Transforming the Master's Degree in Human Development and Family Science*

Abstract: This study chronicles the transformation of a master's program from a traditional degree format to a more integrated, flexible, efficient, and relevant approach. The transformative strategies involve cohort learning, creative concentrations, portfolio documentation, and outreach presentation. Through integrating resources and goals, the new program efficiently promotes student success and excellence. Ongoing assessments include interviews with prospective employers, marketing questionnaires with prospective students, and evaluation data from students and alumni. Relative to the traditional program, the new program doubled applications, expanded enrollment, and reduced time to completion. Overall, graduates reported substantial satisfaction with the program and secured relevant positions in the field. The findings from the assessments and process of transformation suggest programmatic implications for navigating curriculum change in the 21st century.     

Guidelines for Appropriate Care: The Importance of Empirical Normative Analysis

The Royal Dutch Medical Association recently completed a researchproject aimed at investigating how guidelines for `appropriatemedical care' should be construed. The project took as a startingpoint that explicit attention should be given to ethical andpolitical considerations in addition to data about costs andeffectiveness. In the project, two research groups set out todesign guidelines and cost-effectiveness analyses (CEAs) for twocircumscribed medical areas (angina pectoris and majordepression). Our third group was responsible for the normativeanalysis. We undertook an explorative, qualitative pilot study ofthe normative considerations that played a role in constructingthe guidelines and CEAs, and simultaneously interviewedspecialists about the normative considerations that guided theirdiagnostic and treatment decisions. Explicating normativeconsiderations, we argue, is important democratically: the issuesat stake should not be left to decision analysts and guidelinedevelopers to decide. Moreover, it is a necessary condition for asuccessful implementation of such tools: those who draw uponthese tools will only accept them when they can recognizethemselves in the considerations implied. Empirical normativeanalysis, we argue, is a crucial tool in developing guidelinesfor appropriate medical care.     

A Process Evaluation of a Website for Family Life Educators*

Effective professional development is critical to maintaining high‐quality family life education. Most professional development continues to be conducted through workshops, newsletters, and other traditional ways. The growth of information technology provides an important new teaching capacity for professional development. This article explores the development of a website for family life educators, examines procedures for obtaining formative evaluation data about websites, and considers the implications of this work for developing more effective professional development experiences for family life educators.     

高职高专妇产科教学中渗透职业道德教育的探索

职业道德教育是高职高专医学生教育的重要组成部分。通过提高临床医学专业教师的职业道德素养,采用多种方法在理论课、实验课、见习、实习中渗透职业道德教育等途径,使学生在获得专业知识的同时,提高职业道德素养,培养既有专业技能,又有良好医德的新一代医学生。     

城区学龄前儿童运动发育家庭环境量表的信度和效度评价

目的 评价城区学龄前儿童运动发育家庭环境量表( FESMDUPC)的信度和效度,为儿童运动协调能力家庭环境的研究提供有效和可靠测量工具.方法 苏州市区15所幼儿园共1824名学龄前儿童纳入FESMDUPC的信度和效度研究,采用组内相关系数(ICC)、Cronbach α系数、项目水平内容效度指数、验证性因素分别分析FESMDUPC的重测信度、内部一致性信度、内容效度、结构效度.以HOME量表修改版(Observation for Measurement of the EnvironmentRevisited)为外在效标,采用Spearman相关分析评价FESMDUPC的效标相关效度.结果 将前后两次FESMDUPC调查结果进行ICC评价,各条目ICC均超过或接近0.9.该量表总Cronbach α系数为0.875,分别去除各条目后的Cronbach α系数为0.868 ～ 0.873.正式信效度调查数据分析显示:FESMDUPC中23个条目的I-CVI为0.79～1.00,平均I-CVI为0.92.初始模型拟合结果x2/df=4.810,拟合优度模型度指数(GFI)为0.949和调整拟合优度指数(AGFI)为0.937,均＞0.9.规范拟合指数(NFI)为0.889,比较拟合指数(CFI)为0.896,接近0.9.均方根残差RMSEA为0.046＜0.05,提示该模型可以接受,各条日的因素载荷均＞0.3,差异有统计学意义(均P＜0.001).但是由于户外运动空间、户内运动空间、玩具3个因子间的相关性较高,进行高阶验证性因素分析,模型拟合结果较为理想,各条目因素载荷也均＞0.3.FESMDUPC和HOME量表总分的Spearman相关系数为0.476(P＜0.001).其中HOME量表仪学习用品和活动多样性2个因子与FESMDUPC的一阶因子玩具、养育方式、高阶因子的家庭物质环境,以及FESMDUPC总分日常生活照顾相关程度相对较高,其Spearman相关系数均＞0.3.结论 FESMDUPC重测信度、内部一致性信度、结构效度、外在效标效度较好,均达到心理测量学的基本要求,可作为评价学龄前儿童运动发育家庭环境的量化工具.     

