Socioeconomic Mediators of Racial and Ethnic Disparities in Congenital Heart Disease Outcomes: A Population-Based Study in California.

Background Racial/ethnic and socioeconomic disparities exist in outcomes for children with congenital heart disease. We sought to determine the influence of race/ethnicity and mediating socioeconomic factors on 1-year outcomes for live-born infants with hypoplastic left heart syndrome and dextro-Transposition of the great arteries. Methods and Results The authors performed a population-based cohort study using the California Office of Statewide Health Planning and Development database. Live-born infants without chromosomal anomalies were included. The outcome was a composite measure of mortality or unexpected hospital readmissions within the first year of life defined as >3 (hypoplastic left heart syndrome) or >1 readmissions (dextro-Transposition of the great arteries). Hispanic ethnicity was compared with non-Hispanic white ethnicity. Mediation analyses determined the percent contribution to outcome for each mediator on the pathway between race/ethnicity and outcome. A total of 1796 patients comprised the cohort (n=964 [hypoplastic left heart syndrome], n=832 [dextro-Transposition of the great arteries]) and 1315 were included in the analysis (n=477 non-Hispanic white, n=838 Hispanic). Hispanic ethnicity was associated with a poor outcome (crude odds ratio, 1.72; 95% confidence interval [CI], 1.37-2.17). Higher maternal education (crude odds ratio 0.5; 95% CI , 0.38-0.65) and private insurance (crude odds ratio, 0.65; 95% CI , 0.45-0.71) were protective. In the mediation analysis, maternal education and insurance status explained 33.2% (95% CI , 7-66.4) and 27.6% (95% CI , 6.5-63.1) of the relationship between race/ethnicity and poor outcome, while infant characteristics played a minimal role. Conclusions Socioeconomic factors explain a significant portion of the association between Hispanic ethnicity and poor outcome in neonates with critical congenital heart disease. These findings identify vulnerable populations that would benefit from resources to lessen health disparities

The Multi-door Court House (MDC) Scheme in Nigeria: A case study of the Lagos MDC

In 2002 the Lagos Multidoor Courthouse (LMDC) opened its doors to the public. The MDC scheme is designed to provide alternative dispute resolution processes for the resolution of various disputes, as part of the public justice system. An empirical research into the effectiveness of the scheme in Lagos state was carried out in June 2012 and this report presents the findings of and recommendations from the research

Understanding information needs of Australian business organisations

Over the past decade, universities have used repositories as channels to create access to research outputs. Increasingly government and universities are seeking to optimise the impact of their research, particularly to improve public policy. This study looks at the impact of access to research from the perspective of business associations and researchers. It finds that business organisations value trusted timely, relevant research. Accessibility and peer-reviewed research outputs are highly valued but little used. Barriers to use of the research include availability (material not openly accessible), discoverability (ranking on search engines) and knowledge by trusted mediators and connectivity (presentation as part of a cohort of scholarly knowledge). Barriers for researchers include lack of rewards and recognition for research outputs focused on these organisations. The theories used in the study include triple helix, Kautto-Koivula and Huhtaniemi’s model for knowledge and competence management and actor network theory. The study concludes that significant work is required to improve the accessibility and discoverability of research. In particular, the search paradigm is insufficient to provide optimal awareness of and impact of research.Australian Library and Information Associatio

Extending dental nurses' duties: a national survey investigating skill-mix in Scotland's child oral health improvement programme (Childsmile)

Background: Childsmile is Scotland’s national child oral health improvement programme. To support the delivery of prevention in general dental practice in keeping with clinical guidelines, Childsmile sought accreditation for extended duty training for dental nurses to deliver clinical preventive care. This approach has allowed extended duty dental nurses (EDDNs) to take on roles traditionally undertaken by general dental practitioners (GDPs). While skill-mix approaches have been found to work well in general medicine, they have not been formally evaluated in dentistry. Understanding the factors which influence nurses’ ability to fully deliver their extended roles is necessary to ensure nurses’ potential is reached and that children receive preventive care in line with clinical guidance in a cost-effective way. This paper investigates the supplementation of GDPs’ roles by EDDNs, in general dental practice across Scotland. Methods: A cross-sectional postal survey aiming to reach all EDDNs practising in general dental practice in Scotland was undertaken. The survey measured nurses’: role satisfaction, perceived utility of training, frequency, and potential behavioural mediators of, preventive delivery. Frequencies, correlations and multi-variable linear regression were used to analyse the data. Results: Seventy-three percent of practices responded with 174 eligible nurses returning questionnaires. Respondents reported a very high level of role satisfaction and the majority found their training helpful in preparing them for their extended role. While a high level of preventive delivery was reported, fluoride vanish (FV) was delivered less frequently than dietary advice (DA), or oral hygiene advice (OHA). Delivering FV more frequently was associated with higher role satisfaction (p < 0.001). Those nurses who had been practising longer reported delivering FV less frequently than those more recently qualified (p < 0.001). Perceived difficulty of delivering preventive care (skills) and motivation to do so were most strongly associated with frequency of delivery (p < 0.001 for delivery of FV, DA and OHA). Conclusions: This study has provided insight into EDDNs’ experiences and demonstrates that with appropriate training and support, EDDNs can supplement GDPs’ roles in general dental practice in Scotland. However, some barriers to delivery were identified with delivery of FV showing scope for improvement

