Reducing child malnutrition in Nigeria: combined effects of income growth and provision of information about mothers' access to health care services

Using a sample of 1359 Nigerian households from the 2003 Demographic and Health Surveys, this article investigates the contribution of improved maternal information about access to community health services toward the reduction of child stunting and undernourishment. The analysis shows that family wealth and region-specific knowledge about community health care access positively affects child nutrition status measured by height-for-age and weight-for-age. However, these nutrition gains can be reinforced or tempered by differences in mother's education and/or her access to community health services. These findings suggest that interventions which enhance public knowledge about availability and access to health care could strengthen more general development-oriented child nutrition-enhancing interventions, such as poverty reduction or growth in health services infrastructure.     

农村妇女性别意识、家庭事务决策权与孕产期保健

目的了解农村已婚妇女社会性别意识的认知程度、家庭事务决策状况及其对孕产期保健服务利用的影响。方法在新疆维吾尔族自治区和安徽省项目县中,采用整群随机抽样方法获得调查对象,由调查员对其进行面对面问卷调查。结果65.7%的农村已婚妇女社会性别意识得分≤19分,对社会性别意识的认知程度不高;79.3%家庭事务决策权得分≤18分,女性在家庭中处于从属地位;55.7%在孕期进行产前检查,在做过产前检查的妇女中,34.3%接受过≥5次的产前检查;64.0%在孕早期进行第1次产前检查;调查对象的住院分娩率为55.1%;对社会性别意识的认识、对家庭事务的决策程度及其文化程度是影响妇女孕产期保健服务利用的主要因素。结论新疆、安徽省项目地区农村已婚妇女社会性别意识较弱,家庭事务决策权较低下,孕产期保健服务利用不高。     

Staff perception of the impact of health care transformation on quality of care.

OBJECTIVES: To study how medical professionals perceived recent organizational changes and financial cut-backs in terms of organizational and health care quality. DESIGN: A cross-sectional questionnaire survey. SETTING: County council of Stockholm. PARTICIPANTS: A random sample (n=936; 70% response rate) of physicians and nurses employed by the county council of Stockholm. MAIN OUTCOME MEASURES: Staff perception of how recent changes impacted on staff-perceived quality of care, staffs' skills development, management, and perceived organizational efficacy. RESULTS: Over 60% of the respondents rated that patients' access to health care had diminished as a result of ongoing changes. A similar percentage also perceived a decline in the quality of health care delivered in general. However, fewer staff rated a decline during the last year in the quality of care provided by their own department (44%). Staff rating that quality of care in their own department had worsened during the last year also scored substantially lower on all counts of organizational well-being. The most important determinants of staff-perceived quality of care were staff access to pertinent information concerning their daily work and organizational changes, participatory management, performance management, and job commitment. Job satisfaction was more strongly associated with organizational well-being than staff-perceived quality of care. CONCLUSION: Staff perception should be used as an additional indicator of quality of care. To improve quality of care further, management should encourage staff involvement in everyday management issues, including up-to-date information about organizational goals and mission.     

中国儿童健康状况及服务利用地区差异分析

目的了解我国不同地区儿童健康状况及卫生服务利用的地区差异,为确定我国儿童保健工作重点及制定相应措施提供依据。方法以2008年中国卫生服务调查研究资料为基础,采用差异指数和地理分布图方法,分析儿童2周腹泻发病率、2周患病率、2周就诊率和住院率4项指标在不同地区的差异。结果儿童健康状况及卫生服务利用的4项统计指标均呈现农村高于城市。按照行政区域划分,儿童2周腹泻发病率较高的是西南(8.5%)和东北(8.0%),最低的是中南(5.1%);2周患病率和2周就诊率最高的都是中南(14.1%和20.9%),最低的均为西北(7.2%和6.9%);住院率最高的是中南(4.6%),最低的是华北(3.1%)。差异指数无论是在行政区域内部还是在全国范围基本都大于0.20,说明地区差异较为显著。结论我国儿童健康状况及卫生服务利用存在较大地区差异。     

Impacts of managed care patient protection laws on health services utilization and patient satisfaction with care

OBJECTIVE: To assess effects of patient protection laws implemented by the vast majority of states during the 1990s on the public's satisfaction and trust relating to health care, and on key utilization measures. DATA SOURCES/STUDY SETTING: Measures of individuals' health care utilization and satisfaction, and control variables, came from three waves of the Community Tracking Study (CTS) Household Surveys conducted in 1996-1997, 1998-1999, and 2000-2001. The CTS was conducted in 60 randomly selected communities, throughout the U.S. In addition, a supplemental national sample of households from CTS was also included, resulting in a combined sample with cases from 48 states and the District of Columbia. After applying exclusion restrictions, the analysis sample was 149,688 adults. STUDY DESIGN: Using a fixed-effects methodology, we assessed the influence of patient protection laws on satisfaction with care and utilization of services for the entire sample and for subsamples of persons in poor health, with low income, and who were enrolled in HMOs. DATA COLLECTION/EXTRACTION METHODS: One of the authors (Hall) compiled relevant laws in all U.S. states through 2001 from primary legal sources, checking for accuracy by conducting independent research on statutory changes and by asking three to five regulators in each state to verify that the information was correct. PRINCIPAL FINDINGS: Overall, patient protection laws had little or no effect on either trust, satisfaction with care, or utilization. Significance was found postenactment of a state patient protection law only for emergency room visits in the general sample, and only for physician trust in the low-income sample. Because of the number of possible associations examined, occasional findings of significance could occur by chance. CONCLUSIONS: Enactment of managed care patient protection laws did not generally increase utilization of health services or improve patient satisfaction with care.     

