Survey of rehabilitation support for children 0-15 years in a rural part of Kenya.

PURPOSE: Information regarding the nature, availability and distribution of rehabilitation services for children with disabilities across developing countries is scarce, and data that do exist are of variable quality. If planning and development are to progress, information about service provision is vital. The aim was to establish the scope and nature of rehabilitation support available to children with disabilities (0-15 years) and their families in rural Kenya. METHOD: A comprehensive sample comprising service provision in the health and special education sectors was established. Non-governmental and community-based organisations were also included. A survey of rehabilitation services was conducted through examination of service-related documentation and key informant interviews with the heads of services. RESULTS: Rehabilitation comprised hospital-based occupational therapy, physiotherapy and orthopaedic technology; and seven special education establishments plus an education assessment resource centre. There was one non-government organisation and one community-based organisation relevant to children with disabilities. Activities focused on assessment, diagnosis and raising community awareness. Provision was challenged by inadequate staffing, resources and transport. Government funding was supplemented variously by donations and self-sufficiency initiatives. Rehabilitation approaches appeared to be informed by professional background of practitioner, rather than the needs of child. Service documentation revealed use of inconsistent recording methods. CONCLUSIONS: The data highlight the challenges of rehabilitation, demanding greater investment in personnel and their training, more material resources, improved access to the community and better recording mechanisms. IMPLICATIONS FOR REHABILITATION: There needs to be greater investment in rehabilitation provision in developing countries. Consideration of community-based initiatives is required to support better access for all. In order to argue the case for improved resources, better skills and mechanisms for recording, monitoring and evaluating practice are needed.

Social support needs for equity in health and social care: a thematic analysis of experiences of people with chronic fatigue syndrome/myalgic encephalomyelitis.

BACKGROUND: Needs-based resource allocation is fundamental to equitable care provision, which can meet the often-complex, fluctuating needs of people with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This has posed challenges both for those providing and those seeking support providers, in building shared understanding of the condition and of actions to address it. This qualitative study reports on needs for equity in health and social care expressed by adults living with CFS/ME. METHODS: The participants were 35 adults with CFS/ME in England, purposively selected to provide variation in clinical presentations, social backgrounds and illness experiences. Accounts of experienced needs and needs-related encounters with health and social services were obtained through a focus group (n = 6) and semi-structured interviews (n = 35). These were transcribed and needs related topics identified through data-led thematic analysis. FINDINGS: Participants emphasised needs for personalised, timely and sustained support to alleviate CFS/ME impacts and regain life control, in three thematic areas: (1) Illness symptoms, functional limitations and illness management; (2) practical support and social care; (3) financial support. Access of people with CFS/ME to support from health and social services was seen to be constrained by barriers stemming from social, cultural, organisational and professional norms and practices, further heightened for disadvantaged groups including some ethnic minorities. These reduced opportunities for their illness to be explained or associated functional limitations and social disadvantages to be addressed through social support. Participants sought more understanding of bio-psycho-social aspects of CFS/ME, of felt needs of people with CFS/ME and of human rights and disability rights, for providing person-centred, equitable care. CONCLUSIONS: Changes in attitudes of health practitioners, policy makers and general public and more flexibly organised health and social care provision are needed to address equity issues in support needs expressed by people with CFS/ME, to be underpinned by research-based knowledge and communication, for public and professional education. Policy development should include shared decision-making and coordinated action across organizations working for people with CFS/ME, human rights and disadvantaged groups. Experiences of people with CFS/ME can usefully inform an understanding of equity in their health and social care.

Occupational therapy students' attitudes towards inclusion education in Australia, United Kingdom, United States and Taiwan.

This international, cross-cultural study investigated the attitudes of occupational therapy students from Australia, United Kingdom, United States and Taiwan towards inclusive education for students with disabilities. The possible impact of professional education on students' attitudes was also explored. A total of 485 students from 11 entry-level occupational therapy education programmes from Australia, the United Kingdom, the United States and Taiwan participated in the study. Among them, 264 were freshmen (first-year students) and 221 were seniors (final-year students). Data collected from a custom-designed questionnaire were analysed both quantitatively and qualitatively. In general, the occupational therapy students reported having positive attitudes towards inclusion. Considerable differences, however, existed among the student groups from the four countries. Professional education appeared to have a significant impact on students' attitudes towards inclusion from first year to senior year. Although students were in favour of inclusion, they also cautioned that their support for inclusive practices depended on various factors such as adequate preparation, support and assistance to students with disabilities. Limitations of the study included the small, convenience sample and different degree structures of the participating programmes. Future research studies need to compare occupational therapy students' attitudes with students from other health care professions. A longitudinal study on the impact of the professional education programme on students' attitudes towards inclusive education is warranted.

