bluuebunny/crossref_metadata_2025 huggingface dataset:
The Quality of Life Burden Associated With Voice Disorders in Sjögren’s Syndrome
Authors: Tanner Kristine , Pierce Jenny L. , Merrill Ray M. , Miller Karla L. , Kendall Katherine A. , Roy Nelson
Published: April 2015

Objectives:

This study examined quality of life burden of voice disorders in Sjögren’s syndrome (SS).

Methods:

Patients with SS (n = 101) completed interviews involving patient-reported histories of voice disorders, specific voice symptoms, SS disease severity, the Voice-Related Quality of Life (V-RQOL), and the general health-related quality of life Short Form 36 (SF-36) questionnaires. Relationships among voice symptoms, disease severity, and quality-of-life measures were examined and compared with patient-reported voice disorders.

Results:

Significant correlations were observed among voice symptoms, disease severity, V-RQOL, SF-36, and patient-reported voice disorders ( P < .05). Patients with SS who reported a voice disorder experienced a greater burden on general quality of life as compared with those without voice disorders. Specific voice symptoms significantly correlated with reduced SF-36 scores included frequent throat-clearing, throat soreness, difficulty projecting, and vocal discomfort. Despite the added burden of a voice disorder on quality of life in SS, voice-related treatment seeking was low (15.8%). However, the majority of patients who received voice treatment reported voice improvement.

Conclusions:

Individuals with SS frequently experience voice disorders and specific voice-related symptoms that are associated with reduced quality of life. These findings have important implications for voice referral practices and voice disorder symptom management in this population.
Integrating Positive Psychology Into Family Therapy
Authors: Conoley Collie W. , Plumb Evelyn Winter , Hawley Kathryn J. , Spaventa-Vancil Kathryn Z. , Hernández Rafael J.
Published: April 2015

The article provides an overview of positive family therapy that combines family therapy and positive psychology to develop a nonpathologizing, growth-oriented, strengths-based, relationship-focused model of intervening with families. The theoretical roots from both family therapy and positive psychology are described. The unique feature is the mechanism of change, broaden and build theory from positive psychology. Examples of techniques are provided that foster strengths, virtues, approach goals, and positive affect. In accordance with the counseling psychology tradition, we argue that positive family therapy is culturally sensitive, growth oriented, and hope enhancing.
The view from inside leadership configurations
Authors: Gronn Peter
Published: April 2015

In this response to Samia Chreim’s (2015) discussion, it is argued that her article makes an important contribution to recent attempts to define non-heroic approaches to leadership. The primary focus of her article is on the merger and acquisition process as experienced by five firms (an acquiring firm and four acquired business units), and a comparative analysis of transitional leadership patterns in light of explicit pre-merger undertakings given about, and consequent expectations of, subsequent leadership. These expectations were about distributed leadership. In some instances the acquired firms’ expectations were fulfilled while in others they were not. As is pointed out in this response, Chreim’s discussion is significant for the growing body of literature on distributed leadership and, by implication, for wider questions concerned with the appropriate unit of analysis in leadership. Recent scholarship is shown to have been wrestling with different ways of conceptualizing (and researching) leadership in plural or multiple terms, with much of this work occurring in the sub-fields of leadership (such as school education, higher education and public health) rather than in the generic leadership field. On the basis of her findings, Chreim’s discussion queries the value of ‘distributed’ and instead she opts for the idea of leadership configurations. Some of the problems and possibilities of this alternative are discussed, along with suggestions about ways in which Chreim’s work might be extended to advance knowledge in the field, particularly in relation to the idea of group agency.
Sexual orientation discrimination in the United Kingdom’s labour market: A field experiment
Authors: Drydakis Nick
Published: April 2015

Deviations from heteronormativity affect labour market dynamics. Hierarchies of sexual orientation can result in job dismissals, wage discrimination and the failure to promote gay and lesbian individuals to top ranks. In this article, I report on a field experiment (144 job-seekers and their correspondence with 5549 firms) that tested the extent to which sexual orientation affects the labour market outcomes of gay and lesbian job-seekers in the United Kingdom. Their minority sexual orientations, as indicated by job-seekers’ participation in gay and lesbian university student unions, negatively affected their workplace prospects. The probability of gay or lesbian applicants receiving an invitation for an interview was 5.0 percent (5.1%) lower than that for heterosexual male or female applicants. In addition, gay men and lesbians received invitations for interviews by firms that paid salaries that were 1.9 percent (1.2%) lower than those paid by firms that invited heterosexual male or female applicants for interviews. In addition, in male- or female-dominated occupations, gay men and lesbians received fewer invitations for interviews than their non-gay and non-lesbian counterparts. Furthermore, gay men and lesbians also received fewer invitations to interview for positions in which masculine or feminine personality traits were highlighted in job applications and at firms that did not provide written equal opportunity standards, suggesting that the level of discrimination depends partly on the personality traits that employers seek and on organization-level hiring policies. I conclude that heteronormative discourse continues to reproduce and negatively affect the labour market prospects of gay men and lesbians.
Oral Infections, Metabolic Inflammation, Genetics, and Cardiometabolic Diseases
Authors: Janket S.-J. , Javaheri H. , Ackerson L.K. , Ayilavarapu S. , Meurman J.H.
Published: April 2015

