Introduction: Despite the method existing for centuries, uses of crowdsourcing have been rising rapidly since the term was coined a decade ago. Crowdsourcing refers to ‘outsourcing’ a problem or task to a large group of people (i.e., a crowd) rapidly and cheaply. Researchers debate over definitions of crowdsourcing, and it is often conflated with mHealth, web 2.0, or data mining. Due to the inexpensive and rapid nature of crowdsourcing, it may be particularly amenable to health research and practice, especially in a global health context, where health systems, human resources, and finances are often scarce. Indeed, one of the dominant methods of health research prioritization uses crowdsourcing, and in particular, wisdom of the crowds. This method, called the Child Health and Nutrition Research Initiative (CHNRI) method, employs researchers to generate and rank research options which are scored against pre-set criteria. Their scores are combined with weights for each criterion, set by a larger, diverse group of stakeholders, to create a ranked list of research options. Unfortunately, due to difficulties in defining and assembling a group of stakeholders that would be appropriate to each exercise, 75% of CHNRI exercises to-date did not involve stakeholders, and therefore presented unweighted ranks. Methods: First, a crowdsourcing was defined through a literature review. Benefits and challenges of crowdsourcing were explored, in addition to ethical issues with crowdsourcing. A second literature review was conducted to explore ways in which crowdsourcing has been already used in health and global health. As crowdsourcing could be a potential solution to data scarcity or act as a platform for intervention in global health settings, but its potential has never been systematically assessed, a CHNRI exercise was conducted to explore potential uses of crowdsourcing in global health and conflict. Experts from both global health and crowdsourcing participated in generation and scoring ideas. This CHNRI exercise was conducted in-line with previously described steps of the CHNRI method for setting health research priorities. As three quarters of CHNRI exercises have not utilized a larger reference group (LRG) of stakeholders, and the public was cited as the most difficult stakeholder group to involve, we conducted a survey using Amazon Mechanical Turk, an online crowdsourcing platform, that involved an international group of predominantly laypersons who, in essence, formed a public stakeholder group, scoring the most common CHNRI criteria using a 5-point Likert scale. The resulting means were converted to weights that can be used in upcoming exercises. Differences in geographic location, and whether the respondents were health stakeholders were assessed through the Fisher exact test and Wilcoxon rank-sum test, respectively. The influence of other demographic characteristics was explored through random-intercept modelling and logistic regression. Finally, an example of a national-level CHNRI exercise, which is the largest CHNRI conducted to-date, exploring research priorities in child health in India is described. Results: A comprehensive definition of crowdsourcing is given, along with its benefits, challenges, and ethical considerations for using crowdsourcing, based on a literature review. An overview of uses of crowdsourcing in health are discussed, and potential challenges and techniques for improving accuracy, such as introducing thresholds, qualifiers, introducing modular tasks and gamification. Crowdsourcing was frequently used as a diagnostics or surveillance tool. The CHNRI method was not identified in the second literature review. In re-weighting the CHNRI criteria using a public stakeholder group, we identified differences in relative importance of the criteria driven by geographic location and health status. When using random-intercept modelling to control for geographic location, we found differences due to health status in many criteria (n = 11), followed by gender (n = 10), ethnicity (n = 9), and religion (n = 8). We used the CHNRI method to explore potential uses of crowdsourcing in global health, and found that the majority of ideas were problem solving or data generation in nature. The top-ranked idea was to use crowdsourcing to generate more timely reports of future epidemics (such as in the case of Ebola), and other ideas relating to using crowdsourcing for the surveillance or control of communicable disease scored highly. Many ideas were related to the United Nations’ Sustainable Development Goals (SDGs). Finally, a national-level exercise to set research priorities in child health in India identified differential priorities for three regions (Empowered Action Group and North Eastern States, Northern States and Union Territories, and the Southern and Western States). The results will be very useful in developing targeted programmes for each region, enabling India to make progress towards SDG 3.2. Conclusion: Crowdsourcing has grown exponentially in the past decade. Integrating gamification, machine learning, simplifying tasks and introducing thresholds or trustworthiness scores increases accuracy of results. This research provides recommendations for improvements in the CHNRI method itself, and for crowdsourcing, generally. Crowdsourcing is a rapid, inexpensive tool for research, and thus, is a promising data collection method or intervention for health and global health.

