The composite abuse scale: further development and assessment of reliability and validity of a multidimensional partner abuse measure in clinical settings

Absence of a well-validated comprehensive partner abuse questionnaire has been a major methodological issue in domestic violence research. A new multidimensional measure of partner abuse, the Composite Abuse Scale (CAS), has four dimensions: Severe Combined Abuse, Emotional Abuse, Physical Abuse, and Harassment. A general practice patient sample (N = 1,836) has been used in the development and testing of CAS. Factor analyses in this current study confirmed the four dimensions from a preliminary nurses sample study and resulted in a final scale of 30 items consisting of acts of physical, emotional, and sexual abuse. These four factors exhibited good internal reliability (Cronbach's alpha > 0.85) and the corrected item-total correlations were high (> 0.5). Evidence of criterion and construct validity is presented.     

Dermal Versus Total Uptake of Benzene from Mineral Spirits Solvent During Parts Washing

Quantitative approaches to assessing exposure to, and associated risk from, benzene in mineral spirits solvent (MSS), used widely in parts washing and degreasing operations, have focused primarily on the respiratory pathway. The dermal contribution to total benzene uptake from such operations remains uncertain because measuring in vivo experimental dermal uptake of this volatile human carcinogen is difficult. Unprotected dermal uptake involves simultaneous sustained immersion events and transient splash/wipe events, each yielding residues subject to evaporation as well as dermal uptake. A two‐process dermal exposure framework to assess dermal uptake to normal and damaged skin was applied to estimate potential daily dermal benzene dose (D_skin) to workers who used historical or current formulations of recycled MSS in manual parts washers. Measures of evaporation and absorption of MSS dermally applied to human subjects were modeled to estimate in vivo dermal uptake of benzene in MSS. Uncertainty and interindividual variability in D_skin was characterized by Monte Carlo simulation, conditioned on uncertainty and/or variability estimated for each model input. Dermal exposures are estimated to average 33% of total (inhalation + dermal) benzene parts washing dose, with approximately equal predicted portions of dermal dose due to splash/wipe and to continuous contact with MSS. The estimated median (95th percentile) dermal and total daily benzene doses from parts washing are: 0.0069 (0.024) and 0.025 (0.18) mg/day using current, and 0.027 (0.085) and 0.098 (0.69) mg/day using historical, MSS solvents, respectively.     

The Family Context of Assent: Comparison of Child and Parent Perspectives on Familial Decision‐Making

Assent guidelines currently fail to include an assessment of a child's decision‐making ability, experience and interest. This paper summarises a two‐stage study, conducted in the United Kingdom, exploring perspectives on children's decision‐making power and ability within their family, as an indicator for overall decision‐making readiness. Children desired to make some decisions but knew their parents held ultimate authority. Parents believed their children could make some decisions and actively trained them through involvement in daily decisions. Researchers should strive to include children in enrolment decisions to some degree, based on a consideration of their expectations for involvement informed by their daily family context.     

A meta-ethnographic study of health care staff perceptions of the WHO/UNICEF Baby Friendly Health Initiative

BackgroundImplementation of the Baby Friendly Health Initiative (BFHI) is associated with increases in breastfeeding initiation and duration of exclusive breastfeeding and ‘any’ breastfeeding. However, implementation of the BFHI is challenging.AimTo identify and synthesise health care staff perceptions of the WHO/UNICEF BFHI and identify facilitators and barriers for implementation.MethodSeven qualitative studies, published between 2003 and 2013 were analysed using meta-ethnographic synthesis.FindingsThree overarching themes were identified. First the BFHI was viewed variously as a ‘desirable innovation or an unfriendly imposition’. Participants were passionate about supporting breastfeeding and improving consistency in the information provided. This view was juxtaposed against the belief that BFHI represents an imposition on women's choices, and is a costly exercise for little gain in breastfeeding rates. The second theme highlighted cultural and organisational constraints and obstacles to BFHI implementation including resource issues, entrenched staff practices and staff rationalisation of non-compliance. Theme three captured a level of optimism and enthusiasm amongst participants who could identify a dedicated and credible leader to lead the BFHI change process. Collaborative engagement with all key stakeholders was crucial.ConclusionsHealth care staff hold variant beliefs and attitudes towards BFHI, which can help or hinder the implementation process. The introduction of the BFHI at a local level requires detailed planning, extensive collaboration, and an enthusiastic and committed leader to drive the change process. This synthesis has highlighted the importance of thinking more creatively about the translation of this global policy into effective change at the local level.     

Adolescent Violence—Strategies,Outcomes and Dilemmas in Working with Young People and their Families

MATTERS is a program of Berry Street, and has been in existence since 1990. The service is funded to address parent/adolescent conflict and the service delivery model has developed over time in a direction which incorporates family therapy and conflict resolution techniques. Many families come to the service seeking assistance for problems regarding violence, and increasingly around a young person's violence to parents and other family members. In some instances, violence has been present over a long period and has become normalised within the family's experience. When working with families who present with problems of adolescent violence, the service aims to find a pathway for the young person/family to confront violent behaviour and move to a different position about the meaning of violence in their lives. This paper describes the team's approach to working with adolescent violence, utilising ideas from narrative family therapy and psychodynamic theory, and incorporating issues of power in society, culture and gender. Outcomes, dilemmas and future directions are also discussed.     

POLICY INFERENCE USING VAR MODELS

There has been relatively little systematic investigation of the sensitivity of policy inferences derived from VAR models to changes in the lag structure. We investigate this issue using a simple macro model consisting of output, prices, money and interest rates. Using six different lag length selection criteria that vary the bias-efficiency tradeoff, we compare the policy inferences derived from the different estimations of our VAR model. The evidence shows that policy recommendations are quite sensitive to changes in the lag structure.     

A Comparison of Spinal Manipulation by Medical Practitioners and Chiropractors

Recent studies have shown that a significant proportion of the Australian population attend chiropractors. In so far as some patients believe that chiropractic manipulation is effective, it is important to determine whether this belief is a consequence of a psychosomatic remission in symptoms or whether manipulative therapy, per se, is actually effective. A comparison of two groups of 50 patients, matched for condition and some demographic characteristics, treated (with manipulation) by doctors or chiropractors, indicates equivalent and widespread improvement in the presenting symptoms. The psychosomatic explanation is unlikely to be adequate and it may be that manipulation of the spine is effective therapy for some conditions.     

Alternative Dispute Resolution in Child Protection Matters: The Victorian Experience

Abstract

Pre-hearing conferences were introduced in 1992 into the Family Division of the Children's Court, Victoria. Pre-hearing conferences take place when there is a dispute between the Child Protection Service and the child's family about the need for statutory intervention in their family's life. The conference is held prior to any formal hearing so that the family, their legal representatives and the welfare authority can see whether they can negotiate an agreement about a child protection order. The present paper sets out the findings of a study of 208 pre-hearing conferences held in the Melbourne Children's Court from February to July 2002. The study found that the quality of legal advice provided to parents significantly affected the outcome of pre-hearing conferences. Legal representatives varied in their willingness to step aside from the adversarial approach and give priority to discussion about child welfare concerns. It was apparent that professionals coming to the pre-hearings, both legal and welfare, had different expectations of these forums. It is imperative that if pre-hearings are to succeed, then their role and place in the child protection legal process is clearly explicated and professionals receive training in alternative dispute resolution.