This study investigated provider-based complementary/alternative medicine use and its association with receipt of recommended vaccinations by children aged 1-2 years and with acquisition of vaccine-preventable disease by children aged 1-17 years. Results were based on logistic regression analysis of insurance claims for pediatric enrollees covered by two insurance companies in Washington State during 2000-2003. Primary exposures were use of chiropractic, naturopathy, acupuncture, or massage practitioner services by pediatric enrollees or members of their immediate families. Outcomes included receipt by children aged 1-2 years of four vaccine combinations (or their component vaccines) covering seven diseases, and acquisition of vaccine-preventable diseases by enrollees aged 1-17 years. Children were significantly less likely to receive each of the four recommended vaccinations if they saw a naturopathic physician. Children who saw chiropractors were significantly less likely to receive each of three of the recommended vaccinations. Children aged 1-17 years were significantly more likely to be diagnosed with a vaccine-preventable disease if they received naturopathic care. Use of provider-based complementary/alternative medicine by other family members was not independently associated with early childhood vaccination status or disease acquisition. Pediatric use of complementary/alternative medicine in Washington State was significantly associated with reduced adherence to recommended pediatric vaccination schedules and with acquisition of vaccine-preventable disease. Interventions enlisting the participation of complementary/alternative medicine providers in immunization awareness and promotional activities could improve adherence rates and assist in efforts to improve public health.

The Immunization Information Resource Web site is provided as a public service by the Chiropractic Health Care Section of the American Public Health Association. The site compiles annotated bibliographies of citations from the scientific literature, as well as other authoritative peer-reviewed information sources on this topic. Our intent was to create a resource of information for health care professionals that is current, accurate, objective, evidence based, and as user-friendly as possible. This article describes the Internet-based Immunization Information Resource Web site developed and sponsored by the Chiropractic Health Care Section of the American Public Health Association and discusses current issues and future challenges for sustaining and further advancing such evidence-based initiatives for the chiropractic profession.

OBJECTIVES: We gathered information about health behaviors on a chiropractic campus, including compliance with recent guidelines for exercise as well as diet, smoking, and binge drinking. We also assessed the perceived importance of the chiropractic physician in role modeling and teaching healthy behaviors to patients. METHODS: A survey instrument composed of 16 questions was designed and distributed to 279 students, faculty, and staff at a chiropractic college campus in northern California. Confidentiality was maintained throughout the process, and a response rate of 92% was obtained. Statistical analysis was performed on the data collected. RESULTS: The levels of obesity, inactivity, and smoking on this college campus are lower than the levels reported for the metropolitan area, the state, and the nation. The level of binge drinking among our students was high but similar to the reported rates for college students generally. We found interesting and significant relationships between the behaviors of physical activity and diet (red meat consumption), obesity, and self-reported perceived health in our surveyed chiropractic college population. Without exception, all surveyed members of our campus community view doctors of chiropractic as having a responsibility to role model healthy behaviors and to educate their patients with regard to healthy behaviors; however, we also found that less importance was placed on role modeling and patient education by those who were obese or who consumed red meat in excess. CONCLUSIONS: This chiropractic college campus places a high level of importance on both educating patients and role modeling healthy behaviors. In the behavioral domain, the rates of smoking, obesity, and inactivity are lower than what is seen in the general population. However, there remains room for considerable improvement to bring actual health behaviors closer in line with evidence-informed behavioral health practices.

OBJECTIVES: This study examined the relationship among chiropractors' personal immunization decisions, the vaccination status of their children, and their interest in referring patients for immunization. METHODS: This was a secondary analysis of data collected in a 2002 postal survey of Alberta chiropractors (response rate, 78.2%). Analysis was restricted to chiropractors with children (n = 325). Chiropractors indicated their own vaccination status, that of their children, and their interest in referring patients for immunization. Data analysis included frequencies, cross tabulations, and logistic regression models (alpha =.05). RESULTS: Most respondents were male (83.4%), had more than one child (71.8%), and had graduated from chiropractic college a median of 13 years before survey. Of the chiropractors, 92.6% had ever been immunized, but only 35.7% would accept immunization for themselves in the future. Further, 66.8% had at least one immunized child, and 21.8% indicated interest in referring patients for immunization. Chiropractors who would accept immunization for self in the future, compared with those who would not, were more likely to indicate interest in patient referral for immunization (odds ratio, 11.4; 95% confidence interval, 5.4-24.0; P <.001). Chiropractors who have at least one immunized child, compared with those with none immunized, were 6.2 times more likely to indicate interest in referring patients for immunization (odds ratio, 6.2; 95% confidence interval, 1.4-28.4; P =.018). CONCLUSIONS: Alberta chiropractors are consistent in their personal and professional behaviors. Chiropractors who accept vaccinations for themselves or their children are more likely to refer patients to public health for immunizations.

