The sport Injury Rehabilitation Adherence Scale : a reliable scale for use in clinical physiotherapy

Objective
To evaluate, through two studies, the factor structure, inter-rater agreement, and test–retest and inter-rater reliability of the Sport Injury Rehabilitation Adherence Scale (SIRAS).

Design
Repeated measures design in both Study 1 (video evaluation) and Study 2 (clinical evaluation).

Setting
University department (Study 1) and outpatient physiotherapy department (Study 2).

Participants
Sixty physiotherapists and physiotherapy students in Study 1 and 45 patients undergoing physiotherapy treatment for a musculoskeletal injury in Study 2.

Intervention
In Study 1, participants rated the adherence of a simulated videotaped patient demonstrating high, moderate and low adherence during rehabilitation. In Study 2, two physiotherapists rated the adherence of patients at two consecutive rehabilitation sessions.

Main outcome measure
The SIRAS.

Results
In Study 1, principal components analysis confirmed a single factor for the SIRAS, and inter-rater agreement values ranged from 0.87 to 0.93. In Study 2, inter-rater and test–retest reliability coefficients ranged from 0.76 [95% confidence interval (CI) 0.54 to 0.83] to 0.89 (95% CI 0.79 to 0.95), and from 0.63 (95% CI 0.36–0.82) to 0.76 (95% CI 0.55–0.88), respectively.

Conclusion
The SIRAS is a reliable measure with high inter-rater agreement when used to evaluate clinic-based adherence to physiotherapy rehabilitation for musculoskeletal injury.

The utility of a workplace injury instrument in prediction of workplace injury

Workplace injuries are common and destructive to persons, organisations, and society. Various instruments presently exist that are designed to assess the factors underlying workplace injury. The study reports on the construct and predictive validity of a 46-item instrument, the safety perception survey (SPS), currently used to assess safety climate in industrial organisations throughout Australia. Initially, factor analysis was conducted on the data from a sample of 1238 employees from nine organisations, which indicated a one-factor solution, was the best fit. A structural equation model (SEM) linking injury rates to the safety climate measure for 16 sub-groups of six industrial organisations indicated that the measure contributed just 23% of the variance in injury rates. Interestingly, the results indicated that the number of employees was a better and more significant predictor of injury (R² = 0.48). It is proposed that the SPS as is would need to be modified significantly from its current form to produce improvements in validity, as in its current form the survey is no more predictive of injury than organisational size. Future research into safety climate measures should incorporate predictive validity analysis on injury rates, as for many organisations; this is a performance outcome measure.

Emotional intelligence and teacher self efficacy : the contribution of teacher status and length of experience

Practicing teachers and principals in selected Government schools in Victoria provided data on their levels of emotional intelligence and teacher efficacy beliefs. The data supported the theoretical expectation of a linkage between emotional intelligence and teacher self efficacy. Regression analyses showed that neither gender nor age moderated this relationship. However length of teaching experience and current status add significant direct effects on predicting teacher self efficacy but did not moderate the relationship between emotional intelligence and teacher self efficacy. These findings are significant as this now demonstrates a relationship between levels of emotional intelligence in teachers, their self efficacy beliefs and teacher effectiveness.

Dealing constructively with negatively evaluated emotional situations: the key to understanding the different reactions of teachers with high and low levels of emotional intelligence

Recent work on the distinctive features of emotions appraised as either negative or positive has links to the investigation of differences in levels of emotional intelligence. In a study with experienced teachers as participants, it was found that emotional reactions to positive or negative situations was moderated by level of emotional intelligence. The reactions to positively charged emotional situations involving students and peers were similar for teachers with high and low levels of emotional intelligence, although the low level group showed somewhat lower likelihood of making an “emotionally intelligent” response compared to the high level group. A much sharper contrast in response likelihood was found for negatively charged emotional situations involving students and peers. Teachers with high levels of emotional intelligence responded quite differently to those with low levels of emotional intelligence. The results indicate the prospect of clarifying a neglected area of exploration of differences in the likely behaviour of teachers differing in levels of emotional intelligence.

