The effects of domestic violence during pregnancy on maternal and infant health

The present study examined the impact of domestic violence on maternal and infant health by assessing maternal health during pregnancy and infant health at two months postpartum. Two hundred and two women (68 battered and 134 non-battered) were recruited from the community and completed both pregnancy and 2-month postpartum interviews. Results revealed that domestic violence during pregnancy was associated with numerous health problems for mothers and infants including more health problems during pregnancy, more likelihood of premature labor, later entrance into prenatal care, lower infant birth weight, greater utilization of health care resources, and more prenatal substance use. After income was controlled, the relationship between violence and timing of prenatal care and infant birth weight became nonsignificant. Maternal social support was found to protect against the effects of violence for several health outcomes. The current findings suggest the need for domestic violence screening during pregnancy, as well as clinical interventions for battered, pregnant women in order to prevent serious physical and emotional problems for both mothers and their infants.     

Office ergonomics education: a comparison of traditional and participatory methods

Health and safety literature stresses the value of programs aimed at preventing musculoskeletal injuries. The concepts of empowerment learning are often recommended as guidelines for worker education yet these approaches are largely untested. The present study compares the traditional approach involving lecture and discussion with a participatory method. A sample of 102 participants employed at a centralized reservation facility was used. Participants were randomly assigned to either the traditional education group or the participatory education group. Data collection utilized surveys completed by study participants and observational checklists completed by a trained observer. Data were collected prior to intervention and at approximately 3, 6, and 12 months post intervention. Results of data analysis provide no evidence that participatory methods are more effective than traditional methods in encouraging workers to position their work equipment correctly or to maintain good working postures to prevent musculoskeletal injuries.     

Evaluation of an upper extremity student-role functioning scale using item response theory

Millions of workers suffer from upper extremity (musculoskeletal) disorders. Many of these workers are predisposed to upper extremity musculoskeletal disorders because of early exposure to ergonomic risks as students. Computer usage for four or more hours remains the greatest risk for upper extremity musculoskeletal disorders for workers and students alike. Developing preventative methods to reduce student exposure, and thus protect future workers from upper extremity musculoskeletal disorders later in life, requires an appropriate measure for upper extremity musculoskeletal disorder prevalence and related limitations for student functioning. Item response theory analysis was used to evaluate and further develop a upper extremity functioning scale for the student role.     

Correlates of load carriage and obstacle course performance among women

To examine correlates of the speed at which female soldiers carrying loads could cover 3.2 km on foot and traverse an obstacle course, 12 volunteers (mean +/- SD: 25.3 +/- 6 years, 166 +/- 7 cm, 61.3 +/- 7 kg) were timed over 3.2 km while carrying loads of 14, 27, and 41 kg, and while traversing an obstacle course with the two lighter loads. Pearson correlations showed that absolute VO_[2 max] and 3.2 km run time without a load were the best predictors of 3.2 km load carriage time for all loads. Also, larger subjects with greater muscle mass were able to carry the heaviest load faster than smaller, less muscular subjects, likely because the 41 kg load represented a smaller percentage of the former's bodyweight. Maximum number of sit-ups and push-ups, composite score of the Army Physical Fitness Test as well as body height were positively correlated with the speed at which some course segments were traversed.     

The Quality of Stakeholder-Based Decisions

The increased use of stakeholder processes in environmental decision making has raised concerns about the quality of decisions these processes produce. Some claim that stakeholders make inadequate use of scientific information and analysis and are all too ready to sacrifice technical quality for political expediency. This article looks to the case study record to examine the quality of the decisions from stakeholder-based processes. The data for the analysis come from a "case survey," in which researchers coded information from 239 published case studies of stakeholder involvement in environmental decision making. These cases reflect a diversity of planning, management, and implementation activities carried out by environmental and natural resource agencies at many levels of government. Overall, the case-study record suggests that there should be little concern that stakeholder processes are resulting in low-quality decisions. The majority of cases contain evidence of stakeholders improving decisions over the status quo; adding new information, ideas, and analysis; and having adequate access to technical and scientific resources. Indeed, data suggest that it is the more intensive stakeholder processes--precisely those that have aroused recent concern--that are more likely to result in higher-quality decisions.     