PURPOSE: This survey was conducted to identify factors that may be associated with changes in knowledge and attitudes towards basic health promotion and public health concepts among chiropractic students enrolled in a course in community health. METHODS: Anonymous surveys were conducted of students before and after a second-year chiropractic college course in community health. Results were analyzed using percentages and Chi Square statistics as appropriate. RESULTS: Students' knowledge of health promotion and public health concepts improved significantly by the end of the course. Students' attitudes towards these also improved, although to a lesser degree. Students indicated that they had a favorable impression of the importance of utilizing health promotion in practice and working with other public health professionals. However, vaccinations were still looked upon unfavorably by half of the students by the end of the course. Pre-class, a positive attitude towards public health concepts was associated with being female, older, Latino, having children, having a poorer perceived health status, conservative politically and religious. These differences tended to lessen by the end of the course. CONCLUSION: A course in community health was successful in adding to students' knowledge and positive attitudes towards health promotion and public health. However, additional educational strategies are needed to ensure changes in future practice behavior, particularly in the area of vaccinations.

We have investigated the attitudes towards vaccination of undergraduate chiropractic and naturopathic students in the two major complementary and alternative medicine colleges in Canada. While the majority of the students were not averse to vaccination, we found in both colleges that anti-vaccination attitudes were more prevalent in the later years of the programs. Reasons for this are discussed, and we provide suggestions for strategies to address the situation.

Infection control professionals have traditionally relied on didacticism to promote behavior change among health care workers, but this approach yields disappointing results in a postmodern era of social fragmentation and intellectual ambiguity. We define a socioethical approach to behavior change and propose its implementation in 4 movements: from individualism to community, from rationality to rhetoric, from productivity to praxis, and from monologue to dialogue.

This paper describes the Immunization Information Database (IID). The IID is designed for cataloguing and systematically analyzing allegations that give rise to public concern regarding the safety, efficacy, and appropriateness of routine childhood immunizations. We describe the IID's eight data tables (Immunization Type; Claim; Claim Basis; Claimant; Source Documentation; Source Type; Claim Analysis; and Claim Analysis Type), and explain how these tables function to create a conceptual map of existing allegations.

With an increasing number of births in Ontario being conducted by midwives, we undertook a survey of the beliefs and practices of 256 licensed Ontario midwives and student midwives about immunization, particularly against influenza. Overall, 42.9%(48/112) of midwives considered that they knew a lot about immunization; however, 36.2%(38/105) reported no education about immunization during their training. A small majority (55.9%) were in favour of vaccination in general and only 2 of 113 reported spending more than 1h discussing vaccination with their clients. Only 26.9% reported having received influenza vaccine in the previous season (compared to 60% of all health care workers in Ontario). Overall, only 37% believed that influenza vaccine is effective, and 22% believed that the vaccine was a greater risk than influenza. Graduation in 1998 or prior was associated with belief in the effectiveness in vaccine, having been vaccinated, and recommending vaccine to clients. Midwives who reported being immunized themselves were more likely to believe in the safety and efficacy of influenza vaccine, and to recommend vaccination to their clients (26% versus 3%, p=0.001). If greater attention is not focused on promoting the utility of immunization to midwives, the success of population immunization programs may be compromised.

CONTEXT: Until recently, Web of Science was the only database available to track citation counts for published articles. Other databases are now available, but their relative performance has not been established. OBJECTIVE: To compare the citation count profiles of articles published in general medical journals among the citation databases of Web of Science, Scopus, and Google Scholar. DESIGN: Cohort study of 328 articles published in JAMA, Lancet, or the New England Journal of Medicine between October 1, 1999, and March 31, 2000. Total citation counts for each article up to June 2008 were retrieved from Web of Science, Scopus, and Google Scholar. Article characteristics were analyzed in linear regression models to determine interaction with the databases. MAIN OUTCOME MEASURES: Number of citations received by an article since publication and article characteristics associated with citation in databases. RESULTS: Google Scholar and Scopus retrieved more citations per article with a median of 160 (interquartile range [IQR], 83 to 324) and 149 (IQR, 78 to 289), respectively, than Web of Science (median, 122; IQR, 66 to 241)(P <.001 for both comparisons). Compared with Web of Science, Scopus retrieved more citations from non-English-language sources (median, 10.2% vs 4.1%) and reviews (30.8% vs 18.2%), and fewer citations from articles (57.2% vs 70.5%), editorials (2.1% vs 5.9%), and letters (0.8% vs 2.6%)(all P <.001). On a log(10)-transformed scale, fewer citations were found in Google Scholar to articles with declared industry funding (nonstandardized regression coefficient,-0.09; 95% confidence interval [CI],-0.15 to -0.03), reporting a study of a drug or medical device (-0.05; 95% CI,-0.11 to 0.01), or with group authorship (-0.29; 95% CI,-0.35 to -0.23). In multivariable analysis, group authorship was the only characteristic that differed among the databases; Google Scholar had significantly fewer citations to group-authored articles (-0.30; 95% CI,-0.36 to -0.23) compared with Web of Science. CONCLUSION: Web of Science, Scopus, and Google Scholar produced quantitatively and qualitatively different citation counts for articles published in 3 general medical journals.

