The Knowledge of Effective Parenting Scale (KEPS): A Tool for Public Health Approaches to Universal Parenting Programs

Improving the knowledge, skills, and confidence of parents is often the aim of parenting-focused public health strategies and parenting programs, yet research on parental knowledge is limited compared with research on other parenting variables. In this study, a nonclinical sample of 62 parents of children aged 2-3?years was assessed for knowledge of child development processes and milestones [using the Knowledge of Infant Development Inventory (KIDI)] and knowledge of effective parenting strategies [using the Knowledge of Effective Parenting Scale (KEPS)], along with self-reported measures of parenting dysfunction and nurturance, parental confidence, parental affective state, and problematic child behavior. Additionally, in-home observations of parent-child interactions were conducted with dependent measures of aversive and non-aversive parent behavior, a composite measure of parenting competence, and aversive child behavior. Results showed that KEPS scores were significantly negatively related to self-reported parenting dysfunction, internalized problematic child behavior, and parental anxiety, and positively related to observed parenting competence. Knowledge as assessed by the KIDI was significantly positively associated only with KEPS scores. These results suggest that increasing parental knowledge of effective parenting strategies at a population level is likely to be more beneficial to parents than increasing their knowledge of child development processes and milestones.     

The Parent Perspective: Informing the Cultural Sensitivity of Parenting Programs in Rural Communities

Using focus group methodology, this study examined parents’ perceptions of a behavioral parenting program offered in a rural, Appalachian community to parents of children with disruptive behavior problems. Parents were asked to comment on barriers to participation, strengths and weaknesses of the parenting program, and recommendations for program improvements. Results suggest that evidence-based parenting programs offer a unique form of social support beyond that received from the kinship communities that typically characterize rural society. However, fears of being judged by mental health professionals and distrust of others are significant cultural and interpersonal barriers that must be addressed through future program modifications. Data representing the parent voice provide rich and innovative ideas that serve to advance research associated with enhancing the cultural sensitivity of evidence-based parenting programs in rural communities.     

Peer Reviewed: A New Evaluation Tool to Obtain Practice-Based Evidence of Worksite Health Promotion Programs

Introduction

The Centers for Disease Control and Prevention developed the Swift Worksite Assessment and Translation (SWAT) evaluation method to identify promising practices in worksite health promotion programs. The new method complements research studies and evaluation studies of evidence-based practices that promote healthy weight in working adults.

Methods

We used nationally recognized program evaluation standards of utility, feasibility, accuracy, and propriety as the foundation for our 5-step method: 1) site identification and selection, 2) site visit, 3) post-visit evaluation of promising practices, 4) evaluation capacity building, and 5) translation and dissemination. An independent, outside evaluation team conducted process and summative evaluations of SWAT to determine its efficacy in providing accurate, useful information and its compliance with evaluation standards.

Results

The SWAT evaluation approach is feasible in small and medium-sized workplace settings. The independent evaluation team judged SWAT favorably as an evaluation method, noting among its strengths its systematic and detailed procedures and service orientation. Experts in worksite health promotion evaluation concluded that the data obtained by using this evaluation method were sufficient to allow them to make judgments about promising practices.

Conclusion

SWAT is a useful, business-friendly approach to systematic, yet rapid, evaluation that comports with program evaluation standards. The method provides a new tool to obtain practice-based evidence of worksite health promotion programs that help prevent obesity and, more broadly, may advance public health goals for chronic disease prevention and health promotion.     

Parent Training: Implementation Strategies for Adventures in Parenting

Adventures in Parenting, an informational booklet published by the National Institute of Child Health and Human Development, offers five principles that parents can use to develop a mental model of parenting: Responding, Preventing, Monitoring, Mentoring, and Modeling (RPM3). The current study was designed to assess the differential impact of three intervention conditions utilizing Adventures in Parenting on knowledge of RPM3 principles. Significant intervention effects were found for measures of knowledge of RPM3 principles; the more intensive interventions (i.e., face-to-face groups and web-based sessions) were associated with increased knowledge of RPM3 principles over 3 months. Results are discussed in terms of their contribution to new approaches of parent education, particularly the use of web-based training. Editors' Strategic Implications: Parent educators should review the promising findings regarding the RPM3 model. Preventionists, more broadly, may be interested in the effect of the program's delivery mechanism, with a comparison of participants who were randomly assigned to web-based, group-based, and booklet only conditions.     

