Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment.Methods: Multilevel multinomial regression analysis controlling for age, gender, ethnicity, and (...) referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 years] using anonymised administrative data from young people's mental health services.Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement. Similarly, they were less likely to transfer or end treatment for other reasons than by case closure due to mutual agreement.Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services. (shrink)

For many rare diseases, the availability of effective interventions is limited or non-existent. In this context, clinical research evaluating emerging interventions may be the only potentially “the...

Home-based service jobs have developed considerably across Western societies. In fact, chances are high that a working-class woman in France today will, at some point in her life, be a house cleaner, home-based child care provider, or home aide for the elderly. Going against political, scholarly, and everyday discourses that, saturated with the double prejudices of gender and class, treat all these home service occupations, which require little prior training, the same, this article illuminates the variability of the (...) forms of subordination experienced by women practicing these occupations in France. Comparing these jobs with the ensemble of low-skill jobs and with each other exposes what is specific to the particular form of subordination each job type entails, in terms of the extent of job supervision and the nature of the home where it is practiced, the presence or absence of relations with coworkers and/or a “public,” and the nature of this “public.” It mobilizes nationwide statistical data in a new way to shift attention to these numerous ordinary work situations, which are much less studied than those of the domestic workers of the wealthiest cities of the Western world. (shrink)

This study uses data from the Ghana Demographic and Health Survey of 1993 to examine factors determining the use of maternal–child health services in rural Ghana. The MCH services under study are: use of a doctor for prenatal care; soliciting four or more antenatal check-ups; place of delivery; participation in family planning. Bivariate and multivariate techniques are employed in the analyses. The analyses reveal that the use of MCH services tends to be shaped mostly by level of education, (...) religious background and region of residence, and partially by ethnicity and occupation. The implications of these results are discussed. (shrink)

“Only about 25 percent of the employees in child-care operations around the country have had professional training in dealing with children.”—_Newsweek_ This book is a proven, practical approach to providing that training at a minimum of expense and disruption of services. Written for trainers, it may profitably be used by any individual who wants to know more about positive methods for working with children. The information provided here has been used extensively to train child-care providers throughout (...) Illinois. Covered in detail are discipline, professionalism, child and adult communication, child development, observation, assessment, play, nutrition, health and safety, parent involvement and education, child abuse, developmental care, and organization of the environment. Illinois Governor James Thompson, former DCFS Director Gregory Coler, and DCFS Director Gordon Johnson have all endorsed these materials by continuing to recommend them for day-care training in Illinois. (shrink)

In recent decades, many studies have examined gender-related differences in paid employment and the reconciliation of family and employment. Considering perceptions of time conflicts with regards to work at home and leisure activities, this article contributes to a more encompassing understanding of attitudes toward reconciliation problems. Special attention is given to the role of external child care services. The use of an original data set from 60 Swiss municipalities and hierarchical multiresponse regression models enable an analysis of the (...) various aspects of time conflicts simultaneously, and a consideration of how different policy contexts shape these attitudes. This study provides evidence that the communal provision of external child care is related to gender-specific perceptions of time conflicts. Most interestingly, men seem to be affected most strongly by communal policy conditions, whereby the provision of external child care is related to systematically higher levels of time conflicts. (shrink)

The relatively recent shift of family caregiving to the public market of service work raises questions about how to theorize paid caregiving. This article examines how to conceptualize child rearing when it is transferred to a paid worker. The gendered character of commodified caregiving is complicated by structural locations of race and class that define the employer-employee relationship. Previous discussions of paid child care work as emotionally meaningful work have been criticized as idealizations that mask the exploitative (...) nature of the work. Yet, emotional meaning is not simply a cover-up or an idealization of the labor; rather, it is an integral component of the work of caregiving, the practice of which is distorted by societal assumptions about gender and race. To better understand paid child care work, the significance of emotional meaning, as well as gender, race, and ethnic dimensions of paid child care work need to be explored. (shrink)

El presente texto se inscribe dentro de la temática dirigida a la investigación sobre la violencia intrafamiliar. Tiene como objetivo sistematizar aspectos históricos y teóricos inherentes al estudio del maltrato infantil y sus consecuencias en el ámbito social y familiar para su detección y tratamiento en el nivel de atención primaria de los servicios de salud en Cuba. Mediante una revisión bibliográfica se logró concretar un análisis documental de materiales y textos en soporte digital e impreso que condujo a los (...) acercamientos teórico e histórico del fenómeno en el ámbito internacional y nacional, para su conceptualización, la determinación de su tipología y el establecimiento de sus consecuencias; elementos imprescindibles del saber profesional del futuro egresado de las ciencias médicas, en función de su desempeño en los diferentes niveles de atención de salud, en especial, la atención primaria. The text falls within the research on intrafamiliar violence subject matter. Its objective is to systematize historical and theoretical aspects inherent to the study of child abuse and its consequences within the social and domestic scopes for its detection and treatment in the Cuban primary health care services. By means of a bibliographic review, a documentary analysis of electronic and printed form materials and texts was summarized. It led to theoretical and historical approaches to the phenomenon within the national and international scopes for its conceptualization, the establishment of its typology and consequences. They are essential elements of the professional knowledge of future medical sciences graduates towards their performance in different health care levels, especially in primary health care. (shrink)

Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services. Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of (...) this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area. (shrink)

This study explores the pivotal role of the body for political recognition and rights claims in child welfare “moral” interventions. I examine how the bodily figures in child welfare assessments, linking these manifestations to the concept of the moral economy of care. A sample of assessment reports from a Swedish municipality, all addressing violations of children’s bodies or integrity, are used as empirical material. I show how the psychosomatically suffering child is being best “heard” as vulnerable. (...) I also argue that such a moral economy of care silences children’s accounts of gendered and racial injustices. Furthermore, racialized moral divides are indicated when assessments of different child bodies are considered. A concluding remark points to a need for a child welfare moral economy of social justice that responds to structural intersecting injustices in childhoods, including to those of a racialized child welfare and its individualized and symptom-oriented services. (shrink)

Implementing The new NHS and the 1997 NHS (Primary Care) Act will gradually extend cash-limiting into primary health care, especially general practice. UK policy-makers have avoided providing clear, unambivalent direction about how to 'ration' NHS resources. The 'Child B' case became an epitome of public debate about NHS rationing. Among many other decision-making processes which occurred, Cambridge and Huntingdon Health Authority applied an ethical code to this rationing decision. Using new data this paper analyses the rationing criteria (...) NHS managers and clinicians used at local level in the Child B case; and the organisational structures which confronted them with such decisions. Primary Care Groups are likely to confront similar rationing decisions in respect of 'gate-kept' NHS services. However, such rationing processes are not so easily transposed to open-access services such as general practice. NHS rationing decisions, especially in PCGs, will require a much more specific ethical code than hitherto used. (shrink)

Background: Hospitalized children have the right to “partake in practices related to their treatment and care.” Midwives and nurses have important roles and responsibilities regarding the protection and enforcement of these rights, such as providing information and advocating for children. Objectives: This study aims to determine the attitudes of midwives and nurses toward their roles and responsibilities in the implementation of child rights in healthcare services and the factors affecting their attitudes. Methods: This descriptive cross-sectional study included 122 (...) midwives and nurses in total. The data were collected through a questionnaire. Ethical considerations: Written permission was obtained from an ethics committee in the center of the city where the research was conducted. Results: The mean age of the participants was 36.70 ± 8.03 years; 58.9% of midwives and nurses stated that they understood the child’s consent about the treatment by looking at the child’s facial expression; 36% of midwives and nurses stated that children could not participate in decisions regarding their own health. It was observed that obtaining the child’s consent in matters related to treatment does not make any difference between midwives and nurses. The rate of the midwives stating that they would report suspicious violence-neglect and abuse was found to be higher. Conclusion: The variables of the unit of employment, the state of having children, choosing the profession and practicing in it willingly, and getting training on children’s rights make a difference in terms of children’s rights in healthcare services. Midwives and nurses should be reminded of child rights in healthcare services through regular in-service training programs. (shrink)

This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of (...) children. Such models of health care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of (...) children. Such models of health care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

This article provides a conversation analytic description of a two-part structure, ‘I don’t want X, I want/just want Y’. Drawing on a corpus of recordings of family mealtimes and television documentary data, I show how speakers use the structure in two recurrent environments. First, speakers may use the structure to reject a proposal regarding their actions made by an interlocutor. Second, speakers may deliver the structure following a co-interactant’s formulation of their actions or motivations. Both uses decrease the likelihood of (...) challenge in third-turn position. When responding to multi-unit turns speakers routinely deal with the last item first. The value of ‘I want Y’ is to formulate an alternative sense of agency which undermines the preceding turn and shifts the trajectory of the ongoing sequence. The article contributes to work in discursive psychology as I show how speakers may formulate their ‘wants’ in the service of sequentially unfolding social interaction. (shrink)

The moral value of law can take many forms. It is instrumentally valuable when it coordinates interaction, provides moral advice and leadership, models the virtues, and motivates us to be moral. It is intrinsically valuable when it constitutes the collective moral conscience of citizens, embodies an ideal form of communal life, and expresses the moral integrity of the community. We analyse all of these potential values of law and assess their moral significance. In doing so, we are careful to distinguish (...) between the general concept of law and the actual law of any particular legal system. We argue that, although in principle law does have the potential to help us to be moral in each of the ways noted, many actual legal systems are conducive to great immorality and injustice. Being moral and living well under such regimes is likely to be much harder than it would be otherwise, even in the absence of any legal system. (shrink)

