Infant gaze averting during social interaction : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in psychology at Massey University

The general aim of the present research was to investigate infant gaze averting during social interaction. Two preliminary hypotheses were examined : first, that infant gaze averting would occur spontaneously during social interaction, and second that any gaze averting would increase alongside developmental progress. A short-term (nine week) longitudinal case-study approach with home visits was planned. Conducting the research in the participants' homes was novel for this area of study. Prior studies had all been conducted in a laboratory setting. Six mother-infant dyads agreed to participate. The primiparous mothers were all full-time caregivers with an age range of 21-26 years. The healthy, full-term infants were all aged approximately three months at commencement. There were three of each gender. Visits to each pair occurred every nine/ten days. The following three sources of data collection were implemented: interview, observation and daily diary recording by the mother. Target behaviours noted were: episodes of active gaze averting and new developmental milestones (according to a developmental checklist formulated for the present study). Other relevant qualitative information was also gathered at each visit. Although basically a qualitative study, quantitative data was incorporated in the form of graphs of each infant's gaze averting frequency and developmental progress. The main findings here were: infant gaze averting did occur during interaction with mother and other caregivers for all six cases; the prediction that there is a relationship between gaze averting and developmental progress was not supported. Descriptive data provided an interesting and unexpected outcome. This was the discovery of three separate styles of gaze averting. These were described, their various criteria identified, and a classification system developed. The results of the present study have important practical implications. They present a challenge to one current theory of psychopathology which maintains that gaze averting is abnormal and may be a precursor of autism. This has ramifications for the present diagnosic system and treatment of some childhood psychopathologies. The findings of the present study indicate that a re-think of perspectives regarding gaze averting (of all styles) may be required

Parental Concerns about the Health of Adolescents with Intellectual Disability: A Brief Report

Background. Parents of adolescents with intellectual disability are concerned about the future health and well-being needs of their children. Method. Qualitative data was collected as part of a cross-sectional descriptive study and semi-structured interviews were conducted with 32 parents. The results were themed. Results. Most parents discussed areas of their children's health which made them anxious about the future. These concerns were collated into five themes. Conclusion. The health and well-being themes were dependency, general health, challenging behaviours, and increasing support needs

Hendra Virus and Horse Owners – Risk Perception and Management

Hendra virus is a highly pathogenic novel paramyxovirus causing sporadic fatal infection in horses and humans in Australia. Species of fruit-bats (genus Pteropus), commonly known as flying-foxes, are the natural host of the virus. We undertook a survey of horse owners in the states of Queensland and New South Wales, Australia to assess the level of adoption of recommended risk management strategies and to identify impediments to adoption. Survey questionnaires were completed by 1431 respondents from the target states, and from a spectrum of industry sectors. Hendra virus knowledge varied with sector, but was generally limited, with only 13% of respondents rating their level of knowledge as high or very high. The majority of respondents (63%) had seen their state’s Hendra virus information for horse owners, and a similar proportion found the information useful. Fifty-six percent of respondents thought it moderately, very or extremely likely that a Hendra virus case could occur in their area, yet only 37% said they would consider Hendra virus if their horse was sick. Only 13% of respondents stabled their horses overnight, although another 24% said it would be easy or very easy to do so, but hadn’t done so. Only 13% and 15% of respondents respectively had horse feed bins and water points under solid cover. Responses varied significantly with state, likely reflecting different Hendra virus history. The survey identified inconsistent awareness and/or adoption of available knowledge, confusion in relation to Hendra virus risk perception, with both over-and under-estimation of true risk, and lag in the uptake of recommended risk minimisation strategies, even when these were readily implementable. However, we also identified frustration and potential alienation by horse owners who found the recommended strategies impractical, onerous and prohibitively expensive. The insights gained from this survey have broader application to other complex risk-management scenarios

Ask For It: Development of a Health Advocacy Intervention for Adults with Intellectual Disability and Their General Practitioners