The 2000 Dietary Guidelines for Americans: foundation of US nutrition policy

The Dietary Guidelines for Americans form the foundation of US federal nutrition policy. The Food Guide Pyramid, the most widely distributed and best‐recognised nutrition education tool ever produced in the US, is based partially on the Dietary Guidelines. In addition, every federal nutrition programme in the United States uses the Dietary Guidelines as part of their nutrition standards. Federal law requires that the guidelines be reviewed every five years. The Dietary Guidelines Advisory Committee was charged with answering the question, ‘what should Americans eat to be healthy?’ After rigorously reviewing the scientific, peer‐reviewed literature the committee recommended a new set of guidelines for the year 2000. The guidelines are intended for healthy children (ages 2 years and older) and generally healthy adults of any age. The guidelines were expanded from seven in 1995 to ten in 2000. The 2000 Dietary Guidelines for Americans are; (1) aim for a healthy weight; (2) be physically active each day; (3) let the pyramid guide your food choices; (4) eat a variety of grains daily, especially whole grains; (5) eat a variety of fruits and vegetables daily; (6) keep foods safe to eat; (7) choose a diet that is low in saturated fat and cholesterol and moderate in total fat; (8) choose beverages and foods that moderate your intake of sugars; (9) choose and prepare foods with less salt; and (10) if you drink alcoholic beverages, do so in moderation.     

Cultural Diversity and the Case Against Ethical Relativism

The movement to respect culturaldiversity, known as multiculturalism, poses a dauntingchallenge to healthcare ethics. Can we construct adefensible passage from the fact of culturaldifferences to any claims regarding morality? Or doesmulticulturalism lead to ethical relativism? Macklinargues that, in view of a leading distinction betweenuniversalism in ethics and moral absolutism, the onlyreasonable passage avoids both absolutism andrelativism. She presents a strong case againstethical relativism and its pernicious consequences forcross-cultural issues in healthcare. She alsoprovides sound criteria for the assessment of aculture's moral progress.     

Dual loyalties and the ethical and human rights obligations of occupational health professionals

BACKGROUND: Underlying most ethical dilemmas in occupational health practice is the problem of Dual Loyalties where health professionals have simultaneous obligations, explicit or implicit, to a third party, usually a private employer. METHODS: A literature review was undertaken of case studies of workplace occupational health conflicts, international human rights and ethical codes and strategies for managing dual loyalties, complemented by iterative discussions in an international working group convened to address the problem of Dual Loyalties. RESULTS: Violations of the worker-patient's human rights may arise from: (1) the incompatibility of simultaneous obligations; (2) pressure on the professional from the third party; and (3) separation of the health professional's clinical role from that of a social agent. The practitioner's contractual relationship with the third party is often the underlying problem, being far more explicit than their moral obligation to patients, and encouraging a social identification at the expense of a practitioner's professional identity. CONCLUSIONS: Because existing ethical guidelines lack specificity on managing Dual Loyalties in occupational health, guidelines that draw on human rights standards have been developed by the working group. These guidelines propose standards for individual professional conduct and complementary institutional mechanisms to address the problem.     