Although several epidemiologic studies reported plausible and potentially causal associations between oral infections and cardiometabolic diseases (CMDs), controversy still lingers. This might be due to unrecognized confounding from metabolic inflammation and genetics, both of which alter the immune responses of the host. Low-grade inflammation termed metainflammation is the hallmark of obesity, insulin resistance, type 2 diabetes, and CMDs. According to the common soil theory, the continuum of obesity to CMDs is the same pathology at different time points, and early metainflammations, such as hyperglycemia and obesity, display many adverse cardiometabolic characteristics. Consequently, adipose tissue is now considered a dynamic endocrine organ that expresses many proinflammatory cytokines such as TNF- α, IL-6, plasminogen activator inhibitor 1, and IL-1 β. In metainflammation, IL-1 β and reactive oxygen species are generated, and IL-1 β is a pivotal molecule in the pathogenesis of CMDs. Note that the same cytokines expressed in metainflammation are also reported in oral infections. In metabolic inflammation and oral infections, the innate immune system is activated through pattern recognition receptors—which include transmembrane receptors such as toll-like receptors (TLRs), cytosolic receptors such as nucleotide-binding oligomerization domain–like receptors, and multiprotein complexes called inflammasome. In general, TLR-2s are presumed to recognize lipoteichoic acid of Gram-positive microbes—and TLR-4s, lipopolysaccharide of Gram-negative microbes—while nucleotide-binding oligomerization domain–like receptors detect both Gram-positive and Gram-negative peptidoglycans on the bacterial cell walls. However, a high-fat diet activates TLR-2s, and obesity activates TLR-4s and induces spontaneous increases in serum lipopolysaccharide levels (metabolic endotoxemia). Moreover, genetics controls lipid-related transcriptome and the differentiation of monocyte and macrophages. Additionally, genetics influences CMDs, and this creates a confounding relationship among oral infections, metainflammation, and genetics. Therefore, future studies must elucidate whether oral infections can increase the risk of CMDs independent of the aforementioned confounding factors.
Activity of order n in continuous systems
Authors: Castro Rodrigo , Kofman Ernesto
Published: April 2015

In this work we generalize the concept of activity of continuous time signals. We define the activity of order n of a signal and show that it allows us to estimate the number of sections of polynomials up to order n which are needed to represent that signal with a certain accuracy. Then we apply this concept to obtain a lower bound for the number of steps performed by quantization-based integration algorithms in the simulation of ordinary differential equations.

We perform an exhaustive analysis over two examples, computing the activity of order n and comparing it with the number of steps performed by different integration methods. This analysis corroborates the theoretical predictions and also allows us to measure the suitability of the different algorithms depending on how close to the theoretical lower bound they perform.
Elevated Psychopathy Scores Among Mixed Sexual Offenders
Authors: Brown Allison R. , Dargis Monika A. , Mattern Alexandra C. , Tsonis Michelle A. , Newman Joseph P.
Published: April 2015

Past research has revealed a relationship between sexual offending and psychopathy. Notably, offenders who sexually assault a minor as well as an adult (mixed offenders) score higher on the Psychopathy Checklist–Revised (PCL-R) than child sex offenders, rapists, and nonsex offenders. Moreover, both PCL-R Factor 1 (interpersonal-affective traits) and PCL-R Factor 2 (impulsive-antisocial traits) scores have been implicated in explaining these higher psychopathy scores. Using data from 2,514 male prisoners, focusing on a subset of 40 mixed offenders, we attempted to replicate and clarify these findings. As predicted, mixed offenders scored higher on PCL-R total and Factor 1 than other offender groups. Given this distinctive profile, greater understanding of the association between these psychopathic traits and mixed sexual offending may be crucial for evaluating and treating sex offenders as well as for reducing victimization.
Citizens’ Revolution and International Integration
Authors: Falconí Fander , Oleas-Montalvo Julio
Published: April 2015

Can a country with an open economy tending toward reprimarization achieve a form of integration into the global economy other than the one determined by Latin America’s historical dependency? Dependency has created trade and technological gaps, among them the one generated by the physical balance (exporting more than is imported). In Ecuador, the Citizens’ Revolution government is attempting to overcome these structural problems by rejecting free-trade agreements and foreign investment that could yield negative balances or threaten national sovereignty. Its new productive model is based on the development of basic industry, the selective replacement of imports, and an intelligent diversification of the exportable supply. The idea is to achieve a society based more on producing services, less dependent on the extraction of natural resources, and with greater generation capacity in science, technology, and innovation. Although the plan faces an adverse international order, it could benefit from the new moment of political and financial integration in Latin America.