The impact of managed care on substance abuse treatment services

OBJECTIVE: To examine the impact of managed care on the number and types of services offered by substance abuse treatment (SAT) facilities. Both the number and types of services offered are important factors to analyze, as research shows that a broad range of services increases treatment effectiveness. DATA SOURCES: The 2000 National Survey of Substance Abuse Treatment Services (NSSATS), which is designed to collect data on service offerings and other characteristics of SAT facilities in the United States. These data are merged with data from the 2002 Area Resource File (ARF), a county-specific database containing information on population and managed care activity. We use data on 10,513 facilities, virtually a census of all SAT facilities. STUDY DESIGN: We estimate the impact of managed care (MC) on the number and types of services offered by SAT facilities using instrumental variables (IV) techniques that account for possible endogeneity between facilities' involvement in MC and service offerings. Due to limitations of the NSSATS data, MC and specific services are modeled as binary variables. PRINCIPAL FINDINGS: We find that managed care causes SAT facilities to offer, on average, approximately two fewer services. This effect is concentrated primarily in medical testing services (i.e., tests for TB, HIV/AIDs, and STDs). We also find that MC increases the likelihood of offering substance abuse assessment and relapse prevention groups, but decreases the likelihood of offering outcome follow-up. CONCLUSION: Our findings raise policy concerns that managed care may reduce treatment effectiveness by limiting the range of services offered to meet patient needs. Further, reduced onsite medical testing may contribute to the spread of infectious diseases that pose important public health concerns.     

Perceptions of well-being among child care teachers

The perception of well-being among 235 randomly selected teachers was investigated in the context of ten different child care activities. The term well-being was defined as a linear composite of ratings on the Happiness and Relaxation scales. The results indicated that child related education, experience, and their interaction do not influence the overall well-being of teachers. However, the well-being changed significantly across child care activities and the pattern of changes was dependent on the amount of child care experience. Nurturing children and working with parents were found to be the most enjoyable and least stressful tasks. Not surprisingly, supervision of toileting was the least liked activity and controlling children's behavior was the most stressful task. The well-being of caregivers was considered a key to delivering quality child care.     

德尔菲法在三级妇幼保健服务项目确定中的应用

根据妇幼保健机构的功能定位确定服务项目是妇幼保健机构建设和管理的重要内容。笔者采用德尔菲专家咨询法,通过两轮专家咨询对妇幼保健服务的重要性打分和一轮集中讨论,围绕着妇幼保健机构的功能定位,在大保健的理念下,梳理了三级妇幼保健服务项目,重新对省、地、县三级妇幼保健机构应该开展的服务项目进行界定。     

中国老年人对医疗服务与长期照料服务的需要与利用研究——基于中国健康与养老追踪调查的实证分析

目的 了解中国老年人对医疗和长期照料服务的需要与利用情况;分析对医养结合型服务的潜在需要;为促进我国医养结合型服务的发展提供参考依据。方法 利用中国健康与养老追踪调查的数据,分析60岁以上老年人对医疗服务与长期照料服务的需要与利用情况以及对医养结合型服务的潜在需要。结果 全体老年人中,有14.01%和7.21%的老人存在应就诊而未就诊和应住院未住院的情况;在失能老人中,有39.44%的比例未获得照料;在潜在存在医养结合型服务需要的老人中,仅有37.46%的老人两种需要同时得到满足。结论 老年人对医疗与长期照料服务的需要较大并且同时存在,但对它们的利用并不充分。建议政府推进医养结合型服务的发展,在促进医养结合型服务供给的同时提高对老年人的保障力度。     

Notions of child health: mothers' accounts of health in their young babies

This paper is concerned with mothers’ understandings of child health in their young babies. To explore how child health is depicted, explained and contextualised by mothers, altogether 29 mothers in Stockholm and London were interviewed through the baby's first months about day-to-day experiences of the baby's health and well-being. The analysis of the mothers’ accounts reveals how the mothers, in the process of assessing health, try to ‘read’ the bodily signs and reactions in their babies. Some major themes emerge on how the mothers identify and characterise threats to the health of the baby; here described as threats of abnormalities, threats to the survival of the baby, threats to the thriving of the baby and threats from illnesses. Notions of child health are discussed in relation to the ‘bodily’ and the ‘social’, and how the embodied images of child health are intertwined with the mothers’ presentations of themselves as responsible for the health of their children and as ‘worthy’ parents.     