The expressed needs of people with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review.

BACKGROUND: We aimed to review systematically the needs for support in managing illness and maintaining social inclusion expressed by people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) METHODS: We carried out a systematic review of primary research and personal ('own') stories expressing the needs of people with CFS/ME. Structured searches were carried out on Medline, AMED, CINAHL, EMBASE, ASSIA, CENTRAL, and other health, social and legal databases from inception to November 2007. Study inclusion, data extraction and risk of bias were assessed independently in duplicate. Expressed needs were tabulated and a conceptual framework developed through an iterative process. RESULTS: Thirty two quantitative and qualitative studies, including the views of over 2500 people with CFS/ME with mainly moderate or severe illness severity, met the inclusion criteria. The following major support needs emerged: 1) The need to make sense of symptoms and gain diagnosis, 2) for respect and empathy from service providers, 3) for positive attitudes and support from family and friends, 4) for information on CFS/ME, 5) to adjust views and priorities, 6) to develop strategies to manage impairments and activity limitations, and 7) to develop strategies to maintain/regain social participation. CONCLUSIONS: Although the studies were heterogeneous, there was consistent evidence that substantial support is needed to rebuild lives. Gaining support depends - most importantly - on the ability of providers of health and social care, colleagues, friends and relatives, and those providing educational and leisure services, to understand and respond to those needs.

Occupational therapy students' attitudes towards individuals with disabilities: a comparison between Australia, Taiwan, the United Kingdom, and the United States.

INTRODUCTION: Students who are enrolled in professional education programs such as occupational therapy may have inherent attitudes towards the future clients they work with. These attitudes may be influenced by the level of their professional education as well as cultural values of their country of origin. PURPOSE: The purpose of the study was to examine occupational therapy students' attitudes towards individuals with disabilities from an international, cross-cultural perspective and to investigate the possible impact of professional education on students' attitudes. METHOD: 485 occupational therapy students from 11 university programs (3 from Australia, 3 from the United Kingdom, 3 from the United States, and 2 from Taiwan) completed the Interactions with Disabled Person's (IDP) scale. RESULTS: Significant differences were found between occupational therapy students from Australia, Taiwan, the United States, and the United Kingdom on the following IDP variables: overall attitude towards individuals with disabilities, 'discomfort', 'sympathy', 'uncertainty', 'coping', 'fear', and 'vulnerability'. Significant differences between first year students as a total group and final year students as a total group were found on their overall attitudes towards individuals with disabilities, 'discomfort', and 'uncertainty'. CONCLUSION/IMPLICATIONS: The attitudes towards individuals with disabilities among first year and final year occupational therapy students varies between countries and the students' year level also impacts on their attitudes towards individuals with a disability.

Bioaccumulation of polybrominated diphenyl ethers in harbor seals from the northwest Atlantic.

Polybrominated diphenyl ethers (PBDEs) were analyzed in blubber of harbor seals (Phoca vitulina concolor) collected between 1991 and 2005 along the northwest Atlantic. summation operatorPBDE concentrations (mono- to hexa-BDEs) detected in blubber samples (n=42) ranged from 80 to 25720 ng g(-1)lw, (overall mean 2403+/-5406 ng g(-1)lw). By age, mean summation operatorPBDE concentrations were: 3645+/-7388, 2945+/-5995, 1385+/-1265, and 326+/-193 ng g(-1)lw in pups, yearlings, adult males, and adult females, respectively. Unlike the trend for PCBs, no decreasing gradient from urban to rural/remote areas was observed for PBDEs in these samples, likely reflecting inputs from local sources. No significant temporal trend was observed for PBDEs in harbor seals between 1991 and 2005, although congener profiles shifted over time. Tetra-BDE-47 was the dominant congener, followed by BDEs-99, -100, -153, -154, and -155 in varying order, suggesting exposure to the penta-BDE product. In adult males, the hexa-BDEs contributed more to the total (22%) than BDEs-99 and -100 (14%), and concentrations of BDE-155 were elevated compared with -154. Higher BDEs were detected in a subset of seals (n=12) including hepta-BDE-183, the marker for the octa-BDE mixture, and octa-BDE-197, along with several unidentified hepta- and octa- congeners. BDE-209 was detected in seal blubber at concentrations ranging from 1.1 to 8 ng g(-1)lw, indicating that deca-BDE is bioavailable in this marine food web. This is the first study to document the accumulation of BDE-209 at measurable levels in wild harbor seals. While the PBDE patterns in blubber indicate exposure to all three BDE commercial mixtures, the data also suggest that BDE-209 debromination by seal prey fish may contribute to the loading of lower brominated congeners (hexa- to octa-BDEs) in these seals.

