A substantial proportion of American, Canadian and English preschoolers regularly participate in family child care making its quality of vital importance for the children concerned, their parents, the school system and the society in which they live. This article discusses the seven key caregiver behaviors and physical space characteristics…
Wong, Michelle S; Showell, Nakiya N; Bleich, Sara N; Gudzune, Kimberly A; Chan, Kitty S
To examine the association between healthcare provider communication quality and child obesity status, and the role of parent obesity and child race/ethnicity regarding this association. We conducted a cross-sectional secondary data analysis with the 2011-2013 Medical Expenditures Panel Survey of parents with children ages 6-12 (n=5390). We used multivariable logistic regression to examine the association of parent-reported healthcare provider communication quality (explaining well, listening carefully, showing respect, and spending enough time) with child obesity status, and effect modification by parent obesity and child race/ethnicity. Parents of obese children were more likely to report that their child's healthcare provider listened carefully (OR=1.41, p=0.002) and spent enough time (OR=1.33, p=0.022) than parents of non-obese children. Non-obese parents of obese children experienced better communication in the domains of listening carefully (pobese non-Hispanic Asian children and non-Hispanic Black children were more likely to report that providers explained things well (p=0.043) and listened carefully (p=0.012), respectively. Parents of obese children experienced better communication if parents were non-obese or children were non-Hispanic Black or Asian. Healthcare providers should ensure effective communication with obese parents of obese children. Copyright © 2017 Elsevier B.V. All rights reserved.
Bromer, Juliet; Korfmacher, Jon
Research Findings: Home-based child care accounts for a significant proportion of nonparental child care arrangements for young children in the United States. Yet the early care and education field lacks clear models or pathways for how to improve quality in these settings. The conceptual model presented here articulates the components of…
Forry, Nicole; Simkin, Shana; Wessel, Julia; Rodrigues, Katherine
Early life experiences are critical to a child's development. Research has shown that, for a variety of reasons, children born into low-income families are at a disadvantage when compared to their higher-income peers. Fortunately, research has also shown a positive association between high quality child care and the academic and social-emotional…
Full Text Available Context: With the critical Indian challenge on child survival and health, time is ripe to initiate focus on quality of services apart from measuring coverage, to bring about improvements. Aims: To assess the quality of child health services provided at 24 × 7 Primary Health Centers of Vadodara District in Gujarat in terms of Input and Process Indicators. Settings and Design: The study was carried out in 12 randomly chosen 24 × 7 Primary Health Centers (PHCs of Vadodara district using a modified quality assessment checklist of the Program on District Quality Assurance for Reproductive and Child Health (RCH services with use of scores from May 2010 to June 2011. Subjects and Methods: Inputs assessment was done by facility survey. Process assessment for the four child health service components used actual observation of service, review of records and interview of service providers and clients. Results: The mean obtained score for facilities in Input section was 65%. Highest score was obtained for Drugs and Consumables (86% followed by Equipments and Supplies (74%. The score obtained for Infrastructure facility was 65%, Personnel and training was 56% and Essential protocols and guidelines scored 43%. The mean obtained score in the process section was 55%. Highest scores were obtained for immunization at 76%. This was followed by newborn care (52%, growth monitoring (52%. management of sick child (41%. Conclusion: Quality improvement efforts should focus not only on resource-intensive structural improvements, but also on cost-effective measures at improving service delivery process, especially adherence to service guidelines by providers.
Swartz, Rebecca Anne; Wiley, Angela R.; A. Koziol, Natalie; Magerko, Katherine A.
Background: Family child care is commonly used in the US by families, including by those receiving child care subsidies. Psychosocial influences upon the workforce and professional development participation of family child care providers (FCCPs) have implications for the investment of public dollars that aim to improve quality and stability of…
Durden, Tonia; Mincemoyer, Claudia; Crandall, Leslie; Alviz, Kit; Garcia, Aileen
High-quality family childcare (FCC) can positively influence all areas of a child's growth and development. Thus, it is important to invest in efforts to increase quality, including providing professional development to enhance the skills of those caring for children in their homes. This study explores the characteristics of FCC providers who…
Donoghue, Elaine A
High-quality early education and child care for young children improves physical and cognitive outcomes for the children and can result in enhanced school readiness. Preschool education can be viewed as an investment (especially for at-risk children), and studies show a positive return on that investment. Barriers to high-quality early childhood education include inadequate funding and staff education as well as variable regulation and enforcement. Steps that have been taken to improve the quality of early education and child care include creating multidisciplinary, evidence-based child care practice standards; establishing state quality rating and improvement systems; improving federal and state regulations; providing child care health consultation; as well as initiating other innovative partnerships. Pediatricians have a role in promoting quality early education and child care for all children not only in the medical home but also at the community, state, and national levels. Copyright © 2017 by the American Academy of Pediatrics.
Schaack, Diana D.; Le, Vi Nhuan; Messan Setodji, Claude
Research Findings: Although there has been considerable research on the associations between the qualifications of teachers in center-based settings and preschool-age children's developmental outcomes, very little is known about the relationships between home provider qualifications and the developmental outcomes of toddlers who attend licensed…
The contributions in this thesis revolve around mothers' employment and child care quality. The first topic of interest is how mothers' employment is affected by modern child care services and parental leave entitlements. There is already an extensive literature on the effects of modern social
Levi, Benjamin H.; Crowell, Kathryn; Walsh, Kerryann; Dellasega, Cheryl
Background: Childcare providers are often "first responders" for suspected child abuse, and how they understand the concept of "reasonable suspicion" will influence their decisions regarding which warning signs warrant reporting. Objective: The purpose of this study was to investigate how childcare providers interpret the…
Lanigan, Jane D.
Objective: To examine the association between child care practices and child care provider knowledge and beliefs about their role in supporting children's healthful eating. Design: Longitudinal design using survey and observation data from baseline and year 1 of the Encouraging Healthy Activity and Eating in Childcare Environments (ENHANCE) pilot…
Oana Staiculescu; Angel-Cristian Staiculescu
Providing a high quality products and services is a key to business success. That is because high quality promotes customer satisfaction and customer satisfaction has a direct link to business revenue. Clients want quality products and services in order to feel they are getting value for money, especially in these hard economic times. Although it is well known that advertising may win new customers, quality can be the reason to keep them. A good manager is aware that the costs of winning mark...
Cleveland, Gordon; Krashinsky, Michael
Nonprofit child care centers are frequently observed to produce child care which is, on average, of higher quality than care provided in commercial child care centers. In part, this nonprofit advantage is due to different input choices made by nonprofit centers--lower child--staff ratios, better-educated staff and directors, higher rates of…
Lê Cook, Benjamin; Brown, Jonathan D; Loder, Stephen; Wissow, Larry
Significant Latino-white disparities in youth mental health care access and quality exist yet little is known about Latino parents' communication with providers about youth mental health and the role of acculturation in influencing this communication. We estimated regression models to assess the association between time in the US and the number of psychosocial issues discussed with the medical assistant (MA) and doctor, adjusting for child and parent mental health and sociodemographics. Other proxies of acculturation were also investigated including measures of Spanish and English language proficiency and nativity. Parent's length of time in the US was positively associated with their communication of: their child's psychosocial problems with their child's MA, stress in their own life with their child's MA, and their child's school problems with their child's doctor. These differences were especially apparent for parents living in the US for >10 years. Parent-child language discordance, parent and child nativity were also significantly associated with communication of psychosocial problems. Greater provider and MA awareness of variation in resistance to communicating psychosocial issues could improve communication, and improve the prevention, diagnosis and treatment of youth mental illness.
Hagy, Alison P.
An implicit price for child care staff-to-child ratio was used to study demand for child care quality. Direct purchase-of-service contracts or vouchers, which subsidize only providers meeting state regulations, effectively lower implicit price and have little influence on the demand for quality. (Author/SK)
Vermeer, Harriet J.; van IJzendoorn, Marinus H.; Cárcamo, Rodrigo A.; Harrison, Linda J.
The current study provides a systematic examination of child care quality around the globe, using the Environment Rating Scales (ERS). Additional goals of this study are to examine associations between ERS process quality and structural features (group size, caregiver-child ratio) that underpin quality and between ERS and more proximal aspects of…
Benjamin-Neelon, Sara E; Vaughn, Amber E; Tovar, Alison; Østbye, Truls; Mazzucca, Stephanie; Ward, Dianne S
Developing healthy eating behaviors and food preferences in early childhood may help establish future healthy diets. Large numbers of children spend time in child care, but little research has assessed the nutritional quality of meals and snacks in family child care homes. Therefore, it is important to assess foods and beverages provided, policies related to nutrition and feeding children, and interactions between providers and children during mealtimes. We examined associations between the nutrition environments of family child care homes and children's diet quality. We assessed the nutrition environments of 166 family child care homes using the Environment and Policy Assessment and Observation (EPAO) (scores range: 0-21). We also recorded foods and beverages consumed by 496 children in care and calculated healthy eating index (HEI) (scores range: 0-100). We used a mixed effects linear regression model to examine the association between the EPAO nutrition environment (and EPAO sub-scales) and child HEI, controlling for potential confounders. Family child care homes had a mean (standard deviation, SD) of 7.2 (3.6) children in care, 74.1% of providers were black or African American, and children had a mean (SD) age of 35.7 (11.4) months. In adjusted multivariable models, higher EPAO nutrition score was associated with increased child HEI score (1.16; 95% CI: 0.34, 1.98; p = 0.006). Higher scores on EPAO sub-scales for foods provided (8.98; 95% CI: 3.94, 14.01; p = 0.0006), nutrition education (5.37; 95% CI: 0.80, 9.94; p = 0.02), and nutrition policy (2.36; 95% CI: 0.23, 4.49; p = 0.03) were all associated with greater child HEI score. Foods and beverages served, in addition to nutrition education and nutrition policies in family child care homes, may be promising intervention targets for improving child diet quality. Copyright © 2018. Published by Elsevier Ltd.
Gerstenblatt, Paula; Faulkner, Monica; Lee, Ahyoung; Doan, Linh Thy; Travis, Dnika
Family child care providers contend with a number of work stressors related to the dual roles of operating a small business and providing child care in their home. Research has documented many sources of work related stress for family child care providers; however, research examining family child care providers' experiences outside of the…
EPA and the U.S. Geological Survey (USGS) have initiated the “Village Blue” research project to provide real-time water quality monitoring data to the Baltimore community and increase public awareness about local water quality in Baltimore Harbor and the Chesapeake Bay. The Village Blue demonstration project complements work that a number of state and local organizations are doing to make Baltimore Harbor “swimmable and fishable” 2 by 2020. Village Blue is designed to build upon EPA’s “Village Green” project which provides real-time air quality information to communities in six locations across the country. The presentation, “Real-time water quality monitoring and providing water quality information to the Baltimore Community”, summarizes the Village Blue real-time water quality monitoring project being developed for the Baltimore Harbor.
Kouros, Chrystyna D.; Papp, Lauren M.; Goeke-Morey, Marcie C.; Cummings, E. Mark
Using a daily diary method, this study examined concurrent and time-lagged relations between marital and parent-child relationship qualities, providing a test of the spillover and compensatory hypotheses. Additionally, this study tested both mothers’ and fathers’ depressive symptoms as moderators of these daily linkages. Participants were 203 families, in which mothers and fathers completed daily diaries for 15 days. At the end of each reporting day, parents independently rated the emotional quality of their relationship with their spouse and with their child that day. Controlling for global levels of marital satisfaction, marital conflict, and parenting, a positive association was found between mothers’ and fathers’ daily ratings of marital quality and their ratings of parent-child relationship quality, supporting the spillover hypothesis. When considering time-lagged relations, support was found for the compensatory hypothesis for mothers: lower levels of marital quality were related to increases in mother-child relationship quality from one day to the next. Further, both maternal and paternal depressive symptoms moderated the link between marital quality and the other parent’s relationship quality with their child. Whereas maternal depressive symptoms strengthened spillover relations for fathers on the next day, paternal depression was related to less spillover for mothers on the same day. Alternative models did not find evidence for parent-child relationship quality as a predictor of changes in marital quality on the next day. The findings underscore the importance of the quality of the marital relationship for predicting the quality of other family relationships. PMID:24821519
This study offers a profile of child care workers in family day care homes and child care centers, reporting general statistics and examining their wages, benefits, training, working conditions, and turnover rates. In addition, it looks at government regulation and licensing, employer-sponsored programs, child abuse, insurance rates, and federal…
The development of a checklist for use in monitoring and evaluating the quality of child care services, and the implications of use of the checklist by day care providers, are discussed. Several research studies that used the indicator checklist model have attempted to determine whether compliance with state child care regulations has a positive…
De Falco, Simona; Emer, Alessandra; Martini, Laura; Rigo, Paola; Pruner, Sonia; Venuti, Paola
Child healthy development is largely influenced by parent-child interaction and a secure parent-child attachment is predictively associated with positive outcomes in numerous domains of child development. However, the parent-child relationship can be affected by several psychosocial and socio-demographic risk factors that undermine its quality and in turn play a negative role in short and long term child psychological health. Prevention and intervention programs that support parenting skills in at-risk families can efficiently reduce the impact of risk factors on mother and child psychological health. This study examines predictors of mother-child interaction quality and child attachment security in a sample of first-time mothers with psychosocial and/or socio-demographic risk factors. Forty primiparous women satisfying specific risk criteria participated in a longitudinal study with their children from pregnancy until 18 month of child age. A multiple psychological and socioeconomic assessment was performed. The Emotional Availability Scales were used to measure the quality of emotional exchanges between mother and child at 12 months and the Attachment Q-Sort served as a measure of child attachment security at 18 months. Results highlight both the effect of specific single factors, considered at a continuous level, and the cumulative risk effect of different co-occurring factors, considered at binary level, on mother-child interaction quality and child attachment security. Implication for the selection of inclusion criteria of intervention programs that support parenting skills in at-risk families are discussed.
Lam, Marcus; Klein, Sacha; Freisthler, Bridget; Weiss, Robert E.
Reliable access to dependable, high quality childcare services is a vital concern for large numbers of American families. The childcare industry consists of private nonprofit, private for-profit, and governmental providers that differ along many dimensions, including quality, clientele served, and organizational stability. Nonprofit providers are theorized to provide higher quality services given comparative tax advantages, higher levels of consumer trust, and management by mission driven entrepreneurs. This study examines the influence of ownership structure, defined as nonprofit, for-profit sole proprietors, for-profit companies, and governmental centers, on organizational instability, defined as childcare center closures. Using a cross sectional data set of 15724 childcare licenses in California for 2007, we model the predicted closures of childcare centers as a function of ownership structure as well as center age and capacity. Findings indicate that for small centers (capacity of 30 or less) nonprofits are more likely to close, but for larger centers (capacity 30+) nonprofits are less likely to close. This suggests that the comparative advantages available for nonprofit organizations may be better utilized by larger centers than by small centers. We consider the implications of our findings for parents, practitioners, and social policy. PMID:23543882
Lam, Marcus; Klein, Sacha; Freisthler, Bridget; Weiss, Robert E
Reliable access to dependable, high quality childcare services is a vital concern for large numbers of American families. The childcare industry consists of private nonprofit, private for-profit, and governmental providers that differ along many dimensions, including quality, clientele served, and organizational stability. Nonprofit providers are theorized to provide higher quality services given comparative tax advantages, higher levels of consumer trust, and management by mission driven entrepreneurs. This study examines the influence of ownership structure, defined as nonprofit, for-profit sole proprietors, for-profit companies, and governmental centers, on organizational instability, defined as childcare center closures. Using a cross sectional data set of 15724 childcare licenses in California for 2007, we model the predicted closures of childcare centers as a function of ownership structure as well as center age and capacity. Findings indicate that for small centers (capacity of 30 or less) nonprofits are more likely to close, but for larger centers (capacity 30+) nonprofits are less likely to close. This suggests that the comparative advantages available for nonprofit organizations may be better utilized by larger centers than by small centers. We consider the implications of our findings for parents, practitioners, and social policy.
Fisk, William; Seppanen, Olli
This paper summarizes the current scientific evidence that improved indoor environmental quality can improve work performance and health. The review indicates that work and school work performance is affected by indoor temperature and ventilation rate. Pollutant source removal can sometimes improve work performance. Based on formal statistical analyses of existing research results, quantitative relationships are provided for the linkages of work performance with indoor temperature and outdoor air ventilation rate. The review also indicates that improved health and related financial savings are obtainable from reduced indoor tobacco smoking, prevention and remediation of building dampness, and increased ventilation. Example cost-benefit analyses indicate that many measures to improve indoor temperature control and increase ventilation rates will be highly cost effective, with benefit-cost ratios as high as 80 and annual economic benefits as high as $700 per person.
Garner, Pamela W.; Parker, Tameka S.
This article describes the implementation of a service-learning project, which was infused into a child development course. The project linked family child care providers, their licensing agency, and 39 preservice teachers in a joint effort to develop a parent handbook to be used by the providers in their child care businesses and to support…
Neuharth-Pritchett, Stacey; Getch, Yvette Q.
Limited information exists about management of asthma in child care settings and primary school classrooms. The goal of this study was to evaluate a brief asthma management intervention for child care providers and primary school teachers. Child care providers and primary school teachers were recruited to participate in two 3-h workshops on asthma…
Mocan, H Naci
Using a newly compiled data set, this paper estimates multi- product translog cost functions for 399 child care centers from California, Colorado, Connecticut, and North Carolina. Quality of child care is controlled by a quality index, which has been shown to be positively related to child outcomes by previous research. Nonprofit centers that receive public money, either from the state or federal government, (which is tied to higher standards), have total variable costs that are 18 percent hi...
Pluess, Michael; Belsky, Jay
Research on differential susceptibility to rearing suggests that infants with difficult temperaments are disproportionately affected by parenting and child care quality, but a major U.S. child care study raises questions as to whether quality of care influences social adjustment. One thousand three hundred sixty-four American children from…
Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace
Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…
McCombie, Sally M.
The current media are laden with reports of the many significant problems facing today's youth. In fact, parenting has become a national topic of discussion. Parenting instruction, a responsibility that had previously rested in the home, has become part of educational curricula. Courses in child development are offered for high school students in…
Werner, Claudia Denise
The use of center child care in Western countries has increased over the last three decades and is nowadays the most frequently used type of non-parental care for children aged zero to four (OECD, 2013). The aim of the current dissertation is to shed more light on indicators of child care quality in center child care and to answer the question whether narrow-focused caregiver interventions are effective in improving child care quality. The reported meta-analysis shows that narrow-focus interv...
Simona eDe Falco
Full Text Available Child healthy development is largely influenced by parent-child interaction and a secure parent-child attachment is predictively associated with positive outcomes in numerous domains of child development. However, the parent-child relationship can be affected by several psychosocial and socio-demographic risk factors that undermine its quality and in turn play a negative role in short and long term child psychological health. Prevention and intervention programs that support parenting skills in at-risk families can efficiently reduce the impact of risk factors on mother and child psychological health. This study examines predictors of mother-child interaction quality and child attachment security in a sample of first-time mothers with psychosocial and/or socio-demographic risk factors. Forty primiparous women satisfying specific risk criteria participated in a longitudinal study with their children from pregnancy until 18 month of child age. A multiple psychological and socioeconomic assessment was performed. The Emotional Availability Scales were used to measure the quality of emotional exchanges between mother and child at 12 months and the Attachment Q-Sort served as a measure of child attachment security at 18 months. Results highlight both the effect of specific single factors, considered at a continuous level, and the cumulative risk effect of different co-occurring factors, considered at binary level, on mother-child interaction quality and child attachment security. Implication for the selection of inclusion criteria of intervention programs that support parenting skills in at-risk families are discussed.
Torre, Carolyn T; Crowley, Angela A
Safe medication administration is an essential component of high-quality child care. Its achievement in New Jersey was impeded by a controversy over whether teaching child care providers medication administration involves registered nurses in the process of nursing delegation. Through the theoretical framework of the Diffusion of Innovation, this paper examines how the interpretation of regulatory policy related to nursing practice in New Jersey was adjusted by the Board of Nursing following a similar interpretation of regulatory policy by the Board of Nursing in Connecticut. This adjustment enabled New Jersey nurses to continue medication administration training for child care providers. National data supporting the need for training child care providers in medication administration is presented, the Diffusion of Innovation paradigm is described; the Connecticut case and the New Jersey dilemma are discussed; the diffusion process between the two states is analyzed and an assessment of the need for further change is made.
Jessica H. Mirman
Full Text Available Objectives: Child Restraint System (CRS misuse is common. We characterized caregivers’ use of child passenger safety informational and instructional resources and determined whether there were differences in the quality of CRS installations associated with prior exposure to specific resources as evaluated in a standardized CRS installation environment. Methods: Caregivers completed self-report surveys and installed a forward-facing CRS in a controlled environment. Installations were evaluated for security (tightness and accuracy (no errors by a child passenger safety technician (CPST. Results: CRS manuals were the most common way caregivers learned to install a CRS. Primary care providers (PCPs were the most frequently endorsed source of CRS safety information. There was no strong pattern of associations between prior exposure to resources and installation quality (security or accuracy, although some evidence supports protective effects of learning from CPSTs; 13% (19 out of 151 installations were secure and 57% (86 out of 151 installations were accurate. Conclusions: A focus on developing effective and lasting behavioral interventions is needed.
Mangione-Smith, R; McGlynn, E A
To present a conceptual framework for evaluating quality of care for children and adolescents, summarize the key issues related to developing measures to assess pediatric quality of care, examine some existing measures, and present evidence about their current level of performance. Assessing the quality of care for children poses many challenges not encountered when making these measurements in the adult population. Children and adolescents (from this point forward referred to collectively as children unless differentiation is necessary) differ from adults in two clinically important ways (Jameson and Wehr 1993): (1) their normal developmental trajectory is characterized by change, and (2) they have differential morbidity. These factors contribute to the limitations encountered when developing measures to assess the quality of care for children. The movement of a child through the various stages of development makes it difficult to establish what constitutes a "normal" outcome and by extension what constitutes a poor outcome. Additionally, salient developmental outcomes that result from poor quality of care may not be observed for several years. This implies that poor outcomes may be observed when the child is receiving care from a delivery system other than the one that provided the low-quality care. Attributing the suboptimal outcome to the new delivery system would be inappropriate. Differential morbidity refers to the fact that the type, prevalence, and severity of illness experienced by children is measurably different from that observed in adults. Most children experience numerous self-limited illness of mild severity. A minority of children suffer from markedly more severe diseases. Thus, condition-specific measures in children are problematic to implement for routine assessments because of the extremely low incidence and prevalence of most severe pediatric diseases (Halfon 1996). However, children with these conditions are potentially the segment of the
Bromer, Juliet; Henly, Julia R.
This paper presents a qualitative investigation of the work-family support roles of a sample of 29 child care providers serving low-income families in the Chicago area (16 family, friend, and neighbor providers (FFN), 7 licensed family child care providers (FCC), and 6 center-based teachers). Providers report offering low-income parents…
Using data from the American Time Use Survey, I find that a first-born child receives 20-30 more minutes of quality time each day with his or her parent than a second-born child of the same age from a similar family. The birth-order difference results from parents giving roughly equal time to each child at any point in time while the amount of…
Werner, Claudia Denise
The use of center child care in Western countries has increased over the last three decades and is nowadays the most frequently used type of non-parental care for children aged zero to four (OECD, 2013). The aim of the current dissertation is to shed more light on indicators of child care quality in
Pluess, Michael; Belsky, Jay
Research on differential susceptibility to rearing suggests that infants with difficult temperaments are disproportionately affected by parenting and child care quality, but a major U.S. child care study raises questions as to whether quality of care influences social adjustment. One thousand three hundred sixty-four American children from reasonably diverse backgrounds were followed from 1 month to 11 years with repeated observational assessments of parenting and child care quality, as well as teacher report and standardized assessments of children's cognitive-academic and social functioning, to determine whether those with histories of difficult temperament proved more susceptible to early rearing effects at ages 10 and 11. Evidence for such differential susceptibility emerges in the case of both parenting and child care quality and with respect to both cognitive-academic and social functioning. Differential susceptibility to parenting and child care quality extends to late middle childhood. J. Belsky, D. L. Vandell, et al.'s (2007) failure to consider such temperament-moderated rearing effects in their evaluation of long-term child care effects misestimates effects of child care quality on social adjustment.
Shpancer, Noam; Britner, Preston A.
Examined the possible existence, direction, and nature of subconscious, cognitive biases in participants' quality attributions to maternal and nonmaternal child-care interactions, the relationship of such biases to subject's background, and their attitudes toward child care and maternal employment. Potential explanations for the biases and the…
U.S. Department of Health & Human Services — Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2014 reporting. Dataset contains...
U.S. Department of Health & Human Services — Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2016 reporting. Source: Mathematica...
U.S. Department of Health & Human Services — Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2015 reporting. Source: Mathematica...
Franz, Annabel O; McKinney, Cliff
Previous literature has not examined the processes underlying the relations among parent-child relationship quality, parental psychopathology, and child psychopathology in the context of gender. Further, research examining these variables in emerging adulthood is lacking. The current study examined whether parent-child relationship quality would mediate the relation between parental and child psychopathology, and whether gender moderated these associations. Participants were emerging adults (N = 665) who reported on perceptions of their parents' and their own psychological problems as well as their parent-child relationship quality. Results indicated that the relation between parental internalizing problems and parent-child relationship quality was positive for males, and that mother-child relationship quality was related positively to psychological problems in males. This suggests that sons may grow closer to their parents (particularly their mother) who are exhibiting internalizing problems; in turn, this enmeshed relationship may facilitate transmission of psychopathology. Mediational paths were conditional upon gender, suggesting moderated mediation. Overall, the current study emphasizes that the complexities of parenting must be understood in the context of gender. Further, the mother-son dyad may particularly warrant further attention.
Lynch, Meghan; Batal, Malek
Recent research has revealed child care settings and providers to be important influences on children's developing behaviors. Yet most research on children's nutritional development has focused on home settings and parents. Thus, through semistructured interviews with child care providers, this study aimed to develop a better understanding of the…
Kilburn, Janice E.; Shapiro, Cheri J.
Strategic workforce training of organizations that provide services to families of young children with special needs can help strengthen families and prevent child maltreatment, but few curriculua are available for this purpose. One professional development curriculum, "Preventing Child Abuse and Neglect: Parent-Provider Partnerships in Child…
Gibbons, Stephen; Silva, Olmo
Child wellbeing at school and enjoyment of the learning environment are important economic outcomes, in particular because a growing body of research shows they are strongly linked to later educational attainments and labour market success. However, the standard working assumption in the economics of education is that parents choose schools on the…
Sangra, Albert; Fernandez-Michels, Pedro
Purpose: The paper seeks to describe the Catalan corporate e-learning providers from the perspective of quality perception, quality assessment and quality control. Design/methodology/approach: A literature review reveals key aspects of the definition of quality in e-learning. The results of the review constitute the basis for exploratory research…
Thackeray, Rosemary; Magnusson, Brianna M.
Background: Child care facilities are prime locations for the transmission of infectious and communicable diseases. Children and child care providers are at high risk for cytomegalovirus (CMV) infection which causes severe birth defects and developmental delays. Objective: The goals of study were: (1) to determine the level of cytomegalovirus…
Perry, Samuel L; Snawder, Kara J
Frequent pornography use is often negatively associated with marital quality. Recent research has argued that this negative association is particularly strong for those who are embedded in religious communities, likely due to the greater stigma and shame associated with viewing pornography. In order to test and extend this theory, the current study examined how religious service attendance moderates the link between parents' pornography consumption and four measures of parent-child relationship quality. Analyses of 2006 Portraits of American Life Study data (N = 2610) revealed that greater pornography viewing predicted negative outcomes on two out of four measures of parent-child relationship quality, while religious service attendance was associated with more positive parent-child relationship outcomes. Interaction effects, however, affirmed that the negative association between porn viewing frequency and three parent-child relationship outcomes was stronger for participants who attended religious services more often. Analyzing fathers (N = 771) and mothers (N = 904) separately revealed that the observed relationships held more consistently for fathers than mothers. Evidence for directionality was presented by incorporating re-interview data from 2012. While pornography use may be negatively associated with some aspects of parent-child relationship quality, this association was particularly strong for those embedded within religious communities, possibly owing to greater attendant guilt and shame.
Kaderli, Reto; Pfortmueller, Carmen A; Businger, Adrian P
In the last decade assessing the quality of healthcare has become increasingly important across the world. Switzerland lacks a detailed overview of how quality management is implemented and of its effects on medical procedures and patients' concerns. This study aimed to examine the systematics of quality management in Switzerland by assessing the providers and collected parameters of current quality initiatives. In summer 2011 we contacted all of the medical societies in Switzerland, the Federal Office of Public Health, the Swiss Medical Association (FMH) and the head of Swiss medical insurance providers, to obtain detailed information on current quality initiatives. All quality initiatives featuring standardised parameter assessment were included. Of the current 45 initiatives, 19 were powered by medical societies, five by hospitals, 11 by non-medical societies, two by the government, two by insurance companies or related institutions and six by unspecified institutions. In all, 24 medical registers, five seals of quality, five circles of quality, two self-assessment tools, seven superior entities, one checklist and one combined project existed. The cost of treatment was evaluated by four initiatives. A data report was released by 24 quality initiatives. The wide variety and the large number of 45 recorded quality initiatives provides a promising basis for effective healthcare quality management in Switzerland. However, an independent national supervisory authority should be appointed to provide an effective review of all quality initiatives and their transparency and coordination.
Kwon, Sooyoun; Yeoh, Yoonjae; Abe, Satoko
This study aimed to investigate the nutritional quality and patterns of lunch menus provided by child care centers in South Korea and Japan. The weekly lunch menus from Monday to Saturday that child care centers provided in November 2014 in South Korea and Japan were analyzed. For Korea, a total of 72 meals provided by 12 centers in Seoul were analyzed by referring to the homepage of the Center for Children's Foodservice Management, which serviced menus for child care centers. For Japan, a total of 30 meals provided by 5 child care centers in Tokyo were analyzed. Nutrient content and pattern in lunch menus were evaluated. The lunch menus in Korea and Japan provided 359.5 kcal (25.7% of the estimated energy requirement) and 376.3 kcal (29.5% of the estimated energy requirement), respectively. 'Rice + Soup + Main dish + Side dish I + Side dish II' were provided in 66.7% of meals in Korea, while various patterns with rice and soup as their bases were provided in Japan. The lunch menus of child care centers in Korea and Japan provide similar amounts of energy, protein, carbohydrate, vitamin A, calcium, and other nutrients. However, there were significant differences in the lunch menu patterns in Korea and Japan. This study provides information about the nutritional content and pattern of lunch menus at child care centers in Asian countries with rice as a staple food.
Hennink-Kaminski, Heidi; Vaughn, Amber E; Hales, Derek; Moore, Reneé H; Luecking, Courtney T; Ward, Dianne S
Formation of diet and physical activity habits begins during early childhood. However, many preschool-aged children in the United States do not achieve recommendations for a nutritious diet or active lifestyle. Two important spheres of influence, home and child care, could ensure that children receive consistent health messages. Innovative approaches that engage both parents and child care providers in a substantial way are needed. Social marketing, a promising approach for health promotion targeting children, uses principles that recognize the need to engage multiple stakeholders and to emphasize benefits and overcome barriers associated with behavior change. Yet, application of social marketing principles in interventions for preschool-age children is limited. Healthy Me, Healthy We (HMHW) is 2-arm, cluster randomized controlled trial to evaluate the effect of a 8-month social marketing campaign on the diet and physical activity behaviors of preschool children (3-4years old), their parents, and child care providers. The campaign is delivered by the child care center and includes branded classroom and at-home activities and materials. Primary outcomes are children's diet quality (assessed with Healthy Eating Index scores) and minutes of non-sedentary activity (measured via accelerometers). Secondary outcomes assess children's body mass index, nutrition and physical activity practices at the child care center and at home, and health behaviors of child care providers and parents. HMHW is an innovative approach to promoting healthy eating and physical activity in preschool children. The campaign targets children during a key developmental period and leverages a partnership between providers and parents to affect behavior change. Copyright © 2017 Elsevier Inc. All rights reserved.
Background: The umpteenth threats to change of healthcare provider by dissatisfied patients on formal sector health insurance are well known and can be a proxy indicator for the need for quality improvement in service delivery. Objective: This study was aimed at evaluating patientsf satisfaction with quality of care provided ...
Donisch, Katelyn; Bray, Chris; Gewirtz, Abigail
This study systematically examined child-service providers' conceptualizations of trauma-informed practice (TIP) across service systems, including child welfare, juvenile justice, mental health, and education. Eleven focus groups and nine individual interviews were conducted, totaling 126 child-service providers. Conventional content analysis was used to analyze the qualitative data with interrater reliability analyses indicating near perfect agreement between coders. Qualitative analysis revealed that child-service providers identified traumatic stress as an important common theme among children and families served as well as the interest in TIP in their service systems. At the same time, child-service providers generally felt knowledgeable about what they define TIP to be, although they articulated wide variations in the degree to which they are taught skills and strategies to respond to their traumatized clients. The results of this study suggest a need for a common lexicon and metric with which to advance TIP within and across child-service systems. © The Author(s) 2016.
Discusses the concept of Total Quality Management (TQM), developed by W. Edward Deming and Joseph Juran in 1940s, and its applications for child care centers. Discusses how TQM focuses on customer satisfaction, measuring performance, benchmarking, employee empowerment, and continuous training. Includes a list of suggested readings on TQM. (MDM)
Fanger, Povl Ole
Three recent independent studies have documented that the quality of indoor air has a significant and positive influence on the productivity of office workers. A combined analysis of the results of the three studies shows a significant relationship between productivity and perceived indoor air...... quality. The impact on productivity justifies a much higher indoor air quality than the minimum levels prescribed in present standards and guidelines. One way of providing air of high quality for people to breathe, without involving excessive ventilation rates and energy use, is to provide "personalized...... air" to each individual. The application of this concept is discussed....
Datta Gupta, Nabanita; Simonsen, Marianne
universal preschool programs and family day care vis-à-vis home care. We find that, compared to home care, being enrolled in preschool at age three does not lead to significant differences in child outcomes at age seven no matter the gender or the mother's level of education. Family day care, on the other...... hand, seems to significantly deteriorate outcomes for boys whose mothers have a lower level of education. Finally, longer hours in non-parental care lead to poorer child outcomes.......Exploiting a rich panel data child survey merged with administrative records along with a pseudoexperiment generating variation in the take-up of preschool across municipalities, we provide evidence of the effects on non-cognitive child outcomes of participating in large scale publicly provided...
Smith, Katy Duncan; Merchen, Eileen; Turner, Crystal D; Vaught, Cara; Fritz, Terrie; Mold, Jim
Providing recommended well child care to children insured bythe Medicaid Program can be challenging. Members of the Department of Family and Preventive Medicine (DFPM) at the University of Oklahoma Health Sciences Center contracted to help practices improve the rates and quality of well child care visits within the Oklahoma Medicaid Program. Sixteen pediatric and family medicine practices in three Oklahoma counties chose to participate in this quality improvement initiative. The records of Sooner Care-insured children age 0-20 were reviewed for both rate and quality of well child care visits made during the previous twelve months. Performance feedback was provided. Practice guidelines, Sooner Care requirements, and tips from exemplary practices were provided. In two of the counties, a case manager helped practices with challenging patients. Practice Enhancement Assistants (PEAs) then helped practices implement a variety of strategies to increase visit rates and improve the quality of early and periodic screening, diagnosis, and treatment (EPSDT) visits. Information technology (IT) support was provided when needed. The average rates of visits, for all counties combined, increased. Visit rates increased more in the younger age groups (birth to two years). There was significant improvement in quality of visits. Rates and quality improved much more in some practices than in others. A combination of academic detailing, performance feedback, practice facilitation, case management, and IT support produced increases in the quality and rates of EPSDT exams.
Sienkiewicz, Kristine L; Rainchuso, Lori; Boyd, Linda D; Giblin, Lori
Purpose: The aim of this study was to assess child care providers' level of knowledge of first aid management and attitudes towards dental injuries among preschool-age children within Fairfield County, Connecticut and Boston, Massachusetts. Methods: This descriptive cross-sectional study used a web-based, validated questionnaire adapted from several studies with permission from authors. A panel of 5 dental experts determined the relevance of the questions and overall content (I-CVI range 0.8-1; S-CVI = 0.95). The 28 question survey included demographics, level of knowledge, attitudes about traumatic dental injuries, emergency management, and 2 case study questions on management of luxation and tooth fracture. Survey data was coded and analyzed for associations and trends using STATA® statistics/data analysis software v. 11.2. Results: A total of 100 child care providers completed the online questionnaire. Eighty-four percent self-reported little to no knowledge about dental injury management. Sixty percent of child care providers agreed that they are responsible for managing dental injuries. Approximately two-thirds of child care providers reported not feeling adequately informed about dental injuries, with 77% expressing interest in receiving more information. Conclusions: The majority of child care providers' do not have the knowledge to perform adequate first aid following a dental injury. Professional development on first aid for dental injuries is recommended among this workforce population. Copyright © 2017 The American Dental Hygienists’ Association.
Lehrer, Joanne S.; Lemay, Lise; Bigras, Nathalie
The current study examined how parental perceptions of child care quality were related to external quality ratings and considered how parental perceptions of quality varied according to child care context (home-based or centre-based settings). Parents of 179 4-year-old children who attended child care centres (n = 141) and home-based settings…
Nelson, Jackie A.
Constructive parent-child conflict interactions that teach children to problem-solve and negotiate can enhance children's social adjustment. This paper identifies constructive and destructive qualities of mother-child conflict and explores whether child temperament moderated associations with changes in externalizing problems over time. One…
Lawrence, Sharmila; Stephens, Samuel A.
This "Topic of Interest" provides a comprehensive list of research in the Research Connections collection that was published in 2005 or later addressing issues related to quality improvement specifically in home-based child care. The resources are grouped under the following headings: Overviews, Summaries, and Reviews of Quality…
Many believe that increasing the quantity of children will lead to a decrease in their quality. This paper exploits plausibly exogenous changes in family size caused by relaxations in China's One Child Policy to estimate the causal effect of family size on school enrollment of the first child. The results show that for one-child families, an additional child significantly increased school enrollment of first-born children by approximately 16 percentage-points. The effect is larger for househo...
Akgündüz, Y.E.; Plantenga, J.
Little is known about how competition affects child care centers’ quality. This paper examines the impact of competition on the quality of Dutch child care centers. The results show that high density of child care centers in an area improves scores in quality assessment measures. The positive
Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas
Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier
Clark, Alena; Anderson, Jennifer; Adams, Elizabeth; Baker, Susan; Barrett, Karen
Objective: Determine child care providers' infant feeding knowledge, attitude and behavior changes after viewing the infant feeding Web site and determine the effectiveness of the Web site and bilingual educational materials. Design: Intervention and control groups completed an on-line pretest survey, viewed a Web site for 3 months, and completed…
Mishra, Kriti; Siddharth, V
Neural Tube defects are one of the most common congenital disorders, presenting in a paediatric rehabilitation set-up. With its wide spectrum of clinical presentation and possible complications, the condition can significantly impact an individual's functional capacity and quality of life. The condition also affects the family of the child leaving them with a lifelong impairment to cope up with. Through this 16-year-old child, we shed light on the effects of providing rehabilitation, even at a later stage and its benefits. We also get a glimpse of difficulties in availing rehabilitation services in developing countries and the need to reach out many more neglected children like him with good functional abilities. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Full Text Available Privately provided accommodation is a growing service in Uganda’s higher education sector due to education liberalization and demand for education. This research took a case study of Nsamizi Training Institute of Social Development (NTISD to determine the relationship between privately provided accommodation service quality and customer satisfaction. Specifically, the objectives of the study were (a to find out the relationship between security and NTISD students’ satisfaction with privately provided accommodation, and (b to find out the hierarchical level of importance of NTISD student satisfaction of the three service quality dimensions (reliability, security, and tangibles with privately provided accommodation. Using quantitative and qualitative modes of data analysis and a sample of 300 students from 20 private hostels, this study established a strong positive significant relationship between security and satisfaction regarding privately provided accommodation. This implies that accommodation service providers should increase the quality of security so as to increase the satisfaction of students regarding privately provided accommodation. The study established the hierarchical order of importance from the most important service quality dimension, respectively, as follows: reliability, security, and tangibles. Therefore, private accommodation service managers should pay extra attention to the dimensions in the same order.
Lemay, Lise; Bigras, Nathalie; Bouchard, Caroline
This study explored whether the relationships between specific features of child care quality and externalizing and internalizing behaviors in 24-month-old children are moderated by gender and temperament. Questionnaires were used to record children's gender and measure their temperament. Child care quality was observed with the "Échelles…
da Silva-Júnior, Ivam Freire; Hartwig, Andréia Drawanz; Stüermer, Vanessa Müller; Demarco, Giulia Tarquínio; Goettems, Marília Leão; Azevedo, Marina Sousa
This study aims to assess and compare Oral Health-Related Quality of Life (OHRQoL) in child abuse victims and non-abused children in a Southern Brazilian city. The study compared two independent samples of children aged 8-10 years: 48 child abuse victims recruited from a centre for Child and Adolescent Psychological Support (NACA) for abused children, and 144 public and private school students. Data collection consisted of administration of the Child Perceptions Questionnaire 8-10 (CPQ 8-10 ) to measure OHRQoL (dependent variable), clinical examination (dental caries), and collection of socioeconomic and demographic information (age, sex, skin colour, family income, and type of school). Multiple linear regression models were used to assess the association between presence of abuse and OHRQoL and subscales. After adjustment for clinical and sociodemographic variables, child abuse victims were found to exhibit higher CPQ scores on the overall scale and on the oral symptoms and functional limitations subscales. In conclusion, child abuse victims have a higher impact on OHRQoL. Based on the results, it is possible to suggest that greater care should be taken of these children, not only in providing treatment for oral disorders, but also in providing interdisciplinary care. Copyright © 2017 Elsevier Ltd. All rights reserved.
... health and safety, nutrition, first aid, the recognition of communicable diseases, child abuse detection... 45 Public Welfare 1 2010-10-01 2010-10-01 false Activities to improve the quality of child care... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve...
Shaharum bin Ramli
Nuclear Malaysia level quality manuals need to be shared with all divisions. A manual is usually distributed in the form of an electronic document that contains all procedures. Navigation from one heading or procedure to another should be facilitated by providing bookmarks or similar. This paper shows how to do it for Microsoft Word and PDF documents. (author)
Facility/staff themes which emerged as contributing to the poor care were; inadequate resources, inadequate staffing, poor teamwork, and inadequate knowledge/supervision. Conclusion The findings of this study reveal that health care workers rate the quality of emergency obstetric care they provide as poor. They were ...
Peterson, Carole; Nguyen, Duyen T K
The first years of life are typically shrouded by infantile amnesia, but there is enormous variability between adults in how early and how much they can remember from this period. This study examined one possible factor affecting this variability: whether the perceived quality of parent-child relationships is associated with the number of early memories young adults can retrieve, and their age at the time of their first memory. We found such associations but they were qualified by parent gender. Mother-child relationships that were more affectively intense (greater social support but also more negative interchanges) were associated with recalling more early memories, although paternal companionship was most associated with how early an individual's first memory was. Affective tone of retrieved memories was also assessed, and a greater proportion of affectively positive memories (as well as fewer affectively neutral memories for males) was associated with high parental involvement in children's lives.
Albrecht, F.; Blaschke, T.; Lang, S.; Abdulmutalib, H. M.; Szabó, G.; Barsi, Á.; Batini, C.; Bartsch, A.; Kugler, Zs.; Tiede, D.; Huang, G.
The availability and accessibility of remote sensing (RS) data, cloud processing platforms and provided information products and services has increased the size and diversity of the RS user community. This development also generates a need for validation approaches to assess data quality. Validation approaches employ quality criteria in their assessment. Data Quality (DQ) dimensions as the basis for quality criteria have been deeply investigated in the database area and in the remote sensing domain. Several standards exist within the RS domain but a general classification - established for databases - has been adapted only recently. For an easier identification of research opportunities, a better understanding is required how quality criteria are employed in the RS lifecycle. Therefore, this research investigates how quality criteria support decisions that guide the RS lifecycle and how they relate to the measured DQ dimensions. Subsequently follows an overview of the relevant standards in the RS domain that is matched to the RS lifecycle. Conclusively, the required research needs are identified that would enable a complete understanding of the interrelationships between the RS lifecycle, the data sources and the DQ dimensions, an understanding that would be very valuable for designing validation approaches in RS.
Boucher, Nathan A; Mcmillen, Marvin A; Gould, James S
Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization's quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts.
This article examines the results of an audit into recovery nurse knowledge and understanding of paediatric care standards. It will critically analyse the availability of current standards for children's services in the recovery room and discuss the need for a national document specifically dedicated to standards of practise for the care of the child in the recovery room providing immediate post operative care. The article will also look at the development of such a document.
Broekhuizen, Martine L; Aken, Marcel A G van; Dubas, Judith S; Mulder, Hanna; Leseman, Paul P M
The current study investigated whether the relation between child care quality and children's socio-emotional behavior depended on children's affective self-regulation skills and gender. Participants were 545 children (Mage=27 months) from 60 center-based child care centers in the Netherlands. Multi-level analyses showed that children with low affective self-regulation skills or who were male demonstrated less teacher-rated social competence when exposed to relatively low quality child care. In addition, children with low affective self-regulation skills also showed more social competence in the case of relatively high quality child care, suggesting mechanisms of differential susceptibility. No main effects of child care quality or interactions were found for teacher- and parent-rated externalizing behavior. These findings emphasize the importance of considering children's affective self-regulation skills and gender in understanding the effects of child care quality. High quality child care can be a means to strengthen children's social development. Copyright © 2015 Elsevier Inc. All rights reserved.
Ghaznavi, Kimia; Malik, Shaista
A gap exists in knowledge and the observed frequency with which patients with diabetes actually receive treatment for optimal cardiovascular risk reduction. Many interventions to improve quality of care have been targeted at the health systems level and provider organizations. Changes in several domains of care and investment in quality by organizational leaders are needed to make long-lasting improvements. In the studies reviewed, the most effective strategies often have multiple components, whereas the use of one single strategy, such as reminders only or an educational intervention, is less effective. More studies are needed to examine the effect of several care management strategies simultaneously, such as use of clinical information systems, provider financial incentives, and organizational model on processes of care and outcomes.
Broekhuizen, Martine L.; Van Aken, Marcel A G; Dubas, Judith S.; Mulder, Hanna; Leseman, Paul P M
The current study investigated whether the relation between child care quality and children's socio-emotional behavior depended on children's affective self-regulation skills and gender. Participants were 545 children (Mage=27 months) from 60 center-based child care centers in the Netherlands.
Li, W; Farkas, G; Duncan, GJ; Burchinal, MR; Vandell, DL
The effects of high- versus low-quality child care during 2 developmental periods (infant-toddlerhood and preschool) were examined using data from the National Institute of Child Health and Human Development Study of Early Child Care. Propensity score matching was used to account for differences in families who used different combinations of child care quality during the 2 developmental periods. Findings indicated that cognitive, language, and preacademic skills prior to school entry were hig...
McConley, Regina L; Mrug, Sylvie; Gilliland, M Janice; Lowry, Richard; Elliott, Marc N; Schuster, Mark A; Bogart, Laura M; Franzini, Luisa; Escobar-Chaves, Soledad L; Franklin, Frank A
Risk factors for child obesity may be influenced by family environment, including maternal depression, family structure, and parenting quality. We tested a path model in which maternal depression and single parent status are associated with parenting quality, which relates to three risk factors for child obesity: diet, leisure, and sedentary behavior. Participants included 4,601 5th-grade children and their primary caregivers who participated in the Healthy Passages study. Results showed that associations of maternal depression and single parenthood with child BMI are mediated by parenting quality and its relation to children's leisure activity and sedentary behavior. Interventions for child obesity may be more successful if they target family environment, particularly parenting quality and its impact on children's active and sedentary behaviors.
Jenaro, C; Vega, V; Flores, N; Cruz, M
Concepts such as support, quality of life and quality of services are customary in services for people with intellectual disabilities. The identification of the different ways of conceiving, prioritising and implementing these concepts by service providers can help to drive changes to achieve better personal outcomes for this population. The current study aims to identify service providers' perceptions regarding the quality of life of their clients and the quality of services they provide. It also aims to identify similarities and differences of appraisals among professionals, and to identify associations between supports, quality of life and quality of services. Data were collected from 22 service providers who attended three focus groups (professionals, direct support staff, and managers) from whom 424 comments were analysed. Service providers were asked about the required support for users, the meaning of quality of life for those users, and about features that should characterise quality services. Thematic analysis was employed and transcripts of the sessions were coded according to the dimensions of models on supports, quality of life and quality of services. Chi-squared tests were utilised to test for potential differences among groups. Each professional group has its own priorities concerning required supports. Among the organisation different and potentially conflicting perceptions regarding the meaning of experiencing quality of life coexist. Concerning quality of services, only managers mentioned personal outcomes. Finally, institutionalisation has a negative impact on supports, quality of life and quality of services. It is necessary to move beyond a shared awareness of the negative impact of institutionalisation towards the transformation of services in search of personal quality outcomes. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.
Pike, Alison; Oliver, Bonamy R
Bidirectional associations between sibling relationships and children's problem behaviors are robust, and links with prosocial behavior have also been reported. Using cross-lagged models, we were able to conservatively test temporal directions of links between positive and negative aspects of sibling relationships and children's prosocial behavior and conduct problems across a 3-year time span in middle childhood. The Avon Longitudinal Study of Parents and Children (ALSPAC; http://www.bristol.ac.uk/alspac/researchers/data-access/data-dictionary/) is an ongoing population-based study designed to investigate the effects of a wide range of factors on children's health and development. For the purposes of the current analyses, we included 2,043 ALSPAC families who had just 1 older sibling as well as the target child, with an age gap of no more than 5 years. Mothers reported about the quality of the sibling relationship and both children's prosocial behavior and conduct problems when the target child was 4 years of age and again when the target child was 7 years old. Confirming our hypothesis, individual child behavior was predictive of sibling relationship quality, and sibling relationship quality was predictive of later child behavior, providing robust evidence of bidirectionality for both prosocial behavior and conduct problems. It would be consistent to expect that an improvement in either sibling relationship quality or individual children's behavior could have a positive spill over effect. We also found evidence of older sibling dominance in the domain of prosocial behavior and the positive aspects of sibling interaction. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Datta Gupta, Nabanita; Simonsen, Århus Universitet, Marianne
universal pre-school programs and family day care vis-à-vis home care. We find that, compared to home care, being enrolled in pre-school at age three does not lead to significant differences in child outcomes at age seven no matter the gender or mother’s level of education. Family day care, on the other......Exploiting a rich panel data child survey merged with administrative records along with a pseudo-experiment generating variation in the take-up of pre-school across municipalities, we provide evidence of the effects on non-cognitive child outcomes of participating in large scale publicly provided...... hand, seems to significantly deteriorate outcomes for boys whose mothers have a lower level of education. Finally, increasing hours in family day care from 30-40 hours per week to 40-50 hours per week and hours in pre-school from 20-30 hours per week to 30-40 hours per week leads to significantly...
Datta Gupta, Nabanita; Simonsen, Marianne
universal pre-school programs and family day care vis-à-vis home care. We find that, compared to home care, being enrolled in pre-school at age three does not lead to significant differences in child outcomes at age seven no matter the gender or mother's level of education. Family day care, on the other......Exploiting a rich panel data child survey merged with administrative records along with a pseudo-experiment generating variation in the take-up of pre-school across municipalities, we provide evidence of the effects on non-cognitive child outcomes of participating in large scale publicly provided...... hand, seems to significantly deteriorate outcomes for boys whose mothers have a lower level of education. Finally, increasing hours in family day care from 30-40 hours per week to 40-50 hours per week and hours in pre-school from 20-30 hours per week to 30-40 hours per week leads to significantly...
Lin, Xiuyun; Zhang, Yulin; Chi, Peilian; Ding, Wan; Heath, Melissa A; Fang, Xiaoyi; Xu, Shousen
The purpose of the current study was to examine the mutual relationships between dyadic level (i.e., marital quality and parenting stress) and individual level factors (i.e., children and parental depressive symptoms) in families of children with Oppositional Defiant Disorder (ODD). Specifically, we explored whether marital interaction (marital quality) was associated with symptoms of child depression through parent-child interaction (parenting stress) and parent depressive symptoms. We also explored whether parent-child interaction was associated with symptoms of parent depression through marital interaction and child depressive symptoms. This study was conducted with 256 parent-child dyads, consisting of children with ODD and one of each child's parents. Participants were recruited from 14 primary schools located in northern, eastern, and southwestern China. Results revealed that marital quality predicted symptoms of child depression through the parenting stress, but not parent depressive symptoms; and parenting stress predicted symptoms of parent depression through marital quality, but not through child depressive symptoms. Also, parenting stress significantly and directly predicted parent depressive symptoms. We concluded in families of children with ODD, the association of marital interaction and parent-child interaction on both symptoms of parent and child depression highlighted the mutual effects of the couple subsystem and the parent-child subsystem. Furthermore, in regard to parental and child depressive symptoms, implications for intervention are provided.
