Welfare practice in response of child neglect: reconstruction and analysis of the discourses on family, childrearing, and motherhood

Child neglect is an ongoing social problem, estimated to affect 5 - 10 per cent of children. The term neglect describes a behavior that deviates from an ideal norm. However, both the form of this ideal norm and the definition of deviation depend on contemporary discourses and scientific positions. Historically, it has been more frequently poor families and single mothers who have been disciplined for child neglect by the state, whilst their economic situation was marginalized. Parallel current findings raise questions regarding how these discourses form, how they influence decision-making processes, and whether a continuity can be ascertained in measures of social disciplining. Our ongoing research project on welfare practice in response of child neglect aims to reconstruct and analyze current discourses on family, childrearing, and motherhood in the context of child neglect. Taking a multi-perspectival approach, it will analyze and compare the expert discourse, the political/public discourse, and the perspective of affected mothers across two different time periods in five selected Swiss cantons. Preliminary findings indicate that gender categories, especially motherhood, continue to be of great importance. On the basis of a first analysis of casefiles, one could speak of a “motherism”: in case processing and in the course of the case, responsibility is attributed to the mother, and social and pedagogical contexts are neglected, even the financial situation seems to be given less importance. Instead, the willingness to cooperate often seems to be a key factor in deciding on further interventions. Furthermore, there are indications that in decision-making processes with far-reaching consequences, legal arguments are preferred while childrearing aspects are neglected. It can also be noted that normative and sometimes stigmatizing statements do not seem to belong to the past. In this article, we will give insight into the research design and first findings and discuss the necessity of reflecting on the images of family, childrearing, and motherhood in light of the rapid social changes in the spheres of family, motherhood, and fatherhood

Optimizing early rule-out strategies for acute myocardial infarction: utility of 1-hour copeptin

Combined testing of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin at presentation provides a very high-although still imperfect-negative predictive value (NPV) for the early rule-out of acute myocardial infarction (AMI). We hypothesized that a second copeptin measurement at 1 h might further increase the NPV.In a prospective diagnostic multicenter study, we measured hs-cTnT and copeptin concentrations at presentation and at 1 h in 1439 unselected patients presenting to the emergency department with suspected AMI. The final diagnosis was adjudicated by 2 independent cardiologists blinded to copeptin concentrations. We investigated the incremental value of 1-h copeptin in the rule-out setting (0-h hs-cTnT negative and 0-h copeptin negative) and the intermediate-risk setting (0-h hs-cTnT negative and 0-h copeptin positive).The adjudicated diagnosis was AMI in 267 patients (18.6%). For measurements obtained at presentation, the NPV in the rule-out setting was 98.6% (95% CI, 97.4%-99.3%). Whereas 1-h copeptin did not increase the NPV significantly, 1-h hs-cTnT did, to 99.6% (95% CI, 98.7%-99.9%, P = 0.008). Similarly, in the intermediate-risk setting (NPV 92.8%, 95% CI, 88.7%-95.8%), 1-h copeptin did not significantly increase the NPV (P = 0.751), but 1-h hs-cTnT did, to 98.6 (95% CI, 96%-99.7%, P < 0.001).One-hour copeptin increased neither the safety of the rule-out process nor the NPV in the intermediate-risk setting. In contrast, the incremental value of 1-h hs-cTnT was substantial in both settings. ClinicalTrials.gov/NCT00470587