Early Postpartum Discharge Programs in the United States: A Literature Review and Critique

No abstract available for this article.     

Early Childhood Special Education in the People's Republic of China

Services for young children with special needs are a relatively recent phenomenon in the People's Republic of China. Approximately 2.46 million children under the age of six are thought to exhibit some type of disability. As a socially and economically developing nation, China is confronted with the monumental task of providing early intervention to this rapidly growing segment of its population. Issues confronting education officials include, among others, the integration of typical and atypical preschoolers, a critical shortage of appropriately trained professionals, and the lack of sufficient numbers of early childhood special education programs. Collaborative planning holds promise for improvement.     

A Comparison of External and Self-evaluations of Quality in Early Childhood Education

The aim of the study is to compare how the pedagogues in preschool units evaluate the quality of their own work in relation to an external evaluator. The study is part of a project whose aim was to develop a Model of Competence Development. In this project the quality of 20 preschool units were evaluated by an external evaluator using the Early Childhood Environment Rating Scale [ECERS]. In nine of the total 20 preschool units the pedagogues also evaluated the quality in their own preschool unit. The uses of both externaland self-evaluations of quality in the project gave an opportunity to compare these evaluations with one another as well as using the results to plan the content of a targeted development program. To take the point of departure in both externaland self-evaluations of quality is of importance as the results of this study shows that they differ from each other.     

Working Together to Improve the Quality of Care and Education in Early Childhood Programs

This study examines the impact of a professional development school (PDS) partnership between a university and two early childhood centers on the quality of care and education within the programs. The Early Childhood Environment Rating Scale (Harms, Clifford, and Cryer, 1998) was used to rate the environment of the two early childhood professional development schools. The environments were rated at the beginning of the PDS relationship and again one year later. Results indicate that the PDS partnerships increased the quality of care and education in both early childhood programs. Researchers suggest that universities can have an impact on the field of early childhood education at a local level if they are willing to reach out into the community.     

Working Together to Improve the Quality of Care and Education in Early Childhood Programs

This study examines the impact of a professional development school (PDS) partnership between a university and two early childhood centers on the quality of care and education within the programs. The Early Childhood Environment Rating Scale (Harms, Clifford, and Cryer, 1998) was used to rate the environment of the two early childhood professional development schools. The environments were rated at the beginning of the PDS relationship and again one year later. Results indicate that the PDS partnerships increased the quality of care and education in both early childhood programs. Researchers suggest that universities can have an impact on the field of early childhood education at a local level if they are willing to reach out into the community.     

Professional and Parent Views of Early Childhood Programs: A Cross-Cultural Study

Interrelationships between the macro-, mesoand microsystems can affect the partnerships which parents and professionals form to effectively support the growth of young children. These “systems” were explored through a cross cultural study.

To study the mesosystem where family and early childhood progam meet, a fivesection survey was sent to a random sampling of ten per cent of parents and professionals involved in early childhood programs in Kronobergs Lan, Smaland, Sweden and St. Louis County, Minnesota, United States. In general, parents and professionals in Sweden agreed with each other that open-ended, creative, childcentered materials and activities were important. In the United States, however, there were many significant differences between parent and professional views. More parents than professionals favored academic tasks and conformity to rules, while more professionals than parents supported children's creative exploration of the environment. The views of the respondents were affected in diverse ways by the macro-system political and economic societal contexts.

This study suggests that parents and professionals, particularly those who have significantly different ideas, may need to discuss a common purpose and philosophy about what is important for young children in early childhood programs. This purpose needs to take seriously the societal context in which children live. Building on a common base, various formats for involvement can be created to maximize the support network among parents, professionals and young children.     

Creating Supportive Breastfeeding Policies in Early Childhood Education Programs: A Qualitative Study from a Multi-Site Intervention

Objectives To understand the process by which early childhood education (ECE) providers effectively used an existing intervention to facilitate the creation or strengthening of a written breastfeeding policy, understand the factors important to this process, and present a logic model to guide future intervention design and evaluation. Methods A purposive sample of interviewees who recently completed an ECE nutrition and physical activity intervention and reported positive pre-post scores for breastfeeding support were recruited to complete semi-structured interviews. Interviews were recorded, transcribed, and coded, following a Grounded Theory approach. Results The ECE programs (n?=?23) had a written breastfeeding policy and were located across six states in the United States. The most common aspects of breastfeeding support covered in the policies were handling and storing of breastmilk, pieces of equipment to be provided (e.g., breast pump), and the creation of a space or room designated for breastfeeding and pumping. Many factors important to the policy creation process were identified such as motivation, education, technical assistance, perceptions of parental indifference, staff buy-in, and time and administrative constraints. Once motivated to create a policy, ECE providers described actions, such as gathering background information and model policies, discussing policy needs with stakeholders, utilizing technical assistance, and overcoming barriers. Conclusions for Practice From these findings, a logic model was created to guide future intervention design and evaluation, and several recommendations were made to help guide subsequent interventions in promoting the development and implementation of written breastfeeding policies at ECE programs.     

