Effect of audit and feedback on the availability, utilisation and quality of emergency obstetric care in three districts in Malawi

BACKGROUND: Facility-based maternal death reviews and criterion-based clinical audit, were introduced in three districts in Malawi in 2006. RESEARCH QUESTION: Can audit and feedback improve the availability, utilisation and quality of emergency obstetric care (EmOC)? PARTICIPANTS AND METHODS: Observational study in which emergency obstetric care offered to women who gave birth in 73 health facilities (13 hospitals and 60 health centres) in three districts in Malawi in 2005 (baseline, 41,637 women) was compared to 2006 (43,729 women) and 2007 (51,085 women). RESULTS: The number of comprehensive and basic EmOC facilities did not change over the 3-year period (p for trend=1.000). Although institutional delivery rate decreased in 2006, overall it increased over 3 years (p for trend<0.001) - 31.8% (2005), 31.1% (2006) and 34.7% (2007), and Caesarean section rate was low and did not change (p for trend=0.257) - 1.7% (2005), 1.6% (2006) and 1.5% (2007). There was a significant increase in the met need for EmOC (p for trend<0.001) - 15.2% for 2005, 17.0% for 2006 and 18.8% for 2007. Maternal mortality decreased significantly from 250 per 100,000 women in 2005 to 222 in 2006 and 182 in 2007 (p for trend<0.001). Similarly, the case fatality rate decreased monotonically (p for trend<0.001) - 3.7% (2005), 3.0% (2006) and 1.5% (2007). DISCUSSION: Audit and feedback can improve availability, utilisation and quality of emergency obstetric care in countries with limited resources. CONCLUSION: There is need to increase availability of emergency obstetric care by upgrading some health centres to EmOC level through training of staff and provision of equipment and supplies.     

Parent and Child Therapy: An Attachment‐Based Intervention for Children With Challenging Problems

Parent and Child Therapy (PACT) is an attachment‐based intervention for children aged between 4 and 12 years old experiencing emotional and behavioural problems. It is appropriate for distressed parent—child relationships which have not responded to systemic family therapy. PACT seeks to reframe parent—child relationship distress using narrative techniques and experiential tasks based on the concept of supported looking. Therapy occurs in parallel for parent and child using a one‐way screen. PACT improves parents' reflective capacity and sensitivity, and for the child's sense of security in her primary attachment relationship. An outline of the four stages of PACT is presented along with a case study to illustrate the course of PACT. Finally, we discuss the dissemination of PACT within a busy child and adolescent mental health service and outline our plans for future outcome evaluation.     

A bargaining model and empirical analysis of strike activity across industries

This study extends the analysis on the inter-industry propensity to strike found in Leigh (1983) by (1) developing a more elaborate model, (2) developing proxies for all the parameters of the model, and (3) testing the modified model on two new data sets. The results suggest that strikes are more frequent in hazardous industries employing few women and where the average level of schooling is low. In addition, the evidence suggests strikes and wages may be simultaneously determined.     

Male-female differences in the potential for union growth outside traditionally unionized industries

Using recent NLS data on preferences for union representation, this paper examines whether differences by sex exist in the potential for union organizing outside of traditionally unionized industries. The methodology distinguishes between workers’ preferences for union representation and the relative supply of union jobs in explaining interindustry differences in the extent of unionization. Within the private sector, women employed in industries other than those traditionally unionized are found to have at least as strong a preference for unionization as do comparable men but a considerably lower opportunity for unionized employment given the desire for union representation. Comparing the public sector with traditionally organized industries, the greater extent of unionization in the public sector is largely explained by a stronger desire for union representation on the part of both male and female public sector employees. The helpful comments of Rodney Fort, Daniel Hamermesh, Robert Hutchens, and Jon Sonstelie on an earlier draft of the paper are gratefully acknowledged.     

Power and Competition in the UK Retail Grocery Market

The UK retail grocery market is widely recognized as being oligopolistic. This has raised concerns over the level and use of power by the leading retailers. This paper considers the changes in the UK retail grocery market in the context of a discussion of power. This discussion focuses on the possibility of a dominant chain arising in the market. Vertical and horizontal relationships and price and non-price competition form the organizing principles of the analysis. Policy implications are suggested and other conclusions are drawn.     

Are unionized blue collar jobs more hazardous than nonunionized blue collar jobs?

The University of Michigan’s Quality of Employment Survey for 1977 (QES) contains 13 questions pertaining to health and safety conditions at the workplace. Using these questions, together with the injury rate associated with the worker’s industry, this study finds evidence that unionized blue collar jobs are more hazardous than nonunionized blue collar jobs whether hazards are defined as resulting in injury or disease. In addition, the evidence suggests that age, schooling, and being female are negatively associated with the probability of holding a hazardous job. Race has no apparent effect on the probability.     

A dual approach to Bayesian inference and adaptive control

Probability updating via Bayes' rule often entails extensive informational and computational requirements. In consequence, relatively few practical applications of Bayesian adaptive control techniques have been attempted. This paper discusses an alternative approach to adaptive control, Bayesian in spirit, which shifts attention from the updating of probability distributions via transitional probability assessments to the direct updating of the criterion function, itself, via transitional utility assessments. Results are illustrated in terms of an adaptive reinvestment two-armed bandit problem.     

The Stigma of Privilege: Racial Identity and Stigma Consciousness Among Biracial Individuals

Racial identification is a complex and dynamic process for multiracial individuals, who as members of multiple racial groups have been shown to self-identify or be identified by others differently, depending on the social context. For biracial individuals who have white and minority ancestry, such identity shifting (e.g., from minority to white, or vice versa) may be a way to cope with the threats to their racial identity that can be signaled by the presence or absence of whites and/or minorities in their social environment. We examine whether stigma consciousness (Pinel in J Pers Soc Psychol 76(1):114–128, 1999; i.e., the chronic awareness of the stereotyping and prejudice that minorities face) interacts with the sociocultural context to predict social identity threat, belonging, and racial identification. Using experience sampling methodology, minority/white biracial individuals (27 Asian/white, 22 black/white, and 26 Latino/white) reported the racial composition of their environment, social identity threat for their component racial identities, overall feelings of belonging, and racial identification over a 1-week period. Results suggest that stigma consciousness predicts the extent to which biracial people identify with their white background and experience belonging in different racial contexts. We discuss racial identity shifting in response to context-based threats as a protective strategy for biracial people, and identity where participants’ sociocultural contexts and experiences with racial identity and threat differ as a result of their minority racial group or ascribed race.     

"Many Helping Hands": A Review and Analysis of Long-term Care Policies, Programs, and Practices in Singapore

Using the political economy perspective to examine key long-term care policies and provisions, we uncover some ideological underpinnings of policy-making in Singapore. Family involvement, an inherent part of the long-term care system, is overtly reinforced by legislations and policy imperatives. Further, the government encourages and expects the participation of nonstate actors in the provision of services as part of its Many Helping Hands approach to welfare provision. In our analysis, we argue that the government's emphasis of certain ideology, such as self-reliance and cultural exceptionalism, allows it to adopt a residual and philanthropic approach in support of its macro-economic and legitimacy concerns.