The World Health Organization (WHO) recommends exclusive breast-feeding until 6 months of age, where exclusive breast-feeding is defined as giving human breast milk only with no other foods or fluids. This recommendation has since been adopted by many countries. A systematic review of studies in exclusively breast-fed infants by Reilly and colleagues found a mean milk intake at 6 months of age that seemed too low to cover infant energy requirements. However, the evidence was relatively scarce, only from cross-sectional studies and based on the method of test-weighing, which has been criticised for under-estimating milk intake. Furthermore, longitudinal studies indicated no marked increase in milk intake over time, but these studies did not include measurements at 6 months of age. Reilly and Wells proposed the hypothesis that for exclusive breast-feeding to adequately cover infant energy requirements to 6 months of age, either 1) infants had to be unusually small, or 2) breast milk energy content had to be unusually high, or 3) milk intake had to be unusually high. The Reilly-Wells hypothesis was backed up by evidence of a world-wide low prevalence of exclusive breast-feeding to 6 months, and by studies consistently reporting a maternally perceived insufficient milk supply as a major reason for mothers to cease exclusive breast-feeding and introduce either formula supplementation or complementary foods. Based on the Reilly-Wells hypothesis, the research question for the First-Feed study was: To explore how exclusive breast-feeding to 6 months of age is achievable – mainly from an energy balance point of view. The First-Feed study tested the hypothesis that successful exclusive breast-feeding to 6 months of age would include 1) infants that were small and/or growing slowly, 2) milk intakes and/or milk energy content that were higher than literature values and increasing over time, 3) infant energy requirements that were lower than reference values, and/or 4) infant feeding practices that were strained by very frequent and/or very time consuming breast-feeds. The study was designed as the first longitudinal observational study to use an isotopic method to measure milk intake and energy balance in exclusively breast-fed infants to 6 months of age, and it evaluated parts of the methodology employed in the study, in order to appreciate the results in light of the methodological strengths and limitations. The First-Feed study found that infants were overall of normal size and growing well relative to WHO Child Growth Standards. Metabolisable milk intakes were significantly higher than the values obtained by Reilly and colleagues at both 3½ and 6 months of age, and increased significantly over time. Infant energy requirements, determined as metabolisable energy intake, was significantly higher than references for mean energy requirements at 3½ months of age, while it was appropriate at 6 months of age. Breast-feeding practices showed no change over time in feeding frequency, but a significant decrease in time spent on breast-feeds. The First-Feed study had several limitations. Firstly, due to the inclusion criteria of exclusive breast-feeding, the participants were characterised as an affluent and well-supported sample of mother-infant pairs, who were highly motivated to breast-feed. Therefore, the generalisability of the present study to other populations should be accepted with caution. Secondly, the anthropometric measurements were prone to imprecision, as is often the case in field studies. Thirdly, the imprecision of the dose-to-infant procedure for administration of doubly-labelled water considerably reduced the precision of the doubly-labelled water method. This, in addition to the biological variation, increased the variation in some outcome variables. However, the First-Feed study is unique as it is the first to use a more objective method to measure milk intake in a longitudinal design, and on a sample of infants with a very high success rate of exclusive breast-feeding to 6 months of age. The WHO changed the recommendation on exclusive breast-feeding from 4 – 6 months to 6 months (exactly) in 2001. Since then, many resources have been invested in breast-feeding promotion, but rates of initiation, duration and exclusivity is only slowly improving. The present study supports that exclusive breast-feeding can adequately cover infant energy requirements to 6 months of age - even without undue strain on breast-feeding practices and even in mothers where initial breast-feeding problems were very common. However, the present study found a wide variation in both infant size, milk intake and energy requirements. It therefore begs the question if a recommendation based on one age-point (6 months exactly) is appropriate given the vast biological variation in variables that are important for the adequacy of exclusive breast-feeding, or if the recommendation should be adapted to include developmental milestones (e.g. oral motor skills) indicative of readiness for complementary foods.

