Addressing inequality: Educators responding to the contexts of young children’s lives?

A child's early relationships and experiences influence their long-term development and learning. In Australia, some children can face complex levels of deprivation when compared to their peers. This study sheds light on how educators are responding. Data analysed consist of individual interviews with early childhood educators working in diverse communities. The findings highlight educators’ accounts of responsiveness as narrowly framed with attention focused on children's cultural heritage which overshadows other equity groups. The paper argues that by becoming sensitive to the contexts of children's lives, there is potential to build the early childhood workforce's capacity for addressing inequalities in childhood.     

Coherence principles in interval‐based dose finding

This paper studies the notion of coherence in interval‐based dose‐finding methods. An incoherent decision is either (a) a recommendation to escalate the dose following an observed dose‐limiting toxicity or (b) a recommendation to deescalate the dose following a non–dose‐limiting toxicity. In a simulated example, we illustrate that the Bayesian optimal interval method and the Keyboard method are not coherent. We generated dose‐limiting toxicity outcomes under an assumed set of true probabilities for a trial of n=36 patients in cohorts of size 1, and we counted the number of incoherent dosing decisions that were made throughout this simulated trial. Each of the methods studied resulted in 13/36 (36%) incoherent decisions in the simulated trial. Additionally, for two different target dose‐limiting toxicity rates, 20% and 30%, and a sample size of n=30 patients, we randomly generated 100 dose‐toxicity curves and tabulated the number of incoherent decisions made by each method in 1000 simulated trials under each curve. For each method studied, the probability of incurring at least one incoherent decision during the conduct of a single trial is greater than 75%. Coherency is an important principle in the conduct of dose‐finding trials. Interval‐based methods violate this principle for cohorts of size 1 and require additional modifications to overcome this shortcoming. Researchers need to take a closer look at the dose assignment behavior of interval‐based methods when using them to plan dose‐finding studies.     

Using a Person-Centered Approach to Examine the Impact of Homelessness on School Absences

Brought on by increasing levels of economic vulnerability, homelessness is a pressing issue for our schools. Homeless students often miss an inordinate amount of school days and are thought to fall at the farthest end of a “continuum of poverty.” Theoretically they have worse outcomes than their peers, though the past 20 years of literature have found inconsistencies in these comparisons. Thus the literature suggests analysis to compare types of students based on outcomes rather than demographic categorizations, a person-centered approach. Using this approach, a comparison of the number of absences for homeless students and their housed peers is made through quantile analysis. Using school administrative data collected over one school year for an entire school district we found that homeless students as an aggregate do not miss significantly more days of school than their poorest peers. However, we found homelessness and poverty dramatically increase the number of absences for children who are in the higher percentiles of absences meaning homelessness has a greater impact on those who miss more days of school in general compared to regular attendees. Findings from this study indicate that homelessness may exacerbate problems rather than cause them. Implications for practice are discussed and directions for future study are proposed.     

Maternal mortality: What can we learn from stories of postpartum haemorrhage?

Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality.Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring.This article will identify some of the lessons that can be learnt from the recent Australian and UK maternal death reports. This paper presents an overview of the process and systems for the reporting of maternal death in Australia. It will then specifically focus on obstetric haemorrhage, with a focus on postpartum haemorrhage, for the 12-year period, 1994–2005. Vignettes from the maternal mortality reports in Australia and the United Kingdom are used to highlight the important lessons for providers of maternity care.     

Reducing poverty and inequality through tax-benefit reform and the minimum wage: the UK as a case-study

Atkinson’s book Inequality: What Can Be Done? (Harvard University Press, 2015) sets out a range of concrete proposals aimed at reducing income inequality, which cover a very broad span but include major changes to the income tax and social transfers system and the minimum wage. These are framed with specific reference to the UK but have much broader relevance in demonstrating how substantial the impact on inequality of such measures could be. This paper assesses the first-round effects of these tax, transfer and minimum wage reforms on income inequality and poverty based on a microsimulation approach using EUROMOD. The reforms involve a significantly more progressive income tax structure, a major increase in the minimum wage to the level which is estimated to represent the ‘Living Wage’, and alternative routes to reforming social transfers – either to strengthen the social insurance element or to restructure the entire system as a Participation Income (a variant of Basic/Citizen’s Income). The results show how the first-round effects of either set of tax and transfer proposals would be to substantially reduce the extent of income inequality and relative income poverty and the paper draws out how the two approaches differ in their effects. The additional impact of raising the minimum wage to the Living Wage is modest, reflecting in particular the position of beneficiaries in the household income distribution and the offsetting effects on household income of the withdrawal of means-tested cash transfers.     

The nature,extent and determinants of violence against psychiatric personnel

Violence against psychiatric staff seems to be on the increase. Such abuse can lead to mental health consequences for the staff and a reluctance to be closely involved with patients. Few Swedish investigations have examined violence against mental nurses and psychiatrists, or undertaken comparative studies between them. In this study we examined the extent, nature and determinants (i.e. risk factors) of violence against psychiatric nurses (n = 731) and psychiatrists (n = 320) working in the eight health care districts of Stockholm. These caregivers were assessed cross-sectionally by means of a questionnaire covering various areas (e.g. violence and work environment). The majority of the participants (85%) reported having been exposed to violence during their careers, with 57% being victimized in the past 12 months. Physical violence was common, and factors such as negative attitudes to work and diminished sense of autonomy were associated with an increased vulnerability to violence. Nurses and psychiatrists did not differ in violence variables. In spite of the weaknesses of the design (cross-sectional self-selecting sample), this study corroborates previous findings and identifies personal factors associated with violence that have received little attention in the literature (e.g. lack of respect for the organization of care).