We have investigated the attitudes towards vaccination of undergraduate chiropractic and naturopathic students in the two major complementary and alternative medicine colleges in Canada. While the majority of the students were not averse to vaccination, we found in both colleges that anti-vaccination attitudes were more prevalent in the later years of the programs. Reasons for this are discussed, and we provide suggestions for strategies to address the situation.

BACKGROUND: The citation rate for articles is viewed as a measure of their importance and impact; however, little is known about what features of articles are associated with higher citation rate. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cohort study of all original articles, regardless of study methodology, published in the Lancet, JAMA, and New England Journal of Medicine, from October 1, 1999 to March 31, 2000. We identified 328 articles. Two blinded, independent reviewers extracted, in duplicate, nine variables from each article, which were analyzed in both univariable and multivariable linear least-squares regression models for their association with the annual rate of citations received by the article since publication. A two-way interaction between industry funding and an industry-favoring result was tested and found to be significant (p = 0.02). In our adjusted analysis, the presence of industry funding and an industry-favoring result was associated with an increase in annual citation rate of 25.7 (95% confidence interval, 8.5 to 42.8) compared to the absence of both industry funding and industry-favoring results. Higher annual rates of citation were also associated with articles dealing with cardiovascular medicine (13.3 more; 95% confidence interval, 3.9 to 22.3) and oncology (12.6 more; 95% confidence interval, 1.2 to 24.0), articles with group authorship (11.1 more; 95% confidence interval, 2.7 to 19.5), larger sample size and journal of publication. CONCLUSIONS/SIGNIFICANCE: Large trials, with group authorship, industry-funded, with industry-favoring results, in oncology or cardiology were associated with greater subsequent citations.

BACKGROUND: The effect of low-intensity ultrasonography on fracture healing is controversial, and current management of fractures does not generally involve the use of ultrasound therapy. We describe a systematic review and meta-analysis of randomized controlled trials of low-intensity pulsed ultrasound therapy for healing of fractures. METHODS: We searched 5 electronic databases (MEDLINE, EMBASE, Cochrane Database of Randomised Clinical Trials, HealthSTAR and CINAHL) for trials of ultrasonography and fracture healing, in any language, published from 1966 to December 2000. In addition, selected journals published from 1996 to December 2000 were searched by hand for relevant articles, and attempts were made to contact content experts in the area of ultrasound therapy and fracture healing as well as primary authors of reviewed trials. Trials selected for review met the following criteria: random allocation of treatments; inclusion of skeletally mature patients of either sex with 1 or more fractures; blinding of both the patient and the assessor(s) as to fracture healing; administration of low-intensity pulsed ultrasound treatments to at least 1 of the treatment groups; and assessment of time to fracture healing, as determined radiographically by bridging of 3 or 4 cortices. Two reviewers independently applied selection criteria to blinded articles, and selected articles were scored for methodologic quality. The internal validity of each trial was assessed with the use of a 5-point scale that evaluates the quality of trial method on the basis of description and appropriateness of randomization and double-blinding, and assessment of study withdrawals and likelihood of bias. RESULTS: We identified 138 potentially eligible studies, of which 6 met our inclusion criteria. Agreement beyond chance of quality assessments of the 6 trials was good (intraclass correlation coefficient 0.77, p = 0.03). One trial was a repeat analysis of previously reported data, and 2 trials appeared to report on a shared group of subjects. Three trials, representing 158 fractures, were of sufficient homogeneity for pooling. The pooled results showed that time to fracture healing was significantly shorter in the groups receiving low-intensity ultrasound therapy than in the control groups. The weighted average effect size was 6.41 (95% confidence interval 1.01-11.81), which converts to a mean difference in healing time of 64 days between the treatment and control groups. INTERPRETATION: There is evidence from randomized trials that low-intensity pulsed ultrasound treatment may significantly reduce the time to fracture healing for fractures treated nonoperatively. There does not appear to be any additional benefit to ultrasound treatment following intramedullary nailing with prior reaming. Larger trials are needed to resolve this issue.

