Adult health in child care: Health status,behaviors, and concerns of teachers,directors, and family child care providers

This article reports the results of a statewide survey of health status, behaviors, and concerns of 446 randomly selected early childhood professionals (78 group child care center directors, 236 teachers, and 132 family child care providers). More than 85% of each professional group rated their health as either good or excellent; 87% have worked when ill. Twenty-five percent of the sample (33% directors, 15% staff, 36% family providers) have become pregnant since working in child care. Respondents reported being “overweight” at levels more than twice state adult frequencies. Dramatic changes were reported in perceived frequency of various symptoms and becoming ill since working in child care. Significant differences between the groups were found for number of absences due to illness, nutrition, stressfulness of working in child care, and ergonomics and physical demands of the job.     

Evaluation of Mental Health Consultation in Child Care Centers

Mental health professionals have speculated that their consultation services should improve the overall quality of a child care center, but few research studies have shown this effect in child care settings. In the present study, mental health consultation services were provided by four agencies to 25 urban child care centers to enhance children's emotional lives and social abilities, and to strengthen child care center staff's capacity to work with children who have difficult behaviors. A one-year evaluation was conducted to assess the impact of the mental health services on the teachers and child care centers using observational measures, director- and teacher-completed questionnaires, and qualitative focus group data. Centers with more than one year of consultation showed increases in overall quality, teachers' self-efficacy, and teachers' competence. In addition, staff expressed satisfaction with the mental health consultation services provided. Implications of findings and suggestions for future interventions are discussed.     

Why are suspected cases of child maltreatment referred by educators so often unsubstantiated?

School professionals have a unique vantage point for identifying child maltreatment and they are a frequent source of referral to child protective services. Disturbingly, past studies have found that maltreatment concerns reported by educators go unsubstantiated by child protective services at much higher rates than suspected maltreatment reported by other professionals. This study explores whether there are systematic differences in the characteristics of cases reported by educators as compared to other professionals and examines whether such variation might account for differences in investigation outcome. Analyses were based on 7,725 cases of suspected maltreatment referred by professionals to child protective services from the Canadian Incidence Study of Reported Child Abuse and Neglect – 2003 a national database on the characteristics of children and families investigated by child protective services. School professionals were responsible for 35.8% of professional referrals. Reports by educators were much more likely to be unsubstantiated (45.3%) than those by other professionals (28.4%) in subsequent child protective investigation. Cases reported by educators were found to contain significantly more child risk factors (e.g., child emotional and behavioural problems) and fewer caregiver and family risk factors (e.g., caregiver mental health problem, single parent family) than cases reported by other professionals. Even controlling for these differences, educator-reported concerns were still 1.84, 95% CI [1.41, 2.40] times as likely to be unsubstantiated as reports from other professionals. Contrary to the notion that educators are mostly reporting non-severe cases, suspected/substantiated cases reported by school professionals were more likely to be judged as chronic and more likely to involve families with a previous child protection history. Results are concerning for the capacity of the education and child protection systems to work together to meet their shared goal of promoting healthy child development. Additional research is needed on the way in which child risks and problems influence child protective service, particularly in the context of chronic abuse and neglect and lack of availability of child and family mental health interventions. Potential problems with credibility of school professionals as reporters of child maltreatment concerns also warrant further investigation.     

Day care homes can foster children's health

Conclusion Because so many infants and young children are cared for in family day care homes, these can play a very important role in the promotion of children's health. Parents and family day care home caregivers should work closely to provide adequate child health supervision, emergency care, nutrition education, mental health services, and sick care services. Further documentation of the health-service needs in this area would be useful in indicating where in-service training and health education for parents and caregivers should be concentrated. Health professionals from both private and public agencies should begin to direct their efforts on behalf of the many children who are cared for in family day care homes and to utilize these as resources for health promotion and disease prevention.     

