The childhood development initiative: developing quality services

The Childhood Development Initiative (CDI) has created a ten-year strategy to improve the health, safety and learning of the children of Tallaght West, and to strengthen their sense of belonging in their own communities. This paper portrays an overview of the strategy, the principles of freedom and prevention which underpin the project and outlines two of the eight activities, namely the Early Childhood Care and Education (ECCE) programme and the Enhancing Quality through Integration and Training (EQIT) programme. These two activities seek to develop high quality services in accordance with international evidence on early childhood development, local quantitative and qualitative research, national policy developments and scientific service design and will be rigorously evaluated. We will argue that given the process adopted and positive evaluation results, these services should be replicated and mainstreamed

How Are Our Kids?: Children and Families in Tallaght West, Co. Dublin

'How are our kids?' It's a simple and straightforward question - one that any parent in Ireland will occasionally ask. In the case of Tallaght West this question is particularly urgent. The research presented in this document shows that the majority of children in Tallaght West are carrying a disproportionate burden of the inequality and poverty whichexists in Irish society as a whole - at least one in three children in this area is likely to beliving in poverty. Before the parents and guardians of these children can answer 'our kids are doing well' change is required and that change must be lasting.This research is part of the Childhood Development Initiative in Tallaght West. We are asking 'how are our kids?' because we know that, on various levels, many are not doing well and we are determined to do something about it. We want to know how these children and families are coping in the midst of challenging circumstances. We want to know exactly what conditions exist that support their developmental capacities, so that these can be built upon. We want to obtain a better understanding of what their actual needs are so that we can advocate for, and put in place, services that meet those needs

Re-thinking identity The challenge of diversity

Includes bibliographical referencesSIGLEAvailable from British Library Document Supply Centre- DSC:m03/34582 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Safeguarding people living in vulnerable conditions in the COVID-19 era through universal health coverage and social protection

The COVID-19 pandemic is unprecedented. The pandemic not only induced a public health crisis, but has led to severe economic, social, and educational crises. Across economies and societies, the distributional consequences of the pandemic have been uneven. Among groups living in vulnerable conditions, the pandemic substantially magnified the inequality gaps, with possible negative implications for these individuals' long-term physical, socioeconomic, and mental wellbeing. This Viewpoint proposes priority, programmatic, and policy recommendations that governments, resource partners, and relevant stakeholders should consider in formulating medium-term to long-term strategies for preventing the spread of COVID-19, addressing the virus's impacts, and decreasing health inequalities. The world is at a never more crucial moment, requiring collaboration and cooperation from all sectors to mitigate the inequality gaps and improve people's health and wellbeing with universal health coverage and social protection, in addition to implementation of the health in all policies approach

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)