Exposure of male mice to early life stress alters the levels of specific sperm miRNAs that promote stress-associated behaviors in their offspring. To begin to evaluate whether similar phenomena occur in men, we searched for sperm miRNA changes that occur in both mice and men exposed to early life stressors that have long-lasting effects. For men, we used the Adverse Childhood Experience (ACE) questionnaire. It reveals the degree of abusive and/or dysfunctional family experiences when young, which increases risks of developing future psychological and physical disorders. For male mice, we used adolescent chronic social instability (CSI) stress, which not only enhances sociability defects for >1 year, but also anxiety and defective sociability in female offspring for multiple generations through the male lineage. Here we found a statistically significant inverse correlation between levels of multiple miRNAs of the miR-449/34 family and ACE scores of Caucasian males. Remarkably, we found members of the same sperm miRNA family are also reduced in mice exposed to CSI stress. Thus, future studies should be designed to directly test whether reduced levels of these miRNAs could be used as unbiased indicators of current and/or early life exposure to severe stress. Moreover, after mating stressed male mice, these sperm miRNA reductions persist in both early embryos through at least the morula stage and in sperm of males derived from them, suggesting these miRNA changes contribute to transmission of stress phenotypes across generations. Since offspring of men exposed to early life trauma have elevated risks for psychological disorders, these findings raise the possibility that a portion of this risk may be derived from epigenetic regulation of these sperm miRNAs.

It is now widely accepted that effective interpersonal communication is at the heart of quality health care delivery but that current standards in medicine must be improved (Numann 1988; Cowan et al. 1992). One approach acknowledged by the General Medical Council (1991) devotes more attention during training to the theme of communication, and quite significant modifications of the undergraduate medical curriculum are presently taking place. This article documents the results of a postal survey of the 26 UK Schools of Medicine, designed to illuminate current practices and future plans in respect of communication skills training (CST). As such, it takes advantage of the present period of ongoing curricular innovation and change to extend and update earlier reviews (Whitehouse 1991; Frederikson & Bull 1992). A total of 19 responses was received. Following preliminary analysis, the four schools who had already implemented their new curriculum were selected for further in-depth investigation by means of telephone interviews. In addition to reporting frequencies and percentages for responses to questions, cross-tabulations were carried out to explore relationships between certain of the findings. Apart from some consistency in CST teaching methods adopted, the overall picture to emerge is one of considerable variability in such areas as course content, timing, duration and assessment. Foremost among the difficulties encountered in implementing CST appeared to be lack of adequate physical resources and suitably trained staff. Future plans were often sketchy and inchoate. Results are discussed and tentative recommendations for the further development of CST in the medical curriculum proffered.

Effective provider-patient communication and the relationships that it supports are located at the centre of quality health-care delivery. The patient-centred approach is increasingly seen as an effective way to provide effective patient care, being more sensitive and responsive to the needs of the individual. Empathy has been identified as a core component of "patient-centredness" but definitions often lack conceptual clarity. This paper proposes to clarify the definition of empathy keeping the discussion true to Rogers' original definitions of the concept whilst integrating the work of other writers. A major thrust is the development of an innovative conceptual model of empathy which has the potential to both integrate previous research findings and provide a framework for future research and training. The model is based in social psychological conceptions of attitude.

Background/aim: Increased enrolments in occupational therapy education programs, together with changes in the employment patterns of practising occupational therapists, have resulted in a crisis in fieldwork education in Australia.This study aimed to investigate fieldwork supervisors' perspectives regarding the benefits and challenges of providing fieldwork placements, explore the potential link between providing student placements and later workforce recruitment, and document currently employed models of fieldwork supervision. Methods: Participants included past, present and potential future fieldwork supervisors, sourced from fieldwork coordinators' databases at The University of Queensland and James Cook University. Using an online, purpose-designed questionnaire, descriptive data (frequencies and percentages) were gathered from forced-choice questions. For open-ended questions, content analysis was conducted to identify categories and themes. Results: One hundred and thirty-two surveys were completed. Benefits of fieldwork placements related to opportunities for later recruitment of fieldwork students, students conducting projects and developing resources, a sense of contributing to the occupational therapy profession, and the development of employee skills. Challenges related to staffing issues, lack of physical resources and prohibitive workload pressures. Multiple models of supervision were employed in supervisors' workplaces, and almost all participants responsible for workplace employment had employed fieldwork students they had previously supervised. Conclusions:The results demonstrate a strong link between supervision and later recruitment of fieldwork students, suggesting that supervision of students is of considerable advantage to the host organisations in the recruitment of appropriately prepared employees. The study also demonstrates additional benefits to be promoted to supervisors and organisations to encourage and support fieldwork placements.