Preschool Teachers' Use of Time-Out: Is What They Say What They Do?

Using triangulation, this study employed two methods to compare whether the responses of early childhood teachers about their use of timeout as a discipline method in focus group discussion was congruent with their behavior from classroom videotapes. The subjects were 5 teachers, who were among a larger group that had participated in one of 6 focus groups and were later videotaped in their preschool classes. These teachers volunteered to be videotaped after they had engaged in the focus groups. In the focus groups, teachers were asked to discuss how they respond to children's misbehaviors and how they make decisions about their responses. The videotapes were subsequently taken during 2 typical mornings in each class. Detailed analyses of the teachers' use or nonuse of time-out as well as their rationale for using this method, were undertaken for both focus group responses and behaviors observed on the videotapes. Results showed that the verbal responses of the teachers were very congruent with what they carried out while teaching.     

Peer Passengers: How Do They Affect Teen Crashes?

PurposeThe specific mechanisms by which peer passengers increase teen drivers' crash risk are not completely understood. We aimed to provide insight on the two primary hypothesized mechanisms, distraction and promotion of risk-taking behavior, for male and female teen drivers and further for select driver–passenger gender combinations.MethodsFrom the National Motor Vehicle Crash Causation Survey (2005–2007), we analyzed a nationally representative sample of 677 drivers aged 16–18 years (weighted n = 277,484) involved in serious crashes, to compare the risk of specific distraction-related and risk-taking–related precrash factors (documented via on-scene crash investigation) for teens driving with peer passengers and teens driving alone.ResultsCompared with males driving alone, those with peer passengers were more likely to perform an aggressive act (risk ratio, RR [95% confidence interval] = 2.36 [1.29–4.32]) and perform an illegal maneuver (RR = 5.88 [1.81–19.10]) just before crashing; risk taking increased regardless of passenger gender. Crash-involved males with passengers were also more likely to be distracted by an exterior factor (RR = 1.70 [1.15–2.51]). Conversely, females with passengers were more often engaged in at least one interior nondriving activity (other than conversing with passengers) (RR = 3.87 [1.36–11.06]), particularly when driving with opposite-gender passengers. Female drivers, both with and without passengers, rarely drove aggressively or performed an illegal maneuver before crashing.ConclusionsPassengers may affect male teen driver crashes through both distraction and risk-promoting pathways, and female involvement primarily through internal distraction. Results of this and future studies investigating peer–driver interactions may guide development of passenger-related crash prevention efforts to complement already existing Graduated Driver Licensing passenger restrictions.     

Plant Protein and Animal Proteins: Do They Differentially Affect Cardiovascular Disease Risk?

Proteins from plant-based compared with animal-based food sources may have different effects on cardiovascular disease (CVD) risk factors. Numerous epidemiologic and intervention studies have evaluated their respective health benefits; however, it is difficult to isolate the role of plant or animal protein on CVD risk. This review evaluates the current evidence from observational and intervention studies, focusing on the specific protein-providing foods and populations studied. Dietary protein is derived from many food sources, and each provides a different composite of nonprotein compounds that can also affect CVD risk factors. Increasing the consumption of protein-rich foods also typically results in lower intakes of other nutrients, which may simultaneously influence outcomes. Given these complexities, blanket statements about plant or animal protein may be too general, and greater consideration of the specific protein food sources and the background diet is required. The potential mechanisms responsible for any specific effects of plant and animal protein are similarly multifaceted and include the amino acid content of particular foods, contributions from other nonprotein compounds provided concomitantly by the whole food, and interactions with the gut microbiome. Evidence to date is inconclusive, and additional studies are needed to further advance our understanding of the complexity of plant protein vs. animal protein comparisons. Nonetheless, current evidence supports the idea that CVD risk can be reduced by a dietary pattern that provides more plant sources of protein compared with the typical American diet and also includes animal-based protein foods that are unprocessed and low in saturated fat.     

Assessment of PCB Congener Analytical Methods: Do They Meet Risk Assessment Needs?