Preferences for Parenting Programs in Head Start: Using Conjoint Analysis to Understand Engagement in Parenting Health Promotion Programs

Prevention Science - The impact of evidence-based parenting health promotion programs is threatened by limited enrollment and attendance. We used a discrete choice experiment (DCE) to examine how...     

Nurses' Logs as an Evaluation Tool for School-Based Violence Prevention Programs

ABSTRACT: Programs for preventing violence among youth should be evaluated to determine if they are effective. Nurses' logs appear to be a useful tool for evaluating school-based violence prevention programs. The logs provide a record of students' visits to the school nurse that can be used to determine if a violence prevention program is associated with a reduction in fighting—and other injury-related nurse visits. This method has many strengths: it is simple and inexpensive, it does not interrupt the school routine, it permits school-level rather than student-level data collection, it provides a ready "baseline," and it allows continuous data collection. However, potential limitations do exist. For example, the method may provide insufficient information and may be affected by factors unrelated to the intervention. School officials can increase the usefulness of the logs by encouraging standardization and providing training in their use.     

Primary Care Service Areas: A New Tool for the Evaluation of Primary Care Services

Objective. To develop and characterize utilization-based service areas for the United States which reflect the travel of Medicare beneficiaries to primary care clinicians.
Data Source/Study Setting. The 1996–1997 Part B and 1996 Outpatient File primary care claims for fee-for-service Medicare beneficiaries aged 65 and older. The 1995 Medicaid claims from six states (1995) and commercial claims from Blue Cross Blue Shield of Michigan (1996).
Study Design. A patient origin study was conducted to assign 1999 U.S. zip codes to Primary Care Service Areas on the basis of the plurality of beneficiaries' preference for primary care clinicians. Adjustments were made to establish geographic contiguity and minimum population and service localization. Generality of areas to younger populations was tested with Medicaid and commercial claims.
Data Collection/Extraction Methods. Part B primary care claims were selected on the basis of provider specialty, place of service, and CPT code. Selection of Outpatient File claims used provider number, type of facility/service, and revenue center codes.
Principal Findings. The study delineated 6,102 Primary Care Service Areas with a median population of 17,276 (range 1,005–1,253,240). Overall, 63 percent of the Medicare beneficiaries sought the plurality of their primary care from within area clinicians. Service localization compared to Medicaid (six states) and commercial primary care utilization (Michigan) was comparable but not identical.
Conclusions. Primary Care Service Areas are a new tool for the measurement of primary care resources, utilization, and associated outcomes. Policymakers at all jurisdictional levels as well as researchers will have a standardized system of geographical units through which to assess access to, supply, use, organization, and financing of primary care services.     

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.     

Evaluation of a Parent Education Program Emphasizing Responsive Parenting and Mindfulness: An Inclusive Randomized Controlled Trial

Child & Youth Care Forum - Recent studies indicate that parent education programs that include content to enhance parents’ mental states may prove efficacious in improving parenting...     

Development of a Web‐Based Evaluation System: A Tool for Measuring Life Skills in Youth and Family Programs*

The need for evaluation of youth and family programming has never been more acute, yet practitioners often do not have the tools to conduct effective evaluations. We present the development and piloting of a web‐based evaluation system as a tool for evaluating participant outcomes in Cooperative Extension programming. Results of a peer review of the system and pilot test of the instrument are presented. Implications for implementing evaluations for youth and family programs are discussed.     