医疗保健体育与高职护理专业结合教学探索

运用问卷调查、文献资料、对比实验、数理统计等方法,对襄樊职业技术学院医学院高级护理专业医疗保健体育教学进行调研分析。结论：医疗保健体育教学与护理专业技能培养形成了有机结合的教学模式,提高了高职生身心健康水平,促进高职生掌握医疗保健专业知识;为高职院校体育教学改革更好地服务专业教学开辟了新的途径。对策：提高学生对医疗保健体育价值的认识;把医疗保健体育作为基础课纳入护理专业教学体系;加强医疗保健体育教师队伍建设。     

Many women and providers are unprepared for an evidence-based, educated conversation about birth

Findings from recent Canadian studies on the knowledge and beliefs about birth practices among first-time pregnant women and among obstetricians and other birth providers indicate that many women are inadequately informed and many providers deliver non-evidence-based maternity care. Consequently, informed decision making is problematic for pregnant women and their providers. New strategies are needed to inform pregnant women about key procedures and approaches that might be used in birth so they can have an educated, shared discussion with their provider and successfully advocate for their preferred birth experience. In addition, providers can be encouraged to supplement their knowledge with current, evidence-based maternity care practices. To avoid a lack of informed decision making and to ensure that natural, safe, and healthy birth practices are based on current evidence, pregnant women and providers must work together to inform themselves and to add childbirth to the women's health agenda.     

Safe,Healthy Birth: What Every Pregnant Woman Needs to Know

In spite of technology and medical science''s ability to manage complex health problems, the current maternity care environment has increased risks for healthy women and their babies. It comes as a surprise to most women that standard maternity care does not reflect best scientific evidence. In this column, evidence-based maternity care practices are discussed with an emphasis on the practices that increase safety for mother and baby, and what pregnant women need to know in order to have safe, healthy births is described.     

Back pain/discomfort in pregnancy: invisible and forgotten

This paper is a comprehensive literature review of original research on the nature of back pain/discomfort in pregnancy. The causes of back pain/discomfort in pregnancy are reviewed and discussed, and the clinical manifestations and implications are explored. This analysis revealed that approximately 50% of pregnant women experience back pain/discomfort with little or no intervention from their health care providers. Thus, back pain/discomfort in pregnancy seems to be invisible and forgotten in contemporary antenatal care. Evidence-based guidelines are provided for both women and health professionals as a way of increasing attention to the prevention of unnecessary back pain/discomfort during pregnancy.     

Teasing apart the child care conundrum: A factorial survey analysis of perceptions of child care quality, fair market price and willingness to pay by low-income, African American parents

Child care quality plays a crucial role in children's social and cognitive development. While child care quality is a critical issue for all children, it matters more for low-income children. Policy makers have increased the emphasis on allowing parents, not government, to make decisions about the type of care they want for their children. Yet most research on child care quality has focused on how child care professionals, not parents define high quality care. This study investigates how low-income families evaluate child care quality by examining the child care preferences of a sample of low-income African American parents. We employ the factorial survey method, a method used in sociological research to assess people's perceptions and rankings of individual attributes associated with complex multidimensional phenomena. The factorial survey method permits a simultaneous assessment of how respondents evaluate and make tradeoffs among multiple child care characteristics. We assess the impact of child care characteristics on respondents’ perceptions of child care desirability, fair market value, and willingness to pay. Findings indicate that parents’ definition of quality focused squarely on the care giving environment, specifically the qualifications, experience, training and behavior associated with the child care provider. The type of care facility—family, center, relative or neighbor care was largely irrelevant to this sample of parents. Parents believed that the characteristics they defined as desirable child care situations were worth more, and parents were willing to pay more for these characteristics. These parents also defined quality in terms of race and class, and they wanted racial and economic diversity. This research suggests parents may choose lower quality care, not because they do not know what quality is or because they define quality care differently, but because such care may be neither available nor affordable in their communities.     

Center-Based Evening Child Care: Implications for Young Children's Development

With increasing numbers of women joining the evening/nighttime workforce, there is a need for quality childcare during these hours. This project, conducted in Japan, sought to compare the effects of child day care, child evening care, and child night care on the development and adaptation of young children. Caregivers completed a survey on the childrearing environment at home, their feelings of self-efficacy, and the presence of support for childcare. Childcare professionals evaluated the development of children. The results of the discriminant analysis indicate that factors in the home environment, not type of center-based care, explained developmental variance.     