Ethical issues in occupational medicine practice: knowledge and attitudes of occupational physicians

Views on ethical conduct in occupational medicine practice canvary from country to country and even between occupational healthpractitioners. However, there are many areas of common agreement,and this is apparent on comparing guidance documents on ethicsproduced by several different organizations. The usefulnessof these documents will depend in part on how aware practitionersare of their existence. A standardized questionnaire administeredto 70 occupational physicians in the Netherlands, UK, and Singaporeshowed that there was a lack of awareness of guidance documentson ethics, even for publications from their own countries. Onlyfive of the 70 respondents consulted an ethics document in thepast year. In addition to publications, other avenues were usedfor advice on ethical issues. There was a difference in opinionbetween the physicians from Singapore and those from the twoEuropean countries on whether specific occupational health activitieswere ethical. These findings reinforce the need for internationalguidance on ethics to take into account differences in attitudesand practice between countries. On many issues there was nounanimity of opinion, even between occupational physicians fromthe same country. This may be an indication of the complexityof ethical matters, and provides a rationale for publishingguidance on ethics in occupational medicine.     

Private Interests and the Start of Fluoride-Supplemented High-Carbohydrate Nutritional Guidelines

Fluoride has no tangible health benefits other than preventing dental caries and there is a small difference between its minimum effective dose and its minimum toxic dose. Leading global organizations currently recommend fluoride supplementation because they recommend high-carbohydrate diets which can cause dental caries. Low-carbohydrate diets prevent dental caries making such fluoride recommendations largely unnecessary. A dental organization was among the first to initiate the public health recommendations which started fluoride-supplemented high-carbohydrate nutritional guidelines. This start required expert panels at this dental organization to reverse on three key scientific points between 1942 and 1949: (1) that topical fluoride had potential harms, (2) that dental caries was a marker for micronutrient deficiencies, and (3) that low-carbohydrate diets are to be recommended for dental caries prevention. Internal documents show that private interests motivated the events which led these expert panels to engage in pivotal scientific reversals. These private interests biased scientific processes and these reversals occurred largely in an absence of supporting evidence. It is concluded that private interests played a significant role in the start of public health endorsements of fluoride-supplemented high-carbohydrate nutritional guidelines.     

Connecting Research and Policymaking: Implications for Theory and Practice from the Family Impact Seminars*

This paper addresses a conundrum that merits scholarly attention—why social scientists' ability to generate high quality research has outpaced their ability to disseminate research into the policymaking process. The paper describes Family Impact Seminars, a series of seminars, briefing reports, and follow‐up activities that provide up‐to‐date, solution‐oriented information to state policymakers. In support of the proposed “three‐communities” theory, the utilization of research in policymaking appears to depend upon several pragmatic practices and procedures, ten which are detailed in the paper.     

《中国计划生育学杂志》论文中医学伦理意识的调查与思考

目的:从科技论文角度探讨我国计划生育科研工作中存在的医学伦理学问题。方法:查阅2005～2009年《中国计划生育学杂志》发表的学术论文,统计作者自述"通过伦理委员会审查""研究对象知情同意"情况。结果:5年间共出版60期(月刊),发表了以人为研究对象、前瞻性研究论文681篇,其中论文说明研究"经过伦理委员会审查"仅4篇(0.59%),"研究对象知情同意"49篇(7.20%)。结论:本次调查论文有关医学伦理学阐述的比例很低,反映出计划生育科研论文作者和编辑者的伦理学意识相当薄弱,与国外生物医学期刊差距较大。提示科技管理部门应重视对科研人员伦理学知识的宣传教育,加强计划生育科研工作伦理学规范。通过完善期刊编审程序,加强科研伦理学审查提高论文质量,促进我国人口和计划生育科学研究健康持续发展。     

The Influence of the Australian Dietary Guidelines on Culinary Textbooks Used in Education over the Last 30 Years

