The effects of the Healthy Steps for Young Children Program: results from observations of parenting and child development

The Healthy Steps for Young Children Program (HS) is designed to provide support for new parents through the pediatrician's office. We present findings of the effect of HS on the quality of mother–child interaction, security of attachment, and child behavior using observational data from two of the HS sites that utilized a randomized treatment design. Results indicated that mothers participating in Healthy Steps were more likely to interact sensitively and appropriately than mothers in the comparison group at the second assessment point (age 34–37 months) but not at the first assessment point (age 16–18 months). There were no differences in child outcomes at either time point when the cross-sectional data were analyzed. However, the results of the longitudinal analysis (which included families who participated in the home observations at both Time 1 and Time 2) indicated that Healthy Steps participation was associated with greater security of attachment and fewer child behavior problems.     

Biodeterioration of Incralac used for the protection of bronze monuments

Outdoor bronze sculptures are highly susceptible to corrosion in many environments and organic coatings are widely used for their protection. The purpose of this study was to determine the susceptibility of the commonly used coating Incralac to biodeterioration by microorganisms. A yeast was isolated from a bronze statue treated with Incralac and its ability to degrade Incralac was determined using growth curves, scanning electron microscopy (SEM), and electrochemical impedance spectroscopy (EIS). The organism grew slowly on Incralac in liquid culture, but SEM images demonstrated its ability to adhere to Incralac coated metal. Additionally, the yeast caused a rapid drop in the low frequency impedance of Incralac coated metal that was not observed under sterile conditions, indicating that the organism accelerated deterioration of the coating. The potential for microbial growth to accelerate deterioration of Incralac should be considered when developing a maintenance strategy for the protection of outdoor metal monuments.     

Population policies and education: exploring the contradictions of neo‐liberal globalisation

The world is increasingly characterised by profound income, health and social inequalities (Appadurai, 2000 Appadurai, A. 2000. Grassroots globalisation and the research imagination. Public Culture, 12(1): 1–19. [Crossref], [Web of Science ®] [Google Scholar]). In recent decades development initiatives aimed at reducing these inequalities have been situated in a context of increasing globalisation with a dominant neo‐liberal economic orthodoxy. This paper argues that neo‐liberal globalisation contains inherent contradictions regarding choice and uniformity. This is illustrated in this paper through an exploration of the impact of neo‐liberal globalisation on population policies and programmes. The dominant neo‐liberal economic ideology that has influenced development over the last few decades has often led to alternative global visions being overlooked. Many current population and development debates are characterised by polarised arguments with strongly opposing aims and views. This raises the challenge of finding alternatives situated in more middle ground that both identify and promote the socially positive elements of neo‐liberalism and state intervention, but also to limit their worst excesses within the population field and more broadly. This paper concludes with a discussion outling the positive nature of middle ground and other possible alternatives.     

Making the Critical Appraisal for Summaries of Evidence (CASE) for evidence-based medicine (EBM): critical appraisal of summaries of evidence

Objectives:

Standards for evaluating evidence-based medicine (EBM) point-of-care (POC) summaries of research are lacking. The authors developed a “Critical Appraisal for Summaries of Evidence” (CASE) worksheet to help assess the evidence in these tools. The authors then evaluated the reliability of the worksheet.

Methods:

The CASE worksheet was developed with 10 questions covering specificity, authorship, reviewers, methods, grading, clarity, citations, currency, bias, and relevancy. Two reviewers independently assessed a random selection of 384 EBM POC summaries using the worksheet. The responses of the raters were then compared using a kappa score.

Results:

The kappa statistic demonstrated an overall moderate agreement (κ = 0.44) between the reviewers using the CASE worksheet for the 384 summaries. The 3 categories of evaluation questions in which the reviewers disagreed most often were citations (κ =  0), bias (κ = 0.11), and currency (κ = −0.18).

Conclusions:

The CASE worksheet provided an effective checklist for critically analyzing a treatment summary. While the reviewers agreed on worksheet responses for most questions, variation occurred in how the raters navigated the tool and interpreted some of the questions. Further validation of the form by other groups of users should be investigated.

Highlights

• Few critical appraisal tools have been evaluated with inter-rater reliability testing.
• The ways that users of evidence-based medicine (EBM) point-of-care (POC) tools interpret how to appraise an evidence summary—particularly when defining the grading of evidence, currency, and bias—may vary even when a standard evaluation sheet is used.
• The Critical Appraisal for Summaries of Evidence (CASE) worksheet had a moderate level of inter-rater reliability, similar to previous evaluative studies of critical appraisals tools.

Implications

• Medical librarians can develop tools useful for librarians, students, and clinicians to guide them in appraising clinical evidence summaries.
• The CASE worksheet can be a valuable tool to consider the quality of individual evidence summaries and to see patterns of overall quality in EBM POC tools.

     

Strategies for incorporating cultural competence into childbirth education curriculum

Cultural competence affects all interactions with prospective parents and families. Childbirth educators need to assess their own cultural competence, beginning with an understanding of their own background and how it affects interactions with families. The purpose of this article is to enhance the incorporation of cultural competency, cultural awareness, and cultural sensitivity into the childbirth education curricula. Methods for enhancing cultural competence in a multicultural global society are discussed. Strategies are also presented to address the challenges of assessing parents and families of diverse cultures and their beliefs, traditions, and special needs in the plan of care.