This article conceptualises theories of ethics relevant to the recognised problem of decision variability in child protection. Within this field, social workers are faced with multiple ethical imperatives when making decisions about children’s care. They must respond to justice principles concerned with duties and consequences, as well as ethical obligations created by the relational and contextual elements of each case. Recent scholarship on decision variability highlights the justice issues that arise when decisions in response to apparently similar cases (...) differ. An ethical imperative is that similar cases should be treated ‘like for like’ so that children’s and family’s rights are upheld consistently. This article contends that ethical concepts relating to both universalist duties such as respect for persons, extended by the concept of interactive universalism, and contextual responses based on an ethic of care, help theorise the complexities of ethical decisions in child protection. These concepts develop a nuanced understanding of the ways social workers resist risk discourses, may make decisions reflecting the participation of service users, and contextual evaluations of risk based on understanding service user’s life histories. Understanding this combination helps explain the reasons behind variability, and evaluate the moral acceptability or otherwise of apparently variable decisions. (shrink)

Background There is considerable variation in the functionality of bioethical services in different institutions and countries for children in hospital, despite new challenges due to increasing technology supports for children with serious illness and medical complexity. We aimed to understand how bioethics services address bioethical concerns that are increasingly encountered in paediatric intensive care. Methods A qualitative descriptive design was used to describe clinician’s perspectives on the functionality of clinical bioethics services for paediatric intensive care units. Clinicians who (...) were members of formal or informal clinical bioethics groups, or who were closely involved with the process of working through ethically challenging decisions, were interviewed. Interviews took place online. Resulting transcripts were analysed using thematic analysis. Results From 33 interviews, we identified four themes that described the functionality of bioethics services when a child requires technology to sustain life: striving for consensus; the importance of guidelines; a structure that facilitates a time-sensitive and relevant response; and strong leadership and teamwork. Conclusions Clinical bioethics services have the potential to expand their role due to the challenges brought by advancing medical technology and the increasing options it brings for treatment. Further work is needed to identify where and how bioethics services can evolve and adapt to fully address the needs of the decision-makers in PICU. (shrink)

With places at nursery school promised for every child above the age of four, this book raises the stakes by looking at the quality of what is provided, and how that compares to what should be provided. Beyond Quality In Early Childhood Education and Care challenges received wisdom and the tendency to reduce philosophical issues of value to purely technical issues of measurement and management. In its place, it offers alternative ways of understanding early childhood, early childhood institutions (...) and pedagogical work. The book places issues of early childhood into a global context and relates them to writers from many fields. Drawing on work with aboriginal peoples in Canada, on the experience of Reggio-Emilia in Italy and on a project in Stockholm inspired by Reggio, the book considers the implications of these alternative ways of understanding, for practice and a reconceptualization of early childhood education and care. (shrink)

Child welfare clinics established in a rural Jamaican community for research purposes are described. These special clinics were able to devote more resources to the care of their children than is usual, yet the growth and health of these children were very similar to those in another group to whom this service was not available and who attended routine government welfare clinics only infrequently.

Inequitable access to health care, social inequities, and racist and discriminatory care has resulted in the trend toward poorer health outcomes for Indigenous infants and their families when compared to non‐Indigenous families in Canada. How Indigenous mothers experience care during an admission of their infant to the Neonatal Intensive Care Unit has implications for future health‐seeking behaviors which may influence infant health outcomes. Nurses are well positioned to promote positive health care interactions and improve health (...) outcomes by effectively meeting the needs of Indigenous families. This qualitative study was guided by interpretive description and the Two‐Eyed Seeing framework and aimed to understand how Indigenous mothers experience accessing and using the health care system for their infants. Data were collected by way of interviews and a discussion group with self‐identifying Indigenous mothers of infants less than two years of age living in Hamilton, Ontario, Canada. Data underwent thematic analysis, identifying nursing strategies to support positive health care interactions and promote the health and wellness of Indigenous infants and their families. Building relationships, providing holistic care, and taking a trauma‐informed approach to the involvement of child protection services are three key strategies that nurses can use to positively impact health care experiences for Indigenous families. (shrink)