Cookery the Australian Way (CAW), a key culinary textbook, was evaluated to determine whether recipes reflected the prevailing dietary guidelines, specifically to limit saturated fat, added salt, and sugar. Seven-hundred recipes from Editions 3 to 8 were analysed using FoodWorks® 7. Saturated fat, total sugars, and sodium/100 g and per serve was compared using SPSS® (Version 22). A 43% reduction in sodium/100 g in soups and a 50% reduction in sodium/100 g for meats and poultry domain was observed in the 31 years from Editions 3 to 8. A 38% reduction in saturated fat/100 g was observed in the meats and poultry domain across the same time period. Dessert recipes showed a smaller but significant reduction in saturated fat/serve and mixed results for sugar. These observations suggest some modification to reflect dietary guidelines occurred. Cookery texts used in education should incorporate nutrition and reflect dietary guidelines. This series is a positive example for other publishers.     

Development of the SoFAS (Solid Fats and Added Sugars) Concept: The 2010 Dietary Guidelines for Americans

The diets of most US children and adults are poor, as reflected by low diet quality scores, when compared with the recommendations of the Dietary Guidelines for Americans (DGAs). Contributing to these low scores is that most Americans overconsume solid fats, which may contain saturated fatty acids and added sugars; although alcohol consumption was generally modest, it provided few nutrients. Thus, the 2005 DGAs generated a new recommendation: to reduce intakes of solid fats, alcohol, and added sugars (SoFAAS). What precipitated the emergence of the new SoFAAS terminology was the concept of discretionary calories (a “calorie” is defined as the amount of energy needed to increase the temperature of 1 kg of water by 1°C), which were defined as calories consumed after an individual had met his or her recommended nutrient intakes while consuming fewer calories than the daily recommendation. A limitation with this concept was that additional amounts of nutrient-dense foods consumed beyond the recommended amount were also considered discretionary calories. The rationale for this was that if nutrient-dense foods were consumed beyond recommended amounts, after total energy intake was met then this constituted excess energy intake. In the 2010 DGAs, the terminology was changed to solid fats and added sugars (SoFAS); thus, alcohol was excluded because it made a minor contribution to overall intake and did not apply to children. The SoFAS terminology also negated nutrient-dense foods that were consumed in amounts above the recommendations for the specific food groups in the food patterns. The ambiguous SoFAS terminology was later changed to “empty calories” to reflect only those calories from solid fats and added sugars (and alcohol if consumed beyond moderate amounts). The purpose of this review is to provide an historical perspective on how the dietary recommendations went from SoFAAS to SoFAS and how discretionary calories went to empty calories between the 2005 and 2010 DGAs. This information will provide practitioners, as well as the public, with valuable information to better understand the evolution of SoFAS over time.     

城市学龄前儿童运动发育家庭环境量表的初步编制

目的编制城市学龄前儿童家庭运动环境评价量表(Family Environment Scale on Motor Development for Pre-school Urban Children,FESMDPU),为家庭环境与儿童运动发育的关联性研究提供量化工具。方法以HOME和AHEMD-SR量表为蓝本,在确立71个初始条目的基础上,运用临界比、相关分析和探索性因素分析的结果对条目进行删减。结果根据各条目临界比保留全部条目,根据各条目与总分的相关系数删减15个条目,最后通过第1次和第2次探索性因素分析结果删除5个条目,最后共保留51个条目。此外,探索性因素分析提取了户外运动空间、户内运动空间、精细运动玩具、大运动玩具、空间色彩类玩具、温暖/鼓励、日常生活照顾7个因子。结论保留51个条目作为FESMDPU进一步研究的内容,为该量表的应用性研究奠定了基础。     

The Internet doctor and medical ethics Ethical implications of the introduction of the Internet into medical encounters

In this article, consultation via the Internet and the use of the Internet as a source of medical information is examined from an ethical point of view. It is argued that important ethical aspects of the clinical interaction, such as dialogue and trust will be difficult to realise in an Internet-consultation. Further, it is doubtful whether an Internet doctor will accept responsibility. However, medical information via the Internet can be a valuable resource for patients wanting to know more about their disease and, thus, it is a means to enhancing their autonomy. This revised version was published online in July 2006 with corrections to the Cover Date.     