Emotional reactions following exposure to idealized bodies predict unhealthy body change attitudes and behaviors in women and men

Objective: We explored the extent to which changes in emotional states following exposure to images of idealized bodies predict unhealthy body change attitudes and behaviors in women and men, and whether particular psychological traits mediate these effects. Method: One hundred thirty-three women and 93 men were assessed for unhealthy attitudes and behaviors related to body weight and muscles using the Eating Disorder Inventory-2 (EDI-2), the Obligatory Exercise Questionnaire, and the strategies to increase muscles subscale of the Body Change Inventory. Psychological traits assessed included body dissatisfaction (EDI-2), internalization of the thin/athletic ideal (Sociocultural Attitudes Towards Appearance Questionnaire-3), body comparison (Body Comparison Scale), self-esteem (Rosenberg Self-Esteem Inventory), depression (Beck Depression Inventory-II), and identity confusion (Self-Concept Clarity Scale). Participants were then exposed to photographs of thin female models and muscular male models, and visual analogue scales were used to measure changes in postexposure state body dissatisfaction, anger, anxiety, and depression.
Results: Postexposure increases in state anger, anxiety, depression, and body dissatisfaction correlated with drive for thinness and disordered eating symptomatology in women, while postexposure increases in state body dissatisfaction correlated with muscle development in men. Analyses revealed that internalization and body comparison mediated these relationships, with trait body dissatisfaction, trait depression, self-esteem, and self-concept/identity confusion serving as mediators for women only. Conclusion: These results are indicative of gender differences in: (a) reactions to idealized bodies; (b) psychological traits that predispose individuals to experience these reactions; and (c) types of body change behavior that are associated with these reactions.

Emotional toil: psychosocial care in rural settings for patients with cancer

Aim. This paper is a report of a study to identify experienced rural nurses' perceptions of key issues related to the provision of effective psychosocial care for people with cancer in rural settings.

Background. A cancer diagnosis has a major impact on psychological and emotional wellbeing, and psychosocial support provided by nurses is an integral part of ensuring that people with cancer have positive outcomes. Although, ideally, people with cancer should be managed in specialist settings, significant numbers are cared for in rural areas.

Methods. Using a qualitative descriptive approach, three focus groups were conducted in 2005 with 19 nurses in three hospitals in rural Victoria, Australia.

Findings. Participants indicated that a key issue in providing psychosocial care to patients with cancer in the rural setting was their own 'emotional toil'. This Global Theme encapsulated three Organizing Themes– task vs. care, dual relationships and supportive networks – reflective of the unique nature of the rural environment. Nurses in rural Australia are multi-skilled generalists and they provide care to patients with cancer without necessarily having specialist knowledge or skill. The fatigue and emotional exhaustion that the nurses described often has a major impact on their own well-being.

Conclusion. In the rural context, it is proposed that clinical supervision may be an important strategy to support clinicians who face emotional exhaustion as part of their cancer nursing role.

Emotional growth: helping children and families 'bounce back'

Background: Depression is becoming increasingly prevalent in young people and is occurring earlier. General practitioners are prescribing antidepressants more frequently for this group, yet they are usually not the answer to the problem. Objective: This article examines the increase in prevalence rates of childhood and adolescent depression. We draw on recent research into resilience and positive psychology to suggest guidelines for the GP in helping young people and their parents develop better coping skills in the short term, and greater resilience in the long term. Discussion: Resilience is the ability to bounce back after encountering difficulties, negative events, hard times or adversity and to be able to return to the original level of emotional wellbeing. It is the capacity to maintain a healthy and fulfilling life despite adversity. Young people who have the skills to be resilient have a lower likelihood of becoming depressed or suicidal and a higher likelihood of maintaining emotional wellbeing. Self efficacy, optimistic and helpful thinking, and maintaining a success orientation are all important skills in being resilient.

Promoting the social and emotional health of primary school-aged children: reviewing the evidence base for school-based interventions

Schools are key settings for promoting the social and emotional health and well-being of children. This study investigated the effectiveness of interventions to improve the social and emotional well-being of primary school-aged children. The protocol development stage of the proposed systematic review identified related and comparable research reviews, indicating a more useful review of reviews. Eight reviews of intervention effectiveness covering 322 primary studies were reviewed. The majority examined classroom-based interventions. Greater effectiveness results from a sustained focus on the promotion of mental health, on self-esteem and coping outcomes within the broad school climate, and on replicating positive impacts rather than the prevention of mental health problems. Conclusions are limited by short duration of studies, lack of detail of interventions, identified outcomes and socio-demographic data, and the relationship between processes and outcomes. This study has clearly shown how crucial carefully designed studies are in understanding strategies with potential to impact on the mental health and well-being of children.

