication, behavioral health treatment; and a significant increase in use of social workers for community referrals. Structured interventions had limited influence on the process of change. Black box warnings exerted a powerful effect on prescribing practices. Systemic changes involving financial incentives, increased access to mental health providers, practice guidelines, and technology for continuing education may offer possibilities for changing practice patterns. [ABSTRACT FROM AUTHOR]

Background: A number of significant chemical incidents occur in the UK each year and may require Emergency Departments (EDs) to receive and manage contaminated casualties. Previously UK EDs have been found to be under-prepared for this, but since October 2005 acute hospital Trusts have had a statutory responsibility to maintain decontamination capacity. We aimed to evaluate the level of preparedness of Emergency Departments in North West England for managing chemical incidents. Methods: A face-to-face semi-structured interview was carried out with the Nurse Manager or a nominated deputy in all 18 Emergency Departments in the Region. Results: 16/18 departments had a written chemical incident plan but only 7 had the plan available at interview. All had a designated decontamination area but only 11 felt that they were adequately equipped. 12/18 had a current training programme for chemical incident management and 3 had no staff trained in decontamination. 13/18 could contain contaminated water from casualty decontamination and 6 could provide shelter for casualties before decontamination. Conclusion: We have identified major inconsistencies in the preparedness of North West Emergency Departments for managing chemical incidents. Nationally recognized standards on incident planning, facilities, equipment and procedures need to be agreed and implemented with adequate resources. Issues of environmental safety and patient dignity and comfort should also be addressed. [ABSTRACT FROM AUTHOR]

Focus by child health professionals on the well-being of young Australian children and their families has intensified in the past decade, with particular attention drawn to the importance of the early detection and intervention of developmental problems. While many children with developmental difficulties are detected in the preschool years, those with more subtle forms of developmental problems are often only noticed by their mothers, passing unnoticed by professionals until the children begin school and fail socially or academically. This study aimed to ascertain ways in which child health professionals may utilise the experience of mothers to improve early recognition and diagnosis of subtle developmental and behavioural problems in children. French philosopher, Roland Barthes (1973) proposed that myths play an important social role in defining underlying social values that affect how people interpret what others say or do. This paper explores how the social myths of childhood, motherhood and medicine impact upon the early detection of children with subtle developmental problems. In particular, it examines how social myths affect when and how mothers become concerned about their children's development, from whom they seek advice, and the responses which mothers receive in regard to their concerns. Mythical notions of the 'blameless child', 'boys will be boys' and 'children who look OK are OK', and the constituted myth of motherhood, are all shown to affect when mothers become concerned about their children's development. What mothers do about their concerns and the responses they receive from child health professionals are also influenced by these myths. The myth of medicine is also examined to determine how it affects communication between mothers and doctors, the roles and responsibilities of doctors, and the value placed on a mother's concerns by doctors. [ABSTRACT FROM AUTHOR]

The study examined practices by pediatric residents (n = 61) concerning psychosocial care during well child visits. A random sample (n = 719) of well child visits was selected, and a medical record review was conducted. Results suggested that a behavioral health issue was discussed in 38% of the cases. The most frequent type of problem discussed involved a medical component, while problems with mood were rarely discussed (<1%). Residents treated 67% of the cases and referred 20% of the cases with behavioral health concerns. Logistic regression suggested that residents were significantly more likely to treat medically focused problems (P = 0.05), but more likely to refer children with social/environmental or learning problems (P = 0.05). Results suggested the need for further training in recognition of internalizing disorders. [ABSTRACT FROM AUTHOR]

The pressing need for identification and treatment of behavioral health disorders in primary care has renewed interest in the concept of co-located models of care. The purpose of this article is to describe three North Carolina practice models in which mental health professionals are co-located with pediatric primary care providers. Each of the models was sustainable, partly due to systemic changes brought about by advocacy efforts. In addition to providing practical guidance for possible replication in primary care, this article reflects on how advocacy efforts can impact the success of co-location models. [ABSTRACT FROM AUTHOR]

Photothabdus is a genus of Gram-negative bacteria from the family Enterobacteriaceae. Members of Photorhabdus have a complex life cycle during which the bacterium has a pathogenic interaction with insect larvae whilst also maintaining a mutualistic relationship with nematodes from the family Heterorhabditidae. During growth in the insect, Photorhabdus bacteria produce a broad-spectrum antibiotic identified as 3,5-dihydroxy-4-isopropylstilbene (ST). The biochemical pathway responsible for the production of this antibiotic has not been characterized. In this report, a mutant strain of Photothabdus Iuminescens subsp. laumondil 1101, BMM9O1, has been isolated, by transposon mutagenesis, that is unable to produce the ST antibiotic. Using in silico studies, feeding experiments and biochemical analyses, it is shown that the gene mutated in this strain, st/A, encodes phenylalanine ammonia-lyase (PAL). PAL catalyses the non-oxidative deamination of L-phenylalanine to trans-cinnamic acid and the enzyme is ubiquitous in plants, where it is involved in the production of phenylpropanoids such as lignin and phytoalexins. However, this is the first report of PAL activity in a member of the Proleobacteria, [ABSTRACT FROM AUTHOR]

Focuses on the legislative future of Wales. Analysis of the "Report of theCommission on the Powers and Electoral Arrangements of the National Assembly forWales"; Reviews of Welsh Devolution.

