Examining the Efficacy of a Family Peer Advocate Model for Black and Hispanic Caregivers of Children with Autism Spectrum Disorder.

Autism spectrum disorder (ASD) affects individuals across all racial and ethnic groups, yet rates of diagnosis are disproportionately higher for Black and Hispanic children. Caregivers of children with ASD experience significant stressors, which have been associated with parental strain, inadequate utilization of mental health services and lower quality of life. The family peer advocate (FPA) model has been utilized across service delivery systems to provide family-to-family support, facilitate engagement, and increase access to care. This study used a randomized controlled design to examine the efficacy of FPAs in a racially and ethnically diverse sample. Results demonstrate significantly increased knowledge of ASD and reduced levels of stress for caregivers who received the FPA intervention as compared to treatment as usual.

How the World Trade Organisation is shaping domestic policies in health care.

High up on the agenda of the World Trade Organisation (WTO) is the privatisation of education, health, welfare, social housing and transport. The WTO's aim is to extend the free market in the provision of traditional public services. Governments in Europe and the US link the expansion of trade in public services to economic success, and with the backing of powerful medico-pharmaceutical, insurance, and service corporations, the race is on to capture the share of gross domestic product that governments currently spend on public services. They will open domestic European services and domestic markets to global competition by government procurement agreements, dispute-settlement procedures, and the investment rules of global financial institutions. The UK has already set up the necessary mechanisms: the introduction of private-sector accounting rules to public services; the funding of public-sector investment via private-public partnerships or the private finance initiative; and the change to capitation funding streams, which allows the substitution of private for public funds and services. We explain the implications of these changes for European public-health-care systems and the threat they pose to universal coverage, solidarity through risk-pooling, equity, comprehensive care, and democratic accountability.

Acute services. Time to strip the beds?

The health authority and trust proposals for Birmingham's health services, currently the subject of consultation, are radical, untested and uncosted. They assume that once emergency assessment and ambulatory care centres are operational, under half the current caseload will need inpatient stays. University Hospital Birmingham trust's proposal for a new hospital built and operated by the private sector assumes no growth in activity and a 17 per cent reduction in the present bed complement, at a time when emergency admissions in Birmingham are increasing by 5 per cent a year. Analysis of the proposals suggests they will destabilise an already precarious acute service in Birmingham.

Floating metatarsal: concomitant Lisfranc fracture-dislocation and complex dislocation of the first metatarsophalangeal joint.

We describe a unique composite injury of the foot, with concomitant Lisfranc fracture-dislocation, and complex dislocation of the first metatarsophalangeal joint. When examining patients with Lisfranc joint injuries, one must keep in mind that the axial compression forces causing the injury may also damage the metatarsophalangeal joints, and direct attention to these structures. The reduction and stabilization of a "floating" first metatarsal should begin at the distal (metatarsophalangeal) end. The reduction of the distal dislocation will release tension on the plantar fascia, enabling the subsequent reduction of the proximal (Lisfranc) dislocation. A medial approach is convenient, affords easy access to the plantar and dorsal aspects of the joint, and repair of the medial joint structures when damaged. The use of screws for fixation of Lisfranc's fracture-dislocation, is well justified by the stability achieved.