Prospective study of the participation patterns of Grade 6 and Year 8 students in Victoria, Australia in activities outside of school.

BACKGROUND: Positive participation outcomes are deemed the ultimate goal of health care and specifically of occupational therapy. Knowledge of the typical participation patterns of children in Australia will provide essential information to support our understanding of participation and the goal of maximising children's engagement. AIMS: This study investigated the participation of Grade 6 and Year 8 Victorian students in activities outside school and explored differences between genders and between students in different year levels. Secondarily, we began to establish Australian normative data on the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children. METHODS: This cross sectional survey methods study recruited students from a random selection of public schools. Participation was measured using the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children questionnaires. RESULTS: Participants included 84 (37 female, 47 male) students in Grade 6 (n = 43) and Year 8 (n = 41). Differences between year levels were only evident for participation in Recreational and Active Physical activities. Grade 6 students did more activities, more intensely than Year 8 students, but with no difference in enjoyment. The mean number of Recreational activities done by Grade 6 students was 8.5 (95%CI: 7.9-9.1) compared to Year 8 students 6.9 (95%CI: 6.1-7.7; P = 0.001). Gender differences were evident in the participation patterns within Social, Skill-Based and Self-Improvement activities. CONCLUSION: The findings suggested that gender was a more important influence on participation patterns than a 2-year age gap, with participation patterns being relatively stable between Grade 6 and Year 8.

A qualitative exploration of first-time fathers' experiences of becoming a father.

This study aimed to explore first-time fathers' experiences of becoming a father, focusing on their expectations, experiences, and how they are coping with this transition. An interpretative phenomenological analysis (IPA) epistemology and methodology were adopted as the study was focused on understanding the meaning and experiences of this transition for fathers. Nine participants were recruited from seven NCT antenatal classes. The mean age of participants was 38 years (range=30 to 46 years). Participants completed a semi-structured interview between four and eleven weeks post birth. One overarching superordinate theme was derived: 'searching for a place'. This theme consisted of three sub-themes--'the separation connection struggle', 'a sense of utility, agency and control' and 'changing focus of affection'. The findings expand on our understanding of new fathers' experiences, and suggest that first-time fathers experienced an array of psychological responses during each stage of their transition as they searched for their place as father in relation to their partner, child and work. Professionals working in antenatal and postnatal services should discuss with men the possible emotional and psychological changes they may go through to enable more realistic expectations to be considered.

Postexposure prophylaxis for HIV.

Health care workers are at risk for human immunodeficiency virus (HIV) and other infectious pathogens through exposure to blood and body fluids. Antiretroviral medications have been prescribed for postexposure prophylaxis following occupational exposure to the HIV since the early 1990s. This practice has since been extended to nonoccupational situations, such as sexual assaults. The efficacy of prophylactic therapy may be highly time-dependent and should be initiated as soon as possible. Wound care management and referral for social, medical, or advocacy services remain important for all cases.

Assessment of teacher interruptions on learners during oral case presentations.

BACKGROUND: Studies have only recently begun to investigate the effects of interruptions on physicians in the emergency department (ED). OBJECTIVES: To determine the frequency and nature of interruptions by the training physician that occur when medical trainees do oral case presentations (OCPs) in the ED. METHODS: This was an observational study. Learner OCPs to attending emergency physicians were observed in the ED of an urban Level 1 trauma center at a major teaching hospital. A single investigator followed attending physicians blinded to the study objective in a nonrandomized convenience sampling of all ED shifts, recording information regarding teacher interruptions during new patient presentations. Learners completed a brief questionnaire after each OCP. RESULTS: A total of 196 OCPs were observed. The mean (+/-SD) duration of OCPs was 3.30 (+/-1.85) minutes, and the mean (+/-SD) number of interruptions was 0.75 (+/-0.60) per minute and 2.49 (+/-1.95) per OCP. The number of interruptions (per OCP) and duration of OCP varied by learner level of training, with more experienced learners giving shorter presentations and being interrupted less often. Frequency (per minute) of interruptions did not vary by learner level. In 40.3% of OCPs, attending physicians interrupted to give an assessment and/or a plan before the learner had done so, but 8.3% of interrupted learners believed that teacher interruptions were "disruptive" to their OCP. CONCLUSIONS: Attending emergency physicians frequently interrupt learners during new patient OCPs, with the number of interruptions varying by learner level of training. Teacher interruptions appear to have minimal, if any, detrimental effect on the perceived effectiveness of OCPs as a learning experience.

A retrospective review comparing the use of Gonal-F and Metrodin-HP for in-vitro fertilisation (IVF).