Background:The public domain of midwifery practice, represented by the educational and hospital institutions could be blamed for a subconscious ethical dilemma for midwifery practitioners. The result of such tension can be seen in complaints from maternity service users of dehumanised care. When expectations are not met, women report dehumanising experiences that carry long term consequences to both them and their child.Objectives:To revisit the ethical foundation of midwifery practice to reflect the feminist Ethic of Care and reframe what (...) is valuable to women and midwives during the childbirth experience.Research Design:A comprehensive literature review is presented from the midwifery and feminist ethics discourse.Ethical Considerations:Nil to report.Findings:Women are vulnerable during childbirth as they need care, yet they prioritise elements of relationship in their experience. The Ethic of Care approach equalises the relationship between the midwife and the woman, providing the space for relationship building and allowing midwives to meet the expectations of their accepted responsibility.Discussion:Some midwives manage to balance the demands of the institution with the needs of the woman. This is described as both an emotional and professionally challenging balancing act.Conclusion:Until there is a formal acknowledgement of the different ethical approach to midwifery practice from within the profession and the Institution, midwifery identity and practice will continue to be compromised. (shrink)

This article regards a particular way through which adults take children into consideration and listen their voices. Reflections have sprung from a research context, focused on existential questions that children pose during their preschool years in early education settings. The research explored the meanings of these questions for children and adults involved in their education. The questions of meaning emerged by children’s discourses are considered through the representations of childhood that subtend parents and teachers’ educational practices. The article discusses one (...) of these representations, that of philosopher child, with regard on his various internal perspectives. Lipman, Kyle, Martens and Matthews are some of the authors taken into consideration in order to examine briefly some traditional approaches of doing philosophy with children and to understand the practices that teachers operate everyday in early childhood education and care services. (shrink)

This study examined the patterns and characteristics of non-parental child care arrangements for Chinese very young children before they enter preschool and the extent to which families’ utilization of non-parental child care influenced parenting stress. A total of 3,842 Chinese parents of infants and toddlers were selected from 10 provinces to participate in this study. The results indicated that Chinese families relied heavily on grandparents to care for their children; a set of family demographics predicted (...) the utilization of non-parental child care arrangements, including parents’ educational level, household income, labor force participation, and maternal age; there existed a clear parental preference for publicly funded, affordable, and high-quality child care services; and families’ use of non-parental child care was generally not linked to parenting stress. These findings shed light on the development of the infant-toddler non-parental child care system in the Chinese sociocultural context. (shrink)

The current thesis discusses how tools for analysing power are developed predominately for adults, and thus remain underdeveloped in terms of understanding injustices related to age, ethnicity/race and gender in childhoods. The overall aim of this dissertation is to inscribe a discourse of intersecting social injustices as relevant for childhoods and child welfare, and by interlinking postcolonial, feminist, and critical childhood studies. The dissertation is set empirically within the policy and practice of Swedish child welfare, here exemplified by (...) the assessment framework Barns Behov i Centrum. It aims to explore how Swedish child welfare, as a field of knowledge, modes of knowing and knowing subjects, constitutes an arena for claims and responses to intersecting social justice issues. The material consists of BBIC primers and selected samples from, a total of 283 case reports from a Swedish social service agency. The case reports address assessments of children. This dissertation is based on four qualitative studies using discourse analysis, as well as analysis inspired by thematic and case-study methodology. Two studies focus on child welfare discourses in BBIC documents involving social problems and violence, and two studies are based on child welfare case reports. Studies I­­-II address child welfare policy and practice by analysing the conditions required for children to participate, in terms of children’s moral status and in terms of status of ‘evidencing’ needs for protection. Studies III­­-IV explore this further from the perspective of intersecting and embodied social injustices in childhoods. Together, the studies interconnect child welfare as a field of knowledge, modes of knowing and knowers with child welfare as a moral arena for claims to rights, recognition, and social justice. The synthesised findings point to child biowelfare, in which justice discourses are largely absent. Biowelfare is informed by a mode of knowing and ‘evidencing’ risks to children’s health and development, which are confined to scientific predicting-believing, seeing-believing by professionals and a moral economy of care, all of which constrain the idea that injustices are structural and intersecting. Biowelfare primarily responds to children as ‘speaking’ biological bodies, rather than as voices of justice. In this sense, injustices of an epistemological nature are interconnected with social injustices. When issues of justice are mobilised in case reports and policy, they come across as rather ‘unjust’, primarily confined to the sphere of the family home of racialised children and not connected to ‘general’ children. In addition to intersections of age, ethnicity/race and gender, class and health are fundamental to recognition and protection in biowelfare. Finally, the dissertation indicates the need for a moral economy which responds to intersecting social injustices such as racial, gender-based and ageist violence in childhoods, and violations of children’s bodily integrity. (shrink)

What this book is about -- Theoretical perspectives : modernity and postmodernity, power and ethics -- Constructing early childhood institution : what do we think it is? -- Constructing the early childhood institution : what do we think they are for? -- Beyond the discourse of quality to the discourse of meaning making -- The stockholm project : constructing a pedagogy that speaks in the voice of the child, the pedagogue and the parent -- Pedagogical documentation : a practice (...) for reflection and democracy -- Minority directions in the majority world : threats and possibilities. (shrink)

Paid care services such as child care, elder care, teaching, and nursing are vulnerable to competitive pressures that often generate low-pay/low-quality outcomes. Both workers and consumers suffer as a result. This article develops an economic analysis of the “care sector” that emphasizes the potential to build political coalitions that could push for a high-pay/high-quality alternative.

