Infrastructural Work in Child Welfare: incommensurable politics in the Dutch Child Index

The Dutch Child Index is a nationwide information system (IS) designed to alert professionals about each other’s involvedness with at-risk children, enabling identification of individual at-risk children, improvement of multidisciplinary collaboration and timely interventions. In this paper, we study the infrastructural work and complexities engaged in making the collaborative system of the Child Index function in real life and in care situations. We use the information infrastructure perspective as an analytical lens and describe the infrastructural work that is performed to make the Child Index become part of actual practices. We also identify flexibility, heterogeneity and the connection to existing platforms as difficulties participants have had while performing infra- structural work. The paper makes two main contributions. First, it provides an in-depth empirical analysis of this specific collaborative and preventive infrastructure. Second, based on this empirical analysis, we argue that when developing and understanding infrastructures, it is important to identify limits to the integrative capacity and disciplining power of ISs as result of conflicting infrastructural work due to incommensurable politics. perspective as an analytical lens and describe the infrastructural work that is performed to make the Child Index become part of actual practices. We also identify flexibility, heterogeneity and the connection to existing platforms as difficulties participants have had while performing infrastructural work. The paper makes two main contributions. First, it provides an in-depth empirical analysis of this specific collaborative and preventive infrastructure. Second, based on this empirical analysis, we argue that when developing and understanding infrastructures, it is important to identify limits to the integrative capacity and disciplining power of IS’s as result of conflicting infrastructural work due to incommensurable politics

‘We are the advocates for the babies’ - understanding interactions between patients and health care providers during the prevention of mother-to-child transmission of HIV in South Africa : a qualitative study

BACKGROUND : HIV/AIDS has had a significant impact on maternal and child health in South Africa. It is thus of vital importance to implement interventions to prevent mother-to-child transmission of HIV (PMTCT) as early as possible during pregnancy. Negative interactions between patients and health care providers (HCPs) can be an important barrier to antenatal care, PMTCT use and PMTCT adherence. Research about respectful maternity care has focused more on the patient perspective. We therefore compared the patient and HCP perspectives and reflected on how interactions between HCPs and patients can be improved. OBJECTIVE : To obtain insights into the attitudes of HCPs in the context of HIV and PMTCTrelated care, by studying patient and HCP perceptions of their interactions, in a peri-urban hospital setting in Gauteng province, South Africa. METHODS : A qualitative study was conducted in a public tertiary-level hospital. Fourteen semistructured in-depth interviews were conducted with nurses and doctors in the antenatal clinic and postnatal ward. Thirty-one semi-structured in-depth interviews and two focus group discussions were conducted with HIV positive and negative women on the postnatal ward. RESULTS : HCPs experienced a difficult work environment due to a high workload. This was combined with frustrations when they felt that patients did not take responsibility for their own or their child’s health. They were motivated by the need to help the child. Patients experienced judging comments by HCPs especially towards younger, older and foreign women. They expressed fear to ask questions and self-blame, which in some cases delayed health care seeking. No discrimination or isolation of HIV infected patients was reported by patients and HCPs. CONCLUSION : We hypothesize that more humane working conditions for obstetric HCPs and a caring, personalised approach to patient management can improve patient-provider interactions and access to respectful care. These are critical to preventing mother-to-child transmission of HIV.The South African Medical Research Councilhttp://www.tandfonline.com/loi/zgha20am2020Paediatrics and Child Healt

The prevalence of sickness absence among primary school pupils:Reason to be worried?

Background Absence from school can lead to lower educational achievement and poor health. Little is known about school absence in primary education. This study’s first aim was to examine the prevalence of school absence in primary schools and differing types of absence, including sickness absence. The second aim was to determine which pupil characteristics and types of absence were associated with extensive sickness absence. Methods The school absence registries for the school year 2015–2016 were analysed retrospectively in eight mainstream primary schools with 2216 pupils, and six schools for special primary education with 1000 pupils in the West-Brabant region of the Netherlands. Descriptive analyses, χ2-tests, Mann-Whitney U tests and logistic regression analyses were performed. Results The one-year prevalence of school absence was 85% in mainstream primary schools and 79% in special schools. Sickness absence was the most prevalent type of absence, occurring in 75 and 71% of pupils, respectively The prevalence of extensive sickness absence was 13 and 23%, respectively. In mainstream schools, extensive sickness absence was associated with a young age, low parental educational level, more doctor’s visits and unauthorised absence, and in special schools with more doctor’s visits, other authorised absence, tardiness and unauthorised absence. Conclusions The prevalence of extensive sickness absence was high, and as this was associated with other types of absence, these pupils missed even more days of school. Public health research, policy and practice should address sickness absence among primary school pupils, to prevent adverse effects on children’s development

Stakeholder perspectives on primary school pupils and sickness absence:Exploring opportunities and challenges

School absenteeism and its underlying causes can have negative effects on the cognitive, psychosocial and health development of a child. Research in primary education shows high rates of sickness absence. Many stakeholders are involved in addressing school absenteeism, including primary school professionals, child and youth healthcare physicians, school attendance officers and parents. This study explores these stakeholders’ perspectives, their approaches and what they envisage to be necessary in order to improve. It also aims to unveil opportunities and challenges in addressing sickness absence among primary school pupils. Qualitative research was performed with six semi-structured focus group interviews and involving 27 participants from the West-Brabant and Amsterdam regions of the Netherlands. Thematic analysis was used. The overarching theme was aiming for the child’s wellbeing. Each focus group interview started with low awareness of sickness absence as a threat to this wellbeing, but awareness grew during the interviews. The participating stakeholders regarded problematic sickness absence as complex due to a wide variety of causes, and felt that each other’s expertise was necessary to reduce sickness absence. Schools registered absence, but only occasionally used planned steps; they based the identification of problematic sickness on gut feeling rather than any agreed-upon criteria. To be able to systematically address sickness absence and thus improve the wellbeing of children, stakeholders felt the need for a clearly structured approach, including monitoring of sickness absence of all pupils, identifying problematic absence and promoting collaboration with other stakeholders. An approach should allow for tailoring solutions to the individual child