The CAPACITI Decision-Support Tool for National Immunization Programs

ObjectivesImmunization programs in low-income and middle-income countries (LMICs) are faced with an ever-growing number of vaccines of public health importance recommended by the World Health Organization, while also financing a greater proportion of the program through domestic resources. More than ever, national immunization programs must be equipped to contextualize global guidance and make choices that are best suited to their setting. The CAPACITI decision-support tool has been developed in collaboration with national immunization program decision makers in LMICs to structure and document an evidence-based, context-specific process for prioritizing or selecting among multiple vaccination products, services, or strategies.MethodsThe CAPACITI decision-support tool is based on multi-criteria decision analysis, as a structured way to incorporate multiple sources of evidence and stakeholder perspectives. The tool has been developed iteratively in consultation with 12 countries across Africa, Asia, and the Americas.ResultsThe tool is flexible to existing country processes and can follow any type of multi-criteria decision analysis or a hybrid approach. It is structured into 5 sections: decision question, criteria for decision making, evidence assessment, appraisal, and recommendation. The Excel-based tool guides the user through the steps and document discussions in a transparent manner, with an emphasis on stakeholder engagement and country ownership.ConclusionsPilot countries valued the CAPACITI decision-support tool as a means to consider multiple criteria and stakeholder perspectives and to evaluate trade-offs and the impact of data quality. With use, it is expected that LMICs will tailor steps to their context and streamline the tool for decision making.     

General Surgery Programs in Small Rural New York State Hospitals: A Pilot Survey of Hospital Administrators

CONTEXT: Hospitals play a central role in small rural communities and are frequently one of the major contributors to the local economy. Surgical services often account for a substantial proportion of hospital revenues. The current shortage of general surgeons practicing in rural communities may further threaten the financial viability of rural hospitals and communities. PURPOSE: To describe hospital administrators' perceptions regarding the current state of general surgery programs at small rural hospitals in New York State, including the impact that surgical services have on hospital financial viability. METHODS: A list of hospitals belonging to the rural hospitals group of the Healthcare Association of New York State was obtained to determine prospective survey recipients. Sixty-eight administrators at each of the identified hospitals were subsequently surveyed and 38 respondents met all inclusion criteria. FINDINGS: Approximately 87% of hospital administrators perceive that the general surgery program is critical to the hospital's financial viability. Forty percent of respondents report that they would be forced to close the hospital if the surgical program was lost. Among the 42% of administrators trying to recruit a general surgeon, almost two thirds have been searching for more than 1 year. CONCLUSIONS: According to the perceptions of hospital administrators, the financial viability of rural hospitals in New York State depends in large part on their ability to provide surgical services. Additionally, general surgeons appear to be in high demand at a significant number of the surveyed institutions.     

Economic Evaluation of Vaccination Programs: A Guide for Selecting Modeling Approaches

ObjectivesIllustrate 3 economic evaluation methods whose value measures may be useful to decision makers considering vaccination programs.MethodsKeyword searches identified example publications of cost-effectiveness analysis (CEA), fiscal health modeling (FHM), and constrained optimization (CO) for economic evaluation of a vaccination program in countries where at least 2 of the methods had been used. We examined the extent to which different value measures may be useful for decision makers considering adoption of a new vaccination program. With these findings, we created a guide for selecting modeling approaches illustrating the decision-maker contexts and policy objectives for which each method may be useful.ResultsWe identified 8 countries with published evaluations for vaccination programs using >1 method for 4 infections: influenza, human papilloma virus, rotavirus, and malaria. CEA studies targeted health system decision makers using a threshold to determine the efficiency of a new vaccination program. FHM studies targeted public sector spending decision makers estimating lifetime changes in government tax revenue net of transfer payments. CO studies targeted decision makers selecting from a mix of options for preventing an infectious disease within budget and feasibility constraints. Cost and utility inputs, epidemiologic models, comparators, and constraints varied by modeling method.ConclusionsAlthough CEAs measures of incremental cost-effectiveness ratios are critical for understanding vaccination program efficiency for all decision makers determining access and reimbursement, FHMs provide measures of the program’s impact on public spending for government officials, and COs provide measures of the optimal mix of all prevention interventions for public health officials.     

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.     