Congener-specific PCB analysis allows use of toxic equivalency (TEQ) TCDD-based risk assessment approaches when analytical methods are sufficiently sensitive. Many efforts to analyze fish samples for PCB congeners report the majority of samples as non-detects; these data are of little use for human health risk assessment if the limits of analytical detection exceed levels of potential health concern. However, increasing analytical sensitivity is costly and technically difficult. An approach to assess analytical sensitivity needs for risk assessment by defining toxicological endpoints of concern and acceptable risk levels is presented. This framework was applied to assessment of potential PCB TEQ cancer risks to the general United States population and tribal consumers of Columbia River fish, but may be easily adjusted for other situations. A probabilistic model was used to calculate the necessary analytical sensitivity for PCB TEQ cancer risk assessment using the Environmental Protection Agency's new draft cancer risk slope factor for TCDD and fish consumption data. Desired levels of analytical sensitivity were estimated for the congener expected to contribute the most to PCB TEQ, PCB 126, and compared to limits of detection for various analytical methods. The financial and health value of methods with different levels of analytical sensitivity were compared using a value of information approach, which includes analytical cost and cost of potential health outcomes, and a proposed risk assessment utility approach which considers the relative health protectiveness of analytical options non-monetarily. Sensitivity analyses indicate that average consumption rate, cancer risk slope factor choice, and knowledge of existing PCB contamination are important considerations for planning PCB congener analysis. Received: 17 January 2002/Accepted: 29 July 2002     

Receipt of Transition Services Within a Medical Home: Do Racial and Geographic Disparities Exist?

Objectives 1. Rank states and southern region by racial disparity between black and white Youth with Special Health Care Needs (YSHCN) for Healthcare Transition receipt; 2. Determine if a racial and geographic disparity exists after control of characteristics. Methods The 05/06 National Survey of Children with Special Health Care Needs data were used. A composite of Medical Home and Transition Outcome Measures captured Healthcare Transition. If both were met, Healthcare Transition was received; otherwise, if neither were met, it was not received. Race was grouped as Non-Hispanic black or white. Census Bureau regions defined geography. South was categorized as Deep South or remaining southern states. Characteristics included sex, age, health condition effect, education, poverty, adequate insurance, and metropolitan status. Observations were limited to YSHCN. Chi-square and logistic regression were conducted. Alpha was set to .05. Results A national 42% Healthcare Transition rate, and 25% racial gap was calculated (higher rate among white YSHCN). White YSHCN had more than twice, and Midwestern had 44% higher Healthcare Transition odds in regression analysis; sex, health condition effect, insurance, and education remained significant. For the Southern region, the Healthcare Transition rate was 38% with a 26% racial gap. White YSHCN had about 2.6 higher odds, and southern geography was not associated in regression analysis. Education, poverty, adequate insurance, and health condition effect remained significant. Conclusions A low Healthcare Transition rate was found, and disparities are poignant. Culturally salient intervention programs to address racial and geographic disparities are needed for Healthcare Transition eligible YSHCN.     

Who Are the Medical Travelers and What Do They Want?: A Qualitative Study

The ongoing debate on U.S. healthcare reform fueled by increasing cost and poor access to quality healthcare is spurring interest in medical travel. The topic of medical travel—going abroad to seek medical care—has been widely reported in various news outlets. This issue even resulted in a Senate Hearing before the Special Committee on Aging. Despite this popularity, very little empirical research has been conducted to describe and understand medical travelers. To fill this gap, the present study involves in-depth interviews of medical travel facilitators with extensive exposure to and communication with medical travelers. This article has multiple objectives. It aims to develop a demographic and psychographic profile of medical travelers and identify their underlying motives to seek medical care overseas. Based on these insights, it presents a list of propositions to be tested in further research. Finally, it offers practical implications for the healthcare industry.     

