Disparities in Healthcare Utilization Among Adults with Obesity in the United States,Findings from the NHIS: 2006–2015

Population Research and Policy Review - Few studies of disparities consider logistical hurdles faced by adults with obesity in obtaining needed healthcare. This study compared adults with obesity...     

Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

Prolonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.     

Separating Spheres? Diverging Trends in Youth's Gender Attitudes About Work and Family

The authors investigated whether trends in attitudes about gender were consistent with the gender stall primarily occurring in the family domain and examined potential mechanisms associated with changing gender norms. Using data from Monitoring the Future surveys (1976–2015), the authors assessed three components of trends in youth's beliefs about gender: the marketplace, the family, and mothers' employment. Findings showed continued increases in egalitarianism from 1976 through the mid‐1990s across all three dimensions. Thereafter, support for egalitarianism in the public sphere plateaued at high levels, rising support for mothers' employment persisted at a slower pace, and conventional ideology about gender in families returned. The changing demographic composition of American high school students did not account for the gender attitude trends. Youth's mothers' employment and increased education were related to increased egalitarianism. Changes in population averages of mothers' employment and educational attainment were only weakly associated with increases in egalitarian attitudes.     

ENTERTAINING MALTHUS: BREAD,CIRCUSES, AND ECONOMIC GROWTH

Motivated by the basic adage that man does not live by bread alone, we offer a theory of historical economic growth and population dynamics where human beings need food to survive, but enjoy other things, too. Our model imposes a Malthusian constraint on food, but introduces a second good to the analysis that affects living standards without affecting population growth. We show that technological change does a good job explaining historical consumption patterns and population dynamics, including the Neolithic Revolution, the Industrial Revolution, and the Great Divergence. Our theory stands in contrast to models that assume a single composite good and a Malthusian constraint. These models generate negligible growth prior to the Industrial Revolution. However, recent revisions to historical data show that historical living standards—though obviously much lower than today's—varied over time and space much more than previously thought. These revisions include updates to Maddison's dataset, which served as the basis for many papers taking long‐run stagnation as a point of departure. This new evidence suggests that the assumption of long‐run stagnation is problematic. Our model shows that when we give theoretical accounting of these new observations the Industrial Revolution is much less puzzling. (JEL B10, I31, J1, N1, O30)     

Pointing to Visible and Invisible Targets

We investigated how the visibility of targets influenced the type of point used to provide directions. In Study 1, we asked 605 passersby in three localities for directions to well-known local landmarks. When that landmark was in plain view behind the requester, most respondents pointed with their index fingers, and few respondents pointed more than once. In contrast, when the landmark was not in view, respondents pointed initially with their index fingers, but often elaborated with a whole-hand point. In Study 2, we covertly filmed the responses from 157 passersby we approached for directions, capturing both verbal and gestural responses. As in Study 1, few respondents produced more than one gesture when the target was in plain view and initial points were most likely to be index finger points. Thus, in a Western geographical context in which pointing with the index finger is the dominant form of pointing, a slight change in circumstances elicited a preference for pointing with the whole hand when it was the second or third manual gesture in a sequence.     

Case Reading as a Practice and Training Intervention in Domestic Violence and Child Protection

This article explores the role of a case-reading tool, developed by the Safe and Together Institute, deployed across five Australian states, and which engaged workers from child protection (CP) and specialist domestic and family violence (DFV) services. It aimed to assess the extent to which DFV is identified in CP case files and to assess the quality of case practice from a DFV-informed perspective, as documented in the case file. The Safe and Together approach to child welfare provides a robust foundation upon which practitioners from statutory and nonstatutory backgrounds can work collaboratively and reach consensus about how best to ensure the safety and wellbeing of children living with DFV. The case reading is both a process of transformative working for practitioners and an analytical tool through which their agencies can affect systemic change.

IMPLICATIONS

• A national audit of 20 child protection case files using the Safe and Together case-reading process indicated that documented child protection practice sits at the lower end of a domestic and family violence-informed Continuum of Practice.

• Analysis indicates a need to improve: child protection engagement with fathers who use DFV, assessments of their parenting role and its impact on children and family functioning; identification of adult survivors’ protective capacities and their impact on children.

• Research in this area may have broader implications for other professions and government policy both nationally and internationally.

     

Toward Father‐friendly Parenting Interventions: A Qualitative Study

Levels of father participation in parenting interventions are often very low, yet little is known about the factors which influence father engagement. We aimed to qualitatively explore perceived barriers to, and preferences for, parenting interventions in a community sample of fathers. Forty‐one fathers across nine focus groups were interviewed using a semi‐structured interview. Data were analysed using inductive thematic analysis. Key barriers to father participation identified included: the perception that interventions are mother‐focused; beliefs about gender roles regarding parenting and help‐seeking; mothers’ role as ‘gatekeeper’; lack of knowledge and awareness of parenting interventions; and lack of relevance of interventions. Fathers reported preferences for specific content and intervention features, facilitator characteristics, practical factors, and highlighted the need for father‐targeted recruitment and advertising. Many of the barriers and preferences identified are consistent with previous research; however, fathers’ beliefs and attitudes around gender roles and help‐seeking, as well as the perception that interventions are predominantly mother‐focused, may be key barriers for community fathers. Strategies to overcome these barriers and better meet the needs of fathers in promoting and delivering parenting interventions are discussed.