Detecting and Characterizing Particulate Organic Nitrates with an Aerodyne Long-ToF Aerosol Mass Spectrometer

Particulate organic nitrate (pON) can be a major part of secondary organic aerosol (SOA) and is commonly quantified by indirect means from aerosol mass spectrometer (AMS) data. However, pON quantification remains challenging. Here, we set out to quantify and characterize pON in the boreal forest, through direct field observations at Station for Measuring Ecosystem Atmosphere Relationships (SMEAR) II in Hyytia''la'', Finland, and targeted single precursor laboratory studies. We utilized a long time-of-flight AMS (LToF-AMS) for aerosol chemical characterization, with a particular focus to identify CxHyOzN+ ("CHON+") fragments. We estimate that during springtime at SMEAR II, pON (including both the organic and nitrate part) accounts for similar to 10% of the particle mass concentration (calculated by the NO+/NO2+ method) and originates mainly from the NO3 radical oxidation of biogenic volatile organic compounds. The majority of the background nitrate aerosol measured is organic. The CHON+ fragment analysis was largely unsuccessful at SMEAR II, mainly due to low concentrations of the few detected fragments. However, our findings may be useful at other sites as we identified 80 unique CHON+ fragments from the laboratory measurements of SOA formed from NO3 radical oxidation of three pON precursors (beta-pinene, limonene, and guaiacol). Finally, we noted a significant effect on ion identification during the LToF-AMS high-resolution data processing, resulting in too many ions being fit, depending on whether tungsten ions (W+) were used in the peak width determination. Although this phenomenon may be instrument-specific, we encourage all (LTOF-) AMS users to investigate this effect on their instrument to reduce the possibility of incorrect identifications.Peer reviewe

How to deal with sickness absence among primary school pupils? Adaptation of the “Medical Advice for Sick-reported Students” intervention

BackgroundMissing school impacts both education and health. The purpose of this study was to address sickness absence in primary schools by adjusting the ‘Medical Advice for Sick-reported Students’ intervention for secondary schools. This was necessary because of fundamental differences in relation to the children’s age and in the schools’ organizational structure.MethodsThe intervention mapping approach steps 1 through 4 were used to adapt ‘Medical Advice for Sick-reported Students’ to primary schools (MASS-PS), including a literature search, stakeholder interviews, establishing a planning group and pre-testing.ResultsIn step 1, a planning group was formed and a logic model of the problem was created. In step 2, a logic model of change was created. In step 3, a theoretical basis and practical strategies were determined. In step 4, practical support materials were designed, and two pre-tests of the materials were performed.ConclusionIntervention mapping was successfully used to adapt MASS to primary schools. The main changes were the lowering of the threshold for extensive sickness absence, consultations between teacher and attendance coordinator, and addition of two experts. With MASS-PS, sickness absence can be addressed as a “red flag” for underlying problems

Preventive child health care

Preventive child healthcare (PCH) is preventive health care for children, adolescents and their parents. This care takes place at the health clinic and/or the youth and family center (young children), and at schools (older children). The care consists first of all of preventive care offered to individual children and families, for example vaccinations, screening, growth monitoring and counseling for school absences due to health reasons. Secondly, PCH offers preventive care to groups of children, for example by creating a healthy school environment (nutrition, exercise). Central to the PCH approach is the development of the healthy child. PCH is offered free of charge with a high outreach, in young children more than 95% of all children are reached, under the responsibility of municipalities. PCH balances in its work between missing the risks of problems on the one hand and labeling too many children "with a problem" on the other hand. This balancing act is evident, among other things, in the social discussions about ADHD and about child abuse

Developing a complex intervention programme for informal caregivers of stroke survivors:The Caregivers' Guide

Background: Stroke affects the entire family system. Failure to meet the needs of caregivers leads to physical and mental overburdening. Stroke caregivers may benefit from professional support. The literature reviews have shown that there is still no clarity concerning the most appropriate set-up of a support programme. In Germany, there is no stroke caregiver support programme that operates throughout the course of rehabilitation. Aim: The aim was to develop a complex intervention programme for stroke caregivers in North-Rhine Westphalia, Germany. Methods: A naturalistic enquiry approach, using a mixed-methods design, was applied. Within one overarching qualitative study, three separate, explorative, inductive, qualitative substudies were conducted: (i) seven explorative interviews with experienced stroke caregivers, (ii) six semi-structured interviews with professionals working within stroke rehabilitation and (iii) seventeen participant observations with focus on professional-caregiver interactions. Regional stroke units, rehabilitation centres, outpatient services and the home environment of caregivers were included. By means of a four-step qualitative content analysis, all three data sets were coded, categorised and subsequently condensed into subthemes, clustered into main themes, and finally translated into 'Conceptual Building Blocks' of the programme. Results: The need for a personalised, holistic and multicomponent caregiver support programme emerged from all three substudies. Fourteen themes were condensed from the subthemes. Caregivers should be approached directly after stroke using outreach counselling. Support should be provided by a specially trained focal person across the entire patient's rehabilitation trajectory. The newly developed support programme consists of five flexible 'Conceptual Building Blocks': Content, Human Resources, Personalised Approach, Timing and Setting. Conclusion: Through a qualitative mixed-methods design, an in-depth contextual understanding of stroke caregiver needs within the rehabilitative support system was reached. This allowed the development of a context tailored comprehensive caregiver support programme consisting of five 'Conceptual Building Blocks'