Injury profiles of Indigenous and non-Indigenous people in New South Wales

Objectives:
To compare the injury profiles of the Indigenous population in New South Wales with that of the non-Indigenous population.
Design and setting:
Descriptive analysis of NSW Health data obtained from the Health Outcomes Information and Statistical Toolkit (HOIST) database. Hospitalisation data were collected for the period 1 July 1999 to 30 June 2003. Mortality data were collected for the period 1 January 1999 to 31 December 2002.
Main outcome measures:
Hospitalisation and death rates due to injury by age, sex, injury mechanism and Indigenous status. Rate ratios for comparison between Indigenous and non-Indigenous populations.
Results:
Rates of death from injury were higher for all age groups in the Indigenous population, except people older than 65 years. Indigenous people aged 25–44 years were twice as likely to be hospitalised as their non-Indigenous counterparts (rate ratio [RR], 2.09; 95% CI, 2.03–2.14), and five times as likely to be hospitalised for interpersonal violence (RR, 5.19; 95% CI, 4.98–5.40).
Conclusion:
The higher rates of injury-related hospitalisation and death in the Indigenous population in NSW are consistent with data reported for other parts of Australia. Of particular concern is the number of Indigenous deaths and hospitalisations due to interpersonal violence.

Effect of Glucocorticoid pretreatment on oxidative liver injury and survival in jaundiced rats with Endotoxing Cholangitis

Introduction: Biliary tract infection is associated with high mortality. This study investigated the effect of glucocorticoid pretreatment on lipopolysaccharide (LPS)-induced cholangitis. Methods: Rats undergoing either sham operation or ligation of the extrahepatic bile duct (BDL) for 2 weeks were randomly assigned to receive intravenous injections of dexamethasone (DX) or normal saline (NS) prior to infusing LPS into the biliary tract. The plasma levels of tumor necrosis factor-α (TNFα), chemokines monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-2 (MIP-2) as well as liver mRNA expression of MCP-1 and MIP-2 were determined. Infiltration of monocytes, Kupffer cells, and neutrophils in rat liver were studied with immunohistochemistry. Oxidative liver injury was measured by the malondialdehyde (MDA) content. Results: Dexamethasone pretreatment resulted in significantly decreased plasma levels of TNFα at 1 hour, MCP-1 and MIP-2 at 2 and 3 hours, and decreased liver MCP-1 mRNA expression at 3 hours following LPS infusion in BDL-DX rats than in BDL-NS rats. The number of inflammatory cells in the liver was significantly different between sham- and BDL-treated rats but was not affected by DX pretreatment. Pretreatment with DX resulted in significantly decreased liver MDA contents in the BDL-DX group than that in the BDL-NS group. Jaundiced rats pretreated with 5 mg DX prior to infusion of 1 g of LPS were 6.8 times more likely to survive than those that were not pretreated. Conclusions: Pretreatment of jaundiced, LPS-treated rats with a  supraphysiological dose of dexamethasone may rescue their lives by suppression of chemokine expression and alleviation of oxidative liver injury.

The expression of suppression: loss and emotional labour in narratives of organisation change

This paper focuses on themes of emotionality and emotional labour derived inductively from retrospective narratives constructed by employees who experienced rapid organisational change and specifically addresses the question: 'How do people talk about the need to "dull down" their emotions during situations of organisational change?' We highlight themes of loss associated with retrospective displays of emotion and argue that loss and emotion management are most typically associated with issues concerning transition from the past or resistance to the future. We show how emotional labour serves both to mute and, ironically, to heighten emotions in the talk of change and extend studies of emotional labour beyond the service encounter and into the realm of organisational change.

Injury prevention during physical activity in the Australian Defence Force

Introduction:
Injuries sustained by Australian Defence Force (ADF) personnel during non-combat military training and sports activity are associated with increasing costs due to work days lost, medical treatment, compensation, and early retirement. In 2001, the ADF commissioned a systematic review of the evidence-base for reducing injuries associated with physical activity, while at the same time improving physical activity participation rates to sustain a trained, fit and deployable workforce.

Method:
Literature from on-line library databases, relevant unclassified military reports, and material from previously published sport-specific injury countermeasure reviews were systematically and critically analysed to address the study aims.

Results:
Modification of intensity, frequency and duration of basic military training activities and improved equipment is likely to reduce injury occurrence. Sports injury countermeasures used for the civilian population have merit for the ADF physical activity program. Injury countermeasures should be designed to minimise any possible deterrent effect on the motivation to participate in regular physical activity. Increasing the participation of ADF personnel in physical activity in the presence of evidence-based injury prevention strategies has the potential to increase health, fitness and deployability with minimal impact on injury frequency.

Conclusion:
Recommendations arising from the review include injury intervention trials in basic military training and sports. These and other interventions should be supported by refinement to ADF injury surveillance systems. Research should focus on interventions with the greatest gain for fitness, deployability, and cost effectiveness.