Two per cent of people in Australia have intellectual disability and the adults in this population often have poor health status. This poor health can be partly attributed to communication difficulties encountered by people with intellectual disability and also health professionals in consultation settings. The design and development processes of an educational intervention to improve communication between patients, general practitioners (GPs) and also advocates in a population of adults with intellectual disability are described. The design process was collaborative and involved adults with intellectual disability, GPs, parents, support workers and other professionals. It was a nine-step development process and led to the final communication tool package, the ask (advocacy skills kit) 5-year health diary and educational session. As a result of the collaborative design and development processes, this diary included qualities not found in most other medical record keeping systems: visual appeal, advice on how to be a health advocate, utility for a range of users, privacy, portability and sufficient capacity to record personal patient information which enhanced communication between doctor, patient and advocate. It is proving to be very popular. Clear implications were found for applying established criteria and incorporating the needs of users in the design of educational interventions in the intellectually disabled population. Health promotion tools aiming to improve the current poor health status of adults with intellectual disability should be developed further

Collaboration between Librarians and Learning Technologists to enhance the learning of health sciences students.

Collaboration between Librarians and Learning Technologists at Bournemouth University (BU) has been stimulated and cemented by Pathfinder funding from the Higher Education Academy. This paper will consider four case studies collected as part of the eRes Project that describe the use of Web 2.0 technologies in the School of Health and Social Care at BU. The project aimed to enhance the student learning experience in an increasingly electronic environment. This was achieved by developing and disseminating innovative pedagogical frameworks, bringing together learning activities and academically led quality e-resources within the unit of study. An e-reading strategy which encompasses models for resource discovery and e-literacy was developed, drawing on the experiences and findings of the case studies. Issues considered in this paper will include accessing academic electronic reading materials and using a social bookmarking tool integrated within BU’s virtual learning environment with students studying away from the main campus. Additionally the paper will consider how technology can be used to motivate students, especially in large groups and how it can be used to engage students with a subject perceived as “dry” or “difficult”. The rich possibilities of health science materials can be exploited more fully using new technologies embedded within the curriculum

Serum prolactin monitoring in patients on risperidone admitted to the acute wards at Mount Carmel hospital

First-generation antipsychotics have been shown to increase prolactin levels in the body. Atypical antipsychotics have a lower tendency to produce hyperprolactinaemia due to a weaker and transient dopamine antagonistic effect. Despite being an atypical antipsychotic, Risperidone, tends to cause a higher increase in prolactin due to a stronger and more prolonged blockade on dopamine receptors. The purpose of this audit is to assess current practices at Mount Carmel Hospital (MCH) with regards to serum prolactin monitoring in patients taking Risperidone when compared to Maudsley Prescribing Guidelines in Psychiatry, 14th Edition (2021). The audit was based on patients acutely admitted between June and December 2021. Focus was placed on prolactin levels checked during admission in patients previously on Risperidone, prolactin levels checked in the preceding six months if no prolactin level was checked during admission and the appropriate action taken in cases where the serum Prolactin was noted to be high. From this audit it was concluded that there is inadequate monitoring of serum prolactin levels in patients prescribed Risperidone at MCH. Increased awareness of Risperidoneinduced hyperprolactinemia and associated guidelines are required to improve clinical practice. The recommendations suggested from this audit were to increase awareness of serum prolactin monitoring guidelines amongst all medical and nursing staff at MCH and to create a simple flow-chart outlining the appropriate serum prolactin monitoring guidelines and distribute this to MCH wards.peer-reviewe

Effectiveness of moving on: an Australian designed generic self-management program for people with a chronic illness

