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21.
A proportional hazards model was used to evaluate the association between ten categorical covariates and the risk of pre-term delivery for women having their first child and women in subsequent pregnancies. An adaptation of the model for use with grouped survival times made it possible to model foetal life times between 28 and 36 completed weeks of gestation for 67,000 Scottish singleton births in 1981. The use of the model was justified by testing time-dependent effects. For both groups of women age, and a history of abortion, were major factors associated with increased hazard. For women experiencing a second or higher-order birth a history of perinatal death was also associated with substantially increased hazard to the pregnancy.  相似文献   
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The ethical work of program evaluators is based on a covenant of honesty and transparency among stakeholders. Yet even under the most favorable evaluation conditions, threats to ethical standards exist and muddle that covenant. Unfortunately, ethical issues associated with different evaluation structures and contracting arrangements have received little attention in the evaluation research literature. This article focuses on the unintended ethical threats associated with multitiered evaluation contexts. After briefly reviewing the various frames through which evaluation theory and ethics are commonly viewed, we discuss ethical challenges associated with multitiered evaluation designs including examples drawn from our evaluation projects. The article concludes with specific findings and recommendations for evaluators, grantors, grantees, and researchers.  相似文献   
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Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.  相似文献   
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This article provides the most recent U.S. prevalence estimates of forced sex and unwanted sexual activity. Results of a national telephone survey conducted in 2001-2003 indicate that 1 in 59 U.S. adults (2.7 million women and 978,000 men) experienced unwanted sexual activity in the 12 months preceding the survey and that 1 in 15 U.S. adults (11.7 million women and 2.1 million men) have been forced to have sex during their lifetime. There were 60.4% of females and 69.2% of males who were 17 years old or younger at the time the first forced sex occurred. This study provides an update to the National Violence Against Women Survey with more recent national data. Findings suggest that victimization rates have remained consistent since the 1990s. These findings suggest that a continued effort toward primary prevention of sexual violence, particularly rape of children and adolescents, is needed.  相似文献   
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Using a spatially extensive urban database constructed from the Maryland Biological Stream Survey (MBSS), we describe the relationships of nutrients in small-order streams to eight defined categories of percent catchment urbanization, correlations between chloride and conductivity in urban streams, and relationships between nutrients and chloride with two Maryland-specific indices of biotic integrity for benthic macroinvertebrates and fish assemblages. Stream nutrients become elevated with increasing percent catchment urbanization, followed by increases in all four measured nitrogen species and total phosphorus at catchment urbanization levels greater than 10%. There was a strong collinear relationship (r 2 = 0.90) between chloride and conductivity (trimeans) across all eight urbanization classes, where Cl (mg/L) = −0.397 + 0.188*conductivity (μS/cm). Critical values for all water quality parameters with the two Maryland biological indices were derived using quantile regression, with significant regressions developed for 11 of 16 water quality parameters and the two biotic indices. For nitrate (NO3-N), the critical thresholds between fair and poor stream quality for the two Maryland biological indices were 0.83 mg/L (benthic macroinvertebrate assemblages) and 0.86 mg/L (fish assemblages). Increasing stream nutrient and chloride levels, associated with widespread catchment urbanization intensity, now affect many small streams in Maryland, with implications for decreasing water quality in major tributaries and the Chesapeake Bay.  相似文献   
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This article examines the reasons offered by New York dairy farmers for hiring undocumented immigrant workers in their milking parlors, and connects those discourses to broader economic and cultural change in U.S. agrarian society. Based on interviews with 25 dairy farmers on 22 farms, this article examines farmers’ assessments of the Amish, white non‐Amish, Puerto Rican, and undocumented Latino labor pool. The analysis shows that farmers consider undocumented immigrants the most “reliable” workforce, and that their reliability stems from their deportability and from their separation from their families, which drives them to work long hours. I argue that farmer discourses about immigrant “reliability” must be understood in the context of economic pressure to adopt a more commercial orientation to dairying, and of modern agrarian values that prize urban middle‐class lifestyles. Ultimately, worker “reliability” is a euphemism for the transnational separation of workers from their families, and one that is operationalized by farmers to justify the pursuit of economic success and more leisure time off the farm.  相似文献   
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Objective: Despite declining cigarette smoking rates in the US, there is a continued need for tobacco prevention education campaigns to reach young adults. Recognizing the need for improved tobacco control messaging, the University of Texas (UT) System engaged The University of Texas at Austin Center for Health Communication to develop a brand and message that would strengthen tobacco control efforts at its 14 institutions. Methods: This article describes the iterative process involved in creating a brand for tobacco control, including an environmental scan, identifying potential message themes, and creating and refining logos. Results: This article highlights the process of developing a system-wide tobacco control brand. Specifically, the process included coordinating an interdisciplinary team with content and design experts, and presenting ideas to stakeholders for serial feedback and refinement, among others. Conclusions: Ultimately, this project offers a model for other systems of higher education interested in pursuing similar initiatives.  相似文献   
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