All cycles of IVF with pituitary down-regulation (n = 57) done at the Damansara Fertility Centre in the year 2000 were studied. All the 57 patients had controlled ovarian hyperstimulation, either using Metrodin HP (n = 27) or Gonal-F (n = 30). Of these, 53 patients reached oocyte pick-up, 26 patients in Metrodin HP group and 27 patients in Gonal-F group. Gonal-F resulted in a higher clinical pregnancy rate of 66.6% compared to Metrodin HP 38.5% (p < 0.05). The live birth rate tends to be higher in Gonal-F group (40.7%) compared to Metrodin HP (30.8%), (p > 0.05).

Gamma-hydroxybutyrate serum levels and clinical syndrome after severe overdose.

STUDY OBJECTIVE: We discuss a prospective case series of patients who present with a severe gamma-hydroxybutyrate intoxication with confirmatory serum and urine gamma-hydroxybutyrate levels. METHODS: Patients with a clinical suspicion of gamma-hydroxybutyrate-like drug overdoses and a Glasgow Coma Scale score of 8 or lower were identified from July 1998 through January 1999. Serial serum specimens and a single urine specimen were collected. The levels of gamma-hydroxybutyrate were performed by gas chromatography-mass spectrometry. RESULTS: All 16 suspected severe gamma-hydroxybutyrate overdose patients had significant serum or urine levels of gamma-hydroxybutyrate. Serum levels ranged from 45 to 295 mg/L, with a median of 180 mg/L (interquartile range [IQR] 235 to 118 mg/L). Patients who developed a Glasgow Coma Scale score of 3 had serum levels that ranged from 72 to 300 mg/L, with a median of 193 mg/L (IQR 242 to 124 mg/L). The time of awakening ranged from 30 minutes to 190 minutes, with a median of 120 minutes (IQR 150 to 83 minutes). Quantitative serum gamma-hydroxybutyrate levels did not correlate with the degree of coma or the time to awakening. Urine levels ranged from 432 to 2,407 mg/L, with a median of 1,263 mg/L (IQR 1,550 to 796 mg/L). Mild transitory hypoventilation occurred in 5 of the 16 patients. CONCLUSION: All of our patients with clinically suspected severe gamma-hydroxybutyrate overdose were confirmed to have significant serum and urine levels of exogenous gamma-hydroxybutyrate. They presented with severe coma that lasted 1 to 2 hours. Transient hypoventilation occurred in one third of these patients.

Clinical Course of γ-Hydroxybutyrate Overdose.

STUDY OBJECTIVE: To describe the clinical characteristics and course of γ-hydroxybutyrate (GHB) overdose. METHODS: We assembled a retrospective series of all cases of GHB ingestion seen in an urban public-hospital emergency department and entered in a computerized database January 1993 through December 1996. From these cases we extracted demographic information, concurrent drug use, vital signs, Glasgow Coma Scale (GCS) score, laboratory values, and clinical course. RESULTS: Sixty-one (69%) of the 88 patients were male. The mean age was 28 years. Thirty-four cases (39%) involved coingestion of ethanol, and 25 (28%) involved coingestion of another drug, most commonly amphetamines. Twenty-five cases (28%) had a GCS score of 3, and 28 (33%) had scores ranging from 4 through 8. The mean time to regained consciousness from initial presentation among nonintubated patients with an initial GCS of 13 or less was 146 minutes (range, 16-389). Twenty-two patients (31%) had an initial temperature of 35°C or less. Thirty-two (36%) had asymptomatic bradycardia; in 29 of these cases, the initial GCS score was 8 or less. Ten patients (11%) presented with hypotension (systolic blood pressure≤90 mm Hg); 6 of these patients also demonstrated concurrent bradycardia. Arterial blood gases were measured in 30 patients; 21 had a Pco2 of 45 or greater, with pH ranging from 7.24 to 7.34, consistent with mild acute respiratory acidosis. Twenty-six patients (30%) had an episode of emesis; in 22 of these cases, the initial GCS was 8 or less. CONCLUSION: In our study population, patients who overdosed on GHB presented with a markedly decreased level of consciousness. Coingestion of ethanol or other drugs is common, as are bradycardia, hypothermia, respiratory acidosis, and emesis. Hypotension occurs occasionally. Patients typically regain consciousness spontaneously within 5 hours of the ingestion. [Chin RL, Sporer KA, Cullison B, Dyer JE, Wu TD: Clinical course of γ-hydroxybutyrate overdose. Ann Emerg Med June 1998;31: 716-722.].