Training child care personnel in rural areas

The purpose of this paper is to discuss the needs of child care personnel in rural areas and to describe the various approaches used by Mount Saint Vincent's Department of Child Study to implement pre- and in-service education programmes for these caregivers. The Department of Child Study has offered child care training programmes in rural and remote parts of Atlantic Canada and in two countries in the Caribbean. Factors which affect the development of preschool distance education programmes, including the special local conditions which determine the selection of the most appropriate model, are presented.     

Experiences of Finnish care leavers of their involvement in the aftercare services for child welfare clients

Children and young people placed in out-of-home care form a vulnerable group. Their involvement in decision making of their future is undermined by the lack of a safe ‘adult security net’ and the brevity of the period in which they are supposed to gain independence. Although there are some studies showing that the opportunity to affect the decision making is insufficient, there are no studies about how the involvement might actually be developed. This study describes young people's experiences of their involvement and the developmental needs for it in aftercare services for child welfare clients. The design was that of a qualitative explorative study. In total, 16 care leavers participated in the study. Data were collected by thematic interviews in autumn 2016 and analysed by qualitative content analysis. Good value-based collaboration with the staff and the possibility of mental, concrete and social support enhanced the young people's active involvement in their lives. The topics the interviewees wanted to see developed included the core values in the aftercare services, the comprehensiveness of the support and a future-oriented approach. Collaborative relationships should, it emerged, be based on individuality, equality, fairness, trust, a non-judgmental attitude, flexibility and safety and a general approach valuing, respecting, listening to and empowering the young person. Support should be provided with a comprehensive approach and in a multiprofessional and coordinated manner. The transition period to an independent life should be extended and carefully prepared, with an option for the continuity of the collaboration with the employees if needed.     

围产保健与儿童保健监测的方法与应用

目的：研究最佳围产保健与儿童保健的监测方法与应用,为母婴与儿童提供及时,系统的保健服务。方法：新婚妇女在婚前检查时建立围产保健册、随后开始月经监测,确定早孕后,定期作产前复查等监测。直到产后42d为止;新生儿应在出生42d内建立儿童保健册,然后根据监测对象的年龄 常规体检的原则,完成相应年龄段的询问,体检、实验室检查与评价。监测全程均有质量控制措施,所有的监测结果均录入计算机。实现计算机化管理。结果：该监测系统已经在我国的32个县（市）中实施,覆盖地区的总人口超过2千万,从1993年至,围产保健监测系统已成地连续运转了8年,儿童保健监测系统已成功地连续运转了4年。结论：该围产保健与儿童保健监监适合我国,国情,运转顺利,对促进和提高当地的围产保健与儿童保健工作水平,提高我国人口素质将发挥重要作用。     

Providers' evaluations of family day care services

Family day care is an informal and largely unregulated form of child care with providers a key element in creating effective programs. Relatively little is known of how providers perceive the needs of clients [parents and children] and how they evaluate the adequacy of their services in meeting family needs. Thirty-two registered home providers estimated parents' reasons for selecting family day care, and the degree to which their services met parents' and children's needs for care. They also evaluated the importance of program goals and provider qualifications and indicated their experience and training for day care. Knowledge of providers' perceptions of the quality of their services and their ability to meet client needs can help educators create training programs with appropriate content and format.     

Intra-cultural variation in child care practices in Japan

This study, comprising three sub-studies, aims to examine how child-rearing practices vary according to different social circumstances in Japan. By comparing teacher–child interaction at mealtimes in day care centres both on an isolated small island located in Okinawa prefecture, Tarama, and in a large industrialised city, Tokyo, the following was shown. In Tarama, teachers, children, and their families were familiar with each other before the children's enrolment, while in Tokyo, it was typical that they first met when the children entered the centre. Such differences in social relationships were reflected in teacher–child interactions at mealtimes. First, in Tarama, ownership distinctions at the table were not so rigorous compared to those in Tokyo, implying that the teacher–child lunchtime in Tarama was similar to a home-like private situation. Second, in both Tarama and Tokyo, teachers encouraged children's eating by giving various kinds of assistance, but their approaches were different. Teachers in Tokyo paid much attention to improve children's eating skills, while in Tarama, teachers placed more weight on ensuring primary functions of mealtimes. The results indicated that child care practices were deeply rooted in social communities.     

Menu variety in Mississippi child care centers

Licensed child care centers in Mississippi were surveyed to determine variety of menu offerings. Each randomly selected center was sent a questionnaire which included a request for cycle menus currently being used. Ninety-two centers #op41#pc#cp returned both the survey and menus for five days which gave a total of 460 lunch menus for analysis. Menus were analyzed using nutrient analysis software and a frequency analysis showed the most commonly used foods.The foods used most often were milk, white bread, pear halves, tossed green salad, frozen broccoli, sliced ham, and sausage pizza. The majority of the centers used two or more foods as many as three times per week. Results from this study support the need for more training for menu planners in child care centers.