Methods to Account for Attrition in Longitudinal Data: Do They Work? A Simulation Study

Attrition threatens the internal validity of cohort studies. Epidemiologists use various imputation and weighting methods to limit bias due to attrition. However, the ability of these methods to correct for attrition bias has not been tested. We simulated a cohort of 300 subjects using 500 computer replications to determine whether regression imputation, individual weighting, or multiple imputation is useful to reduce attrition bias. We compared these results to a complete subject analysis. Our logistic regression model included a binary exposure and two confounders. We generated 10, 25, and 40% attrition through three missing data mechanisms: missing completely at random (MCAR), missing at random (MAR) and missing not at random (MNAR), and used four covariance matrices to vary attrition. We compared true and estimated mean odds ratios (ORs), standard deviations (SDs), and coverage. With data MCAR and MAR for all attrition rates, the complete subject analysis produced results at least as valid as those from the imputation and weighting methods. With data MNAR, no method provided unbiased estimates of the OR at attrition rates of 25 or 40%. When observations are not MAR or MCAR, imputation and weighting methods may not effectively reduce attrition bias.     

Dairy Foods: Are They Politically Correct?

This article considers the scientific evidence on the prevalence and management of verified lactose intolerance and the growing misperception that dairy foods should be avoided because ethnic populations cannot tolerate them. Healthcare professionals, in particular, must understand why eliminating dairy foods is rarely necessary and is generally undesirable. The genetically programmed ability to digest the milk sugar lactose normally declines throughout childhood in all ethnic groups. Only rarely does lactase nonpersistence result in verifiable lactose intolerance. The intolerance-gastrointestinal symptoms, such as diarrhea, bloating, and abdominal cramping-is easily managed when it occurs and is not a barrier to the consumption of 2 to 3 servings of calcium-rich dairy foods, as encouraged by the Dietary Guidelines for Americans.     

Perceived Nutrition and Health Concerns: Do They Protect against Unhealthy Dietary Patterns in Polish Adults?

The aim of the study was to explore the associations between perceived health and nutrition concerns, sociodemographic characteristics and unhealthy dietary patterns in a representative group of Polish adults. The data were collected in 2017 through a cross-sectional quantitative survey under the National Health Program 2016–2020. Logistic regression models were used to analyze the data. It was found that higher health concerns decreased the chances of adhering to upper tertiles of “Fast food & alcohol” and “Refined food & sweetened beverages” dietary patterns (DPs), thus displaying less frequent consumption of such foods. No relationship was found between health concerns and adhering to the “Fat food” and “Butter” DPs. Nutrition concerns increased the likelihood of frequent consumption of foods from “Fast food & alcohol” DP. Women were less likely to adhere to unhealthy eating patterns than men, while older people were less likely to often consume fast food, alcohol, or refined food and sweetened beverages. Findings of this study showed that concerns about health or nutrition were differently associated with dietary patterns and consumption of unhealthy foods. These relationships should be considered when developing interventions to address health-related lifestyle changes. However, further research is needed to identify cause-effect relationships between these variables.     

Practitioner Response to Parental Need in Email Consultation: How Do They Match? A Content Analysis

Background

Single session email consultations in web-based parenting support may be used for a variety of reasons. Parents may be looking for information on developmental needs of children, for suggestions to improve their parenting skills, or for referrals to helpful resources. The way the practitioner meets the needs of parents, choosing a short-term and text-based approach, has not been analyzed up till now.

Objective

To determine if and how practitioner response in single session email consultation matches the need of parents.

Method

A content analysis of single session email consultations (129 questions; 5,997 response sentences) was conducted. Three perspectives on the parent–practitioner communication were distinguished to assess the match between parenting questions and consultations, i.e., the expert oriented, parent oriented and context oriented perspective.

Results

The parent oriented type is the dominant paradigm in requesting and providing email consultations, with which the other types may be combined. Most consultations showed a mixed perspective with the use of a limited amount of techniques within each perspective. Correlations between the practitioner’s approach and parental expectancies were weak.

Conclusions

Professionals have a broad approach to email consultation, offering advice of different perspectives, rather than restricting the advice in order to match a prevalent parental need. All proposed textual techniques were observed in email consultations, providing evidence of their feasibility. Since practice of email consultations is relatively new, practitioners may benefit from the proposed systematic approach to writing email consultations, identifying parental need and permitting the use of professional techniques.