Polybrominated diphenyl ethers (PBDEs) in farmed and wild salmon marketed in the Northeastern United States.

Recently, we reported on the analysis of polychlorinated biphenyls (PCBs) and chlorinated pesticides in farmed Atlantic salmon (Salmo salar) from Maine, eastern Canada, and Norway, and wild Alaskan Chinook salmon (Oncorhynchus tshawytscha). In this paper, we extend the analysis to polybrominated diphenyl ethers (PBDEs) in these samples. Total PBDE concentrations in the farmed salmon (0.4-1.4ng/g, wet weight, ww) were not significantly different from those in the wild Alaskan Chinook samples (0.4-1.2ng/g, ww), nor were significant differences found among regions. However, significant intra-regional variations in concentrations of total PBDEs and tetra-BDE 47 were observed in the salmon from the Canadian farms (p<0.01). Congener profiles were dominated by BDE-47, followed by the penta-BDEs 99 and 100. PBDE concentrations in the Canadian samples were lower than those reported two years earlier. Removal of skin resulted in no overall reduction in PBDE concentrations in our farmed salmon, and in some cases, PBDE concentrations were higher in skin-off samples. PBDEs were correlated with lipids only in the skinned samples, suggesting that there is greater accumulation and retention of PBDEs in muscle lipids than in skin-associated fat. In skin-on samples, modest correlations were observed between concentrations of PBDEs and PCBs (R(2)=0.47) and mono-ortho PCBs (R(2)=0.50), whereas PBDEs were not correlated with non-ortho PCBs.

PCBs, PCDD/Fs, and organochlorine pesticides in farmed Atlantic salmon from Maine, eastern Canada, and Norway, and wild salmon from Alaska.

Farmed Atlantic salmon (Salmo salar) from Maine and eastern Canada, wild Alaskan Chinook salmon (Oncorhynchus tshawytscha), and organically farmed Norwegian salmon samples were analyzed for the presence of polychlorinated biphenyls (PCBs), dioxin-like PCBs, polychlorinated dibenzo-p-dioxins (PCDDs), dibenzo-p-furans (PCDFs), and chlorinated pesticides. PCDD and PCDF congeners were not detected in > 80% of the samples analyzed. Total PCB concentrations (7.2-29.5 ng/g, wet weight, ww) in the farmed salmon were significantly higher than those in the wild Alaskan Chinook samples (3.9-8.1 ng/g, ww). Concentrations of PCBs, WHO PCB TEQs, and chlorinated pesticides varied significantly by region. PCB and WHO PCB TEQ concentrations in farmed salmon from eastern Canada were lower than those reported in samples collected two years earlier, possibly reflecting recent industry efforts to lower contaminant concentrations in feed. Organically farmed Norwegian salmon had the highest concentrations of PCBs (mean: 27 ng/g, ww) and WHO PCB TEQs (2.85 pg/g,ww); their TEQ values are in the higher range of those reported in farmed salmon from around the world. Removal of skin from salmon fillets resulted in highly variable reductions of lipids and contaminants, and in some skin-off samples, contaminant levels were higher, suggesting that skin removal does not protect the consumer from health risks associated with consumption of farmed salmon.

Air-water Henry's law constants for PCB congeners: Experimental determination and modeling of structure-property relationship.