A significant international development agenda in the practice of nurses supporting families with young children focuses on establishing partnerships between professionals and service users. Qualitative data were generated through interviews and focus groups with 22 nurses from three child and family health service organisations, two in Australia and one in New Zealand. The aim was to explore what is needed in order to sustain partnership in practice, and to investigate how the concept of practice architectures can help understand attempts (...) to enhance partnerships between nurses and families. Implementation of the Family Partnership Model (FPM) is taken as a specific point of reference. Analysis highlights a number of tensions between the goals of FPM and practice architectures relating to opportunities for ongoing learning; the role of individual nurses in shaping the practice; relationships with peers and managers; organisational features; and extra‐organisational factors. The concept of practice architectures shows how changing practice requires more than developing individual knowledge and skills, and avoids treating individuals and context separately. The value of this framework for understanding change with reference to context rather than just individual’s knowledge and skills is demonstrated, particularly with respect to approaches to practice development focused on providing additional training to nurses. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bringing Cancer Care to Those who Don't Have ItLawrence N. ShulmanI have been treating cancer patients in the Harvard Medical School hospitals since 1977, and in those 35 years we have made tremendous progress. Though work still needs to be done, and far too many patients still die of cancer, many are cured. In particular, children and young adults have a high rate of cure from such diseases (...) as Hodgkin's lymphoma, non-Hodgkin's lymphoma, acute lymphoblastic leukemia, and childhood sarcoma. Patients with breast cancer in the US have a greater than 80% chance for long-term survival. The death rate from cervical cancer in the US is very low. These results have been achieved by making diagnoses earlier, in many cases surgical excision, and often systemic therapies such as chemotherapy, hormonal therapy, radiation therapy, and more recently by using so-called "targeted" therapies—those directed at particular molecular characteristics of the cancer cells.Princess Dina Mired has said that the opportunity to survive cancer should not be an accident of geography. In cases where we already have effective and inexpensive tools to cure cancer, these treatments should be considered a basic human right, a life-saving medical service.I met Patty, a young woman living in the U.S. during November of her senior year in high school, after she discovered a small lump above her left collar bone. Though she felt entirely well, she called her primary care doctor who saw her the next day, felt the enlarged lymph node, and referred her to a surgeon, who did a biopsy later that week. Her primary care doctor also called me, and we scheduled a visit when the pathology results were available. The following week the pathologist notified Patty's pediatrician that the biopsy showed Hodgkin's lymphoma. When I met Patty, she was a bright and focused young woman, waiting to hear about her college applications and enjoying her senior year. Her cancer diagnosis was completely out of context with her life as she planned it, but with the support of her family and boyfriend, she seemed prepared to take things one step at a time. A PET CT scan demonstrated a modest mass in the mediastinum (chest), but no other disease. She was in an early stage of the disease with an excellent prognosis. We recommended and administered six months of chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine—four chemotherapy agents that are off-patent, and relatively inexpensive. She lost her hair, not a trivial issue for her, but otherwise felt reasonably well during the treatment. She was determined to graduate with her classmates, and was able continue to attend school and keep up with her work. In June, seven months into her cancer diagnosis and treatment, she graduated with honors, and was on track to enroll in college in September.Like other 18-year-old women with Hodgkin's lymphoma, Patty had an over 80% chance for cure with the potential for a long and productive life ahead of her because we could perform a biopsy, make a diagnosis, and safely and effectively treat her with four inexpensive, off-patent, chemotherapy drugs. She had nearly the same likelihood of living a long and fruitful life as her classmates, and had the same chances for childbearing. In my line of work, with the knowledge we now possess, to allow someone like Patty to die without a chance of curative care is simply unacceptable. Treatment of curable cancers should be considered on par with the right to clean water, adequate nutrition, treatment for infectious disease, and access to maternal and child healthcare services.But in many places in the world, people with cancers we could easily eradicate in Boston have no access to cancer services, and do die unnecessarily. The local healthcare infrastructure has no [End Page E10] capacity to evaluate a patient, perform or process a biopsy, make a diagnosis, or treat the patient with potentially curative surgery, chemotherapy and radiation. I have rounded on the wards of hospitals in developing countries, stopping to talk with numerous patients like Patty: young women, some of whom might have had Hodgkin's lymphoma, but no... (shrink)