HistCite —— 一个新的科学文献分析工具

1955年,尤金·加菲尔德博士(Dr. Eugene Garfiled)首次提出了利用论文的相互间引用关系来分析科学文献的概念(Citation Indexes for Science)。如今这位 SCI的创始人老骥伏枥,笔不辍耕,近几年又在努力研发一种新的文献分析工具,即“HistCite^TM(www.histcite.com)”。开发这个软件的目的是为广大的科研人员、各研究所和大学的科研管理部门和图书馆文献人员们提供一种便捷的工具,指导他们如何从众多的科学文献资料中找出各个学科本身,以及之间的研究历史轨迹、发展规律和未来趋势。 HistCite^TM是一种新软件文件包,主要作用是对文献搜索的结果进行分析和组构,从而了解各个学科发展的峰谷趋势,历史重大事件,以及各大学、研究所及作者的科研文章的产出数量等。并根据结果进一步做出其所需拓扑图表等。如: (1)可根据搜索结果中的关键文献条目的频率分布,获知某个作者、单位或期刊在搜索结果中的出现的频次。(2)可根据搜索结果勾画出众多文章出版的时间图,获知某个学科领域的峰谷时期。(3)可根据搜索提供的单词在文章题目出现的频次,获知某个国家或研究单位的文章产出量以及许多其他的趋势分析。(4)可根据搜索去研究文章之间的引用关系,易于用户确定引用最多的文章、作者、单位及全球分布规律,从而得知谁是该领域的引领人物,是什么研究结果影响着这个领域的发展走向。(5)可根据自动生成某次搜索结果做出文章之间的引用关系图表。这些拓扑图表,也称为历史图,它显示了某个专业领域内的关键事件,以及它们之间的年代顺序及相互影响。从中让读者对某个主题的历史发展有个快速、深刻的了解,并对写某个主题历史的作者有很大的帮助。社会工作者和历史学家也可以根据这些客观的数据确定他们的观点。 HistCite^TM可供许多专业领域的研究者使用,如: (1)写综述文章时,利用HistCite^TM程序可以帮助作者获得主题内容的发展和目前的状况。(2)快速对大量的数据进行总结和形象化分析,可以帮助研究人员及博士生们确定研究主题,完成研究论文。(3)教师们可以利用HistCite^TM产生的图表形象地对学生讲解教学内容。(4)作者、出版商和期刊编辑可用该软件得知其出版物在某个学科领域内所扮演的角色。也可以利用HistCite了解出版的文章在特定领域内的情况,学科编辑和审稿人可以通过HistCite^TM迅速了解学科情况,杜绝剽窃、造假、一稿多用等不良学术风气。(5)图书管理员可以为读者提供更多的搜索信息。(6)对用文献计量学去规划科学发展的学者来说,使用HistCite^TM,可以借用HistCite^TM工具减少烦琐劳动,轻易快捷地完成这些大量繁重的分析工作,作出客观地研究结论 使用HistCite^TM之前,首先要通过Thomson Scientific Web of Science上进行文献搜索,然后把结果保存引入到HistCite^TM的程序中,在使用者的操作下进行分析。HistCite^TM的高级版本还可以提供其他引文数据分析。 HistCite^TM的发明者尤金·加菲尔德博士(Dr. Eugene Garfiled)强调: HistCite^TM不仅仅是一个文献列表分析软件,更是一种强有力的分析工具,它会使你更好的理解某个科学领域的结构和历史。 AMG科学出版公司也参与了HistCite^TM软件开发工作。AMG公司的总裁Alexander Grimwade博士声称HistCite^TM的应用仅仅受一个人的想象力的限制。由于它使搜索结果的分析和组织简单化,以至于让研究者更愿意想象“如果…那么…”,从而对某一学科产生了新的理解。 软件能兼容大多数个人电脑Windows系统运行,HistCite^TM软件本身需要很小的硬件空间,但是运行大量的数据组需要有相当大小的硬盘和内存空间。     