BACKGROUND: As the number of studies in the literature is increasing, orthopaedic surgeons highly depend on meta-analyses as their primary source of scientific evidence. The objectives of this review were to assess the scientific quality and number of published meta-analyses on orthopaedics-related topics over time. METHODS: We conducted, in duplicate and independently, a systematic review of published meta-analyses in orthopaedics in the years 2005 and 2008 and compared them with a previous systematic review of meta-analyses from 1969 to 1999. A search of electronic databases (MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews) was performed to identify meta-analyses published in 2005 and 2008. We searched bibliographies and contacted content experts to identify additional relevant studies. Two investigators independently assessed the quality of the studies, using the Oxman and Guyatt index, and abstracted relevant data. RESULTS: We included forty-five and forty-four meta-analyses from 2005 and 2008, respectively. While the number of meta-analyses increased fivefold from 1999 to 2008, the mean quality score did not change significantly over time (p = 0.067). In the later years, a significantly lower proportion of meta-analyses had methodological flaws (56% in 2005 and 68% in 2008) compared with meta-analyses published prior to 2000 (88%)(p = 0.006). In 2005 and 2008, respectively, 18% and 30% of the meta-analyses had major to extensive flaws in their methodology. Studies from 2008 with positive conclusions used and described appropriate criteria for the validity assessment less often than did those with negative results. The use of random-effects and fixed-effects models as pooling methods became more popular toward 2008. CONCLUSIONS: Although the methodological quality of orthopaedic meta-analyses has increased in the past twenty years, a substantial proportion continues to show major to extensive flaws. As the number of published meta-analyses is increasing, a routine checklist for scientific quality should be used in the peer-review process to ensure methodological standards for publication.

OBJECT: Because of their location and biological behavior, brainstem cavernous malformations (CMs) pose a formidable clinical challenge to the neurosurgeon. The optimal management of these lesions requires considerable neurosurgical judgment. Accordingly, the authors reviewed their experience with the management of pediatric brainstem CMs at the Hospital for Sick Children. METHODS: The authors performed a retrospective chart review of pediatric patients who had received diagnoses of a brainstem CM at the Hospital for Sick Children over the past 20 years. RESULTS: Twenty patients were diagnosed with brainstem CMs. The mean age at diagnosis was 10.1 +/- 5.4 years, and the patients included 13 boys and 7 girls. The mean maximal diameter of the CM was 14.3 +/- 11.2 mm. The lesions were evenly distributed on the right and left sides of the brainstem with 4 midbrain, 13 pontine, and 3 medullary lesions. Seven patients underwent surgery for the management of their CMs, with a mean age at presentation of 5.2 years, and a mean CM size of 21.0 mm. Of note from the surgical group, 2 patients had a family history of CMs, 2 lesions were medullary, the CM reached a pial surface in 6 of 7 patients, and 6 of 7 lesions were located on the right side. The mean age at presentation among the 13 patients in the nonsurgical group was 12.7 years, and the mean CM size was 10.6 mm. Seven of these patients had a prior history of radiation for tumor, and only 3 had lesions that reached a pial surface. CONCLUSIONS: The management of brainstem CMs in children is influenced by multiple factors. The majority of patients received conservative management and tended to be asymptomatic with smaller lesions. Patients with larger lesions and direct pial contact, in whom symptoms arose at a younger age were more likely to undergo surgical management. A history of familial CM was also a predictor for receiving surgical treatment. No patients with a prior history of radiation therapy underwent surgery for CMs. The presence of multiple lesions seemed to have no impact on the type of management chosen. Patients who underwent surgery did suffer morbidity related to the procedure, and tended to improve clinically over time. Conservative management was associated with new deficits arising in children, some of which improved with time. Consideration of many clinical and radiological parameters is thus prudent when managing the care of children with brainstem CMs.

