Interprofessional Client-Centered Reasoning Processes in Home Modification Practice

We investigated the complex reasoning processes of professional home evaluators involved with home safety assessments. Twenty evaluators with varied professional training engaged in in-depth qualitative interviews. Two primary themes emerged: integrating expertise and tailoring interventions. Within these themes, evaluators expressed differences and similarities in how they obtained information, developed interventions, and addressed professional-client interactive reasoning as they identified needs. We propose an adapted ecological model to describe best practices for personalizing home modifications through an interprofessional lens. Differences among professional home evaluators reveal unique, yet overlapping reasoning processes. Interprofessional teams may better meet the holistic needs of home modification consumers.     

Women's acceptance of the diaphragm: the role of relationship factors

The vaginal diaphragm is a candidate for a female-controlled method of reducing risk of HIV/STI acquisition. We examined the association between relationship and partner factors and three measures of diaphragm acceptability: current use, consistency of use, and satisfaction with use. We conducted a telephone survey with 448 female members of a managed care organization, aged 18-49, who currently used contraception (including 140 diaphragm users, 187 pill users, and 121 male condom users). Use of a specific contraceptive was significantly associated with relationship length, condom-use negotiation self-efficacy, importance of covert use, perceived motivation of partner to prevent HIV/STIs, and perceived satisfaction of partner with current method. In addition, among diaphragm users, communication about HIV/STIs and perceived partner motivation to use a diaphragm were related to consistent use. These results suggest that acceptability of contraceptive methods among women is influenced by their perceptions of their male partner and relationship factors.     

Potential Airborne Asbestos Exposure and Risk Associated with the Historical Use of Cosmetic Talcum Powder Products

Over time, concerns have been raised regarding the potential for human exposure and risk from asbestos in cosmetic‐talc–containing consumer products. In 1985, the U.S. Food and Drug Administration (FDA) conducted a risk assessment evaluating the potential inhalation asbestos exposure associated with the cosmetic talc consumer use scenario of powdering an infant during diapering, and found that risks were below levels associated with background asbestos exposures and risk. However, given the scope and age of the FDA's assessment, it was unknown whether the agency's conclusions remained relevant to current risk assessment practices, talc application scenarios, and exposure data. This analysis updates the previous FDA assessment by incorporating the current published exposure literature associated with consumer use of talcum powder and using the current U.S. Environmental Protection Agency's (EPA) nonoccupational asbestos risk assessment approach to estimate potential cumulative asbestos exposure and risk for four use scenarios: (1) infant exposure during diapering; (2) adult exposure from infant diapering; (3) adult exposure from face powdering; and (4) adult exposure from body powdering. The estimated range of cumulative asbestos exposure potential for all scenarios (assuming an asbestos content of 0.1%) ranged from 0.0000021 to 0.0096 f/cc‐yr and resulted in risk estimates that were within or below EPA's acceptable target risk levels. Consistent with the original FDA findings, exposure and corresponding health risk in this range were orders of magnitude below upper‐bound estimates of cumulative asbestos exposure and risk at ambient levels, which have not been associated with increased incidence of asbestos‐related disease.     

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.     

Environmental quality and the well-being of children

There are many reasons for believing that the environment exerts an influence (directly or indirectly) on the wellbeing of children and families. However, while clear evidence is available that low socioeconomic status is associated with lower than average levels of wellbeing, especially among adults, the evidence linking the social and emotional adjustment of children with the quality of the environment is patchy and equivocal. In this paper we focus on three levels of the family environment: the street, the home and the neighborhood. Neighborhood quality was measured by the Vinson-Homel social problems index, street-type as residential or commercial/retail, and housing quality in terms of upkeep, floor occupied, availability of playspace and occupancy type. The research hypothesis was that after allowing for community selection processes children living in lower quality environments would be less satisfied with various areas of their lives, would experience more negative emotions, and would have more restricted and less positive friendship patterns. The sample comprised 321 families which included a 9–11 year old child, drawn from 18 neighborhoods of Sydney. Neighborhood social problem score and street-type, and some aspects of housing, predicted emotional and social adjustment. Before and after controls for family composition, social class and culture, children living in commercial streets, particularly in inner-city areas, stood out from all others in their feelings of loneliness, dislike of other children and feelings of rejection, worry, fear, anger and unhappiness. Children living in high social problems areas showed a pattern of social constriction rather than maladjustment. These results suggest not simply the influence of social class but genuine community socialization effects. Possible sources of, and mechanisms for, these effects are suggested.