A standard interview guide focused on behavioral health referral practices and communication patterns was developed and administered to 47 pediatricians in private practice. Results suggested that the most frequent reasons for referral to a mental health provider were diagnostic uncertainty, failure to respond to treatment, presence of severe affective symptoms, and need for ongoing psychotherapy. Only a third of the providers indicated that their patients frequently followed through with recommendations to receive mental health care. More than half of the pediatricians wanted more information regarding their patients referred for mental health services, and they expressed a strong interest in colocation with a mental health provider. [ABSTRACT FROM AUTHOR]

Objective. There has been a strong push toward the recognition and treatment of children with behavioral health problems by primary care pediatricians. This study was designed to assess the extent to which a sample of primary care pediatricians diagnose and treat behavioral health problems and to identify factors that may contribute to their behavioral health practice. Methods. A standard interview was conducted with 47 pediatricians who work in primary care settings in a predominantly urban setting in North Carolina. Pediatricians' responses to questions about the estimated percentage of children in their practice with a behavioral health disorder, tools used to make diagnoses, frequent and infrequent diagnoses made, comfort level with making a diagnosis, reasons for not making a diagnosis, use of psychotropic medications, types of nonmedication interventions provided, educational background, and needs involving behavioral health issues were evaluated. Results. Pediatricians estimated that the average percentage of children in their practices with a behavioral health disorder was 15%. The study did not find significant differences in perceptions related to time in practice or gender of the pediatric provider. The most frequent behavioral health diagnosis was attention-deficit/hyper-activity disorder (ADHD), and the majority incorporated behavioral questionnaires, expressed a high level of comfort with the diagnosis, and frequently or occasionally prescribed stimulants. Variability was noted in both practice and comfort for other behavioral health disorders. Slightly fewer than half of the pediatricians fre-quently diagnosed anxiety and depression. Those who make these diagnoses commonly incorporated questionnaires and reported frequent or occasional use of selective serotonin reuptake inhibitors. Comfort in making the diagnosis of anxiety was highly associated with use of selective serotonin reuptake inhibitors.... [ABSTRACT FROM AUTHOR]

Man's oldest fungicide has probably long functioned in this role in plants, as a natural component of induced antifungal defence. Elemental sulphur (S0) is the only inorganic phytoalexin and the only phytoalexin produced by so many different taxa. S0 (detected by GC-MS as 32S8) is produced in representative species of Sterculiaceae (cocoa), Solanaceae (tomato, tobacco), Malvaceae (cotton), and Leguminosae (French bean) in response to xylem-invading fungal and bacterial pathogens. Production was more rapid and intensive in disease-resistant genotypes. Gene expression for S0 production may be xylem-specific as S0 was not present in leaves of six species undergoing hypersensitivity to Pseudomonas syringae. Anomalously, high constitutive S0 levels occurred in leaves of Arabidopsis and Brassica oleracea. S0 was highly toxic (ED50 1–3 μg ml−1) to many fungal pathogens representing ascomycetes, basidiomycetes, and deuteromycetes, but not to an oomycete, Phytophthora, or to bacteria. Levels in cocoa and tomato xylem and Arabidopsis leaves were potentially inhibitory, but in other interactions were below theoretically toxic concentrations. However, S0 accumulation is highly localized, suggesting that the element is produced in sufficient amounts, at the right time and place to be effective. SEM-EDX revealed S in tomato and cocoa xylem walls, xylem parenchyma, and vascular gels and tyloses, all sites appropriate to counter vascular pathogenic Verticillium dahliae. Transient increases in sulphate, glutathione and cysteine occurred in tomato xylem. The sulphate may reflect the over-expression of sulphate transporters, but the thiols might be possible precursors. Analysis of differential gene expression should reveal what may be a novel biosynthetic pathway of S0 formation in eukaryotes. [ABSTRACT FROM PUBLISHER]

Although the prevalence is unknown, affective disorders are more common in children with epilepsy than in healthy controls. The purpose of the present study was to examine the occurrence of anxiety in children and adolescents with epilepsy and to determine factors associated with elevation of these symptoms. Children and adolescents (n=101) between the ages of 6 and 16 years were given the Revised Children’s Manifest Anxiety Scale (RCMAS). Mild to moderate symptoms of anxiety were reported by 23% of the patients. Based on regression analysis, factors significantly associated with increased anxiety included the presence of comorbid learning or behavioral difficulties, ethnicity, and polytherapy. Results suggest the need to monitor children and adolescents with epilepsy for affective symptoms in order to provide appropriate interventions. [Copyright &y& Elsevier]

Parental beliefs and attitudes concerning epilepsy may significantly impact adjustment and quality of life for both the child and family. The purpose of the present study was to examine the relationship between parental anxiety and quality of life in pediatric patients with ongoing epilepsy. Subjects were parents (n=200) of children between the ages of 6 and 16 years who had been diagnosed and treated for epilepsy for at least 1 year. Parents were given quality of life and anxiety questionnaires during the child’s clinic visit. A stepwise regression analysis suggested that severity of comorbid conditions, parental anxiety, seizure control, and number of medications were significantly associated with quality of life for these children. Parents with increased anxiety whose children had poorly controlled seizures and a comorbid disability were found to have diminished quality of life. [Copyright &y& Elsevier]