Children may be abused physically, sexually, emotionally and by omission or commission in any permutation under these headings. This is discussed in terms of the separate and overlapping responsibilities of parents, guardians, the community in which they live and the network of professional services developed to care for, protect and educate children. An attempt is made to place these issues within an ethical framework, with regard to the legislature of England and Wales. It is argued that professionals working within (...) this field have an obligation either to keep up to date in respect of a large and growing body of research and practice knowledge or to consult 'experts' within the field when making complex and far-reaching decisions on behalf of abused children and their families. A representative, inevitably incomplete, bibliography is discussed and appended and there is brief reference to the role of expert witnesses concerning children involved in civil legal proceedings. (shrink)

European states differ tremendously in the extent to which their national education systems administer preschool programs, and whether or not these services can serve as day care for working parents. This article traces contemporary policy differences in three countries—France, Sweden, and Germany—to the effects of nineteenth-century conflicts between religious and secular forces over education. Intense, clerical-anticlerical conflict in France led to the incorporation of preschools into the national education system. In Sweden and Germany, the more accommodating relationship between church (...) and state assured that no such incorporation took place. These decisions had lasting consequences for the nature and extensiveness of child care services for preschool-aged children. (shrink)

This book explores two public sector scandals in the UK, drawing on Max Weber's thought on 'the iron cage' to understand how these cases of patient-neglect in NHS hospitals and failures by police and social workers to address the organised sexual exploitation of young girls occurred. Through examination of the management failures and institutional vulnerabilities, and with attention to the trends of bureaucratisation and rationalisation that characterised both scandals, it reveals the explanatory power of Weber's thought, developing a theoretical model (...) that updates and extends Weber's work in light of the cases discussed. Showing that ordinary people as well as ordinary people, including professionals, are still trapped in the 'iron cage', it will appeal to scholars of sociology and social theory, as well as those providing training and working within the caring and service professions of policing, social work and nursing. (shrink)

This paper evaluates the ethical consequences of the use of marketing techniques in the child adoption process within England and Wales. Since 1995 the political climate in the UK has seen a reassessment of the manner in which the state organises care for children who are within its legal guardianship. Successive UK governments have acknowledged the under‐utilisation of child adoption as a moral and efficient means of child‐care. However, the presentation of child adoption in (...) a more active fashion involves concerns about the manner in which child adoption has been organised. Increasingly child adoption organisations and social work professionals are being made accountable through the language of customer service and performance measurements. The use of commercial techniques such as marketing is justified on utilitarian grounds. However, any utilisation of marketing within the child adoption process is forced to ensure that the child is not de‐centred. Legislation requires that the needs and welfare of the child are the first consideration for the adoption agency. Here we begin to see tensions between the humanitarian project that is child adoption, and the unease produced by viewing the child as human ‘product’. This invites analysis via critical theory. The use of marketing in child adoption raises issues related to the objectification and commodification of the child and prospective adopters. Within child adoption it is assumed that we must engage with the child as ‘face’ (Bauman, 1995). But will these assumptions stand the encroachment of marketing techniques into this very sensitive area? (shrink)

This paper evaluates the ethical consequences of the use of marketing techniques in the child adoption process within England and Wales. Since 1995 the political climate in the UK has seen a reassessment of the manner in which the state organises care for children who are within its legal guardianship. Successive UK governments have acknowledged the under‐utilisation of child adoption as a moral and efficient means of child‐care. However, the presentation of child adoption in (...) a more active fashion involves concerns about the manner in which child adoption has been organised. Increasingly child adoption organisations and social work professionals are being made accountable through the language of customer service and performance measurements. The use of commercial techniques such as marketing is justified on utilitarian grounds. However, any utilisation of marketing within the child adoption process is forced to ensure that the child is not de‐centred. Legislation requires that the needs and welfare of the child are the first consideration for the adoption agency. Here we begin to see tensions between the humanitarian project that is child adoption, and the unease produced by viewing the child as human ‘product’. This invites analysis via critical theory. The use of marketing in child adoption raises issues related to the objectification and commodification of the child and prospective adopters. Within child adoption it is assumed that we must engage with the child as ‘face’ (Bauman, 1995). But will these assumptions stand the encroachment of marketing techniques into this very sensitive area? (shrink)

An extensive body of research documents that women experience a motherhood penalty at work whereas men experience a fatherhood premium. Yet much of this work presupposes that employers are aware of a worker’s parental status. Given the different consequences that parenthood has on outcomes such as pay and promotions, it is conceivable that men and women may deploy their status as parents differently when interacting with employers. Drawing on in-depth interviews with a racially diverse sample, this article examines how mothers (...) and fathers working in the service sector use their parental status when negotiating work and child care responsibilities. Mothers, particularly black mothers, were less likely to openly discuss their children at work. In some cases, women purposefully concealed from their employers the fact that they were mothers or found other ways of signaling their commitment to their jobs. Fathers, on the other hand, were more likely to discuss their children with their employers and overwhelmingly characterized their managers as understanding of their parenting obligations. Together, these findings help us understand how mothers and fathers navigate the consequences of parenthood in the workplace and add nuance to previous studies of motherhood penalties and fatherhood premiums. (shrink)