Early detection of emotional and behavioural problems in children with diabetes: the validity of the child health questionnaire as a screening instrument

Aims: To assess the validity of the Child Health Questionnaire (CHQ) as a screening tool for detecting 'at risk' emotional and behavioural  maladjustment in children with diabetes, using the Behaviour Assessment System for Children (BASC) as a gold standard measure. Methods: CHQ and BASC were administered to 103 parents of children with Type 1 diabetes, aged 7–12 years. Sub-scales of the two measures were compared using Pearson's bivariate correlations. CHQ sensitivity and specificity cut-points were optimized against the BASC borderline category using receiver operating characteristic curves. Results: The BASC Externalizing Problems scale correlated strongly with CHQ Behaviour, Global Behaviour, Mental Health, Family Activities and Family Cohesion scales (r-values −0.68, −0.54, −0.51, −0.59, and −0.42, respectively). BASC Internalizing Problems scale correlated strongly with CHQ Behaviour, Mental Health and Family Cohesion scales (r-values −0.40, −0.43 and −0.45, respectively). Using receiver operating characteristic curve analysis, the CHQ Mental Health scale most effectively identified children classified as borderline on the BASC Internalizing Problems scale (sensitivity 87%, specificity 78%), while the CHQ Global Behaviour scale most effectively identified children classified as borderline on the BASC Externalizing Problems scale (sensitivity 73%, specificity 82%). Conclusions: Significant correlations were seen between the CHQ Global Behaviour and Mental Health scales and the BASC Externalizing and Internalizing scales, respectively. Sequential use of the CHQ, as a screening tool, followed by an established mental health measure such as the BASC, may help identify children with diabetes 'at risk' for chronic maladjustment and poor health outcomes.

Burden of disease and injury in Aboriginal and non-Aboriginal populations in the Northern Territory

Objective:
To quantify the burden of disease and injury for the Aboriginal and non-Aboriginal populations in the Northern Territory.

Design and setting:
Analysis of Northern Territory data for 1 January 1994 to 30 December 1998 from multiple sources.

Main outcome measures:
Disability-adjusted life-years (DALYs), by age, sex, cause and Aboriginality.

Results:
Cardiovascular disease was the leading contributor (14.9%) to the total burden of disease and injury in the NT, followed by mental disorders (14.5%) and malignant neoplasms (11.2%). There was also a substantial contribution from unintentional injury (10.4%) and intentional injury (4.9%). Overall, the NT Aboriginal population had a rate of burden of disease 2.5 times higher than the non-Aboriginal population; in the 35-54-year age group their DALY rate was 4.1 times higher. The leading causes of disease burden were cardiovascular disease for both Aboriginal men (19.1%) and women (15.7%) and mental disorders for both non-Aboriginal men (16.7%) and women (22.3%).

Conclusions:
A comprehensive assessment of fatal and non-fatal conditions is important in describing differentials in health status of the NT population. Our study provides comparative data to identify health priorities and facilitate a more equitable distribution of health funding.

Biliary intervention augments chemotactic reaction and aggravates cholestatic liver injury in rats

Background
Intervention of the biliary system is frequently done in patients with obstructive jaundice and is associated with significant morbidity and mortality. The pathogenesis is unknown.
Materials and methods
A rat model of bile duct ligation (BDL) for 2 weeks was established in which biliary intervention was feasible by injection of normal saline through an indwelling catheter in the bile ducts. Plasma levels of C-C chemokine MCP-1 and C-X-C chemokine MIP-2 were measured by using ELISA. Blood monocytes, Kupffer cells, and neutrophils in the liver were characterized with antibodies to ED1, ED2, and myeloperoxidase (MPO). Lipid peroxidation was measured by malondialdehyde contents and apoptosis by TUNEL stain of the liver.
Results
Biliary intervention resulted in an increase of plasma MCP-1 and MIP-2 proteins by 1 h, which declined to normal level by 3 h in both sham and BDL rats. The levels in BDL rats were significantly higher than in sham at most points. There was a transient increase of ED1- and ED2-positive cells and MPO-staining cells in sham rat liver by 1 h after intervention. ED2-positive cells increased significantly by 1 h, while ED1- and MPO-positive cells decreased, yet insignificantly after intervention in BDL rats. The cell counts in BDL were constantly higher than in sham. Malondialdehyde increased precipitously in BDL by 3 h and was significantly higher than in sham throughout the study period. Parenchymal liver injury, manifested by elevated ALT, as well as apoptosis and necrosis of liver cells, was significantly increased in BDL rats, but not in sham rats.
Conclusion
Biliary intervention augments chemokine expression, precipitates lipid peroxidation, and aggravates liver injury in cholestatic rats.