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Following on from ideas developed by Gerstmann, a body of work has suggested that impairments in finger gnosis may be causally related to children's difficulties in learning arithmetic. We report a study with a large sample of typically developing children (N=197) in which we assessed finger gnosis and arithmetic along with a range of other relevant cognitive predictors of arithmetic skills (vocabulary, counting, and symbolic and nonsymbolic magnitude judgments). Contrary to some earlier claims, we found no meaningful association between finger gnosis and arithmetic skills. Counting and symbolic magnitude comparison were, however, powerful predictors of arithmetic skills, replicating a number of earlier findings. Our findings seriously question theories that posit either a simple association or a causal connection between finger gnosis and the development of arithmetic skills.

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Pattern understanding (patterning) is commonly taught in early years classrooms. However, the relationship between patterning and academic attainment is not well understood. Studies investigating children's pattern understanding are reviewed. There is some evidence to suggest that pattern understanding is causally related to acquiring math and reading skills. However, much of the evidence is weak and these conclusions remain tentative. Future studies of the relationship between patterning and other skills need to use psychometrically robust measures and analytic techniques that control for the effects of measurement error. The suggestion from current studies that training patterning skills in young children can improve math and reading attainments is tantalizing but larger, methodologically more robust, Randomized Controlled Trials are badly needed to confirm such claims.

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The benefits of a holistic approach to health care include positive outcomes for patients and financial benefits for hospitals and the community. Traditionally, holistic health care incorporated only physical, psychological and social needs of patients and excluded spiritual and religious aspects. This trend has changed in recent years with health care experiencing the integrated work of chaplains, pastoral carers and spiritual carers. As evidence supports a positive relationship between religious/spiritual involvement and physical/mental health outcomes, this development is indeed worthwhile. This literature review explores issues of spiritual care, pastoral care and chaplaincy and the relationship to quality patient care within a context of holistic health care.