Lin, Xiuyun; Zhang, Yulin; Chi, Peilian; Ding, Wan; Heath, Melissa A.; Fang, Xiaoyi; Xu, Shousen
The purpose of the current study was to examine the mutual relationships between dyadic level (i.e., marital quality and parenting stress) and individual level factors (i.e., children and parental depressive symptoms) in families of children with Oppositional Defiant Disorder (ODD). Specifically, we explored whether marital interaction (marital quality) was associated with symptoms of child depression through parent-child interaction (parenting stress) and parent depressive symptoms. We also explored whether parent-child interaction was associated with symptoms of parent depression through marital interaction and child depressive symptoms. This study was conducted with 256 parent-child dyads, consisting of children with ODD and one of each child's parents. Participants were recruited from 14 primary schools located in northern, eastern, and southwestern China. Results revealed that marital quality predicted symptoms of child depression through the parenting stress, but not parent depressive symptoms; and parenting stress predicted symptoms of parent depression through marital quality, but not through child depressive symptoms. Also, parenting stress significantly and directly predicted parent depressive symptoms. We concluded in families of children with ODD, the association of marital interaction and parent-child interaction on both symptoms of parent and child depression highlighted the mutual effects of the couple subsystem and the parent-child subsystem. Furthermore, in regard to parental and child depressive symptoms, implications for intervention are provided. PMID:29104548
Full Text Available The purpose of the current study was to examine the mutual relationships between dyadic level (i.e., marital quality and parenting stress and individual level factors (i.e., children and parental depressive symptoms in families of children with Oppositional Defiant Disorder (ODD. Specifically, we explored whether marital interaction (marital quality was associated with symptoms of child depression through parent-child interaction (parenting stress and parent depressive symptoms. We also explored whether parent-child interaction was associated with symptoms of parent depression through marital interaction and child depressive symptoms. This study was conducted with 256 parent-child dyads, consisting of children with ODD and one of each child's parents. Participants were recruited from 14 primary schools located in northern, eastern, and southwestern China. Results revealed that marital quality predicted symptoms of child depression through the parenting stress, but not parent depressive symptoms; and parenting stress predicted symptoms of parent depression through marital quality, but not through child depressive symptoms. Also, parenting stress significantly and directly predicted parent depressive symptoms. We concluded in families of children with ODD, the association of marital interaction and parent-child interaction on both symptoms of parent and child depression highlighted the mutual effects of the couple subsystem and the parent-child subsystem. Furthermore, in regard to parental and child depressive symptoms, implications for intervention are provided.
Nikolopoulos, Hara; Farmer, Anna; Berry, Tanya R; McCargar, Linda J; Mager, Diana R
In 2008, the Alberta government released the Alberta Nutrition Guidelines for Children and Youth (ANGCY) as a resource for child care facilities to translate nutrition recommendations into practical food choices. Using a multiple case study method, early adoption of the guidelines was examined in two child care centres in Alberta, Canada. Key constructs from the Diffusion of Innovations framework were used to develop an interview protocol based on the perceived characteristics of the guidelines (relative advantage, compatibility, complexity, trialability and observability) by child care providers. Analysis of the ANGCY was conducted by a trained qualitative researcher and validated by an external qualitative researcher. This entailed reviewing guideline content, layout, organisation, presentation, format, comprehensiveness and dissemination to understand whether characteristics of the guidelines affect the adoption process. Data were collected through direct observation, key informant interviews and documentation of field notes. Qualitative data were analysed using content analysis. Overall, the guidelines were perceived positively by child care providers. Child care providers found the guidelines to have a high relative advantage, be compatible with current practice, have a low level of complexity, easy to try and easy to observe changes. It is valuable to understand how child care providers perceive characteristics of guidelines as this is the first step in identifying the needs of child care providers with respect to early adoption and identifying potential educational strategies important for dissemination. © 2012 Blackwell Publishing Ltd.
Dev, Dipti A; Speirs, Katherine E; Williams, Natalie A; Ramsay, Samantha; McBride, Brent A; Hatton-Bowers, Holly
Supporting children's self-regulation in eating through caregivers' practice of responsive feeding is paramount to obesity prevention, and while much attention has been given to supporting children's self-regulation in eating through parents' responsive feeding practices in the home setting, little attention has been given to this issue in childcare settings. This qualitative study examines childcare providers' perspectives on using responsive feeding practices with young children (2-5years). Individual semi-structured interviews were conducted with providers until saturation was reached. Data was analyzed using thematic analysis. The final sample included 18 providers who were employed full-time in Head Start or state-licensed center-based childcare programs, cared for children (2-5y), and were directly responsible for serving meals and snacks. Providers were primarily (67%) employed in childcare programs that served children from low-income families and received reimbursement for meals and snacks from the US Department of Agriculture's Child and Adult Care Food Program. Three factors emerged that shaped childcare providers' experiences using responsive feeding practices: the providers' perspectives about whether or not young children can self-regulate food intake, their understanding of Child and Adult Care Food Program (CACFP) portion size regulations, and the availability of food at the center where they worked. Future research should examine how childcare providers' understanding of children's ability to self-regulate their food intake, the appropriate use of the CACFP regulations in relationship to serving sizes, and having food available to offer seconds promotes providers' use of responsive feeding practices in center-based childcare programs and children's dietary behaviors. Copyright © 2017 Elsevier Ltd. All rights reserved.
Recent changes to the Child Care and Development Fund (CCDF) require a state's child care market price survey to: (1) be statistically valid and reliable and (2) reflect variations in the cost of child care services by geographic area, type of provider, and age of child. States may use an alternative methodology for setting payment rates--such as…
Owen, Margaret Tresch; Klausli, Julia F.; Mata-Otero, Ana-Maria; Caughy, Margaret O'Brien
Research Findings: Child care delivery practices promoting continuous, primary caregiver-child relationships (relationship-focused child care) were evaluated for 223 preschool-age children (45% African American, 55% Latino) attending child care centers serving low-income children. Both relationship-focused and non-relationship-focused centers were…
Rose, Katherine K.; Vittrup, Brigitte; Leveridge, Tinney
Background: This study investigated parental decision making about non-parental child care programs based on the technological and quality components of the program, both child-focused and parent-focused. Child-focused variables related to children's access to technology such as computers, educational television programming, and the internet.…
Public Policy Forum, 2008
A recent survey of 430 parents in southeastern Wisconsin finds the majority are satisfied with the quality of their child care arrangements and their options for child care. Most say they would not change anything about their child care arrangement if they had the chance, and nearly two-thirds report a willingness to pay more for their current…
Yanos, Philip T; Garcia, Christine I; Hansell, Stephen; Rosato, Mark G; Minsky, Shula
This study investigated how managed care affects clinical decision-making in a behavioral health care system. Providers serving children and adolescents under both managed and unmanaged care (n = 28) were interviewed about their awareness of differences between the benefit arrangements, how benefits affect clinical decision-making, outcomes and quality of care; and satisfaction with care. Quantitative and qualitative findings indicated that providers saw both advantages and disadvantages to managed care. Although most providers recognized the advantages of managed care in increasing efficiency, many were concerned that administrative pressures associated with managed care compromise service quality.
Jenaro, C.; Vega, V.; Flores, N.; Cruz, M.
Background: Concepts such as support, quality of life and quality of services are customary in services for people with intellectual disabilities. The identification of the different ways of conceiving, prioritising and implementing these concepts by service providers can help to drive changes to achieve better personal outcomes for this…
Lary, D. J.
The urbanization of national and global populations is associated with increasing challenges to creation of sustainable and livable communities. In urban environments, there is currently a lack of accurate actionable information on atmospheric composition on fine spatial and temporal scales. There is a pressing need to better characterize the complex spatial distribution of environmental features of cityscapes and improve understanding of their relationship to health and quality of life. This talk gives an overview of integrating sensing of atmospheric composition on multiple scales using a wide range of devices from distributed low cost-sensors, to aerial vehicles, to satellites. Machine learning plays a key role in providing both the cross-calibration and turning the exposure dosimetry into actionable insights for urban environments.
Administration for Children & Families, 2015
The director measure is intended for use with program directors in center-based, family child care, and Head Start/Early Head Start settings for children from birth through five years old. This measure asks respondents general questions about the early childhood education environment, the children enrolled in the program, and how the program…
Hussein, A S; Ahmad, R; Ibrahim, N; Yusoff, A; Ahmad, D
To assess the knowledge, attitudes and experience of a group of Malaysian dental health care providers regarding child physical abuse (CPA) cases in terms of frequency of occurrence, diagnosis, risk factors and reporting. A questionnaire was distributed to all dental health care providers attending a national paediatric dentistry conference in Kuantan, Malaysia, and demographical variables, knowledge, attitudes and experience about CPA, risk factors and the reasons for not reporting abuse cases were collected. Descriptive statistics and bivariance analysis were performed. A 5 % level of statistical significance was applied for the analyses (p ≤ 0.05). The response rate was 74.7 %. Half of the respondents (52.8 %) stated that the frequency of occurrence of CPA is common in Malaysia. Full agreement between dental health care providers was not determined concerning the identification of signs of CPA and its risk factors. Although 83.3 % were aware that reporting CPA is a legal requirement in Malaysia, only 14.8 % have reported such cases. Lack of adequate history was the main reason for not reporting. Virtually two-thirds of the respondents (62 %) indicated that they had not received sufficient information about CPA and were willing to be educated on how to diagnose and report child abuse cases (81.5, 78.7 %, respectively). There were considerable disparities in respondents' knowledge and attitudes regarding the occurrence, signs of suspected cases, risk factors and reporting of CPA. Despite being aware of such cases, only a handful was reported. Enhancement in the education of Malaysian dental health care providers on recognising and reporting CPA is recommended.
An in-house staff development program was designed and implemented for unskilled child caregivers employed at Tiny Tots Educare Academies, Inc., a privately owned and operated child care center located in Ellenton, Florida. Employees had little knowledge of child development and other topics related to early childhood education and, therefore,…
Betancourt, Joseph R
The goal of this paper is to define cultural competence and present a practical framework to address crosscultural challenges that emerge in the clinical encounter, with a particular focus on the issue of nonadherence. English-language literature, both primary and reports from various agencies, and the author's personal experiences in clinical practice. Relevant literature on patient-centered care and cultural competence. There is a growing literature that delineates the impact of sociocultural factors, race, ethnicity, and limited-English proficiency on health and clinical care. The field of cultural competence focuses on addressing these issues. Health care providers need a practical set of tools and skills that will enable them to provide quality care to patients during a brief encounter, whatever differences in background that may exist. Cultural competence has evolved from the gathering of information and making of assumptions about patients on the basis of their sociocultural background to the development of skills to implement the principles of patient-centered care. This patient-based approach to cross-cultural care consists of first, assessing core cross-cultural issues; second, exploring the meaning of the illness to the patient; third, determining the social context in which the patient lives; and fourth, engaging in negotiation with the patient to encourage adherence. Addressing adherence is a particularly challenging issue, the determinants of which are multifactorial, and the ESFT (explanatory/social/fears/treatment) model--derived from the patient-based approach--is a tool that identifies barriers to adherence and provides strategies to address them. It obviously is impossible to learn everything about every culture and that should not be expected. Instead, we should learn about the communities we care for. More important, we should have a framework that allows us to provide appropriate care for any patient--one that deals with issues of adherence
Nicklas, T A; Baranowski, T; Baranowski, J C; Cullen, K; Rittenberry, L; Olvera, N
Children's intakes of fruit, juice, and vegetables (FJV) do not meet the recommended minimum of five daily servings, placing them at increased risk for development of cancer and other diseases. Because children's food preferences and practices are initiated early in life (e.g., 2-5 years of age), early dietary intervention programs may have immediate nutritional benefit, as well as reduce chronic disease risk when learned healthful habits and preferences are carried into adulthood. Families and child-care settings are important social environments within which food-related behaviors among young children are developed. FJV preferences, the primary predictor of FJV consumption in children, are influenced by availability, variety, and repeated exposure. Caregivers (parents and child-care providers) can influence children's eating practices by controlling availability and accessibility of foods, meal structure, food modeling, food socialization practices, and food-related parenting style. Much remains to be learned about how these influences and practices affect the development of FJV preferences and consumption early in life.
Dev, Dipti A; McBride, Brent A
The Academy of Nutrition and Dietetics (Academy) recommends feeding practices for child-care providers to establish nutrition habits in early childhood to prevent obesity. With >12 million US children in child care, little is known about child-care providers' feeding practices. The purpose of this study was to examine child-care providers' feeding practices to assess whether providers met the Academy's benchmarks and whether attainment of benchmarks varied across child-care contexts (Head Start, Child and Adult Care Food Program [CACFP], and non-CACFP). Cross-sectional data was collected in 2011 and 2012 from 118 child-care providers who completed self-administered surveys regarding their feeding practices for 2- to 5-year-old children. χ(2) tests and analysis of variance were used to determine variation across contexts. Head Start providers sat more frequently with children during meals (P=0.01), ate the same foods as children (P=0.001), and served meals family style (Pchildren (P=0.01) received more nutrition-education opportunities compared with CACFP and non-CACFP. Head Start providers encouraged more balance and variety of foods (Pchildren about nutrition (PAcademy's benchmarks compared with CACFP and non-CACFP providers. Possible reasons for this compliance might be attributed to Head Start nutrition performance standards and increased nutrition-training opportunities for Head Start staff. Head Start programs can serve as a model in implementing the Academy's benchmarks. Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
Huang, Keng-Yen; Caughy, Margaret O'Brien; Lee, Li-Ching; Miller, Therese; Genevro, Janice
This study examined the stability of maternal punitive/high-power discipline (PD) and inductive/authoritative discipline (ID) over the second and third years of life and the effect of maternal discipline on quality of mother–child interactions. Data from a longitudinal sample with 179 mother–toddler dyads were analyzed, and selected factors (i.e., child sex, temperament) that might moderate the association between maternal discipline and quality of mother–child interactions were also examined...
El-Dardiry, Giulia; Dimitrakaki, Christine; Tzavara, Chara; Ravens-Sieberer, Ulrike; Tountas, Yannis
In this paper, we examined dimensions of child health-related quality of life in Greece in relation to parental assessments of neighbourhood social capital and social support networks. For the analysis, two main measures were used: (1) child self-reported health-related quality of life in ten dimensions, as measured by the KIDSCREEN questionnaire;…
Frontline workers in the area of child welfare often enter the field without having taken any specialized coursework in the area of child maltreatment. This article discusses an interdisciplinary certificate program that is specifically designed to teach persons from various academic areas the knowledge and skills necessary to work with children who experience maltreatment. The child advocacy studies certificate program specifically focuses on coursework in the area of child maltreatment and child advocacy to better train future frontline workers in their vital roles. This certificate will decrease underreporting of child abuse cases by mandated reporters by making them more aware of the signs and symptoms of child maltreatment and also give students a greater understanding of how to work with individuals from various fields.
Dev, Dipti A; McBride, Brent A; Speirs, Katherine E; Blitch, Kimberly A; Williams, Natalie A
National early childhood obesity prevention policies recommend that child-care providers avoid controlling feeding practices (CFP) (eg, pressure-to-eat, food as reward, and praising children for cleaning their plates) with children to prevent unhealthy child eating behaviors and childhood obesity. However, evidence suggests that providers frequently use CFP during mealtimes. Using the Academy of Nutrition and Dietetics (2011) benchmarks for nutrition in child care as a framework, researchers assessed child-care providers' perspectives regarding their use of mealtime CFP with young children (aged 2 to 5 years). Using a qualitative design, individual, face-to-face, semi-structured interviews were conducted with providers until saturation was reached. Providers were selected using maximum variation purposive sampling from varying child-care contexts (Head Start, Child and Adult Care Food Program [CACFP]-funded centers, non-CACFP programs). All providers were employed full-time in Head Start or state-licensed center-based child-care programs, cared for children (aged 2 to 5 years), and were directly responsible for serving meals and snacks. Child-care providers' perspectives regarding CFP. Thematic analysis using NVivo (version 9, 2010, QSR International Pty Ltd) to derive themes. Providers' perspectives showed barriers, motivators, and facilitators regarding their use of mealtime CFP. Providers reported barriers to avoiding CFP such as CFP were effective for encouraging desired behaviors, misconceptions that providers were encouraging but not controlling children's eating, and fear of parents' negative reaction if their child did not eat. Providers who did not practice CFP were motivated to avoid CFP because they were unnecessary for encouraging children to eat, and they resulted in negative child outcomes and obesity. Facilitators as an alternative to CFP included practicing healthful feeding practices such as role modeling, peer modeling, and sensory exploration of
Sood, Erica; Pinder, Wendy; Pendley, Jennifer S.; Fisher, Alicia O.; Wali, Prateek D.; del Rosario, Fernando
Objective To examine the role of provider communication about psychosocial causes of abdominal pain and recommendations for psychosocial intervention during a gastroenterology clinic visit in predicting families’ causal beliefs and perceptions of treatment acceptability. Method Participants were 57 children with a diagnosed or suspected abdominal pain-related functional gastrointestinal disorder (FGID) presenting for an outpatient gastroenterology follow-up visit and their accompanying parent. Children and parents completed questionnaires assessing child anxiety and abdominal pain severity, recall of provider communication about causes of abdominal pain and recommendations for intervention, their own causal beliefs about pain, and perceived acceptability of cognitive behavioral therapy (CBT) and standard medical treatment (SMT) after reading descriptions of each treatment. Providers completed a questionnaire assessing their perceptions and communication about the causes of the child’s abdominal pain and perceived acceptability of CBT. Results Provider communication about psychosocial causes and interventions was reported infrequently by parents, children, and providers. Parents rated psychosocial causes for abdominal pain as less likely than physical causes, and children and parents rated CBT as less acceptable than SMT. Parents’ recall of provider communication about psychosocial causes was associated with their own causal beliefs about pain and their perceived acceptability of CBT. Children’s and parents’ recall of provider recommendations for psychosocial intervention was associated with their perceived acceptability of CBT. Conclusion Results highlight the importance of provider communication about psychosocial contributors to abdominal pain and psychosocial interventions for children with FGIDs. Medical and mental health providers can partner to deliver care to children with FGIDs using a biopsychosocial approach. PMID:27035693
Vu, Catherine M; Schwartz, Sara L; Austin, Michael J
BANANAS, Inc. is a nonprofit organization that has provided child care resource and referral services for over 35 years. BANANAS emerged as a grassroots effort initiated by a group of female volunteers who sought to build a network of women with children who needed childcare. As the organization developed, its leaders recognized and responded to additional needs, including resource and information sharing, workshops and classes, and political advocacy. Beginning as a collective, BANANAS has grown into a multifaceted service delivery and advocacy nonprofit operating with an annual budget of $12 million. This history of the agency reflects the development of a unique community-based effort, its challenges and rewards, and the multiple successes that this pioneering nonprofit has experienced.
Raikes, Helen; Torquati, Julia; Wang, Cixin; Shjegstad, Brinn
Research Findings: This study investigated parents' experiences using Child Care and Development Fund and other state-dispersed child care subsidies, reasons for choosing their current child care program, and perceptions of the quality of child care received from their current program. A telephone survey of 659 parents receiving child care…
Full Text Available OBJECTIVE: To compare caretakers' perceived quality of care (PQC for under-fives treated for malaria, pneumonia and diarrhoea by community health workers (CHWs and primary health facility workers (PHFWs. METHODS: Caretaker rated PQC for children aged (2-59 months treated by either CHWs or PHFWs for a bought of malaria, pneumonia or diarrhoea was cross-sectionally compared in quality domains of accessibility, continuity, comprehensiveness, integration, clinical interaction, interpersonal treatment and trust. Child samples were randomly drawn from CHW (419 and clinic (399 records from eight Midwestern Uganda districts. An overall PQC score was predicted through factor analysis. PQC scores were compared for CHWs and PHFWs using Wilcoxon rank-sum test. Multinomial logistic regression models were used to specify the association between categorized PQC and service providers for each quality domain. Finally, overall PQC was dichotomized into "high" and "low" based on median score and relative risks (RR for PQC-service provider association were modeled in a "modified" Poisson regression model. RESULTS: Mean (SD overall PQC was significantly higher for CHWs 0.58 (0 .66 compared to PHFWs -0.58 (0.94, p<0.0001. In "modified" Poisson regression, the proportion of caretakers reporting high PQC was higher for CHWS compared to PHFWs, RR=3.1, 95%CI(2.5-3.8. In multinomial models PQC was significantly higher for CHWs compared to PHFWs in all domains except for continuity. CONCLUSION: PQC was significantly higher for CHWs compared to PHFWs in this resource constrained setting. CHWs should be tapped human resources for universal health coverage while scaling up basic child intervention as PQC might improve intervention utilization.
Prosser Lisa A
Full Text Available Abstract Background Child maltreatment causes substantial morbidity and mortality in the U.S. Morbidity associated with child maltreatment can reduce health-related quality of life. Accurately measuring the reduction in quality of life associated with child maltreatment is essential to the economic evaluation of educational programs and interventions to reduce the incidence of child maltreatment. The objective of this study was to review the literature for existing approaches and instruments for measuring quality-of-life for child maltreatment outcomes. Methods We reviewed the current literature to identify current approaches to valuing child maltreatment outcomes for economic evaluations. We also reviewed available preference-based generic QOL instruments (EQ-5D, HUI, QWB, SF-6D for appropriateness in measuring change in quality of life due to child maltreatment. Results We did not identify any studies that directly evaluated quality-of-life in maltreated children. We identified 4 studies that evaluated quality of life for adult survivors of child maltreatment and 8 studies that measured quality-of-life for pediatric injury not related to child maltreatment. No study reported quality-of-life values for children younger than age 3. Currently available preference-based QOL instruments (EQ-5D, HUI, QWB, SF-6D have been developed primarily for adults with the exception of the Health Utilities Index. These instruments do not include many of the domains identified as being important in capturing changes in quality of life for child maltreatment, such as potential for growth and development or psychological sequelae specific to maltreatment. Conclusion Recommendations for valuing preference-based quality-of-life for child maltreatment will vary by developmental level and type of maltreatment. In the short-term, available multi-attribute utility instruments should be considered in the context of the type of child maltreatment being measured. However
Full Text Available Background: Infectious disease and malnutrition are common in children. Primary health care came into being to decrease the morbidity. Quality assessment is neither clinical research nor technology assessment. It is primarily an administrative device used to monitor performance to determine whether it continues to remain within acceptable bounds. Aims and Objectives: To assess the quality of service in the delivery of child health care in a primary health care setting. To evaluate client satisfaction. To assess utilization of facilities by the community. Materials and Methods: Study Type: Cross-sectional community-based study. Quality assessment was done by taking 30-50%, of the service provider. Client satisfaction was determined with 1 Immunization and child examination-90 clients each. Utilization of services was assessed among 478 households. Statistical Analysis: Proportions, Likert′s scale to grade the services and Chi-square. Results: Immunization service: Identification of needed vaccine, preparation and care was average. Vaccination technique, documentation, EPI education, maintenance of cold chain and supplies were excellent. Client satisfaction was good. Growth monitoring: It was excellent except for mother′s education andoutreach educational session . Acute respiratory tract infection care: History, physical examination, ARI education were poor. Classification, treatment and referral were excellent. Client satisfaction was good. Diarrheal disease care: History taking was excellent. But examination, classification, treatment, ORT education were poor. Conclusion: Mothers education was not stressed by service providers. Service providers′ knowledge do not go with the quality of service rendered. Physical examination of the child was not good. Except for immunization other services were average.
Milot, Tristan; St-Laurent, Diane; Ethier, Louise S; Provost, Marc A
This study (a) assessed whether child neglect is associated with posttraumatic stress disorder (PTSD) and dissociative symptoms in the preschool period and (b) examined the role of quality of mother-child affective communication in the development of trauma-related symptoms among neglected children. Participants were 33 neglected and 72 non-neglected preschoolers (mean age = 60 months). Neglected children were recruited from the Child Protection Agencies. Neglected and non-neglected children victims of other form of abuse were excluded from the study. Trauma symptoms were evaluated through mother and preschool teacher reports. Quality of mother-child affective communication was assessed in a lab visit during an unstructured task. According to teachers, neglected children displayed more PTSD and dissociative symptoms than non-neglected children. Quality of mother-child communication was lower in neglected dyads. Mother-child affective communication predicted teacher-reported child trauma symptomatology, over and above child neglect. Discussion focuses on the traumatic nature of child neglect and the underlying parent-child relational processes.
Langlais, Amanda G.
Recent changes made by the Council for Professional Recognition to the Child Development Associate (CDA) credentialing program create an opportunity to redesign high school child development programs. On April 1, 2011, the Council for Professional Recognition lifted the age restriction in the CDA credentialing requirements, now allowing students…
Dinehart, Laura; Kenny, Maureen C.
This study sought to assess child abuse knowledge and reporting practices of a diverse sample of early care and education (ECE) practitioners. One hundred and thirty-seven practitioners in the state of Florida completed the "Early Childhood Educators Child Abuse Questionnaire." Results revealed that only a minority of participants have…
Rosenthal, Marjorie S; Crowley, Angela A; Curry, Leslie
To describe the perspective and strategies of family child care providers (FCCPs) to reduce children's suboptimal weight trajectories. In-person, in-depth interviews with FCCPs. Family child care homes. Seventeen FCCPs caring for children 6 weeks to 9 years old; 94% caring for children paying with a state subsidy. Strategies of FCCP to reduce children's suboptimal weight trajectories. Constant comparative method of qualitative data analysis. Family child care providers described 3 core strategies: (1) improving children's behavior, (2) engaging and educating parents, and (3) leveraging influences external to their relationship with parents to effect positive change and to avoid parental conflict. These strategies were framed within their knowledge of child development, parental communication, and community services. The findings suggest that FCCPs' role in obesity prevention may be framed within knowledge that may be commonly expected of a child care provider. Partnerships between public health policy makers and FCCP may reduce obesigenic environments by employing training and resources that link obesity prevention and child care provider expertise. Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Communicable Diseases is very low in both settings though it is relatively better in Jimma University Specialized Hospital. Therefore, a continuous process of quality improvement is recommended in both settings. KEYWORDS: Health care, Health ...
Using multiple births as an exogenous shift in family size, I investigate the impact of the number of children on child investment and child well-being. Using data from the 1980 US Census Five-Percent Public Use Micro Sample, 2SLS results demonstrate that parents facing a change in family size reallocate resources in a way consistent with Becker's…
Landry, Susan H; Zucker, Tricia A; Taylor, Heather B; Swank, Paul R; Williams, Jeffrey M; Assel, Michael; Crawford, April; Huang, Weihua; Clancy-Menchetti, Jeanine; Lonigan, Christopher J; Phillips, Beth M; Eisenberg, Nancy; Spinrad, Tracy L; de Villiers, Jill; de Villiers, Peter; Barnes, Marcia; Starkey, Prentice; Klein, Alice
Despite reports of positive effects of high-quality child care, few experimental studies have examined the process of improving low-quality center-based care for toddler-age children. In this article, we report intervention effects on child care teachers' behaviors and children's social, emotional, behavioral, early literacy, language, and math outcomes as well as the teacher-child relationship. The intervention targeted the use of a set of responsive teacher practices, derived from attachment and sociocultural theories, and a comprehensive curriculum. Sixty-five childcare classrooms serving low-income 2- and 3-year-old children were randomized into 3 conditions: business-as-usual control, Responsive Early Childhood Curriculum (RECC), and RECC plus explicit social-emotional classroom activities (RECC+). Classroom observations showed greater gains for RECC and RECC+ teachers' responsive practices including helping children manage their behavior, establishing a predictable schedule, and use of cognitively stimulating activities (e.g., shared book reading) compared with controls; however, teacher behaviors did not differ for focal areas such as sensitivity and positive discipline supports. Child assessments demonstrated that children in the interventions outperformed controls in areas of social and emotional development, although children's performance in control and intervention groups was similar for cognitive skills (language, literacy, and math). Results support the positive impact of responsive teachers and environments providing appropriate support for toddlers' social and emotional development. Possible explanations for the absence of systematic differences in children's cognitive skills are considered, including implications for practice and future research targeting low-income toddlers.
Clair, Nancy; Miske, Shirley; Patel, Deepa
Since the breakup of the Soviet Union and former Yugoslavia, Central and Eastern European (CEE) countries have engaged in education reforms based on international frameworks. One of these, the Child-Friendly Schools (CFS) approach, is distinctively grounded in the Convention on the Rights of the Child (CRC). CFS standards are comprehensive,…
McBride, C M; Persky, S; Wagner, L K; Faith, M S; Ward, D S
Providing personalized genetic-risk feedback of a child's susceptibility to adult-onset health conditions is a topic of considerable debate. Family health history (FHH), specifically parental overweight/obesity status, is a useful assessment for evaluating a child's genetic and environmental risk of becoming obese. It is unclear whether such risk information may influence parents' efforts to reduce their child's risk of obesity. To evaluate whether telling mothers the magnitude of their child's risk of becoming obese based on personal FHH influenced food choices for their young child from a virtual reality-based buffet restaurant. Overweight/obese mothers of a child aged 4-5 years who met eligibility criteria (N=221) were randomly assigned to one of three experimental arms, which emphasized different health information: arm 1, food safety control (Control); arm 2, behavioral-risk information (BRI) alone or arm 3, behavioral-risk information plus personal FHH-based risk assessment (BRI+FHH). Mothers donned a head-mounted display to be immersed in a virtual restaurant buffet, where they selected virtual food and beverages as a lunch for their child. Mothers who were randomized to BRI+FHH filled the index child's plate with an average of 45 fewer calories than those in the Control arm (Prisk message (that is, only one overweight parent). The influence of communicating a child's inherited risk of obesity on mothers' feeding practices may vary by the risk level conveyed. High-risk messages may best be coupled with strategies to increase mother's perceptions that efforts can be undertaken to reduce risk and build requisite behavioral skills to reduce risk.
Cappe, Émilie; Poirier, Nathalie; Sankey, Carol; Belzil, Andréa; Dionne, Carmen
This study aimed to investigate the quality of life of parents of a child with autism spectrum disorder in Quebec. Seventy-seven participants completed a questionnaire with socio-biographic information and five self-assessed scales, to measure perceived stress, social support and control, coping strategies, and quality of life. Perception of their child's autonomy level, of the severity of the disorder, of the family's income, as well as changes in their professional or familial organization influenced parents' quality of life. Perceiving their situation as a threat predicted poor quality of life, whereas satisfaction of social support predicted good quality of life. In addition, parents who used problem solving and support-seeking coping strategies had a better relationship with their child, whereas those who used more emotion-centered coping strategies struggled. Lastly, parents who felt they had the power to contribute to their child's development were more satisfied and less disturbed. Beyond the parents' actual situation, our results underscore the importance of paying attention to their own perception of the situation in order to provide them with appropriate support.
Dev, Dipti A; Carraway-Stage, Virginia; Schober, Daniel J; McBride, Brent A; Kok, Car Mun; Ramsay, Samantha
National childhood obesity prevention policies recommend that child-care providers educate young children about nutrition to improve their nutrition knowledge and eating habits. Yet, the provision of nutrition education (NE) to children in child-care settings is limited. Using the 2011 Academy of Nutrition and Dietetics benchmarks for NE in child care as a guiding framework, researchers assessed child-care providers' perspectives regarding delivery of NE through books, posters, mealtime conversations, hands-on learning, and sensory exploration of foods to young children (aged 2 to 5 years). Using a qualitative design (realist method), individual, semistructured interviews were conducted until saturation was reached. The study was conducted during 2012-2013 and used purposive sampling to select providers. Final sample included 18 providers employed full-time in Head Start or state-licensed center-based child-care programs in Central Illinois. Child-care providers' perspectives regarding implementation of NE. Thematic analysis to derive themes using NVivo software. Three overarching themes emerged, including providers' motivators, barriers, and facilitators for delivering NE to children. Motivators for delivering NE included that NE encourages children to try new foods, NE improves children's knowledge of healthy and unhealthy foods, and NE is consistent with children's tendency for exploration. Barriers for delivering NE included that limited funding and resources for hands-on experiences and restrictive policies. Facilitators for delivering NE included providers obtain access to feasible, low-cost resources and community partners, providers work around restrictive policies to accommodate NE, and mealtime conversations are a feasible avenue to deliver NE. Providers integrated mealtime conversations with NE concepts such as food-based sensory exploration and health benefits of foods. Present study findings offer insights regarding providers' perspectives on
Scheig Associates, Inc., Gig Harbor, WA.
The two separate evaluation instruments combined here are designed to help companies identify applicants for the positions of director and child care provider who have the greatest probability of being outstanding performers on the job. Each instrument contains three sections. Section 1 is an interest and willingness checklist, which acts as a…
Roeters, A.; Lippe, A.G. van der; Kluwer, E.S.
This study investigated whether the amount and nature of parent-child time mediated the association between parental work characteristics and parent-child relationship quality. We based hypotheses on the conflict and enrichment approaches, and we tested a path model using self-collected data on
Roeters, Anne; Van Der Lippe, Tanja; Kluwer, Esther S.
This study investigated whether the amount and nature of parent-child time mediated the association between parental work characteristics and parent-child relationship quality. We based hypotheses on the conflict and enrichment approaches, and we tested a path model using self-collected data on 1,008 Dutch fathers and 929 Dutch mothers with…
Roeters, A.; Lippe, T. van der; Kluwer, E.S.
This study investigated whether the amount and nature of parent-child time mediated the association between parental work characteristics and parent-child relationship quality. We based hypotheses on the conflict and enrichment approaches, and we tested a path model using self-collected data on
Ponczek, Vladimir; Souza, Andre Portela
This paper presents new evidence of the causal effect of family size on child quality in a developing-country context. We estimate the impact of family size on child labor and educational outcomes among Brazilian children and young adults by exploring the exogenous variation of family size driven by the presence of twins in the family. Using the…
Whittaker, Jessica E. V.; Williford, Amanda P.; Carter, Lauren M.; Vitiello, Virginia E.; Hatfield, Bridget E.
Research Findings: This study explored the quality of teacher-child interactions within the context of a newly developed standardized task, Teacher-Child Structured Play Task (TC-SPT). A sample of 146 teachers and 345 children participated. Children who displayed the highest disruptive behaviors within each classroom were selected to participate.…
Wang, Xiaohua; Qu, Zhiyong; Zhou, Qianyun; Ran, Chun; Wang, Xia; Hu, Juan
The objective of this study was to examine rates of depression among migrant children (MC) and left-behind children (LBC) as compared to non-left-behind children (NLBC) and also to examine the relationship between depression among these children and the quality of their parent-child and teacher-child relationships. This study collected data from a large sample of 3,759 children aged from 8 to 17 years, including 824 who had been left behind by one parent (LBCO), 423 who had been left behind by both parents (LBCB), 568 MC and 1944 NLBC. Children’s Depression Inventory–Short Form was used to measure child depression. Parent-Child Relationship Scale (PCRS) and Teacher-Child Relationship Scale (TCRS) were used to measure the quality of parent-child and teacher-child relationships, respectively. The results showed that the prevalence of depression was 10.5% among NLBC, 13.1% among LBCO, 16.1% among LBCB, and 20.1% among MC. Depression was related to parent-child relationship quality and teacher-child relationship quality. Negative parent-child relationship was more relevant to depression than negative teacher-child relationship among LBCB, while negative teacher-child relationship was the most correlated with depression among MC. PMID:26719895
Many believe that increasing the quantity of children will lead to a decrease in their quality. This paper exploits plausibly exogenous changes in family size caused by relaxations in China's One Child Policy to estimate the causal effect of family size on school enrollment of the first child. The results show that for one-child families, an…
Simmons, J C
In recent years, increasing interest has been placed on how health care workers can be trained and equipped to better protect them from possible workplace accidents and injuries while improving the care they deliver. Better workplace safety also means better customer and employee satisfaction, improved workforce retention and recruitment, and cost savings. Workplace safety is constantly evolving and addresses a whole host of issues ranging from needles and sharps injuries to moving patients to human factor analyses. This issue takes a cross-sectional look at how hospitals and health systems are addressing problem areas--and sharing information and best practices--to strengthen their quality of care at the workplace level.
Anderson, Sheila; Qiu, Wei; Wheeler, Shanalyn J
The purpose of this study was to explore the influence of the quality of early father-child rough-and-tumble play (RTP) on toddler aggressive behaviors and more fully understand how child, mother, and father characteristics were associated with higher quality father-child RTP among contemporary urban Chinese families. Participants included 42 families in Changsha, China. Play observations of fathers and their children were coded for RTP quality. The specific RTP quality of father-child reciprocity of dominance was associated with fewer toddler aggressive behaviors, as rated by both fathers and mothers. Mothers' democratic parenting attitudes were associated with higher quality father-child RTP. These findings suggest that higher quality father-child RTP may be one way in which some fathers influence children's expression of aggressive behaviors, and the quality of father-child RTP may be influenced by the broader family, social, and cultural contexts. © 2017 Michigan Association for Infant Mental Health.
Hujala, Eeva; Fonsen, Elina; Elo, Janniina
In this study we examine parents' and teachers' perceptions of the early childhood education and care (ECEC) quality in Finland. The study is based on the paradigm of inclusionary quality and the assessment is based on the quality evaluation model. The parents and teachers assess the quality to be good. The strength of the quality was the effect…
Davison, Kirsten K.; Hesketh, Kathryn; Taveras, Elsie M.; Gillman, Matthew W.; Benjamin Neelon, Sara E.
Abstract Background: Identifying characteristics associated with the Institute of Medicine's (IOM) recommended feeding practices among infant and toddler care providers in child care centers could help in preventing childhood obesity. Methods: In 2009, at baseline in a pilot intervention study of 29 licensed Massachusetts child care centers with at least 50% of enrolled children identified as racial minorities, 57 infant and 109 toddler providers completed feeding questionnaires. To assess provider adherence to six IOM-recommended behaviors, we used cluster-adjusted multivariable logistic regression models including provider type (infant or toddler), race, education, and center Child and Adult Care Food Program (CACFP) participation. Results: In multivariable analysis, CACFP participation was associated with providers sitting with children at meals (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.2–21.7), offering fruits and vegetables (OR, 3.3; 95% CI 1.7–6.2), and limiting fast food (OR, 3.5; 95% CI, 1.8–6.7). Providers at centers serving meals family style were less likely to allow children to leave food unfinished (OR, 0.27; 95% CI, 0.09–0.77). Infant providers were more likely than toddler providers to sit with children at meals (OR, 6.98; 95% CI, 1.51–32.09), allow children to eat when hungry (OR, 3.50; 95% CI, 1.34–9.16), and avoid serving sugary (OR, 8.74; 95% CI, 3.05–25.06) or fast foods (OR, 11.56; 95% CI, 3.20–41.80). Conclusions: CACFP participation may encourage IOM-recommended feeding practices among infant and toddler providers. Child care providers may benefit from education about how to feed infants and toddlers responsively, especially when offering foods family style. Future research should explore ways to promote child-centered feeding practices, while addressing barriers to providing children with nutrient-rich foods. PMID:25918873
Ravens-Sieberer, Ulrike; Karow, Anne; Barthel, Dana; Klasen, Fionna
This article provides an overview of the conceptual foundations of measuring health-related quality of life (HRQoL) in children and adolescents in child and adolescent psychiatry, and of the current state of research in this field. The available procedures for determining quality of life are presented according to their areas of use and their psychometric characteristics. The internationally available generic instruments for measuring HRQoL in children are identified and assessed in terms of their strengths and weaknesses with regard to selected criteria. As a result, seven generic HRQoL instruments and two utility procedures have been identified which satísfy the following criteria: (i) psychometric qualíty; (ii) age-appropriate measurement; (iii) versions for self-reporting and external rating; and (iv) cross-cultural measurement. The identified instruments satisfy the individual criteria to different degrees. They are increasingly being used in health services research, treatment studies, and epidemiological research; however, they are not yet widely used as part of the clinical routine in child and adolescent psychiatrics. PMID:25152654
Hudson, Kelly P.
Approximately 214,000 licensed child care homes operate in the United States servicing over 3 million children, while 5,300 homes are in Washington State servicing 175,000 children. Research suggests that children who acquire social-emotional skills between birth and age 5 are equipped for greater success in school and later adulthood. However,…
Li, Weilin; Farkas, George; Duncan, Greg J; Burchinal, Margaret R; Vandell, Deborah Lowe
The effects of high- versus low-quality child care during 2 developmental periods (infant-toddlerhood and preschool) were examined using data from the National Institute of Child Health and Human Development Study of Early Child Care. Propensity score matching was used to account for differences in families who used different combinations of child care quality during the 2 developmental periods. Findings indicated that cognitive, language, and preacademic skills prior to school entry were highest among children who experienced high-quality care in both the infant-toddler and preschool periods, somewhat lower among children who experienced high-quality child care during only 1 of these periods, and lowest among children who experienced low-quality care during both periods. Irrespective of the care received during infancy-toddlerhood, high-quality preschool care was related to better language and preacademic outcomes at the end of the preschool period; high-quality infant-toddler care, irrespective of preschool care, was related to better memory skills at the end of the preschool period. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Butler, Ashleigh E; Hall, Helen; Copnell, Beverley
To explore bereaved parents' interactions with healthcare providers when a child dies in a paediatric intensive care unit. Although most children admitted to a paediatric intensive care unit will survive, 2-5% will die during their stay. The parents of these children interact and form relationships with numerous healthcare staff during their child's illness and death. Although previous studies have explored the parental experience of child death in intensive care generally, the nature of their relationships with healthcare providers during this time remains unknown. This study used a constructivist grounded theory approach. Data were collected via semi-structured, audio-recorded interviews with 26 bereaved parents from four paediatric intensive care units over 18 months in 2015-2016. Constant comparative analysis and theoretical memos were used to analyse the data. The theory "Transitional togetherness" demonstrates the changing nature of the parent-healthcare provider relationship across three key phases of the parents' journey. Phase one, "Welcoming expertise," focuses on the child's medical needs, with the healthcare provider dominant in the relationship. Phase two, "Becoming a team," centres around the parents' need to recreate a parental role and work collaboratively with healthcare providers. Finally, "Gradually disengaging" describes the parents' desire for the relationship to continue after the child's death as a source of support until no longer needed. Findings from this study offer valuable insights into the changing nature of the parent-healthcare provider relationship and highlight the key foci of the relationship at each stage of the parental journey. © 2017 John Wiley & Sons Ltd.
Ludmila Mourão Xavier Gomes
Full Text Available OBJECTIVE: To evaluate the quality of healthcare provided to sickle cell disease children by primary healthcare services in a region of high prevalence. METHODS: A cross-sectional, descriptive study was performed by interviewing members of families with sickle cell disease children. The children had been identified from the Neonatal Screening Program in Minas Gerais state over the last 12 years in towns of the Montes Claros-Bocaiuva microregion. A structured questionnaire specially developed for this study and based on three axes was used: indicators of the child's health (immunization, growth and development, prophylaxis antibiotic therapy, perception of care by the family (health education and accessibility and knowledge of the family about the disease. RESULTS: Sixty-three of 71 families with children identified as having sickle cell disease were interviewed. The predominant genotypes were Hb SS (44.4% and Hb SC (41.2%. Adequate monitoring of growth and development was recorded for the first year of life in 23 children (36.6% and for the second year of life in 18 children (28.6%. The basic vaccination schedule was completed by 44 children (69.8% but 62 vaccination record cards (98.4% identified delays of special vaccines. Regular use of prophylactic penicillin was reported by 55 caregivers (87.3%. The family's perception of the care provided suggests poor accessibility to health services and lack of opportunities to answer doubts. The average performance of families in knowledge testing was 59.8%. CONCLUSION: The quality of healthcare is unsatisfactory. The care provided to children with sickle cell disease in primary healthcare services needs improvements.
...) that provides healthy meals and snacks in child and adult day care facilities. This report uses the Cost, Quality and Child Outcomes study to analyze the characteristics of three types of child care centers: (1...
Opydo-Szymaczek, Justyna; Jarząbek-Bielecka, Grażyna; Kędzia, Witold; Borysewicz-Lewicka, Maria
Despite the recognition of the clinical importance of child sexual abuse, primary health care providers are often not ad-equately prepared to perform medical evaluations and diagnose child sexual maltreatment. Paper presents basic symptoms and signs of CSA, which may suggest the need for further patient's diagnosis and referral. Since the great majority of sexually abused children do not have any abnormal physical findings, special attention is paid to the silent warning signs of CSA, such as changes in attitude towards own body and eating habits. Numerous studies suggest that victims of CSA may develop obesity or eating disorders of various forms and intensities.
Beurkens, Nicole M.; Hobson, Jessica A.; Hobson, R. Peter
The aim of this study was to examine how severity of autism affects children's interactions (relatedness) and relationships with their parents. Participants were 25 parent-child dyads that included offspring who were children with autism aged from 4 to 14 years. The severity of the children's autism was assessed using the calibrated severity…
Morgan, Judith K; Ambrosia, Marigrace; Forbes, Erika E; Cyranowski, Jill M; Amole, Marlissa C; Silk, Jennifer S; Elliott, Rosalind D; Swartz, Holly A
Maternal depression is associated with negative outcomes for offspring, including increased incidence of child psychopathology. Quality of mother-child relationships can be compromised among affectively ill dyads, such as those characterized by maternal depression and child psychopathology, and negatively impact outcomes bidirectionally. Little is known about the neural mechanisms that may modulate depressed mothers' responses to their psychiatrically ill children during middle childhood and adolescence, partially because of a need for ecologically valid personally relevant fMRI tasks that might most effectively elicit these neural mechanisms. The current project evaluated maternal response to child positive and negative affective video clips in 19 depressed mothers with psychiatrically ill offspring using a novel fMRI task. The task elicited activation in the ventral striatum when mothers viewed positive clips and insula when mothers viewed negative clips of their own (versus unfamiliar) children. Both types of clips elicited activation in regions associated with affect regulation and self-related and social processing. Greater lifetime number of depressive episodes, comorbid anxiety, and poor mother-child relationship quality all emerged as predictors of maternal response to child affect. Findings may be specific to dyads with psychiatrically ill children. Altered neural response to child affect may be an important characteristic of chronic maternal depression and may impact mother-child relationships negatively. Existing interventions for depression may be improved by helping mothers respond to their children's affect more adaptively. Copyright © 2015 Elsevier B.V. All rights reserved.
Spence, Alison C; Campbell, Karen J; Crawford, David A; McNaughton, Sarah A; Hesketh, Kylie D
Young children's diets are currently suboptimal. Given that mothers have a critical influence on children' diets, they are typically a target of interventions to improve early childhood nutrition. Understanding the maternal factors which mediate an intervention's effect on young children's diets is important, but has not been well investigated. This research aimed to test whether maternal feeding knowledge, maternal feeding practices, maternal self-efficacy, and maternal dietary intakes acted as mediators of the effect of an intervention to improve child diet quality. The Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program was a cluster-randomized controlled trial, conducted from 2008-2010. This novel, low-dose, health promotion intervention was delivered quarterly over 15 months and involved educational activities, promotion of peer discussion, a DVD and written materials. Post-intervention, when children were approximately 18 months of age, child diets were assessed using multiple 24-hour recalls and a purpose-developed index of diet quality, the Obesity Protective Dietary Index. Maternal mediators were assessed using a combination of previously validated and purpose-deigned tools. Mediation analysis was conducted using the test of joint significance and difference of coefficients methods. Across 62 parents' groups in Melbourne, Australia, 542 parents were recruited. Post- intervention, higher maternal feeding knowledge and lower use of foods as rewards was found to mediate the direct intervention effect on child diet quality. While other aspects of maternal feeding practices, self-efficacy and dietary intakes did not act as mediators, they were associated with child diet quality. Mediation analysis of this novel health promotion intervention showed the importance of maternal feeding knowledge and use of foods as rewards in impacting child diet quality. The other maternal factors assessed were appropriate targets but further research on how to
... Quality Control Region. 81.31 Section 81.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.31 Metropolitan Providence Interstate Air Quality Control Region. The Metropolitan Providence Interstate Air Quality Control Region (Rhode Island-Massachusetts) consists of the...
Mori, Yuka; Downs, Jenny; Wong, Kingsley; Anderson, Barbara; Epstein, Amy; Leonard, Helen
Although research in this area remains sparse, raising a child with some genetic disorders has been shown to adversely impact maternal health and family quality of life. The aim of this study was to investigate such impacts in families with a child with the CDKL5 disorder, a newly recognised genetic disorder causing severe neurodevelopmental impairments and refractory epilepsy. Data were sourced from the International CDKL5 Disorder Database to which 192 families with a child with a pathogenic CDKL5 mutation had provided data by January 2016. The Short Form 12 Health Survey Version 2, yielding a Physical Component Summary and a Mental Component Summary score, was used to measure primary caregiver's wellbeing. The Beach Center Family Quality of Life Scale was used to measure family quality of life. Linear regression analyses were used to investigate relationships between child and family factors and the various subscale scores. The median (range) age of the primary caregivers was 37.0 (24.6-63.7) years and of the children was 5.2 (0.2-34.1) years. The mean (SD) physical and mental component scores were 53.7 (8.6) and 41.9 (11.6), respectively. In mothers aged 25-54 years the mean mental but not the physical component score was lower than population norms. After covariate adjustment, caregivers with a tube-fed child had lower mean physical but higher mean mental component scores than those whose child fed orally (coefficient = -4.80 and 6.79; p = 0.009 and 0.012, respectively). Child sleep disturbances and financial hardship were negatively associated with the mental component score. The mean (SD) Beach Center Family Quality of Life score was 4.06 (0.66) and those who had used respite services had lower scores than those who had not across the subscales. Emotional wellbeing was considerably impaired in this caregiver population, and was particularly associated with increased severity of child sleep problems and family financial difficulties. Family quality
Espinet, Stacey; Naqvi, Reza; Lingard, Lorelei; Steele, Margaret
Introduction The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. Methods A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Results Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Discussion Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Conclusion Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families. PMID:29662521
Gotovac, Sandra; Espinet, Stacey; Naqvi, Reza; Lingard, Lorelei; Steele, Margaret
The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families.
Child Care Action Campaign, New York, NY.
This Child Care Action Campaign (CCAC) Information Guide focuses on questions for parents to ask when looking for the right childcare program. The guide provides a checklist for parents to use when evaluating potential or currently used childcare programs. By sharing and discussing the checklist with caregivers, parents and caregivers can work…
Joyce E Thompson
Full Text Available OBJECTIVE: To obtain a snapshot of the maternal and newborn care provided by different types of maternal and child health providers in Latin America and the Caribbean (LAC to 1 better inform advocacy and programmatic strategies and interventions to improve the quality of those services in the region, and 2 determine the need for more rigorous study of the issues. METHODS: A rapid assessment of 83 health workers providing antepartum, intrapartum, and immediate postpartum and newborn care (within two hours of birth in eight LAC countries was conducted in November and December of 2011. Health workers were observed by two-person expert maternal/newborn clinician teams using pretested forms based on international quality-of-care standards. A total of 105 care encounters were observed, primarily in urban, public, referral-level settings. Providers of care included obstetricians, midwives, generalist physicians, medical residents, registered nurses, auxiliary nurses, and students of medicine, midwifery, and nursing. RESULTS: Hand washing, as an indicator of quality of antepartum care, was observed in only 41% of the observed encounters. Labor management often lacked certain elements of respectful maternity care across all provider groups. Several clinical tasks of high importance in the identification and prevention of common complications of antepartum, intrapartum, and immediate postpartum/newborn care were not documented as performed during the observation periods. Providers self-reported limited competence (ability to perform to a defined level of proficiency in manual removal of the placenta, bimanual compression of the uterus, and newborn resuscitation. CONCLUSIONS: The findings suggest that 1 the quality of maternal and newborn care and 2 the competence of maternal and child health providers in the diverse selection of LAC countries that were studied require substantial attention.
Benjamin Neelon, Sara E.; Reyes-Morales, Hortensia; Haines, Jess; Gillman, Matthew W.; Taveras, Elsie M.
Objective The purpose of the present study was to assess the nutritional quality of foods and beverages listed on menus serving children in government-sponsored child-care centres throughout Mexico. Design For this cross-sectional menu assessment, we compared (i) food groups and portion sizes of foods and beverages on the menus with MyPlate recommendations and (ii) macronutrients, sugar and fibre with Daily Reference Intake standards. Setting Menus reflected foods and beverages served to children attending one of 142 government-sponsored child-care centres throughout Mexico. Subjects There were fifty-four distinct menus for children aged 4–6 months, 7–9 months, 10–12 months, 13–23 months, 24–47 months and 48–72 months. Results Menus included a variety of foods meeting minimum MyPlate recommendations for each food category except whole grains for children aged 48–72 months. Menus listed excessive amounts of high-energy beverages, including full-fat milk, fruit juice and sugar-sweetened beverages for children of all ages. The mean daily energy content of menu items yielded an average of 2·76 MJ for infants, 4·77 MJ for children aged 13–23 months, 5·36 MJ for children aged 24–47 months and 5·87 MJ for children aged 48–72 months. Foods and beverages on menus provided sufficient grams of carbohydrate and fat, but excessive protein. Conclusions Menus provided a variety of foods but excessive energy. Whole grains were limited, and high-energy beverages were prevalent. Both may be appropriate targets for nutrition intervention. Future studies should move beyond menus and assess what children actually consume in child care. PMID:23036360
Friesen, Myron D.; Woodward, Lianne J.; Horwood, L. John; Fergusson, David M.