Background: This paper presents the evaluation of “Moving On”, a generic self-management program for people with a chronic illness developed by Arthritis NSW. The program aims to help participants identify their need for behavior change and acquire the knowledge and skills to implement changes that promote their health and quality of life. Method: A prospective pragmatic randomised controlled trial involving two group programs in community settings: the intervention program (Moving On) and a control program (light physical activity). Participants were recruited by primary health care providers across the north-west region of metropolitan Sydney, Australia between June 2009 and October 2010. Patient outcomes were self-reported via pre- and post-program surveys completed at the time of enrolment and sixteen weeks after program commencement. Primary outcomes were change in self-efficacy (Self-efficacy for Managing Chronic Disease 6-Item Scale), self-management knowledge and behaviour and perceived health status (Self-Rated Health Scale and the Health Distress Scale). Results: A total of 388 patient referrals were received, of whom 250 (64.4%) enrolled in the study. Three patients withdrew prior to allocation. 25 block randomisations were performed by a statistician external to the research team: 123 patients were allocated to the intervention program and 124 were allocated to the control program. 97 (78.9%) of the intervention participants commenced their program. The overall attrition rate of 40.5% included withdrawals from the study and both programs. 24.4% of participants withdrew from the intervention program but not the study and 22.6% withdrew from the control program but not the study. A total of 62 patients completed the intervention program and follow-up evaluation survey and 77 patients completed the control program and follow- up evaluation survey. At 16 weeks follow-up there was no significant difference between intervention and control groups in self-efficacy; however, there was an increase in self-efficacy from baseline to follow-up for the intervention participants (t=−1.948, p=0.028). There were no significant differences in self-rated health or health distress scores between groups at follow-up, with both groups reporting a significant decrease in health distress scores. There was no significant difference between or within groups in self-management knowledge and stage of change of behaviours at follow-up. Intervention group attenders had significantly higher physical activity (t=−4.053, p=0.000) and nutrition scores (t=2.315, p= 0.01) at follow-up; however, these did not remain significant after adjustment for covariates. At follow-up, significantly more participants in the control group (20.8%) indicated that they did not have a self-management plan compared to those in the intervention group (8.8%) (X2=4.671, p=0.031). There were no significant changes in other self-management knowledge areas and behaviours after adjusting for covariates at follow-up. Conclusions: The study produced mixed findings. Differences between groups as allocated were diluted by the high proportion of patients not completing the program. Further monitoring and evaluation are needed of the impact and cost effectiveness of the program. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN1260900029821

Molar incisor hypomineralisation: Teaching and assessment across the undergraduate dental curricula in the UK.

No consensus exists on how molar incisor hypomineralisation (MIH) should be covered by the undergraduate dental curricula. To assess the current teaching and assessment of MIH in the UK. A piloted questionnaire regarding the teaching and assessment of MIH was disseminated to paediatric, restorative and orthodontic teaching leads in each UK dental school (n = 16). Data were analysed using descriptive statistics, chi-squared and Kruskal-Wallis tests. Response rates from paediatric, restorative and orthodontic teams were 75% (n = 12), 44% (n = 7) and 54% (n = 8), respectively. Prevention of caries, preformed metal crowns, anterior resin composites and vital bleaching were taught significantly more by paediatric teams (p = .006). Quality of life and resin infiltration were absent from restorative teaching. Orthodontic teaching focussed on the timing of first permanent molar extractions. Paediatric teams were mainly responsible for assessment. Risk factors, differential diagnoses for MIH and defining clinical features were more likely to be assessed by paediatric teams than by others (p = .006). All specialities reported that students were prepared to manage MIH. Molar incisor hypomineralisation is primarily taught and assessed by paediatric teams. No evidence of multidisciplinary or transitional teaching/assessment existed between specialities. Developing robust guidance regarding MIH learning in the UK undergraduate curricula may help improve consistency

Best Practices for Virtual Care: A Consensus Statement From the Canadian Rheumatology Association

Objective. To develop best practice statements for the provision of virtual care in adult and pediatric rheumatology for the Canadian Rheumatology Association\u27s (CRA) Telehealth Working Group (TWG). Methods. Four members of the TWG representing adult, pediatric, university-based, and community rheumatology practices defined the scope of the project. A rapid literature review of existing systematic reviews, policy documents, and published literature and abstracts on the topic was conducted between April and May 2021. The review informed a candidate set of 7 statements and a supporting document. The statements were submitted to a 3-round (R) modified Delphi process with 22 panelists recruited through the CRA and patient advocacy organizations. Panelists rated the importance and feasibility of the statements on a Likert scale of 1-9. Statements with final median ratings between 7-9 with no disagreement were retained in the final set. Results. Twenty-one (95%) panelists participated in R1, 15 (71%) in R2, and 18 (82%) in R3. All but 1 statement met inclusion criteria during R1. Revisions were made to 5/7 statements following R2 and an additional statement was added. All statements met inclusion criteria following R3. The statements addressed the following themes in the provision of virtual care: adherence to existing standards and regulations, appropriateness, consent, physical examination, patient-reported outcomes, use in addition to in-person visits, and complex comanagement of disease. Conclusion. The best practice statements represent a starting point for advancing virtual care in rheumatology. Future educational efforts to help implement these best practices and research to address identified knowledge gaps are planned