A modified gas-purging technique was used for the determination of Henry's law constants (HLCs) for four non-ortho- and eight mono-ortho-substituted polychlorinated biphenyls (PCBs). The method involves measurement of a compound's concentration in only the water phase while that compound is being stripped isothermally from the solution at a known gas flow rate. HLCs were calculated from the slope of a plot of ln(Cn) versus (1/V)n, where (Sigma 1/V)n = 1/V0 + 1/V1 + ... + 1/V(n-1). The HLCs ranged from 5.6 to 21.8 Pa m3/mol, with an average precision of 13%, and they are comparable to values in the literature. Meta-analysis technique and principal component regression (PCR) were applied to model the relationship between experimentally determined HLC values of 94 PCB congeners and the congeners' structures. Cross-validation yields an optimal model with two principal components. Statistical analysis suggests that HLCs of PCBs are primarily affected by meta-chlorine substitution, a relationship which has never been discussed in the literature. The substitution of chlorines on the biphenyl rings generally leads to smaller HLCs. The predicted HLCs are in good agreement with the experimentally determined values.

Organic pollutants in wild ducks from New York state: I. Interspecies differences in concentrations and congener profiles of PCBs and PCDDs/PCDFs.

Wild ducks of three species, common mergansers (Mergus merganser americanus), gadwalls (Anas streptera), and mallards (Anas platyrhynchos), were collected near industrial sites in the Massena, NY area of the St. Lawrence River (SLR) in 1988/89 and 1994. Additional samples were collected in 1994 near a former polychlorinated biphenyl (PCB) capacitor plant at Fort Edward, NY (a mallard and two wood ducks (Aix sponsa)), and at control sites (common mergansers, mallards and wood ducks). On a lipid basis, PCB concentrations in liver tissue from the 1994 collection ranged from 0.1 mug/g in a control wood duck to 676 mug/g in a common merganser from the SLR area. However, the highest total polychlorinated dibenzofuran (PCDF) concentrations were found in liver and fat tissues of gadwalls and mallards collected near the SLR industrial sites (2.8-12 ng/g lipid). These two species bioaccumulated non-2,3,7,8-substituted PCDFs in addition to 2,3,7,8-PCDF isomers, whereas common mergansers preferentially bioaccumulated 2,3,7,8-substituted PCDFs. The mergansers from the SLR sites were the only specimens contaminated with polychlorinated dibenzo-p-dioxins (PCDDs), which were all 2,3,7,8-substituted. The PCB and PCDF congener patterns in the duck tissues appear to have been influenced by both sampling location and species trophic level.

Retention indexes for temperature-programmed gas chromatography of polychlorinated biphenyls.

A noninteger retention index was defined based on a series of PCB internal standards, namely congeners 8 (2,4'-dichlorobiphenyl), 31 (2,4',5-trichlorobiphenyl), 44 (2,2',3,5'-tetrachlorobiphenyl), 101 (2,2',4,5,5'-pentachlorobiphenyl), 138 (2,2',3,4,4',5'-hexachlorobiphenyl), 180 (2,2',3,4,4',5,5'-heptachlorobiphenyl), and 194 (2,2',3,3',4,4',5,5'-octachlorobiphenyl). These retention index markers are common congeners present in technical mixtures and most environmental samples, and they show a linear dependence of retention time on the number of chlorine atoms, in the temperature-programmed analysis. The index values are calculated with a single regression equation instead of the Van den Dool and Kratz equation. The retention indexes of all 209 PCBs on two commonly used columns (DB-XLB and DB-5), as well as on a supplementary column of DB-17 in capillary gas chromatography, were determined using this system. The reliability of the retention index is quite good, with the average 95% confidence limits for three measurements on each PCB being +/-0.1 index unit under the same chromatographic conditions and +/-0.4 index unit under different column head pressures. The effect of heating rate of the programmed runs on the retention index was also investigated. The inversion of the elution order of some congener pairs on the DB-XLB column for different temperature heating rates was observed. Our index values were compared with those of Castello and Testini.

Helping children with learning disabilities. Making sense of multisensory environments.

Multisensory environments are specially designed to enable individuals with learning disabilities to enjoy a wide range of sensory experiences. The author, a lecturer in occupational therapy, outlines the history and features of multisensory environments. Using two case studies, he illustrates how they can be used in successful therapeutic interventions. The article reviews the function of multisensory environments for children with learning disabilities.