Data from the Christchurch Health and Development Study, a 30-year prospective longitudinal study, were used to examine the associations between the quality of parent-child relations in adolescence and adult parenting behaviour 15 years later. At ages 14 and 15 years, cohort members were interviewed about the quality of their relationship with…
This study investigates the relationship between internal teacher profiles and pre-K teacher-child interaction quality in the pre-K classroom. Two questions were addressed: (1) What internal profiles exist for pre-kindergarten (pre-K) teachers? and (2) Do internal profiles relate to observed structural and process quality in the pre-K classroom?…
Zablotsky, Benjamin; Anderson, Connie; Law, Paul
Parents raising children with autism spectrum disorders (ASDs) have been shown to experience high levels of stress and report a lower quality of life. The current study examined the association between child autism symptomatology, mother's quality of life, and mother's risk for depression in a sample of 1,110 mothers recruited from a…
This study examined critically the concept of quality education and the right of the girl child to such education in Nigeria. It argued that the indices of quality education which include relevance, efficiency and essence are yet to be fully realized, due to inadequate human, physical and financial resources. It further observed ...
Fraser, Angela; Wohlgenant, Kelly; Cates, Sheryl; Chen, Xi; Jaykus, Lee-Ann; Li, You; Chapman, Benjamin
Children enrolled in child care are 2.3-3.5 times more likely to experience acute gastrointestinal illness than children cared for in their own homes. The purpose of this study was to determine the frequency surfaces were touched by child care providers to identify surfaces that should be cleaned and sanitized. Observation data from a convenience sample of 37 child care facilities in North Carolina and South Carolina were analyzed. Trained data collectors used iPods (Apple, Cupertino, CA) to record hand touch events of 1 child care provider for 45 minutes in up to 2 classrooms in each facility. Across the 37 facilities, 10,134 hand contacts were observed in 51 classrooms. Most (4,536) were contacts with porous surfaces, with an average of 88.9 events per classroom observation. The most frequently touched porous surface was children's clothing. The most frequently touched nonporous surface was food contact surfaces (18.6 contacts/observation). Surfaces commonly identified as high-touch surfaces (ie, light switches, handrails, doorknobs) were touched the least. General cleaning and sanitizing guidelines should include detailed procedures for cleaning and sanitizing high-touch surfaces (ie, clothes, furniture, soft toys). Guidelines are available for nonporous surfaces but not for porous surfaces (eg, clothing, carpeting). Additional research is needed to inform the development of evidence-based practices to effectively treat porous surfaces. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Full Text Available Early childhood care and education providers (CCPs work with over 7 million young children. These children are vulnerable to physical, sexual and emotional abuse, and neglect. However, CCPs make less than 1% of all reports of suspected child abuse and neglect that are made to child protective services. CCPs are therefore an untapped resource in the public health response to child maltreatment. However, their knowledge and attitudes about duties to report child maltreatment are poorly understood. Moreover, no rigorous research has tested whether their knowledge and attitudes about reporting child maltreatment can be improved. These gaps in knowledge are important because knowledge of the duty and positive attitudes towards it produce more effective reporting, and little evidence exists about how to enhance cognitive and affective attributes. Using the CONSORT approach, we report a single-blind test-retest randomized controlled trial evaluating iLook Out for Child Abuse, a customized online educational intervention for CCPs to increase knowledge and attitudes towards the reporting duty. 762 participants were randomized with results analyzed for 741 participants (372 in the intervention group; 369 in the control. Knowledge of the reporting duty increased in the intervention group from 13.54 to 16.19 out of 21 (2.65 increase, 95% CI: (2.37, 2.93; large effect size 0.95, p < 0.001; the control group remained stable, moving from 13.54 to 13.59 (0.05 increase, 95% CI: (-0.12, 0.22; negligible effect size 0.03, p = 0.684. Attitudes were enhanced on all 13 items for the intervention group, remaining stable in the control, with significant differences between groups on all items (p < 0.05. Gains were largely sustained at four month follow-up. Findings support education for CCPs and other professions. Future research should also explore effects of education on reporting behavior.US National Institutes of Health NCT02225301.
Mathews, Ben; Yang, Chengwu; Lehman, Erik B; Mincemoyer, Claudia; Verdiglione, Nicole; Levi, Benjamin H
Early childhood care and education providers (CCPs) work with over 7 million young children. These children are vulnerable to physical, sexual and emotional abuse, and neglect. However, CCPs make less than 1% of all reports of suspected child abuse and neglect that are made to child protective services. CCPs are therefore an untapped resource in the public health response to child maltreatment. However, their knowledge and attitudes about duties to report child maltreatment are poorly understood. Moreover, no rigorous research has tested whether their knowledge and attitudes about reporting child maltreatment can be improved. These gaps in knowledge are important because knowledge of the duty and positive attitudes towards it produce more effective reporting, and little evidence exists about how to enhance cognitive and affective attributes. Using the CONSORT approach, we report a single-blind test-retest randomized controlled trial evaluating iLook Out for Child Abuse, a customized online educational intervention for CCPs to increase knowledge and attitudes towards the reporting duty. 762 participants were randomized with results analyzed for 741 participants (372 in the intervention group; 369 in the control). Knowledge of the reporting duty increased in the intervention group from 13.54 to 16.19 out of 21 (2.65 increase, 95% CI: (2.37, 2.93); large effect size 0.95, p < 0.001); the control group remained stable, moving from 13.54 to 13.59 (0.05 increase, 95% CI: (-0.12, 0.22); negligible effect size 0.03, p = 0.684). Attitudes were enhanced on all 13 items for the intervention group, remaining stable in the control, with significant differences between groups on all items (p < 0.05). Gains were largely sustained at four month follow-up. Findings support education for CCPs and other professions. Future research should also explore effects of education on reporting behavior. US National Institutes of Health NCT02225301.
Razafimahefa-Raoelina, T; Farinetti, A; Nicollas, R; Triglia, J-M; Roman, S; Anderson, L
The aim of this study was to assess quality of life in children fitted with cochlear implants, using combined self- and parental assessment. Thirty-two children, aged 6 to 17 years, with prelingual hearing loss and receiving cochlear implants at a mean age of 22 months, were included along with their families. The KIDSCREEN-27 questionnaire was implemented, in face-to-face interview, in its parents and children-adolescents versions, with 27 items covering physical well-being ("physical activities and health"), psychological well-being ("general mood and feelings about yourself"), autonomy & parents ("family and free time"), peers & social support ("friends") and school environment ("school and learning"). Parent and child responses were compared with a general population database, and pairwise. Global scores were compared against the general population on Cohen d effect-size. For child self-assessment, the results were: physical well-being, 72.81 (d=0); psychological well-being, 78.13 (d=-0.4); autonomy & parents, 63.84 (d=-0.2); peers & social support, 61.72 (d=-0.4); and school environment 73.83 (d=0). For parent assessment, the respective results were 62.66 (d=-0.8), 74.89 (d=-0.3), 57.37 (d=-1.2), 51.56 (d=-0.8), and 68.95 (d=-0.4). Half of the children could not answer the questionnaire, mainly due to associated disability. Schooling and language performance were poorer in non-respondent than respondent children. Quality of life was comparable between implanted and non-implanted children: Cohen d, 0 to 0.4. Early cochlear implantation in children with pre-lingual hearting loss provides quality of life comparable to that of the general population. Copyright © 2015. Published by Elsevier Masson SAS.
Butler, Ashleigh E; Copnell, Beverley; Hall, Helen
This study explores the influences of the paediatric intensive care environment on relationships between parents and healthcare providers when children are dying. It forms part of a larger study, investigating parental experiences of the death of their child in intensive care. Constructivist grounded theory. Four Australian paediatric intensive care units. Audio-recorded, semi-structured interviews were conducted with twenty-six bereaved parents. Data were analysed using the constant comparison and memoing techniques common to grounded theory. The physical and social environment of the intensive care unit influenced the quality of the parent-healthcare provider relationship. When a welcoming, open environment existed, parents tended to feel respected as equal and included members of their child's care team. In contrast, environments that restricted parental presence or lacked resources for parental self-care could leave parents feeling like 'watchers', excluded from their child's care. The paediatric intensive care unit environment either welcomes and includes parents of dying children into the care team, or demotes them to the status of 'watcher'. Such environments significantly influence the relationships parents form with healthcare staff, their ability to engage in elements of their parental role, and their experiences as a whole. Copyright © 2017 Elsevier Ltd. All rights reserved.
Abstract Purpose An important question in child psychiatry is the agreement between parents and children. We studied mother?child concordance about the quality of life of children (QoL). We hypothesized that mothers of depressed children rate lower QoL than children for themselves while mothers of non-depressed children rate better QoL; that inter-informant agreement is higher in the non-depressed sample; and finally that agreement incre...
Helmerhorst, Katrien O. W.; Fukkink, Ruben G.; Riksen-Walraven, J. Marianne A.; Gevers Deynoot-Schaub, Mirjam J. J. M.; Tavecchio, Louis W. C.
This study examined the effects of a newly developed on-site consultancy programme to improve global quality of the child care environment in non-parental child care centres for 0- to 4-year-old children as measured with the ITERS-R/ECERS-R. Using a randomised controlled trial with a pretest, posttest, and follow-up test, we compared 35…
Bech-Larsen, Tino; Jensen, Birger Boutrup
When the buyer and the consumer of a food product are not identical, the risk of discrepancies between food quality expectations and experience is even higher than when the buyer is also the consumer. In such situations the interpersonal aspects of food quality formation become the focus...... of attention. The purpose of this article is to discuss the interpersonal aspects of food quality formation, and to explore these in the context of parents buying new types of healthier in-between meals for their children. To pursue this we introduce the concept of dyadic quality assessment and apply...... parental knowledge of their children’s quality assessments significantly affect the willingness to pay. Accordingly, interaction between parents and children should be promoted when developing, testing and marketing new and healthier food products for children....
Basinga, Paulin; Gertler, Paul J; Binagwaho, Agnes; Soucat, Agnes L B; Sturdy, Jennifer; Vermeersch, Christel M J
Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026-0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. The P4P scheme in Rwanda had
Sanitation access can provide positive externalities; for example, safe disposal of feces by one household prevents disease transmission to households nearby. However, little empirical evidence exists to characterize the potential health benefits from sanitation externalities. This study investigated the effect of community sanitation coverage versus individual household sanitation access on child health and drinking water quality. Using a census of 121 villages in rural Mali, we analyzed the association of community latrine coverage (defined by a 200 m radius surrounding a household) and individual household latrine ownership with child growth and household stored water quality. Child height-for-age had a significant and positive linear relationship with community latrine coverage, while child weight-for-age and household water quality had nonlinear relationships that leveled off above 60% coverage (p water quality were not associated with individual household latrine ownership. The relationship between community latrine coverage and child height was strongest among households without a latrine; for these households, each 10% increase in latrine coverage was associated with a 0.031 (p-value = 0.040) increase in height-for-age z-score. In this study, the level of sanitation access of surrounding households was more important than private latrine access for protecting water quality and child health. PMID:28514143
Brelsford, Gina M
Social scientific research on family life, religion, and spirituality tends to focus on global religiousness and spirituality with few studies seeking to understand interpersonal religious and spiritual contributors, namely sanctification and spiritual disclosure, from multiple family members' perspectives. This study explored 91 mother-college student and 64 father-college student dyads who rated their use of spiritual disclosure and theistic and nontheistic sanctification of the parent-child dyad in relation to parent-child relationship quality (e.g., parent-child relationship satisfaction and open communication). Results indicate significant positive links between higher levels of spiritual disclosure and greater theistic and nontheistic sanctification, for mothers, fathers, and their children. However, only greater nontheistic sanctification and higher levels spiritual disclosure were significantly related to increased parent-child relationship quality. Through use of Actor-Partner Interdependence Models (APIMs) results indicated unique contributions of spiritual disclosure to parent-child relationship quality above nontheistic sanctification for open communication in the family. However, full models, which included nontheistic sanctification and spiritual disclosure, predict college students' relationship satisfaction with their mothers and fathers. Implications for interpersonal religiousness and spirituality as contributors to familial relationship quality in research and practice are discussed. © 2013 American Psychological Association
Full Text Available The aim of the paper was to investigate how the quality of family environment is related to the child's adaptation capabilities. Child's adaptation was evaluated with a special assessment called SPP-3 (Systematic Psychological Assessment of a 3-year Old Child, that screens the population of 3-year olds to look for inadequate adaptation patterns. I assumed that in families where parents have higher education and where the environment is more stimulating children will show more effective and adaptive behaviour. Seventy-five children and parents who attended the psychological assessment in their regional hospitals first concluded the psychological examination (SPP-3 and then filled-in two questionnaires: The Family Environment Questionnaire (Zupančič, Podlesek, & Kavčič, 2004 and The Home Literacy Environment Questionnaire (Marjanovič Umek, Podlesek, & Fekonja, 2005. The results showed that quality of family environment does effect the child's adaptive capabilities and is associated with parental level of education. Of special importance for the child's socialization is the parents' ability to use effective control (to have consistent and clear demands. Hypothesis that the level of parental education affects the child's adaptation capabilities was not confirmed. Perhaps the parents' relations with the child are of greater importance, and these are probably not related to parents' education. The results show that child's adaptation capabilities are associated with parenting methods, so preventive psychological counselling may also be used to help parents choose more effective methods in order to allow the child to develop effective adaptive behaviour.
A model of the determinants of child quality and of the value of a woman's time is developed and tested using data from the Malaysian Family Life Survey of 1976-1977. Child quality is measured by educational attainment; factors influencing the value of the mother's time include size and age composition of household, family income, education, and hours worked. The results indicate that size and age composition of household affect a woman's asking wage. However, more data are needed before the effects of family structure on schooling can be measured with confidence.
Meng, Lexuan; Chaudhary, Sanjay K.; Guerrero, Josep M.
Customers may have different power quality requirements, thus, the economic operational strategy can try to provide them with distinctive quality levels as customized service. An optimization based method is proposed in this paper to realize this functionality, offering the possibility...
Schmied, Virginia; Fowler, Cathrine; Rossiter, Chris; Homer, Caroline; Kruske, Sue
Australia has a system of universal child and family health (CFH) nursing services providing primary health services from birth to school entry. Herein, we report on the findings of the first national survey of CFH nurses, including the ages and circumstances of children and families seen by CFH nurses and the nature and frequency of the services provided by these nurses across Australia. A national survey of CFH nurses was conducted. In all, 1098 CFH nurses responded to the survey. Over 60% were engaged in delivering primary prevention services from a universal platform. Overall, 82.8% reported that their service made first contact with families within 2 weeks of birth, usually in the home (80.7%). The proportion of respondents providing regular support to families decreased as the child aged. Services were primarily health centre based, although 25% reported providing services in other locations (parks, preschools).The timing and location of first contact, the frequency of ongoing services and the composition of families seen by nurses varied across Australian jurisdictions. Nurses identified time constraints as the key barrier to the delivery of comprehensive services. CFH nurses play an important role in supporting families across Australia. The impact of differences in the CFH nursing provision across Australia requires further investigation. What is known about the topic? Countries that offer universal well child health services demonstrate better child health and developmental outcomes than countries that do not. Australian jurisdictions offer free, universal child and family health (CFH) nursing services from birth to school entry. What does this paper add? This paper provides nation-wide data on the nature of work undertaken by CFH nurses offering universal care. Across Australia, there are differences in the timing and location of first contact, the frequency of ongoing services and the range of families seen by nurses. What are the implications for
Fifolt, Matthew; Preskitt, Julie; Rucks, Andrew; Corvey, Kathryn; Benton, Elizabeth Cason
Q-sort methodology is an underutilized tool for differentiating among multiple priority measures. The authors describe steps to identify, delimit, and sort potential health measures and use selected priority measures to establish an overall agenda for continuous quality improvement (CQI) activities within learning collaboratives. Through an iterative process, the authors vetted a list of potential child and adolescent health measures. Multiple stakeholders, including payers, direct care providers, and organizational representatives sorted and prioritized measures, using Q-methodology. Q-methodology provided the Alabama Child Health Improvement Alliance (ACHIA) an objective and rigorous approach to system improvement. Selected priority measures were used to design learning collaboratives. An open dialogue among stakeholders about state health priorities spurred greater organizational buy-in for ACHIA and increased its credibility as a statewide provider of learning collaboratives. The integrated processes of Q-sort methodology, learning collaboratives, and CQI offer a practical yet innovative way to identify and prioritize state measures for child and adolescent health and establish a learning agenda for targeted quality improvement activities.
Love, John M.; Constantine, Jill; Paulsell, Diane; Boller, Kimberly; Ross, Christine; Raikes, Helen; Brady-Smith, Christy; Brooks-Gunn, Jeanne
In 1994, the Secretary's Advisory Committee on Services for Families with Infants and Toddlers set forth a vision for Early Head Start programs in declaring that all child care settings used by Early Head Start families, whether or not the program provides the care directly, must meet the high standards of quality embodied in the Head Start…
O'Connor, Thomas G; Wang, Hongyue; Moynihan, Jan A; Wyman, Peter A.; Carnahan, Jennifer; Lofthus, Gerry; Quataert, Sally A.; Bowman, Melissa; Burke, Anne S.; Caserta, Mary T
Background Quality of the parent-child relationship is a robust predictor of behavioral and emotional health for children and adolescents; the application to physical health is less clear. Methods We investigated the links between observed parent-child relationship quality in an interaction task and antibody response to meningococcal conjugate vaccine in a longitudinal study of 164 ambulatory 10-11 year-old children; additional analyses examine associations with cortisol reactivity, BMI, and somatic illness. Results Observed negative/conflict behavior in the interaction task predicted a less robust antibody response to meningococcal serotype C vaccine in the child over a 6 month-period, after controlling for socio-economic and other covariates. Observer rated interaction conflict also predicted increased cortisol reactivity following the interaction task and higher BMI, but these factors did not account for the link between relationship quality and antibody response. Conclusions The results begin to document the degree to which a major source of child stress exposure, parent-child relationship conflict, is associated with altered immune system development in children, and may constitute an important public health consideration. PMID:25862953
Piovesan, Chaiana; Abella, Cássia; Ardenghi, Thiago Machado
To assess the relationship of child oral health-related quality of life and socioeconomic backgrounds to traumatic dental injuries in schoolchildren. This study followed a cross-sectional design, with a multistage random sample of 792 12-year-old schoolchildren, representative of Santa Maria, a city in southern Brazil. The participants completed the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14), their parents or guardians answered questions on socioeconomic status, and a dental examination provided information on the prevalence of dental trauma. The assessment of association used Poisson regression models. The prevalence of TDI was 9.7%. The maxillary central incisors were the most frequently traumatised, and the most commonly observed traumatic dental injury was enamel fracture. No association was observed among child oral health-related quality of life and socioeconomic factors with traumatic dental injuries after the adjustment. Socioeconomic indicators are not associated with dental trauma in schoolchildren and this oral health condition has no negative impacts on children's quality of life.
Horner, Sharon D; Brown, Adama
Most studies of childhood asthma management use data from a single family reporter and fail to capture the parent-child dyadic influences. In this descriptive exploratory study with 183 parent-child dyads, data were collected from both parents and children. Using structural equation modeling, the relationships of parents' and children's asthma knowledge, self-efficacy to manage asthma, and asthma management on the child's quality of life were examined. Direct significant relationships from knowledge to self-efficacy to asthma management were found for each member of the dyad. The associations between parents' and children's self-efficacy and asthma management were not statistically significant. Only the children's self-efficacy to manage asthma was significantly associated with children's asthma-related quality of life.
White-Koning, Melanie; Arnaud, Catherine; Dickinson, Heather O
children aged 8 to 12 years who had cerebral palsy and were living in 7 countries in Europe. RESULTS: The mean child-reported scores of quality of life were significantly higher than the parent proxy reports in 8 domains, significantly lower for the finances domain, and similar for the emotions domain...
Huang, Keng-Yen; Caughy, Margaret O'Brien; Lee, Li-Ching; Miller, Therese; Genevro, Janice
This study examined the stability of maternal punitive/high-power discipline (PD) and inductive/authoritative discipline (ID) over the second and third years of life and the effect of maternal discipline on quality of mother-child interactions. Data from a longitudinal sample with 179 mother-toddler dyads were analyzed, and selected factors (i.e.,…
von Otter, Cecilia; Stenberg, Sten-Åke
We analyse the utility of social capital for children's achievement, and if this utility interacts with family human capital and the quality of the parent-child relationship. Our focus is on parental activities directly related to children's school work. Our data stem from a Swedish cohort born in 1953 and consist of both survey and register data.…
Chen, Kuan-Lin; Wang, Hui-Yi; Tseng, Mei-Hui; Shieh, Jeng-Yi; Lu, Lu; Yao, Kai-Ping Grace; Huang, Chien-Yu
The Cerebral Palsy Quality of Life for Children (CP QOL-Child) is the first health condition-specific questionnaire designed for measuring QOL in children with cerebral palsy (CP). However, its construct validity has not yet been confirmed by confirmatory factor analysis (CFA). Hence, this study assessed the construct validity of the caregiver…
Theunissen, N.C.M.; Vogels, T.G.C.; Koopman, H.M.; Verrips, G.H.W.; Zwinderman, K.A.H.; Verloove-Vanhorick, S.P.; Wit, J.M.
This study evaluates the agreement between child and parent reports on children's health-related quality of life (HRQoL) in a representative sample of 1,105 Dutch children (age 8-11 years old). Both children and their parents completed a 56 item questionnaire (TACQOL). The questionnaire contains
Powell, Douglas R.
One of the important influences on a child's development is the quality of his or her early care and education experiences. It is estimated that more than 1 million children in the U.S. are cared for while their parents are at work by nonlicensed caregivers who are family, friends, or neighbors - and these caregivers can be difficult to reach…
Klemp, Marc; Weisdorf, Jacob L.
We take Gary Becker's child quantity-quality trade-off hypothesis to the historical record, investigating the causal link from family size to the literacy status of offspring using data from Anglican parish registers, c. 1700-1830. Extraordinarily forhistorical data, the parish records enable us ...
Hooper, Alison; Hallam, Rena
Toddlers' engagement with their social and physical environment is an important aspect of their experience in early care and education programs. The purpose of this research study was to examine how global quality relates to children's engagement in toddler child care classrooms. Additionally, this study explored how toddlers' group engagement…
Kostas A. Fanti; Stelios N. Georgiou
The current investigation examines longitudinal differences between bullies, victims, and bully victims in terms of the quality of their relationship with their parents and school performance. We also investigate the transactional association between the quality of the parent-child relationship and bullying behavior, after taking into account the longitudinal association among bullying, victimization, and school performance. The sample consisted of 895 mothers and their children who participa...
Õun, Tiia; Tuul, Maire; Tera, Signe; Sagen, Kelli; Mägi, Helena
Various factors of the quality of preschool child care institutions influence the development of children and their future success in school. The activities of preschool child care institutions in Estonia are based on the national curriculum. Several indicators of structural quality have been determined on the national level. The aim of the…
Gillette, Chris; Blalock, Susan J; Rao, Jaya K; Williams, Dennis; Loughlin, Ceila E; Sleath, Betsy
The objectives of this study were to: (1) describe the extent to which general pediatric providers discuss risks associated with asthma control medications with families, and (2) examine factors that are associated with risk discussions. This study was a cross-sectional secondary analysis of audio taped medical visits involving 35 pediatric providers and 248 children with asthma with their caregivers. Transcripts of the visits were coded for discussions about asthma medication risks. Generalized estimating equations were used to analyze the data. Providers discussed asthma control medication risks during 23% of visits. Risks were more likely to be discussed when the visit was longer and when the provider prescribed a new asthma control medication. When providers discussed asthma control medication risks, they were most likely to ask the family general questions and make general statements. Across all of the visits, caregivers asked a total of 16 questions and made a total of 20 statements about risks associated with asthma medications; children asked a total of 3 questions and made two statements about risks associated with asthma control medications. Providers discussed risks associated with asthma control medications in less than one-quarter of medical visits. Providers should involve families in discussions about risks associated with medications during every visit to assess potential barriers to medication adherence. © 2013 Wiley Periodicals, Inc.
Ddumba-Nyanzi, Ismael; Kaawa-Mafigiri, David; Johannessen, Helle
Objectives: In the context of HIV clinical care, open discussion regarding sexual health and reproductive plans has become increasingly relevant. The aim of this paper is to explore barriers to communication between providers and women living with HIV regarding childbearing. Methods: In-depth int......Objectives: In the context of HIV clinical care, open discussion regarding sexual health and reproductive plans has become increasingly relevant. The aim of this paper is to explore barriers to communication between providers and women living with HIV regarding childbearing. Methods: In....... Results: Four themes emerged describing barriers to communication, from the HIV-positive women’s point of view: (i) provider indifference or opposition to childbearing post HIV diagnosis, (ii) anticipation of negative response from provider, (iii) provider’s emphasis on ‘scientific’ facts, (iv...
Connolly, Anne M; Cunningham, Clare; Sinclair, Adriane J; Rao, Arjun; Lonergan, Amy; Bye, Ann M E
The study aimed to create and evaluate the educational effectiveness of a digital resource instructing paediatric trainees in a systematic approach to critical and quality observation of normal child development. A digital educational resource was developed utilising the skills of an expert developmental paediatrician who was videoed assessing normal early child development at a series of critical stages. Videos illustrated aspects of language, sophistication of play and socialisation, cognition, and motor progress. Expert commentary, teaching text and summaries were used. A randomised controlled trial evaluated the resource. Paediatric trainees were recruited from The Sydney Children's Hospitals Network. Outcome measures were repeated at three time points (pre-teaching, immediate-post and 1 month) and included self-rated attitudes, knowledge of markers of development and observational expertise. Qualitative data on teaching usefulness were obtained through open-ended questions. Fifty-six paediatric trainees (registrar 79%, women 82%; mean age 31 years) completed the pre-assessment, 46 the immediate-post and 45 the 1-month follow-up (20% attrition). Compared with the Control group, the Teaching group scored higher over time on markers of development (P = 0.006), observational expertise (P improves knowledge, increases confidence and is useful, providing a structured approach to developmental assessment. The techniques taught can be applied to every paediatric consultation. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Anne H Berman
Full Text Available The KIDSCREEN-27 is a measure of child and adolescent quality of life (QoL, with excellent psychometric properties, available in child-report and parent-rating versions in 38 languages. This study provides child-reported and parent-rated norms for the KIDSCREEN-27 among Swedish 11-16 year-olds, as well as child-parent agreement. Sociodemographic correlates of self-reported wellbeing and parent-rated wellbeing were also measured.A random population sample consisting of 600 children aged 11-16, 100 per age group and one of their parents (N = 1200, were approached for response to self-reported and parent-rated versions of the KIDSCREEN-27. Parents were also asked about their education, employment status and their own QoL based on the 26-item WHOQOL-Bref. Based on the final sampling pool of 1158 persons, a 34.8% response rate of 403 individuals was obtained, including 175 child-parent pairs, 27 child singleton responders and 26 parent singletons. Gender and age differences for parent ratings and child-reported data were analyzed using t-tests and the Mann-Whitney U-test. Post-hoc Dunn tests were conducted for pairwise comparisons when the p-value for specific subscales was 0.05 or lower. Child-parent agreement was tested item-by-item, using the Prevalence- and Bias-Adjusted Kappa (PABAK coefficient for ordinal data (PABAK-OS; dimensional and total score agreement was evaluated based on dichotomous cut-offs for lower well-being, using the PABAK and total, continuous scores were evaluated using Bland-Altman plots.Compared to European norms, Swedish children in this sample scored lower on Physical wellbeing (48.8 SE/49.94 EU but higher on the other KIDSCREEN-27 dimensions: Psychological wellbeing (53.4/49.77, Parent relations and autonomy (55.1/49.99, Social Support and peers (54.1/49.94 and School (55.8/50.01. Older children self-reported lower wellbeing than younger children. No significant self-reported gender differences occurred and parent ratings
Soo, J; Letona, P; Chacon, V; Barnoya, J; Roberto, C A
Food marketing has been implicated as an important driver of obesity. However, few studies have examined food marketing in low- and middle-income countries (LMICs). This study documents the prevalence of advertising on cereal boxes in Guatemala and examines associations between various marketing strategies and nutritional quality. One box from all available cereals was purchased from a supermarket located in an urban area in Guatemala City, Guatemala. A content analysis was performed to document child-oriented marketing practices, product claims and health-evoking images. The Nutrient Profile Model (NPM) was used to calculate an overall nutrition score for each cereal (the higher the score, the lower the nutritional quality). In all, 106 cereals were purchased, and half of the cereals featured child-oriented marketing (54, 50.9%). Cereals had a mean (±s.d.) of 5.10±2.83 product claims per cereal, and most cereals (102, 96.2%) contained health-evoking images. Child-oriented cereals had, on average, higher NPM scores (13.0±0.55 versus 7.90±0.74, Ptargeting children were generally of poor nutritional quality. Cereals displaying health claims were also not healthier than those without such claims. Our findings support the need for regulations restricting the use of child-oriented marketing and health claims for certain products.
Tovar, Alison; Mena, Noereem Z; Risica, Patricia; Gorham, Gemma; Gans, Kim M
It is important to understand the perceptions and beliefs of family child care providers (FCCPs) regarding which factors influence children's physical activity (PA), screen-time (ST), and dietary behaviors in order to develop and implement appropriate obesity prevention interventions. The aim of this qualitative study was to explore the aforementioned perceptions and beliefs of FCCPs in Rhode Island. Four focus groups (n = 30) were held with FCCPs. Providers were female, Hispanic, and Spanish speaking. Providers were asked about different aspects of feeding, PA, and ST behaviors. Themes were coded using NVivo10 (QSR International Pty Ltd, Doncaster, Victoria, Australia). Content analysis was used to analyze final themes. Providers understood the importance of providing opportunities for healthy eating and PA for the children they cared for, but there was room for improvement, especially with regard to certain feeding and ST practices. Several barriers were evident, including the lack of physical infrastructure for PA, cultural beliefs and practices related to child feeding, and difficulties working with parents to provide consistent messages across environments. Given that FCCPs are aware of the importance of healthy eating and PA, there is a need to address the specific barriers they face, and operationalize some of their knowledge into practical everyday actions. This formative work will inform the development of a culturally relevant, multicomponent intervention for ethnically diverse FCCPs to improve the food and PA environments of their homes, which should, in turn, improve the dietary, PA, and ST behaviors of the 2- to 5-year-old children they care for.
Leever, Martin G.; DeCiani, Gina; Mulaney, Ellen; Hasslinger, Heather; Gambrill, Eileen
Noting that child welfare professionals can improve the quality and integrity of the services they provide if they develop ethical decision making skills, this book provides child welfare administrators and caseworkers with a framework for assessing ethical dilemmas, making sound ethical decisions, and delivering services with integrity to…
Moilanen, Kristin L.; Rambo-Hernandez, Karen E.
The purpose of the present study was to explore the degree to which short-term longitudinal change in adolescent self-regulation was attributable to maternal parenting and mother-child relationship quality. A total of 821 mother-adolescent dyads provided data in the 1992 and 1994 waves of the Children of the National Longitudinal Survey of…
The overall goal of this dissertation was to examine teacher characteristics, teachers' beliefs, and contextual factors that may motivate teachers' decisions to engage in high quality teacher-child interactions. I use two complementary studies to meet this goal. These two studies provide insight into several aspects of early childhood teachers'…
The Best Interests of the Child from different cultural perspectives : Factors influencing judgements of the quality of child-rearing environment and construct validity of the Best Interests of the Child-Questionnaire (BIC-Q) in Kosovo and Albania
Zevulun, Daniëlle; Post, Wendy J.; Zijlstra, A. Elianne; Kalverboer, Margrite E.; Knorth, Erik J.
Child-rearing practices and beliefs of what determines a ‘good quality’ of child-rearing differ across cultural contexts and diverse interpretations can be given to “a child’s best interests”. This study aims to examine the cultural factors that influence judgements of the quality of children’s
Tornello, Samantha L; Patterson, Charlotte J
According to family systems theory, parent-child relationships are an important aspect of individual wellbeing. This study explored associations among parental disclosure, parent-child relationships, and wellbeing among 84 adult children with gay fathers. We explored associations between the adult children's wellbeing and the children's ages at sexual orientation disclosure, geographic distance, relationship quality, and closeness with their fathers. We found that when parental disclosure had occurred earlier in the adult child's life, participants reported feeling closer to fathers in adulthood. Those who reported closer relationships with their fathers reported greater wellbeing. Using a stepwise regression, we found that adult children's reports of closeness with fathers were the best predictors of adult children's wellbeing.
Full Text Available This cross-sectional study assessed the impact of Developmental Enamel Defects (DED on Child Oral Health-Related Quality of Life (COHRQoL. A sample of 944 11- to 14-year-old Brazilian schoolchildren was examined for the prevalence and severity of DED. The children completed the Child Perceptions Questionnaire (CPQ11-14, and socioeconomic status was also collected using a questionnaire. Poisson regression models were used to assess the association between DED and overall and domain-specific CPQ11-14 scores. The prevalence of DED was 19.7%. In general, children with DED did not indicate any decrease in self-perception. However, this condition was associated with an impact on the functional limitation domain. The presence of DED may cause negative impacts on a child's perception of oral health and on their daily performance.
Martin, Christina Gamache; Kim, Hyoun K; Bruce, Jacqueline; Fisher, Philip A
This study examined a neurobiologically informed model of the emergence of child externalizing behaviors in an ethnically diverse community sample of 232 9-12 year old children. Replicating extensive prior research, our analyses revealed that parents' inconsistent discipline and poor quality monitoring were predictive of child externalizing behavior. In addition, poor parental monitoring, but not inconsistent discipline, was associated with children having a significantly flatter morning-to-evening cortisol slope, which was in turn, related to higher levels of externalizing behaviors. An indirect effect of parental monitoring on externalizing behaviors, through child diurnal cortisol rhythms, was also supported. These findings highlight the role of the hypothalamic-pituitary-adrenal (HPA) axis and its hormonal end product, cortisol, in the relationship between the caregiving environment and the development of externalizing behaviors. Copyright © 2013 Elsevier Ltd. All rights reserved.
Douglass, Anne; Klerman, Lorraine
Research Findings: This study investigated how the Strengthening Families through Early Care and Education initiative in Illinois (SFI) influenced change in 4 child care programs. Findings indicate that SFI influenced quality improvements through 4 primary pathways: (a) Learning Networks, (b) the quality of training, (c) the engagement of program…
Astri Drange Hole
Full Text Available This paper examines empirically if there is a link between quality of care in the Norwegian nursing home industry and exposure of the industry to competition. Exposing public care to competition implies that the responsibility for providing care services is shared between public authorities and private actors. In Norway, exposure to competition means tender competition. Suppliers bid for a contract issued by the Norwegian authorities for a limited number of years. Quality of care in an institution is the major competitive factor. The provider categories of elderly care are: 1 care provided by institutions run by municipalities, 2 care provided by institutions run by private companies, which have won a tender competition, 3 care provided by institutions run by private companies owned by private families, voluntary religious or idealistic organizations. Nurse-to-patient ratio is used as a proxy for quality of care. The regression analysis indicates a relationship between quality of care and exposure to competition. The quality of care in provider category 2 is significantly lower than in provider category 1, but there are more variations in the quality of care in provider category 1 than in provider category 2. We find the lowest quality of care in provider category 1. There is also a relationship between the quality of care in an institution and the educational level of the staff, the location, the workforce, and the size of an institution. Finally, there is a relationship between the quality of care in an institution and the real and the required capacity, and the financial status in a region.
Ramsay, Samantha A.; Branen, Laurel J.; Fletcher, Janice; Price, Elizabeth; Johnson, Susan L.; Sigman-Grant, Madeleine
Objective: To explore the verbal communication of child care providers regarding preschool children's internal and non-internal hunger and satiation cues. Methods: Video observation transcripts of Head Start staff (n=29) at licensed child care centers in Colorado, Idaho, and Nevada were analyzed for common themes. Results: Adults' verbal…
Patten, Peggy; Ricks, Omar Benton
Many parents want to know how important the quality of care is to children's social, emotional, and academic development. This Digest synthesizes some major recent research on child care quality. First, the Digest explains what features contribute to quality of care. The Digest also explains the differences between studies of how quality is…
Moini, Joy S; Zellman, Gail L; Gates, Susan M
.... Difficulty in obtaining child care creates conflicts between parental obligations and mission responsibilities, and if parents have no child care, they may fail to report for duty in order to care for their children...
Lalonde, Gabrielle; Bernier, Annie; Beaudoin, Cindy; Gravel, Jocelyn; Beauchamp, Miriam H
The young brain is particularly vulnerable to injury due to inherent physiological and developmental factors, and even mild forms of traumatic brain injury (mTBI) can sometimes result in cognitive and behavioural difficulties. Despite the high prevalence of paediatric mTBI, little is known of its impact on children's social functioning. Parent-child relationships represent the centre of young children's social environments and are therefore ideal contexts for studying the potential effects of mTBI on children's social functioning. The aim of this study was to assess the quality of parent-child interactions after mTBI using observational assessment methods and parental report. The sample included 130 children (18-60 months at recruitment) divided into three groups: children with uncomplicated mTBI (n = 47), children with orthopaedic injury (OI, n = 27), and non-injured children (NI, n = 56). The quality of parent-child interactions was assessed 6 months post-injury using the Mutually Responsive Orientation (MRO) scale, an observational measure which focuses on the dyadic nature of parent-child exchanges, and the Parental Stress Index questionnaire (Parent-Child Dysfunctional Interaction (PCDI) domain). Significant differences with medium effect sizes were found between the mTBI group and the NI group on the MRO, but not between the OI group and the other two groups. PCDI scores did not differ across groups, suggesting that observational measures may be more sensitive to changes in parent-child interactions after TBI. The current findings have implications for children's post-injury social development and highlight the importance of monitoring social outcomes even after minor head injuries. © 2016 The British Psychological Society.
Andreyeva, Tatiana; Kenney, Erica L; O'Connell, Meghan; Sun, Xiaohan; Henderson, Kathryn E
This study assessed the dietary quality of lunches and feeding practices (family-style service, teacher role modeling) in Connecticut child care centers and made comparisons by center participation in the federal Child and Adult Care Food Program (CACFP). Plate waste methods and visual observation of lunches served and consumed. A total of 97 randomly selected licensed Connecticut child care centers (53 CACFP and 44 non-CACFP). A total of 838 preschool-aged children. Total energy intake, macronutrient intake, and intake by CACFP meal component as well as use of family-style dining, management of additional helpings, and whether and what teachers consumed in view of children. Child dietary intake at lunch was compared with dietary and CACFP recommendations using a mixed linear regression model. The CACFP centers were more likely to offer family-style service and have staff eat the same foods as the children. Children in non-CACFP centers consumed more saturated fat (4.1 vs 2.7 g; P feeding practices in child care settings require further exploration in the context of serving children at risk for food insecurity and in light of recent work on responsive feeding. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Kiss, Eniko; Kapornai, Krisztina; Baji, Ildikó; Mayer, László; Vetró, Agnes
An important question in child psychiatry is the agreement between parents and children. We studied mother-child concordance about the quality of life of children (QoL). We hypothesized that mothers of depressed children rate lower QoL than children for themselves while mothers of non-depressed children rate better QoL; that inter-informant agreement is higher in the non-depressed sample; and finally that agreement increases with age of the child. QoL of depressed children (N = 248, mean age 11.45 years, SD 2.02) were compared to that of non-depressed children (N = 1695, mean age 10.34 years, SD 2.19). QoL was examined by a 7 item questionnaire (ILK). Mothers of depressed children rated lower QoL than their children while mothers of nondepressed children rated higher QoL than their children. Agreement was low in both samples but higher in the controls. Inter-informant agreement was only influenced by depression. Our results show that mothers relate more serious negative effects to childhood depression than their children and rate less problems for their non-depressed children compared to self-reports. Mother-child agreement is negatively influenced by depression which further stresses the importance of obtaining reports from the child and at least one parent in order to understand the subjective experiences caused by the illness.
This paper will analyse the difficulties in providing a global quality assurance system for Surveyors. Using case studies from the United Kingdom and elsewhere opportunities for harmonising Quality Assurance systems will be explored. The difficulties in moving towards common quality assurance systems will be analysed. Possible alternatives in the form of the development a knowledge bank of mutual agreements and top up qualifications will be investigated. The paper also looks at the role of FI...
This paper analyses quality of the living flowers and plants transportation. A part of this paper compares the demands for a particular transport mode and a practical demonstration of these transport modes within a specific transport mode. The paper presents a survey of quality of services provided by individual transport modes.
Feb 2, 2012 ... Objective: This study was aimed at evaluating patients' satisfaction with quality of care provided at the National Health. Insurance Scheme .... patient values and preferences. Several ... and patient centered, and that the health consumer's .... socio-demographic factors influence the perceived quality.
Underhill, Meghan L.; Kiviniemi, Marc T.
Background: Two-thirds of adults aged 50 years and older are adherent to recommendations for colorectal cancer screening. Provider-patient communication and characteristics of the patient-provider relationship may relate to screening behavior. Methods: The association of provider communication quality, relationship, and colorectal cancer screening…
Full Text Available Picky eating is a problematic eating behavior caregivers may encounter with children under their care. A picky eater (PE is typically characterized as consuming a narrow range of food, as well as rejecting several food items. Much of the literature regarding PEs involves parents, although use of nonparental childcare arrangements in the United States has increased in the past several decades. Although data on parental mealtime strategies exist, little is known about how parent and childcare provider pickiness perceptions differ between types of childcare, such as center-based childcare (CBCC and home-based childcare (HBCC, or how these perceptions influence the mealtime strategies utilized. The objectives of this study were to (1 compare perceptions of child pickiness between parents and childcare providers, (2 compare percent agreement in pickiness perception between the dyads of CBCC parents and providers and HBCC parents and providers, and (3 identify mealtime strategy utilization based on pickiness perception. A total of 52 child, parent, and childcare provider triads participated in the study and completed the Mealtime Assessment Survey and the Parent/Teacher Mealtime Strategy Survey regarding the same child. Results showed that parents are 1.4 times more likely than childcare providers to perceive a child as being picky, HBCC parents and providers are 1.4 times more likely to perceive a child as being picky than CBCC parents and providers, CBCC parents and providers disagree more in their perception of child pickiness than HBCC parents and providers (41% vs 26%, and finally, perception of child pickiness has a greater influence on mealtime strategies utilized by parents. These results can be used to focus intervention efforts aimed at improving child eating habits across the home and childcare location.
The Lesbian and Gay Child Care Task Force documented anecdotal evidence of homophobia in child care and school age communities, including: (1) refusal to accept children from lesbian, gay, bisexual, and transgender (LGBT) families into child care; (2) biased attitudes expressed to children when they speak about their families; and (3) demonstrated…
Stattin, Pär; Sandin, Fredrik; Sandbäck, Torsten; Damber, Jan-Erik; Franck Lissbrant, Ingela; Robinson, David; Bratt, Ola; Lambe, Mats
Cancer quality registers are attracting increasing attention as important, but still underutilized sources of clinical data. To optimize the use of registers in quality assurance and improvement, data have to be rapidly collected, collated and presented as actionable, at-a-glance information to the reporting departments. This article presents a dashboard performance report on select quality indicators to cancer care providers. Ten quality indicators registered on an individual patient level in the National Prostate Cancer Register of Sweden and recommended by the National Prostate Cancer Guidelines were selected. Data reported to the National Prostate Cancer Register are uploaded within 24 h to the Information Network for Cancer Care platform. Launched in 2014, "What''s Going On, Prostate Cancer" provides rapid, at-a-glance performance feedback to care providers. The indicators include time to report to the National Prostate Cancer Register, waiting times, designated clinical nurse specialist, multidisciplinary conference, adherence to guidelines for diagnostic work-up and treatment, and documentation and outcome of treatment. For each indicator, three performance levels were defined. What's Going On, a dashboard performance report on 10 selected quality indicators to cancer care providers, provides an example of how data in cancer quality registers can be transformed into condensed, at-a-glance information to be used as actionable metrics for quality assurance and improvement.
Frakt, Austin B; Pizer, Steven D; Feldman, Roger
Objective. To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings. Data Source. We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical. Study Design. We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan–provider integration. Data Collection. With the exception of Medigap premium data, all data were publicly available. We ascertained plan–provider integration through examination of plans’ websites and governance documents. Principal Findings. We found that integrated plan–providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits. Conclusions. Current policy encourages plan–provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur). PMID:23800017
Frakt, Austin B; Pizer, Steven D; Feldman, Roger
To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings. We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical. We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan-provider integration. With the exception of Medigap premium data, all data were publicly available. We ascertained plan-provider integration through examination of plans' websites and governance documents. We found that integrated plan-providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits. Current policy encourages plan-provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur). © Health Research and Educational Trust.
Portrait, France R M; van der Galiën, Onno; Van den Berg, Bernard
The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition. Copyright © 2015 John Wiley & Sons, Ltd.
Owens, Christine; Stoken, Amy; Fritts, Jonathan; Magar, Michele; Bellm, Dan; Shukla, Renu; Vardell, Rosemarie; Wayne, Claudia; Whitebook, Marcy
Research on child care quality and experience in the field shows that the quality of working conditions are linked to a caregiver's ability to provide quality care. Noting that legal rights that generally apply to most child care teachers are not upheld in every workplace, this guide provides information on federal legal rights of child care…
Piotrowski, Caroline C; Tailor, Ketan; Cormier, Damien C
Although the majority of families that experience intimate partner violence (IPV) have more than one child, most research to date has focused upon a single child within these families. A significant body of research has indicated siblings play an important role in children's adjustment and well-being. To address this gap, the three main goals of the present study were to compare the adjustment of older and younger siblings exposed to IPV, to describe and compare the quality of these sibling relationships from multiple perspectives, and to investigate how sibling adjustment and relationship quality influence children's adjustment. Forty-seven sibling pairs and their mothers were recruited from the community. Mothers self-reported on their violent experiences using the Conflict Tactics Scale, and also estimated the length of time their children were exposed to IPV. Mothers and children completed assessments of child adjustment and the quality of sibling relationships. Observers also assessed the quality of sibling interaction. Results indicated that adjustment between siblings was highly inter-related. On average, mothers reported sibling relationships as less positive but also as less hostile than did siblings themselves. Higher levels of sibling hostility, lower levels of sibling warmth and higher levels of disengagement each significantly predicted child adjustment; however, these effects were predicated upon the adjustment of the other sibling. The sibling relationships of children exposed to IPV made a difference in their individual adjustment, and their adjustment issues influenced how they feel about and interacted with their sibling. Sibling hostility played a stronger role in adjustment issues than sibling warmth. The nature of sibling influences and the direction of future research were discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.
Malloy, Erin; Butt, Shiraz; Sorter, Michael
Inpatient child and adolescent psychiatry leadership roles are often multifaceted, necessitating strong clinical knowledge and skills, organizational and leadership abilities, and in the academic setting the desire and skill in teaching and research. Early career psychiatrists who do possess these attributes may find themselves unprepared for such challenges as dealing with complex administrative and economic issues, accreditation, legal matters, and multitasking. This article offers a primer addressing these basic issues and in managing change through quality improvement processes.
Mandavia, Rishi; Mehta, Nishchay; Schilder, Anne; Mossialos, Elias
Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency. To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care. Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as 'positive', those that were 'intermediate' showed improvement in some measures, and those classified as 'negative' showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist. Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points. The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives - if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK. © British Journal of General Practice 2017.
Maintains that Total Quality Management (TQM) is one method that helps to monitor and improve the quality of child care. Lists four steps for a child-care center to design and implement its own TQM program. Suggests that quality assurance in child-care settings is an ongoing process, and that TQM programs help in providing consistent, high-quality…
Walubita, Mulima; Sikateyo, Bornwell; Zulu, Joseph M
Zambia is experiencing high prevalence of childhood cancer. However, very few children access and complete treatment for cancer. This study aimed to document the challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia, and their coping strategies. This was an exploratory health facility-based qualitative study that was conducted at a Paediatric oncology ward at referral hospital in Zambia. In-depth individual interviews conducted with fifteen (15) caregivers and seven (7) key informants were analysed using thematic analysis. Several challenges related to managing the childhood cancer diagnosis were recorded. Individual and family challenges were inadequate knowledge on childhood cancer, lack of finances to meet treatment and transport costs as well as long period of hospitalisation that affected women's ability to perform multiple responsibilities. Whereas challenges at community level were inadequate support to address emotional and physical distress and social stigmatisation experienced by caregivers. Health systems issues included inadequate specialised health workers, poor communication among health workers, limited space and beds as well as insufficient supplies such as blood. Cultural related factors were the belief that cancer is a product of witchcraft as well as religious beliefs regarding the role of faith healing in childhood cancer treatment. Coping strategies used by parents/ caregivers included praying to God, material support from organisations and church as well as delaying having another child. Addressing the challenges for health care providers, parents and patients who face a childhood cancer diagnosis may require adopting a systems or an ecological approach that allows developing strategies that simultaneously address challenges related to the individual, family, community, health system and cultural aspects.
Full Text Available The paper summarizes main results of partial research aimed at detection of the key factors affecting quality in the sector of tourism services providers, namely tour operators and travel agencies. A primary questionnaire survey was conducted; the researched factors were distributed in the context of service quality dimensions (Grönroos model; the dimensions were tested in relation to sex, age and education of the respondents (ANOVA; Brown-Forsythe test. Assurance was identified as the most important dimension. The output of the study is determining the significance of individual quality factors from the perspective of a potential customer when selecting a service provider.
Shelton, Katherine H.; Van Den Bree, Marianne B. M.
This prospective, longitudinal study investigated the moderating role of pubertal timing on reciprocal links between adolescent appraisals of parent-child relationship quality and girls' (N = 1,335) and boys' (N = 1,203) cigarette and alcohol use across a 12-month period. Reciprocal effects were found between parent-child relations and on-time…
This paper focuses upon the micro level of the pre-school classroom, taking the example of the Indian Integrated Child Development Service (ICDS), and the discourse of "child-centred" pedagogy that is often associated with quality pre-schooling. Through an analysis of visual data, semi-structured and film elicitation interviews drawn…
Haven, Erin L.; Manangan, Christen N.; Sparrow, Joanne K.; Wilson, Beverly J.
This study examined associations between parent-child interactions and the development of social skills in 42 children (21 typically developing and 21 with autism spectrum disorders) between the ages of 3 years, 0 months and 6 years, 11 months. We expected that positive parent-child interaction qualities would be related to children's social…
Sturms, LM; van der Sluis, CK; Groothoff, JW; ten Duis, HJ; Eisma, WH
Objectives: To describe the long-term health-related quality of life (HRQOL) reported by young traffic injury victims and to assess the child-parent agreement on the child's HRQOL. Design: Cohort study with a mean follow-up of 2.4 years. Setting: Traumatology department in a university hospital in
Plunkett, Diane M.
The purpose of this study was to gain greater understanding of the potential benefits of assistive technology (AT) devices on young children's social development. Specifically, changes to the quality of the adult/young child social interactions as a function of the child's access to and use of his/her personal AT device was examined. Using a…
Full Text Available In this study we apply the analytic hierarchy process (AHP to evaluate the service quality of third-party logistics (3PL service providers. We first conceptualize five dimensions of 3PL service quality (i.e. tangibles, reliability, responsiveness, assurance and empathy. We then apply the AHP method to determine the relative weights of the five service quality dimensions and eventually select the best 3PL service provider. To implement this idea in practice, we conduct an empirical case study on four companies providing 3PL services in Korea. The results indicate that Responsiveness out of the five service quality dimensions is the most important factor in the perception of 3PL customers.