Object Enrolling a selected sample of ruptured intracranial aneurysms, the International Subarachnoid Aneurysm Trial (ISAT) found endovascular coiling to be superior to microsurgical clipping. The performance of coiling in a more general population of ruptured aneurysms has not been adequately studied. Methods Using provincial administrative data from Ontario, the authors conducted a retrospective cohort study of adult patients with subarachnoid hemorrhage (SAH) who underwent aneurysm repair. The exposure was defined as endovascular versus surgical aneurysm repair. The prespecified primary outcome was time to death or readmission for SAH. Data from the entire cohort were analyzed using a multivariable adjusted Cox proportional hazards model. Propensity scores were used to compare a matched subgroup of patients with aneurysms who had similar baseline characteristics. The potential impact of unmeasured confounding was assessed using sensitivity analysis. Results Between 1995 and 2004, 2342 aneurysms were clipped and 778 were coiled in Ontario. The proportion of aneurysms treated by coiling increased steadily over time. In the adjusted analysis of the entire cohort, endovascular coiling was associated with a significantly increased hazard of death or SAH readmission (hazard ratio 1.25 [95% CI 1.00-1.55], p = 0.04). Similar results were obtained from the propensity score matched analysis (hazard ratio 1.25 [95% CI 1.04-1.50], p = 0.02). Measures of procedural morbidity and mortality were not significantly different between groups. Conclusions The results of the current analysis call into question the generalizability of the ISAT to all ruptured aneurysms. Given the limitations inherent in this form of analysis, further clinical studies-rigorously assessing the performance of endovascular therapy in patients with non-ISAT-like aneurysms-are indicated.

Object Intramedullary spinal cord low-grade gliomas (LGGs) are rare CNS neoplasms in pediatric patients, and there is little information on therapy for and outcome of these tumors in this population. Furthermore, most patient series combine adult and pediatric patients or high- and low-grade tumors, resulting in controversial data regarding optimal treatment of these children. To clarify these issues, the authors performed a regional population-based study of spinal cord LGGs in pediatric patients. Methods All pediatric patients with LGGs treated during the MR imaging era (1985-2007) were identified in the comprehensive database of the Hospital for Sick Children in Toronto. Data on demographics, pathology, treatment details, and outcomes were collected. Results Spinal cord LGGs in pediatric patients constituted 29 (4.6%) of 635 LGGs. Epidemiological and clinical data in this cohort were different than in patients with other spinal tumors and strikingly similar to data from pediatric patients with intracranial LGGs. The authors observed an age peak at 2 years and a male predominance in patients with these tumors. Histological testing revealed a Grade I astrocytoma in 86% of tumors. Although 5-year progression-free survival for the entire group was 48 +/- 9%, all patients were alive at a median follow-up of 8.2 years. Five-year progression-free survival was 88 +/- 13% for patients undergoing gross-total resection and 34 +/- 11% for those undergoing all other therapies, respectively (p = 0.02). Chemotherapy and radiation therapy showed similar efficacy, achieving sustained tumor control in most patients. However, this excellent survival rate was associated with an 83% rate of significant neurological and orthopedic sequelae. Conclusions This study provides basic data on the incidence, clinical course, and outcome of spinal cord LGGs in pediatric patients. The similarities between spinal and intracranial LGGs in pediatric patients showing excellent survival but high morbidity suggest that a less aggressive approach may be the preferable treatment option for these patients.

STUDY DESIGN.: Questionnaire survey. OBJECTIVE.: To elicit orthopedic surgeons' attitudes toward chiropractic. SUMMARY OF BACKGROUND DATA.: Orthopedic surgeons and chiropractors often attend to similar patient populations, but little is known about the attitudes of orthopedic surgeons toward chiropractic. METHODS.: We administered a 43-item cross-sectional survey to 1000 Canadian and American orthopedic surgeons that inquired about demographic variables and their knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ). RESULTS.: 487 surgeons completed the survey (response rate, 49%). North American orthopedic surgeons' attitudes toward chiropractic were diverse, with 44.5% endorsing a negative impression, 29.4% holding favorable views, and 26.1% being neutral. Approximately half of respondents referred patients for chiropractic care each year, mainly due to patient request.The majority of surgeons believed that chiropractors provide effective therapy for some musculoskeletal complaints (81.8%), and disagreed that chiropractors could provide effective relief for nonmusculoskeletal conditions (89.5%). The majority endorsed that chiropractors provide unnecessary treatment (72.7%), engage in overly-aggressive marketing (63.1%) and breed dependency in patients on short-term symptomatic relief (52.3%).In our adjusted generalized linear model, older age (-2.62 points on the CAQ for each 10 year increment; 95% confidence interval [CI]=-3.74 to -1.50), clinical interest in foot and ankle (-2.77; 95% CI =-5.43 to -0.10), and endorsement of the research literature (-4.20; 95% CI =-6.29 to -2.11), the media (-3.05; 95% CI =-5.92 to -0.19), medical school (-7.42; 95% CI =-10.60 to -4.25), or 'other'(-4.99; 95% CI =-8.81 to -1.17) as a source of information regarding chiropractic were associated with more negative attitudes; endorsing a relationship with a specific chiropractor (5.05; 95% CI = 3.00 to 7.10) or residency (3.79;95% CI = 0.17 to 7.41) as sources of information regarding chiropractic were associated with more positive attitudes. CONCLUSION.: North American orthopedic surgeons' attitudes toward chiropractic range from very positive to extremely negative. Improved interprofessional relations may be important to ensure optimal care of shared patients.