Multicultural Training in the United States: A Survey of Occupational Therapy Programs

ABSTRACT

This study was designed to describe multicultural training practices in occupational therapy programs. A survey was sent to occupational therapy programs in the United States to gather information on multicultural content, skills, and teaching methods as well as diversity context and challenges. The response rate was 54%. The most frequently covered multicultural content was related to cultural background and sociopolitical factors. Multicultural skills covered most often were practice oriented and interpersonal skills. Teaching methods reported as used most often differed from the methods thought by the respondents to be most effective. Programs reported multiple challenges to multicultural training including lack of time and lack of diversity in the student body, faculty, and environment. Results suggest that educators may need to expand multicultural content and skills to prepare occupational therapy students for providing care in increasingly diverse practice settings. In addition, increased use of teaching methods that focus on exposure to diverse populations and reflection may be needed to improve the effectiveness of multicultural training in occupational therapy programs.     

Ethics and Childhood Vaccination Policy in the United States

Childhood immunization involves a balance between parents’ autonomy in deciding whether to immunize their children and the benefits to public health from mandating vaccines. Ethical concerns about pediatric vaccination span several public health domains, including those of policymakers, clinicians, and other professionals.In light of ongoing developments and debates, we discuss several key ethical issues concerning childhood immunization in the United States and describe how they affect policy development and clinical practice. We focus on ethical considerations pertaining to herd immunity as a community good, vaccine communication, dismissal of vaccine-refusing families from practice, and vaccine mandates.Clinicians and policymakers need to consider the nature and timing of vaccine-related discussions and invoke deliberative approaches to policymaking.Following the December 2014 measles outbreak at a popular amusement park in California,1,2 which spread to other states, Canada, and Mexico, there has been increased attention to US childhood immunization practices. A recent study attributed the outbreak to underimmunization,3 and several policymakers have called for an end to religious and philosophical (i.e., personal-belief) exemptions altogether, with the state of California passing legislation removing the option of personal-belief exemptions.4,5 Political candidates have expressed various viewpoints on vaccination.6 In light of these developments, we discuss several key ethical issues concerning childhood immunization in the United States and describe how they affect policy development and clinical practice. There are a myriad of ethical issues regarding such topics as vaccination development, administration, communication, and safety monitoring. We focus on a few key ethical issues concerning childhood immunization in the United States—what we refer to as a “vaccine ethics” approach—and describe how such an approach affects policy development and clinical immunization practice.     

Perceptions of Early Childhood Special Education Professionals: Assessment of Functional Skills Among Children With Special Needs

The perceptions of 20 early childhood special education professionals about the ability of a traditional, norm-referenced test and an activity-based assessment to assess the functional skills of a child with special needs, provide information about the child's level of functioning, and provide useful information for the child's intervention planning were studied. Videotaped segments of a child with special needs being tested with these instruments and their derived assessment reports developed by trained intervention evaluators were used to generate professionals' perceptions. Findings revealed that early childhood special education-professionals perceived the activity-based assessment to be significantly more able to (1) assess the functional skills of children with special needs, (2) provide information about the child's level of functioning, and (3) provide useful information for the child's intervention planning than the traditional, norm-referenced test.     

Expensive Cancer Drugs: A Comparison between the United States and the United Kingdom

Context: This article compares the United Kingdom''s and the United States’ experiences with expensive cancer drugs to illustrate the challenges posed by new, extremely costly, medical technologies.Methods: This article describes British and American coverage, access, and cost-sharing policies with regard to expensive cancer drugs and then compares the costs of eleven such drugs to British patients, American Medicare beneficiaries, and American patients purchasing the drugs in the retail market. Three questions posed by these comparisons are then examined: First, which system is fairer? In which system are cancer patients better off? Assuming that no system can sustainably provide to everyone at least some expensive cancer drugs for some clinical indications, what challenges does each system face in making these difficult determinations?Findings: In both the British and American health care systems, not all patients who might benefit from or desire access to expensive cancer drugs have access to them. The popular characterization of the United States, where all cancer drugs are available for all to access as and when needed, and that of the British NHS, where top-down population rationing poses insurmountable obstacles to British patients’ access, are far from the reality in both countries.Conclusions: Key elements of the British system are fairer than the American system, and the British system is better structured to deal with difficult decisions about expensive end-of-life cancer drugs. Both systems face common ethical, financial, organizational, and priority-setting challenges in making these decisions.     

Early Childhood Intervention Programs in the US: Recent Advances and Future Recommendations

Recent scientific reviews, long term outcome studies, and effectiveness trials of early childhood intervention programs in the US have important lessons for the future of these interventions in the US and internationally. Programs should (1) employ more center-based or mixed center-based and home visiting models, (2) monitor standards of quality, (3) become more family focused and culturally competent, and (4) broaden the focus of their evaluations. If these recommendations are followed then we will be in a better position to get the best return on our investments in early childhood.     