Butler, Ashleigh E; Copnell, Beverley; Hall, Helen
Entering the paediatric intensive care unit with a critically ill child is a stressful experience for parents. In addition to fearing for their child's well-being, parents must navigate both a challenging environment and numerous new relationships with healthcare staff. How parents form relationships with staff and how they perceive both their own and the healthcare providers' roles in this early stage of their paediatric intensive care journey is currently unknown. This paper explores bereaved parents' perceptions of their role and their relationships with healthcare providers when their child is admitted to the intensive care unit, as part of a larger study exploring their experiences when their child dies in intensive care. A constructivist grounded theory approach was utilised to recruit 26 bereaved parents from 4 Australian intensive care units. Parents participated in audio-recorded, semi-structured interviews lasting 90-150min. All data were analysed using the constant comparative analysis processes, supported by theoretical memos. Upon admission, parents viewed healthcare providers as experts, both of their child's medical care and of the hospital system. This expertise was welcomed, with the parent-healthcare provider relationship developing around the child's need for medical care. Parents engaged in 2 key behaviours in their relationships with staff: prioritising survival, and learning 'the system'. Within each of these behaviours are several subcategories, including 'Stepping back', 'Accepting restrictions' and 'Deferring to medical advice'. The relationships between parents and staff shift and change across the child's admission and subsequent death in the paediatric intensive care unit. However, upon admission, this relationship centres around the child's potential survival and their need for medical care, and the parent's recognition of the healthcare staff as experts of both the child's care and the hospital system. Copyright © 2017 Australian
Rhebergen, Martijn D F; Lenderink, Annet F; van Dijk, Frank J H; Hulshof, Carel T J
To assess whether experts can provide high-quality answers to occupational safety and health (OSH) questions in online Question & Answer (Q&A) networks. The authors evaluated the quality of answers provided by qualified experts in two Dutch online networks: ArboAntwoord and the Helpdesk of the Netherlands Center for Occupational Diseases. A random sample of 594 answers was independently evaluated by two raters using nine answer quality criteria. An additional criterion, the agreement of answers with the best available evidence, was explored by peer review of a sample of 42 answers. Reviewers performed an evidence search in Medline. The median answer quality score of ArboAntwoord (N=295) and the Netherlands Center for Occupational Diseases Helpdesk (N=299) was 8 of 9 (IQR 2). The inter-rater reliability of the first nine quality criteria was high (κ 0.82-0.90, p<0.05). A question answered by two or more experts had a greater probability of a high-quality score than questions answered by one expert (OR 4.9, 95% CI 2.7 to 9.0). Answers most often scored insufficient on the use of evidence to underpin the answer (36% and 38% for the networks, respectively) and on conciseness (35% and 31%, respectively). Peer review demonstrated that 43%-72% of the answers in both online networks were in complete agreement with the best available evidence. OSH experts are able to provide quality answers in online OSH Q&A networks. Our answer quality appraisal instrument was feasible and provided information on how to improve answer quality.
Yang, Ya-Ting; Lin, Neng-Pai; Su, Shyi; Chen, Ya-Mei; Chang, Yao-Mao; Handa, Yujiro; Khan, Hafsah Arshed Ali; Elsa Hsu, Yi-Hsin
The rapid population aging is now a global issue. The increase in the elderly population will impact the health care industry and health enterprises; various senior needs will promote the growth of the senior health industry. Most senior health studies are focused on the demand side and scarcely on supply. Our study selected quality enterprises focused on aging health and analyzed different strategies to provide excellent quality services to senior health enterprises. We selected 33 quality senior health enterprises in Taiwan and investigated their excellent quality services strategies by face-to-face semi-structured in-depth interviews with CEO and managers of each enterprise in 2013. A total of 33 senior health enterprises in Taiwan. Overall, 65 CEOs and managers of 33 enterprises were interviewed individually. None. Core values and vision, organization structure, quality services provided, strategies for quality services. This study's results indicated four type of value-added strategy models adopted by senior enterprises to offer quality services: (i) residential care and co-residence model, (ii) home care and living in place model, (iii) community e-business experience model and (iv) virtual and physical portable device model. The common part in these four strategy models is that the services provided are elderly centered. These models offer virtual and physical integrations, and also offer total solutions for the elderly and their caregivers. Through investigation of successful strategy models for providing quality services to seniors, we identified opportunities to develop innovative service models and successful characteristics, also policy implications were summarized. The observations from this study will serve as a primary evidenced base for enterprises developing their senior market and, also for promoting the value co-creation possibility through dialogue between customers and those that deliver service. © The Author 2017. Published by Oxford
Senneseth, Mette; Hauken, May A; Matthiesen, Stig B; Gjestad, Rolf; Laberg, Jon C
Partners of cancer patients report psychological distress and reduced quality of life. However, partners' mental health status and quality of life during child-rearing years and the influence of social support and hardiness on their well-being have not yet been studied. The aim of this study was to describe psychological distress, quality of life, social support, and hardiness of the partners facing spousal cancer during child-rearing years and investigate whether social support or hardiness moderated the relationship between psychological distress and quality of life. Cross-sectional data were collected in Norway from December 2013 to July 2015 as part of the Cancer-PEPSONE study. Five questionnaires were administered to 14 females and 21 males (n = 35). Participants reported more psychological distress and lower quality-of-life scores than other healthy Norwegian populations. Psychological distress seemed to be associated with their not being in control of their futures. Received social support moderated the effect of psychological distress on quality of life. Facing spousal cancer during child-rearing years seemed to have a substantial impact on partners' mental health and an adverse impact on their quality of life. Accordingly, these partners' self-care abilities may be reduced. Received social support may reduce the multiple burdens and consequently allow for enhancement of self-care. Interventions should aim to improve the social support provided to child-rearing partners, which may improve their quality of life. Providing adequate information about their partner's cancer illness and treatment may enhance their feelings of control, which may be beneficial for their mental health status.
Issel, L Michele; Olorunsaiye, Comfort; Snebold, Laura; Handler, Arden
We explored the relationships between local health department (LHD) structure, capacity, and macro-context variables and performance of essential public health services (EPHS). In 2012, we assessed a stratified, random sample of 195 LHDs that provided data via an online survey regarding performance of EPHS, the services provided or contracted out, the financial strategies used in response to budgetary pressures, and the extent of collaborations. We performed weighted analyses that included analysis of variance, pairwise correlations by jurisdiction population size, and linear regressions. On average, LHDs provided approximately 13 (36%) of 35 possible services either directly or by contract. Rather than cut services or externally consolidating, LHDs took steps to generate more revenue and maximize capacity. Higher LHD performance of EPHS was significantly associated with delivering more services, initiating more financial strategies, and engaging in collaboration, after adjusting for the effects of the Affordable Care Act and jurisdiction size. During changing economic and health care environments, we found that strong structural capacity enhanced local health department EPHS performance for maternal, child, and adolescent health.
Mother-child agreement and influencing factors were studied in depressed and non-depressed children. We hypothesized that age and gender of the child and maternal depression influenced mother-child agreement; parents of depressed children underestimated the quality of life of their children; agreement was better in older and non-depressed children. We studied depressed children with Major Depressive Disorder (n = 354, mean age = 11.69 +/- 2.05 years), and non-depressed school-age children (n = 1695, mean age = 10.34 +/- 2.19 years). Psychiatric diagnosis was obtained by a semi-structured interview; depressive symptoms and quality of life were measured by self-reported questionnaires. Mother-child agreement about depressive symptoms increased as children got older. Mother-son reports showed significant difference, mother-daughter reports were similar. Depressed mothers reported more serious symptoms for their children. Depressed children's parent rated lower quality of life than children for themselves. Agreement was influenced by depression of the child and only marginally by age. Age and psychiatric illness of the examined person influences agreement, which finding may well be important in practice.
Hughes, B.; Chan, J.
A three year survey, beginning in 1991, was conducted by the Canadian Electrical Association to study the levels of power quality that exist in Canada, and to determine ways to increase utility expertise in making power quality measurements. Twenty-two utilities across Canada were involved, with a total of 550 sites being monitored, including residential and commercial customers. Power disturbances, power outages and power quality were recorded for each site. To create a group average power quality plot, the transient disturbance activity for each site was normalized to a per channel, per month basis and then divided into a grid. Results showed that the average power quality provided by Canadian utilities was very good. Almost all the electrical disturbance within a customer premises were created and stayed within those premises. Disturbances were generally beyond utility control. Utilities could, however, reduce the amount of time the steady-state voltage exceeds the CSA normal voltage upper limit. 5 figs
Executing Quality describes the perceived process experienced by participants while engaging in Keystone Standards, Training, Assistance, Resources, and Support (Keystone STARS) quality rating improvement system (QRIS). The purpose of this qualitative inquiry was to understand the process of Keystone STARS engagement in order to generate a…
Asefzadeh, Saeed; Gholami, Soheyla; Rajaee, Roya; Najafi, Marziye; Alijanzadeh, Mehran
Quality is the center of attention in all service providing organizations that are effective in promoting satisfaction of patients who are referred to medical centers. The aim of this study was to investigate the quality of health service providers in a case study of Qazvin, Iran, in 2014. This descriptive study was conducted on 1,002 people who were residents of Qazvin Province (Iran) in 2014. The people were selected randomly from the population of the study area. The main variables studied were education, perceptions, expectations, and gaps in service quality. The data collection tool was the standard Servequal questionnaire. To determine the reliability of the research tool, we used Cronbach's Alpha coefficient and the test-retest method. Statistical analyses were conducted using SPSS and the ANOVA test. The mean age of people included in the study was 32 ± 9.9 years, and the average waiting time to receive services was 73 ± 47 minutes. Hospitals and doctors' offices had the highest quality gap of -1.420 ± 0.82 and -1.01 ± 0.75, respectively. The service quality gaps in medical centers, health providers of rural area, and health providers of urban area were -0.883 ± 0.67, -0.882 ± 0.83, and -0.804 ± 0.62, respectively. There was a significant relationship between peoples' perceptions and expectations concerning the quality of health services and their educational levels. The higher gaps in quality in hospitals and in doctors' offices require more attention. Managers and policy makers should consider developing and implementing plans to reduce these gaps in quality and to promote better health services in these two sectors.
Sellevold, Gerd Sylvi
Background: Many nursing homes are multicultural workplaces where the majority of healthcare providers have an ethnic minority background. This environment creates challenges linked to communication, interaction and cultural differences. Further, the healthcare providers have varied experiences and understanding of what quality care of patients with dementia involves. Purpose: The aim of this study is to illuminate multi-ethnic healthcare providers´ lived experiences of their own workin...
Jacobsen, Heidi; Vang, Kristin Alvestad; Lindahl, Karoline Mentzoni; Wentzel-Larsen, Tore; Smith, Lars; Moe, Vibeke
The main aim of this study was to investigate the quality of social interaction between 60 foster parents and their foster children compared to a group of 55 non-foster families at 2 (T1) and again at 3 (T2) years of age. Video observations were used to investigate child-parent interaction at both time-points. "This is My Baby" interview was administered to investigate foster parents' commitment at T1. The main results revealed significant group differences at T1 on all child-parent social interaction measures, although not at T2. Further, a significant group by time interaction was identified for parental sensitivity, revealing a positive development over time in the foster group. Finally, a significant positive relation was found between commitment at T1 and parental sensitivity. The results convey an optimistic view of the possibilities for foster dyads to develop positive patterns of social interaction over time.
Bahadori, Mohammadkarim; Raadabadi, Mehdi; Heidari Jamebozorgi, Majid; Salesi, Mahmood; Ravangard, Ramin
The healthcare organizations need to develop and implement quality improvement plans for their survival and success. Measuring quality in the healthcare competitive environment is an undeniable necessity for these organizations and will lead to improved patient satisfaction. This study aimed to measure the quality of provided services for patients with chronic kidney disease in Kerman in 2014. This cross-sectional, descriptive-analytic study was performed from 23 January 2014 to 14 February 2014 in four hemodialysis centers in Kerman. All of the patients on chronic hemodialysis (n = 195) who were referred to these four centers were selected and studied using census method. The required data were collected using the SERVQUAL questionnaire, consisting of two parts: questions related to the patients' demographic characteristics, and 28 items to measure the patients' expectations and perceptions of the five dimensions of service quality, including tangibility, reliability, responsiveness, assurance, and empathy. The collected data were analyzed using SPSS 21.0 through some statistical tests, including independent-samples t test, one-way ANOVA, and paired-samples t test. The results showed that the means of patients' expectations were more than their perceptions of the quality of provided services in all dimensions, which indicated that there were gaps in all dimensions. The highest and lowest means of negative gaps were related to empathy (-0.52 ± 0.48) and tangibility (-0.29 ± 0.51). In addition, among the studied patients' demographic characteristics and the five dimensions of service quality, only the difference between the patients' income levels and the gap in assurance were statistically significant (P expectations of patients on hemodialysis were more than their perceptions of provided services. The healthcare providers and employees should pay more attention to the patients' opinions and comments and use their feedback to solve the workplace problems and
McClintock, Heather F; Kurichi, Jibby E; Barg, Frances K; Krueger, Alice; Colletti, Patrice M; Wearing, Krizia A; Bogner, Hillary R
Significant disparities in health care access and quality persist between persons with disabilities (PWD) and persons without disabilities (PWOD). Little research has examined recommendations of patients and providers to improve health care for PWD. We sought to explore patient and health care provider recommendations to improve health care access and quality for PWD through focus groups in the physical world in a community center and in the virtual world in an online community. In all, 17 PWD, 4 PWOD, and 6 health care providers participated in 1 of 5 focus groups. Focus groups were conducted in the virtual world in Second Life ® with Virtual Ability, an online community, and in the physical world at Agape Community Center in Milwaukee, WI. Focus group data were analyzed using a grounded theory methodology. Themes that emerged in focus groups among PWD and PWOD as well as health care providers to improve health care access and quality for PWD were: promoting advocacy, increasing awareness and knowledge, improving communication, addressing assumptions, as well as modifying and creating policy. Many participants discussed political empowerment and engagement as central to health care reform. Both PWD and PWOD as well as health care providers identified common themes potentially important for improving health care for PWD. Patient and health care provider recommendations highlight a need for modification of current paradigms, practices, and approaches to improve the quality of health care provision for PWD. Participants emphasized the need for greater advocacy and political engagement. Copyright © 2018 Elsevier Inc. All rights reserved.
Coley, Sheryl L; Zapata, Jasmine Y; Schwei, Rebecca J; Mihalovic, Glen Ellen; Matabele, Maya N; Jacobs, Elizabeth A; Anderson, Cynthie K
African American mothers and other mothers of historically underserved populations consistently have higher rates of adverse birth outcomes than White mothers. Increasing prenatal care use among these mothers may reduce these disparities. Most prenatal care research focuses on prenatal care adequacy rather than concepts of quality. Even less research examines the dual perspectives of African American mothers and prenatal care providers. In this qualitative study, we compared perceptions of prenatal care quality between African American and mixed race mothers and prenatal care providers. Prenatal care providers (n = 20) and mothers who recently gave birth (n = 19) completed semistructured interviews. Using a thematic analysis approach and Donabedian's conceptual model of health care quality, interviews were analyzed to identify key themes and summarize differences in perspectives between providers and mothers. Mothers and providers valued the tailoring of care based on individual needs and functional patient-provider relationships as key elements of prenatal care quality. Providers acknowledged the need for knowing the social context of patients, but mothers and providers differed in perspectives of "culturally sensitive" prenatal care. Although most mothers had positive prenatal care experiences, mothers also recalled multiple complications with providers' negative assumptions and disregard for mothers' options in care. Exploring strategies to strengthen patient-provider interactions and communication during prenatal care visits remains critical to address for facilitating continuity of care for mothers of color. These findings warrant further investigation of dual patient and provider perspectives of culturally sensitive prenatal care to address the service needs of African American and mixed race mothers. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Eiriz, Vasco; Figueiredo, José António
To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key variables related to the quality of health care services based on a review of the available literature, and to establish a conceptual framework in order to test the framework and variables empirically. Systematic review of the literature. Health care services quality should not be evaluated exclusively by customers. Given the complexity, ambiguity and heterogeneity of health care services, the authors develop a framework for health care evaluation based on the relationship between customers (patients, their relatives and citizens) and providers (managers, doctors, other technical staff and non-technical staff), and considering four quality items (customer service orientation, financial performance, logistical functionality and level of staff competence). This article identifies important changes in the Portuguese health care industry, such as the ownership of health care providers. At the same time, customers are changing their attitudes towards health care, becoming much more concerned and demanding of health services. These changes are forcing Portuguese private and public health care organisations to develop more marketing-oriented services. This article recognises the importance of quality evaluation of health care services as a means of increasing customer satisfaction and organisational efficiency, and develops a framework for health care evaluation based on the relationship between customers and providers.
Meaghann S. Weaver
Full Text Available Pediatric palliative care studies often rely on proxy-reported instead of direct child-reported quality of life metrics. The purpose of this study was to longitudinally evaluate quality of life for pediatric patients receiving palliative care consultations and to compare patient-reported quality of life with parent perception of the child’s quality of life across wellness domains. The 23-item PedsQL™ V4.0 Measurement Model was utilized for ten child and parent dyads at time of initial palliative care consultation, Month 6, and Month 12 to assess for physical, emotional, social, and cognitive dimensions of quality of life as reported independently by the child and by the parent for the child. Findings were analyzed using Bland–Altman plots to compare observed differences to limits of agreement. This study revealed overall consistency between parent- and child-reported quality of life across domains. Physical health was noted to be in closest agreement. At the time of initial palliative care consult, children collectively scored their social quality of life higher than parental perception of the child’s social quality of life; whereas, emotional and cognitive quality of life domains were scored lower by children than by the parental report. At the one year survey time point, the physical, emotional, and social domains trended toward more positive patient perception than proxy perception with congruence between quality of life scores for the cognitive domain. Findings reveal the importance of eliciting a child report in addition to a parent report when measuring and longitudinally trending perceptions on quality of life.
Abrahamson, Kathleen; Myers, Jaclyn; Arling, Greg; Davila, Heather; Mueller, Christine; Abery, Brian; Cai, Yun
The objective of this study was to explore home and community-based service (HCBS) providers' perspectives of organizational readiness for quality improvement (QI). Data were obtained from a survey of participants (N = 56) in a state-sponsored HCBS QI initiative. Quality improvement challenges included lack of time and resources, staff apprehension or resistance, resistance from consumers and families, and project sustainability. Support from leadership was viewed as an important factor in participating organizations' decision to engage in QI. Internal resources available to support QI varied widely between participating organizations, with differences observed between smaller and larger agencies, as well as between provider types and populations served.
Harland, Juliet; Bath, Peter
The quality of health information available on the Internet has proved difficult to assess objectively. The Internet's growing popularity as a source of health information, accompanied by the lack of regulation of websites, has resulted in research that has developed and tested tools to evaluate health website quality. However, only a few studies have tested the validity and reliability of these tools. There is a lack of consensus about appropriate indicators with which to operationalize the concept of quality health information. This study aimed to contribute to this research by testing the validity and reliability of existing tools, through their application to websites that provided information about multiple sclerosis. Furthermore, a specific tool for evaluating multiple sclerosis information was developed, contributing to the debate about suitable criteria for measuring the ;quality' of health information on the web.
Selebatso, Moses; Maude, Glyn; Fynn, Richard W. S.
Arid and semi-arid environments have low and unpredictable rainfall patterns resulting in limited availability of surface water for wildlife. In the Central Kalahari Game Reserve (CKGR) wildlife populations have lost access to natural surface water through cordon fences, livestock and human encroachment along the access routes. Artificial waterholes have been developed in the reserve to compensate for this loss. However, there have not been any assessments of the quality of water provided for wildlife and how that may be contributing to populations declines in the CKGR. We assessed water quality from 12 artificial waterholes against both Botswana and international livestock standards for drinking. Overall the quality of water provided is poor and poses a health risk to both animals and humans. Eight out of twelve boreholes tested exceeded the maximum acceptable Total Dissolved Solids (TDS) limits while three and four boreholes have toxic levels of lead and arsenic, respectively. Thus, pumping ground water could have more negative than positive impacts on wildlife thus defeating the intended management purpose. Failure to provide water of acceptable quality is a major concern for wildlife management in the CKGR and it may underlie some wildlife declines in the reserve. These findings confirm that restriction of populations from natural water sources create complex management challenges, especially where safe and sustainable alternative sources are scarce. Restriction of access of the population to natural water sources by fences and provision of poor quality water could compromise the overall fitness of wildlife populations and contribute to their decline.
Patel, Bhavika J; Lai, Lillian; Goldfield, Gary; Sananes, Renee; Longmuir, Patricia E
Psychosocial health issues are common among children with cardiac diagnoses. Understanding parent and child perceptions is important because parents are the primary health information source. Significant discrepancies have been documented between parent/child quality-of-life data but have not been examined among psychosocial diagnostic instruments. This study examined agreement and discrepancies between parent and child reports of psychosocial health and quality of life in the paediatric cardiology population. Children (n=50, 6-14 years) with diagnoses of CHDs (n=38), arrhythmia (n=5), cardiomyopathy (n=4), or infectious disease affecting the heart (n=3) were enrolled, completing one or more outcome measures. Children and their parents completed self-reports and parent proxy reports of quality of life - Pediatric Quality of Life Inventory - and psychosocial health - Behavioral Assessment Scale for Children (Version 2). Patients also completed the Multidimensional Anxiety Scale for Children. Associations (Pearson's correlations, Intraclass Correlation Coefficients) and differences (Student's t-tests) between parent proxy reports and child self-reports were evaluated. Moderate parent-child correlations were found for physical (R=0.33, p=0.03), school (R=0.43, pParent-child reports of externalising behaviour problems, for example aggression, were strongly correlated (R=0.70, pparent-child associations were found for emotional quality of life (R=0.25, p=0.10), internalising problems (R=0.17, p=0.56), personal adjustment/adaptation skills (R=0.23, p=0.42), or anxiety (R=0.07, p=0.72). Our data suggest that clinicians caring for paediatric cardiac patients should assess both parent and child perspectives, particularly in relation to domains such as anxiety and emotional quality of life, which are more difficult to observe.
Grispen, Janaica E J; Ickenroth, Martine H P; de Vries, Nanne K; van der Weijden, Trudy; Ronda, Gaby
Diagnostic self-tests (tests on body materials that are initiated by consumers with the aim of diagnosing a disorder or risk factor) are becoming increasingly available. Although the pros and cons of self-testing are currently not clear, it is an existing phenomenon that is likely to gain further popularity. To examine consumers' use of and needs for information about self-testing, and to assess the quality of consumer information provided with home test kits, as perceived by consumers and as assessed using a checklist of quality criteria. A cross-sectional Internet survey among 305 self-testers assessed their use of and needs for information and their perception of the quality of consumer information provided with self-test kits. A meta-search engine was used to identify Dutch and English consumer information for home diagnostic tests available online at the time of the study. The quality of this consumer information was evaluated using a checklist of quality criteria. The consumers' information needs were in line with the most frequently used information, and the information was perceived as being of moderate to good quality. The information was mostly in agreement with clinical practice guidelines, although information on reliability and follow-up behaviour was limited. Approximately half of the instruction leaflets did not include information on the target group of the test. Although generally of moderate to good quality, some aspects of the information provided were in many cases insufficient. European legislation concerning self-tests and accompanying information needs to be adapted and adhered to more closely. © 2012 John Wiley & Sons Ltd.
Portrait, F.R.M.; van den Berg, B.
Background and objectives: The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare
Guo, Jing; Ren, Xuezhu; Wang, Xiaohua; Qu, Zhiyong; Zhou, Qianyun; Ran, Chun; Wang, Xia; Hu, Juan
The objective of this study was to examine rates of depression among migrant children (MC) and left-behind children (LBC) as compared to non-left-behind children (NLBC) and also to examine the relationship between depression among these children and the quality of their parent-child and teacher-child relationships. This study collected data from a large sample of 3,759 children aged from 8 to 17 years, including 824 who had been left behind by one parent (LBCO), 423 who had been left behind b...
Sardasht, Fatemeh Ghaffari; Shourab, Nahid Jahani; Jafarnejad, Farzaneh; Esmaily, Habibollah
Improving the quality of healthcare services is considered as the main strategy to improve maternal and neonatal health outcomes. Providing appropriate healthcare for mothers and their newborn children is facilitated significantly by considering the mothers' health and welfare before pregnancy occurs. Therefore, the aim of this study was to compare the quality of preconception care provided to women of reproductive age provided by five health centers in Mashhad in 2012 and 2013. Multi-stage sampling was used to select the participants in this descriptive study. As a result, 360 women of reproductive age and 39 healthcare providers from 24 healthcare centers in Mashhad were selected to participate. The data gathering tool was a checklist based on the Donabedian model that includes the three dimensions of structure, process, and outcome. The data were analyzed by SPSS software (version 11.5), Kruskal-Wallis tests, ANOVA, and Spearman rank correlation. The results showed that preconception care at the 24 healthcare centers had essentially the same conditions. But in the process and outcome components, the quality of the preconception care at five of the health centers was significantly different (p=0.008). The highest quality of care processes was identified at health center number 3. The difference in the component of outcomes being followed up by the healthcare providers at five of the health centers was statistically significant (p=0.000); however, there were no significant differences found among the satisfaction and awareness of the women who participated at the five health centers. The results showed that the performance of health personnel in providing preconception care and providing follow-up care was not satisfactory.
Background Small-scale evaluations suggest that the provision of feedback to parents about their child’s weight status may improve recognition of overweight, but the effects on lifestyle behaviour are unclear and there are concerns that informing parents that their child is overweight may have harmful effects. The aims of this study were to describe the benefits and harms of providing weight feedback to parents as part of a national school-based weight-screening programme in England. Methods We conducted a pre-post survey of 1,844 parents of children aged 4–5 and 10–11 years who received weight feedback as part of the 2010–2011 National Child Measurement Programme. Questionnaires assessed general knowledge about the health risks associated with child overweight, parental recognition of overweight and the associated health risks in their child, child lifestyle behaviour, child self-esteem and weight-related teasing, parental experience of the feedback, and parental help-seeking behaviour. Differences in the pre-post proportions of parents reporting each outcome were assessed using a McNemar’s test. Results General knowledge about child overweight as a health issue was high at baseline and increased further after weight feedback. After feedback, the proportion of parents that correctly recognised their child was overweight increased from 21.9% to 37.7%, and more than a third of parents of overweight children sought further information regarding their child’s weight. However, parent-reported changes in lifestyle behaviours among children were minimal, and limited to increases in physical activity in the obese children only. There was some suggestion that weight feedback had a greater impact upon changing parental recognition of the health risks associated with child overweight in non-white ethnic groups. Conclusions In this population-based sample of parents of children participating in the National Child Measurement Programme, provision of weight feedback
Antczak, Paul; Jacinto,Gilda; Simek, Jimmy
The National Aeronautics and Space Administration's (NASA) agency-wide movement to cultivate a quality workplace is the basis for Lewis Research Center to implement Total Quality Fundamentals (TQF) initiatives. The Lewis Technical Services Directorate (TSD) introduced the Total Quality Fundamentals (TQF) workshops to its work force as an opportunity to introduce the concepts and principles of TQF. These workshops also provided the participants with the opportunity to dialogue with fellow TSD employees and managers. This report describes, through the perspective of the Lewis TSD TQF Coaches, how the TQF work- shop process was accomplished in TSD. It describes the structure for addressing the need, implementation process, input the TSD Coaches provided, common themes and concerns raised, conclusions, and recommendations. The Coaches concluded that these types of workshops could be the key to open the communication channels that are necessary to help everyone at Lewis understand where they fit in the organization. TQF workshops can strengthen the participant's connection with the Mission, Vision of the Center, and Vision of the Agency. Reconunendations are given based on these conclusions that can help the TSD Quality Board develop attainable measures towards a quality workplace.
Carrell, Douglas T; Cartmill, Deborah; Jones, Kirtly P; Hatasaka, Harry H; Peterson, C Matthew
To evaluate variability in donor semen quality between seven commercial donor sperm banks, within sperm banks, and between intracervical insemination and intrauterine insemination. Prospective, randomized, blind evaluation of commercially available donor semen samples. An academic andrology laboratory. Seventy-five cryopreserved donor semen samples were evaluated. Samples were coded, then blindly evaluated for semen quality. Standard semen quality parameters, including concentration, motility parameters, World Health Organization criteria morphology, and strict criteria morphology. Significant differences were observed between donor semen banks for most semen quality parameters analyzed in intracervical insemination samples. In general, the greatest variability observed between banks was in percentage progressive sperm motility (range, 8.8 +/- 5.8 to 42.4 +/- 5.5) and normal sperm morphology (strict criteria; range, 10.1 +/- 3.3 to 26.6 +/- 4.7). Coefficients of variation within sperm banks were generally high. These data demonstrate the variability of donor semen quality provided by commercial sperm banks, both between banks and within a given bank. No relationship was observed between the size or type of sperm bank and the degree of variability. The data demonstrate the lack of uniformity in the criteria used to screen potential semen donors and emphasize the need for more stringent screening criteria and strict quality control in processing samples.
Beehler, Gregory P; Lilienthal, Kaitlin R
The Primary Care Behavioral Health (PCBH) model of integrated primary care is challenging to implement with high fidelity. The Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) was designed to assess provider adherence to essential model components and has recently been adapted into a quality improvement toolkit. The aim of this pilot project was to gather preliminary feedback on providers' perceptions of the acceptability and utility of the PPAQ toolkit for making beneficial practice changes. Twelve mental health providers working in Department of Veterans Affairs integrated primary care clinics participated in semistructured interviews to gather quantitative and qualitative data. Descriptive statistics and qualitative content analysis were used to analyze data. Providers identified several positive features of the PPAQ toolkit organization and structure that resulted in high ratings of acceptability, while also identifying several toolkit components in need of modification to improve usability. Toolkit content was considered highly representative of the (PCBH) model and therefore could be used as a diagnostic self-assessment of model adherence. The toolkit was considered to be high in applicability to providers regardless of their degree of prior professional preparation or current clinical setting. Additionally, providers identified several system-level contextual factors that could impact the usefulness of the toolkit. These findings suggest that frontline mental health providers working in (PCBH) settings may be receptive to using an adherence-focused toolkit for ongoing quality improvement. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Spooner, Kiara K; Salemi, Jason L; Salihu, Hamisu M; Zoorob, Roger J
This study aimed to describe disparities and temporal trends in the level of perceived patient-provider communication quality (PPPCQ) in the United States, and to identify sociodemographic and health-related factors associated with elements of PPPCQ. A cross-sectional analysis was conducted using nationally-representative data from the 2011-2013 iterations of the Health Information National Trends Survey (HINTS). Descriptive statistics, multivariable linear and logistic regression analyses were conducted to examine associations. PPPCQ scores, the composite measure of patients' ratings of communication quality, were positive overall (82.8; 95% CI: 82.1-83.5). However, less than half (42-46%) of respondents perceived that providers always addressed their feelings, spent enough time with them, or helped with feelings of uncertainty about their health. Older adults and those with a regular provider consistently had higher PPPCQ scores, while those with poorer perceived general health were consistently less likely to have positive perceptions of their providers' communication behaviors. Disparities in PPPCQ can be attributed to patients' age, race/ethnicity, educational attainment, employment status, income, healthcare access and general health. These findings may inform educational and policy efforts which aim to improve patient-provider communication, enhance the quality of care, and reduce health disparities. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Borges, Juliana Bassalobre Carvalho; Carvalho, Sebastião Marcos Ribeiro de; Silva, Marcos Augusto de Moraes
To evaluate the service quality provided to heart surgery patients during their hospital stay, identifying the patient's expectations and perceptions. To associate service quality with: gender, age and the use of extracorporeal circulation. We studied 82 elective heart surgery patients (52.4% females and 47.6% males), operated by midsternal thoracotomy, age: 31 to 83 years (60.4 +/- 13.2 years); period: March to September 2006. Service quality was evaluated in two instances: the expectations at pre-operative and the perceptions of the service received on the 6th post-operative; through the application of the modified SERVQUAL scale (SERVQUAL-Card). The result was obtained by the difference of the sum of the scores on perception minus those of the expectations, and through statistical analysis. The SERVQUAL-Card scale was statistically validated, showing adequate level of internal consistency. We found a higher frequency of myocardial revascularization 55 (67.0%); first heart surgery 72 (87.8%) and the use of ECC 69 (84.1%). We noticed high mean values for expectations and perceptions with significant results (Pquality of service with: gender, in empathy (P= 0.04) and age, in reliability (P = 0.02). There was no significant association between ECC and quality of service. Service quality was satisfactory. The patient demonstrated a high expectation to hospital medical service. Women present a higher perception of quality in empathy and younger people in reliability. The use of ECC is not related to service quality in this sample. The data obtained in this study suggest that the quality of this health service can be monitored through the periodical application of the SERVQUAL scale.
Aarons, Gregory A.; Fettes, Danielle L.; Sommerfeld, David H.; Palinkas, Lawrence
Many public sector services systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well-suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems. This paper describes the process of using mixed methods in implementation research and provides an applied example of an examination of factors impacting staff retention during an evidence-based intervention implementation in a statewide child welfare system. We integrate qualitative data with previously published quantitative analyses of job autonomy and staff turnover during this statewide implementation project in order to illustrate the utility of mixed method approaches in providing a more comprehensive understanding of opportunities and challenges in implementation research. PMID:22146861
Aarons, Gregory A; Fettes, Danielle L; Sommerfeld, David H; Palinkas, Lawrence A
Many public sector service systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems. This article describes the process of using mixed methods in implementation research and provides an applied example of an examination of factors impacting staff retention during an evidence-based intervention implementation in a statewide child welfare system. The authors integrate qualitative data with previously published quantitative analyses of job autonomy and staff turnover during this statewide implementation project in order to illustrate the utility of mixed method approaches in providing a more comprehensive understanding of opportunities and challenges in implementation research.
Child Trends, 2010
This paper presents a profile of New Mexico's Look for the STARS--AIM HIGH prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…
Hu, Bi Ying; Chen, Liang; Fan, Xitao
This paper investigates early childhood education (ECE) teachers' self-reported and observed teacher-child interaction quality (TIQ) and the associated teachers' professional competence features using a latent profile analysis (LPA) approach to identify the variations in the quality of classroom experiences in Chinese preschools. A total of 164…
McNabb, Marion; Chukwu, Emeka; Ojo, Oluwayemisi; Shekhar, Navendu; Gill, Christopher J; Salami, Habeeb; Jega, Farouk
Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs) are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre. Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care. Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (pmobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.
Sellevold, Gerd Sylvi; Egede-Nissen, Veslemøy; Jakobsen, Rita; Sørlie, Venke
Many nursing homes appear as multicultural workplaces where the majority of healthcare providers have an ethnic minority background. This environment creates challenges linked to communication, interaction and cultural differences. Furthermore, the healthcare providers have varied experiences and understanding of what quality care of patients with dementia involves. The aim of this study is to illuminate multi-ethnic healthcare providers' lived experiences of their own working relationship, and its importance to quality care for people with dementia. The study is part of a greater participatory action research project: 'Hospice values in the care for persons with dementia'. The data material consists of extensive notes from seminars, project meetings and dialogue-based teaching. The text material was subjected to phenomenological-hermeneutical interpretation. Participants and research context: Participants in the project were healthcare providers working in a nursing home unit. The participants came from 15 different countries, had different formal qualifications, varied backgrounds and ethnic origins. Ethical considerations: The study is approved by the Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services. The results show that good working relationships, characterized by understanding each other's vulnerability and willingness to learn from each other through shared experiences, are prerequisites for quality care. The healthcare providers further described ethical challenges as uncertainty and different understandings. The results are discussed in the light of Lögstrup's relational philosophy of ethics and the concepts of vulnerability, ethic responsibility, trust and openness of speech. The prerequisite for quality care for persons with dementia in a multicultural working environment is to create arenas for open discussions between the healthcare providers. Leadership is of great importance.
Podell, Rachel; Shriqui, Vered Kaufman; Sagy, Yael Wolff; Manor, Orly; Ben-Yehuda, Arie
In view of increasing global and local trends in population ageing and the high healthcare utilization rates among the elderly, this study assesses the quality of primary care provided to the elderly population in Israel. It examines changes in quality over time, how quality varies across sub-groups of the elderly, and how quality in Israel compares with other countries. Data originate from the National Program for Quality Indicators in Community Healthcare (QICH), which operates in full collaboration with Israel's four HMOs. The study population included all elderly Israeli residents aged 65 years or older during 2002-2015 (N = 879,671 residents in 2015). Seven elderly-specific quality indicators from within the QICH framework were included: influenza and pneumococcal vaccinations, benzodiazepine overuse, long-acting benzodiazepine use, body weight documentation, weight loss and underweight. In addition, two non-age specific quality indicators relating to diabetes mellitus were included: the rate of HbA1C documentation and uncontrolled diabetes. Data were collected from patient electronic medical records (EMR) in accordance with each HMO, and aggregated by three variables: gender, age, and socio-economic position (SEP). During the measurement period, vaccination rates significantly increased (Influenza: from 42.0% in 2002 to 63.2% in 2015; and pneumococcal vaccination: from 25.8% in 2005 to 77.0% in 2015). Body weight documentation (in 65-74 year old persons) increased from only 16.3% in 2003 to 80.9% in 2015. The rate of underweight (BMI quality of care for the elderly in comparison with the international healthcare community. Overall, the quality of care received by elderly Israelis has improved substantially since measurements first began; yet, females receive lower quality care than males. Monitoring results of primary care quality indicators can contribute to population's successful aging; both chronic conditions at earlier ages (e.g. diabetes), and
Diomidous, Marianna; Ponirou, Paraskevi; Mpizopoulou, Zoi; Tzalera, Vaia; Mechili, Aggelos
The aim of this study is to examine the infections control methods in ICU as well as the issue of quality in health services provided, as they constitute an important quality assurance indicator. Moreover, nowadays the causes of Nosocomial infections are known and so do the measures for their control. There is a need however for an information resource that will promote specialized and general guidelines. The measures include the appropriate use of gloves, cleaning and disinfection of the ICU environment and hand washing which is the most important of all. Therefore an effort was made to develop an easy to navigate webpage with practical and comprehensible clinical guidelines. Additionally, it gives to all visitors the opportunity for further information research with the use of the included links. For the development of the web side existing clinical guide lines were scrutinizes as well as studies that concern the effectiveness of the measures mentioned and for the identification of quality assurance criteria.
Effectiveness of the Lunch is in the Bag program on communication between the parent, child and child-care provider around fruits, vegetables and whole grain foods: A group-randomized controlled trial.
Sharma, Shreela V; Rashid, Tasnuva; Ranjit, Nalini; Byrd-Williams, Courtney; Chuang, Ru-Jye; Roberts-Gray, Cynthia; Briley, Margaret; Sweitzer, Sara; Hoelscher, Deanna M
To evaluate the effectiveness of the parent- and early care education (ECE) center-based Lunch is in the Bag program on communication between parent, child, and their ECE center providers around fruits, vegetables and whole grain foods (FVWG). A total of n=30 ECE center; 577 parent-child dyads participated in this group-randomized controlled trial conducted from 2011 to 2013 in Texas (n=15 ECE center, 327 dyads intervention group; n=15 ECE center, 250 dyads comparison group). Parent-child and parent-ECE center provider communication was measured using a parent-reported survey administered at baseline and end of the five-week intervention period. Multilevel linear regression analysis was used to compare the pre-to-post intervention changes in the parent-child and parent-ECE center provider communication scales. Significance was set at pparent-child and parent-ECE center provider communication scores were low. There was a significant increase post-intervention in the parent-ECE center provider communication around vegetables (Adjusted β=0.78, 95%CI: 0.13, 1.43, p=0.002), and around fruit (Adjusted β=0.62, 95%CI: 0.04, 0.20, p=0.04) among the parents in the intervention group as compared to those in the comparison group. There were no significant intervention effects on parent-child communication. Lunch is in the Bag had significant positive effects on improving communication between the parents and ECE center providers around FVWG. Copyright © 2015 Elsevier Inc. All rights reserved.
Das, Ashis; Gopalan, Saji S; Chandramohan, Daniel
Pay for Performance (P4P) mechanisms to health facilities and providers are currently being tested in several low- and middle-income countries (LMIC) to improve maternal and child health (MCH). This paper reviews the existing evidence on the effect of P4P program on quality of MCH care in LMICs. A systematic review of literature was conducted according to a registered protocol. MEDLINE, Web of Science, and Embase were searched using the key words maternal care, quality of care, ante natal care, emergency obstetric and neonatal care (EmONC) and child care. Of 4535 records retrieved, only eight papers met the inclusion criteria. Primary outcome of interest was quality of MCH disaggregated into structural quality, process quality and outcomes. Risk of bias across studies was assessed through a customized quality checklist. There were four controlled before after intervention studies, three cluster randomized controlled trials and one case control with post-intervention comparison of P4P programs for MCH care in Burundi, Democratic Republic of Congo, Egypt, the Philippines, and Rwanda. There is some evidence of positive effect of P4P only on process quality of MCH. The effect of P4P on delivery, EmONC, post natal care and under-five child care were not evaluated in these studies. There is weak evidence for P4P's positive effect on maternal and neonatal health outcomes and out-of-pocket expenses. P4P program had a few negative effects on structural quality. P4P is effective to improve process quality of ante natal care. However, further research is needed to understand P4P's impact on MCH and their causal pathways in LMICs. PROSPERO registration number CRD42014013077 .
Keller, H H; Vesnaver, E; Davidson, B; Allard, J; Laporte, M; Bernier, P; Payette, H; Jeejeebhoy, K; Duerksen, D; Gramlich, L
Malnutrition is common in acute care hospitals worldwide and nutritional status can deteriorate during hospitalisation. The aim of the present qualitative study was to identify enablers and challenges and, specifically, the activities, processes and resources, from the perspective of nutrition care personnel, required to provide quality nutrition care. Eight hospitals participating in the Nutrition Care in Canadian Hospitals study provided focus group data (n = 8 focus groups; 91 participants; dietitians, dietetic interns, diet technicians and menu clerks), which were analysed thematically. Five themes emerged from the data: (i) developing a nutrition culture, where nutrition practice is considered important to recovery of patients and teams work together to achieve nutrition goals; (ii) using effective tools, such as screening, evidence-based protocols, quality, timely and accurate patient information, and appropriate and quality food; (iii) creating effective systems to support delivery of care, such as communications, food production and delivery; (iv) being responsive to care needs, via flexible food systems, appropriate menus and meal supplements, up to date clinical care and including patient and family in the care processes; and (v) uniting the right person with the right task, by delineating roles, training staff, providing sufficient time to undertake these important tasks and holding staff accountable for their care. The findings of the present study are consistent with other work and provide guidance towards improving the nutrition culture in hospitals. Further empirical work on how to support successful implementation of nutrition care processes is needed. © 2013 The British Dietetic Association Ltd.
Boyd, Jamie M; Burton, Rachael; Butler, Barb L; Dyer, Dianne; Evans, David C; Felteau, Melissa; Gruen, Russell L; Jaffe, Kenneth M; Kortbeek, John; Lang, Eddy; Lougheed, Val; Moore, Lynne; Narciso, Michelle; Oxland, Peter; Rivara, Frederick P; Roberts, Derek; Sarakbi, Diana; Vine, Karen; Stelfox, Henry T
The aim of this study was to develop and evaluate the content validity of quality criteria for providing patient- and family-centered injury care. Quality criteria have been developed for clinical injury care, but not patient- and family-centered injury care. Using a modified Research AND Development Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Methodology, a panel of 16 patients, family members, injury and quality of care experts serially rated and revised criteria for patient- and family-centered injury care identified from patient and family focus groups. The criteria were then sent to 384 verified trauma centers in the United States, Canada, Australia, and New Zealand for evaluation. A total of 46 criteria were rated and revised by the panel over 4 rounds of review producing 14 criteria related to clinical care (n = 4; transitions of care, pain management, patient safety, provider competence), communication (n = 3; information for patients/families; communication of discharge plans to patients/families, communication between hospital and community providers), holistic care (n = 4; patient hygiene, kindness and respect, family access to patient, social and spiritual support) and end-of-life care (n = 3; decision making, end-of-life care, family follow-up). Medical directors, managers, or coordinators representing 254 trauma centers (66% response rate) rated 12 criteria to be important (95% of responses) for patient- and family-centered injury care. Fewer centers rated family access to the patient (80%) and family follow-up after patient death (65%) to be important criteria. Fourteen-candidate quality criteria for patient- and family-centered injury care were developed and shown to have content validity. These may be used to guide quality improvement practices.
Lefaiver, Cheryl A; Keough, Vicki A; Letizia, Marijo; Lanuza, Dorothy M
Caregivers are essential members of the health care team who provide care, valued at more than $250 billion each year, to millions of persons who require assistance with health and daily care. Patients with respiratory diseases who are waiting for a lung transplant are required to have an identified caregiver. The caregivers are rarely studied. To explore the relationships among the health status of caregivers of lung transplant candidates, caregivers' reaction to caregiving, and caregivers' perceived quality of life. This descriptive study examined the quality of life of lung transplant caregivers from a multidimensional perspective. Twenty-nine dyads of lung transplant candidates and their caregivers were recruited from a Midwestern medical center. Data were collected by self-report: caregivers completed the Quality of Life Index, SF-12 health survey, Profile of Mood States-Short Form, and the Caregiver Reaction Assessment. Caregivers reported favorable levels of quality of life, physical health, and mood during the pretransplant waiting phase. However, problem areas for caregivers during this time included fatigue, depression, and the financial impact of the transplant. Data analyses indicated that depression, caregiver general health, impact on finances, and lack of family support had the greatest effect on caregivers' quality of life. Nurses are urged to recognize the role of caregivers in the transplant process, ask about and listen to caregivers' needs, and include caregivers in the plan of care.
Nieuwesteeg, Anke M; Pouwer, Frans; van Bakel, Hedwig Ja; Emons, Wilco Hm; Aanstoot, Henk-Jan; Odink, Roelof; Hartman, Esther E
In young children with type 1 diabetes mellitus (T1DM) parents have full responsibility for the diabetes-management of their child (e.g. blood glucose monitoring, and administering insulin). Behavioral tasks in childhood, such as developing autonomy, and oppositional behavior (e.g. refusing food) may interfere with the diabetes-management to achieve an optimal blood glucose control. Furthermore, higher blood glucose levels are related to more behavioral problems. So parents might need to negotiate with their child on the diabetes-management to avoid this direct negative effect. This interference, the negotiations, and the parent's responsibility for diabetes may negatively affect the quality of parent-child interaction. Nevertheless, there is little knowledge about the quality of interaction between parents and young children with T1DM, and the possible impact this may have on glycemic control and psychosocial functioning of the child. While widely used global parent-child interaction observational methods are available, there is a need for an observational tool specifically tailored to the interaction patterns of parents and children with T1DM. The main aim of this study is to construct a disease-specific observational method to assess diabetes-specific parent-child interaction. Additional aim is to explore whether the quality of parent-child interactions is associated with the glycemic control, and psychosocial functioning (resilience, behavioral problems, and quality of life). First, we will examine which situations are most suitable for observing diabetes-specific interactions. Then, these situations will be video-taped in a pilot study (N = 15). Observed behaviors are described into rating scales, with each scale describing characteristics of parent-child interactional behaviors. Next, we apply the observational tool on a larger scale for further evaluation of the instrument (N = 120). The parents are asked twice (with two years in between) to fill out
Full Text Available Abstract Background In young children with type 1 diabetes mellitus (T1DM parents have full responsibility for the diabetes-management of their child (e.g. blood glucose monitoring, and administering insulin. Behavioral tasks in childhood, such as developing autonomy, and oppositional behavior (e.g. refusing food may interfere with the diabetes-management to achieve an optimal blood glucose control. Furthermore, higher blood glucose levels are related to more behavioral problems. So parents might need to negotiate with their child on the diabetes-management to avoid this direct negative effect. This interference, the negotiations, and the parent's responsibility for diabetes may negatively affect the quality of parent-child interaction. Nevertheless, there is little knowledge about the quality of interaction between parents and young children with T1DM, and the possible impact this may have on glycemic control and psychosocial functioning of the child. While widely used global parent-child interaction observational methods are available, there is a need for an observational tool specifically tailored to the interaction patterns of parents and children with T1DM. The main aim of this study is to construct a disease-specific observational method to assess diabetes-specific parent-child interaction. Additional aim is to explore whether the quality of parent-child interactions is associated with the glycemic control, and psychosocial functioning (resilience, behavioral problems, and quality of life. Methods/Design First, we will examine which situations are most suitable for observing diabetes-specific interactions. Then, these situations will be video-taped in a pilot study (N = 15. Observed behaviors are described into rating scales, with each scale describing characteristics of parent-child interactional behaviors. Next, we apply the observational tool on a larger scale for further evaluation of the instrument (N = 120. The parents are asked
Bezemer Pieter D
Full Text Available Abstract Background To assess health-related quality of life (HRQoL in children (8–11 years and adolescents (12–18 years who survived retinoblastoma (RB, by means of the KIDSCREEN self-report questionnaire and the proxy-report version. Methods This population-based cross-sectional study (participation rate 70% involved 65 RB survivors (8–18 years and their parents. Child/adolescents' and parents' perception of their youth's HRQoL was assessed using the KIDSCREEN, and the results were compared with Dutch reference data. Relations with gender, age, marital status of the parents, and visual acuity were analyzed. Results RB survivors reported better HRQoL than did the Dutch reference group on the dimensions "moods and emotions" and "autonomy". Increased ratings of HRQoL in RB survivors were mainly seen in perceptions of the younger children and adolescent girls. RB survivors with normal visual acuity scored higher on "physical well-being" than visually impaired survivors. Age was negatively associated with the dimensions "psychological well-being", "self-perception" (according to the child and parent reports and "parent relations and home life" (according to the child. "Self-perception" was also negatively associated with visual acuity (according to the child. Only parents of young boys surviving RB reported lower on "autonomy" than the reference group, and parents of low visual acuity and blind RB survivors reported higher on "autonomy" than parents of visually unimpaired survivors. Survivors' perceptions and parents' perceptions correlated poorly on all HRQoL dimensions. Conclusion RB survivors reported a very good HRQoL compared with the Dutch reference group. The perceptions related to HRQoL differ substantially between parents and their children, i.e. parents judge the HRQoL of their child to be relatively poorer. Although the results are reassuring, additional factors of HRQoL that may have more specific relevance, such as psychological
Loi, Elizabeth C; Vaca, Kelsey E C; Ashland, Melanie D; Marchman, Virginia A; Fernald, Anne; Feldman, Heidi M
Preterm birth may leave long-term effects on the interactions between caregivers and children. Language skills are sensitive to the quality of caregiver-child interactions. Compare the quality of caregiver-child play interactions in toddlers born preterm (PT) and full term (FT) at age 22months (corrected for degree of prematurity) and evaluate the degree of association between caregiver-child interactions, antecedent demographic and language factors, and subsequent language skill. A longitudinal descriptive cohort study. 39 PT and 39 FT toddlers individually matched on sex and socioeconomic status (SES). The outcome measures were dimensions of caregiver-child interactions, rated from a videotaped play session at age 22months in relation to receptive language assessments at ages 18 and 36months. Caregiver intrusiveness was greater in the PT than FT group. A composite score of child interactional behaviors was associated with a composite score of caregiver interactional behaviors. The caregiver composite measure was associated with later receptive vocabulary at 36months. PT-FT group membership did not moderate the association between caregiver interactional behavior and later receptive vocabulary. The quality of caregiver interactional behavior had similar associations with concurrent child interactional behavior and subsequent language outcome in the PT and FT groups. Greater caregiver sensitivity/responsiveness, verbal elaboration, and less intrusiveness support receptive language development in typically developing toddlers and toddlers at risk for language difficulty. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available Introduction: Cardiovascular diseases are among the most prevalent chronic diseases leading to high degrees of mortality and morbidity worldwide and in Iran. The aim of the current study was to determine and develop appropriate indicators for evaluating provided service quality for cardiovascular patients admitted to Cardiac Care Units (CCU in Iran. Methods: In order to determine the indicators for evaluating provided service quality, a four-stage process including reviewing systematic review articles in premier bibliographic databases, interview, performing two rounds of Delphi technique, and holding experts panel by attendance of experts in different fields was adopted. Finally, after recognizing relevant indicators in resources, these indicators were finalized during various stages using ideas of 27 experts in different fields. Results: Among 2800 found articles in the text reviewing phase, 21 articles, which had completely mentioned relevant indicators, were studied and 48 related indicators were extracted. After two interviews with a cardiologist and an epidemiologist, 32 items of the indicators were omitted and replaced by 27 indicators coping with the conditions of Iranian hospitals. Finally, 43 indicators were added into the Delphi phase and after 2 rounds of Delphi with 18 specialists, 7 cases were excluded due to their low scores of applicability. In the experts’ panel stage, 6 items were also omitted and 10 new indicators were developed to replace them. Eventually, 40 indicators were finalized. Conclusion: In this study, some proper indicators for evaluating provided service quality for CCU admissions in Iran were determined. Considering the informative richness of these indicators, they can be used by managers, policy makers, health service providers, and also insurance agencies in order to improve the quality of services, decisions, and policies.
Piovesan, Chaiana; Antunes, José Leopoldo Ferreira; Guedes, Renata Saraiva; Ardenghi, Thiago Machado
Child oral health-related quality of life (COHRQoL) has been increasingly assessed; however, few studies appraised the influence of socioeconomic status on COHRQoL in developing countries. This study assessed the relationship of COHRQoL with socioeconomic backgrounds and clinical factors. This study followed a cross-sectional design, with a multistage random sample of 792 schoolchildren aged 12 years, representative of Santa Maria, a southern city in Brazil. Participants completed the Brazilian version of the Child Perceptions Questionnaire (CPQ(11-14)), their parents or guardians answered questions on socioeconomic status, and a dental examination provided information on the prevalence of caries, dental trauma and occlusion. The assessment of association used hierarchically adjusted Poisson regression models. Higher impacts on COHRQoL were observed for children presenting with untreated dental caries (RR 1.20; 95% CI 1.07-1.35) and maxillary overjet (RR 1.19; 95% CI 1.02-1.40). Socioeconomic factors also associated with COHRQoL; poorer scores were reported by children whose mothers have not completed primary education (RR 1.30; 95% CI 1.17-1.44) and those with lower household income (RR 1.13; 95% CI 1.02-1.26). Poor socioeconomic standings and poor dental status have a negative impact on COHRQoL; reducing health inequalities may demand dental programmes and policies targeting deprived population.
Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of quality prenatal care, clinical and
Naiara Barros Polita
Full Text Available ABSTRACT Objective: To synthesize and interpret findings and conclusions of qualitative research addressing the experience of the father in the care of the child with cancer. Method: Meta-synthesis of 16 qualitative studies from six databases, analyzed through taxonomic analysis. Results: Child and adolescent cancer have several repercussions on the daily life of the father, especially related to the stigma around the disease, the fear of the unknown and the social and family role. Faced with the illness and the need to care for the child, the father seeks to recover normality in the family and transitions between hegemonic masculine behaviors and practices culturally recognized as female. Final Considerations: The complex experience of the father, influenced by masculinities, was evidenced. The limitations regard the restricted understanding of the contextual specificities of the experiences, due to the limited characteristics of the parents and children described in the studies. The knowledge produced is useful to promote involvement of fathers in the care of the child, as well as to strengthen and assist him in this task.
Herman-Smith, Robert L.
Research Findings: A 2003 amendment to the Child Abuse Prevention and Treatment Act (CAPTA) required states to develop plans to ensure that children younger than the age of 3 years who are victims of substantiated abuse or neglect have access to developmental screenings. Programs authorized under Part C of the Individuals with Disabilities…
Beaulieu, Marie-Dominique; Geneau, Robert; Del Grande, Claudio; Denis, Jean-Louis; Hudon, Eveline; Haggerty, Jeannie L; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William
To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Three regions of Quebec. Health care professionals and staff of 5 PC practices. Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Irrespective of their models, PC practices' pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. Copyright© the College of Family Physicians of Canada.
Perlman, Michal; Falenchuk, Olesya; Fletcher, Brooke; McMullen, Evelyn; Beyene, Joseph; Shah, Prakesh S
The quality of staff/child interactions as measured by the Classroom Assessment Scoring System (CLASS) in Early Childhood Education and Care (ECEC) programs is thought to be important for children's outcomes. The CLASS is made of three domains that assess Emotional Support, Classroom Organization and Instructional Support. It is a relatively new measure that is being used increasingly for research, quality monitoring/accountability and other applied purposes. Our objective was to evaluate the association between the CLASS and child outcomes. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were conducted up to July 3, 2015. Studies that measured association between the CLASS and child outcomes for preschool-aged children who attended ECEC programs were included after screening by two independent reviewers. Searches and data extraction were conducted by two independent reviewers. Thirty-five studies were systematically reviewed of which 19 provided data for meta-analyses. Most studies had moderate to high risk of bias. Of the 14 meta-analyses we conducted, associations between Classroom Organization and Pencil Tapping and between Instructional Support and SSRS Social Skills were significant with pooled correlations of .06 and .09 respectively. All associations were in the expected direction. In the systematic review, significant correlations were reported mainly from one large dataset. Substantial heterogeneity in use of the CLASS, its dimensions, child outcomes and statistical measures was identified. Greater consistency in study methodology is urgently needed. Given the multitude of factors that impact child development it is encouraging that our analyses revealed some, although small, associations between the CLASS and children's outcomes.
McCormick, Meghan P.; O'Connor, Erin E.
Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,364) and 2-level hierarchical linear models with site fixed effects, we examined between- and within-child associations between teacher-child relationship closeness and conflict and standardized measures of children's…
Full Text Available Government institutions need to assess how well they meet the needs of their customers, and what their customers think about the quality of the services they provide. This is aligned with the Batho Pele principle of the South African government. The SERVQUAL scale, augmented with a qualitative survey, was used to determine how the National Home Builders Registration Council (NHBRC is perceived by its clients, which key factors drive such perceptions, and whether the perceptions are consistent across the different client groups of this regulatory institution. The complementary role of qualitative data in illuminating issues driving quantitative results is highlighted. Service quality scores are computed for the NHBRC. The convergence of opinions of different customer groups was studied using correlation analysis. The significance of service quality perception gaps was tested using the multivariate analysis of variance, and the reliability of the SERVQUAL scale was examined using exploratory factor analysis. It was observed that by improving the feedback mechanism of the NHBRC, their clients customer service quality perceptions could be enhanced.
Matthews, Hannah; Reeves, Rhiannon
The Child Care and Development Block Grant (CCDBG) is the primary funding source for federal child care subsidies to low-income working families, as well as improving child care quality. Based on preliminary state-reported data from the federal Office of Child Care, this fact sheet provides a snapshot of CCDBG program participation in 2012, noting…
Aoyama, Megumi; Wei, Chang Nian; Chang-nian, Wei; Harada, Koichi; Ueda, Kimiyo; Takano, Miyuki; Ueda, Atsushi
The purpose of this study was to clarify the role of community factors in parents' quality of child-nurturing life (QCNL). We developed a questionnaire to evaluate the degree of QCNL and determine the structural factors related to QCNL as community factors related to parents' QCNL derived from focus group interviews and the Delphi technique. The questionnaire also included the battery of the self-rating depression scale and Tsumori-Inage Infant's Developmental Test. Using the questionnaire, we then conducted a quantitative survey of parents whose children attended nursery schools in Kumamoto Prefecture. Factor analysis, calculation of the mean score and/or ratio to each item, Pearson's correlation coefficient, t test, multiple regression analysis, and covariance structure analysis were performed. The questionnaire we developed consisted of seven items with 75 elements, involving ten elements as community factors. Subjects included 699 parents (mean age 33.6 ± 5.4 years) and 965 children (age range 0-6 years). Factor analysis revealed that community factors consisted of five factors, such as "lifestyle rooted in the ground," "balance of housekeeping and work," "community network," "amenity," and "regeneration of life". These factors may be dominant in a rural area. Finally, we developed a structural model with "community factors," QCNL, QOL, and "child growth" by covariance structural analysis. The analysis revealed that community factors had a positive relation to parents' QCNL (r = 0.81, p < 0.001) and that parental SDS score had a negative relation to parents' QCNL (r = -0.59, p < 0.001). The analysis did show that community factors were positively related to the sound growth of children. The covariance structure analysis revealed that community factors were associated with parents' QCNL, SDS, and "child growth."
Tomazoni, Fernanda; Zanatta, Fabricio B; Tuchtenhagen, Simone; da Rosa, Guilherme N; Del Fabro, Joana P; Ardenghi, Thiago M
Child oral health-related quality of life (COHRQoL) has been increasingly assessed. However, the full relationship between gingivitis and COHRQoL has been assessed by only a small number of studies. This study aims to assess the association between gingival bleeding and how a child perceives its OHRQoL. This cross-sectional study used multistage random sampling to enroll 1,134 12-year-old schoolchildren from Santa Maria, a southern city in Brazil. Participants were examined for gingival bleeding according to the community periodontal index criteria, a full-mouth clinical examination of six sites per tooth. COHRQoL was assessed by the Brazilian version of the Child Perceptions Questionnaire for 11- to 14-Year-Old Children (CPQ11-14), and data on socioeconomic status were collected. Multilevel Poisson regression models fitted the association of gingivitis with overall and domain-specific CPQ11-14 scores. In general, children with bleeding in ≥15% of sites had higher total CPQ11-14 scores and domain-specific scores than their counterparts. This association persisted after adjustment for other potential confounders. The presence and extent of gingival bleeding was associated mainly with emotional limitation domains of the CPQ11-14; those with extended levels of gingivitis had a 1.20 times higher mean score than those with low-level/no gingival bleeding (rate ratio = 1.20; 95% confidence interval = 1.10 to 1.31). The present results indicate that the presence of extensive levels of gingivitis might be negatively associated with how children perceive their oral health and their daily life.
Hinno, S; Partanen, P; Vehviläinen-Julkunen, K
In several European countries, the availability of qualified nurses is insufficient to meet current healthcare requirements. Nurses are highly dissatisfied with the rising demands of the healthcare environment and increasingly considering leaving their jobs. The study aims to investigate the relationships between the characteristics of hospital nurses' work environment and the quality of care provided, and furthermore to examine Dutch nurses' career plans. A cross-sectional, questionnaire survey of registered nurses (n = 334) working in the academic and district hospitals was conducted in 2005/2006. Previously validated questionnaires translated into the participants' language were used. Factor and regression analysis were used for data analysis. Overall, nurses rated their work environment rather favourably. Five work environment characteristics were identified: support for professional development, adequate staffing, nursing competence, supportive management and teamwork. Significant relationships were found between nurses' perceptions of their work environment characteristics and quality of care provided and nurses' career plans. When work environment characteristics were evaluated to be better, nurse-assessed quality of care also increased and intentions to leave current job decreased linearly. Study findings suggest that nurses' perceptions of their work environment are important for nurse outcomes in hospital settings. Further research is needed to explore the predictive ability of the work environment for nurse, patient and organizational outcomes in hospitals. © 2011 The Authors. International Nursing Review © 2011 International Council of Nurses.
Mendes, Isabel Amélia Costa; Trevizan, Maria Auxiliadora; de Godoy, Simone; Nogueira, Paula Cristina; Ventura, Carla Aparecida Arena; Furlan, Claudia Elizangela Bis
To identify the expectations and perceptions of clients concerning the quality of hospital care provided to them and their respective companions at a private Brazilian hospital using SERVQUAL. The SERVQUAL questionnaire can provide information concerning expectations and perceptions of clients. In addition, it is able to identify the participation of frontline employees and how they contribute to the organization's end product (service delivery). In total, 172 inpatients for surgical reasons answered the SERVQUAL questionnaire. It consists of 23 pairs of statements, 22 of which are distributed into the dimensions of tangibles, reliability, responsiveness, assurance and empathy. Statement 23 refers to the overall quality of care. Exploratory analysis, internal consistency (Cronbach's alpha) and the kappa Coefficient were calculated using the Statistical Package for Social Sciences and SAS 9.2. Ethical approval was obtained from the Institutional Review Board at the Hospital das Clínicas at the University of São Paulo at Ribeirao Preto Medical School. Most participants had a bachelor's degree and were over than 60years old. Cronbach's alpha coefficients indicated good internal consistency (α=0.93) and high levels of agreement were observed (91.10%). The SERVQUAL questionnaire was sensitive to items in each dimension for which clients' perceptions surpassed their expectations. The continuous quality assessment of health services is mandatory for nursing leadership. The nursing leadership can further explore the SERVQUAL with a view to better attending to the clients' expectations. Copyright © 2017. Published by Elsevier Inc.
McClellan, Sean R; Snowden, Lonnie
This study examined the association between language access programming and quality of psychiatric care received by persons with limited English proficiency (LEP). In 1999, the California Department of Mental Health required county Medicaid agencies to implement a "threshold language access policy" to meet the state's Title VI obligations. This policy required Medi-Cal agencies to provide language access programming, including access to interpreters and translated written material, to speakers of languages other than English if the language was spoken by at least 3,000, or 5%, of the county's Medicaid population. Using a longitudinal study design with a nonequivalent control group, this study examined the quality of care provided to Spanish speakers with LEP and a severe mental illness before and after implementation of mandatory language access programming. Quality was measured by receipt of at least two follow-up medication visits within 90 days or three visits within 180 days of an initial medication visit over a period of 38 quarter-years. On average, only 40% of Spanish-speaking clients received at least three medication follow-up visits within 180 days. In multivariate analyses, language access programming was not associated with receipt of at least two medication follow-up visits within 90 days or at least three visits within 180 days. This study found no evidence that language access programming led to increased rates of follow-up medication visits for clients with LEP.
This research uses data from the Early Childhood in Foster and Kinship Care (ECIFKC) study to identify the proportion of young children, under 2 years of age, in foster and kinship care who use formal child care; weekly hours of child care; predictors of weekly hours of child care; and quality of care experienced. The sample for these analyses…
Chiou, Shyh-Shin; Jang, Ren-Chin; Liao, Yu-Mei; Yang, Pinchen
Long-term survival of childhood leukemia has become a reality with treatment advancement; hence, the need to assess the survivors' health-related quality of life (HRQL) is essential. Although a growing number of Western studies have documented the considerable impact of diagnosis and treatment on HRQL in pediatric leukemia survivors, little finding has been reported in non-Western developing countries. We used a previously validated 14-dimensional questionnaire, Child Health Questionnaire 50-item Parent Form (CHQ-PF 50), to examine the perceived HRQL of 32 child/adolescent survivors, currently aged 13.17 ± 2.49 years, who had experienced first complete continuous remission from leukemia for at least 3 years. The HRQL status was compared with that obtained from community subjects (N = 154) and survivors' nonadult siblings (N = 30). Intelligence quotients (IQ) and computerized neuropsychological assessments were performed for subjects. The HRQL of leukemia survivors was noted to be worse than that of community children and nonadult siblings as reflected by significantly lower scores in both the physical summary and the psychosocial summary score of CHQ-PF 50. 15.6% of the survivors had impaired intelligence (estimated IQ below 70). 27.8% of the adolescents were impaired in the cognitive domains as assessed by neuropsychological tests. In this Taiwanese single institution experience, pediatric leukemia survivors carried a morbidity burden into their teen years as reflected by worse HRQL than controls. These findings may guide the support required by this population.
Weber, S; Jud, A; Landolt, M A
To review data on health-related quality of life (HRQoL) in individuals with childhood trauma, including psychological maltreatment, physical maltreatment, sexual abuse, and neglect. The literature search was conducted with pre-defined keywords using the following electronic bibliographic databases: EMBASE, PubMed, MEDLINE, CINAHL, PsyINFO, PSYNDEX, and Cochrane Database of Systematic Reviews. Further databases were searched for relevant dissertations. Study selection and data extraction were completed by two independent reviewers. The literature search yielded 1568 entries. Nineteen articles met all inclusion criteria and were retained for further analysis. Findings quite consistently showed significant negative associations between child maltreatment and both self- and proxy-rated HRQoL. Effect sizes range from small to large. Number of types of maltreatment and HRQoL were found to be negatively related. Data on HRQoL for maltreated children are still rare. Studies often investigate adult survivors of child maltreatment. Considering HRQoL in children and adolescents who suffered maltreatment would allow the planning of effective interventions and the evaluation of treatments to improve HRQoL of these children.
Lingen, M; Albers, L; Borchers, M; Haass, S; Gärtner, J; Schröder, S; Goldbeck, L; von Kries, R; Brockmann, K; Zirn, B
Recent progress in genetic testing has facilitated obtaining an etiologic diagnosis in children with developmental delay/intellectual disability (DD/ID) or multiple congenital anomalies (MCA) or both. Little is known about the benefits of diagnostic elucidation for affected families. We studied the impact of a genetic diagnosis on parental quality of life (QoL) using a validated semiquantitative questionnaire in families with a disabled child investigated by array-based comparative genomic hybridization (aCGH). We received completed questionnaires from 95 mothers and 76 fathers of 99 families. We used multivariate analysis for adjustment of potential confounders. Taken all 99 families together, maternal QoL score (percentile rank scale 51.05) was significantly lower than fathers' QoL (61.83, p = 0.01). Maternal QoL score was 20.17 [95% CI (5.49; 34.82)] percentile rank scales higher in mothers of children with diagnostic (n = 34) aCGH as opposed to mothers of children with inconclusive (n = 65) aCGH (Hedges' g = 0.71). Comparison of these QoL scores with retrospectively recalled QoL before aCGH revealed an increase of maternal QoL after diagnostic clarification. Our results indicate a benefit for maternal QoL if a genetic test, here aCGH, succeeds to clarify the etiologic diagnosis in a disabled child. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Full Text Available Abstract Background Prevention of mother-to-child transmission has been considered as not a simple intervention but a comprehensive set of interventions requiring capable health workers. Viet Nam's extensive health care system reaches the village level, but still HIV-infected mothers and children have received inadequate health care services for prevention of mother-to-child transmission. We report here the health workers' perceptions on factors that lead to their failure to give good quality prevention of mother-to-child transmission services. Methods Semistructured interviews with 53 health workers and unstructured observations in nine health facilities in Hanoi were conducted. Selection of respondents was based on their function, position and experience in the development or implementation of prevention of mother-to-child transmission policies/programmes. Results Factors that lead to health workers' failure to give good quality services for prevention of mother-to-child transmission include their own fear of HIV infection; lack of knowledge on HIV and counselling skills; or high workloads and lack of staff; unavailability of HIV testing at commune level; shortage of antiretroviral drugs; and lack of operational guidelines. A negative attitude during counselling and provision of care, treating in a separate area and avoidance of providing service at all were seen by health workers as the result of fear of being infected, as well as distrust towards almost all HIV-infected patients because of the prevailing association with antisocial behaviours. Additionally, the fragmentation of the health care system into specialized vertical pillars, including a vertical programme for HIV/AIDS, is a major obstacle to providing a continuum of care. Conclusion Many hospital staff were not being able to provide good care or were even unwilling to provide appropriate care for HIV-positive pregnant women The study suggests that the quality of prevention of
Lichtenstein, Brian J; Reuben, David B; Karlamangla, Arun S; Han, Weijuan; Roth, Carol P; Wenger, Neil S
The quality of care of older adults in the United States has been consistently shown to be inadequate. This gap between recommended and actual care provides an opportunity to improve the value of health care for older adults. Prior work from the Assessing Care of Vulnerable Elders (ACOVE) investigators first defined, and then sought to improve, clinical practice for common geriatric conditions. A critical component of the ACOVE intervention for practice improvement was an emphasis on the delegation of specific care processes, but the independent effect of delegation on the quality of care has not been evaluated. This study analyzed the pooled results of prior ACOVE projects from 1998 to 2010. Totaled, these studies included 4,776 individuals aged 65 and older of mixed demographic backgrounds and 16,204 ACOVE quality indicators (QIs) for three geriatric conditions: falls, urinary incontinence, and dementia. In unadjusted analyses, QI pass probabilities were 0.36 for physician-performed tasks, 0.55 for nurse practitioner (NP)-, physician assistant (PA)-, and registered nurse (RN)-performed tasks; and 0.61 for medical assistant- and licensed vocational nurse-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, and RNs was 1.37 (P = .05). These findings suggest that delegation of selected tasks to nonphysician healthcare providers is associated with higher quality of care for these geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions in older adults. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.
Ronis, Scott T; Slaunwhite, Amanda K; Malcom, Kathryn E
This paper reviews how child and youth mental health care services in Canada, the United States, and the Netherlands are organized and financed in order to identify systems and individual-level factors that may inhibit or discourage access to treatment for youth with mental health problems, such as public or private health insurance coverage, out-of-pocket expenses, and referral requirements for specialized mental health care services. Pathways to care for treatment of mental health problems among children and youth are conceptualized and discussed in reference to health insurance coverage and access to specialty services. We outline reforms to the organization of health care that have been introduced in recent years, and the basket of services covered by public and private insurance schemes. We conclude with a discussion of country-level opportunities to enhance access to child and youth mental health services using existing health policy levers in Canada, the United States and the Netherlands.
Bedregal, Paula; Hernández, Viviana; Mingo, M Verónica; Castañón, Carla; Valenzuela, Patricia; Moore, Rosario; de la Cruz, Rolando; Castro, Daniela
Early child development is a population determinant of physical, mental and social health. To know the base line situation prior to the implementation of "Chile grows with you" (Chile Crece Contigo) is key to its evaluation. To compare early child development and associated factors at baseline in pre-school children from public and private health sectors. The sample consisted of 1045 children aged 30-58 months, 52% male, and 671 from the public and 380 from the private sector of the metropolitan region in Chile were evaluated using Battelle Developmental Inventory-1 and a household interview of primary carer. Abnormal child development was found in 14.4% of children in the private sector compared to 30.4% in the public sector. There were no differences in adaptive area (26.3% vs 29.2%), but there were statistically significant differents in cognitive (8.8% vs 12.1%), social-personal (13.2% vs 32.5%), motor (19.2% vs 35.3%), and communication (19% vs 36.8%) development. The logistic regression showed that, independent of socioeconomic level, the risk factors are: Apgarsocial policy. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.
Gouws, Eleanor; Bryce, Jennifer; Pariyo, George; Armstrong Schellenberg, Joanna; Amaral, João; Habicht, Jean-Pierre
Sound policy and program decisions require timely information based on valid and relevant measures. Recent findings suggest that despite the availability of effective and affordable guidelines for the management of sick children in first-level health facilities in developing countries, the quality and coverage of these services remains low. We report on the development and evaluation of a set of summary indices reflecting the quality of care received by sick children in first-level facilities. The indices were first developed through a consultative process to achieve face validity by involving technical experts and policymakers. The definition of evaluation measures for many public health programs stops at this point. We added a second phase in which standard statistical techniques were used to evaluate the content and construct validity of the indices and their reliability, drawing on data sets from the multi-country evaluation of integrated management of childhood illness (MCE) in Brazil, Tanzania and Uganda. The statistical evaluation identified important conceptual errors in the indices arising from the theory-driven expert review. The experts had combined items into inappropriate indicators resulting in summary indices that were difficult to interpret and had limited validity for program decision making. We propose a revised set of summary indices for the measurement of child health care in developing countries that is supported by both expert and statistical reviews and that led to similar programmatic insights across the three countries. We advocate increased cross-disciplinary research within public health to improve measurement approaches. Child survival policymakers, program planners and implementers can use these tools to improve their monitoring and so increase the health impact of investments in health facility care.
Full Text Available Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre.Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care.Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (p<0.0001, out of a total possible score of 25, with the most significant improvements related to health counseling, technical services provided, and quality of health education.These study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.
Kochendorfer, Logan B; Kerns, Kathryn A
Relationships with parents and friends are important contexts for developing romantic relationship skills. Parents and friends may influence both the timing of involvement and the quality of romantic relationships. Three models of the joint influence of parents and friends (direct effects model, mediation model, and moderator model) have been proposed. The present study uses data from a longitudinal study (n = 1012; 49.8% female; 81.1% Caucasian) to examine how attachment and friendship quality at age 10 years predict romantic relationship involvement and quality at ages 12 and 15 years. The results supported the direct effects model, with attachment and friendship quality uniquely predicting different romantic relationship outcomes. The findings provide further support for the important influence of family and friends on early romantic relationships.
Balfour, Margaret E; Zinn, Tylar E; Cason, Karena; Fox, Jerimya; Morales, Myra; Berdeja, Cesar; Gray, Jay
The authors describe a quality improvement approach in which a crisis center and a payer collaborate to improve care. Each crisis visit is considered as a potentially missed opportunity for community stabilization. Daily data on crisis visits are sent to the payer for a more up-to-date analysis of trends than is possible with financial claims data, which may lag behind services provided by up to 90 days. Using these trend data, the two organizations collaborate to identify patterns that lead to opportunities for improvement and develop multiple rapid-cycle projects for better management of services, resulting in significant decreases in readmissions and in the number of high utilizers.
Wills, Russell; Ritchie, Miranda; Wilson, Mollie
To improve detection and quality of assessment of child and partner abuse within a health service. A formal organisational change approach was used to implement the New Zealand Family Violence Intervention Guidelines in a mid-sized regional health service. The approach includes obtaining senior management support, community collaboration, developing resources to support practice, research, evaluation and training. Formal pre-post evaluations were conducted of the training. Barriers and enablers of practice change were assessed through 85 interviews with 60 staff. More than 6000 clinical records were audited to assess rates of questioning for partner abuse. Identifications of partner abuse and referrals made were counted through the Family Violence Accessory File. Referrals to the Department of Child, Youth and Family Services (CYFS) were recorded routinely by the CYFS. Audits assessed quality of assessment of child and partner abuse, when identified. More than 700 staff were trained in dual assessment for child and partner abuse. Evaluations demonstrate improved confidence following training, though staff still need support. Barriers and enablers to asking about partner abuse were identified. Referrals from the health service to the CYFS increased from 10 per quarter to 70 per quarter. Identification of partner abuse increased from 30 to 80 per 6-month period. Routine questioning rates for partner abuse vary between services. Achieving and sustaining improved rates of identification and quality of assessment of child and partner abuse is possible with a formal organisational change approach.
Gil, J; Rodríguez, J M; Hernández, Q; Gil, E; Balsalobre, M D; González, M; Torregrosa, N; Verdú, T; Alcaráz, M; Parrilla, P
Hernia is especially prevalent in developing countries where the population is obliged to undertake strenuous work in order to survive, and International Cooperation Programmes are helping to solve this problem. However, the quality of surgical interventions is unknown. The objective of the present study was to evaluate the quality of hernia repair processes carried out by the Surgical Solidarity Charity in Central African States. A total of 524 cases of inguinal hernia repair carried out in Cameroon and Mali during 2005 to 2009 were compared with 386 cases treated in a Multicentre Spanish Study (2003). General data (clinical, demographic, etc.), type of surgery, complications, and effectiveness and efficiency indicators were collected. Preoperative studies in the Spanish group were greater in number than in the African group. The use of local anesthesia was similar. Antibiotic prophylaxis was higher in the African group (100% to 75.4%). The use of mesh was similar. The incidence of hematomas was higher in the Spanish group (11.61% to 4.61%), but the incidence of infection of the wound and of hernia recurrence was similar, although follow-up was only carried out in 20.97% in the African group (70% in the Spanish group). Hospital stay of more than 24 h was higher in the Spanish group. The standard quality of surgery for the treatment of hernia in developing countries with few instrumental means, and in sub-optimal surgical conditions is similar to that provided in Spain.
Besson, Marie; Samer, Caroline; Rollason, Victoria; Dayer, Pierre; Desmeules, Jules
Quality therapeutics play an important role in Switzerland's health care and economy. Switzerland holds a key position in the world of research and development, as well as in drug production. Recently, new emphasis has been placed on promoting clinical research and maintaining Switzerland's position as a center of excellence in the field. Recent revisions to the law regarding medical trials in human research allow for better allocation of regulatory resources and simplified procedures for drugs already authorized in Switzerland. The country has its own regulatory agency, the Swiss Agency for Therapeutic Products (Swissmedic), which is a public institution of the Swiss government. Swissmedic is responsible for ensuring safety in medicines, particularly regarding authorizations and market surveillance in the sector of medicinal products and medical devices. Although the centralized authorization procedure of the European Union for medicines does not apply to Switzerland, there are mutual recognition mechanisms between the Swiss medicine regulatory authority and the European Medicines Agency. Swissmedic is also in charge of postmarketing safety and oversees the national pharmacovigilance center, which collaborates closely with the World Health Organization center in Uppsala. In addition, university hospital-based clinical pharmacologists, who are involved in basic science and clinical research, regulatory affairs, ethics committees, and pharmacovigilance, promote quality therapeutics. This article discusses the role of the various stakeholders and the recent efforts made to provide a better allocation of resources aimed at further improving quality therapeutics in Switzerland. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.
Bromer, Juliet; Bibbs, Tonya
Family child care (FCC) providers often experience isolation from other early childhood and child care professionals. Yet, research suggests that providers who network with other providers, engage with community resources, and belong to support groups tend to offer higher quality child care. For example, the Family Child Care Network Impact Study…
Sampogna, F; Johansson, V; Axtelius, B; Abeni, D; Söderfeldt, B
To measure the agreement between patients and their caregivers in evaluating patients' oral quality of life. Cross-sectional study. Data collected in four Swedish dental clinics in 2004. Consecutive patients. Data were completed for 444 patients. Fifteen dentists and 12 dental hygienists agreed to participate. For each patient, the patient him/herself and his/her caregiver completed the 14-item Oral Health Impact Profile (OHIP-14), a specific instrument used to measure quality of life in oral conditions, with higher scores indicating a worse quality of life. Information on personal and clinical characteristics of patients were also collected. Median OHIP-14 scores given by caregivers and patients were calculated and compared in different subgroups of patients. Cohen's kappa was calculated to measure the agreement between the evaluation of patients and caregivers. OHIP-14 scores median values were 3.0 among patients and 9.0 among caregivers. Caregivers always gave a higher score than patients, especially in older patients and patients with lower education. The concordance between patients' and caregivers' evaluation was very low (for different OHIP-14 cutoffs: Cohen's kappa from 0.10 to 0.15). In this study, great discrepancies were observed between patients and caregivers in the evaluation of patients' oral quality of life, with caregivers overestimating the burden of dental conditions on patients. It is important to improve patient-caregiver communication, in order to increase patient satisfaction and provide better care. A good patient-caregiver relationship is essential for the patients' well-being and their adherence to treatment.
Han, Bong-Gyoon [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Watson, Zoe [Univ. of California, Berkeley, CA (United States); Cate, Jamie H. D. [Univ. of California, Berkeley, CA (United States); Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Glaeser, Robert M. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)
Analysis of images of biotinylated Escherichia coli 70S ribosome particles, bound to streptavidin affinity grids, demonstrates that the image-quality of particles can be predicted by the image-quality of the monolayer crystalline support film. Also, the quality of the Thon rings is a good predictor of the image-quality of particles, but only when images of the streptavidin crystals extend to relatively high resolution. When the estimated resolution of streptavidin was 5 Å or worse, for example, the ribosomal density map obtained from 22,697 particles went to only 9.5 Å, while the resolution of the map reached 4.0 Å for the same number of particles, when the estimated resolution of streptavidin crystal was 4 Å or better. It thus is easy to tell which images in a data set ought to be retained for further work, based on the highest resolution seen for Bragg peaks in the computed Fourier transforms of the streptavidin component. The refined density map obtained from 57,826 particles obtained in this way extended to 3.6 Å, a marked improvement over the value of 3.9 Å obtained previously from a subset of 52,433 particles obtained from the same initial data set of 101,213 particles after 3-D classification. These results are consistent with the hypothesis that interaction with the air-water interface can damage particles when the sample becomes too thin. Finally, streptavidin monolayer crystals appear to provide a good indication of when that is the case.
Full Text Available E-Customs initiative includes a number of IT projects, organizational and legal measures. They are designed to creation of a simple and paperless environment for trade and customs, to short the duration of customs clearance and to ensure an appropriate level of security of commercial transactions. Modern customs administration must operate on the basis of advanced infrastructure in the field of information and communication technologies. Only then will it be able to provide cheaper and more efficient customs services. Therefore, the greatest challenge and the main goal of the e-Customs programme is to harmonize customs procedures and systems in the 28 Member States. The article describes the assumptions and objectives of the e-Customs, presents its genesis and evolution. Particular attention was paid to the activities that are aimed at improving the quality of customs services provided to European companies.
Scott, Anthony; Sivey, Peter; Ait Ouakrim, Driss; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris
The use of blended payment schemes in primary care, including the use of financial incentives to directly reward 'performance' and 'quality' is increasing in a number of countries. There are many examples in the US, and the Quality and Outcomes Framework (QoF) for general practitioners (GPs) in the UK is an example of a major system-wide reform. Despite the popularity of these schemes, there is currently little rigorous evidence of their success in improving the quality of primary health care, or of whether such an approach is cost-effective relative to other ways to improve the quality of care. The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians (PCPs) and to identify:i) the different types of financial incentives that have improved quality;ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives; andiii) the characteristics of PCPs who have responded to financial incentives. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library), MEDLINE, HealthSTAR, EMBASE, CINAHL, PsychLIT, and ECONLIT. Searches of Internet-based economics and health economics working paper collections were also conducted. Finally, studies were identified through the reference lists of retrieved articles, websites of key organisations, and from direct contact with key authors in the field. Articles were included if they were published from 2000 to August 2009. Randomised controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series analyses (ITS) evaluating the impact of different financial interventions on the quality of care delivered by primary healthcare physicians (PCPs). Quality of care was defined as patient reported outcome
Hullmann, Stephanie E; Wolfe-Christensen, Cortney; Meyer, William H; McNall-Knapp, Rene Y; Mullins, Larry L
The current study sought to examine the relation of parental overprotection and perceived child vulnerability to parent-reported health-related quality of life in parents of children with cancer. Parents (N = 89) of children who had been diagnosed with cancer completed measures of parental overprotection, perceived child vulnerability, and parent-proxy report of health-related quality of life. After controlling for theoretically relevant covariates, parental overprotection and perceived child vulnerability were both found to be significantly related to child health-related quality of life. Additional analyses revealed that perceived child vulnerability mediated the relationship between overprotective parenting behaviors and the child's health-related quality of life. The findings highlight the need to assess for these discrete parenting variables in parents of children with cancer and to develop interventions to target parental perceptions of vulnerability.
Knowing and applying standards is an opportunity of the years 2007-2008 in any kind of field where a successful activity is intended and this assures a certain way towards competence and quality. The most recent German studies highlighted, to the surprise of the specialists, that standardization holds the second place, after the material means, in the row of the elements considered to be decisive for the success of a business. The existence of standards and the concern for their implementation in the activity provides a high technical and quality level of the products services offered to the clients and the increase in the level of competence of the personnel, who will be able to cope with all the challenges. This need comes from the process of Romania’s accession to the European Union. There are a lot of reasons why standards represent a fundamental part of our daily life. Practically, we are surrounded by standards. Everything is „working” well and it is efficient if the standards used as a base for manufacturing „things” have been correctly developed and applied. Standards open communication channels and commercial channels, promote the understanding of technical products, the compatibility of products and services, facilitate mass production and, most importantly, they are the necessary base for the achievement of the objectives in the fields of health and safety and a better quality of life. The transition towards the global market needs an instrument for the removal of the barriers to the application of the latest discoveries in the field of medical instruments, materials and manual labor. Each medical device, equipment and material used in the Dental and General Medicine is standardized, in fact that leads to their better knowing and provides controllable treatment for manual labor with predictable and repeatable results. This presentation intends to make a survey of some general aspects on standardization as well as a review of the standards in
Yu. A. Rolik
Full Text Available The problem of providing electric power quality in the electric power systems (EPS that are equipped with sufficiently long air or cable transmission lines is under consideration. This problem proved to be of particular relevance to the EPS in which a source of electrical energy is the generator of wind turbines since the wind itself is an instable primary energy source. Determination of the degree of automation of voltage regulation in the EPS is reduced to the choice of methods and means of regulation of power quality parameters. The concept of a voltage loss and the causes of the latter are explained by the simplest power system that is presented by a single-line diagram. It is suggested to regulate voltage by means of changing parameters of the network with the use of the method of reducing loss of line voltage by reducing its reactance. The latter is achieved by longitudinal capacitive compensation of the inductive reactance of the line. The effect is illustrated by vector diagrams of currents and voltages in the equivalent circuits of transmission lines with and without the use of longitudinal capacitive compensation. The analysis of adduced formulas demonstrated that the use of this method of regulation is useful only in the systems of power supply with a relatively low power factor (cosφ < 0.7 to 0.9. This power factor is typical for the situation of inclusion the wind turbine with asynchronous generator in the network since the speed of wind is instable. The voltage regulation fulfilled with the aid of the proposed method will make it possible to provide the required quality of the consumers’ busbars voltage in this situation. In is turn, it will make possible to create the necessary conditions for the economical transmission of electric power with the lowest outlay of reactive power and the lowest outlay of active power losses.
It is appropriate that after almost half a century of Science and Mathematics education reform we take a look back and a peek forward to understand the present state of this wonderfully complex system. Each of the components of this system including teaching, professional development, assessment, content and the district K-12 curriculum all need to work together if we hope to provide quality science, mathematics and technology education for ALL students. How do the state and national standards drive the system? How do state policies on student testing and teacher licensure come into play? How do we improve the preparation, retention and job satisfaction of our K-12 teachers? What initiatives have made or are making a difference? What else needs to be done? What can the physics community do to support local efforts? This job is too big for any single organization or individual but we each can contribute to the effort. Our Center at Northeastern University, with support from the National Science Foundation, has a sharply defined focus: to get high quality, research-based instructional materials into the hands of K-12 classroom teachers and provide the support they need to use the materials effectively in their classrooms.
Dearing, Eric; McCartney, Kathleen; Taylor, Beck A
Higher quality child care during infancy and early childhood (6-54 months of age) was examined as a moderator of associations between family economic status and children's (N = 1,364) math and reading achievement in middle childhood (4.5-11 years of age). Low income was less strongly predictive of underachievement for children who had been in higher quality care than for those who had not. Consistent with a cognitive advantage hypothesis, higher quality care appeared to promote achievement indirectly via early school readiness skills. Family characteristics associated with selection into child care also appeared to promote the achievement of low-income children, but the moderating effect of higher quality care per se remained evident when controlling for selection using covariates and propensity scores.
Chen, Xi; McElwain, Nancy L; Lansford, Jennifer E
Using data from a subsample of 913 study children and their friends who participated in the NICHD Study of Early Child Care and Youth Development, the interactive contributions of child-reported attribution biases and teacher-reported child emotional intensity (EI) at Grade 4 (M = 9.9 years) to observed child-friend interaction at Grade 6 (M = 11.9 years) were examined. Study children's hostile attribution bias, combined with high EI, predicted more negative child-friend interaction. In contrast, benign attribution bias, combined with high EI, predicted more positive child-friend interaction. The findings are discussed in light of the "fuel" interpretation of EI, in which high-intensity emotions may motivate children to act on their cognitive biases for better or for worse. © 2017 The Authors. Child Development © 2017 Society for Research in Child Development, Inc.
Song, Won O; Song, SuJin; Nieves, Violeta; Gonzalez, Andie; Crockett, Elahé T
Children enrolled in Migrant and Seasonal Head Start (MSHS) programs are at high risks of health problems. Although non-family child care providers play important roles on children's health status as role models, educators, program deliverers, and information mediators, little is known about their nutritional health attitudes and behaviors, and weight status. Therefore, we investigated nutritional health attitudes and behaviors and their associations with overweight/obesity among child care providers in Michigan MSHS centers. A total of 307 child care providers aged ≥ 18 years working in 17 Michigan MSHS centers were included in this cross-sectional study conducted in 2013. An online survey questionnaire was used to collect data on nutritional health attitudes and behaviors of child care providers. Weight status was categorized into normal weight (18.5 ≤ BMI obese (BMI ≥ 30 kg/m(2)) based on child care providers' self-reported height and weight. Factor analysis was performed to investigate patterns of nutritional health attitudes and behaviors. Multivariate logistic regression was conducted to estimate the odds ratios (ORs) and 95 % confidence intervals (CIs) of overweight/obesity across tertiles of pattern scores taking the lowest tertile group as the reference group after adjustment for potential confounding variables. Three patterns of nutritional health attitudes and behaviors were identified: pattern 1) "weight loss practices with weight dissatisfaction", pattern 2) "healthy eating behaviors", and pattern 3) "better knowledge of nutrition and health". The pattern 1 scores were positively associated with overweight/obesity (Tertile 2 vs. Tertile 1: OR = 5.81, 95 % CI = 2.81-12.05; Tertile 3 vs. Tertile 1: OR = 14.89, 95 % CI = 6.18-35.92). Within the pattern 2, the OR for overweight/obesity in individuals with the highest scores was 0.37 (95 % CI = 0.19-0.75) compared with those with the lowest scores. However, the
Day, Crispin; Michelson, Daniel; Hassan, Imren
OBJECTIVES. Dissatisfaction with services has been associated with poorer child mental health outcomes, early treatment termination as well as disagreements over the nature of mental health difficulties, reasons for referral and therapy goals. The development of straightforward, reliable, and accurate methods of eliciting service users' views is essential within child and adolescent mental health care. This paper describes the development of the child and adolescent service experience (ChASE), a tool to measure children and young people's service experience DESIGN. The study comprises a non-experimental, cross-sectional design. METHODS. Participants were 132 mental health service users aged 8-18 years. Participants and their main carer completed the ChASE, Parent Satisfaction Questionnaire (PSQ) (Stallard, 1996) and Strengths and Difficulties (SDQ) Impact Supplement. Clinicians completed the SDQ Impact Supplement and provided clinical activity data. A sub-sample of participants completed the ChASE on a second occasion, 6 weeks after the completion of the first questionnaire. RESULTS. Scrutiny of ChASE data indicated high levels of completion. Principal axis factoring identified three factors within the ChASE: Relationship, Privacy, and Session Activity. The ChASE has good internal consistency and test-retest reliability. Significant correlations were found between the ChASE and carer satisfaction, service use, and youth clinical outcomes. CONCLUSIONS. The ChASE is a short, psychometrically robust tool for routine measurement of children, and young people's experience of mental health services, which users can complete easily. The results underline the importance of alliance factors to children and young people and their association with clinical improvement as well as the potential for the ChASE to be used a measure of children's therapeutic progress and alliance. ©2011 The British Psychological Society.
Freeman, Ruth; Gibson, Barry; Humphris, Gerry; Leonard, Helen; Yuan, Siyang; Whelton, Helen
Objective: To use a model of health learning to examine the role of health-learning capacity and the effect of a school-based oral health education intervention (Winning Smiles) on the health outcome, child oral health-related quality of life (COHRQoL). Setting: Primary schools, high social deprivation, Ireland/Northern Ireland. Design: Cluster…
Rajindrajith, Shaman; Devanarayana, Niranga Manjuri; Benninga, Marc Alexander
The aim of this study was to evaluate the association between fecal incontinence (FI), child abuse, somatization, and health-related quality of life (HRQoL) in adolescents. Adolescents (ages 13-18 years) were selected from 4 semi-urban schools in the Gampaha district, Sri Lanka. A validated,
Spoth, Richard; Neppl, Tricia; Goldberg-Lillehoj, Catherine; Jung, Tony; Ramisetty-Mikler, Suhasini
This article reports two exploratory studies testing a model guided by a social interactional perspective, positing an inverse relation between the quality of parent-child interactions and adolescent problem behaviors. It addresses mixed findings in the literature related to gender differences. Study 1 uses cross-sectional survey data from…
Papadopoulou, Elena; Gregoriadis, Athanasios
The purpose of this study was to examine young children's perceptions about the quality of their interactions with their teachers and the possible association of teacher-child relationships with children's school engagement. Additionally, gender and ethnicity differences were investigated regarding both teachers' and children's perceptions. Young…
Gonsoulin, Simon; Clark, Heather Griller; Rankin, Victoria E.
This National Evaluation and Technical Assistance Center for the Education of Children and Youth Who are Neglected, Delinquent, or At-Risk (NDTAC) practice guide examines the principle that quality education services are critical for youth involved with the juvenile justice and child welfare systems. This principle asserts that, to address the…
Thullen, Matthew; Bonsall, Aaron
113 parents of children aged 5-13 with ASD completed online surveys assessing co-parenting quality, parenting stress, and child feeding challenges. Results indicated that food selectivity was both the most frequently reported type of challenging feeding behavior and the most often reported as problematic but was also the only type of challenging…
van Oers, Hedy A.; Tacke, Carline E.; Haverman, Lotte; Kuipers, Irene M.; Maurice-Stam, Heleen; Kuijpers, Taco W.; Grootenhuis, Martha A.
Kawasaki disease (KD) is an acute paediatric vasculitis. The psychosocial consequences of this sudden illness for parents are unknown. This study aimed to evaluate health related quality of life (HRQOL) and parental perceptions of child vulnerability (PPCV) in parents of children with KD, and to
Roggman, Lori A; Cook, Gina A; Innocenti, Mark S; Jump Norman, Vonda; Boyce, Lisa K; Christiansen, Katie; Peterson, Carla A
Home-visiting programs aiming to improve early child development have demonstrated positive outcomes, but processes within home visits to individual families are rarely documented. We examined family-level variations in the home-visiting process (N = 71) from extant video recordings of home visits in two Early Head Start programs, using an observational measure of research-based quality indicators of home-visiting practices and family engagement, the Home Visit Rating Scales (HOVRS). HOVRS scores, showing good interrater agreement and internal consistency, were significantly associated with parent- and staff-reported positive characteristics of home visiting as well as with parenting and child language outcomes tested at program exit. When home-visiting processes were higher quality during the program, home visit content was more focused on child development, families were more involved in the overall program, and most important, scores on measures of the parenting environment and children's vocabulary were higher at the end of the program. Results showed that home visit quality was indirectly associated with child language outcomes through parenting outcomes. Observation ratings of home visit quality could be useful for guiding program improvement, supporting professional development, and increasing our understanding of the links between home-visiting processes and outcomes. © 2016 Michigan Association for Infant Mental Health.
Laible, Deborah; Murphy, Tia Panfile; Augustine, Mairin
Researchers have speculated that a number of factors likely predict the quality of reminiscing between preschool children and their mothers. This study was designed to investigate three such factors, including child temperament, maternal personality, and maternal caregiving representations. Seventy mothers and their preschool children were…
Pinto, Ana Isabel; Pessanha, Manuela; Aguiar, Cecilia
This study examined the joint effects of home environment and center-based child care quality on children's language, communication, and early literacy development, while also considering prior developmental level. Participants were 95 children (46 boys), assessed as toddlers (mean age = 26.33 months; Time 1) and preschoolers (mean age = 68.71…
Vitiello, Virginia E.; Moas, Olga; Henderson, Heather A.; Greenfield, Daryl B.; Munis, Pelin M.
Research Findings: The purpose of this study was to examine whether child temperament differentially predicted academic school readiness depending on the quality of classroom interactions for 179 Head Start preschoolers. Teachers rated children's temperament as overcontrolled, resilient, or undercontrolled in the fall and reported on children's…
Full Text Available The work of a nurse plays a significant role in the treatment, rehabilitation and promotion of patient health. It is particularly important in the patient's home environment. The variety of benefits provided requires specific skills, abilities as well as the need for constant updating of knowledge. What is more, an environmental nurse working alone in the patient's home for his or her patients is often an authority. The quality of nursing is considered from the very beginning of its professional development. It is one of the elements of health care but no less important than others. It refers to the direct relationship between the patient and the nurse. It is dependent on many factors, primarily from the working environment. Purpose of research The aim of the study was to find nurses' opinions about the impact of the working environment on the quality of services provided within the primary care Material and methods For the purposes of this paper, a questionnaire consisting of 20 questions was used. The study was conducted among 128 family nurses of the Podkarpackie Voivodeship from January to April 2017. All persons were informed about the purpose of the study. They were voluntary and anonymous. For the purpose of this paper, hypotheses were used for questions on nominal scales: V Kramer (2x3, 4x5, etc., Phi (2x2. Tb - Kendall or Tc tests were used for the order scales. Statistical analysis was performed using the SPSS program and all compounds were statistically significant when p <0.05. Results and conclusions: 128 nurses participated in the study. The average age of the respondents was nearly 41 years +/- 9 years. 15.6% of the respondents provided individual nursing care, 21.1% as part of a group nursing practice, and 30.5% were employed in non-public health care facilities. The remaining 25.8% in public outpatient clinics of primary care. The results of the research indicate significant variation in the working conditions of nurses in the
Bobzien, Monika; Hausmann, Verena; Kornder, Theo; Manz-Gill, Brigitte
Within the framework of internal evaluation and self-evaluation activities in a child guidance clinic, measures of success have to date been based primarily on the degree to which the delegating organisations are satisfied with the results of the counselling. The orientation of the success of counselling towards the results stems from the fact that the process of helping is not generally manifest to parents, schools, and education staff. It takes place in the context of direct contact between therapists and children, the immediate addresses of help, and therefore often remains "hidden". Since the children's perspective--their impressions and appraisals--has often been neglected in past assessment methods, it hardly plays any role at all in the discussion of quality at counselling centres. This made it all the more stimulating for all those involved to initiate improvement measures within the framework of quality management on the basis of a client survey and in this way to launch a shared learning process as to how client orientation can flow directly into everyday practice. This is certainly the first attempt of its kind in the work of child guidance clinics to develop an understanding of client orientation in line with the expectations of parents and children and to link this to the quality development of the service. In the first part of this experiential report, the external process coach provides a brief summary of the assessment method employed in connection with the introduction of internal quality management at the counselling centre. This is followed by the centre's own description of the concrete performance of the client survey with children using the example of social-therapeutic child group work. The study concludes with a discussion of the benefit drawn from this process for the improvement of this pedagogical project.
Buist, Kirsten L.; Verhoeven, Marjolein; Hoksbergen, René; ter Laak, Jan; Watve, Sujala; Paranjpe, Analpa
The aims of the present study were (a) to examine whether Dutch and Indian early adolescents differ concerning sibling and parent-child relationship quality and externalizing and internalizing problems, and (b) to compare the associations between sibling and parent-child relationship quality and externalizing and internalizing problems for Indian…
Buist, K. L.|info:eu-repo/dai/nl/241099218; Verhoeven, Marjolein|info:eu-repo/dai/nl/304349747; Hoksbergen, R.|info:eu-repo/dai/nl/068229127; Ter Laak, J.; Watve, S.; Paranjpe, A.
The aims of the present study were (a) to examine whether Dutch and Indian early adolescents differ concerning sibling and parent-child relationship quality and externalizing and internalizing problems, and (b) to compare the associations between sibling and parent-child relationship quality and
Choo, Hyekyung; Shek, Daniel
Analyzing data from a probability sample representative of secondary school students in Singapore (N = 1,599), this study examined the independent impact between the quality of mother-child relationship, the quality of father-child relationship and family conflict on the frequency of drinking and drunkenness, and whether each dyadic parent-child…
Brown, Meta; Flinn, Christopher J.
Policies governing divorce and parenting, such as child support orders and enforcement, child custody regulations, and marital dissolution requirements, can have a large impact on the welfare of parents and children. Recent research has produced evidence on the responses of divorce rates to unilateral divorce laws and child support enforcement. In…
Calderon, Lindsay E; Carney, Logan D; Kavanagh, Kevin T
In this study the authors investigate the sound pressure levels produced by crying children and discuss the possible adverse effects that direct exposure may impose on a tending guardian or healthcare professional. Sound intensity levels from various pediatric patients (N = 26) were measured under two segregate conditions, one imitating the exposure of an examining physician and the other resembling that of parental guardians. Interestingly, all of the recorded sound levels fell between 99-120 dB(A) of sound pressure; children presenting the greatest risk for intense cries with potentially harmful sound intensities were between the ages of 9 months and 6 years. The authors found that elevated noise levels produced from crying children can cause acute discomfort and mild pain to those exposed. In addition, there is a theoretical risk that chronic exposure to these intense sound pressures may result in noise-induced hearing loss in a parental guardian or an examining physician. Parents of young children may be more likely to succumb to impulsive reactions in attempting to arrest the crying, which could be a precipitating factor for child abuse, responding to physical stress as much as emotional stress. Social workers and medical personnel should consider suggesting the use of ear plugs by parental guardians of frequently crying children as a modality for the prevention of child abuse.
Spieker, Susan J; Oxford, Monica L; Fleming, Charles B; Lohr, Mary Jane
Parents who are involved with child welfare services (CWSI) often have a history of childhood adversity and depressive symptoms. Both affect parenting quality, which in turn influences child adaptive functioning. We tested a model of the relations between parental depression and child regulatory outcomes first proposed by K. Lyons-Ruth, R. Wolfe, A. Lyubchik, and R. Steingard (2002). We hypothesized that both parental depression and parenting quality mediate the effects of parental early adversity on offspring regulatory outcomes. Participants were 123 CWSI parents and their toddlers assessed three times over a period of 6 months. At Time 1, parents reported on their childhood adversity and current depressive symptoms. At Time 2, parents' sensitivity to their child's distress and nondistress cues was rated from a videotaped teaching task. At Time 3, observers rated children's emotional regulation, orientation/engagement, and secure base behavior. The results of a path model partly supported the hypotheses. Parent childhood adversity was associated with current depressive symptoms, which in turn related to parent sensitivity to child distress, but not nondistress. Sensitivity to distress also predicted secure base behavior. Depression directly predicted orientation/engagement, also predicted by sensitivity to nondistress. Sensitivity to distress predicted emotion regulation and orientation/engagement. Results are discussed in terms of intervention approaches for CWSI families. © 2017 Michigan Association for Infant Mental Health.
Juliana Cristina Scotton
Full Text Available Bokashi soil conditioner aims to assist in the resilience of natural microbiota and its associated functions. Currently, there are several formulations of this conditioner, however, little is known about the influence of the sources of inoculum on the quality of the same. This study objective was to evaluate the effects of different sources of bokashi inoculum on microbiological and physical attributes of the soil. The experiment was conducted in tubes designated as microcosms, incubated at 24 °C for 32 days, with 4 treatments and 10 replications: C - control; SI - bokashi bran without inoculum; IN1 - bokashi with forest inoculum; IN2 - bokashi with consortium inoculum. The microbiological parameters of colony forming units of fungi and bacteria, microbial biomass carbon, basal soil respiration, metabolic and microbial quotient were evaluated. Among the physical parameters evaluated were dispersed clay, geometric mean diameter and organic carbon. The data were submitted to ANOVA and the measurements compared by the Tukey test at 5%. The fungal density was significantly higher for SI and IN1, as compared to the other treatments. In regards to the bacteria, there was an increase for IN1, in comparison with the control. The IN1 treatment demonstrated higher microbial activity and higher C uptake in the soil. Regarding the physical attributes, there was greater clay dispersion for IN2 and greater GMD for C. The bokashi formulation with forest inoculum and cropping field provides higher microbiological quality to the soil under controlled conditions.