¿Puede un país con una economía abierta y una tendencia a la reprimarización lograr una forma de integración en la economía mundial que no esté determinada por la dependencia histórica de Latinoamérica? La dependencia ha creado brechas en el comercio y la tecnología, incluyendo aquella generada por el equilibrio fiscal (exportando más de lo que se importa). En Ecuador, el gobierno de la Revolución Ciudadana intenta superar estos problemas estructurales al rechazar los acuerdos de libre comercio e inversión extranjera que podrían producir saldos negativos o amenazar la soberanía nacional. Su nuevo modelo productivo se basa en el desarrollo de la industria básica, la sustitución selectiva de importaciones, y una inteligente diversificación de la oferta exportable. La idea es lograr una sociedad que se base preponderantemente en la producción de servicios, dependa menos de la extracción de recursos naturales, y tenga mayor capacidad de generación en las áreas de ciencia, tecnología e innovación. Aunque el plan se enfrenta a un orden internacional adverso, podría beneficiarse del nuevo momento de integración política y económica en América Latina.
“You People Would Keep On Dwelling”
Authors: Udvarhelyi Éva Tessza
Published: April 2015

Large-scale housing poverty has remained mostly unsolved throughout Hungarian history. While social, economic and political forces have all contributed to the endurance of gaping social inequalities and a skewed distribution of social resources, at certain moments of history, the state took a more active role in addressing these pressing social issues. The Hungarian state’s changing cycles of (dis)engagement with social inequality, poverty and redistribution have led to alternating phases of investment and disinvestment into affordable housing. At the same time, housing for the very poor has never been high on the agenda of dominant political forces and solutions to homelessness have always been associated with temporary and second-class solutions. In this paper, I examine the Hungarian state’s relationship to housing and homelessness throughout the twentieth century. Paying particular attention to processes of dehousing, I also analyze the ideological and moral underpinnings of social, housing and criminal approaches to poverty and homelessness.
Gender Differences in Responses to Moral Dilemmas
Authors: Friesdorf Rebecca , Conway Paul , Gawronski Bertram
Published: April 2015

The principle of deontology states that the morality of an action depends on its consistency with moral norms; the principle of utilitarianism implies that the morality of an action depends on its consequences. Previous research suggests that deontological judgments are shaped by affective processes, whereas utilitarian judgments are guided by cognitive processes. The current research used process dissociation (PD) to independently assess deontological and utilitarian inclinations in women and men. A meta-analytic re-analysis of 40 studies with 6,100 participants indicated that men showed a stronger preference for utilitarian over deontological judgments than women when the two principles implied conflicting decisions ( d = 0.52). PD further revealed that women exhibited stronger deontological inclinations than men ( d = 0.57), while men exhibited only slightly stronger utilitarian inclinations than women ( d = 0.10). The findings suggest that gender differences in moral dilemma judgments are due to differences in affective responses to harm rather than cognitive evaluations of outcomes.
In Good Company
Authors: vanDellen Michelle R. , Shah James. Y. , Leander N. Pontus , Delose Julie E. , Bornstein Jerica X.
Published: April 2015

Effective self-regulation could involve not only managing internal resources for goal pursuit but also the often-fleeting interpersonal resources that can support goal attainment. In five studies, we test whether people who are effective self-regulators tend to position themselves in social environments that best afford self-regulatory success. Results indicated individual differences in self-regulatory effectiveness predict stronger preferences to spend time with, collaborate with, and be informed by others who were (a) high in self-control or self-regulation themselves or (b) instrumental to one’s goal pursuit. These preferences for supportive social environments appeared to be both targeted and strategic. Together, the findings suggest that effective self-regulation may involve positioning oneself in social environments that support goal pursuit and increase one’s chances of success.
Review and Synthesize Completed Research Through Systematic Review
Authors: Hopp Lisa , Rittenmeyer Leslie
Published: April 2015