Federal budget helps drive health policy. A close-up look at the budget process and how it affects health care funding

Crafting the budget is an annual process that Congress and the administration use to define the national policy agenda. It is a massive undertaking to decide how more than two trillion dollars is spent by the federal government. Over 20 percent of the budget is used for health care. The budget is a political document that defines the priorities of the federal government and directly influences overall health policy. Its construction deserves to be followed and influenced by physicians to ensure the health of the public.     

Quality of Life Indexes for National Policy: Review and Agenda for Research

A number of governments and public policy institutes have developed Quality of Life Indexes – statistics that attempt to measure the quality of life for entire states or regions. We develop 14 criteria for determining the validity and usefulness of such QOL indexes to public policy. We then review 22 of the most-used QOL indexes from around the world. We conclude that many of the indexes are successful in that they are reliable, have established time series measures, and can be disaggregated to study subpopulations. However, many fall short in four areas: (1) indexes vary greatly in their coverage and definitions of domains of QOL, (2) none of the indexes distinguish among the concepts of input, throughput, and output that are used by public policy analysts, (3) they fail to show how QOL outputs are sensitive to public policy inputs, and (4) none have examined convergent validity against each other. We conclude that many of these indexes are potentially very useful for public policy and recommend research to further improve them.     

Risk Perception in a Developing Country: The Case of Chile

In this work we characterize risk perception in Chile, based on the psychometric paradigm, exploring the difference between perceived social and personal risk. For this purpose, we conducted a survey including 54 hazards, 16 risk attributes, and 3 risk constructs. The survey, divided into four parts, was administered to 508 residents of Santiago, Chile. Using factor analysis, three main factors, which accounted for 80% of the sample's variance, were identified: factor 1, commonly called "Dread Risk" in the literature, explained 37% of variance; factor 2, "Unknown Risk," explained 28%; and factor 3, which we called "Personal Effect," explained 15% of the variance. On average, individuals perceived themselves as less exposed to risk and with more control and knowledge about them than the general population. OLS regression models were used to test the association of perceived risk with the three main factors. For social risk, factor 1 had the greatest explanatory power, while factor 2 had a negative sign. For personal risk, only factors 2 and 3 were significant, with factor 3 having the greatest explanatory power. Risk denial (defined as the difference between perceived personal and social risk) was associated with factors 1 and 2 only, with factor 2 having a negative sign. The difference between desired and actual regulation levels proved positive for all hazards, thus indicating that Chileans are dissatisfied with the current regulation level for all the hazards analyzed. The comparison of data at the aggregate and at the individual subject's level suggests that while the aggregate analysis overestimates the magnitude of the correlations it still reflects the tendency of the individual responses.     

Perspectives on Incorporating Human Neurobehavioral End Points in Risk Assessments

Three topics are addressed: (1) measurement issues (e.g., the reliability and validity of neurobehavioral test scores), (2) general principles of assessment, including test selection, and (3) interpretation of scores. Psychological tests generally perform as well as medical tests in terms of reliability and validity. Test manuals, assessment textbooks, and psychologists are useful resources to the risk assessor. The variety of different tests employed in neurobehavioral studies complicates interstudy comparisons. In addition, tests that ostensibly assess the same general domain of function might assess somewhat different abilities within that domain. Although a uniform battery for use in all studies seems desirable, the battery appropriate for a specific study depends on study goals, knowledge about the mechanism(s) of neurotoxicity, nature of the study population, and pattern of exposure. Exposure-related neurobehavioral deficits are generally indicators of "altered function" rather than of "clinical disease." Limiting concern to end points corresponding to clinical disease might not be appropriate. Many neurobehavioral diagnoses are phenomenological and a neurotoxicant might cause a unique pattern of deficits for which no label has been created. The concern that a small shift in the central tendency of a distribution of test scores has no significance for the individual should be reexamined in light of the prevention paradox, formulated on the basis of epidemiologic studies of chronic disease. Poor performance on a neurobehavioral test does not necessarily map clearly onto underlying behavioral or neural substrate. The absence of such linkages, given current knowledge about brain-behavior relationships, should not reduce confidence in neurobehavioral end points. Use of neurobehavioral test scores involves considerations that differ little from those that the risk assessor routinely addresses in using end points commonly used in research on other topics in environmental epidemiology.