Barriers and Facilitators for Consumer Adherence to the Dietary Guidelines for Americans: The HEALTH Study

The majority of the US population does not meet recommendations for consumption of milk, whole grains, fruit, and vegetables. The goal of our study was to understand barriers and facilitators to adherence to the Dietary Guidelines for Americans for four nutrient-rich food groups in fifth-grade children and unrelated adult caregivers across six sites in a multistate study. A total of 281 unrelated adult caregivers (32% African American, 33% European American, and 35% Hispanic American) and 321 children (33% African American, 33% European American, and 34% Hispanic American) participated in 97 Nominal Group Technique sessions. Nominal Group Technique is a qualitative method of data collection that enables a group to generate and prioritize a large number of issues within a structure that gives everyone an equal voice. The core barriers specific to unrelated adult caregivers were lack of meal preparation skills or recipes (whole grains, fruit, vegetables); difficulty in changing eating habits (whole grains, fruit, vegetables), cost (milk, whole grains, fruit, vegetables), lack of knowledge of recommendation/portion/health benefits (milk, vegetables), and taste (milk, whole grains, vegetables). Specific to children, the core barriers were competing foods (ie, soda, junk foods, sugary foods [whole grains, milk, fruit, vegetables]), health concerns (ie, milk allergy/upset stomach [milk]), taste/flavor/smell (milk, whole grains, fruit, vegetables), forget to eat them (vegetables, fruit), and hard to consume or figure out the recommended amount (milk, fruit). For both unrelated adult caregivers and children, reported facilitators closely coincided with the barriers, highlighting modifiable conditions that could help individuals to meet the Dietary Guidelines for Americans.     

Intent to receive HPV vaccine and reasons for not vaccinating among unvaccinated adolescent and young women: findings from the 2006-2008 National Survey of Family Growth

Background and purpose

HPV vaccine coverage for females has increased in the U.S., although challenges to achieving high coverage remain. HPV vaccine coverage continues to lag behind that of other routinely recommended adolescent vaccines and these gaps in coverage are widening. To inform strategies to improve uptake, we explore correlates of vaccine intention and describe reasons for refusing HPV vaccination among unvaccinated females in a nationally representative sample of adolescents and young adults during early stages of HPV vaccine availability.

Methods

In 2007–2008, 1243 females aged 15–24 years were asked about HPV vaccination in the National Survey of Family Growth (NSFG). For unvaccinated women (n = 955), we evaluated demographic and sexual behavior correlates of likelihood to receive the vaccine in the next 12 months in bivariate and multivariable analyses by age. Correlates to the main reasons for foregoing vaccination are described.

Results

A minority (42.5%) of unvaccinated respondents said they intended to receive HPV vaccine in the next 12 months: 37.6% of adolescents (15–19 years) and 42.0% of young adults (20–24 years). Sexually experienced women were more than twice as likely as non-sexually experienced women to intend to receive HPV vaccine (15–19 years: aOR = 2.39, 95% CI = 1.15, 4.94; 20–24 years: aOR = 2.17, 95% CI = 1.08, 4.33). Having health insurance was associated with being likely to receive HPV vaccine among adolescents. Hispanic young adults were more likely than non-Hispanic Whites to be likely to receive HPV vaccine. The belief of not being at risk for HPV and institutional barriers were the two most commonly cited reasons for foregoing vaccination.Among unvaccinated women who did not intend to get vaccinated, respondents who never had sex were more likely to report not being at risk as the main reason for not needing the vaccine compared to women with sexual experience (44.5 vs. 24.4%) but this finding was only marginally significant in our limited sample.

Conclusion

In the first years immediately post-licensure of an HPV vaccine, the majority of unvaccinated women indicated that they were unlikely to seek vaccination. Intent to receive the HPV vaccine is tied to sexual experience and most women who do not intend to get vaccinated and have never had sex believe they are not at risk of HPV or do not need an HPV vaccine. These findings highlight the need to better communicate information regarding lifetime risk for HPV and the importance of receiving HPV vaccine prior to sexual initiation. These findings should inform strategies to increase vaccine uptake.