Occupational therapy and physiotherapy for children with disabilities.

The aim of paediatric occupational therapy and physiotherapy is to minimise the impact of impairments on the child and to enhance the overall quality of life for the child and the family. In this article a physiotherapist and an occupational therapist outline the settings for therapy, including schools, the assessment of child and family and the goals and process of treatment. They also outline the particular role of each therapy.

Methodological refinements in the determination of 146 polychlorinated biphenyls, including non-ortho- and mono-ortho-substituted PCBs, and 26 organochlorine pesticides as demonstrated in heron eggs.

A method for the determination of 146 polychlorinated biphenyls (PCBs), including four non-ortho- and eight mono-ortho-substituted congeners, and 26 chlorinated pesticides is described. The method consists of ultrasonic extraction, Florisil cleanup, HPLC fractionation over porous graphitic carbon (PGC), and final determination with GC/ECD, GC/MS, or both. Two PCB congeners (PCB 30 and PCB 161) and two polybromobiphenyls (2,4',5-tribromobiphenyl and 3,3',4,4'-tetrabromobiphenyl) were used as surrogate standards to evaluate the analytical efficiency. Four PCB congeners, PCB 14 and PCB 159 for the first fraction, PCB 61 for the second fraction, and PCB 204 for the third fraction, were used as internal standards to monitor the GC performance. The retention behavior of PCBs and pesticides on the PGC column are discussed. The method was found to be reproducible, effective, and reliable under the operational conditions proposed and was applied successfully to the analysis of individual PCBs and chlorinated pesticides in black-crowned night heron (Nycticorax nycticorax) egg samples.

Reevaluation of headspace solid-phase microextraction and gas chromatography-mass spectrometry for the determination of methyl tert-butyl ether in water samples.

A headspace solid-phase microextraction (SPME) and gas chromatography-mass spectrometry (GC-MS) method has been reevaluated for the determination of methyl tert-butyl ether (MTBE) in water. Factors affecting method performance were examined. The internal standard, deuterated MTBE, is necessary because it allows normalization of the calibration since the deuterated MTBE and MTBE experience the same extraction efficiency. The method detection limit was 6.6 ng/l, with a linear range up to 160 microg/l. SPME extraction efficiency and detection sensitivity for MTBE decreased in the presence of gasoline matrix. However, reliable measurement of MTBE was possible in the background matrix concentration of 0.97 mg/l gasoline using deuterated internal standard. Reproducibility was 4.5% at the spiking level of 47 ng/l. The average recoveries of MTBE in spiked fountain water, tap water, and snow at 60 ng/l and in spiked rainwater at 580 ng/l ranged from 101 to 105%. The method was successfully applied to the analysis of trace levels of MTBE in various water samples, including rain and snow samples collected in Albany, NY, USA.

Aqueous solubilities of non-ortho and mono-ortho PCBs at four temperatures.

The temperature-dependent aqueous solubilities of 12 non-ortho and mono-ortho coplanar PCBs (IUPAC Nos. 77, 81, 105, 114, 118, 123, 126, 156, 157, 167, 169, and 189) were determined at 5 degrees C, 15 degrees C, 25 degrees C, and 35 degrees C. A generator-column/extractor-column technique was used, followed by off-line GC/ECD analysis. The relative standard deviations for the measurements were < or = 7.4%. The determined solubilities increase exponentially with temperature from 5 degrees C to 35 degrees C for all 12 tested PCBs, and their enthalpies of solution were determined to range from 22.3 to 45.0 kJ/mol. The determined solubilities of PCB 77 at 25 degrees C were further compared with the results reported previously and with the calculated data. Within homolog groups, congeners with more ortho-substitution generally have greater aqueous solubilities. The measured aqueous solubilities of 58 congeners compiled from the literature and from this study were used for evaluation of quantitative structure-property relationships relating chlorine substitution pattern to the aqueous solubilities. A useful equation by which to estimate aqueous solubilities was derived on the basis of multi-regression analysis, which employs easily calculable molecular descriptors. The validity of this equation is demonstrated by comparison of the estimated values with experimental values. This newly developed model agrees well with log K(ow)-based model predictions.