The evidence-based health care movement has generated new opportunity for scholars to generate synthesized sources of evidence. Systematic reviews are rigorous forms of synthesized evidence that scholars can conduct if they have requisite skills, time, and access to excellent library resources. Systematic reviews play an important role in synthesizing what is known and unknown about a particular health issue. Thus, they have a synergistic relationship with primary research. They can both inform clinical decisions when the evidence is adequate and identify gaps in knowledge to inform research priorities. Systematic reviews can be conducted of quantitative and qualitative evidence to answer many types of questions. They all share characteristics of rigor that arise from a priori protocol development, transparency, exhaustive searching, dual independent reviewers who critically appraise studies using standardized tools, rigor in synthesis, and peer review at multiple stages in the conduct and reporting of the systematic review.
Predicting the EQ-5D-3L Preference Index from the SF-12 Health Survey in a National US Sample
Authors: Coca Perraillon Marcelo , Shih Ya-Chen Tina , Thisted Ronald A.
Published: April 2015

Background. When data on preferences are not available, analysts rely on condition-specific or generic measures of health status like the SF-12 for predicting or mapping preferences. Such prediction is challenging because of the characteristics of preference data, which are bounded, have multiple modes, and have a large proportion of observations clustered at values of 1. Methods. We developed a finite mixture model for cross-sectional data that maps the SF-12 to the EQ-5D-3L preference index. Our model characterizes the observed EQ-5D-3L index as a mixture of 3 distributions: a degenerate distribution with mass at values indicating perfect health and 2 censored (Tobit) normal distributions. Using estimation and validation samples derived from the Medical Expenditure Panel Survey 2000 dataset, we compared the prediction performance of these mixture models to that of 2 previously proposed methods: ordinary least squares regression (OLS) and two-part models. Results. Finite mixture models in which predictions are based on classification outperform two-part models and OLS regression based on mean absolute error, with substantial improvement for samples with fewer respondents in good health. The potential for misclassification is reflected on larger root mean square errors. Moreover, mixture models underperform around the center of the observed distribution. Conclusions. Finite mixtures offer a flexible modeling approach that can take into account idiosyncratic characteristics of the distribution of preferences. The use of mixture models allows researchers to obtain estimates of health utilities when only summary scores from the SF-12 and a limited number of demographic characteristics are available. Mixture models are particularly useful when the target sample does not have a large proportion of individuals in good health.
Computing Expected Value of Partial Sample Information from Probabilistic Sensitivity Analysis Using Linear Regression Metamodeling
Authors: Jalal Hawre , Goldhaber-Fiebert Jeremy D. , Kuntz Karen M.
Published: April 2015

Decision makers often desire both guidance on the most cost-effective interventions given current knowledge and also the value of collecting additional information to improve the decisions made (i.e., from value of information [VOI] analysis). Unfortunately, VOI analysis remains underused due to the conceptual, mathematical, and computational challenges of implementing Bayesian decision-theoretic approaches in models of sufficient complexity for real-world decision making. In this study, we propose a novel practical approach for conducting VOI analysis using a combination of probabilistic sensitivity analysis, linear regression metamodeling, and unit normal loss integral function—a parametric approach to VOI analysis. We adopt a linear approximation and leverage a fundamental assumption of VOI analysis, which requires that all sources of prior uncertainties be accurately specified. We provide examples of the approach and show that the assumptions we make do not induce substantial bias but greatly reduce the computational time needed to perform VOI analysis. Our approach avoids the need to analytically solve or approximate joint Bayesian updating, requires only one set of probabilistic sensitivity analysis simulations, and can be applied in models with correlated input parameters.
Mapping between 6 Multiattribute Utility Instruments
Authors: Chen Gang , Khan Munir A. , Iezzi Angelo , Ratcliffe Julie , Richardson Jeff
Published: April 2015

Background: Cost-utility analyses commonly employ a multiattribute utility (MAU) instrument to estimate the health state utilities, which are needed to calculate quality-adjusted life years. Different MAU instruments predict significantly different utilities, which makes comparison of results from different evaluation studies problematical. Aim: This article presents mapping functions (“crosswalks”) from 6 MAU instruments (EQ-5D-5L, SF-6D, Health Utilities Index 3 [HUI 3], 15D, Quality of Well-Being [QWB], and Assessment of Quality of Life 8D [AQoL-8D]) to each of the other 5 instruments in the study: a total of 30 mapping functions. Methods: Data were obtained from a multi-instrument comparison survey of the public and patients in 7 disease areas conducted in 6 countries (Australia, Canada, Germany, Norway, United Kingdom, and United States). The 8022 respondents were administered each of the 6 study instruments. Mapping equations between each instrument pair were estimated using 4 econometric techniques: ordinary least squares, generalized linear model, censored least absolute deviations, and, for the first time, a robust MM-estimator. Results: Goodness-of-fit indicators for each of the results are within the range of published studies. Transformations reduced discrepancies between predicted utilities. Incremental utilities, which determine the value of quality-related health benefits, are almost perfectly aligned at the sample means. Conclusion: Transformations presented here align the measurement scales of MAU instruments. Their use will increase confidence in the comparability of evaluation studies, which have employed different MAU instruments.
A Randomized Trial Examining Three Strategies for Supporting Health Insurance Decisions among the Uninsured
Authors: Politi Mary C. , Kaphingst Kimberly A. , Liu Jingxia (Esther) , Perkins Hannah , Furtado Karishma , Kreuter Matthew W. , Shacham Enbal , McBride Timothy
Published: April 2015