Mohd Salleh, Mohd Idzwan; Zakaria, Nasriah; Abdullah, Rosni
The Ministry of Health Malaysia initiated the total hospital information system (THIS) as the first national electronic health record system for use in selected public hospitals across the country. Since its implementation 15 years ago, there has been the critical requirement for a systematic evaluation to assess its effectiveness in coping with the current system, task complexity, and rapid technological changes. The study aims to assess system quality factors to predict the performance of electronic health in a single public hospital in Malaysia. Non-probability sampling was employed for data collection among selected providers in a single hospital for two months. Data cleaning and bias checking were performed before final analysis in partial least squares-structural equation modeling. Convergent and discriminant validity assessments were satisfied the required criterions in the reflective measurement model. The structural model output revealed that the proposed adequate infrastructure, system interoperability, security control, and system compatibility were the significant predictors, where system compatibility became the most critical characteristic to influence an individual health care provider's performance. The previous DeLone and McLean information system success models should be extended to incorporate these technological factors in the medical system research domain to examine the effectiveness of modern electronic health record systems. In this study, care providers' performance was expected when the system usage fits with patients' needs that eventually increased their productivity. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.
Fernandes, A.; Riffler, M.; Ferreira, J.; Wunderle, S.; Borrego, C.; Tchepel, O.
Satellite data provide high spatial coverage and characterization of atmospheric components for vertical column. Additionally, the use of air pollution modelling in combination with satellite data opens the challenging perspective to analyse the contribution of different pollution sources and transport processes. The main objective of this work is to study the AOD over Portugal using satellite observations in combination with air pollution modelling. For this purpose, satellite data provided by Spinning Enhanced Visible and Infra-Red Imager (SEVIRI) on-board the geostationary Meteosat-9 satellite on AOD at 550 nm and modelling results from the Chemical Transport Model (CAMx - Comprehensive Air quality Model) were analysed. The study period was May 2011 and the aim was to analyse the spatial variations of AOD over Portugal. In this study, a multi-temporal technique to retrieve AOD over land from SEVIRI was used. The proposed method takes advantage of SEVIRI's high temporal resolution of 15 minutes and high spatial resolution. CAMx provides the size distribution of each aerosol constituent among a number of fixed size sections. For post processing, CAMx output species per size bin have been grouped into total particulate sulphate (PSO4), total primary and secondary organic aerosols (POA + SOA), total primary elemental carbon (PEC) and primary inert material per size bin (CRST1 to CRST_4) to be used in AOD quantification. The AOD was calculated by integration of aerosol extinction coefficient (Qext) on the vertical column. The results were analysed in terms of temporal and spatial variations. The analysis points out that the implemented methodology provides a good spatial agreement between modelling results and satellite observation for dust outbreak studied (10th -17th of May 2011). A correlation coefficient of r=0.79 was found between the two datasets. This work provides relevant background to start the integration of these two different types of the data in order
Yigzaw, Tegbar; Abebe, Fantu; Belay, Lalem; Assaye, Yewulsew; Misganaw, Equlinet; Kidane, Ashebir; Ademie, Desalegn; van Roosmalen, Jos; Stekelenburg, Jelle; Kim, Young-Mi
BACKGROUND: Despite much progress recently, Ethiopia remains one of the largest contributors to the global burden of maternal and newborn deaths and stillbirths. Ethiopia's plan to meet the sustainable development goals for maternal and child health includes unprecedented emphasis on improving
Vandenberg, Ann E; Echt, Katharina V; Kemp, Lawanda; McGwin, Gerald; Perkins, Molly M; Mirk, Anna K
Suboptimal prescribing persists as a driver of poor quality care of older veterans and is associated with risk of hospitalization and emergency department visits. We adapted a successful medication management model, Integrated Management and Polypharmacy Review of Vulnerable Elders (IMPROVE), from an urban geriatric specialty clinic to rural community-based clinics that deliver primary care. The goals were to promote prescribing quality and safety for older adults, including reduced prescribing of potentially inappropriate medications (PIMs). We augmented the original model, which involved a pharmacist-led, one-on-one medication review with high-risk older veterans, to provide rural primary care providers (PCPs) and pharmacists with educational outreach through academic detailing and tools to support safe geriatric prescribing practices, as well as individual audit and feedback on prescribing practice and confidential peer benchmarking. Twenty PCPs and 4 pharmacists at 4 rural Georgia community-based outpatient clinics participated. More than 7,000 older veterans were seen in more than 20,000 PCP encounters during the 14-month intervention period. Implementation of the IMPROVE intervention reduced PIM prescribing incidence from 9.6 new medications per 100 encounters during baseline to 8.7 after the intervention (P = .009). IMPROVE reduced PIM prevalence (proportion of encounters involving veterans who were taking at least 1 PIM) from 22.6% to 16.7% (P < .001). These approaches were effective in reducing PIMs prescribed to older veterans in a rural setting and constitute a feasible model for disseminating geriatric best practices to the primary care setting. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.
Ergen, William F; Pasricha, Trisha; Hubbard, Francie J; Higginbotham, Tina; Givens, Tonya; Slaughter, James C; Obstein, Keith L
of 0 (P = .036). The mean BBPS segment score was greater for the booklet group than the no-booklet group (right colon, P = .097; transverse colon, P = .023; left colon, P = .045). In a randomized controlled trial, we found that providing hospitalized patients with an educational booklet on colonoscopy preparation increases the odds of a quality bowel preparation more than 2-fold. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.
Ameh, Soter; Klipstein-Grobusch, Kerstin; D'ambruoso, Lucia; Kahn, Kathleen; Tollman, Stephen M; Gómez-Olivé, Francesc Xavier
The integrated chronic disease management (ICDM) model was introduced as a response to the dual burden of HIV/AIDS and non-communicable diseases (NCDs) in South Africa, one of the first of such efforts by an African Ministry of Health. The aim of the ICDM model is to leverage HIV programme innovations to improve the quality of chronic disease care. There is a dearth of literature on the perspectives of healthcare providers and users on the quality of care in the novel ICDM model. This paper describes the viewpoints of operational managers and patients regarding quality of care in the ICDM model. In 2013, we conducted a case study of the seven PHC facilities in the rural Agincourt sub-district in northeast South Africa. Focus group discussions (n = 8) were used to obtain data from 56 purposively selected patients ≥18 years. In-depth interviews were conducted with operational managers of each facility and the sub-district health manager. Donabedian’s structure, process and outcome theory for service quality evaluation underpinned the conceptual framework in this study. Qualitative data were analysed, with MAXQDA 2 software, to identify 17 a priori dimensions of care and unanticipated themes that emerged during the analysis. The manager and patient narratives showed the inadequacies in structure (malfunctioning blood pressure machines and staff shortage); process (irregular prepacking of drugs); and outcome (long waiting times). There was discordance between managers and patients regarding reasons for long patient waiting time which managers attributed to staff shortage and missed appointments, while patients ascribed it to late arrival of managers to the clinics. Patients reported anti-hypertension drug stock-outs (structure); sub-optimal defaulter-tracing (process); rigid clinic appointment system (process). Emerging themes showed that patients reported HIV stigmatisation in the community due to defaulter-tracing activities of home-based carers, while
McStay, Rebecca L; Trembath, David; Dissanayake, Cheryl
While the impact of raising a child with an Autism Spectrum Disorder (ASD) is well documented, with mothers reporting higher levels of stress than mothers of children with other disabilities, positive maternal outcomes have also been identified. What remains unclear, however, is the role of child age on maternal outcomes. We sought to clarify the role of child age in maternal stress and family quality of life (FQoL) in mothers raising a child with ASD. Participants included 140 mothers of children aged 3-16 years grouped to represent four key stages of childhood (preschool, early school years, middle school, early high school). Using a cross-sectional design, mothers completed questionnaires assessing potential risk (e.g., child problem behaviour, symptom severity) and protective (e.g., family characteristics) factors attributed to maternal outcomes. The results revealed significant age related group differences in child internalising behaviour and ASD symptomatology between the early and middle school years. Lower levels of adaptive social behaviour in older age groups were also found. Although mothers of older children reported significantly less support from professionals than mothers of younger children, no significant age effects were found to contribute to maternal reports of stress or FQoL. The current findings support the view that mothers appear to demonstrate stable levels of stress and FQoL despite fluctuations in key child variables and a reduction in supports, across age, highlighting the ongoing nature of maternal needs and heightened levels of child symptomatology during adolescence. Copyright © 2014 Elsevier Ltd. All rights reserved.
Nieuwesteeg, Anke; Hartman, Esther; Pouwer, Frans; Emons, Wilco; Aanstoot, Henk-Jan; Van Mil, Edgar; Van Bakel, Hedwig
In young children with type 1 diabetes mellitus (T1DM), parents have complete responsibility for the diabetes-management. In toddlers and (pre)schoolers, the tasks needed to achieve optimal blood glucose control may interfere with normal developmental processes and could negatively affect the quality of parent-child interaction. Several observational instruments are available to measure the quality of the parent-child interaction. However, no observational instrument for diabetes-specific situations is available. Therefore, the aim of the present study was to develop a qualitative observation instrument, to be able to assess parent-child interaction during diabetes-specific situations. First, in a pilot study (n = 15), the observation instrument was developed in four steps: (a) defining relevant diabetes-specific situations; (b) videotaping these situations; (c) describing all behaviors in a qualitative observation instrument; (d) evaluating usability and reliability. Next, we examined preliminary validity (total n = 77) by testing hypotheses about correlations between the observation instrument for diabetes-specific situations, a generic observation instrument and a behavioral questionnaire. The observation instrument to assess parent-child interaction during diabetes-specific situations, which consists of ten domains: "emotional involvement", "limit setting", "respect for autonomy", "quality of instruction", "negative behavior", "avoidance", "cooperative behavior", "child's response to injection", "emphasis on diabetes", and "mealtime structure", was developed for use during a mealtime situation (including glucose monitoring and insulin administration). The present study showed encouraging indications for the usability and inter-rater reliability (weighted kappa was 0.73) of the qualitative observation instrument. Furthermore, promising indications for the preliminary validity of the observation instrument for diabetes-specific situations were found (r ranged
The birth of the first child brings with it considerable changes in the lives of the parents, and the transfer to parenthood is felt to be very demanding in particular by many mothers. There is a marked decrease in the mean satisfaction with the partnership. A stress-resources model is used to analyse which factors influence partnership satisfaction and the health-related quality of life of parents in the first two years of the life of their first child, drawing on data from a controlled inte...
Chang, Lei; Lansford, Jennifer E.; Schwartz, David; Farver, Joann M.
The present study used a family systems approach to examine harsh parenting, maternal depressed affect, and marital quality in relation to children's externalising behaviour problems in a sample of 158 Hong Kong primary school children. At two time points, peers and teachers provided ratings of children's externalising behaviours, and mothers…
Damush, Teresa M; Miech, Edward J; Sico, Jason J; Phipps, Michael S; Arling, Greg; Ferguson, Jared; Austin, Charles; Myers, Laura; Baye, Fitsum; Luckhurst, Cherie; Keating, Ava B; Moran, Eileen; Bravata, Dawn M
To identify key barriers and facilitators to the delivery of guideline-based care of patients with TIA in the national Veterans Health Administration (VHA). We conducted a cross-sectional, observational study of 70 audiotaped interviews of multidisciplinary clinical staff involved in TIA care at 14 VHA hospitals. We de-identified and analyzed all transcribed interviews. We identified emergent themes and patterns of barriers to providing TIA care and of facilitators applied to overcome these barriers. Identified barriers to providing timely acute and follow-up TIA care included difficulties accessing brain imaging, a constantly rotating pool of housestaff, lack of care coordination, resource constraints, and inadequate staff education. Key informants revealed that both stroke nurse coordinators and system-level factors facilitated the provision of TIA care. Few facilities had specific TIA protocols. However, stroke nurse coordinators often expanded upon their role to include TIA. They facilitated TIA care by (1) coordinating patient care across services, communicating across service lines, and educating clinical staff about facility policies and evidence-based practices; (2) tracking individual patients from emergency departments to inpatient settings and to discharge for timely follow-up care; (3) providing and referring TIA patients to risk factor management programs; and (4) performing regular audit and feedback of quality performance data. System-level facilitators included clinical service leadership engagement and use of electronic tools for continuous care across services. The local organization within a health care facility may be targeted to cultivate internal facilitators and a systemic infrastructure to provide evidence-based TIA care. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
Stolt, S; Korja, R; Matomäki, J; Lapinleimu, H; Haataja, L; Lehtonen, L
It is not clearly understood how the quality of early mother-child interaction influences language development in very-low-birth-weight children (VLBW). We aim to analyze associations between early language and the quality of mother-child interaction, and, the predictive value of the features of early mother-child interaction on language development at 24 months of corrected age in VLBW children. A longitudinal prospective follow-up study design was used. The participants were 28 VLBW children and 34 full-term controls. Language development was measured using different methods at 6, 12 and at 24 months of age. The quality of mother-child interaction was assessed using PC-ERA method at 6 and at 12 months of age. Associations between the features of early interaction and language development were different in the groups of VLBW and full-term children. There were no significant correlations between the features of mother-child interaction and language skills when measured at the same age in the VLBW group. Significant longitudinal correlations were detected in the VLBW group especially if the quality of early interactions was measured at six months and language skills at 2 years of age. However, when the predictive value of the features of early interactions for later poor language performance was analyzed separately, the features of early interaction predicted language skills in the VLBW group only weakly. The biological factors may influence on the language development more in the VLBW children than in the full-term children. The results also underline the role of maternal and dyadic factors in early interactions. Copyright © 2014 Elsevier Ltd. All rights reserved.
Yuan, Zhaohe; Fang, Yanming; Zhang, Taikui; Fei, Zhangjun; Han, Fengming; Liu, Cuiyu; Liu, Min; Xiao, Wei; Zhang, Wenjing; Wu, Shan; Zhang, Mengwei; Ju, Youhui; Xu, Huili; Dai, He; Liu, Yujun; Chen, Yanhui; Wang, Lili; Zhou, Jianqing; Guan, Dian; Yan, Ming; Xia, Yanhua; Huang, Xianbin; Liu, Dongyuan; Wei, Hongmin; Zheng, Hongkun
Pomegranate (Punica granatum L.) has an ancient cultivation history and has become an emerging profitable fruit crop due to its attractive features such as the bright red appearance and the high abundance of medicinally valuable ellagitannin-based compounds in its peel and aril. However, the limited genomic resources have restricted further elucidation of genetics and evolution of these interesting traits. Here, we report a 274-Mb high-quality draft pomegranate genome sequence, which covers approximately 81.5% of the estimated 336-Mb genome, consists of 2177 scaffolds with an N50 size of 1.7 Mb and contains 30 903 genes. Phylogenomic analysis supported that pomegranate belongs to the Lythraceae family rather than the monogeneric Punicaceae family, and comparative analyses showed that pomegranate and Eucalyptus grandis share the paleotetraploidy event. Integrated genomic and transcriptomic analyses provided insights into the molecular mechanisms underlying the biosynthesis of ellagitannin-based compounds, the colour formation in both peels and arils during pomegranate fruit development, and the unique ovule development processes that are characteristic of pomegranate. This genome sequence provides an important resource to expand our understanding of some unique biological processes and to facilitate both comparative biology studies and crop breeding. © 2017 The Authors. Plant Biotechnology Journal published by Society for Experimental Biology and The Association of Applied Biologists and John Wiley & Sons Ltd.
Tuck, Bradford; Berman, Matthew; Hill, Alexandra
Local school districts differ in their ability to pay for teacher quality, and in the amenities they offer as places to live and work. Market clearing with heterogeneous quality yields geographically varying teacher salary levels that confound scarcity with unobserved differences in quality. The paper discusses identification and estimation of a…
Federici, Stefano; Borsci, Simone
The study brings together three aspects rarely observed at once in assistive technology (AT) surveys: (i) the assessment of user interaction/satisfaction with AT and service delivery, (ii) the motivational analysis of AT abandonment, and (iii) the management/design evaluation of AT delivery services. 15 health professionals and 4 AT experts were involved in modelling and assessing four AT Local Health Delivery Service (Centres) in Italy through a SWOT analysis and a Cognitive Walkthrough. In addition 558 users of the same Centres were interviewed in a telephone survey to rate their satisfaction and AT use. The overall AT abandonment was equal to 19.09%. Different Centres' management strategies resulted in different percentages of AT disuse, with a range from 12.61% to 24.26%. A significant difference between the declared abandonment and the Centres' management strategies (p = 0.012) was identified. A strong effect on abandonment was also found due to professionals' procedures (p = 0.005) and follow-up systems (p = 0.002). The user experience of an AT is affected not only by the quality of the interaction with the AT, but also by the perceived quality of the Centres in support and follow-up. Implications for Rehabilitation AT abandonment surveys provide useful information for modelling AT assessment and delivery process. SWOT and Cognitive Walkthrough analyses have shown suitable methods for exploring limits and advantages in AT service delivery systems. The study confirms the relevance of person centredness for a successful AT assessment and delivery process.
Schoenfeld, Adam J; Davies, Jason M; Marafino, Ben J; Dean, Mitzi; DeJong, Colette; Bardach, Naomi S; Kazi, Dhruv S; Boscardin, W John; Lin, Grace A; Duseja, Reena; Mei, Y John; Mehrotra, Ateev; Dudley, R Adams
.4%). No statistically significant variation in guideline adherence by mode of communication (videoconference vs telephone vs webchat) was found. Significant variation in quality was found among companies providing virtual visits for management of common acute illnesses. More variation was found in performance for some conditions than for others, but no variation by mode of communication.
Silva, Amanda Aparecida; Souza, José Maria Pacheco de; Borges, Flávio Notarnicola da Silva; Fischer, Frida Marina
To evaluate working conditions associated with health-related quality of life (HRQL) among nursing providers. Cross-sectional study conducted in a university hospital in the city of São Paulo, Southeastern Brazil, during 2004-2005. The study sample comprised 696 registered nurses, nurse technicians and nurse assistants, predominantly females (87.8%), who worked day and/or night shifts. Data on sociodemographic information, working and living conditions, lifestyles, and health symptoms were collected using self-administered questionnaires. The following questionnaires were also used: Job Stress Scale, Effort-Reward Imbalance (ERI) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Ordinal logistic regression analysis using proportional odds model was performed to evaluate each dimension of the SF-36. Around 22% of the sample was found to be have high strain and 8% showed an effort-reward imbalance at work. The dimensions with the lowest mean scores in the SF-36 were vitality, bodily pain and mental health. High-strain job, effort-reward imbalance (ERI>1.01), and being a registered nurse were independently associated with low scores on the role emotional dimension. Those dimensions associated to mental health were the ones most affected by psychosocial factors at work. Effort-reward imbalance was more associated with health than high-strain (high demand and low control). The study results suggest that the joint analysis of psychosocial factors at work such as effort-reward imbalance and demand-control can provide more insight to the discussion of professional roles, working conditions and HRQL of nursing providers.
Ramsay, Samantha A; Branen, Laurel J; Fletcher, Janice; Price, Elizabeth; Johnson, Susan L; Sigman-Grant, Madeleine
To explore the verbal communication of child care providers regarding preschool children's internal and non-internal hunger and satiation cues. Video observation transcripts of Head Start staff (n=29) at licensed child care centers in Colorado, Idaho, and Nevada were analyzed for common themes. Adults' verbal communication with children at mealtimes emphasized non-internal cues: (1) cueing children to amounts without referencing children's internal cues; (2) meal termination time; (3) asking children if they wanted more without referencing their internal cues; (4) asking children if they were done without referencing their internal cues; (5) telling children to take, try, eat, or finish food; (6) praising children for eating; and (7) telling children about food being good for you. Adults demonstrated an overriding effort to get children to eat. Training needs to be developed that gives specifics on verbally cueing young children to their internal hunger and satiation cues. Published by Elsevier Inc.
Ginieri-Coccossis, M; Rotsika, V; Skevington, S; Papaevangelou, S; Malliori, M; Tomaras, V; Kokkevi, A
Research on quality of life (QoL) of school children with specific learning disabilities (SpLD) and their parents is scarce. The present study explores QoL deficits in newly diagnosed children with SpLD and their parents, in comparison to a similar age group of typically developing children. Possible associations between parental and child QoL were statistically explored in both groups of children. 70 newly diagnosed children with SpLD [International Classification of Diseases-10 (ICD-10) criteria] (38 boys, 32 girls, mean age 10.1 years) and a control group of 69 typically developing children of the same age (40 boys, 29 girls, mean age 10.6 years) were recruited. Children were of normal intelligence quotient, attending mainstream schools. Their parents were also recruited so a child's scores could be associated with corresponding parental scores (mother or father). Children's QoL was assessed by the German questionnaire for measuring quality of life in children and adolescents (KINDL(R) ) questionnaire and parental QoL by World Health Organization Quality of Life brief questionnaire (WHOQOL-BREF) of the World Health Organization. Children with SpLD in comparison to typically developing children reported according to the KINDL(R) measurement poorer emotional well-being, lower self-esteem and satisfaction in their relationships with family and friends. Surprisingly, school functioning was not reported by these children as an area of concern. Parents of children with SpLD indicated experiencing lower satisfaction in the WHOQOL-BREF domains of social relationships and environment. Correlational and regression analysis with parental-child QoL scores provided evidence that in the SpLD group, parental scores on WHOQOL-BREF social relationships and psychological health domains could be predictors of the child's emotional well-being, satisfaction with family, friends and school functioning. Stepwise regression analysis verified the effect of parents' WHOQOL-BREF social
Daniel, Jerlean E.
Jerlean Daniel, PhD, executive director of the National Association for the Education of Young Children, describes what quality child care looks like and how parents and child care providers can work together to nurture young children's healthy development. Dr. Daniel shares information about what to look for in a child care provider, how to…
Ekaterina S. Ralston
Full Text Available The literature indicates that the quality of affective relationships between youth and parents is associated with lower levels of a range of problem behaviors during childhood, early and late adolescence. While the protective effect of parental monitoring on substance use in the high school and post high school years has been demonstrated, there is a knowledge gap concerning effects of parent-child affective quality (PCAQ during the same periods. We tested a conceptual theoretical model to examine the effects of PCAQ on substance use following high school. The sample was from a RCT that assessed adolescents in rural Iowa from the seventh grade through two years after high school (N=456. We specified direct effects of PCAQ in 12th grade on drunkenness, smoking and illicit drug use during the two years immediately following high school graduation. We also specified the effects of early substance use initiation (alcohol, tobacco and marijuana use reported at baseline on later use. The direct effect of PCAQ in 12th grade on substance use was significant for all substances during at least one of the two years past graduation (ypg. Results were: drunkenness 1 ypg, β=-.126, p<.05; smoking 1 ypg, β=-.119, p<.05; 2 ypg, β=-.146, p<.05; illicit drug use 2 ypg, β=-.165, p<.05. Some significant indirect effects of PCAQ at baseline, via PCAQ at 12th grade, were found. Results also indicated significant direct effects of early initiation on two of the three substances, albeit with a different pattern of effects over time for each substance by years post high school. Importantly, while early initiation remains the strongest predictor of long-term tobacco and illicit drug use, results show how PCAQ might reduce its harmful effects.
Jozefiak, Thomas; Larsson, Bo; Wichstrøm, Lars; Wallander, Jan; Mattejat, Fritz
During the recent decade, a number of studies have begun to address Quality of Life (QoL) in children and adolescents with mental health problems in general population and clinical samples. Only about half of the studies utilized both self and parent proxy report of child QoL. Generally children with mental health problems have reported lower QoL compared to healthy children. The question whether QoL assessment by both self and parent proxy report can identify psychiatric health services needs not detected by an established instrument for assessing mental health problems, i.e. the Child Behavior Checklist (CBCL), has never been examined and was the purpose of the present study. No study exists that compares child QoL as rated by both child and parent, in a sample of referred child psychiatric outpatients with a representative sample of students attending public school in the same catchment area while controlling for mental health problems in the child. In the current study patients and students, aged 8-15.5 years, were matched with respect to age, gender and levels of the CBCL Total Problems scores. QoL was assessed by the self- and parent proxy-reports on the Inventory of Life Quality in Children and Adolescents (ILC). QoL scores were analyzed by non-parametric tests, using Wilcoxon paired rank comparisons. Both outpatients and their parents reported significantly lower child QoL on the ILC than did students and their parents, when children were matched on sex and age. Given equal levels of emotional and behavioural problems, as reported by the parents on the CBCL, in the two contrasting samples, the outpatients and their parents still reported lower QoL levels than did the students and their parents. Child QoL reported both by child and parent was reduced in outpatients compared to students with equal levels of mental health problems as reported by their parents on the CBCL. This suggests that it should be helpful to add assessment of QoL to achieve a fuller
LaGrone, L N; Isquith-Dicker, L N; Huaman Egoavil, E; Herrera-Matta, J J; Fuhs, A K; Ortega Checa, D; Revoredo, F; Rodriguez Castro, M J A; Mock, C N
Dual-practice, simultaneous employment by healthcare workers in the public and private sectors is pervasive worldwide. Although an estimated 30 per cent of the global burden of disease is surgical, the implications of dual practice on surgical care are not well understood. Anonymous in-depth individual interviews on trauma quality improvement practices were conducted with healthcare providers who participate in the care of the injured at ten large hospitals in Peru's capital city, Lima. A grounded theory approach to qualitative data analysis was employed to identify salient themes. Fifty interviews were conducted. A group of themes that emerged related to the perceived negative and positive impacts of dual practice on the quality of surgical care. Participants asserted that the majority of physicians in Lima working in the public sector also worked in the private sector. Dual practice has negative impacts on physicians' time, quality of care in the public sector, and surgical education. Dual practice positively affects patient care by allowing physicians to acquire management and quality improvement skills, and providing incentives for research and academic productivity. In addition, dual practice provides opportunities for clinical innovations and raises the economic status of the physician. Surgeons in Peru report that dual practice influences patient care negatively by creating time and human resource conflicts. Participants assert that these conflicts widen the gap in quality of care between rich and poor. This practice warrants redirection through national-level regulation of physician schedules and reorganization of public investment in health via physician remuneration. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.
Siddhanamatha, Harish Rajashekarappa; Heung, Eric; Lopez-Olivo, Maria de Los Angeles; Abdel-Wahab, Noha; Ojeda-Prias, Ana; Willcockson, Irmgard; Leong, Amye; Suarez-Almazor, Maria Eugenia
We performed an environmental scan of currently available websites providing educational information about rheumatoid arthritis (RA) and evaluated the quality of these websites. We searched three separate search engines, Google, Bing, and Ask.com, on August 27, 2015, using two search terms, "arthritis" and "rheumatoid." Only patient education websites were included. Two independent investigators evaluated the accuracy, completeness, technical elements, design and esthetics, readability, usability, and accessibility of the websites. The navigation experience was also evaluated by an adult training expert. We identified 46 websites. Nearly all websites (98%) provided accurate information. However, no website covered all essential RA topics. Common essential topics not covered included epidemiology, pathogenesis, treatment and disease monitoring, complications, self-management, risks and benefits of treatment, prognosis, treatment adherence, questions for patients to ask their doctors, and costs. For the technical elements, all websites disclosed their ownership, but the date that the content was last updated was mentioned in only 10 websites, ranging from 2007 to 2015. The mean reading level was grade 12.1 (standard deviation ±2.3). Most websites (78%) were easy to navigate but only 33% were friendly for people with visual and/or hearing impairments. The navigation experience was rated fair or poor in 41% of the websites. Current patient information on the Internet does not comprehensively address all educational needs of patients with RA, and is often outdated. The findings from our study highlight potential areas for improvement in online education materials for patients with RA. Copyright © 2017. Published by Elsevier Inc.
Horvath, Monica M; Winfield, Stephanie; Evans, Steve; Slopek, Steve; Shang, Howard; Ferranti, Jeffrey
In many healthcare organizations, comparative effectiveness research and quality improvement (QI) investigations are hampered by a lack of access to data created as a byproduct of patient care. Data collection often hinges upon either manual chart review or ad hoc requests to technical experts who support legacy clinical systems. In order to facilitate this needed capacity for data exploration at our institution (Duke University Health System), we have designed and deployed a robust Web application for cohort identification and data extraction--the Duke Enterprise Data Unified Content Explorer (DEDUCE). DEDUCE is envisioned as a simple, web-based environment that allows investigators access to administrative, financial, and clinical information generated during patient care. By using business intelligence tools to create a view into Duke Medicine's enterprise data warehouse, DEDUCE provides a Guided Query functionality using a wizard-like interface that lets users filter through millions of clinical records, explore aggregate reports, and, export extracts. Researchers and QI specialists can obtain detailed patient- and observation-level extracts without needing to understand structured query language or the underlying database model. Developers designing such tools must devote sufficient training and develop application safeguards to ensure that patient-centered clinical researchers understand when observation-level extracts should be used. This may mitigate the risk of data being misunderstood and consequently used in an improper fashion. Copyright © 2010 Elsevier Inc. All rights reserved.
Full Text Available Anthropogenic disturbances to habitats influence the fitness of individual animals, the abundance of their populations, and the composition of their communities. Wetlands in particular are frequently degraded and destroyed, impacting the animals that inhabit these important ecosystems. The creation of wetlands during and following sand extraction processes is inevitable, and thus, sand quarries have the potential to support aquatic animals. To determine how amphibians utilise these wetlands, I conducted nocturnal call surveys at wetlands within the Kables Sands quarry, New South Wales, Australia, and within surrounding reference wetlands, and quantified levels of developmental instability (DI as a proxy for fitness. Whilst quarry and reference wetlands were largely similar in terms of environmental characteristics, quarry wetlands consistently harboured more amphibian species and individuals. Using unsigned asymmetry as a measure of DI, frogs from the quarry sites exhibited significantly lower levels of DI compared to reference wetlands, indicating that quarry wetlands may be comparatively higher quality. Levels of DI within quarry wetlands also compared favourably to data from healthy frog populations extracted from the literature. Further enhancing the suitability of quarry wetlands would require minimal effort, with potentially significant increases in local and regional biodiversity. Documenting species presence and quantifying individual fitness by measuring limb lengths is an economically and logistically feasible method to assess the health of quarry wetlands. Overall, the methods outlined here provide a powerful, yet simple, tool to assess the overall health and suitability of quarry wetlands that could be easily adopted at quarries throughout the world.
Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A
This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation. © The Author(s) 2014.
Sulkers, Esther; Tissing, Wim J E; Brinksma, Aeltsje; Roodbol, Petrie F; Kamps, Willem A; Stewart, Roy E; Sanderman, Robbert; Fleer, Joke
This study investigated the course, predictors, and impact of caregiving stress on the functioning of primary caregivers of children with cancer during the first year after a child's cancer diagnosis. Primary caregivers (N = 95, 100% mother, 86% response rate) of consecutive newly diagnosed paediatric cancer patients (0-18 years) completed measures of caregiving stress, depressive symptoms, anxiety, and self-reported health at diagnosis, and 3, 6, and 12 months thereafter. Results indicated a significant decrease in caregiving stress (especially during the first 3 months after diagnosis). Caregiving stress was predicted by single marital status and the ill child being the mother's only child. Multilevel analyses, controlled for socio-demographic and medical covariates, showed that, over time, the decline in caregiving stress was accompanied by a reduction in depressive symptoms and anxiety. The amount of variance explained by caregiving stress was 53% for depressive symptoms, 47% for anxiety, and 3% for self-reported health. The present study suggests that caregiving stress is an important factor in understanding parental adjustment to childhood cancer. This offers possibilities for developing interventions aimed at preventing caregiving stress, and strengthening mothers' confidence in their ability to provide good care. Copyright © 2014 John Wiley & Sons, Ltd.
Crawford, Bruce; Hashim, Siti Sabzah Mohd; Prepageran, Narayanan; See, Goh Bee; Meier, Genevieve; Wada, Keiko; Coon, Cheryl; Delgleize, Emmanuelle; DeRosa, Michael
Acute otitis media (AOM) affects both child and parental quality of life (QoL). Data on QoL associated with AOM in Malaysia is sparse, and the burden of indirect costs have not been previously reported. To determine the effect of pediatric AOM on child and parental QoL in Malaysia and its economic impact (indirect costs). We utilized a set of QoL questionnaires (PAR-AOM-QOL, OM-6, and EQ-5D) combined with questions addressing work/productivity loss and financial costs associated with caring for a child during his or her illness in an observational, multicenter, prospective study. One hundred and ten AOM patients aged ≤5 years were included in the analysis. The majority of respondents were the patient's mother. Parental QoL was negatively affected for both emotional and daily disturbance scales, but the level of disturbance was low. Using OM-6, the greatest negative impact was on the child's QoL, followed by caregiver concerns, physical suffering, and emotional distress. Using EQ-5D, a moderately positive relationship between parents' emotional disturbance and daily disturbance, and a weak, negative correlation between parental emotional disturbance and parental health status was found. Parents with paid employment took an average of 21 h from work to care for their child, at an average cost of 321.8 Malaysian ringgit (US$97) in addition to their contribution to direct medical costs. Productivity losses whilst at work, uncompensated wage losses, and leisure time losses are also reported. This study found that AOM is associated with some negative impact on parental QoL and significant economic impact at both patient and societal levels. The findings provide useful data on healthcare resource utilization and disease burden of AOM in Malaysia.
Changing family dynamics over the past four decades, including rises in the numbers of working mothers and single-parent families, have created an increased need for affordable child care. Government response to this need has involved a number of stop-and-start policy approaches, which have led to a fractured child care system that makes it…
McElwain, Alyssa D.; Bub, Kristen L.
The present study investigated how changes in specific dimensions of the parent-adolescent relationship predict adolescent engagement in sexual intercourse and oral sex. Longitudinal data from 1,364 participants in the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development were gathered at…
O'Laughlen, Mary C; Hollen, Patricia J; Rance, Karen; Rovnyak, Virginia; Hinton, Ivora; Hellems, Martha A; Radecki, Linda
Although adolescent substance use can have direct effects on asthma symptoms and interact with medications used to treat asthma, no validated health-related quality of life (HRQL) instrument exists for adolescents 17 to 19 years of age with asthma. The American Academy of Pediatric's HRQL instrument, the Child Health Survey for Asthma (CHSA)-Child version, was modified with a substance use subscale to address outcomes specific to adolescents ages 17 to 19 years with asthma. Two cohorts (N = 70) were recruited for instrument testing at pediatric primary care practices and two university clinics. A small methodological study with 24 adolescents was conducted to obtain initial support of the psychometric properties for the CHSA-Teen version at baseline, day 14, and day 16. A follow-up study included 46 teens to provide further support. The psychometric properties of the CHSA-Teen version were good and comparable with the CHSA-Child version for feasibility, reliability, and validity. Health care providers need to be aware of each adolescent's substance use to personalize counseling related to asthma medications. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
Denham, Sara; Humphrey, Tracy; Taylor, Ruth
Women in Scotland with uncomplicated pregnancies are encouraged by professional bodies and national guidelines to access community based models of midwife-led care for their labour and birth. The evidence base for these guidelines relates to comparisons of predominantly urban birth settings in England. There appears to be little evidence available about the quality of the care during the antenatal, birth and post birth periods available for women within the Scottish Community Maternity Unit (CMU) model. The research aim was to explore the safety and effectiveness of the maternity services provided at two rural Community Maternity Units in Scotland, both 40 miles by main road access from a tertiary obstetric unit. Following appropriate NHS and University ethical approval, an anonymous retrospective review of consecutive maternity records for all women who accessed care at the CMUs over a 12 month period (June 2011 to May 2012) was undertaken in 2013 -14. Data was extracted using variables chosen to provide a description of the socio-demographics of the cohort and the process and outcomes of the care provided. Data were analysed using descriptive statistics. Regarding effectiveness, the correct care pathway was allocated to 97.5% of women, early access to antenatal care achieved by 95.7% of women, 94.8% of women at one CMU received continuity of carer and 78.6% of those clinically eligible accessed care in labour. 11.9% were appropriately transferred to obstetrician-led care antenatally and 16.9% were transferred in labour. All women received one-to one care in labour and 67.1% of babies born at the CMUs were breastfed at birth. Regarding safety, severe morbidity for women was rare, perineal trauma of 3rd degree tear occurred for 0.3% of women and 1.0% experienced an episiotomy. Severe post partum haemorrhage occurred for 0.3% of women. Babies admitted to the Neonatal unit were discharged within 48 hrs. These findings support the recommendations of professional
..., where applicable, by local authorities where the child care service is delivered. Outside of the United States, agencies may adopt or create criteria to ensure a child care center or family child care home is... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What are the requirements that child care...
Daniel Tan Lei Shek
Full Text Available The current study investigated the differences between intact and non-intact families in family processes, including systematic family functioning, parental behavioral control, parental psychological control, and parent-child relational qualities. The participants were 3,328 Secondary One students, with a mean age of 12.59 years, recruited from 28 secondary schools in Hong Kong. Four validated scales were used to assess family processes. Results showed that adolescents in non-intact families perceived relatively poorer family functioning, lower level of paternal and maternal behavioral control, lower level of paternal psychological control and poorer parent-child relational qualities than did adolescents in intact families. This generally indicated that family processes were poorer in non-intact families, compared with those in intact families. The theoretical and practical implications of the findings were discussed.
Nalwadda, Gorrette; Tumwesigye, Nazarius M.; Faxelid, Elisabeth; Byamugisha, Josaphat; Mirembe, Florence
Background Low and inconsistent use of contraceptives by young people contributes to unintended pregnancies. This study assessed quality of contraceptive services for young people aged 15–24 in two rural districts in Uganda. Methods Five female and two male simulated clients (SCs) interacted with 128 providers at public, private not-for-profit (PNFP), and private for profit (PFP) health facilities. After consultations, SCs were interviewed using a structured questionnaire. Six aspects of quality of care (client's needs, choice of contraceptive methods, information given to users, client-provider interpersonal relations, constellation of services, and continuity mechanisms) were assessed. Descriptive statistics and factor analysis were performed. Results Means and categorized quality scores for all aspects of quality were low in both public and private facilities. The lowest quality scores were observed in PFP, and medium scores in PNFP facilities. The choice of contraceptive methods and interpersonal relations quality scores were slightly higher in public facilities. Needs assessment scores were highest in PNFP facilities. All facilities were classified as having low scores for appropriate constellation of services. Information given to users was suboptimal and providers promoted specific contraceptive methods. Minority of providers offered preferred method of choice and showed respect for privacy. Conclusions The quality of contraceptive services provided to young people was low. Concurrent quality improvements and strengthening of health systems are needed. PMID:22132168
Garayoa Roca, J.; Castro Tejero, P.
Imaging systems play an increasingly important role in radiotherapy, and to ensure the quality of the process, you must know the characteristics and limitations of available imaging systems. In this study we sought to evaluate the image quality of an IGRT system based on a kilo voltage cone beam.
Escamilla, Veronica; Calhoun, Lisa; Winston, Jennifer; Speizer, Ilene S
Universal access to health care requires service availability and accessibility for those most in need of maternal and child health services. Women often bypass facilities closest to home due to poor quality. Few studies have directly linked individuals to facilities where they sought maternal and child health services and examined the role of distance and quality on this facility choice. Using endline data from a longitudinal survey from a sample of women in five cities in Kenya, we examine the role of distance and quality on facility selection for women using delivery, facility-based contraceptives, and child health services. A survey of public and private facilities offering reproductive health services was also conducted. Distances were measured between household cluster location and both the nearest facility and facility where women sought care. A quality index score representing facility infrastructure, staff, and supply characteristics was assigned to each facility. We use descriptive statistics to compare distance and quality between the nearest available facility and visited facility among women who bypassed the nearest facility. Facility distance and quality comparisons were also stratified by poverty status. Logistic regression models were used to measure associations between the quality and distance to the nearest facility and bypassing for each outcome. The majority of women bypassed the nearest facility regardless of service sought. Women bypassing for delivery traveled the furthest and had the fewest facility options near their residential cluster. Poor women bypassing for delivery traveled 4.5 km further than non-poor women. Among women who bypassed, two thirds seeking delivery and approximately 46% seeking facility-based contraception or child health services bypassed to a public hospital. Both poor and non-poor women bypassed to higher quality facilities. Our findings suggest that women in five cities in Kenya prefer public hospitals and are
Ddumba-Nyanzi, Ismael; Kaawa-Mafigiri, David; Johannessen, Helle
In the context of HIV clinical care, open discussion regarding sexual health and reproductive plans has become increasingly relevant. The aim of this paper is to explore barriers to communication between providers and women living with HIV regarding childbearing. In-depth interviews (IDIs) were conducted with 48 HIV infected women receiving ART at 7 different HIV clinics providing comprehensive HIV care services in four districts in Uganda, between July and August 2012. All women were aware of their HIV diagnosis prior to pregnancy or had given birth while living with HIV. Four themes emerged describing barriers to communication, from the HIV-positive women's point of view: (i) provider indifference or opposition to childbearing post HIV diagnosis, (ii) anticipation of negative response from provider, (iii) provider's emphasis on 'scientific' facts, (iv) 'accidental pregnancy'. Existing evidence regarding effective provider-patient communication should be considered for its application for reproductive counseling among HIV infected women. These data demonstrate the need for current counseling guidelines to explore approaches that encourage open, non-judgmental, non-directive discussions with HIV positive individuals around their reproductive desires and intentions in a health care setting. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Flores, Roseanne L.; Curby, Timothy W.; Coleman, Hardin; Melo, Kristan
Today with the rise in the number of 3- to 6-year-old children enrolled in center-based early childhood programs, and a focus on program quality, it becomes imperative for educators to have a better understanding of the role research plays in establishing high-quality programs as these programs provide much of the foundation that supports early…
Tomkovick, Chuck; And Others
From a national sample of 625 foreign students in U.S. business schools, 282 identified key quality dimensions in enhancing their satisfaction: facilities and equipment, faculty ability to interact with them, reliability, empathy, and responsiveness. (SK)
Broekhuizen, Martine L.; van Aken, Marcel A.G.; Dubas, Judith S.; Leseman, Paul P.M.
High amounts of early child care have sometimes been linked to higher levels of behaviour problems, while high-quality child care has more often been related to fewer behaviour problems and more social competence. The current study investigated whether the level of centre emotional and behavioural
Elizabeth M. Borycki
This special issue of the Knowledge Management & E-Learning: An International Journal is dedicated to describing “Advances in Healthcare Provider and Patient Training to Improve the Quality and Safety of Patient Care.” Patient safety is an important and fundamental requirement of ensuring the quality of patient care. Training and education has been identified as a key to improving healthcare provider patient safety competencies especially when working with new technologies such as electronic ...
Galloway, Helen; Newman, Emily; Miller, Nicola; Yuill, Clare
There are indicators that parental psychological factors may affect how parents evaluate their child's quality of life (QoL) when the child has a health condition. This study examined the impact of parents' perceived stress on parent and child ratings of the QoL of children with ADHD. A cross-sectional sample of 45 matched parent-child dyads completed parallel versions of the KIDSCREEN-27. Children were 8 to 14 years with clinician diagnosed ADHD. Parents who rated their child's QoL lower than their child had higher perceived stress scores. Parent stress was a unique predictor of child QoL from parent proxy-rated but not child-rated QoL scores. Parents' perceived stress may play an important role in their assessments of their child's QoL, suggesting both parent and child perspectives of QoL should be utilized wherever possible. Interventions that target parent stress may contribute to improvements in the child's QoL. © The Author(s) 2016.
Tomamichel, M; Sessa, C; Herzig, S; de Jong, J; Pagani, O; Willems, Y; Cavalli, F
The process by which patients are informed and their consent is obtained in phase I trials has thus far been only marginally studied. Since 1986 we have followed an oral procedure, consisting of three consecutive conversations in which the investigator responsible for phase I studies, the research nurse and the patients' relatives and/or friends also participate, followed by the patients signing of a written consent form. It is required that six items of information considered essential by our staff be conveyed to patients by the responsible investigator. Meerwein's model, which defines three main dimensions of the informing process (the information itself, the emotional and interactive aspects), has been studied to ascertain whether it can be applied to evaluate the quality of the information proffered. Thirty-two conversations were taped, transcribed and evaluated by one psychiatrist and one psychologist. A quantitative analysis of information was performed by calculating the number of patients to whom the essential items of information had been conveyed. The qualitative analysis was performed by rating on a five-point scoring system, from 1 (very bad) to 5 (excellent), the three dimensions of the informing process for each patient and by calculating for each dimension the mean score of the constituent items. Complete information about the characteristics of the phase I drug and the modalities of the treatment and follow up was given to almost 80% of the patients. All but one of the items of the information dimension scored 3.5 or higher, with the one related to the assessment by the doctor of the patient's understanding at the end of the consultation scoring less than 3 in 53% of the patients. All items of the emotional dimension scored higher than 3.5. Greater difficulty was encountered by the physician with the interactive dimension, the lowest mean scores being reported on the items related to the doctor's awareness of the indirectly expressed anxieties of
Tadić, Valerija; Cumberland, Phillippa M; Lewando-Hundt, Gillian; Rahi, Jugnoo S
To investigate agreement between children with visual impairment (VI) and their parents on their ratings of the child's vision-related quality of life (VQoL) and functional vision (FV) using two novel self-report patient-reported outcome measures developed for this population. 99 children aged 10-15 years (mean age=12.2, SD=1.9) with VI (best corrected acuity (logarithm of the minimum angle of resolution) 0.50 or worse in better eye) and their parents participated in a national postal survey, completing the child and proxy versions of our novel instruments assessing VQoL and FV of children with VI-the vision-related quality of life instrument for children and young people (VQoL_CYP) and the functional vision questionnaire for children and young people (FVQ_CYP), respectively. Parent-child agreement was investigated using the Bland-Altman (BA) method. Variation across key sociodemographic and clinical characteristics was examined using the Intraclass Correlation Coefficient. Average parental ratings of their child's VQoL and FV were significantly lower than the children's own ratings, but the range of disagreement was wide, with parents both overestimating and underestimating their child's VQoL (mean score difference=5.7, BA limits of agreement (LOA): lower -22.10 (CI 95% -24.61 to 19.59) and upper 33.50 (CI 95% 30.99 to 36.01)), but more consistently underestimating the child's FV (mean score difference=-11.8, BA LOA: lower -39.60 (CI 95% -42.12 to 37.08) and upper 16 (CI 95% 13.48 to 18.52)). There was variation in agreement by some child characteristics, including vision level, time of onset and course of VI progression. Visually impaired children and their parents perceive the broader impact of living with VI very differently. There is value in routine capture of information independently from children and their parents for comprehensively gauging the impact of childhood VI and tailoring appropriate interventions. Published by the BMJ Publishing Group Limited
Tadić, Valerija; Cumberland, Phillippa M; Lewando-Hundt, Gillian; Rahi, Jugnoo S
Aims To investigate agreement between children with visual impairment (VI) and their parents on their ratings of the child's vision-related quality of life (VQoL) and functional vision (FV) using two novel self-report patient-reported outcome measures developed for this population. Methods 99 children aged 10–15 years (mean age=12.2, SD=1.9) with VI (best corrected acuity (logarithm of the minimum angle of resolution) 0.50 or worse in better eye) and their parents participated in a national postal survey, completing the child and proxy versions of our novel instruments assessing VQoL and FV of children with VI—the vision-related quality of life instrument for children and young people (VQoL_CYP) and the functional vision questionnaire for children and young people (FVQ_CYP), respectively. Parent-child agreement was investigated using the Bland-Altman (BA) method. Variation across key sociodemographic and clinical characteristics was examined using the Intraclass Correlation Coefficient. Results Average parental ratings of their child's VQoL and FV were significantly lower than the children's own ratings, but the range of disagreement was wide, with parents both overestimating and underestimating their child's VQoL (mean score difference=5.7, BA limits of agreement (LOA): lower −22.10 (CI 95% −24.61 to 19.59) and upper 33.50 (CI 95% 30.99 to 36.01)), but more consistently underestimating the child's FV (mean score difference=−11.8, BA LOA: lower −39.60 (CI 95% −42.12 to 37.08) and upper 16 (CI 95% 13.48 to 18.52)). There was variation in agreement by some child characteristics, including vision level, time of onset and course of VI progression. Conclusions Visually impaired children and their parents perceive the broader impact of living with VI very differently. There is value in routine capture of information independently from children and their parents for comprehensively gauging the impact of childhood VI and tailoring appropriate interventions
Nguyen, Phuong H; Kim, Sunny S; Keithly, Sarah C; Hajeebhoy, Nemat; Tran, Lan M; Ruel, Marie T; Rawat, Rahul; Menon, Purnima
Although social franchising has been shown to enhance the quality of reproductive health services in developing countries, its effect on nutrition services remains unexamined. This study assessed the effects of incorporating elements of social franchising on shaping the quality of infant and young child feeding (IYCF) counselling facilities and services in Vietnam. Process-related data collected 12 months after the launch of the first franchises were used to compare randomly assigned Alive & Thrive-supported health facilities (AT-F, n = 20) with standard facilities (SF, n = 12) across three dimensions of service quality: 'structure', 'process' and 'outcome' that capture the quality of facilities, service delivery, and client perceptions and use, respectively. Data collection included facility assessments (n = 32), staff surveys (n = 96), counselling observations (n = 137), client exit interviews (n = 137) and in-depth interviews with mothers (n = 48). Structure: AT-F were more likely to have an unshared, well-equipped room for nutrition counselling than SF (65.0% vs 10.0%). Compared with SF providers, AT-F staff had better IYCF knowledge (mean score 9.9 vs 8.8, range 0-11 for breastfeeding; mean score 3.6 vs 3.2, range 0-4 for complementary feeding). AT-F providers also demonstrated significantly better interpersonal communication skills (score 9.6 vs 5.1, range 0-13) and offered more comprehensive counselling sessions. Overall utilization of franchises was low (10%). A higher proportion of pregnant women utilized franchise services (48.9%), compared with mothers with children 6-23.9 months (1.4%). There was no quantitative difference in client satisfaction with counselling services between AT-F and SF, but franchise users praised the AT-F for problem solving related to child feeding. Incorporating elements of social franchising significantly enhances the quality of IYCF counselling services within government primary healthcare facilities, particularly their
Linares, L Oriana; Li, MiMin; Shrout, Patrick E; Brody, Gene H; Pettit, Gregory S
Sibling unity during family transitions is considered a protective factor for child behavior problems, but there is little empirical support for the widespread child protection policy of placing siblings together in foster care. In a prospective study of 156 maltreated children, siblings were classified in 1 of 3 placement groups: continuously together (n = 110), continuously apart (n = 22), and disrupted placement (siblings placed together were separated; n = 24). Changes in child adjustment as a function of sibling relationship and placement group were examined. Sibling positivity predicted lower child problems at follow-up (about 14 months later), while sibling negativity predicted higher child problems. Placement group did not affect child behavior problems at follow-up; however, compared to siblings in continuous placement (either together or apart), siblings in disrupted placement with high initial behavior problems were rated as having fewer problems at follow-up, while siblings in disrupted placement with low initial behavior problems were rated as having more problems at follow-up. These findings highlight the importance of considering relationships between siblings and the risk that one poses to another before early placement decisions are made.
Ohashi, Kota; Kayama, Makiko; Ryuuo, Shoko; Suzuki, Jun; Hayashinoshita, Yutaka; Ooka, Shiho; Matsuura, Rie
We provided home end-of-life care to a child with a brain tumor. As cases of children with malignancies who receive such care have rarely been described in Japan, we report our experience with this patient. An 11-year-old previously healthy boy was found to have a brainstem glioma in December X. The tumor was reduced by radiotherapy and chemotherapy, but relapse was noted in August X plus 1. Best supportive care alone was selected for this patient. Before the initiation of home care, we consulted a designated hospital for pediatric cancer treatment in the area and requested a case- worker from the child/home section in his resident area. As the patient was too young for long-term care insurance, we immediately applied for a physical disability certificate to augment welfare support. After the initiation of home care, swallowing function diminished markedly, but we provided guidance on dietary contents and suction, allowing continued oral ingestion by prioritizing his and his family's wishes. In January X plus 2 of the following year, his respiratory condition worsened after the development of aspiration pneumonitis, and he died at home. We advocate the establishment of a regional network so that children with brain tumors can receive end-of-life care at home.
Cristian Valentin HAPENCIUC
Full Text Available Taking into account its pragmatic meaning, the success of a travel agency frequently relies on the activity of travel agents. In the process of promoting and selling flat voyages, customer service can be directly influenced by the interaction of factors such as: offer accuracy, sales representatives quality, employee timeliness, politeness of the travel agent, maintaining eye contact etc., all of which are components of the offered product. Thereby, we conducted, within the period 5 - 15 March 2015, a research based on interviews with 26 travel agents from 20 different units, in order to determine their awareness about potential factors that may have an influence on the quality of offered services. By the instrumentality of a questionnaire, we attempted to assess the integrity and loyalty of employees, their attitude regarding the activities they carry, their dissatisfaction, negative and positive factors influencing service quality, and their positioning to the organization and brand.