Trophoblast Organoids: A New Tool for Studying Placental Development

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Adverse pregnancy outcomes such as implantation failure, fetal growth restriction, preeclampsia, and stillbirth occur worldwide at concerning rates.^1–4 Although their root causes are yet to be fully elucidated, the majority of these outcomes can be traced back to defects in placenta formation,⁵ a process that is still poorly understood. A new report in Environmental Health Perspectives leveraged a novel in vitro model to examine how organophosphate flame retardants (OPFRs) placentation and associated effects on birth outcomes.⁶In humans, the process of placentation begins very early in pregnancy, when embryonic cells called trophoblasts enter the uterine lining in a process called invasion. There, they fuse fetal and maternal tissue.⁷ The placenta continues to develop throughout the first trimester, acting as a vital interface that regulates nutrient exchange and waste removal, protects against external insults, and secretes hormones that maintain pregnancy and prepare the mother’s body for birth.⁸Open in a separate windowColored scanning electron micrograph of a human embryo at 11 days implanted in the wall of the uterus. New rodent and in vitro experiments suggest that chemical exposures may interfere with implantation. Image: © Lennart Nilsson, TT/Science Photo Library.Growing evidence suggests that environmental exposures may contribute to pregnancy complications that are mediated by disruption of placentation.^9–11 The effects of these complications can endure into adulthood,¹² making the identification of such environmental culprits all the more pressing. Epidemiological studies have linked OPFRs—widely used in furniture, textiles, electronics, building materials, and food packaging^13,14—to these adverse pregnancy outcomes.¹⁵Despite the varied and important roles of the placenta in fetal development, current knowledge about human placentation and how environmental chemicals may influence the process has been hampered by limited access to developing tissues and the absence of representative experimental models.¹⁶ “To address these conundrums, our study applied human trophoblast organoids, which can display near-physiological cellular composition and behavior relative to immature human placenta,” says senior author Jianying Hu, a professor in the Department of Environmental Science at Peking University.Organoids are self-organizing, three-dimensional structures typically derived from stem cells or tissues in culture that can recapitulate the complex structural, biological, and functional features of tissues and organs, bridging the gap between in vitro and in vivo models.^17,18 In the present study, Hu and colleagues cultured trophoblast organoids from placental villi donated by five women.⁶ They used the organoids to screen the placental toxicity of 46 OPFRs. Three of those chemicals were determined to affect cell proliferation without impairing cell survival. One of the three, 2-ethylhexyl diphenyl phosphate (EHDPP), has been widely detected in both environmental and human samples^11,19 and is associated with pregnancy complications.^20,21 The authors wrote that “EHDPP is the only organophosphate ester approved by the U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition for use as a fire retardant in food packaging materials.”⁶In subsequent in-depth mechanistic studies, they showed that EHDPP reduced metabolic function of trophoblasts. These results were closely recapitulated in parallel in vivo mouse experiments, using doses comparable to human exposures. Both immature and mature placentas from mice exposed before and during gestation exhibited decreased metabolic function and cell proliferation, compared with controls. Finally, exposure to EHDPP led to increased implantation failure, fetal growth restriction, and stillbirth. In offspring that survived to adulthood, exposure was also linked to impaired glucose tolerance, a sign of prediabetes.“The authors were able to use a combination of tools to screen the toxicity of numerous compounds and also validated these results in an in vivo model,” says Liping Feng, an associate professor at Duke University School of Medicine, underscoring the reliability of the study. “In addition, they measured concentrations of EHDPP in the placenta, which is very important because it can differ from that of the maternal circulation.”Feng, who was not involved in the study, adds that it is important to look beyond placental mechanisms to evaluate whether OPFRs can directly affect the embryo or fetus. Toxic chemicals can cross the placenta and even accumulate in the embryo.^22–24 One recent study²⁵ detected OPFRs in both the maternal and fetal sides of the placenta, highlighting the need to fully characterize their mechanism of action to better inform exposure reduction policies.Almudena Veiga-Lopez, an associate professor at the University of Illinois at Chicago College of Medicine, notes that this study primarily focuses on proliferation, which is a feature of “stemness” shared with cell types in other organs. Veiga-Lopez, who also was not involved in the study, says future studies should focus on evaluating functions specific to placental cells, such as cell invasion, cell fusion, and steroidogenesis.     

Challenging the Presumption of Diminished Capacity to Parent: Does Divorce Really Change Parenting Practices?*

Abstract: The purpose of this paper is to determine whether divorced parents exhibit a diminished capacity to parent in the period following divorce. Using 2 waves of data from a national survey of Canadian children, the current study prospectively follows 5,004 children living in 2–biological parent households at initial interview and compares changes in parenting practices between households that subsequently divorce and those that remain intact. Results show that divorce is unrelated to changes in parenting behavior, suggesting that there are more similarities than differences in parenting among recently divorced and continuously married parents.