Background. The Affordable Care Act allows uninsured individuals to select health insurance from numerous private plans, a challenging decision-making process. This study examined the effectiveness of strategies to support health insurance decisions among the uninsured. Methods. Participants ( N = 343) from urban, suburban, and rural areas were randomized to 1 of 3 conditions: 1) a plain language table; 2) a visual condition where participants chose what information to view and in what order; and 3) a narrative condition. We administered measures assessing knowledge (true/false responses about key features of health insurance), confidence in choices (uncertainty subscale of the Decisional Conflict Scale), satisfaction (items from the Health Information National Trends Survey), preferences for insurance features (measured on a Likert scale from not at all important to very important), and plan choice. Results. Although we did not find significant differences in knowledge, confidence in choice, or satisfaction across condition, participants across conditions made value-consistent choices, selecting plans that aligned with their preferences for key insurance features. In addition, those with adequate health literacy skills as measured by the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) had higher knowledge overall ([Formula: see text] = 6.1 v. 4.8, P < 0.001) and preferred the plain language table to the visual ( P = 0.04) and visual to narrative ( P = 0.0002) conditions, while those with inadequate health literacy skills showed no preference for study condition. A similar pattern was seen for those with higher subjective numeracy skills and higher versus lower education with regard to health insurance knowledge. Individuals with higher income felt less confident in their choices ([Formula: see text] = 28.7 v. 10.0, where higher numbers indicate less confidence/more uncertainty; P = 0.004). Conclusions. Those developing materials about the health insurance marketplace to support health insurance decisions might consider starting with plain language tables, presenting health insurance terminology in context, and organizing information according to ways the uninsured might use and value insurance features. Individuals with limited health literacy and numeracy skills and those with lower education face unique challenges selecting health insurance and weighing tradeoffs between cost and coverage.
Diagnostic imaging of pancreatic neuroendocrine neoplasms (pNEN): tumor detection, staging, prognosis, and response to treatment
Authors: Baur Alexander DJ , Pavel Marianne , Prasad Vikas , Denecke Timm
Published: April 2015

Pancreatic neuroendocrine neoplasms (pNEN) are rare malignancies arising from neuroendocrine cells of the pancreas. Functional tumors can present with specific clinical syndromes due to hormonal secretion. These tumors can present as incidental findings on imaging performed for unrelated purposes or they are diagnosed when workup is initiated in patients with specific syndromes or metastases. This article presents an overview of available imaging techniques focusing on computed tomography and magnetic resonance imaging. Recommendations regarding examination protocols are given. Typical imaging features of pNEN and metastases are described. Their potential value for the evaluation of prognosis as well as tumor response under treatment is discussed.
A Pilot Study of Client Satisfaction: An Occupational Therapy Duty System in an Occupational Therapy Bureau
Authors: Dean Rachel
Published: April 2015

The duty system is the telephone referral system for the Kent Occupational Therapy Bureau service for members of the public and health professionals. The duty rota is staffed by occupational therapists and rehabilitation coordinators. This evaluation aimed to determine the quality and equity of the service in relation to client satisfaction.

Over a 2-week period, telephone interviews were conducted using a questionnaire. All members of the public who telephoned to make a referral and had had no prior contact with the bureau were eligible for the study.

The duty system was shown to provide a consistently high level of service in all areas evaluated. However, those interviewed expressed dissatisfaction with the predicted time of wait for an assessment visit and the lack of accurate information regarding this wait.

This pilot study demonstrates that an occupational therapist may not be needed to fulfil the role of duty officer. A trained duty officer with an occupational therapist available for consultation can provide the service, thereby freeing occupational therapists to undertake assessments and reduce waiting lists. More accurate information and regular contact from the bureau regarding the waiting time for an assessment is required to reduce dissatisfaction.
Innovation in Fieldwork Education: Working with Members of the Homeless Population in Glasgow
Authors: Totten Catherine , Pratt Joanne
Published: April 2015

Occupational therapists are increasingly likely to come into contact with clients who have special needs associated with homelessness through acute or community care services. Given the degree of role loss often linked with homelessness, it could also be argued that occupational therapy has a part to play in the development and maintenance of the functional status of the members of this population. Statutory or voluntary sector day shelters might offer a new point of contact for service delivery with homeless people, representing nontraditional sites for occupational therapy services.