Meacock, R.; Kristensen, Søren Rud; Sutton, M.
Despite growing adoption of pay-for-performance (P4P) programmes in health care, there is remarkably little evidence on the cost-effectiveness of such schemes. We review the limited number of previous studies and critique the frameworks adopted and the narrow range of costs and outcomes considered......, and whether performance improvement is a transitory or investment activity. Our application to the Advancing Quality initiative demonstrates that the incentive payments represented less than half of the 13m pound total programme costs. By generating approximately 5200 quality-adjusted life years and 4.4m...
Horwood, Christiane; Butler, Lisa; Barker, Pierre; Phakathi, Sifiso; Haskins, Lyn; Grant, Merridy; Mntambo, Ntokozo; Rollins, Nigel
Community health workers (CHWs) play key roles in delivering health programmes in many countries worldwide. CHW programmes can improve coverage of maternal and child health services for the most disadvantaged and remote communities, leading to substantial benefits for mothers and children. However, there is limited evidence of effective mentoring and supervision approaches for CHWs. This is a cluster randomised controlled trial to investigate the effectiveness of a continuous quality improvement (CQI) intervention amongst CHWs providing home-based education and support to pregnant women and mothers. Thirty CHW supervisors were randomly allocated to intervention (n = 15) and control (n = 15) arms. Four CHWs were randomly selected from those routinely supported by each supervisor (n = 60 per arm). In the intervention arm, these four CHWs and their supervisor formed a quality improvement team. Intervention CHWs received a 2-week training in WHO Community Case Management followed by CQI mentoring for 12 months (preceded by 3 months lead-in to establish QI processes). Baseline and follow-up surveys were conducted with mothers of infants Improved training and CQI-based mentoring of CHWs can improve quantity and quality of CHW-mother interactions at household level, leading to improvements in mothers' knowledge and infant feeding practices. ClinicalTrials.Gov NCT01774136.
Soekarjo, Damayanti; Zehner, Elizabeth
It is important to support women to exclusively breastfeed for 6 months and continue breastfeeding for 24 months and beyond. It is also necessary to provide the poor with access to affordable ways to improve the quality of complementary foods. Currently, many countries do not have the legal and policy environment necessary to support exclusive and continued breastfeeding. Legislative and policy changes are also necessary for introducing complementary food supplements, allowing them to be marketed to those who need them, and ensuring that marketing remains appropriate and in full compliance with the International Code of Marketing of Breastmilk Substitutes. This paper aims to illustrate the above with examples from Indonesia and to identify legislative requirements for supporting breastfeeding and enabling appropriate access to high-quality complementary food supplements for children 6-24 months of age. Requirements include improved information, training, monitoring and enforcement systems for the International Code of Marketing of Breastmilk Substitutes; implementation and monitoring of the Baby-Friendly Hospital Initiative; establishment of a registration category for complementary food supplements to enhance availability of high-quality, low-cost fortified products to help improve young child feeding; clear identification and marketing of these products as complementary food supplements for 6-24-month-olds so as to promote proper use and not interfere with breastfeeding. © 2011 Blackwell Publishing Ltd.
Sibanda Euphemia L
Full Text Available Abstract Background Provider-initiated HIV testing and counselling (PITC is widely recommended to ensure timely treatment of HIV. The Zimbabwe Ministry of Health introduced PITC in 2007. We aimed to evaluate institutional capacity to implement PITC and investigate patient and health care worker (HCW perceptions of the PITC programme. Methods Purposive selection of health care institutions was conducted among those providing PITC. Study procedures included 1 assessment of implementation procedures and institutional capacity using a semi-structured questionnaire; 2 in-depth interviews with patients who had been offered HIV testing to explore perceptions of PITC, 3 Focus group discussions with HCW to explore views on PITC. Qualitative data was analysed according to Framework Analysis. Results Sixteen health care institutions were selected (two central, two provincial, six district hospitals; and six primary care clinics. All institutions at least offered PITC in part. The main challenges which prevented optimum implementation were shortages of staff trained in PITC, HIV rapid testing and counselling; shortages of appropriate counselling space, and, at the time of assessment, shortages of HIV test kits. Both health care workers and patients embraced PITC because they had noticed that it had saved lives through early detection and treatment of HIV. Although health care workers reported an increase in workload as a result of PITC, they felt this was offset by the reduced number of HIV-related admissions and satisfaction of working with healthier clients. Conclusion PITC has been embraced by patients and health care workers as a life-saving intervention. There is need to address shortages in material, human and structural resources to ensure optimum implementation.
Carolina Faria Alvarenga
Full Text Available Gender relations gained greater visibility in the fight against several forms of inequality within the most recent educational policies. However, a setback against the gender agenda neglects its mention in many educational policy documents, such as education plans, and controls school practices. Against this tendency and intertwined with tensions and contradictions, occurred in the context of Child Education in the city of São Paulo an opposite movement: the inclusion of gender in the construction of Quality Indicator for Child Education of the city of São Paulo. a public policy was defined in which gender was introduced as a dimension of quality. Therefore, this paper, part of a doctoral research, is based on the theoretical articulations between Joan Scott and Norbert Elias in order to analyze the process of construction of this public educational policy that leads to Child Education a controversial theme, such as gender relations, and supposes the examination of the game of disputes, tensions, concessions and challenges that shaped such policy.
Snihurowych, Roman R; Cornelius, Felix; Amelung, Volker Eric
Despite the widespread use of branding in nearly all other major industries, most health care service delivery organizations have not fully embraced the practices and processes of branding. Facilitating the increased and appropriate use of branding among health care delivery organizations may improve service and technical quality for patients. This article introduces the concepts of branding, as well as making the case that the use of branding may improve the quality and financial performance of organizations. The concepts of branding are reviewed, with examples from the literature used to demonstrate their potential application within health care service delivery. The role of branding for individual organizations is framed by broader implications for health care markets. Branding strategies may have a number of positive effects on health care service delivery, including improved technical and service quality. This may be achieved through more transparent and efficient consumer choice, reduced costs related to improved patient retention, and improved communication and appropriateness of care. Patient satisfaction may be directly increased as a result of branding. More research into branding could result in significant quality improvements for individual organizations, while benefiting patients and the health system as a whole.
Doru Alexandru Pleşea
Full Text Available The mobile services are distinguished through their quality, either we speak about the way the client is approached and placed in the centre of the operator's actions, or about the services the client benefits in his capacity as a client. The Romanian mobile operators’ services have greatly evolved from their launch in 1997. Along these times, the mobile operators brought more value to these services, due to their need to meet the consumers' expectations with services of high quality and competitiveness. Usually the Romanian consumers place the price in the forefront of their service/mobile phone services acquisition, but an objective analyze of the quality of the mobile phone services has to take into account both technical aspects of the services and the interfacing services too. Therefore, this paper takes into account technical characteristics of the services such as national telephony coverage, data transmission services coverage, the signal quality, maximum speed of data transfer as well as related services such as distribution network, sales and support sales services, after-sales services, and range of available terminals. Based on mobile services comprehensive analysis made available to consumers by the major players on the Romanian market, this paper aims to highlight the main reasons of the consumers’ satisfaction and dissatisfaction.
Flu, Hans Christiaan
The aim of this thesis was to evaluate the quality of care in vascular surgery in end-stage renal disease (ESRD) and peripheral arterial occlusive disease (PAOD): intermittent claudication (IC) and critical lower limb ischaemia (CLI) patients. Therefore firstly it focused on the improvement of the
Rørtveit, Kristine; Severinsson, Elisabeth
The aim of this study was to reflect on aspects of mental health nursing leadership qualities with special focus on the therapeutic process for women who suffer from eating difficulties (ED). Therapy for patients with ED involves motivating them to make meaningful changes. Leadership qualities in MHN should focus on the relationship with the patient and positive empowerment processes. In-depth interviews were conducted with six women suffering from ED who had participated in art therapy. The interviews were analysed by means of an interpretative hermeneutic approach. A main theme 'The mental health nurse as a formative and mindful leader in a group therapeutic relationship' and two themes 'Leading sensitively towards awakening the patients' awareness of their pre-understanding' and 'Leading dialectically towards solving patients' existential dilemmas' were developed and comprised two aspects of leadership. The nurse-patient relationship is influenced by the patients' pre-understanding and existential dilemmas. Leadership qualities associated with being formative and mindful represent important aspects of this relationship and should be investigated and thematically described in greater detail in future research. The nurse-patient relationship should focus on clinical supervision, in order to strengthen the nurses' leadership qualities in terms of being aware and dialectical. © 2011 Blackwell Publishing Ltd.
Bardack, Sarah; Herbers, Janette E; Obradović, Jelena
This study investigates the unique contribution of microsocial and global measures of parent-child positive coregulation (PCR) in predicting children's behavioral and social adjustment in school. Using a community sample of 102 children, ages 4-6, and their parents, we conducted nested path analytic models to identify the unique effects of 2 measures of PCR on school outcomes. Microsocial PCR independently predicted fewer externalizing and inattention/impulsive behaviors in school. Global PCR did not uniquely relate to children's behavioral and social adjustment outcomes. Household socioeconomic status was related to both microsocial and global measures of PCR, but not directly associated with school outcomes. Findings illustrate the importance of using dynamic measures of PCR based on microsocial coding to further understand how the quality of parent-child interaction is related to children's self-regulatory and social development during school transition. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Full Text Available We examine the impact of precarious work (low income and job security satisfaction on the intention to have a first child. We consider a direct and an indirect effect; the latter is mediated by partners' conflict behaviour, conflict level, and partnership quality. We assume that a satisfactory partnership is positively associated with the intention to have a first child. The analyses are based on a subsample of the German Generations and Gender Survey. For men we found a direct effect of income and an indirect effect of job security satisfaction on childbearing intentions, whereas for women no direct and only a weak indirect impact of precarious work could be observed.
Rusby, Julie C.; Jones, Laura Backen; Crowley, Ryann; Smolkowski, Keith
Home-based child caregivers face unique stressors related to the nature of their work. One hundred and fifty-five home-based child care providers in Oregon, USA, participated in this cross-sectional correlational study. We investigated associations between indicators of caregiver stress and child care working conditions, the quality of caregiver…
Islam, Farzana; Rahman, Aminur; Halim, Abdul; Eriksson, Charli; Rahman, Fazlur; Dalal, Koustuv
Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals. Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines. The hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85 % of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health
Kubik-Huch, R.A.; Duerselen, L.; Otto, R.; Rexroth, M.; Porst, R.; Szucs, T.
Purpose: to develop a questionnaire for measuring referring physician satisfaction and to conduct a pilot study in which this questionnaire is given to all physicians referring patients to the authors' radiology department. Materials and methods: after qualitative pre-testing and adjustment of the prototype questionnaire, data were collected using the finalized standardized questionnaire comprising 29 indicators rated on a 4-point ordinal scale mailed with a personalized cover letter to the total referring physician population of a radiology department (n = 727). The replies, rated 1-4, were entered into a data entry mask for statistical analysis. Results: the response rate was 33.8%. The indicators with the highest satisfaction rating were the range of examinations offered (''very satisfied'': 79.3% mean 3.79), the quality of the technical equipment used for MRI and CT (79.3%, 3.79) and mammography (82.5%, 3.82), and the quality of the images yielded by these procedures (74.5%, 3.73 and 82.2%, 3.83). Dissatisfaction was relatively high with the indicators ''time to receipt of the written report'' (28.3% ''not very satisfied'' or ''not at all satisfied'', mean 2.97), ''time to receipt of the X-ray images'' (18.2%, 3.07) and ''availability of previous findings'' (20.9%, 3.05); satisfaction was higher among external referring physicians (p < 0.05). Physicians rated the importance of these three indicators as relatively high (''very important'': 62.4%, 54.3% and 49.6%). Other indicators showing a similar level of dissatisfaction were ''car parking availability'' (24.1%, 3.01), ''patient waiting time'' (27.4%, 2.87) and ''patient environment'' (21.2%, 2.99), although these factors were rated as less important (''very important'': 33.0%, 33.7% and 40.4%). (orig.)
Full Text Available Abstract Background In situations where children are unable or unwilling to respond for themselves, measurement of quality of life (QOL is often obtained by parent proxy-report. However the relationship between child self and parent proxy-reports has been shown to be poor in some circumstances. Additionally the most appropriate statistical method for comparing ratings between child and parent proxy-reports has not been clearly established. The objectives of this study were to assess the: 1 agreement between child and parent proxy-reports on an established child QOL measure (the PedsQL™ using two different statistical methods; 2 effect of chronological age and domain type on agreement between children's and parents' reports on the PedsQL™; 3 relationship between parents' own well-being and their ratings of their child's QOL. Methods One hundred and forty-nine healthy children (5.5 – 6.5, 6.5 – 7.5, and 7.5 – 8.5 years completed the PedsQL™. One hundred and three of their parents completed these measures in relation to their child, and a measure of their own QOL (SF-36. Results Consistency between child and parent proxy-reports on the PedsQL™ was low, with Intra-Class correlation coefficients ranging from 0.02 to 0.23. Correlations were higher for the oldest age group for Total Score and Psychosocial Health domains, and for the Physical Health domain in the youngest age group. Statistically significant median differences were found between child and parent-reports on all subscales of the PedsQL™. The largest median differences were found for the two older age groups. Statistically significant correlations were found between parents' own QOL and their proxy-reports of child QOL across the total sample and within the middle age group. Conclusion Intra-Class correlation coefficients and median difference testing can provide different information on the relationship between parent proxy-reports and child self-reports. Our findings
Escobar, R S; O'Donnell, K A; Colalillo, S; Pawlby, S; Steiner, M; Meaney, M J; Levitan, R D; Silveira, P P
While most "fetal programming" area focused on metabolic disease, intrauterine growth restriction (IUGR) is also associated with a preference for less healthy food. Post-natal factors such as strained maternal-child interactions are equally related to obesogenic eating behaviors. We investigated if IUGR and the quality of the mother/child relationship affect emotional overeating in children. Participants were 196 children from a prospective birth cohort (the MAVAN project). As part of the protocol at 4 years of age, mothers completed the Children Eating Behavior Questionnaire (CEBQ) and mother-child interactions were scored during a structured task. A GLM adjusted for BMI examined the interaction between the "Atmosphere" score (ATM) task, sex and IUGR on the emotional over-eating domain of the CEBQ. There was a significant interaction of BWR vs. sex vs. ATM (P = .02), with no effects of IUGR, sex or ATM. The model was significant for girls with low ATM scores (B = -2.035, P = .014), but not for girls with high (P = 0.94) or boys with high (P = .27) or low (P = .19) ATM scores. Only in IUGR girls, 48 months emotional over-eating correlated with BMI at that age (r = 0.560, P = 0.013) and predicted BMI in the subsequent years (r = 0.654, P = 0.006 at 60 months and r = 0.750, P = 0.005 at 72 months). IUGR and exposure to a negative emotional atmosphere during maternal-child interactions predicted emotional overeating in girls but not in boys. The quality of mother-infant interaction may be an important target for interventions to prevent emotional overeating and overweight in early development, particularly in girls with a history of IUGR. Copyright © 2014 Elsevier Ltd. All rights reserved.
Missbach, Benjamin; Pachschwöll, Caterina; Kuchling, Daniel; König, Jürgen
Food marketing for children is a major concern for public health nutrition and many schools make efforts to increase healthy eating. Food environments surrounding schools in urban areas may undermine these efforts for healthy nutrition within school programs. Our study aim is to describe the nutrition environment within walking distance of schools in terms of food quality and food marketing and to explore the degree to which elements of the nutrition environment varies by proximity to schools. In a cross-sectional study, we analyzed the surrounding food environments of a convenience sample of 46 target schools within 950m walking distance in 7 different urban districts across Vienna, Austria. In total, we analyzed data from 67 fast food outlets and 54 supermarkets analyzing a total of 43.129 packaged snack food and beverage products, from which 85% were for adults and 15% of the products were child-oriented. Proximity to the schools did not affect the availability of child-oriented products and dedicated food advertisements for children. After applying nutrient profiling using the Nutrient Profiling Model (NPM) on child-oriented products, results showed that 15.8% of the packaged snack food were categorized as "healthy" foods and 84.2% as "less healthy"; for beverages 65.7% were categorized as "healthy" and 34.3% as "less healthy". In conclusion, our results show that child-oriented snacks are not more frequently advertised around schools but substantially lack in nutritional quality with the potential to undermine efforts for promoting healthy eating practices within schools.
Full Text Available Food marketing for children is a major concern for public health nutrition and many schools make efforts to increase healthy eating. Food environments surrounding schools in urban areas may undermine these efforts for healthy nutrition within school programs. Our study aim is to describe the nutrition environment within walking distance of schools in terms of food quality and food marketing and to explore the degree to which elements of the nutrition environment varies by proximity to schools. In a cross-sectional study, we analyzed the surrounding food environments of a convenience sample of 46 target schools within 950m walking distance in 7 different urban districts across Vienna, Austria. In total, we analyzed data from 67 fast food outlets and 54 supermarkets analyzing a total of 43.129 packaged snack food and beverage products, from which 85% were for adults and 15% of the products were child-oriented. Proximity to the schools did not affect the availability of child-oriented products and dedicated food advertisements for children. After applying nutrient profiling using the Nutrient Profiling Model (NPM on child-oriented products, results showed that 15.8% of the packaged snack food were categorized as “healthy” foods and 84.2% as “less healthy”; for beverages 65.7% were categorized as “healthy” and 34.3% as “less healthy”. In conclusion, our results show that child-oriented snacks are not more frequently advertised around schools but substantially lack in nutritional quality with the potential to undermine efforts for promoting healthy eating practices within schools.
Charles, Ryan J; Singal, Bonita M; Urquhart, Andrew G; Masini, Michael A; Hallstrom, Brian R
The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) has monitored discharge disposition, after total hip and knee arthroplasties, since inception in 2012 and found the standardized risk of extended care facility (ECF) placement to be highly variable between hospitals. The variation in standardized risks of ECF placement among MARCQI member sites was reported to the collaborative. At the May 2, 2014 quarterly meeting, a quality initiative was started, emphasizing the wide variability between hospitals, the contribution of hospital and surgeon to that variability using median odds ratios, and the need for outlier hospitals to initiate quality improvement (QI) processes. Patients from 29 hospitals that were members of MARCQI before the intervention were included in this analysis. We compared standardized risks before and after the intervention in the entire cohort, and for 3 hospitals that implemented institution-specific QI projects. We report changes in ECF placement, length of stay, emergency room visits, and readmissions over time. This study includes 31,347 patients before and 20,879 patients after the implementation of the quality initiative. The range in standardized risk dropped from 9.4%-46.1% to 9.4%-32.4% and the average dropped from 23.0% to 19.6%. Three outlier hospitals decreased their absolute risk of ECF placement by 12.2%, 8.9%, and 12.4% after QI, without increases in adverse outcomes. Discharge to ECF after primary hip and knee arthroplasties is highly variable and influenced by hospital and surgeon practices. Hospital-level QI measures can decrease ECF admissions. Copyright © 2016 Elsevier Inc. All rights reserved.
Svirydzenka, Nadzeya; Ronzoni, Pablo; Dogra, Nisha
Defining quality in health presents many challenges. The Institute of Medicine (IOM) defined quality clinical care as care that is equitable, timely, safe, efficient, effective and patient centred. However, it is not clear how different stakeholders within a child and adolescent mental health service (CAMHS) understand and/or apply this framework. This project aims to identify key stakeholders" understanding of the meaning of quality in the context of CAMHS. The study sample comprised of three groups: (i) patients and carers, (ii) CAMHS clinical staff, and (iii) commissioners (Total N = 24). Semi-structured interviews were used to collect data and thematic analysis was applied to explore participant's views on the meaning and measurement of quality and how these might reflect the IOM indicators and their relevance in CAMHS. An initial barrier to implementing quality care in CAMHS was the difficulty and limited agreement in defining the meaning of quality care, its measurement and implementation for all participants. Clinical staff defined quality as personal values, a set of practical rules, or clinical discharge rates; while patients suggested being more involved in the decision-making process. Commissioners, while supportive of adequate safeguarding and patient satisfaction procedures, did not explicitly link their view on quality to commissioning guidelines. Identifying practical barriers to implementing quality care was easier for all interviewees and common themes included: lack of meaningful measures, recourses, accountability, and training. All interviewees considered the IOM six markers as comprehensive and relevant to CAMHS. No respondent individually or within one stakeholder group identified more than a few of the indicators or barriers of a quality CAMHS service. However, the composite responses of the respondents enable us to develop a more complete picture of how to improve quality care in practice and guide future research in the area.
Ferro, Mark A; Landgraf, Jeanne M; Speechley, Kathy N
The present study investigated the higher-order summary factor structure of the Child Health Questionnaire Parent Form-50 (CHQ) in a sample of children with new-onset epilepsy. The secondary aim was to identify risk factors predicting health-related quality of life (HRQL) 24 months post-diagnosis. Data came from the Health-related Quality of Life in Children with Epilepsy Study (HERQULES, N = 374), a multi-site study documenting HRQL among children with epilepsy from diagnosis through 24 months. Confirmatory factor analysis was used to determine goodness of fit between the original structure of the CHQ and HERQULES data. Multiple regression was used to identify risk factors at diagnosis for HRQL at 24 months. The models demonstrated good fit: baseline: CFI = 0.945; TLI = 0.941; WRMR = 1.461; RMSEA = 0.058; 24 months: CFI = 0.957; TLI = 0.954; WRMR = 1.393; RMSEA = 0.055. Factor loadings were high and no cross-loadings observed (first order: λ = 0.27-0.99, 0.24-0.98; second order: λ = 0.69-0.86, 0.54-0.92; p children with new-onset epilepsy, and child and family risk factors at diagnosis were found to predict HRQL 24 months post-diagnosis. These findings suggest it is possible to identify at-risk children early in the illness process and provide impetus for adopting family-centered care practices.
Ruzek, Erik; Burchinal, Margaret; Farkas, George; Duncan, Greg J.
Over half of the toddlers in the U.S. experience routine nonparental care, but much less is known about early care than about preschool care. This study analyzed 2-year-old child care and child outcome data from the nationally representative ECLS-B sample of children born in 2001. At two-years of age, 51% of children experienced exclusive parental care, 18% relative care, 15% family child care, and 16% center care. More children in nonparental care were in medium quality care (61%) than in high quality (26%) or low quality (13%) care. Low-income children were more likely than non-low income children to be cared for by their parents and, when in care, were more often in lower quality care. The impact of toddler care quality on cognitive skills was estimated using propensity score adjustments to account for potential selection confounds due to family and child characteristics. Children’s cognitive scores were higher in high or medium quality care than in low quality care, but no evidence emerged suggesting that poverty moderated the quality effects. Nevertheless, this suggests that increasing the proportion of low-income children in high quality care could reduce the achievement gap because low-income children are very unlikely to experience high quality care. PMID:24347815
Sagi, Abraham; Koren-Karie, Nina; Gini, Motti; Ziv, Yair; Joels, Tirtsa
The Haifa Study of Early Child Care examined the unique contribution of various child-care-related correlates to infant-mother attachment. Findings indicated that, after controlling for other potential contributing variables (including mother characteristics, mother-child interaction, and mother- father relationship), center care adversely…
Kubik-Huch, R.A.; Duerselen, L.; Otto, R.; Rexroth, M.; Porst, R.; Szucs, T.
Purpose: To develop a questionnaire for measuring referring physician satisfaction and to conduct a pilot study in which this questionnaire is given to all physicians referring patients to the authors' radiology department. Materials and Methods: After qualitative pre-testing and adjustment of the prototype questionnaire, data were collected using the finalized standardized questionnaire comprising 29 indicators rated on a 4-point ordinal scale mailed with a personalized cover letter to the total referring physician population of a radiology department (n=727). The replies, rated 1-4, were entered into a data entry mask for statistical analysis. Results: The response rate was 33.8%. the indicators with the highest satisfaction rating were the range of examinations offered ('very satisfied': 79.3% mean 3.79), the quality of the technical equipment used for MRI and CT (79.3%, 3.79) and mammography (82.5%, 3.82), and the quality of the images yielded by these procedures (74.5%, 3.73 and 82.2%, 3.83). Dissatisfaction was relatively high with the indicators 'time to receipt of the written report (28.3% 'not very satisfied' or 'not at all satisfied', mean 2.97), 'time to receipt of the X-ray images' (18.2%, 3.07) and 'availability of previous findings' (20.9%, 3.05); satisfaction was higher among external referring physicians (p<0.05). Physicians rated the importance of these three indicators as relatively high ('very important': 62.4%, 54.3% and 49.6%). Other indicators showing a similar level of dissatisfaction were 'car parking availability' (24.1%, 3.01), 'patient waiting time' (27.4%, 2.87) and 'patient environment' (21.2%, 2.99), although these factors were rated as less important ('very important': 33.0%, 33.7% and 40.4%). Conclusion: This questionnaire constitutes a standardized validated instrument for assessing referring physician satisfaction with a radiology department. The data from this pilot study highlight areas for potential improvement. Deployment of
Cheng, Adam; Overly, Frank; Kessler, David; Nadkarni, Vinay M; Lin, Yiqun; Doan, Quynh; Duff, Jonathan P; Tofil, Nancy M; Bhanji, Farhan; Adler, Mark; Charnovich, Alex; Hunt, Elizabeth A; Brown, Linda L
Many healthcare providers rely on visual perception to guide cardiopulmonary resuscitation (CPR), but little is known about the accuracy of provider perceptions of CPR quality. We aimed to describe the difference between perceived versus measured CPR quality, and to determine the impact of provider role, real-time visual CPR feedback and Just-in-Time (JIT) CPR training on provider perceptions. We conducted secondary analyses of data collected from a prospective, multicenter, randomized trial of 324 healthcare providers who participated in a simulated cardiac arrest scenario between July 2012 and April 2014. Participants were randomized to one of four permutations of: JIT CPR training and real-time visual CPR feedback. We calculated the difference between perceived and measured quality of CPR and reported the proportion of subjects accurately estimating the quality of CPR within each study arm. Participants overestimated achieving adequate chest compression depth (mean difference range: 16.1-60.6%) and rate (range: 0.2-51%), and underestimated chest compression fraction (0.2-2.9%) across all arms. Compared to no intervention, the use of real-time feedback and JIT CPR training (alone or in combination) improved perception of depth (pCPR quality was poor for chest compression depth (0-13%), rate (5-46%) and chest compression fraction (60-63%). Perception of depth is more accurate in CPR providers versus team leaders (27.8% vs. 7.4%; p=0.043) when using real-time feedback. Healthcare providers' visual perception of CPR quality is poor. Perceptions of CPR depth are improved by using real-time visual feedback and with prior JIT CPR training. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Conclusion: Medical centers should guide interns in clinical cases and provide structured training. These measures could enhance the public's confidence in interns and improve patient satisfaction with interns through improved clinical skills, and provide an excellent work force for the dental field.
Ueda, Kayo; Ohtera, Shosuke; Kaso, Misato; Nakayama, Takeo
In childbirth, most deliveries are low-risk, defined as spontaneous labor at full term without special high-risk facts or complications, especially in high-resource countries where maternal and perinatal mortality rates are very low. Indeed, the majority of mothers and infants have no serious conditions during labor. However, the quality of care provided is not assured, and performance may vary by birthing facility and provider. The overuse of technology in childbirth in some parts of the world is almost certainly based on assumptions like, "something can go wrong at any minute." There is a need to assess the quality of care provided for mothers and infants in low-risk labor. We aimed to develop specific quality indicators for low-risk labor care provided primarily by midwives in Japan. We used a RAND-modified Delphi method, which integrates evidence review with expert consensus development. The procedure comprises five steps: (1) literature review, including clinical practice guidelines, to extract and develop quality indicator candidates; (2) formation of a multidisciplinary panel; (3) independent panel ratings (Round 1); (4) panel meeting and independent panel ratings (Round 2); and (5) independent panel ratings (Round 3). The three independent panel ratings (Rounds 1-3) were held between July and December 2012. The assembled multidisciplinary panel comprised eight clinicians (two pediatricians, three obstetricians, and three midwives) and three mothers who were nonclinicians. Evidentiary review extracted 166 key recommendations from 32 clinical practice guidelines, and 31 existing quality indicators were added. After excluding duplicate recommendations and quality indicators, the panel discussed 25 candidate indicators. Of these, 18 were adopted, one was modified, six were not adopted, and four were added during the meeting, respectively. We established 23 quality indicators for low-risk labor care provided by midwives in labor units in Japan.
Hudson Scholle, Sarah; Briefer French, Jessica
Abstract Background: Care for patients with serious illness is an emerging practice area that has gained attention as value-based purchasing has increased. While the number of programs is growing, their impact on care quality and outcomes is unknown. Objective: With support from the Gordon and Betty Moore Foundation, the National Committee for Quality Assurance (NCQA) is assessing the feasibility of creating an accountability program focused on serious illness care. Methods: This article describes the process of developing an accountability program, findings from our initial work, and our plans to develop measures for a serious illness care accountability program. We focused on three questions: 1. What patient populations should be targeted for measurement?2. What entities have accountability for ensuring high-quality care for serious illness?3. What structures, processes, and outcomes should be evaluated in an accountability program for serious illness care? Results: Our environmental scan showed that the evidence base for specific patient populations or care models is not sufficiently mature to justify traditional structure and process measures. In visits to serious illness care programs, we observed different staffing models, care models, care settings, and payment structures. We found a gap between recommended inclusion criteria and services when compared to inclusion criteria and services offered by existing programs. Conclusions: To address the challenges, NCQA intends to develop outcome measures driven by patient and family priorities. Structure and process measures will focus on building organizations' capacity to measure outcomes, including patient engagement and outcomes, linked to patient goals. PMID:29313755
Afek, Arnon; Meilik, Ahuva; Rotstein, Zeev
Today, medical organizations have to contend with a highly competitive environment, an atmosphere saturated with a multitude of innovative new technologies and ever-increasing costs. The ability of these organizations to survive and to develop and expand their services mandates adoption of management guidelines based on the world of finance/commerce, adapted to make them relevant to the world of medical service. In this article the authors chose to present a management administration assessment which is a process that ensures that the management will effectively administer the organization's resources, and meet the goals set by the organization. The system demands that hospital "centers of responsibility" be defined, a management information system be set up, activities be priced, budget be defined and the expenses assessed. These processes make it possible to formulate a budget and assess any possible deviation between the budget and the actual running costs. An assessment of deviations will reveal any possible deviation of the most significant factor--efficiency. Medical organization managers, with the cooperation of the directors of the "centers of responsibility", can assess subunit activities and gain an understanding of the significance of management decisions and thus improve the quality of management, and the medical organization. The goal of this management system is not only to Lower costs and to meet the financial goals that were set; it is a tool that ensures quality. Decreasing expenditure is important in this case, but is only secondary in importance and will be a result of reducing the costs incurred by services lacking in quality.
in the diet to diminish the increased incidences of e.g. cardiovascular, cancer and inflammatory diseases is being assessed by performing dietary intervention and epidemiological studies. Other focus areas are health of young populations, to treat overweight, to prevent osteoporosis and postpartum depression......, by identifying risk factors and avoiding risks caused by viral and bacterial contamination and biogenic amines in seafood. The total value chain is addressed by developing consumer driven tailor-made, functional seafood products to improve health and to ensure nutritional quality and safety by full utilisation...
Naburi, Helga; Mujinja, Phares; Kilewo, Charles; Orsini, Nicola; Bärnighausen, Till; Manji, Karim; Biberfeld, Gunnel; Sando, David; Geldsetzer, Pascal; Chalamila, Guerino; Ekström, Anna Mia
Option B+ for the prevention of mother-to-child transmission (PMTCT) of HIV (i.e., lifelong antiretroviral treatment for all pregnant and breastfeeding mothers living with HIV) was initiated in Tanzania in 2013. While there is evidence that this policy has benefits for the health of the mother and the child, Option B+ may also increase the workload for health care providers in resource-constrained settings, possibly leading to job dissatisfaction and unwanted workforce turnover. From March to April 2014, a questionnaire asking about job satisfaction and turnover intentions was administered to all nurses at 36 public-sector health facilities offering antenatal and PMTCT services in Dar es Salaam, Tanzania. Multivariable logistic regression models were used to identify factors associated with job dissatisfaction and intention to quit one's job. Slightly over half (54%, 114/213) of the providers were dissatisfied with their current job, and 35% (74/213) intended to leave their job. Most of the providers were dissatisfied with low salaries and high workload, but satisfied with workplace harmony and being able to follow their moral values. The odds of reporting to be globally dissatisfied with one's job were high if the provider was dissatisfied with salary (adjusted odds ratio (aOR) 5.6, 95% CI 1.2-26.8), availability of protective gear (aOR 4.0, 95% CI 1.5-10.6), job description (aOR 4.3, 95% CI 1.2-14.7), and working hours (aOR 3.2, 95% CI 1.3-7.6). Perceiving clients to prefer PMTCT Option B+ reduced job dissatisfaction (aOR 0.2, 95% CI 0.1-0.8). The following factors were associated with providers' intention to leave their current job: job stability dissatisfaction (aOR 3.7, 95% CI 1.3-10.5), not being recognized by one's superior (aOR 3.6, 95% CI 1.7-7.6), and poor feedback on the overall unit performance (aOR 2.7, 95% CI 1.3-5.8). Job dissatisfaction and turnover intentions are comparatively high among nurses in Dar es Salaam's public-sector maternal care
Gravdal Kvarme, Lisbeth; Albertini-Früh, Elena; Brekke, Idunn; Gardsjord, Ragnhild; Halvorsrud, Liv; Liden, Hilde
To provide knowledge about how immigrant parents of children with complex health needs manage their family lives and how this affects their own health and quality of life. Caregivers of children with complex health needs have additional risk for general health problems and mental health problems and immigrant parents may be more vulnerable to mental distress and failing health and quality of life. This qualitative study used an exploratory design with individual and focus group interviews. Data collection and analysis followed phenomenological hermeneutic guidelines. Individual and group interviews with 27 parents: 18 mothers and 9 fathers from Pakistan, Poland and Vietnam. Immigrant parents of children with complex health needs experience their own health and quality of life challenges. They described the burden of dealing with their child's needs and special care, which affects their sleep and physical and mental health. Single mothers are particularly vulnerable. Parents reported positive and negative effects of their caregiving experience that may affect their health and quality of life. Mothers were the primary caregivers and reported more health problems than did fathers. The lack of respite care, social networks and support impacted maternal health. Immigrant parents struggle to access resources for their child with complex health needs. Hospital nurses, schools and community health care can play a valuable role in supporting the parents of children with complex health needs. It is important that parents are informed about their rights and receive a coordinator and interdisciplinary group to ensure that their needs are met with assistance and respite care. That maternal health was worse in this sample implies that health care professionals should pay more attention to reducing stress among these caregivers. © 2016 John Wiley & Sons Ltd.
Full Text Available Quality of care is essential for further progress in reducing maternal and newborn deaths. The integration of educated, trained, regulated and licensed midwives into the health system is associated with improved quality of care and sustained decreases in maternal and newborn mortality. To date, research on barriers to quality of care for women and newborns has not given due attention to the care provider's perspective. This paper addresses this gap by presenting the findings of a systematic mapping of the literature of the social, economic and professional barriers preventing midwifery personnel in low and middle income countries (LMICs from providing quality of care.A systematic search of five electronic databases for literature published between January 1990 and August 2013. Eligible items included published and unpublished items in all languages. Items were screened against inclusion and exclusion criteria, yielding 82 items from 34 countries. 44% discussed countries or regions in Africa, 38% in Asia, and 5% in the Americas. Nearly half the articles were published since 2011. Data was extracted and presented in a narrative synthesis and tables. Items were organized into three categories; social; economic and professional barriers, based on an analytical framework. Barriers connected to the socially and culturally constructed context of childbirth, although least reported, appear instrumental in preventing quality midwifery care.Significant social and cultural, economic and professional barriers can prevent the provision of quality midwifery care in LMICs. An analytical framework is proposed to show how the overlaps between the barriers reinforce each other, and that they arise from gender inequality. Links are made between burn out and moral distress, caused by the barriers, and poor quality care. Ongoing mechanisms to improve quality care will need to address the barriers from the midwifery provider perspective, as well as the underlying
Luck, J; Peabody, J W; DeMaria, L M; Alvarado, C S; Menon, R
Facing a severe population health crisis due to noncommunicable diseases, Ukraine and other former Soviet republics and Eastern European countries have a pressing need for more effective health systems. Policies to enhance health system effectiveness should consider the perspectives of different stakeholder groups, including providers as well as patients. In addition, policies that directly target the quality of clinical care should be based on objective performance measures. In 2009 and 2010 we conducted a coordinated series of household and facility-level surveys to capture the perspectives of Ukrainian household members, outpatient clinic patients, and physicians regarding the country's health system overall, as well as the quality, access, and affordability of health care. We objectively measured the quality of care for heart failure and chronic obstructive pulmonary disease using CPV(®) vignettes. There was broad agreement among household respondents (79%) and physicians (95%) that Ukraine's health system should be reformed. CPV(®) results indicate that the quality of care for common noncommunicable diseases is poor in all regions of the country and in hospitals as well as polyclinics. However, perspectives about the quality of care differ, with household respondents seeing quality as a serious concern, clinic patients having more positive perceptions, and physicians not viewing quality as a reform priority. All stakeholder groups viewed affordability as a problem. These findings have several implications for policies to enhance health system effectiveness. The shared desire for health system reform among all stakeholder groups provides a basis for action in Ukraine. Improving quality, strengthening primary care, and enhancing affordability should be major goals of new health policies. Policies to improve quality directly, such as pay-for-performance, would be mutually reinforcing with purchasing reforms such as transparent payment mechanisms. Such policies
Full Text Available This study used a qualitative methodology to analyze the discourse of mothers from Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil, whose infant children had died from what were considered avoidable causes (diarrhea, malnutrition, and pneumonia, seeking to elucidate the factors associated with utilization of health care services. Identification of the illness by the mother was related to perception of specific alterations in the child's state of health. Analysis of the alterations helped identify the principal characteristics ascribed to each alteration and their relationship to the search for treatment. The authors also studied the mother's assessment of treatment received at health care facilities; 43.0% of the cases involved problems related to the structure of health care services or the attending health care professionals. In 46.0% of the cases, mothers associated the child's death with flaws in the health care service. The study group showed a variety of interpretations of illness, often distinct from the corresponding biomedical concepts. The fact that attending health care personnel overlooked or underrated the mother's perception of the illness and the lack of communications between health care personnel and the child's family had an influence on the child's evolution and subsequent death.
Pendry, Patricia; Adam, Emma K.
Associations between family functioning and children's stress hormone levels are explored, by examining how aspects of the interparental relationship (parents' marital satisfaction and parent conflict styles), the mother-child relationship (maternal involvement and warmth) and maternal emotional functioning (depression, anxiety and self-esteem)…
de Alencar, Nashalie Andrade; Reis, Kátia Rodrigues; Antonio, Andréa Gonçalves; Maia, Lucianne Cople
Ectodermal dysplasia (ED) is a rare congenital hereditary disorder among a group of syndromes characterized by abnormalities of ectodermic structures. The purpose of this report is to compare the oral health-related quality of life (OHRQoL) before and after complete oral rehabilitation of a five-year-old boy with ED. Delivery of upper and lower dentures resulted in immediate improvement of the child's OHRQoL. Although ED affects patients physically and emotionally, the early oral rehabilitation of young patients is crucial to improve their social interaction and restore their speech and masticatory function.
Wargocki, Pawel; Wyon, David Peter
codes stipulate that they should be. This is sometimes because financial resources for the maintenance and upgrade of school buildings are inadequate, but it is also because schools are increasingly allowing classroom temperatures to drift above the recommended range of 20–22 °C in warm weather......This paper is an overall summary of research by the authors on how classroom conditions affect the performance of schoolwork by children, motivated by the fact that the thermal and air quality conditions in school classrooms are now almost universally worse than the relevant standards and building...... and allowing outdoor air supply rates to remain so low that carbon dioxide (CO2) levels during school hours exceed 1000 ppm for long periods, in order to conserve energy. The research that is summarized in this paper shows that the indoor environmental consequences of either of these investment-free but ill...
Full Text Available With Slovenia joining the EU the need for higher quality and faster transit transport of goods through customs procedures has increased. This paper presents the recent logistics approach, which allows a better link between transportation and freight forwarding. Modern computer programs used by forwarding companies have contributed to this. Forwarder companies may have a role of organizer or a place using the transport services of customs clearance of goods at the entry / exit to / from the European Union. Each type of transport has a role to play, but gets even stronger when combined under one category. This is a multimodal transport. As an example we use logistic work in a logistic company. Here the work is divided in to transit of goods, customs clearance of goods, but also touching the law and the ranking of goods by tariff codes.
Full Text Available Objective To investigate the relationship between macronutrient intake adequacy and the national diet quality index score. Methods The study analyzed a representative sample of 1,662 individuals from the municipality of São Paulo who participated in a cross-sectional study called Health Survey-Capital (2008/2009. Two 24-hour recalls were collected. Habitual intake was determined by the Multiple Source Method. The Brazilian index was calculated as suggested, and macronutrient adequacy was given by the World Health Organization and Food and Agriculture Organization recommendations. A generalized linear model verified the relationship between the Brazilian index and macronutrient adequacy. All analyses with a descriptive level below 0.05 were considered significant. The analyses were performed by the software Stata 12.0, survey mode. Results The vast majority (91% of the population had inappropriate macronutrient intakes, and the total median Brazilian index score was 61.3 points (interquartile range=10.1. The total Brazilian index score of individuals with high lipid intake was worse than that of individuals with proper lipid intake (β=0,96; p=0,004, while those with high protein intake had a better score (β=1,10; p=0,003 than those with proper protein intake. Conclusion The revised Brazilian Healthy Eating Index assesses diet quality properly regarding high lipid intake, but it has some limitations regarding high protein intake according to the World Health Organization and Food and Agriculture Organization recommendations. New studies should investigate the possibility of adapting this index to the World Health Organization and Food and Agriculture Organization recommendations.
Haven, Erin L; Manangan, Christen N; Sparrow, Joanne K; Wilson, Beverly J
This study examined associations between parent-child interactions and the development of social skills in 42 children (21 typically developing and 21 with autism spectrum disorders) between the ages of 3 years, 0 months and 6 years, 11 months. We expected that positive parent-child interaction qualities would be related to children's social skills and would mediate the negative relation between children's developmental status (typical development vs autism spectrum disorders) and social skills. Videotapes of parents and children during a 5-min wordless book task were coded for parent positive affect and emotional support as well as parent-child cohesiveness. Emotional support and cohesiveness were significantly related to children's social skills, such that higher emotional support and cohesiveness were associated with higher social skills, R (2) = .29, p = .02, and R (2) = .38, p = .002, respectively. Additionally, cohesiveness mediated the relation between children's developmental status and social skills. These findings suggest that parent emotional support and cohesiveness between parents and children positively influence children's social skills. Parent positive affect was unrelated to social skills. Implications of these findings for social skills interventions are discussed, particularly for young children with autism spectrum disorders.
Arrow, P; Klobas, E
The aim of this study was to compare changes in child oral health-related quality of life (COHRQoL) after treatment for early childhood caries (ECC) using two alternative treatment approaches. A randomized control trial with random allocation of parent/child dyads with ECC to test (minimum intervention) or control (standard care). Participating parents completed the Early Childhood Oral Health Impact Scale (ECOHIS) at baseline and follow-up. Changes in ECOHIS scores and extent of COHRQoL impacts between and within groups were tested using the chi-squared statistic for groups, Wilcoxon's rank-sum test, and matched-pairs signed-rank test. Two hundred and fifty-four children were randomized (test = 127; control = 127). At baseline, mean ECOHIS score 11.1, sd 8.2; mean age = 3.8 years, sd 0.90; mean dmft = 4.9, sd 4.0; and 59% male. After a mean interval of 11.4 months, 210 children were followed-up and returned a completed questionnaire (test = 111; control = 99). There was no significant difference in COHRQoL changes between test and control. For all the children combined, there were significantly fewer impacts at follow-up in the child and family domains and the total ECOHIS, Wilcoxon signed-rank test, p test and control in the extent of the improvement. © 2016 Australian Dental Association.
Chauhan, Muhammad Aufeef; Ali Babar, Muhammad
Cloud computing is being increasingly adopted in various domains for providing on-demand infrastructure and Software as a service (SaaS) by leveraging the utility computing model and virtualization technologies. One of the domains, where cloud computing is expected to gain huge traction is Global...... Software Development (GSD) that has emerged as a popular software development model. Despite several promised benefits, GSD is characterized by not only technical issues but also the complexities associated with its processes. One of the key challenges of GSD is to provide appropriate tools more...... efficiently and cost-effectively. Moreover, variations in tools available/used by different GSD team members can also pose challenges. We assert that providing Tools as a Service (TaaS) to GSD teams through a cloud-based infrastructure can be a promising solution to address the tools related challenges in GSD...
It is not easy to lay prejudices aside, to find and face the facts, and to let the chips fall where they may. There is no need to wait for improvements in technology before beginning to use outcomes monitoring to guide the business exchange between purchasers and providers. Although future technological improvements will greatly improve the capacity to use objective data to differentiate among providers and to identify strengths and weaknesses within a health care organization, reasonable methods are available today to undertake these important tasks. All that is needed is the courage and willingness to embrace them. The future belongs to purchaser and provider organizations that are willing to seek enlightenment rather than blame.
Larsen, Sara; Hamilton, Stuart; Lucido, Jessica M.; Garner, Bradley D.; Young, Dwane
Shared, trusted, timely data are essential elements for the cooperation needed to optimize economic, ecologic, and public safety concerns related to water. The Open Water Data Initiative (OWDI) will provide a fully scalable platform that can support a wide variety of data from many diverse providers. Many of these will be larger, well-established, and trusted agencies with a history of providing well-documented, standardized, and archive-ready products. However, some potential partners may be smaller, distributed, and relatively unknown or untested as data providers. The data these partners will provide are valuable and can be used to fill in many data gaps, but can also be variable in quality or supplied in nonstandardized formats. They may also reflect the smaller partners' variable budgets and missions, be intermittent, or of unknown provenance. A challenge for the OWDI will be to convey the quality and the contextual “fitness” of data from providers other than the most trusted brands. This article reviews past and current methods for documenting data quality. Three case studies are provided that describe processes and pathways for effective data-sharing and publication initiatives. They also illustrate how partners may work together to find a metadata reporting threshold that encourages participation while maintaining high data integrity. And lastly, potential governance is proposed that may assist smaller partners with short- and long-term participation in the OWDI.
Full Text Available Oral pre-exposure prophylaxis (PrEP has the potential to reduce HIV acquisition among adolescent girls and young women (AGYW in sub-Saharan Africa. However, health care providers' (HCPs perspectives and interactions with potential clients can substantially influence effective provision of quality health services. We examine if HCPs' knowledge, attitude, and skills, as well as their perceptions of facility readiness to provide PrEP are associated with their willingness to provide PrEP to AGYW at high risk of HIV in Tanzania.A self-administered questionnaire was given to 316 HCPs from 74 clinics in two districts and 24 HCPs participated in follow-up in-depth interviews (IDIs. We conducted bivariate and multivariable Poisson regression to assess factors associated with willingness to provide PrEP to AGYW. Thematic content analysis was used to analyze the IDIs, which expanded upon the quantitative results.Few HCPs (3.5% had prior PrEP knowledge, but once informed, 61.1% were willing to prescribe PrEP to AGYW. Higher negative attitudes toward adolescent sexuality and greater concerns about behavioral disinhibition due to PrEP use were associated with lower willingness to prescribe PrEP. Qualitatively, HCPs acknowledged that biases, rooted in cultural norms, often result in stigmatizing and discriminatory care toward AGYW, a potential barrier for PrEP provision. However, better training to provide HIV services was associated with greater willingness to prescribe PrEP. Conversely, HCPs feared the potential negative impact of PrEP on the provision of existing HIV services (e.g., overburdened staff, and suggested the integration of PrEP into non-HIV services and the use of paramedical professionals to facilitate PrEP provision.Preparing for PrEP introduction requires more than solely training HCPs on the clinical aspects of providing PrEP. It requires a two-pronged strategy: addressing HCPs' biases regarding sexual health services to AGYW; and preparing
Kuiper, A.; van de Hoef, R.; Wesseling, M.; Lameijer, B.A.; Does, R.J.M.M.
In the wake of the financial crisis, the financial sector had to make tremendous efforts in being more transparent and cost efficient (Blom and Kuenen 2009). As a consequence, over the last decade, various financial service providers have embraced a range of methods for improving their customer
Smith, Sheila; Robbins, Taylor; Schneider, Will; Kreader, J. Lee; Ong, Christine
Quality Rating Improvement Systems (QRISs) commonly offer on-site technical assistance (TA) and coaching to help early care and education settings achieve quality improvements and a higher QRIS rating. In surveys of administrators overseeing statewide QRISs, almost all states reported the use of on-site TA and coaching in both center-based and…
Dubois-Comtois, Karine; Bernier, Annie; Tarabulsy, George M; Cyr, Chantal; St-Laurent, Diane; Lanctôt, Anne-Sophie; St-Onge, Janie; Moss, Ellen; Béliveau, Marie-Julie
This study investigated different environmental and contextual factors associated with maltreated children's adjustment in foster care. Participants included 83 children (52 boys), ages 1-7 years, and their foster caregivers. Quality of interaction with the foster caregiver was assessed from direct observation of a free-play situation; foster caregiver attachment state of mind and commitment toward the child were assessed using two interviews; disruptive behavior symptoms were reported by foster caregivers. Results showed that quality of interaction between foster caregivers and children were associated with behavior problems, such that higher-quality interactions were related to fewer externalizing and internalizing problems. Foster caregivers' state of mind and commitment were interrelated but not directly associated with behavior problems of foster children. Type of placement moderated the association between foster caregiver commitment and foster child behavior problems. Whereas greater foster caregiver commitment was associated with higher levels of adjustment for children in foster families (kin and non-kin), this was not the case in foster-to-adopt families. Finally, the associations between foster child behavior problems and history of maltreatment and placement related-risk conditions fell below significance after considering child age and quality of interaction with the foster caregiver. Findings underscore the crucial contribution of the foster caregiver-child relationship to fostering child adjustment and, thereby, have important implications for clinical services offered to this population. Copyright © 2015 Elsevier Ltd. All rights reserved.
