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.     

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.     

What They Don’t See

The author is currently living with a chronic autoimmune disease known as Hashimoto’s Thyroiditis, which caused his hypothyroidism. Although this disease is most common in middle-aged women, he was diagnosed at age 23. This disease is unique, because it is not entirely visible to others. In this piece, he presents a personal narrative of his diagnosis process and utilizes poetic inquiry to demonstrate to readers what “they,” meaning individuals without an invisible chronic autoimmune disease, don’t see.     

How Well Do Birth Certificates Describe the Pregnancies They Report? The Washington State Experience with Low-Risk Pregnancies

Objectives: Birth certificates are a major source of population-based data on maternal and perinatal health, but their value depends on the accuracy of the data. This study assesses the validity of information recorded on the birth certificates for women in Washington State who were considered to be low risk at entry into care. Methods: Birth certificates were matched to data abstracted from prenatal and intrapartum clinic and hospital records of a sample of 1937 Washington State obstetrical patients who were considered to be low risk at the beginning of their pregnancies. Accuracy of a variety of pregnancy characteristics (e.g., complications, procedures) on the birth certificate was analyzed using percentage agreement and sensitivity with record abstracts as the gold standard. Next, we weighted the data from each source to produce estimates of pregnancy characteristics in the population. We compared these estimates from the two data sources to see whether they provide similar pictures of this subpopulation. Results: Missing data for specific items on the birth certificates ranged from 0% to 24%. The birth certificate accurately captured gravidity and parity, but was less likely to report prenatal and intrapartum complications. The population estimates of the two data sources were significantly different. Conclusions: Because birth certificates significantly underestimated the complications of pregnancies, number of interventions, number of procedures, and prenatal visits, use of these data for health policy development or resource allocation should be tempered with caution.     

All-Terrain Vehicle Injury Prevention: Healthcare Providers’ Knowledge, Attitudes, and the Anticipatory Guidance They Provide

All-terrain vehicles (ATVs) continue to be an increasing cause of injuries and deaths in children, especially in rural communities. More children die in the United States each year from ATV-related events than from bicycle crashes. The purpose of this study was to determine the ATV anticipatory guidance practices of primary care providers, as well as their attitudes, knowledge, and the barriers faced in educating families about the risk of ATV use. An electronic survey was administered to primary care providers belonging to state medical societies. More than 60% of respondents (Total N?= 218) believed that ATV anticipatory guidance was important to provide to pediatric patients and their families. However, 78% stated they provide ATV safety counseling less than 10% of the time during regular pediatric exams, and only 12% stated they do so greater than 25% of the time. Families rarely ask providers for advice on ATV safety issues; 84% of providers were asked once a year or less. ATV knowledge scores were low (median score 2 of 12); however, those with previous ATV exposure had significantly higher scores. Many respondents affirmed insufficient knowledge (47%) and inadequate resources (63%), but the most commonly identified barrier was that it was not a routine part of their practice. Providers in the study demonstrated limited knowledge, reported multiple barriers, and provided little or no ATV safety counseling. However, they consider ATV anticipatory guidance important for their patients. Armed with increased knowledge and appropriate resources, providers could play a significant role in promoting ATV safety.     

‘They think it's all up to the girls’: gender,risk and responsibility for contraception

Much research suggests that attitudes towards responsibility for use of contraception amongst young people are strongly gendered. However, decision making, if ‘decisions’ happen at all, is bound up with notions of hegemonic masculine and feminine roles as well as factors concerning relationship status. Data from two earlier qualitative studies were re-analysed with an emphasis on findings related to gender and responsibility for use of contraception. The first study investigated unintended conceptions amongst 16–20-year-old women. Interviews focused on knowledge and views about contraception, sex education and sexual health services. The second study involved focus groups with two groups of 14–18-year-old men to explore their views on sex education, sexual health and contraception. Almost all the young women said that young men viewed contraception as ‘not their job’. In contrast, the young men thought that responsibility should be shared. The key issue, however, related to relationship status, with decision-making being shared in long-term relationships. There are some gender differences in accounting for decisions about use of contraception, however the key issue revolves around relationship status.     

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.     

Are They Careful Enough? Testing Consumers’ Perception of Alternative Processing Technologies on the Quality of Organic Food

Given the increasing public interest in how ingredients are processed and the growing demand for organic food products, it is critical to understand consumers’ expectations about the process-related quality of organic products. Consumers perceive organic food to be nutritious, healthy and either natural or less processed, as they are afraid of the loss of nutritional, organoleptic and sensory properties of the food products. However, alternative food processing technologies might generate healthy and safe food options with nutritional quality properties. Simplified communication schemes might help to overcome this barrier for the consumer. The main objective of this study is to propose a working definition of “careful processing” for organic products and test its consistency through an experiment, while being used to rate different processing methods by consumers. Results show that the proposed definition allows the consumer to consistently rate alternative processing technologies. Consumers tend to score alternative processing technologies such as pulsed electric fields and microwaves as less careful, supporting the idea that organic consumers want as little man-made interference in their food products as possible. Results show that a simple but effective definition of careful processing may help consumers to distinguish more organic food products from conventional ones, no matter which communication scheme is used.     

The Role of Psychosocial Factors in the Transition to Substance Use: Are They Protective Among Urban Minority Adolescents?