The models of fieldwork supervision adopted by the College of Occupational Therapists could allow students to experience new forms of service delivery as undergraduates in novel practice settings. This opportunity could serve an adaptive function as health and social care services meet the demands of the changing political and social environment. This paper describes the perceptions of a student who undertook an elective placement in a day centre for homeless men in Glasgow.

Conclusion

In terms of educational development, this model of placement has since been incorporated into the curriculum at Glasgow Caledonian University. On revalidation of the BSc(Hons)OT degree in 1995, there was a decrease in the number of fieldwork hours in the curriculum structure, from 1200 to 1080 hours, and the elective placement was removed. The programme philosophy, however, embraced the learning opportunities provided by placements, such as the one described in this paper. As such, all second-year students have since been required to undertake a placement in the non-statutory, social care sector. In particular, these placements are seen to offer students a chance to develop a deeper understanding of social care needs and issues, and a chance to explore the occupational therapy process in nontraditional settings and thus to think more widely. In addition, they offer an opportunity for students to take much more responsibility for their learning, within a model of supervision where they get professional input, direction and support while developing their own sense of professional identity and autonomy.
A Review of the Use of Self-Report Assessment with Young Children
Authors: Sturgess Jennifer , Rodger Sylvia , Ozanne Anne
Published: April 2015

In recent years, there has been an increase in the development of self-report assessments for children, for both clinical and research use. This increase is compatible with the increase in the use of client-centred practice and other frames of reference that give clients – including children – a greater voice in their therapy. Occupation, the focus of therapy, is best understood from the perspective of the child engaged in it (Primeau and Ferguson 1999).

There is mounting evidence that the views of children are different from, but as valid as, those of their parents (Sturgess and Ziviani 1996, Bouman et al 1999). The purpose of this paper is to provide a contemporary analysis of self-report assessment for children. An extensive review of the self-report literature found a clear rationale for its use and also evidence about the features of effective self-report tools. The results of this literature review and a critique of some self-report assessments available for young children are included in this paper.
Modernising Fieldwork, Part 1: Realising the Potential
Authors: Fisher Angela , Savin-Baden Maggi
Published: April 2015

Fieldwork education has received much attention recently. Many authors have referred to a shortage of placements and highlighted the need to embrace alternative methods of placement provision. This article describes the results of a project that investigated the existing and potential placement capacity for occupational therapy students and the challenges faced by occupational therapists in health and social care. The Coventry and Warwickshire Workforce Development Confederation commissioned this project on behalf of the West Midlands Region, which was where the study was undertaken.

Part 1 presents the first three themes that emerged: placement capacity and barriers to provision; creative solutions; and modernising fieldwork education. Part 2 will present and discuss two further themes: issues of context and current and future models of fieldwork education. Overall, the findings indicate that placement capacity is not being realised and that barriers to placement provision are largely organisational in nature. It is argued here that fieldwork education needs to be seen as a key component of continuing professional development and central to the modernisation agenda, not as an added extra.
Older People and Participation within Disabled Facilities Grant Processes
Authors: Awang Darren
Published: April 2015

As the numbers of older people increase, adapted home environments have become an essential requirement to support independent living. This article presents a qualitative study examining the perceptions of older people using Disabled Facilities Grants to acquire home adaptations.

Using a participatory action research approach and within-method triangulation, the participatory processes of two local authorities and a Care & Repair agency were explored. Data collection included semi-structured interviews with nine service users and seven key adaptation agency workers, in addition to the examination of agency documentation. The data were manually categorised and analysed, using both within-case and cross-case analysis.

The findings demonstrated that the publicity of grants was poor. Service users' experiences varied depending on the levels of support that were available. In addition to paper-based feedback methods, examples of organisational participative mechanisms included a disability forum and a service user group. There was no specific mechanism adopted primarily for older people but, significantly, the older service users welcomed opportunities to express their views. Overall, the participatory levels were low, with emphasis on sensitising services to users' needs (agency controlled) rather than on moves towards greater democratic involvement (user controlled). Further work is required to encourage older people's participation in shaping and controlling service delivery thereby improving the quality of practice in this area.
Pro-Motion: A Positive Way Forward for Clients with Severe and Enduring Mental Health Problems Living in the Community, Part 1
Authors: Heather Frances
Published: April 2015

This is the first part of a two-part article describing a clinical therapeutic intervention planned and organised by a senior occupational therapist and mental health nursing staff for clients with diagnoses of severe and enduring mental health problems. The six participants had a diagnosis of schizophrenia or schizoaffective disorder or bipolar illness. Four were receiving the atypical antipsychotic medication, Clozapine. One was receiving Olanzapine, also atypical, and the last was receiving traditional antipsychotic medication. These clients were all receiving long-term support from the mental health rehabilitation unit. Participation was voluntary and each client gave written consent to participation and publication later.

