Fertility exposure analysis: A new method for assessing the contribution of proximate determinants to fertility differentials

Summary Several recent papers have dealt with the problem of assessing the impact of the proximate determinants on fertility. All these approaches rely on combining a series of separately estimated aggregate level indicators. This paper proposes an approach which uses individual-level data and thus permits regression analyses as well as analyses for sub-groups. In the course of development it became clear that there are several deficiencies and inconsistencies in the measurement and formation of indices proposed elsewhere, which are overcome. We illustrate our approach with data from the Dominican Republic. The approach used involves attributing exposure to one or more of several states, including pregnancy, lactational and non-lactational components of post-partum amenorrhoea, absence of sexual relations and contraception. Key elements are efficacies of contraception and components of post-partum infecundity and the treatment of overlaps through an explicit hierarchy. We treat both unconditional (or additive) and conditional analyses. Intriguing findings on the age-specific pattern of fertility control emerge. Major advantages of regression analysis, such as simultaneous treatment of several variables and estimation of sampling variation are stressed.     

Procurement process: Decision by exclusion and pairwise comparisons

Two case studies illustrate multicriteria decision making techniques frequently used in procurement practice: least-cost sufficient performance and weighted utility optimization. Both techniques have defects and are rarely robust. Decision by exclusion and pairwise comparisons is proposed as a third approach which eliminates inferior alternatives by generalized forms of minimum performance requirements established under multicriteria framework. It is more robust and maintains high level of accountability.     

Effectiveness of a training program for ECT nurses

Electroconvulsive therapy (ECT) is a highly technical procedure requiring a team that consists of an anesthetist, a psychiatrist, a clinical nurse specialist, and recovery nurses. Traditionally, nursing education and training in the context of providing a safe and high standard of care has not been addressed. Ninety-two nurses from 42 different health agencies participated in a training program focusing on defibrillation, electrocardiogram (ECG) and electroencephalogram (EEG) monitoring, intubation, stimulus dosing, setting up the ECT equipment, and caring for the patient. A non-experimental, one-group, pretest-posttest research design was used in this study to evaluate the effectiveness of the training program for nurses working with ECT. Effective training for nurses was hypothesized to make a difference in the standards of practice and clinical effectiveness for patients undergoing ECT. Findings from this study indicated a major knowledge deficit in key components of ECT among nurses who have responsibilities in this area of nursing care. With effective training, nurses' confidence levels increased related to setting up the equipment, administering a double dose, helping with intubation, and using a defibrillator. If nurses are to effectively function as team members in the ECT procedure, they must receive the training necessary to prepare them for this important role. The results of this study support the recommendation of the Royal Australian and New Zealand College of Psychiatrists that ECT nurses should be appropriately trained in anaesthetic and resuscitation techniques and modern ECT practice.     

Recruitment and retention strategies for out-of-school-time programs

Many out-of-school-time (OST) practitioners seek ways to maximize enrollment, enhance frequency of participation, and ensure retention in OST programs, so that the multiple potential benefits of these programs are realized. Three critical areas of program quality are important underpinnings for success in recruitment and retention of youth in OST programs: a sense of safety and community; committed program staff; and challenging, age-appropriate, and fun activities. In addition, a review of over sixty OST evaluations reveals five promising recruitment strategies to boost enrollment: (1) matching the program to participants' needs (offering activities not readily available elsewhere or offering flexible schedules), (2) demonstrating the importance of participation to young people and their families, (3) reaching out directly to youth and their families in their homes and communities, (4) recruiting in peer circles, and (5) making a special effort to recruit at-risk youth. Finally, the evaluation literature points to five promising strategies to enhance regular participation and longterm program retention: (1) sending a clear message that regular attendance is important; (2) setting realistic goals to promote regular attendance, especially as youth grow older; (3) finding a balance among academic and other activities; (4) using incentives; and (5) keeping teens involved with opportunities for leadership, community service, and paid employment.     

Children's services in the UK 1997–2003: problems,developments and challenges for the future

This article reviews developments in children's services since 1997 and considers their effect on children in need by examining government statistics, recent additions to the evidence‐base, and data from two studies conducted by the authors. It shows that there has been extensive service development, mainly beyond the Department of Health, and considerable effort to improve assessment and administrative data. The limits to what can be demonstrably achieved by children's services, particularly in a short period, are acknowledged, and it is argued that the approach of providing predominantly low level interventions to large groups may need re‐thinking if significant and lasting changes to children's development are to be secured. Copyright © 2003 John Wiley & Sons, Ltd.     

An Examination of Cross‐Racial Comparability of Mother‐Child Interaction Among African American and Anglo American Families

This study examined the cross‐racial comparability of maternal quality of assistance and supportive presence coded from a video protocol using data from the Infant Health and Development Program for low‐birth‐weight, premature 30‐month‐olds and their mothers. Evidence of equivalence of measures is necessary before comparisons can be made across groups. Multiple‐group mean and covariance structures analysis was used to demonstrate the invariance of the measures and make comparisons for Anglo American and African American treatment and comparison groups of dyads. Comparisons across groups indicated similar variances and correlation between child and maternal behavior. Differences were found between the mean scores, with Anglo American treatment families scoring the highest.