Changes in psychosocial risk and protective factors associated with the onset of substance use were examined in a sample of 556 urban public school sixth graders. General linear modeling analyses indicated that students who did not use substances by the end of sixth grade consistently had higher scores on protective factors than did students who were already using substances at the beginning of sixth grade. Students who began to use during the school year were in flux with scores similar to nonusers at Time 1 and scores closer to early users by Time 2. These findings suggest that interventions which focus on skill enhancement during the transition to middle school may be effective at delaying the onset of substance use. Editors' Strategic Implications: The authors find the same protective factors in this urban, primarily African American sample that are typical in suburban, White samples. Developmentalists and school officials will find interesting the changing effects of protective factors against early substance use during the transitional sixth grade year.     

Pregnancy Intention and Pregnancy Happiness: Are They Different?

Objectives: This study examines the relationship among pregnancy intention and attitudes, inconsistent contraceptive use, and plans for potential pregnancy among 311 women who presented at local health departments to seek a pregnancy test and for whom a pregnancy would be unintended. Methods: Women were surveyed prior to receiving pregnancy tests. Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies. Frequency distributions and chi-square tests were computed to examine and compare rates of happiness about the pregnancy among women with mistimed or unwanted pregnancy and to compare rates of inconsistent contraceptive use and plans for the pregnancy by intention and level of happiness. Results: Although all of the women selected for our sample stated that their pregnancies would be unintended, almost half (46%) were inconsistent contraceptive users. Further, 48% reported that they would be somewhat or very happy about a pregnancy. The proportion of women who were uncertain about the future of a pregnancy and who considered adoption or abortion was highest among those for whom a potential pregnancy was mistimed and who were unhappy about the pregnancy. Conclusions: Differentiating between pregnancy intention and happiness has practice implications for family planning and prenatal providers. Additional research should further elaborate these distinctions.     

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.     

‘They don’t know much about us’: educational reform impacts on students’ learning in the clinical environment

Placements are an integral component of the medical, nursing, and allied health curriculum. Literature on problem-based learning indicates that curriculum change can impact student experience. However, outside of the nursing literature, there is little research on the impact of education reform on students’ experiences of placements. This paper reports on medical, midwifery and paramedic students’ perception of the impact of education reform they experienced in the clinical setting. A qualitative study using a semi-structured schedule was conducted. Data was collected using focus groups (17), individual interviews (48) and written responses (2) from undergraduate students (103) and graduates (27) from a tertiary institution in Victoria, Australia. Recorded interviews were analysed, coded and categorised into themes. Whilst students indicated they were prepared for the impact of educational reform on their placement experience, they perceived that clinical educators responsible for teaching them were less prepared. Three themes were identified from the data: clinical educator’s lack of familiarity with new curriculum, clinical educator’s negative attitudes to curricular change and looking to the future. Our study advances the understanding of the implications of education reform during the clinical placement of medical, midwifery, and paramedic students. Whilst important lessons can be learned from the medical and nursing literature this study highlights that staff responsible for curriculum change need to action change management process to ensure that the clinical educators are able to deliver the revised program.     

‘They can’t report abuse,they can’t move out. They are at the mercy of these men’: exploring connections between intimate partner violence,gender and HIV in South African clinical settings

This qualitative study captured South African female health provider perspectives of intimate partner violence in female patients, gender norms and consequences for patients’ health. Findings indicated female patients’ health behaviours were predicated on sociocultural norms of submission to men’s authority and economic dependence on their partners. Respondents described how men’s preferences and health decision-making in clinics affected their patients’ health. Adverse gender norms and gender inequalities affected women’s opportunities to be healthy, contributing to HIV risk and undermining effective HIV management in this context. Some providers, seeking to deliver a standard of quality healthcare to their female patients, demonstrated a willingness to challenge patriarchal gender relations. Findings enhance understanding of how socially-sanctioned gender norms, intimate partner violence and HIV are synergistic, also reaffirming the need for integrated HIV-intimate partner violence responses in multi-sector national strategic plans. Health providers’ intimate knowledge of the lived experiences of female patients with intimate partner violence and/or HIV deepens understanding of how adverse gender norms generate health risks for women in ways that may inform policy and clinical practice in South Africa and other high-HIV prevalence settings.     

‘They don't know themselves,so how can they tell us?’: parents navigating uncertainty at the frontiers of neonatal surgery

When a baby is diagnosed with a condition needing surgery they, and their family, start down an uncertain and unknown path. Living with uncertainty underpins every stage of the journey from hospital to home. These journeys span the highly technical to the mundane. They are likely to involve, at crucial points, medicalised and specialised neonatal and surgical care in paediatric centres of excellence where parents are mere spectators. Yet ultimately parents are able to take their baby home, confident experts in their daily care. Drawing on narrative interviews with 42 UK parents whose baby underwent neonatal surgery, this paper explores how parents navigate this uncertainty through acquiring experiential and lay knowledge and developing expertise in their baby's condition and treatment options. These conditions are rare. Building on sociological understandings of the work of chronic illness, as well as more recent work on newborn screening, sharing information online and examinations of experiential knowledge, we explore lay knowledge and expertise as it intersects with biomedical and surgical frontiers. We demonstrate how the development of expertise is an emergent, three-stage process supported by both biomedical and lay knowledge and elucidate this process of knowledge-building as a scaffold through which to manage uncertainty.