This study examined the relationships between attitudes toward and intention to receive the human papilloma virus (HPV) vaccination and intention to use condoms in a sample of female Korean college students. The data were collected in 2008 using a survey administered to a convenience sample of 1359 female Korean college students. Despite the availability of the HPV vaccine in South Korea, many college-age females are not being vaccinated. Attitudes towards the HPV vaccine appear to be an important contributing factor in vaccination, underscoring the need to make information widely available, to promote HPV vaccination, and to help women make informed decisions.

An Undergraduate Nurse Employment Demonstration Project (UNDP) was implemented in four Health Service Areas in British Columbia with a concurrent evaluation study. This demonstration project comprised the development and implementation of a new position in the BC healthcare system. The position enabled third- and fourth-year nursing students to be employed at their level of education. The purposes of the evaluation were to explore the feasibility and outcomes of this type of paid undergraduate student nurse employment. The three-year project and evaluation included both implementation and outcome analysis. The implementation evaluation design was descriptive and prospective, involving multiple data sources. The outcome evaluation design was quasi-experimental, with intervention and comparison groups. Learning outcomes for undergraduate nurses were increased confidence, organizational ability, competency and ability to work with a team. Workplace outcomes were increased unit morale, help with workload and improved patient care. New graduates with undergraduate nurse experience reported less time required for orientation and transition than other graduates who did not have this experience, and workplace nurses viewed these new graduates as more job-ready than other new graduates. After 21 months, new graduates with undergraduate nurse experience were less likely to move to other employment than other new graduates. Results from the four Health Service Areas indicated that the paid undergraduate nurse position was feasible and that outcomes benefited students, new graduates and workplaces. The undergraduate nurse position is now being implemented throughout all Health Service Areas in British Columbia.By 2000, concerns in British Columbia about the nursing workforce, workplace and patient safety had escalated to the point where diverse stakeholder groups were prepared to work together in new ways to prepare nursing graduates to be more job-ready, to recruit and retain new graduates and to retain existing nurses. Stakeholder groups were administrators, labour organizations, professional associations, educators and government. One idea to support job readiness and retention focussed on the feasibility of implementing cooperative education for nursing students. The effort was unsuccessful owing to lack of funding, but resulted in a review of the literature on cooperative education and other work-study programs. Cooperative education connects classroom learning with paid work experience for the purpose of enhancing students' education (Fitt and Heverly 1990; Heinemann and De Falco 1992; Ryder 1987). Reported benefits for students were improved job preparation and graduate retention (Ishida et al. 1998), additional staffing and reduction in orientation time (Cusack 1990; Ishida et al. 1998), increased practice judgment (Cusack 1990; Siedenberg 1989) and better workload management (Ross and Marriner 1985). A work-study model reported in the literature offered benefits similar to those of cooperative education, with greater flexibility in design. An example was the University of Texas Health Science Center at Houston's collaborative work-study scholarship program with local hospitals (Kee and Ryser 2001). Students in second clinical semesters were employed as unlicensed personnel by hospitals. The students, as unlicensed personnel, worked to the level of their nursing preparation. Reported benefits for students were academic credit, financial assistance, interaction with multidisciplinary teams, opportunity to refine clinical skills, understanding of nurses' roles and guaranteed interview for positions on graduation (Kee and Ryser 2001). Benefits for practice organizations were skilled help, the opportunity to recruit new nurses and increased interaction with a university nursing program. While nurse education stakeholders in British Columbia were exploring options, the concept of undergraduate student nurse employment was initiated by a group of fourth-year students at the University of Victoria who were completing the course "Nurses Influencing Change." The students were concerned about having enough practice experience to meet increasing nursing competency requirements and their survival as new graduates given workplace realities. Debt load also was a concern because extensive student practicum time limited opportunities for paid employment during the nursing education program. Students found that the idea of paid undergraduate nurse positions, based on the student employment model in Alberta, was supported by nurse leaders, many practising nurses