Claire James

OBJECTIVE: The purpose of this study was to evaluate the impact and acceptability of an educational multimedia program designed to promote self-management skills in children with asthma. METHODS: We conducted a randomized, controlled trial with measures at baseline and 1- and 6-month follow-up. The trial was conducted in pediatric outpatient respiratory clinics in 3 United Kingdom hospitals. Participants included 101 children aged 7 to 14 years under the care of hospital-based asthma services. The children were randomly assigned to receive an asthma information booklet alone or the booklet plus The Asthma Files, an interactive CD-ROM for children with asthma. Asthma knowledge was the primary outcome measure. Other measures included asthma locus of control, lung function, use of oral steroids, and school absence. RESULTS: At the 1-month follow-up (n = 99), children in the computer group had improved knowledge compared with the control group and a more internal locus of control. There were no differences in objective lung-function measures, hospitalizations, or oral steroid use. The study participants were positive in their evaluation of the intervention. At the 6-month follow-up (n = 90), significantly fewer children in the intervention group had required oral steroids and had had time off school for asthma in the previous 6 months. The difference did not reach statistical significance in the intention-to-treat analysis for both steroid use and school absence. CONCLUSION: The Asthma Files was found to be an effective and popular health education tool for promoting asthma self-management skills within pediatric care.

Family-centered practice encompasses a philosophy and a method of service delivery that underpins early intervention services and is considered “best practice” in fields concerned with optimal child development. The aim of this study was to gain a critical understanding of parental experiences of an early intervention service that professionals believed was based on the principles of family-centered practice. Using qualitative inquiry, in-depth interviews were carried out with parents of 7 children with primary physical disabilities who attended a preschool program. Overall findings revealed that parents were relatively satisfied with the nature of the services they received but identified specific process elements that warranted further attention. These included lack of support at critical times, lack of information, and continuity of care not being adequately developed. Parents in this study felt that there was meaningful collaboration and partnership with individual professionals, but indicated that this was less likely at team level. They also believed that collaboration at a higher organizational level was limited. Parents clearly feel that relationships with professionals are important and perceive that they are in partnership with professionals, but in varying capacities over time. Parent expertise, knowledge, and support were identified as the valuable resources for other parents, professionals, and the organization as a whole, but were not effectively utilized by the service.

The term 'accident' suggests an unexpected or unforeseen happening which afflicts a worker. Historically there has been a tendency to categorise such injuries as aberrant or unusual with a focus upon the individual injured. High injury rates tend to occur in lower socio- economic groups whose perception of causation and work experience place them at odds with management. At the same time injuries are treated, investigated and compensated at an individual leveL This medical and legal individualisation process has served to obscure group susceptibility and group responses to health threat. Further, patterns of behaviour, injuries and overt conflict may be related to the levels of control experienced at work A case study of a large Brisbane factory demonstrated that a conflict of interest was recognised by both workers and management and resulted in tacit acceptance of 'restrictive labour practices', as survival mechanisms. This recognition of inherent danger, injury-avoidance withdrawal and the contradictory nature of control for safety and production, by both sides, is de facto legitimation of occupational injuries being embedded in the social relations of production - rather than being 'accidental'.

Abstract This paper examines the relationship between the labour process and the health status of self-employed workers. While occupational health and safety (OHS) issues have often been seen to be particular problems for groups of workers in different industries, there have been few comparative studies of self-employed and employee workers. This paper reports on a study conducted to remedy this deficiency, to indicate how labour process theory explains the injury and illness pattern differences between self-employed and employee workers, and to suggest how some of the risks to self-employed worker health can be controlled. Knowledge about the influence of labour process factors assists in the re-organization of hazardous work processes and in the targetting of prevention programs. The study focused particularly on transport workers. It was found that self-employed workers were especially vulnerable, particularly those who were older and who drove at night.