Designing Integrated Conflict Management Systems: Guidelines for Practitioners and Decision Makers in Organizations

A committee of the ADR (alternative dispute resolution) in the Workplace Initiative of the Society of Professionals in Dispute Resolution (SPIDR) prepared this document for employers, managers, labor representatives, employees, civil and human rights organizations, and others who interact with organizations. In this document we explain why organizations should consider developing integrated conflict management systems to prevent and resolve conflict, and we provide practical guidelines for designing and implementing such systems. The principles identified in this document can also be used to manage external conflict with customers, clients, and the public. Indeed, we recommend that organizations focus simultaneously on preventing and managing both internal and external conflict. SPIDR recognizes that an integrated conflict management system will work only if designed with input from users and decision makers at all levels of the organization. Each system must be tailored to fit the organization\u27s needs, circumstances, and culture. In developing these systems, experimentation is both necessary and healthy. We hope that this document will provide guidance, encourage experimentation, and contribute to the evolving understanding of how best to design and implement these systems

Direct, indirect and buffering effects of support for mothers on children's socio-emotional adjustment

Support for mothers may improve children’s socioemotional adjustment, yet few studies have consideredthe benefits of formal support (from health and social work professionals) in addition to social support(from family and friends) or explored the mechanisms. These issues were addressed using a birth cohort(n�2,649) to explore how mothers’ perceptions of social and formal support when children were ages10–22 months predicted trajectories of children’s externalizing and internalizing problems from 58 to122 months. We tested mediating pathways from support to child adjustment via 3 family stressorsmeasured at 46–58 months (maternal distress, economic strain, and dysfunctional parenting) andexamined whether support buffered effects of stressors on child adjustment. Social and formal supportwere simultaneously associated with lower child externalizing and internalizing problem trajectoryintercepts at 90 months but did not predict trajectory slopes. Social support effects were mediated mainlyvia lower maternal distress, which then reduced children’s problems via lower dysfunctional parenting,or more directly. Additional indirect effects involved lower economic strain. Formal support effects weremediated to a lesser extent by reduced dysfunctional parenting. Two buffering effects were found: socialsupport reduced effects of economic strain on internalizing problems, and formal support reduced effectsof dysfunctional parenting on internalizing problems. Findings suggest measures promoting families’social integration should benefit children’s socioemotional adjustment via improved parental psycho-logical and economic resources and by buffering impacts of economic strain. Enhancing access to healthand welfare services through greater awareness and trust should benefit children’s adjustment, viaimproved parenting and by buffering impacts of dysfunctional parenting

Greening through schooling:Understanding the link between education and pro-environmental behavior in the Philippines

In recent years, changing lifestyle, consumption and mobility patterns have contributed to a global rise in greenhouse gases responsible for the warming of the planet. Despite its increasing relevance, there is a lack of understanding of factors influencing the environmental behavior of people from emerging economies. In this study, we focus on the role of formal education for pro-environmental behavior in the Philippines and study three potentially underlying mechanisms explaining the education effects: differential knowledge about climate change, risk perceptions, and awareness. Whilst there is some evidence showing that education is associated with pro-environmental behavior, little is known about the actual mechanisms through which it influences decision-making. Using propensity score methods, we find that an additional year of schooling significantly increases the probability of pro-environmental actions, e.g. planting trees, recycling, and proper waste management, by 3.3%. Further decomposing the education effects, it is found that education influences behavior mainly by increasing awareness about the anthropogenic causes of climate change, which may consequently affect the perception of self-efficacy in reducing human impacts on the environment. Knowledge and perceptions about climate risks also explain the education effect on pro-environmental behavior, but to a lesser extent