Professionals’ preferences and experiences with inter-organizational consultation to assess suspicions of child abuse and neglect

This study addresses the following questions in cases of suspected child abuse and neglect (CAN) in children up to four years of age: 1) How many professionals intend to seek inter-organizational consultation? 2) What types of organizations do professionals prefer to consult? and 3) What factors can be identified as facilitator(s) or barrier(s) regarding inter-organizational consultation, based on professionals’ experiences? Professionals working with children in 101 organizations in a medium-sized Dutch city were invited to fill in an online questionnaire. The questionnaire included a vignette about a suspected case. Quantitative, qualitative, and social network analysis approaches were used to analyze the data. Seventy-eight questionnaires were available for analysis. Fifty-five respondents (71%) intended to seek inter-organizational consultation. Ten different organization types were mentioned. The most frequently mentioned organization was preventive child healthcare. In total, 82 text fragments from 39 participants were available to analyze barriers and facilitators to inter-organizational consultation, 60 fragments that entailed a facilitator and 22 fragments that entailed a barrier. The text fragments were subdivided into twelve factors. The three factors that were most often identified as a facilitator were ‘support’, ‘undertaking action’, and ‘regard’. Barriers were found in relation to all twelve factors. No specific barrier(s) stood out. This study demonstrated that most professionals are inclined to seek inter-organizational consultation when they suspect CAN. They are especially likely to seek consultation from preventive child health care organizations. Their experiences mainly revealed facilitators and few barriers. The implications for research and practice are also discussed.     

Diarrhea Management Training in Early Childhood Settings

This study addresses the health of young children and how to safely and effectively care for children with diarrhea in the home and in early child care settings. A baseline survey showed the prevalence of oral rehydration solution (ORS) usage at last diarrhea bout to be low. An educational workshop was developed to train parents and child care professionals on how to properly manage young children with diarrhea and reduce the risk of diarrhea spread at home and in early childhood settings. Specific intervention activities are discussed and program activities, including specially designed materials for mixing homemade ORS are described. A comparison of pre- and postintervention data indicates substantial gains in knowledge among both urban and rural populations. Implications of research findings are discussed along with suggestions for future research.     

Professionals' decision-making about out-of-home placements following instances of child abuse

OBJECTIVE: The goal of this research was to study how different groups of child welfare professionals prioritize and use information to make placement decisions following instances of child abuse. METHOD: A total of 90 juvenile court judges and guardians ad litem, Court Appointed Special Advocates (CASA), social workers, and mental health professionals responded to a detailed questionnaire describing four case studies of child physical abuse in which a parent was the perpetrator, the child was either 2 years or 6 years of age, and the abuse was either first time or chronic. Participants rated the impact of specific pieces of information regarding child, family, and system-level characteristics on their decision-making process. RESULTS: Analyses of reactions to these vignettes demonstrate that professional groups use different kinds of information when making decisions about foster care placements. Social workers and mental health providers rely on information about the severity and pattern of abuse and on information about services offered in the past and parental responses to those services. Judges and guardians ad litem rely more heavily on information about the likelihood of a reoccurrence of abuse and the child's ability to recount the abuse, whereas CASA volunteers rely on information about the stability of the family. CONCLUSIONS: Professional group membership, rather than factors such as age or ethnicity of the child or chronicity of abuse, accounts for different patterns of prioritizing and using information when making decisions about whether a child should remain in the home or be placed in foster care. The implications for community-based training and intervention efforts are discussed.     

Early childhood special education dental and oral hygiene procedures for young children with special needs

Summary The provision of dental services, including dental treatment and oral hygiene maintenance, to special-needs children presents unique challenges to health care professionals as well as to the parents and guardians of these special patients. A knowledge of dental care and of the implications of the various disorders common to these patients is vital to the long-term dental health of children with special needs. Limitations in treatment choices must be carefully explained to parents or guardians if inappropriate expectations are to be avoided. Many of the techniques of delivering quality dental services are difficult, time-consuming, and complicated. Yet it should be noted that the restoration of a diseased mouth takes more time and is more costly both monetarily and psychologically than efforts to provide adequate maintenance and prevention. When caregivers take the time to offer assistance to the young child with special needs, the best form of health care is being provided: prevention.     

Agreement among professionals about a child's sexual abuse status: interviews with sexually anatomically correct dolls as indicators of abuse.

This study was designed to define clinicians' ratings of the comments, behaviors, and affects of abused children and compare them with the same clinicians' decisions about the child's abuse status. The authors concluded that sexually anatomically correct dolls used alone are inadequate in providing enough information for professionals to accurately assess the abuse status of young children. Also it is unclear what observations of the child by mental health professionals are best correlated with their determinations of a child's abuse status. Of concern was the finding that the mental health professionals were more likely to be in agreement with the interviewer's determination of abuse than with the actual status of the child, suggesting undue influence of the interviewer, or, alternatively, both observer and interviewer were responding to unidentified child factors.     