The aims and objectives of the initial group, the selection criteria and the content and process of the group over a period of 6 weeks are described. The subsequent group, also held for 6 weeks, will be described in part 2, together with a brief overview of the further groups that have taken place since. The evaluation methods of the first group were the Beck Anxiety Inventory (BAI) and the State-Trait Anxiety Inventory (STAI) together with verbal and written evaluation. The BAI and the STAI were not repeated in the second group and the rationale for this is explained.

The perceived benefits to clients are illustrated with two brief case vignettes. The benefits to other clients are also mentioned, together with the perceived drawbacks. The article concludes with the plans for the second group.
The Legacy of Violent Attack: An Exploratory Study of Occupational Therapy Students' Experiences of Violent Attack
Authors: Whitehead Alison
Published: April 2015

This study aimed to develop an understanding of occupational therapy students' experiences of violent attack by a client. A qualitative approach was chosen, which involved semi-structured interviews with three students and an analysis of the researcher's experience of violent attack.

A wide variety of reactions to violent attack by a client was reported, including fear, anger, concern for others, minimisation and thoughts about changing career. The explanations for these reactions are reported and discussed. The participants reported changes in their therapeutic relationships with clients. The findings also suggested that there might be some occupational therapy personnel who feel that violence is ‘part of the job’.

Three key issues are discussed: the nature of the reactions to violent attack, the perceptions of role and the therapeutic relationship with the client. It is suggested that these findings have important implications for the education and training and the support of occupational therapy students. Recommendations are made regarding the need for further research to inform the way forward in training and supporting those experiencing violence in clinical practice settings.
Struggling for Occupational Satisfaction: Older People in Care Homes
Authors: Atwal Anita , Owen Sharon , Davies Richard
Published: April 2015

In the United Kingdom, a wide range of health care reforms has been introduced to enhance the wellbeing of older people. These reforms should ensure that both the public and the private sectors deliver best practice to older people. The role of the occupational therapist with older people is well established in a variety of health and social care settings but there is a noticeable absence of input in care homes, despite evidence that has demonstrated the importance of occupations for wellbeing.

The Canadian Occupational Performance Measure (COPM) was used in a research study to determine the types of occupation that seven older people perceived as important, their perceptions of their performance and their perceived level of satisfaction. It was found that these older people most valued leisure and self-care occupations, although occupations related to productivity were also cited. A perceived high performance rating often transferred to a high satisfaction rating and a perceived low performance rating to a low satisfaction rating.

The challenge for occupational therapists is to implement occupation-based therapy that meets all the needs of older people. Furthermore, there is a requirement to develop the evidence base and to look at strategies to promote occupation in order to ensure occupational satisfaction for all.
The Development and Evaluation of the Mayers' Lifestyle Questionnaire (2)
Authors: Mayers Christine A
Published: April 2015

The Mayers' Lifestyle Questionnaire (2) is a client-centred tool which enables people with enduring mental health problems to identify and prioritise issues affecting their quality of life. It was developed following requests from occupational therapists working in community mental health teams. This article briefly describes how the tool was developed and then describes the main study used to evaluate the Mayers' Lifestyle Questionnaire (2). Eighty-three occupational therapists from around the United Kingdom offered to take part in the study. The results are from data returned by 33 occupational therapists and 75 clients.

The occupational therapists and the clients were positive overall in their comments. Three occupational therapists in the study worked with people with brain injury rather than with clients with enduring mental health problems and, having seen and used the tool, they stated that it would prove suitable for some of their clients. The evaluation has led to minor changes being made to the Mayers' Lifestyle Questionnaire (2).
To PhD or Not to PhD: The Question is, Where Do We Work?
Authors: Henderson Sarah Elizabeth , MacIver Donald
Published: April 2015

Research, by informing evidence-based practice, should be the foundation for occupational therapy. Research requires skilled and trained individuals to carry it out effectively. In this piece, two postregistration occupational therapists, currently undertaking PhDs, discuss the limited opportunities available to use their research skills to develop occupational therapy. They explore the barriers that exist for PhD-level basic grade clinicians and, by highlighting the variety of skills that they offer to the workplace, show the benefits of employing research-competent individuals.
An Audit of Referrals to Occupational Therapy for Older Adults attending an Accident and Emergency Department
Authors: Smith Tony , Rees Val
Published: April 2015

The greater number of older people in communities is reflected in their increasing demands on the services of accident and emergency (A&E) departments. Recognition of the complex needs of older adults attending A&E departments has resulted in many National Health Service trusts employing occupational therapists in these departments. The occupational therapists are required to assess and evaluate a patient's functional status and, using a team approach, to make decisions about his or her wider needs, including therapeutic requirements and social provision.