and nursing faculty who also were concerned about meeting patient care standards and adequately preparing nursing students. In 2000, the BC Ministry of Health Services funded an Undergraduate Nurse Demonstration Project (UNDP)- one type of paid employment for undergraduate student nurses - in four Health Service Areas linked with four schools of nursing. A concurrent three-year evaluation study examined the feasibility and outcomes of the UNDP (Gamroth et al. 2004). This paper summarizes the findings of the evaluation. Evaluation Research An Undergraduate Nurse Employment Demonstration Project (UNDP) was implemented in four Health Service Areas in British Columbia with a concurrent evaluation study. This demonstration project comprised the development and implementation of a new position in the BC healthcare system. The position enabled third- and fourth-year nursing students to be employed at their level of education. The purposes of the evaluation were to explore the feasibility and outcomes of this type of paid undergraduate student nurse employment. The three-year project and evaluation included both implementation and outcome analysis. The implementation evaluation design was descriptive and prospective, involving multiple data sources. The outcome evaluation design was quasi-experimental, with intervention and comparison groups. Learning outcomes for undergraduate nurses were increased confidence, organizational ability, competency and ability to work with a team. Workplace outcomes were increased unit morale, help with workload and improved patient care. New graduates with undergraduate nurse experience reported less time required for orientation and transition than other graduates who did not have this experience, and workplace nurses viewed these new graduates as more job-ready than other new graduates. After 21 months, new graduates with undergraduate nurse experience were less likely to move to other employment than other new graduates. Results from the four Health Service Areas indicated that the paid undergraduate nurse position was feasible and that outcomes benefited students, new graduates and workplaces. The undergraduate nurse position is now being implemented throughout all Health Service Areas in British Columbia. By 2000, concerns in British Columbia about the nursing workforce, workplace and patient safety had escalated to the point where diverse stakeholder groups were prepared to work together in new ways to prepare nursing graduates to be more job-ready, to recruit and retain new graduates and to retain existing nurses. Stakeholder groups were administrators, labour organizations, professional associations, educators and government. One idea to support job readiness and retention focussed on the feasibility of implementing cooperative education for nursing students. The effort was unsuccessful owing to lack of funding, but resulted in a review of the literature on cooperative education and other work-study programs. Cooperative education connects classroom learning with paid work experience for the purpose of enhancing students' education (Fitt and Heverly 1990; Heinemann and De Falco 1992; Ryder 1987). Reported benefits for students were improved job preparation and graduate retention (Ishida et al. 1998), additional staffing and reduction in orientation time (Cusack 1990; Ishida et al. 1998), increased practice judgment (Cusack 1990; Siedenberg 1989) and better workload management (Ross and Marriner 1985). A work-study model reported in the literature offered benefits similar to those of cooperative education, with greater flexibility in design. An example was the University of Texas Health Science Center at Houston's collaborative work-study scholarship program with local hospitals (Kee and Ryser 2001). Students in second clinical semesters were employed as unlicensed personnel by hospitals. The students, as unlicensed personnel, worked to the level of their nursing preparation. Reported benefits for students were academic credit, financial assistance, interaction with multidisciplinary teams, opportunity to refine clinical skills, understanding of nurses' roles and guaranteed interview for positions on graduation (Kee and Ryser 2001). Benefits for practice organizations were skilled help, the opportunity to recruit new nurses and increased interaction with a university nursing program. While nurse education stakeholders in British Columbia were exploring options, the concept of undergraduate student nurse employment was initiated by a group of fourth-year students at the University of Victoria who were completing the course "Nurses Influencing Change." The students were concerned about having enough practice experience to meet increasing nursing competency requirements and their survival as new graduates given workplace realities. Debt load also was a concern because extensive student practicum time limited opportunities for paid employment during the nursing education program. Students found that the idea of paid undergraduate nurse positions, based on the student employment model in Alberta, was supported by nurse leaders, many practising nurses and nursing faculty who also were concerned about meeting patient care standards and adequately preparing nursing students.