The role of mental health professionals contributes to mental health promotion and prevention: innovative programmes in Serbia

It has been estimated that 9 to 13% of children and adolescents have a mental disorder that causes significant functioning impairment and that only one fifth of those who need mental health services actually receive them. The majority of children and adolescents are enrolled in schools, where they spend a considerable amount of time, and this is followed by the increasing efforts to establish collaboration between mental health professionals and school personnel. The role of mental health professionals is crucial in improving children’s mental health, as well as for providing better response to parents, educational staff and other agencies. There are several ways for a child psychiatrist to reach children and adolescents in a school setting: through individual student consultations (case consultations), through consultations to schools on general mental issues (systems consultations) and through promotion of mental health by creating and demonstrating evidence-based programmes for children, parents, school staff and others who are involved in child’s care. In order to achieve these goals, we need to establish partnerships and to define roles among organisations and individuals in the wider school environment, such as schools and school management, municipal authorities and administration, media, police, social welfare centres, health centres, parents and youth associations.     

DARING TO GROW OLD: LESSONS IN HEALTHY AGING AND EMPOWERMENT

The capacity to achieve and retain control over one's own life—to make decisions about and exert power over one's situation—is strongly correlated with being healthy. For older persons, there is a real danger that professionals with good intentions will encroach on this control in the name of providing service. We examine the issues of power, control, decision making, and healthy aging from the perspective of educating health care providers. Particular attention is paid to how health care providers see their role in defining older adults as being at risk when they refuse service or take risks that providers define as unacceptable. We raise this issue of appropriate professional control and cite the literature on successful coping to argue for policies and practices that enhance personal autonomy and interdependence as effective vehicles for healthy aging. Lessons from primary health care are applied to healthy aging even in the face of diminished capacities.     

Medical evaluation referral patterns for sexual abuse victims.

It has been recommended that all children suspected of being sexually abused should have medical evaluations. To better understand practices and perceptions of child sexual abuse medical evaluations, a survey was conducted of 579 professionals attending educational programs on child sexual abuse; 85.8% (N = 497) responded. Half (50%) of the respondents reported no previous training in child sexual abuse. Of the 336 nonphysician professionals, 194 (57.7%) were in positions where they make referrals of the victims, and 69% of these did not refer all of the children they saw for medical evaluations. The first referral choice for medical evaluation was most often to the victim's primary physician (57%). For those professionals who did not refer all alleged victims for medical evaluation, neither the victims' age, gender, nor accessibility to care were generally considered relevant in determining the decision to refer. However, the type of abuse and presence of physical and psychological symptoms were considered relevant in making the decision. The majority indicated that the findings of the medical exam were very useful in substantiating or refuting the allegation of abuse. Further training for both medical and nonmedical professionals is needed to increase awareness of the need for and implications of the medical evaluation if children are to receive comprehensive assessments. Physicians may play an active role in this process through education of professionals and provision of care.     

北方地区冬季孕妇装功能设计探析

文章主要针对以河南、河北、山东为代表的华北平原地区冬季气候特点及孕妇的生理特征,展开孕妇装功能设计研究,从保护胎儿的健康发育和增强孕妇日常着装的舒适保健功能的角度,论述了孕妇装设计中面料防静电、防辐射、保暖、安全和保健等性能要素。     

In-house consultation to support professionals’ responses to child abuse and neglect: Determinants of professionals’ use and the association with guideline adherence

This study examined the presence and strengths of determinants associated with consultation of an in-house expert on child abuse and neglect (CAN) by preventive child health care professionals who suspect CAN. This study also assessed the relationship between in-house CAN expert consultation and professionals’ performance of six recommended activities described in a national guideline on preventing CAN for preventive child health care professionals. A total of 154 professionals met the study’s inclusion criteria. They filled in a questionnaire that measured in-house consultation practices and twelve determinants associated with the professional, the in-house expert, and the organizational context. Bivariate and multivariate regression analyses were performed. Almost half of the participants (46.8%) reported to consult the in-house expert in (almost) all of their suspected CAN cases. Professionals who reported better recollection of consulting the in-house expert (i.e. not forgetting to consult the expert) (p = .001), who were more familiar with consultation (p = .002), who had more positive attitudes and beliefs about consultation (p = .011) and who reported being more susceptible to the behavior (p = .001) and expectations/opinions (p = .025) of colleagues regarding in-house expert consultation were more likely to consult the in-house expert. Furthermore, in-house expert consultation was positively associated with two of six key guideline activities: consulting the regional child protection service and monitoring whether support was provided to families. The implications of these results for improving professionals’ responses to CAN are discussed.