A notable feature of post-Fordist economies is the increase in service jobs, which includes care occupations such as child care and elder care (Folbre 2001, 182). The commodification of caring activities raises issues surrounding the reception and dispensation of these services, and this is particularly salient to the focus of this paper, elder care. Because the demand for this type of care has greatly increased in recent decades (Glendinning, Schunk, and McLaughlin 1997; Kaye et (...) al. 2006) and also in recognition of the impact of caring activities on families, many countries have sought to initiate policies to provide state-funded services or to compensate family caregivers for their care work.1If help with the .. (shrink)

Recent estimates indicate that over 40,000 children die annually in the United States and a majority have life-limiting conditions. Children at end of life require extensive healthcare resources, including multiple hospital readmissions and emergency room visits. Yet, many children still suffer from symptoms at end of life—including fatigue, pain, dyspnea, and anxiety—with less than 10% of these children utilizing hospice care services. A critical barrier to pediatric hospice use was the original federal regulations associated with the hospice care (...) that required a diagnosis of 6 months to live and the discontinuation of all curative treatments. The Concurrent Care Provision of the United States’ Affordable Care Act eliminated the need to forgo curative therapies in order to enroll in hospice for children in Medicaid or Children’s Health Insurance Program. Concurrent care for children can help mitigate the tension families experience in choosing between essential forms of care, as well as contribute to improved end-of-life outcomes for the child and possibly bereavement outcomes for the family. Understanding concurrent care for children from a social justice perspective has important advocacy and research implications for hospice and palliative care clinicians providing care for children and their families. We apply Powers and Faden’s theory of social justice “as the moral foundation of public health and health policy” to the provision of concurrent care to children near end of life and families in the United States. The goals of applying this theory are to explore additional insights and perspectives into concurrent care policy may provide and to assess the usefulness of this theory when applied to end-of-life health policy. We argue that concurrent care policy is socially just since it has potential to promote well-being in vulnerable children and families and can limit the inequity children at end-of-life experience in access to high-quality hospice care. (shrink)

SummaryThis paper examines the role of health knowledge in the association between mothers' education and use of maternal and child health services in Ghana. The study uses data from a nationally representative sample of female respondents to the 2008 Ghana Demographic and Health Survey. Ordered probit regression models evaluate whether women's health knowledge helps to explain use of three specific maternal and child health services: antenatal care, giving birth with the supervision of a trained professional and complete (...) child vaccination. The analyses reveal that mothers' years of formal education are strongly associated with health knowledge; health knowledge helps explain the association between maternal education and use of health services; and, net of a set of stringent demographic and socioeconomic controls, mothers' health knowledge is a key factor associated with use of health services. (shrink)

Retrospective and prospective data collected in Cameroon were used to reassess hypotheses about how infant and early childhood mortality is affected by birth spacing and breast-feeding. These data show that: (a) a short preceding birth interval is detrimental for child survival in the first 4 months of life; (b) full and partial breast-feeding have direct protective effects on child survival in the first 4-6 months of life, with the effects of the former stronger than those of the latter; (...) (c) early subsequent conception significantly increases mortality risks in the first 16 months of life of the index child. These findings are robust to various controls, e.g. study design, data defects, child's health conditions at/around birth, postnatal maternal and child recurrent illnesses, patterns of utilisation of health care services, and immunisation status of the child. (shrink)