In order to audit the provision of the occupational therapy service in an A&E department, data were collected monthly over a 3-year period in a single district general hospital on the referrals made by medical and nursing staff. The mean age of the patients referred was 80 years. The majority of the patients were female and living alone. The most common presenting problem was that of a fall, with a resulting fracture in half of the patients. The occupational therapy input in the A&E department was demonstrated in this study to save admissions to acute hospital care, amounting to an equivalent of two beds saved in each of the years covered by the audit.
Exploring the Evidence for Occupational Therapists' Interventions with Clients with Lateral Epicondylitis
Authors: Hong Quan Nha , Durand Marie-José , Loisel Patrick
Published: April 2015

Lateral epicondylitis is known to be a major problem in work absenteeism and permanent partial disability. Although occupational therapists are often asked to treat clients with this disorder, its management remains controversial since there is insufficient research evidence to favour any particular intervention. This study gathered information on the current interventions used by occupational therapists with clients with lateral epicondylitis according to three phases: acute, subacute and chronic. A self-administered questionnaire was sent to a convenience sample of 219 occupational therapists working in the province of Québec in Canada.

After two reminders, a participation rate of 81% was obtained. Over 20 interventions were identified and sorted into five categories: education, activities/exercises, assistive devices, environment and pain management modalities. Overall, education about risk factors was the most frequently used intervention by occupational therapists in all phases. Activities/exercises formed the second most frequently used intervention group, but were more preferred in the subacute and chronic phases.

Although many interventions are currently used in health care facilities, few studies on their effectiveness have been conducted. This study explored the gap between research and practice by surveying clinicians on their management of clients with lateral epicondylitis, allowing the targeting of areas considered useful for future studies in occupational therapy.
Does Age at Entry have an Impact on Academic Performance in Occupational Therapy Education?
Authors: Shanahan Margaret M
Published: April 2015

This article presents a research study that investigated age as a predictor of higher academic outcome in a sample of 425 recent honours graduates from 8 out of 19 (42%) occupational therapy schools in England and Wales.

The initial analysis of the data showed that age was related to academic performance, but this relationship was much weaker when the qualifications used to gain entry to occupational therapy education were added to the statistical analysis. The data were strongly influenced by the superior academic performance of the students who had a previous degree on entry to occupational therapy education. When these degree-level entrants were removed from the age analysis, the academic performance of the remaining mature students did not differ significantly from that of the younger students, thus removing the effect of age that was initially seen in the data.

This result indicates that entry qualifications, in particular a previous degree, have a positive predictive effect on the academic performance of students in occupational therapy education. This finding has implications for those planning new occupational therapy programmes and for admissions tutors in existing programmes.
Is Meeting Spiritual Need within the Occupational Therapy Domain?
Authors: Hoyland Marion , Mayers Christine
Published: April 2015

The profession's present interest in the topic of spirituality initiated the decision to undertake this study, which aimed to investigate the extent to which occupational therapists consider clients' spiritual needs as part of their domain. The objectives of the study were to ascertain whether this was part of the occupational therapist's role and to identify the ways in which occupational therapists addressed the spiritual needs of their clients.

Six senior II occupational therapists participated in semi-structured interviews. The participants felt that all individuals have spiritual needs, although not all would recognise or acknowledge them as such. All the participants considered spiritual care to be part of their role, but there was some uncertainty regarding the relationship of spiritual care to occupational therapy in general. Spiritual needs were addressed by a listening and holistic approach.
An Evaluation of the Clinical Use of the Assessment of Motor and Process Skills with Children
Authors: Payne Sally , Howell Claire
Published: April 2015

This article reports on the use of the Assessment of Motor and Process Skills (AMPS) within a community paediatric occupational therapy service. The AMPS is a widely used observational assessment of functional ability for people from 3 years of age. There is extensive evidence of its validity and reliability, but there has been little published on its clinical use with children. This article describes the application of the AMPS as the first part of an audit in a service to children over a period of 15 months. The clinical utility of the AMPS is discussed.