Childhood immunization reporting laws in the United States: Current status

Context

Immunization Information Systems (IIS), or registries, were developed to improve effectiveness and efficiency in immunization services. Complex laws that govern IIS and immunization records are developed at the state-level, interact with each other, and may impact utility for all immunization stakeholders. As states develop Health Information Exchange laws they may also interact with IIS laws.

Objectives

To provide immunization stakeholders an overview of the laws applicable to healthcare providers and health departments. Comparisons are provided to illustrate the trends since the previous studies.

Methods

IIS relevant statutes, regulations and ordinances of jurisdictions (states, large cities) of 56 “Grantees” receiving funding under the 317b Public Health Service Act were identified via legal databases then systematically reviewed for authorization, reporting and consent requirements. Key provisions were coded and mapped according to 131 variables.

Results

Including subsections, 984 laws across Grantees relate to immunization records, falling under many administrative sections of state and city government. Most Grantees have more than one law that addresses immunization records reporting, exchange and privacy protections. Not all of these laws are in alignment, but there is a trend toward increased Grantee IIS authorizing laws, mandated reporting and implied consent provisions. Of the 56 Grantees, 37 (66%) had IIS authorizing laws, and 46 (82%) had laws addressing healthcare provider and vital statistics reporting. However, much variation remains, even within the provisions of these laws. The coding instrument received 93.7% agreement and a K-α of 0.791.

Conclusions

The trend toward laws that encourage participation should continue to improve functionality and value, but inconsistencies among laws should be addressed, both across jurisdictions within states and between different states. They may impair the value of the information that is collected. Greater uniformity could improve the overall usefulness of IIS.     

Basis of bioethics--bioethics in Japan and the United States

During the past ten years bioethics has gradually become an important subject for discussion in Japan. However these discussions are quite different from those in the United States where bioethics has been a major field of study for some time. The purpose of this paper is to show the differences between the Japanese and American ideas regarding bioethics by studying the social environment in the United States. When compared to Japan, there is a great difference in this environment and the American views on ethics. Japanese studying bioethical problems should study them by first comparing the points of differences stated in this paper and then applying their conclusions to the bioethical problems here in Japan.     

Examining Quality in Two Preschool Settings: Publicly Funded Early Childhood Education and Inclusive Early Childhood Education Classrooms

Background

Although classroom quality is an important consideration, few recent research studies have examined the process and structural quality in publicly funded early childhood education (ECE) and inclusive ECE classrooms. This study provides an important contribution to the literature by comparing two conceptualizations of quality in classrooms serving children from low-income households and those with disabilities.

Objectives

(1) To characterize and to determine differences with regard to process and structural quality in publicly funded ECE and inclusive ECE classrooms, and (2) to examine whether and to what extent the process quality varied when controlling for structural quality and classroom income/race variables.

Method

One hundred and sixty four classrooms (85 ECE, 79 inclusive) that were enrolled in two large-scale intervention studies examining a book-reading program were included in the present study. The Classroom Assessment Scoring System (CLASS; Pianta et al. in Classroom assessment scoring system, Paul H. Brookes, Baltimore, 2008) and three detailed questionnaires were used to quantify process and structural quality, respectively.

Results

Results revealed quantitative differences in process quality, specifically in the emotional support dimension of negative climate as well as all dimensions of instructional support, between the two settings. In addition, teachers’ education was a significant predictor of process quality, and publicly funded ECE classrooms scored over two points higher on the instructional support domain of the CLASS when controlling for other structural quality measures and income and race.

Conclusions

Our findings have implications for best practice guidelines and policies, particularly for classroom environments serving children with disabilities, which are discussed.

     

Air Pollution and Childhood Respiratory Allergies in the United States

Background

Childhood respiratory allergies, which contribute to missed school days and other activity limitations, have increased in recent years, possibly due to environmental factors.

Objective

In this study we examined whether air pollutants are associated with childhood respiratory allergies in the United States.

Methods

For the approximately 70,000 children from the 1999–2005 National Health Interview Survey eligible for this study, we assigned between 40,000 and 60,000 ambient pollution monitoring data from the U.S. Environmental Protection Agency, depending on the pollutant. We used monitors within 20 miles of the child’s residential block group. We used logistic regression models, fit with methods for complex surveys, to examine the associations between the reporting of respiratory allergy or hay fever and annual average exposure to particulate matter ≤ 2.5 μm in diameter (PM_2.5), PM ≤ 10 μm in diameter, sulfur dioxide, and nitrogen dioxide and summer exposure to ozone, controlling for demographic and geographic factors.

Results

Increased respiratory allergy/hay fever was associated with increased summer O₃ levels [adjusted odds ratio (AOR) per 10 ppb = 1.20; 95% confidence interval (CI), 1.15–1.26] and increased PM_2.5 (AOR per 10 μg/m³ = 1.23; 95% CI, 1.10–1.38). These associations persisted after stratification by urban–rural status, inclusion of multiple pollutants, and definition of exposures by differing exposure radii. No associations between the other pollutants and the reporting respiratory allergy/hay fever were apparent.

Conclusions

These results provide evidence of adverse health for children living in areas with chronic exposure to higher levels of O₃ and PM_2.5 compared with children with lower exposures.