Aim of the study The objectives of the study were to investigate and describe the attitude of Saudi pharmacy students toward pharmaceutical care. Method A survey of pharmacy students (8th-10th educational levels) was conducted from September to December 2006, in college of pharmacy King Saud University, Riyadh. The students completed a self-administered questionnaire designed to test the study objectives. The instrument (Standard Pharmaceutical Care Attitudes Survey, PCAS) used in the questionnaire was developed and revalidated in USA. Descriptive statistics on the sample characteristics and questionnaire items include means, standard deviation and frequency distribution. Student's t test and one-way ANOVA were used for inferential statistics. Results A total of 214 students (85.6% response rate) completed the questionnaire. The Cronbach alpha was found to be 0.792. Of the respondents, 95.2% felt that pharmaceutical care movement will improve patient health, 94.9% thought that the practice of pharmaceutical care is valuable, 85%"strongly agree" or "agree" that all pharmacists should perform pharmaceutical care, whereas, about two third (64.5%)"strongly agree" or "agree" that students should perform pharmaceutical care during their clerkships. The rated scores and factor loading, which are used to determine items that belong to the group responses, were reported. Determination of communalities reveled no item had loading factor of <0.4 and therefore, the mean total score was computed to be 56.17 +/- 0.29019. Females had significantly higher positive attitudes than their male counterparts, and this were also associated with age and marital status. Conclusion Saudi pharmacy students in the study indicated favorable positive attitudes toward pharmaceutical care, and the attitude ratings were associated with age, sex and marital status. A nationwide survey including all pharmacy faculties would provide further evidence. The validity of PCAS needs cross validation in Saudi Arabia.

PURPOSE: To determine the self-concepts of chiropractic students as science students and if any personal variable affect their self-concepts. PARTICIPANTS: Students in their first trimester and eighth trimester at the Los Angeles College of Chiropractic during the 1993 academic year (n=158). METHODS: Peterson-Yaakobi Q-Sort, National Assessment of Educational Progress, two-tailed T-test, one way analysis of variance and Spearman-rho correlation. RESULTS: The majority of students have positive self- concepts as science students and although there was a difference between the 2 trimesters, it was not significant. As a group they generally had less exposure to science compared to undergraduates from a selected science program. Variables of socio-economic status, undergraduate major, and highest completed level of education did not statistically affect their self-concept. CONCLUSION: Chiropractic students had the self-concept that enables them to subscribe to the philosophical foundations of science and better engage in basic sciences and, later, science-based clinical research. Knowledge of this self- concept can be used in the development of a more rigorous basic science curricula and clinical research programs at chiropractic colleges with the ultimate goal of providing a more firm scientifically based foundation for the profession.

PURPOSE: Construct validity and concurrent validity were investigated in a prototype survey instrument, the Public Opinion Survey of Human Attributes-Experimental Edition (POSHA-E). The POSHA-E was designed to measure public attitudes toward stuttering within the context of eight other attributes, or "anchors," assumed to range from negative (e.g.,"mental illness"), to neutral (e.g.,"left handed"), to positive (e.g.,"intelligent"). METHOD: Two respondent samples, each composed of 32 adults, completed the POSHA-E on two occasions. Both samples were reported in previously published studies [Reichel, I.,& St. Louis, K. O.(2004). Effects of emotional intelligence training in graduate fluency disorders courses. In A. Packman, A. Meltzer,& H. F. M. Peters (Eds.), Proceedings of the 4th world congress on fluency disorders (pp. 474-481). Nijmegen, The Netherlands: Nijmegen University Press; St. Louis, K. O., Lubker, B. B., Yaruss, J. S.,& Aliveto, E. F.(in press). Development of a prototype questionnaire to survey public attitudes toward stuttering: Reliability of the second prototype. Contemporary Issues in Communication Sciences and Disorders]. One sample completed the POSHA-E twice, two weeks apart, and the results were analyzed for test-retest reliability (T-R). Another sample consisted of graduate students completing the POSHA-E before and after a course in fluency disorders (VAL) to measure changes in students' attitudes toward stuttering. This group also filled out the Bipolar Adjective Scale (BAS) to obtain a second measure of attitudes toward stuttering. RESULTS: Comparing the two groups, VAL respondents' mean ratings about stuttering changed more, and generally in the expected direction of more "positive" attitudes, than T-R respondents' ratings. Moreover, VAL rating changes were in similar directions on the POSHA-E and the BAS. CONCLUSIONS: Results of the study permit the interpretation that the POSHA-E satisfies indicators of construct and concurrent validity, and provides evidence that it can measure positive changes in attitudes. EDUCATIONAL OBJECTIVES: The reader will be able to:(1) define the concepts of construct validity and concurrent validity;(2) describe construct validity and concurrent validity in reference to survey development; and (3) discuss general principles of attitude changes of students after taking a course in fluency disorders.