RESUMEN Introducción: Son escasos los servicios en salud mental dentro del contexto escolar que permitan una integración intersectorial para superar la brecha de falta de asistencia en salud mental en la población infanto - juvenil, aun cuando, es en la escuela donde se detectan mayoritariamente los problemas de salud mental. Objetivo: Comentar el uso de servicios de salud mental en el ambiente escolar en relación con los trastornos mentales y trastornos subumbrales. Método: El presente resultado se obtiene a partir del (...) “Estudio de Prevalencia Comunitaria de Trastornos Psiquiátricos y Utilización de Servicios de la Población Infanto-Juvenil Chilena”. La muestra estuvo representada por sujetos entre 4 y 18 años. La información sobre el uso de servicio de salud mental se recogió con una versión modificada de la Escala Service Assesment for Children and Adolescent. Se realizó un modelo de regresión logística para analizar cinco áreas del uso de servicios en el ambiente escolar, las cuales se correlacionaron con diagnósticos de trastorno mentales y trastorno subumbral de ansiedad, disruptivo y depresión en el último año. Resultados: Las escuelas se enfrentan a grandes desafíos sobre cómo proporcionar apoyo efectivo de salud mental para los estudiantes, que presentan algún tipo de trastorno mental o trastorno subumbral. Discussión: Las instituciones educativas requieren ser visualizadas como una entidad que podría satisfacer las necesidades que se advierten de manera urgente en atención, prevención y promoción de problemas mentales en la población infanto- juvenil, si se vinculan de forma más directa con los servicios de salud mental. ABSTRACT Introduction: Mental health services are scarce within the school context that allow intersectoral integration to overcome the gap in mental health care in the child and adolescent population, being the school where mental health problems are mostly detected. Objective: to know the use of mental health services in the school environment in relation to mental disorders and subthreshold disorders. Method: The present secondary study is carried out from the "Study of Community Prevalence of Psychiatric Disorders and Utilization of Services of the Chilean Child-Youth Population". The sample was represented by subjects between 4 and 18 years old. Information on the use of mental health service was collected with a modified version of the Service Assessment Scale for Children and Adolescents. A logistic regression model was performed to analyze five areas of the use of services in the school environment, which were correlated with diagnoses of mental disorders and subthreshold anxiety, disruptive and depression disorder in the last year. Results: Schools face great challenges on how to provide effective mental health support for students, who present some type of mental disorder or subthreshold disorder. Discusion: Educational institutions need to be visualized as an entity that could meet the needs that are urgently noticed in attention, prevention and promotion of mental problems in the child and adolescent population, if it is linked more directly with health services. (shrink)

This South African study investigates the lived experiences of a group of isiZulu mothers of children diagnosed with multiple disabilities. Data collection from regular focus group discussions proceeded with the assistance of a translator skilled in working in isiZulu and English. The phenomenological approach employed revealed the mothers' philosophical acceptance of their child's disability. Issues of concern to the women that emerged include the effects of the child's disability on their lives, the treatment options for their children, and (...) their perceptions of the causes of the disability. The women reflect on both traditional and Western treatment options and articulate the constraints they experience as caregivers, with limited child-care facilities preventing them from finding employment, difficulties in accessing social service grants exacerbating their position, and various levels of family and community support experienced. The study underlines the need for more adequate service provision for children with special needs and their families, and for intervention programmes to be informed by an understanding of the contexts and ways of making meaning of those whose needs they are intended to serve. (shrink)

The author uses a case history to compare the approaches taken by social care teams in engaging with parents whose care of their children has been called into question. As organising secretary for Parent Aid, a voluntary support service for Essex families who had or were likely to become clients of Social Services, she drew up a list of five keys points that would improve working relations with parents in child protection and court situations and relates them (...) to the ethical framework; write reports that are both factual and objective ; take as much time to build a relationship with the parents as you do with the child; remember to treat gossip with extreme caution; donât back off from parents just because they seem hostile; and try to be as honest and reliable as possible. The examples used to illustrate these points are said to demonstrate the five areas where parents most often take objection to Social Servicesâ approach; the same areas that are most likely to cause parentsâ anxiety and anger to harden into belligerence. The author goes on to show that all of these points can be found embedded in the Code of Practice for Social Workers. (shrink)

The essays of this volume consider how acknowledgement of the fact of dependency changes our conceptions of law, political theory, and morality, as well as our very conceptions of self.

Effective November 1, 2002, the federal Department of Health and Human Services reclassified developing fetuses as “unborn children,” thereby providing health insurance benefits for prenatal care under the State Children's Health Insurance Program. By broadening the current definition of “child” —and thus expanding SCHIP insurance coverage — DHHS hopes to increase the number of low-income pregnant women who receive prenatal services. As noted by one commentator, the new rule represents the first time “any federal policy has defined childhood (...) as beginning at conception.”In an attempt to improve access to publicly funded health insurance for poor children not covered by Medicaid, Congress established SCHIP a 10-year, $40 billion program jointly funded by federal and state governments. Through a series of block grants, SCHIP allows states to either expand income-eligibility for their existing Medicaid program or to create a separate child health program to decrease the number of uninsured poor and near-poor children. (shrink)

Effective November 1, 2002, the federal Department of Health and Human Services reclassified developing fetuses as “unborn children,” thereby providing health insurance benefits for prenatal care under the State Children's Health Insurance Program. By broadening the current definition of “child” —and thus expanding SCHIP insurance coverage — DHHS hopes to increase the number of low-income pregnant women who receive prenatal services. As noted by one commentator, the new rule represents the first time “any federal policy has defined childhood (...) as beginning at conception.”In an attempt to improve access to publicly funded health insurance for poor children not covered by Medicaid, Congress established SCHIP a 10-year, $40 billion program jointly funded by federal and state governments. Through a series of block grants, SCHIP allows states to either expand income-eligibility for their existing Medicaid program or to create a separate child health program to decrease the number of uninsured poor and near-poor children. (shrink)