Full Text Available Background: Maternal mortality ratio and infant mortality rate are as high as 1,576 per 100,000 live births and 78 per 1,000 live births, respectively, in Nigeria's northwestern region, where Sokoto State is located. Using applicable monitoring indicators for tracking progress in the UN/WHO framework on continuum of maternal, newborn, and child health care, this study evaluated the progress of Sokoto toward achieving the Millennium Development Goals (MDGs 4 and 5 by December 2015. The changes in outcomes in 2012–2013 associated with maternal and child health interventions were assessed. Design: We used baseline and follow-up lot quality assurance sampling (LQAS data obtained in 2012 and 2013, respectively. In each of the surveys, data were obtained from 437 households sampled from 19 LQAS locations in each of the 23 local government areas (LGAs. The composite state-level coverage estimates of the respective indicators were aggregated from estimated LGA coverage estimates. Results: None of the nine indicators associated with the continuum of maternal, neonatal, and child care satisfied the recommended 90% coverage target for achieving MDGs 4 and 5. Similarly, the average state coverage estimates were lower than national coverage estimates. Marginal improvements in coverage were obtained in the demand for family planning satisfied, antenatal care visits, postnatal care for mothers, and exclusive breast-feeding. Antibiotic treatment for acute pneumonia increased significantly by 12.8 percentage points. The majority of the LGAs were classifiable as low-performing, high-priority areas for intensified program intervention. Conclusions: Despite the limited time left in the countdown to December 2015, Sokoto State, Nigeria, is not on track to achieving the MDG 90% coverage of indicators tied to the continuum of maternal and child care, to reduce maternal and childhood mortality by a third by 2015. Targeted health system investments at the primary care
Abegunde, Dele; Orobaton, Nosa; Shoretire, Kamil; Ibrahim, Mohammed; Mohammed, Zainab; Abdulazeez, Jumare; Gwamzhi, Ringpon; Ganiyu, Akeem
Maternal mortality ratio and infant mortality rate are as high as 1,576 per 100,000 live births and 78 per 1,000 live births, respectively, in Nigeria's northwestern region, where Sokoto State is located. Using applicable monitoring indicators for tracking progress in the UN/WHO framework on continuum of maternal, newborn, and child health care, this study evaluated the progress of Sokoto toward achieving the Millennium Development Goals (MDGs) 4 and 5 by December 2015. The changes in outcomes in 2012-2013 associated with maternal and child health interventions were assessed. We used baseline and follow-up lot quality assurance sampling (LQAS) data obtained in 2012 and 2013, respectively. In each of the surveys, data were obtained from 437 households sampled from 19 LQAS locations in each of the 23 local government areas (LGAs). The composite state-level coverage estimates of the respective indicators were aggregated from estimated LGA coverage estimates. None of the nine indicators associated with the continuum of maternal, neonatal, and child care satisfied the recommended 90% coverage target for achieving MDGs 4 and 5. Similarly, the average state coverage estimates were lower than national coverage estimates. Marginal improvements in coverage were obtained in the demand for family planning satisfied, antenatal care visits, postnatal care for mothers, and exclusive breast-feeding. Antibiotic treatment for acute pneumonia increased significantly by 12.8 percentage points. The majority of the LGAs were classifiable as low-performing, high-priority areas for intensified program intervention. Despite the limited time left in the countdown to December 2015, Sokoto State, Nigeria, is not on track to achieving the MDG 90% coverage of indicators tied to the continuum of maternal and child care, to reduce maternal and childhood mortality by a third by 2015. Targeted health system investments at the primary care level remain a priority, for intensive program scale-up to
Gutierrez, Emily; Silbert-Flagg, JoAnne; Vohra, Sunita
The use of natural health products by pediatric patients is common, yet health care providers often do not provide management guidance. The purpose of this project was to improve management of natural health products by pediatric nurse practitioners. Pediatric nurse practitioners from large metropolitan city were recruited (n = 32). A paired pretest-posttest design was used. Study participants were engaged to improve knowledge of natural health products, and a management toolkit was created and tested. Mean knowledge scores increased from 59.19 to 76.3 (p improved with regard to patient guidance (p product use (p = .51) and drug/herb interactions (p = .35) were not significant. This investigation is the first known study to improve knowledge and management of natural health products in pediatric clinical practice. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
Smidt, Wilfried; Rossbach, Hans-Günther
A large body of research has examined the quality of educational processes in preschools, but it has usually been studied at the group level. Thus, there is a lack of research on the quality of educational processes as experienced by individual children. Therefore, this study investigated the quality of educational processes in preschools at the…
Martin, Peter; Davies, Roger; Macdougall, Amy; Ritchie, Benjamin; Vostanis, Panos; Whale, Andy; Wolpert, Miranda
Case-mix classification is a focus of international attention in considering how best to manage and fund services, by providing a basis for fairer comparison of resource utilization. Yet there is little evidence of the best ways to establish case mix for child and adolescent mental health services (CAMHS). To develop a case mix classification for CAMHS that is clinically meaningful and predictive of number of appointments attended and to investigate the influence of presenting problems, context and complexity factors and provider variation. We analysed 4573 completed episodes of outpatient care from 11 English CAMHS. Cluster analysis, regression trees and a conceptual classification based on clinical best practice guidelines were compared regarding their ability to predict number of appointments, using mixed effects negative binomial regression. The conceptual classification is clinically meaningful and did as well as data-driven classifications in accounting for number of appointments. There was little evidence for effects of complexity or context factors, with the possible exception of school attendance problems. Substantial variation in resource provision between providers was not explained well by case mix. The conceptually-derived classification merits further testing and development in the context of collaborative decision making.
George, Asha; Young, Mark; Nefdt, Rory; Basu, Roshni; Sylla, Mariame; Clarysse, Guy; Bannicq, Marika Yip; de Sousa, Alexandra; Binkin, Nancy; Diaz, Theresa
We describe community health workers (CHWs) in government community case management (CCM) programs for child survival across sub-Saharan Africa. In sub-Saharan Africa, 91% of 44 United Nations Children's Fund (UNICEF) offices responded to a cross-sectional survey in 2010. Frequencies describe CHW profiles and activities in government CCM programs (N = 29). Although a few programs paid CHWs a salary or conversely, rewarded CHWs purely on a non-financial basis, most programs combined financial and non-financial incentives and had training for 1 week. Not all programs allowed CHWs to provide zinc, use timers, dispense antibiotics, or use rapid diagnostic tests. Many CHWs undertake health promotion, but fewer CHWs provide soap, water treatment products, indoor residual spraying, or ready-to-use therapeutic foods. For newborn care, very few promote kangaroo care, and they do not provide antibiotics or resuscitation. Even if CHWs are as varied as the health systems in which they work, more work must be done in terms of the design and implementation of the CHW programs for them to realize their potential.
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-2480-NC] Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care to Children AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with Comments. SUMMARY: This notice...
Desimone, Laura; Porter, Andrew C.; Birman, Beatrice F.; Garet, Michael S.; Yoon, Kwang Suk
Examined policy mechanisms and processes that districts used to provide high quality inservice professional development to teachers. Data from a national probability sample of professional development coordinators in districts that received federal funding for professional development highlighted specific management and implementation strategies…
... Get your child treated for any bites, especially dog bites, right away. Let your child's doctor know ... Call your health care provider if: Your child's temperature is 101°F (38.3°C) or higher. ...
Szechter, Lisa E; Liben, Lynn S
This research was designed to examine the quality of children's aesthetic understanding of photographs, observe social interactions between parents and children in this aesthetic domain, and study whether qualitatively different dyadic interactions were associated with children's own aesthetic understanding. Parents and children (7-13 years; 40 dyads) individually completed measures of aesthetic understanding and jointly selected photographs for a souvenir scrapbook. Parents' artistic experience varied widely and was associated with their own performance on aesthetic understanding measures. Children's performance on the individual aesthetic tasks was related to age, but not to parents' art experience nor to the qualities of parent-child discussions of aesthetic concepts. Among both parents and children, artistic experience was associated with aesthetic preferences for photographs.
To examine the relationships of providing compassion at work with job performance and mental health, as well as to identify the role of interpersonal relationship quality in moderating these relationships. This study adopted a two-stage survey completed by 235 registered nurses employed by hospitals in Taiwan. All hypotheses were tested using hierarchical regression analyses. The results show that providing compassion is an effective predictor of job performance and mental health, whereas interpersonal relationship quality can moderate the relationships of providing compassion with job performance and mental health. When nurses are frequently willing to listen, understand, and help their suffering colleagues, the enhancement engendered by providing compassion can improve the provider's job performance and mental health. Creating high-quality relationships in the workplace can strengthen the positive benefits of providing compassion. Motivating employees to spontaneously exhibit compassion is crucial to an organization. Hospitals can establish value systems, belief systems, and cultural systems that support a compassionate response to suffering. In addition, nurses can internalize altruistic belief systems into their own personal value systems through a long process of socialization in the workplace. © 2017 Sigma Theta Tau International.
Sidze, Estelle M; Elungata'a, Patricia; Maina, Beatrice W; Mutua, Michael M
This study investigated the associations between parent-child connectedness and sexual behaviors among adolescents living in informal settlements in Nairobi, Kenya, a vulnerable group with respect to reproductive health outcomes. The study was based on data from the Transition to Adulthood project, a study designed to follow adolescents aged 12-22 for 3 years in the informal settlements of Korogocho and Viwandani. Direct face-to-face questions were asked to adolescents about parenting variables and sexual behaviors. This study used a subsample of 689 sexually experienced 12-22-years-olds at Wave 2. Bivariate analysis compared gender differences for three outcomes-sexual activity in the 12 months prior to the survey and, among those who had had sex in this period, multiple sexual partners and condom use at last sex. Multivariate logistic regressions were used to identify associations between these outcomes and the quality of parent-child connectedness. About 60% of adolescent females and males were sexually active in the 12 months prior to the survey. The multivariate results showed a strong association between the quality of parent-child connectedness and condom use among adolescent males. Living with related or unrelated guardians (versus living with biological parents) was also associated with higher odds of multiple sexual partners and lower odds of condom use at last sex among adolescent females and with higher odds of sexual activity among adolescent males. Sexual and reproductive health programs targeting adolescents living in Nairobi informal settlements would benefit from attention to assisting parents to improve their ability to play the connectedness role.
Software projects are often late and over-budget and this leads to major problems for software customers. Clearly, there is a serious issue in estimating a realistic, software project budget. Furthermore, generic estimation models cannot be trusted to provide credible estimates for projects as complex as software projects. This book presents a number of examples using data collected over the years from various organizations building software. It also presents an overview of the non-for-profit organization, which collects data on software projects, the International Software Benchmarking Stan
Korja, Riikka; Piha, Jorma; Otava, Riia; Lavanchy-Scaiola, Chloe; Ahlqvist-Björkroth, Sari; Aromaa, Minna; Räihä, Hannele
Low marital satisfaction has been shown to be a risk factor for early parenthood and parent-child relationship problems (Erel & Burman, ; McHale, ). The aim of this study was to assess how parental reports of marital satisfaction related to family alliance and coordination in the observed triadic interaction. The study group included 120 families. Marital satisfaction was evaluated during pregnancy, at 4 months, and at 18 months using the Revised Dyadic Adjustment Scale (RDAS; Busby, Christensen, Crane & Larsson, ) for both parents. Mother-father-child interaction was analyzed in the Lausanne Triadic Play setting and coded using the Family Alliance Assessment Scale (Favez, Lavanchy Scaiola, Tissot, Darwiche & Frascarolo, ) when the child reached 18 months of age. The mother's higher marital satisfaction at every measuring point was associated with a cooperative family alliance and/or higher family coordination at 18 months. The father's experience of marital satisfaction was not related to family interaction at any assessment point. Our study suggests that a mother's experience of lower marital satisfaction during pregnancy may be an early sign of later problems in family relationships. © 2016 Scandinavian Psychological Associations and John Wiley & Sons Ltd.
Lambert, Andrew J; Daly, Elizabeth M; Dainty, Christopher J
We investigate whether a structured probe beam that creates the beacon for use in a retinal imaging adaptive optics system can provide useful side effects. In particular we investigate whether a Bessel beam that is seen by the subject as a set of concentric rings has a dampening effect on fixation variations of the subject under observation. This calming effect would allow longer periods of observation, particularly for patients with abnormal fixation. An experimental adaptive optics system developed for retinal imaging is used to monitor the fluctuations in aberrations for artificial and human subjects. The probe beam is alternated between a traditional beacon and one provided by a Bessel beam created by SLM. Time-frequency analysis is used to indicate the differences in power and time variation during fixation depending on whether the Bessel beam or the traditional beacon is employed. Comparison is made with the response for an artificial eye to discount systemic variations. Significant evidence is accrued to indicate the reduced fluctuations in fixation when the Bessel beam is employed to create the beacon. © 2013 The Authors Ophthalmic & Physiological Optics © 2013 The College of Optometrists.
Locatelli, Sara M; LaVela, Sherri L
Changes to the work environment prompted by the movement toward patient-centered care have the potential to improve occupational stress among health care workers by improving team-based work activities, collaboration, and employee-driven quality improvement. This study was conducted to examine professional quality of life among providers at patient-centered care pilot facilities. Surveys were conducted with 76 Veterans Affairs employees/providers at facilities piloting patient-centered care interventions, to assess demographics, workplace practices and views (team-based environment, employee voice, quality of communication, and turnover intention), and professional quality of life (compassion satisfaction, burnout, and secondary traumatic stress).Professional quality-of-life subscales were not related to employee position type, age, or gender. Employee voice measures were related to lower burnout and higher compassion satisfaction. In addition, employees who were considering leaving their position showed higher burnout and lower compassion satisfaction scores. None of the work practices showed relationships with secondary traumatic stress.
Parent-child relationship quality and family transmission of parent posttraumatic stress disorder symptoms and child externalizing and internalizing symptoms following fathers' exposure to combat trauma.
Snyder, James; Gewirtz, Abigail; Schrepferman, Lynn; Gird, Suzanne R; Quattlebaum, Jamie; Pauldine, Michael R; Elish, Katie; Zamir, Osnat; Hayes, Charles
Transactional cascades among child internalizing and externalizing symptoms, and fathers' and mothers' posttraumatic stress disorder (PTSD) symptoms were examined in a sample of families with a male parent who had been deployed to recent military conflicts in the Middle East. The role of parents' positive engagement and coercive interaction with their child, and family members' emotion regulation were tested as processes linking cascades of parent and child symptoms. A subsample of 183 families with deployed fathers and nondeployed mothers and their 4- to 13-year-old children who participated in a randomized control trial intervention (After Deployment: Adaptive Parenting Tools) were assessed at baseline prior to intervention, and at 12 and 24 months after baseline, using parent reports of their own and their child's symptoms. Parents' observed behavior during interaction with their children was coded using a multimethod approach at each assessment point. Reciprocal cascades among fathers' and mothers' PTSD symptoms, and child internalizing and externalizing symptoms, were observed. Fathers' and mothers' positive engagement during parent-child interaction linked their PTSD symptoms and their child's internalizing symptoms. Fathers' and mothers' coercive behavior toward their child linked their PTSD symptoms and their child's externalizing symptoms. Each family member's capacity for emotion regulation was associated with his or her adjustment problems at baseline. Implications for intervention, and for research using longitudinal models and a family-systems perspective of co-occurrence and cascades of symptoms across family members are described.
Bhanderi, D J; Mukherjee, S M; Gohel, Manisha K; Christian, D S
A multi-indicator thirty cluster survey was conducted during February- March 2008 in the rural areas of Anand district of Gujrat state to assess the utilization of the reproductive and child health services provided through government sector. In each selected village minimum 40 households were visited till total eight children in age group 12-23 months, at least two antenatal mothers in last trimester and five mothers who delivered in last year were studied. A total of 555 children of age less than three years & 1481 women in reproductive age group were included in the study. 74.8% of the children had institutional delivery. Birth registration was almost 100%. Immunization coverage was 84.5%. Registration of children and pregnant mothers under Mamta Abhiyan(MA) were 91% and 84 % respectively. Only 53% children were brought to Mamta Diwas Kendra regularly. Vitamin A coverage to children was 76.9%. Tetanus toxoid coverage of pregnant women was 85.1%, while Iron tablets were provided to 48.3% women. 43% of the postnatal mothers had no post-partum visit. Utilization of government schemes among postnatal women was 9% to 20%.
Higgins-Steele, Ariel; Waller, Kathryn; Fotso, Jean Christophe; Vesel, Linda
Sierra Leone has among the poorest maternal and child health indicators in the world and investments in public health have been predominately to increase demand for services, with fewer initiatives targeting supply side factors that influence health workers' work environment. This paper uses data from the Quality Circles project in a rural district of Sierra Leone to achieve three objectives. First, we examine the effect of the intervention on organizational skills and relationships among coworkers as well as between health workers and traditional birth attendants. Second, we examine whether changes in organizational skills are associated with changes in relationships among and between formal and informal health providers and between health providers and clients. Third, we aim to further understand these changes through the perspectives of health workers and traditional birth attendants. The Quality Circles project was implemented in Kailahun District in the Eastern province of Sierra Leone from August 2011 to June 2013, with adjacent Tonkolili District serving as the control site. Using a mixed-methods approach, the evaluation included a quantitative survey, in-depth interviews and focus group discussions with health workers and traditional birth attendants. Mean values of the variables of interest were compared across sub-populations, and correlation analyses were performed between changes in organizational skills and changes in relationships. The results demonstrate that the Quality Circles intervention had positive effects on organizational skills and relationships. Furthermore, improvements in all organizational skill variables - problem-solving, strategizing and negotiation skills - were strongly associated with a change in the overall relationship variable. The Quality Circles approach has the potential to support health workers to improve their organizational skills and relationships, which in turn can contribute to improving the interpersonal dimensions of
Gao, Peng; Ma, Hongyan; Luan, Feishi; Song, Haibin
Melon, Cucumis melo L. is an important vegetable crop worldwide. At present, there are phenomena of homonyms and synonyms present in the melon seed markets of China, which could cause variety authenticity issues influencing the process of melon breeding, production, marketing and other aspects. Molecular markers, especially microsatellites or simple sequence repeats (SSRs) are playing increasingly important roles for cultivar identification. The aim of this study was to construct a DNA fingerprinting database of major melon cultivars, which could provide a possibility for the establishment of a technical standard system for purity and authenticity identification of melon seeds. In this study, to develop the core set SSR markers, 470 polymorphic SSRs were selected as the candidate markers from 1219 SSRs using 20 representative melon varieties (lines). Eighteen SSR markers, evenly distributed across the genome and with the highest contents of polymorphism information (PIC) were identified as the core marker set for melon DNA fingerprinting analysis. Fingerprint codes for 471 melon varieties (lines) were established. There were 51 materials which were classified into17 groups based on sharing the same fingerprint code, while field traits survey results showed that these plants in the same group were synonyms because of the same or similar field characters. Furthermore, DNA fingerprinting quick response (QR) codes of 471 melon varieties (lines) were constructed. Due to its fast readability and large storage capacity, QR coding melon DNA fingerprinting is in favor of read convenience and commercial applications.
Gao, Peng; Ma, Hongyan; Luan, Feishi; Song, Haibin
Melon, Cucumis melo L. is an important vegetable crop worldwide. At present, there are phenomena of homonyms and synonyms present in the melon seed markets of China, which could cause variety authenticity issues influencing the process of melon breeding, production, marketing and other aspects. Molecular markers, especially microsatellites or simple sequence repeats (SSRs) are playing increasingly important roles for cultivar identification. The aim of this study was to construct a DNA fingerprinting database of major melon cultivars, which could provide a possibility for the establishment of a technical standard system for purity and authenticity identification of melon seeds. In this study, to develop the core set SSR markers, 470 polymorphic SSRs were selected as the candidate markers from 1219 SSRs using 20 representative melon varieties (lines). Eighteen SSR markers, evenly distributed across the genome and with the highest contents of polymorphism information (PIC) were identified as the core marker set for melon DNA fingerprinting analysis. Fingerprint codes for 471 melon varieties (lines) were established. There were 51 materials which were classified into17 groups based on sharing the same fingerprint code, while field traits survey results showed that these plants in the same group were synonyms because of the same or similar field characters. Furthermore, DNA fingerprinting quick response (QR) codes of 471 melon varieties (lines) were constructed. Due to its fast readability and large storage capacity, QR coding melon DNA fingerprinting is in favor of read convenience and commercial applications. PMID:23285039
Full Text Available Melon, Cucumis melo L. is an important vegetable crop worldwide. At present, there are phenomena of homonyms and synonyms present in the melon seed markets of China, which could cause variety authenticity issues influencing the process of melon breeding, production, marketing and other aspects. Molecular markers, especially microsatellites or simple sequence repeats (SSRs are playing increasingly important roles for cultivar identification. The aim of this study was to construct a DNA fingerprinting database of major melon cultivars, which could provide a possibility for the establishment of a technical standard system for purity and authenticity identification of melon seeds. In this study, to develop the core set SSR markers, 470 polymorphic SSRs were selected as the candidate markers from 1219 SSRs using 20 representative melon varieties (lines. Eighteen SSR markers, evenly distributed across the genome and with the highest contents of polymorphism information (PIC were identified as the core marker set for melon DNA fingerprinting analysis. Fingerprint codes for 471 melon varieties (lines were established. There were 51 materials which were classified into17 groups based on sharing the same fingerprint code, while field traits survey results showed that these plants in the same group were synonyms because of the same or similar field characters. Furthermore, DNA fingerprinting quick response (QR codes of 471 melon varieties (lines were constructed. Due to its fast readability and large storage capacity, QR coding melon DNA fingerprinting is in favor of read convenience and commercial applications.
Trovik Tordis A
Full Text Available Abstract Background Information on oral health-related quality of life, in addition to clinical measures, is essential for healthcare policy makers to promote oral health resources and address oral health needs. Objectives This paper aimed at evaluating the psychometric properties of the Arabic version of Child-OIDP, estimating the prevalence, severity and causes of oral impacts on daily performances in 12-year-old public and private school attendees in Khartoum State and to identify socio-demographic and clinical correlates of oral impacts as assessed by the Child-OIDP inventory. Methods The Child-OIDP questionnaire was translated into Arabic was administered to a representative sample of 1109 schoolchildren in Khartoum state. Clinical measures employed in this study included DMFT index, Gingival index, Plaque index and Dean's index. A food frequency questionnaire was used to study the sugar-sweetened snack consumption. Results The instrument showed acceptable psychometric properties and is considered as a valid, reliable (Cronbach's alpha 0.73 and practical inventory for use in this population. An impact was reported by 54.6% of the schoolchildren. The highest impact was reported on eating (35.5% followed by cleaning (28.3% and the lowest impacts were on speaking (8.6% and social contact (8.7%. Problems which contributed to all eight impacts were toothache, sensitive teeth, exfoliating teeth, swollen gums and bad breath. Toothache was the most frequently associated cause of almost all impacts in both private and public school attendees. After adjusting for confounders in the 3 multiple variable regression models (whole sample, public and private school attendees, active caries maintained a significant association with the whole sample (OR 2.0 95% CI 1.4-2.6 and public school attendees (OR 3.5 95% CI 2.1-5.6, and higher SES was associated with only public school attendees' Child-OIDP (OR 1.9 95% 1.1-3.1. Conclusion This study showed that the
Discusses the inclusion of child day centers on college campuses and what it takes to provide safe, successful, and fun places that support students, faculty, and staff needs. Areas addressed include safety and security, class and room size, inclusion of child-size toilets, and interior color schemes. (GR)
Vicendese, Don; Dharmage, Shyamali C; Tang, Mimi L K; Olenko, Andriy; Allen, Katrina J; Abramson, Michael J; Erbas, Bircan
Indoor environment factors have been associated with risk of asthma exacerbations in children but little is known about their role on asthma hospital readmissions. As children in Western societies continually spend more time indoors, understanding the influence of these factors on asthma exacerbation is important. We examined the role of indoor environmental and lifestyle characteristics on child asthma readmissions. A hospital-based case-control study recruited 22 children readmitted for asthma and 22 controls not readmitted for asthma. Logistic regression models were used to examine the association between aeroallergens and fungi in the bedroom and indoor lifestyle characteristics factors for asthma readmissions. To determine the best possible set of predictors among a large set of risk factors, we used random forests (RF) techniques. Higher levels of airborne Cladosporium and yeast in the child's bedroom increased risk of readmission (OR = 1.68, 95% CI 1.04-2.72 and OR = 1.52, 95% CI 0.99-2.34, respectively). Carpeted floors in the bedroom and synthetic doonas were also associated with increase in asthma readmissions (OR = 4.07, 95% CI 1.03-16.06 and OR = 14.6, 95% CI 1.26-169.4, respectively). In the home, frequent vacuuming using bagged cleaners increased risk of asthma readmission OR = 15.7 (95% CI 2.82-87.2). Factors in the child's bedroom play an important role in increasing the risk of asthma hospital readmissions. These findings have major clinical implications as the identified potential risk factors may be modifiable. Further epidemiological studies with larger samples are necessary to evaluate these associations further.
Chaplin, E; Bailey, M; Crosby, R; Gorman, D; Holland, X; Hippe, C; Hoff, T; Nawrocki, D; Pichette, S; Thota, N
Health care has a number of historical barriers to capturing the voice of the customer and to incorporating customer wants into health care services, whether the customer is a patient, an insurer, or a community. Quality function deployment (QFD) is a set of tools and practices that can help overcome these barriers to form a process for the planning and design or redesign of products and services. The goal of the project was to increase referral volume and to improve a rehabilitation hospital's capacity to provide comprehensive medical and/or legal evaluations for people with complex and catastrophic injuries or illnesses. HIGH-LEVEL VIEW OF QFD AS A PROCESS: The steps in QFD are as follows: capture of the voice of the customer, quality deployment, functions deployment, failure mode deployment, new process deployment, and task deployment. The output of each step becomes the input to a matrix tool or table of the next step of the process. In 3 1/2 months a nine-person project team at Continental Rehabilitation Hospital (San Diego) used QFD tools to capture the voice of the customer, use these data as the basis for a questionnaire on important qualities of service from the customer's perspective, obtain competitive data on how the organization was perceived to be meeting the demanded qualities, identify measurable dimensions and targets of these qualities, and incorporate the functions and tasks into the delivery of service which are necessary to meet the demanded qualities. The future of providing health care services will belong to organizations that can adapt to a rapidly changing environment and to demands for new products and services that are produced and delivered in new ways.
Sredzińska-Kita, Dorota; Mrugacz, Małgorzata; Bakunowicz-Łazarczyk, Alina
The main aim of our work was to estimate the physical and psychomotor development and the arrangement to the daily life for a 8-year-old girl with inborn bilateral anophthalmia. The basic ophthalmic, pediatric and neurological examinations were performed with additional genetic and radiological examinations. The ophthalmic and MRI examination find out the absence of the eyeballs, optic nerves, optic chiasm, optic tracts and optic radiation. Anophthalmia limits in a big grade an independent life of the child. However, currently the girl's development indicates for good intellectual abilities what is promising for future independent life and professional work.
Nieuwesteeg, Anke M; Pouwer, Frans; van Bakel, Hedwig Ja
BACKGROUND: In young children with type 1 diabetes mellitus (T1DM) parents have full responsibility for the diabetes-management of their child (e.g. blood glucose monitoring, and administering insulin). Behavioral tasks in childhood, such as developing autonomy, and oppositional behavior (e......). METHODS/DESIGN: First, we will examine which situations are most suitable for observing diabetes-specific interactions. Then, these situations will be video-taped in a pilot study (N = 15). Observed behaviors are described into rating scales, with each scale describing characteristics of parent...
Hammarberg, Karin; Prentice, Tess; Purcell, Isabelle; Johnson, Louise
Many factors influence the chance of having a baby with assisted reproductive technologies (ART). A 2016 Australian Competition and Consumer Commission (ACCC) investigation concluded that ART clinics needed to improve the quality of information they provide about chance of ART success. To evaluate changes in the quality of information about success rates provided on the websites of ART clinics in Australia and New Zealand before and after the ACCC investigation. Desktop audits of websites of ART clinics in Australia and New Zealand were conducted in 2016 and 2017 and available information about success rates was scored using a matrix with eight variables and a possible range of scores of 0-9. Of the 54 clinic websites identified in 2016, 32 had unique information and were eligible to be audited. Of these, 29 were also eligible to be audited in 2017. While there was a slight improvement in the mean score from 2016 to 2017 (4.93-5.28), this was not statistically significantly different. Of the 29 clinics, 14 had the same score on both occasions, 10 had a higher and five a lower information quality score in 2017. To allow people who consider ART to make informed decisions about treatment they need comprehensive and accurate information about what treatment entails and what the likely outcomes are. As measured by a scoring matrix, most ART clinics had not improved the quality of the information about success rates following the ACCC investigation. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Felfe, Christina; Lalive, Rafael
Many countries are currently expanding access to child care for young children. But are all children equally likely to benefit from such expansions? We address this question by adopting a marginal treatment effects framework. We study the West German setting where high quality center - based care is severely rationed and use within state differences in child care supply as exogenous variation in child care attendance. Data from the German Socio-Economic Panel provides comprehensive informa...
To investigate the effect of implementing the Touchpoints methodology by nurses in the following variables: quality of mother-infant interaction; infant development; maternal representations of child temperament and mothers' perception of the quality of relationship with nurses. Quasi-experimental longitudinal study, including 86 child-mother dyads distributed equally for: Group with Intervention (GI) (n=43), Group without Intervention (GWI) (n=43). These groups belonged to paired samples according to the following criteria: maternal age; socio-economic class; family structure; child health; parents' physical or psychological health; twins; family's nationality; risk during pregnancy; baby APGAR. Paired samples with the same routine visits allowed comparing the impact of Touchpoints intervention on the above mentioned variables. The monitoring of the two groups took place in a period of between 11 and 24 months of children's life (four moments of assessment), being held two Touchpoints sessions in the GI at 12 and 18 months. Two Touchpoints interventions sessions were applied in the GI as follows: the first time, at 12 months; the second time, at 24 months, child age. The instruments used for data collection were: Schedule of Growing Skills II (SGS II); CARE-Index; Temperament Scale; Parent-Caregiver Relationship Scale - parents' version. Infant Locomotor development (p=.036) and maternal representations about the child and motherhood (Z=5.737; p=.019) improved in the GI. No significant results were found for mother-infant interaction in this direct comparison. Nevertheless, findings indicate that maternal sensitivity and infant cooperative behaviour increased from 12 to 24 months in the GI [t(41)=4.513; p<.001], whereas it decreased in the GWI (from 8.62 at 12 months to 8.40 at 24 months). The means of mothers' perceptions of Trust/Caring towards nurses in the GI were higher than in GWI after six months of the Touchpoints intervention [t(84)=2.146; p<.001; M_GI=34
Natan, Merav Ben; Beyil, Valery; Neta, Okev
A correlational design was used to examine nursing staff attitudes and subjective norms manifested in intended and actual care of drug users based on the Theory of Reasoned Action. One hundred and thirty-five nursing staff from three central Israeli hospitals completed a questionnaire examining theory-based variables as well as sociodemographic and professional characteristics. Most respondents reported a high to very high level of actual or intended care of drug users. Nurses' stronger intentions to provide quality care to drug users were associated with more positive attitudes. Nursing staff members had moderately negative attitudes towards drug users. Nurses were found to hold negative stereotypes of drug addict patients and most considered the management of this group difficult. Positive attitudes towards drug users, perceived expectations of others and perceived correctness of the behaviour are important in their effect on the intention of nurses to provide high-quality care to hospitalized patients addicted to drugs.
Jeung Seung Hun [Dept. of Radiology, SeoSan JungAng General Hospital, Seosan (Korea, Republic of); Han, Beom Hul [Dept. of Radiological Science, SeoNam University, Gwangju (Korea, Republic of); Jung, Hong Ryang [Dept. of Radiological Science, Hanseo University, (Korea, Republic of)
Since in case of children, they are sensitive to the radiation compared to the adult and the potential exposure damage lasts longer, the exposure dose should be managed better than for the adult. Therefore, this study was conducted to observe the change in the chest x-ray image by the use of grid, which eliminates the scattering rays but increases the exposure dose during the child chest x-ray examination. As a research method, SNR, CNR and V. Vuichi were measured at 100 cm and 180 cm with the grid varying the kVp to 70, 90 and 110. In addition, SNR, CNR and V. Vuichi were measured fixing 100 cm and 180cm without grid and varying the dose to 6, 8 and 10 mAs. In the results of measuring them by fixing kVp, SNR, VNR and V. Vuichi were represented high when FID is 100cm. And in the results of meaduring them varying mAs, SNR, VNR and V. Vuichi were represented high when FID is 100cm. Currently in our country, the chest x-ray examination is performed at 180 cm. However, as the image is measured high when FID is 100 cm, in case of child, FID is deemed to be 100 cm.
Jeung Seung Hun; Han, Beom Hul; Jung, Hong Ryang
Since in case of children, they are sensitive to the radiation compared to the adult and the potential exposure damage lasts longer, the exposure dose should be managed better than for the adult. Therefore, this study was conducted to observe the change in the chest x-ray image by the use of grid, which eliminates the scattering rays but increases the exposure dose during the child chest x-ray examination. As a research method, SNR, CNR and V. Vuichi were measured at 100 cm and 180 cm with the grid varying the kVp to 70, 90 and 110. In addition, SNR, CNR and V. Vuichi were measured fixing 100 cm and 180cm without grid and varying the dose to 6, 8 and 10 mAs. In the results of measuring them by fixing kVp, SNR, VNR and V. Vuichi were represented high when FID is 100cm. And in the results of meaduring them varying mAs, SNR, VNR and V. Vuichi were represented high when FID is 100cm. Currently in our country, the chest x-ray examination is performed at 180 cm. However, as the image is measured high when FID is 100 cm, in case of child, FID is deemed to be 100 cm
Rogers, Eleanor; Ali, Muhammad; Fazal, Shahid; Kumar, Deepak; Guerrero, Saul; Hussain, Imtiaz; Soofi, Sajid; Alvarez Morán, Jose Luis
To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community. Cross-sectional quality-of-care study. The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model. LHW implementing treatment for uncomplicated SAM in the community. Oedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %. This quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.
Zhu, Jason; Zhang, Tian; Shah, Radhika; Kamal, Arif H; Kelley, Michael J
Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may
This study assesses the effectiveness of a quality-improvement (QI) package designed to enable small-scale commercial reproductive health (RH) service providers to improve the services they offer. The study was conducted among midwives who are members of the Uganda Private Midwives Association. A pretest-post-test quasi-experimental panel study design was used wherein midwife clinics were allocated to two experimental groups and one control group. Baseline and follow-up measurements of structural and process attributes of quality were taken at the clinics by means of a facility inventory, interviews with midwives, and observations of client-provider interactions. Nearly 70 percent of the midwives who were trained to use the package reported that it was easy to use. Among clinics in which midwives received training in the use of the self-assessment tool and in developing action plans, structural and process attributes of quality improved only among those clinics in which the midwives' supervisors received training in finding solutions to the problems identified through self-assessments. The QI package may be implemented with small-scale private providers of RH services who are part of a professional association, network, or franchise that supervises their performance.
This issue brief presents data on the cost of child care, collected from local child care resource and referral agencies (CCR&Rs) surveyed by the Children's Defense Fund. The report's key findings on the high cost of child care are: (1) child care for a 4-year-old in a child care center averages $4,000 to $6,000 a year in cities and states…
Ensuring access to safe drinking water is a key strategy for reducing waterborne illness. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP) differentiates between unimproved and improved sources to universally classify water access. This classification, however, is based on the type and location of the water source and does not take into account water quality; even sources classified as improved can have compromised water quality and pose a health risk from water...
Muhammad Ashraf Majrooh
Full Text Available BACKGROUND: Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In 'Pakistan' antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to 'Divisions' and 'Districts'. By population 'Punjab' is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in 'Punjab' province of 'Pakistan'. METHODS: Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. RESULTS: The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. CONCLUSION: The coverage and quality of the antenatal care services in 'Punjab' are extremely compromised. Only half of the expected pregnancies are enrolled and
Rayess, Hani; Zuliani, Giancarlo F; Gupta, Amar; Svider, Peter F; Folbe, Adam J; Eloy, Jean Anderson; Carron, Michael A
The number of patients using the internet to obtain health information is growing. This material is unregulated and heterogeneous and can influence patient decisions. To compare the quality, readability, and technical aspects of online information about neck-lifts provided by private practice websites vs academic medical centers and reference sources. In this cross-sectional analysis conducted between November 2015 and January 2016, a Google search of the term neck-lift was performed, and the first 45 websites were evaluated. The websites were categorized as private practice vs other. Private websites (PWs) included sites created by private practice physicians. Other websites (OWs) were created by academic medical centers or reference sources. Quality, readability, and technical aspects of online websites related to neck-lifts. Quality was assessed using the DISCERN criteria and the Health on the Net principles (HONcode). Readability was assessed using 7 validated and widely used criteria. Consensus US reading grade level readability was provided by a website (readabilityformulas.com). Twelve technical aspects were evaluated based on criteria specified by medical website creators. Forty-five websites (8 OWs [18%] and 37 PWs [82%]) were analyzed. There was a significant difference in quality between OWs and PWs based on the DISCERN criteria and HONcode principles. The DISCERN overall mean (SD) scores were 2.3 (0.5) for OWs and 1.3 (0.3) for PWs (P analysis, the mean (SD) was 8.6 (1.8) (range, 5-11) for OW, and the mean (SD) was 5.8 (1.7) (range, 2-9) for PW. The mean (SD) readability consensus reading grade level scores were 11.7 (1.9) for OWs and 10.6 (1.9) for PWs. Of a total possible score of 12, the mean (SD) technical scores were 6.3 (1.8) (range, 4-9) for OWs and 6.4 (1.5) (range, 3-9) for PWs. Compared with PWs, OWs had a significantly higher quality score based on both the DISCERN criteria and HONcode principles. The mean readability for OWs and PWs was
Lichtenstein, Brian J.; Reuben, David B.; Karlamangla, Arun S.; Han, Weijuan; Roth, Carol P.; Wenger, Neil S.
OBJECTIVES to examine the effects of delegation on quality of care that patients receive for three common geriatric conditions: dementia, falls, and incontinence. DESIGN pooled analysis of 8 the Assessing Care of Vulnerable Elders (ACOVE) projects from 1998 to 2010. SETTING 15 ambulatory practice sites across the United States PARTICIPANTS 4,776 patients age ≥ 65 years, of mixed demographic backgrounds who participated in ACOVE studies. INTERVENTION multivariate analysis of prior ACOVE observation and intervention studies was conducted, with in addition to two retrospectively defined variables: “intent to delegate” and “maximum delegation” for each ACOVE quality indicator (QI). MEASUREMENTS The primary outcome for the study was QI pass probability, by level of delegation, for 47 ACOVE quality indicators. RESULTS A total of 4,776 patients were evaluated, with 16,204 QIs included for analysis. Across all studies, QI pass probabilities were 0.36 for physician-performed tasks; 0.55 for nurse practitioner (NP), physician assistant (PA), and registered nurse (RN)-performed tasks; and 0.61 for medical assistant (MA), or licensed vocational nurse (LVN)-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, or RNs was 1.37 (p = 0.055) CONCLUSIONS Delegation to non-physician providers is associated with higher quality of care for geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions among older adults. PMID:26480977
Lampi, Jussi; Ung-Lanki, Sari; Santalahti, Päivi; Pekkanen, Juha
Questionnaires can be used to assess perceived indoor air quality and symptoms in schools. Questionnaires for primary school aged children have traditionally been parent-administered, but self-administered questionnaires would be easier to administer and may yield as good, if not better, information. Our aim was to compare the repeatability of self- and parent-administered indoor air questionnaires designed for primary school aged pupils. Indoor air questionnaire with questions on child's symptoms and perceived indoor air quality in schools was sent to parents of pupils aged 7-12 years in two schools and again after two weeks. Slightly modified version of the questionnaire was administered to pupils aged 9-12 years in another two schools and repeated after a week. 351 (52%) parents and 319 pupils (86%) answered both the first and the second questionnaire. Test-retest repeatability was assessed with intra-class correlation (ICC) and Cohen's kappa coefficients (k). Test-retest repeatability was generally between 0.4-0.7 (ICC; k) in both self- and parent-administered questionnaire. In majority of the questions on symptoms and perceived indoor air quality test-retest repeatability was at the same level or slightly better in self-administered compared to parent-administered questionnaire. Agreement of self- and parent administered questionnaires was generally indoor air quality. Children aged 9-12 years can give as, or even more, repeatable information about their respiratory symptoms and perceived indoor air quality than their parents. Therefore, it may be possible to use self-administered questionnaires in future studies also with children.
Ferro, Mark A; Avery, Lisa; Fayed, Nora; Streiner, David L; Cunningham, Charles E; Boyle, Michael H; Lach, Lucyna; Glidden, Gina; Rosenbaum, Peter L; Ronen, Gabriel M
To describe the developmental trajectories of quality of life (QoL) in a large cohort of children with epilepsy, and to assess the relative contribution of clinical, psychosocial, and sociodemographic variables on QoL trajectories. Five assessments during a 28-month prospective cohort study were used to model trajectories of QoL. Participants were recruited with their parents from six Canadian tertiary centers. A convenience sample of 506 children aged 8-14 years with epilepsy and without intellectual disability or autism spectrum disorder were enrolled. A total of 894 children were eligible and 330 refused participation. Participating children were, on average, 11.4 years of age, and 49% were female. Nearly one third (32%) had partial seizures. At baseline, 479 and 503 child- and parent-reported questionnaires were completed. In total, 354 children (74%) and 366 parents (73%) completed the 28-month follow-up. QoL was measured using the child- and parent-reported version of the Childhood Epilepsy QoL scale (CHEQOL-25). Child-reported QoL was fitted best by a six-class model and parent-reported QoL by a five-class model. In both models, trajectories remained either stable or improved over 28 months. Of these children, 62% rated their QoL as high or moderately high, defined as at least one standard deviation above the average CHEQOL-25 score. Greater family, classmate, and peer social support, fewer symptoms of child and parent depression, and higher receptive vocabulary were identified as the most robust predictors of better QoL (all p < 0.001). Most children with epilepsy and their parents reported relatively good QoL in this first joint self- and proxy-reported trajectory study. Findings confirm the heterogeneous QoL outcomes for children with epilepsy and the primary importance of psychosocial factors rather than seizure and AED-specific factors in influencing QoL. These predictors that are potentially amenable to change should now be the focus of specific
Abegunde, Dele; Orobaton, Nosa; Sadauki, Habib; Bassi, Amos; Kabo, Ibrahim A; Abdulkarim, Masduq
Improving maternal and child health remains a top priority in Nigeria's Bauchi State in the northeastern region where the maternal mortality ratio (MMR) and infant mortality rate (IMR) are as high as 1540 per 100,000 live births and 78 per 1,000 live births respectively. In this study, we used the framework of the continuum of maternal and child care to evaluate the impact of interventions in Bauchi State focused on improved maternal and child health, and to ascertain progress towards the achievement of Millennium Development Goals (MDGs) 4 and 5. At baseline (2012) and then at follow-up (2013), we randomly sampled 340 households from 19 random locations in each of the 20 Local Government Areas (LGA) of Bauchi State in Northern Nigeria, using the Lot Quality Assurance Sampling (LQAS) technique. Women residents in the households were interviewed about their own health and that of their children. Estimated LGA coverage of maternal and child health indicators were aggregated across the State. These values were then compared to the national figures, and the differences from 2012 to 2014 were calculated. For several of the indicators, a modest improvement from baseline was found. However, the indicators in the continuum of care neither reached the national average nor attained the 90% globally recommended coverage level. The majority of the LGA surveyed were classifiable as high priority, thus requiring intensified efforts and programmatic scale up. Intensive scale-up of programs and interventions is needed in Bauchi State, Northern Nigeria, to accelerate, consolidate and sustain the modest but significant achievements in the continuum of care, if MDGs 4 and 5 are to be achieved by the end of 2015. The intentional focus of LGAs as the unit of intervention ought to be considered a condition precedent for future investments. Priority should be given to the re-allocating resources to program areas and regions where coverage has been low. Finally, systematic considerations
Full Text Available Improving maternal and child health remains a top priority in Nigeria's Bauchi State in the northeastern region where the maternal mortality ratio (MMR and infant mortality rate (IMR are as high as 1540 per 100,000 live births and 78 per 1,000 live births respectively. In this study, we used the framework of the continuum of maternal and child care to evaluate the impact of interventions in Bauchi State focused on improved maternal and child health, and to ascertain progress towards the achievement of Millennium Development Goals (MDGs 4 and 5.At baseline (2012 and then at follow-up (2013, we randomly sampled 340 households from 19 random locations in each of the 20 Local Government Areas (LGA of Bauchi State in Northern Nigeria, using the Lot Quality Assurance Sampling (LQAS technique. Women residents in the households were interviewed about their own health and that of their children. Estimated LGA coverage of maternal and child health indicators were aggregated across the State. These values were then compared to the national figures, and the differences from 2012 to 2014 were calculated.For several of the indicators, a modest improvement from baseline was found. However, the indicators in the continuum of care neither reached the national average nor attained the 90% globally recommended coverage level. The majority of the LGA surveyed were classifiable as high priority, thus requiring intensified efforts and programmatic scale up.Intensive scale-up of programs and interventions is needed in Bauchi State, Northern Nigeria, to accelerate, consolidate and sustain the modest but significant achievements in the continuum of care, if MDGs 4 and 5 are to be achieved by the end of 2015. The intentional focus of LGAs as the unit of intervention ought to be considered a condition precedent for future investments. Priority should be given to the re-allocating resources to program areas and regions where coverage has been low. Finally, systematic
Wiener, Lori; Viola, Adrienne; Kearney, Julia; Mullins, Larry L; Sherman-Bien, Sandra; Zadeh, Sima; Farkas-Patenaude, Andrea; Pao, Maryland
Caregiving stress has been associated with changes in the psychological and physical health of parents of children with cancer, including both partnered and single parents. While parents who indicate "single" on a demographic checklist are typically designated as single parents, a parent can be legally single and still have considerable support caring for an ill child. Correspondingly, an individual can be married/partnered and feel alone when caring for a child with serious illness. In the current study, we report the results from our exploratory analyses of parent self-reports of behavior changes during their child's treatment. Parents (N = 263) of children diagnosed with cancer were enrolled at 10 cancer centers. Parents reported significant worsening of all their own health behaviors surveyed, including poorer diet and nutrition, decreased physical activity, and less time spent engaged in enjoyable activities 6 to 18 months following their child's diagnosis. More partnered parents found support from friends increased or stayed the same since their child's diagnosis, whereas a higher proportion of lone parents reported relationships with friends getting worse. More lone parents reported that the quality of their relationship with the ill child's siblings had gotten worse since their child's diagnosis. Spiritual faith increased for all parents. © 2015 by Association of Pediatric Hematology/Oncology Nurses.
Rao, A R
Although child survival programs may help to increase the life span of poor children in developing countries such as India, the quality of life will remain unchanged unless the value of involving children in health education efforts is recognized. The primary health care strategy seeks to involve children and communities in making decisions and taking actions to improve their health. Children can be engaged in the learning process through activities such as helping to care for younger siblings, educating children of their own age who are not attending school, and spreading preventive health messages to their homes and communities. Numerous studies have confirmed that children are easily motivated to play such roles and have the desire to transfer their knowledge to others; however, it is essential that health education messages are appropriate for the level of the child. Specific messages with tested effectiveness in child-to-child programs include accident prevention, dental hygiene, neighborhood hygiene, use of oral rehydration in cases of diarrhea, recognition of signs of major illness, care of sick children, use of play and mental stimulation to enhance children's development, and the making of toys and games to aid growth. Children can further be instructed to identify peers with sight and hearing problems as well as those with nutritional deficiencies. In the Malvani Project in Bombay, children are given responsibility for the health care of 3-4 families in their neighborhood. In the NCERT Project in New Delhi, children are organizing artistic exhibitions and plays to convey health messages to their peers who are not in school. Also in New Delhi, the VHAI Project has enlisted children in campaigns to prevent diarrhea and dehydration, smoking, and drug use.
Steele, Joseph R; Schomer, Don F
Imaging services constitute a huge portion of the of the total dollar investment within the health care enterprise. Accordingly, this generates competition among medical specialties organized along service lines for their pieces of the pie and increased scrutiny from third-party payers and government regulators. These market and political forces create challenge and opportunity for a hospital-based radiology practice. Clearly, change that creates or builds greater value for patients also creates sustainable competitive advantage for a radiology practice. The somewhat amorphous concept of quality constitutes a significant value driver for innovation in this scenario. Quality initiatives and programs seek to define and manage this amorphous concept and provide tools for a radiology practice to create or build more value. Leadership and the early adoption of these inevitable programs by a radiology practice strengthens relationships with hospital partners and slows the attrition of imaging service lines to competitors.
Krejsler, John B.
The article argues that Early Childhood Education & Care (ECEC) is being redesigned based on quality reform discourse with references to global knowledge economy across Nordic countries and the EU. This takes place in policy processes that extend from transnational agents like the OECD and EU...... to national governments, local municipalities and ECEC institutions. Drawing on theoretical insights from Foucauldian genealogy, Laclau and others, the article explores how these policy processes reconfigure what counts as quality in ECEC in a Danish context. It is substantiated how the Danish government...... promotes governance structures among municipalities and professionals that pull ECEC into comprehensive educational strategies. This process draws on policy advice from the OECD and EU. Quality reform thus changes in fundamental ways the organisation and content in ECEC. In discourse, learning displaces...
Beehler, Gregory P; Lilienthal, Kaitlin R; Possemato, Kyle; Johnson, Emily M; King, Paul R; Shepardson, Robyn L; Vair, Christina L; Reyner, Jacqueline; Funderburk, Jennifer S; Maisto, Stephen A; Wray, Laura O
Primary care behavioral health (PCBH) is a population-based approach to delivering mental and behavioral health care in the primary care setting. Implementation of the PCBH model varies across practice settings, which can impact how PCBH providers deliver services to patients and in turn may predict a variety of important outcomes. This article aims to characterize PCBH provider engagement in key processes of integrated care as demonstrated in results from empirical studies of real-world clinical practice. For this narrative review of published studies on PCBH provider engagement in processes of care, PubMed and PsycINFO databases were searched from January 1990 through May 2016 to identify relevant articles. Provider adherence to the brief, time-limited treatment model appears suboptimal. Common mental health conditions, such as depression, were often the primary focus of provider attention, with less consistent emphasis on behavioral medicine concerns. Whereas providers regularly conducted qualitative functional assessments with patients, routine use of standardized measures was low. Engagement in interprofessional collaboration with the primary care team was also low, but engagement in behaviors that fostered therapeutic relationships was high. This review identified several strengths and weaknesses of typical PCBH provider practices. Results are discussed in relation to their value as areas for future quality improvement initiatives that can improve PCBH service delivery and, ultimately, patient outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Snyder, James; Gewirtz, Abigail; Schrepferman, Lynn; Gird, Suzanne R.; Quattlebaum, Jamie; Pauldine, Michael R.; Elish, Katie; Zamir, Osnat; Hayes, Charles
Transactional cascades among child internalizing and externalizing symptoms, and fathers’ and mothers’ post-traumatic stress disorder symptoms were examined in a sample of families with a male parent who had been deployed to recent military conflicts in the Middle East. The role of parents’ positive engagement and coercive interaction with their child, and family members’ emotion regulation were tested as processes linking cascades of parent and child symptoms. A subsample of 183 families with deployed fathers and non-deployed mothers and their 4 to 13 year old children who participated in a randomized control trial intervention (After Deployment: Adaptive Parenting Tools, or ADAPT) were assessed at baseline prior to intervention, and at 12 and 24 months after baseline, using parent reports of their own and their child’s symptoms. Parents’ observed behavior during interaction with their children was coded using a multi-method approach at each assessment point. Reciprocal cascades among fathers’ and mothers’ PTSD symptoms, and child internalizing and externalizing symptoms were observed. Fathers’ and mothers’ positive engagement during parent-child interaction linked their PTSD symptoms and their child’s internalizing symptoms. Fathers’ and mothers’ coercive behavior toward their child linked their PTSD symptoms and their child’s externalizing symptoms. Each family members’ capacity for emotion regulation was associated with their adjustment problems at baseline. Implications for intervention, and for research using longitudinal models and a family-systems perspective of co-occurrence and cascades of symptoms across family members are described. PMID:27739388
Leigh, Roland J.; Whyte, C.; Cutter, M. A.; Lobb, D. R.; Monks, P. S.
Under the first phase of the Centre for Earth Observation Instrumentation (CEOI), a breadboard demonstrator of a novel UV/VIS spectrometer has been developed. Using designs from Surrey Satellite Technology Ltd (SSTL) the demonstrator has been constructed and tested at the University of Leicester's Space Research Centre. This spectrometer provides an exceptionally compact instrument for differential optical absorption spectroscopy (DOAS) applications from LEO, GEO, HAP or ground-based platforms. Measurement of atmo spheric compounds with climate change or air quality implications is a key driver for the ground and space-based Earth Observation communities. Techniques using UV/VIS spectroscopy such as DOAS provide measurements of ozone profiles, aerosol optical depth, certain Volatile Organic Compounds, halogenated species, and key air quality parameters including tropospheric nitrogen dioxide. Compact instruments providing the necessary optical performance and spectral resolution are therefore a key enabling technology. The Compact Air Quality Spectrometer (CompAQS) features a concentric arrangement of a spherical meniscus lens, a concave spherical mirror and a suitable curved diffraction grating. This compact design provides efficiency and performance benefits over traditional concepts, improving the precision and spatial resolution available from space borne instruments with limited weight and size budgets. The breadboard spectrometer currently operating at the University of Leicester offers high throughput with a spectral range from 310 to 450 nm at 0.5nm(UV) to 1.0nm (visible) resolution, suitable for DOAS applications. The concentric design is capable of handling high relative apertures, owing to spherical aberration and coma being near zero at all surfaces. The design also provides correction for transverse chromatic aberration and distortion, in addition to correcting for the distortion called `smile' - the curvature of the slit image formed at each
Vandeweghe, Laura; Moens, Ellen; Braet, Caroline; Van Lippevelde, Wendy; Vervoort, Leentje; Verbeken, Sandra
The aim of the current study is to identify strategies to promote healthy eating in young children that can be applied by caregivers, based on their own perceptions of effectiveness and feasibility. Whereas previous research mainly focused on parental influences on children's eating behavior, the growing role of other caregivers in the upbringing of children can no longer be denied. Four focus groups were conducted with three types of caregivers of post-weaning children under 6 years old: parents (n = 14), family child care providers (n = 9), and daycare assistants (n = 10). The audiotaped focus group discussions were transcribed and imported into Nvivo 10.0 for thematic analysis. The behaviors put forward by the caregivers were categorized within three broad dimensions: global influences, general behaviors, and specific feeding practices. Perceived effective strategies to promote healthy eating behavior in children included rewards, verbal encouragement, a taste-rule, sensory sensations, involvement, variation, modeling, repeated exposure, and a peaceful atmosphere. Participants mainly disagreed on the perceived feasibility of each strategy, which largely depended on the characteristics of the caregiving setting (e.g. infrastructure, policy). Based on former research and the current results, an intervention to promote healthy eating behaviors in young children should be adapted to the caregiving setting or focus on specific feeding practices, since these involve simple behaviors that are not hindered by the limitations of the caregiving setting. Due to various misconceptions regarding health-promoting strategies, clear instructions about when and how to use these strategies are necessary.