Safe Access to Safe Water in Low Income Countries: Water Fetching in Current Times

A substantial portion of the world’s population does not have ready access to safe water. Moreover, obtaining water may involve great expense of time and energy for those who have no water sources in or near home. From an historical perspective, with the invention of piped water, fetching water has only recently become largely irrelevant in many locales. In addition, in most instances, wells and clean surface water were so close by that fetching was not considered a problem. However, population growth, weather fluctuations and social upheavals have made the daily chore of carrying water highly problematic and a public health problem of great magnitude for many, especially women, in the poor regions and classes of the world. In this paper, we consider gender differences in water carrying and summarize data about water access and carrying from 44 countries that participated in the Multiple Indicator Cluster Survey (MICS) program. Women and children are the most common water carriers, and they spend considerable time (many trips take more than an hour) supplying water to their households. Time is but one measure of the cost of fetching water; caloric expenditures, particularly during droughts, and other measures that affect health and quality of life must be considered. The full costs of fetching water must be considered when measuring progress toward two Millennium Development Goals – increasing access to safe drinking water and seeking an end to poverty

Endgame for polio eradication? Options for overcoming social and political factors in the progress to eradicating polio.

In 1988, the Global Polio Eradication Initiative (GPEI) was launched with the goal of eradicating polio by the year 2000. After 25 years, several dynamics still challenge this large public health campaign with new cases of polio being reported annually. We examine the roots of this initiative to eradicate polio, its scope, the successes and setbacks during the last 25 years and reflect on the current state of affairs. We examine the social and political factors that are barriers to polio eradication. Options are discussed for solving the current impasse of polio eradication: using force, respecting individual freedoms and gaining support from those vulnerable to fundamentalist \u27propaganda\u27. The travails of the GPEI indicate the need for expanding the Convention on the Rights of the Child to address situations of war and civic strife. Such a cultural and structural reference will provide the basis for global stakeholders to engage belligerent local actors whose local political conflicts are barriers to the eradication of polio. Disregard for these actors will result in stagnation of polio eradication policy, delaying eradication beyond 2018

Early reflections of pregnancy performance and neonatal outcome in maternal serum

The primary aim was to evaluate the association of adverse pregnancy outcomes with firstly the serum markers being used in our second trimester screening programme (MSAFP and MShCG) and secondly with the serum markers that will problanly be used in first trimester screening for fetal DS (PAPP-A and free β-hCG). The second aim was to investigate the pathophysiological mechnaism underlying this association. There is evidence in the literature that impaired placental development or function provides a link in this association. Therefore, we decided to examine the impact of ischaemic placental lesions and chromosomal placental pathology on the evelation of MSAFP and MShCG in the second trimester. Zie: Samenvatting

Validation of the Teacher Questionnaire of Montessori Practice for Early Childhood in the Dutch Context

Montessori education has existed for more than 100 years and counts almost 16,000 schools worldwide (Debs et al., 2022). Still, little is known about the implementation and fidelity of Montessori principles. Measuring implementations holds significant importance as it provides insight into current Montessori practices and because it is assumed that implementation might influence its effectiveness. In the Netherlands, it is especially important to measure fidelity because of the country’s history of flexible implementation of Montessori principles. No instruments currently exist that are specifically designed to measure Montessori implementation in the Dutch context. This study aims to validate a translated version of the Teacher Questionnaire for Montessori Practices, developed by Murray et al. (2019), within the Dutch early childhood education context. Additionally, it seeks to investigate the extent to which Montessori principles are implemented in Dutch early childhood schools. Data were collected from 131 early childhood Montessori teachers. Confirmatory factor analysis revealed that the Dutch dataset did not align with the factor structure proposed by Murray et al. (2019). Subsequent exploratory factor analysis led to the identification of a 3-factor solution, encompassing dimensions related to Children’s Freedom, Teacher Guidance, and Curriculum, which shows some similarities with Murray et al.’s (2019) factors. Implementation levels in the Netherlands varied, with the highest level of implementation observed in Children’s Freedom and the lowest in Curriculum

A homozygous variant in growth and differentiation factor 2(GDF2)may cause lymphatic dysplasia with hydrothorax and nonimmune hydrops fetalis

The etiology of nonimmune hydrops fetalis is extensive and includes genetic disorders. We describe a term-born female neonate with late onset extensive nonimmune hydrops, that is, polyhydramnios, edema, and congenital bilateral chylothorax. This newborn was successfully treated with repetitive thoracocentesis, total parenteral feeding, octreotide intravenously and finally surgical pleurodesis and corticosteroids. A genetic cause seemed plausible as the maternal history revealed a fatal nonimmune hydrops fetalis. A homozygous truncating variant inGDF2(c.451C>T, p.(Arg151*)) was detected with exome sequencing. Genetic analysis of tissue obtained from the deceased fetal sibling revealed the same homozygous variant. The parents and two healthy siblings were heterozygous for theGDF2variant. Skin and lung biopsies in the index patient, as well as the revised lung biopsy of the deceased fetal sibling, showed lymphatic dysplasia and lymphangiectasia. To the best of our knowledge, this is the first report of an association between a homozygous variant inGDF2with lymphatic dysplasia, hydrothorax and nonimmune hydrops fetalis

Risks versus benefits of medication use during pregnancy:What do women perceive?

Background: Understanding perception of risks and benefits is essential for informed patient choices regarding medical care. The primary aim of this study was to evaluate the perception of risks and benefits of 9 drug classes during pregnancy and associations with women's characteristics. Methods: Questionnaires were distributed to pregnant women who attended a Dutch Obstetric Care facility (first-and second-line care). Mean perceived risk and benefit scores were computed for 9 different drug classes (paracetamol, antacids, antibiotics, antifungal medication, drugs against nausea and vomiting, histamine-2 receptor antagonists/proton pump inhibitors, antidepressants, nonsteroidal anti-inflammatory drugs, and sedatives/anxiolytics). For each participant, we computed weighted risk and benefit sum scores with principal component analysis. In addition, major concerns regarding medication use were evaluated. Results: The questionnaire was completed by 136 women (response rate 77%). Pregnant women were most concerned about having a child with a birth defect (35%), a miscarriage (35%), or their child developing an allergic disease (23%), respectively, as a result of drug use. The majority of studied drug classes were perceived relatively low in risk and high in benefit. Higher risk scores were reported if women were in their first trimesters of pregnancy (p=0.007). Lower benefit scores were reported if women were single (p=0.014), smoking (p=0.028), nulliparous (p=0.006), or did not have a family history of birth defects (p=0.005). Conclusion: Pregnant women's concerns regarding potential drug adverse effects were not only focused on congenital birth defects but also included a wider range of adverse outcomes. This study showed that most of the studied drug classes were perceived relatively low in risk and high in benefit