The majority of children attending ophthalmology clinics require a visual acuity assessment. The optimal technique depends on age as well as the ability to cooperate with testing. Most acuity assessments are performed subjectively by an orthoptist. Objective acuity assessment by Visual Evoked Potential (VEP) provides a complementary assessment in those subjects who cannot complete subjective tests. The aim of this study was to develop and evaluate a rapid, objective visual acuity assessment. The technique was named the step_ VEP and is based on the real-time analysis of steady-state VEPs (ssVEP). It presents high contrast checkerboard stimuli of sizes 0.4 to 3.0 LogMAR with a successive approximation algorithm. Speed of response detection, specificity and sensitivity were optimised by investigation of recording montage and analysis techniques in a group of normal children and adults (N=102). The success, duration and outcome of step_ VEP acuity assessment was compared to transient VEP (t-VEP) acuity assessment and subjective acuity assessment in a group of paediatric patients (N=218). I-D Laplacian analysis of three occipital electrodes was significantly faster than conventional recording and analysis (Oz-Fz) at detecting ssVEP responses near visual acuity threshold (3' checks) from three years upwards, and at detecting responses to 6' and 9' checks in the 7-9 year age group. A lateral electrode site at 15% of the half-head circumference was fastest most often in adults. Step_ VEPs were 16% more successful than t-VEPs and 9% more successful than subjective tests in providing a complete acuity assessment. Subjective acuity scores were systematically higher than VEP acuity scores in subjects who successfully completed both assessments. A closer agreement with subjective acuity scores was found for step_ VEPs than t-VEPs. The disparity between step_ VEP acuity score and subjective acuity score was shown to reduce with age.

Objective: to examine the effects of work on health and pyschosocial status among boys aged 10-16 years in Jordan. Study design: This is a comparative cross-sectional study, comparing working and non-working with respect to health and psycho-social outcomes, taking account of confounding due socio-economical factors. Results. Bivariate analysis showed that child's work was a strong significant predictor for eight z score, height z score, PCV, morbidity, skinfold thickness percentile and PEFR. This significant effect persisted in the full regression models after controlling for socio-economic and smoking status. Working children had significant lower weight z score (B=-0.31), height z score (B=-0.51), PCV (B=-2.96), skinfold thickness percentile (B=-6.85) compared to non-working subjects. Pyschosocial score tended to be reduced by 13 points (better pyschosocial status) when the child was non-working (B=-12.7). The significant negative relationship between work and PEFR in the bivariate model disappeared in the full regression model. In multiple regression modelling work status explained 3% of the 6.5% of variance explained in the weight z-score model, 6.7% of 9.8% for height z-score, 12.5% of 14.9% for PCV, 15% of 21% for skinfold thickness, 115 of 24% for PEFR, 9.4% of 30.9% for morbidity and 46% of 50% for pyschosocial status. Mean height and weight z-scores and packed cell volume among working children were significantly lower than those of their siblings; 5% and 9.6% of working children respectively were wasted and stunted (z score<-2 SD) compared to none of the siblings. No statistically significant correlation was also found between weight z-scores, height z-scores, packed cell volume and skinfold thickness of siblings and the proportion of household income contributed by the working child. Duration of work, child's monthly income, household per capita income and maternal height, were significant predictors of the growth of working children expressed by weight and height z score.

Weight monitoring is an integral part of routine community child health care in the United Kingdom. An intensive focus on fluctuations in charted weight of young babies has been charged by some breastfeeding advocates with undermining continued breastfeeding. Concern has also been expressed by clinicians and women about the applicability of current growth charts to breastfed babies - a concern echoed by the World Health Organisation. This ethnographic study involved two phases. Six months' participant observation in a child health clinic in the Northwest of England was followed by longitudinal interviews with 14 breastfeeding women. Equal numbers of first and second-time mothers were included; they were interviewed two to three times in the first six months. Data were analysed using grounded theory, allowing an in-depth examination of the lived experiences of weighing and how these shaped on-going feeding decisions and the course of breastfeeding. Weighing babies was the major focus of clinic visits for women and for health visitors. Interactions centred on the concern that the baby's weight should 'follow the line' of the centiles on the chart. Mothers and health visitors also collaborated in efforts to achieve prescriptive routines of baby feeding and sleeping. Breastfeeding was treated as a milk production system, and required to measure up. If weight gain caused concern a variety of strategies were used, including formula supplements and 'worrying'. Techniques to improve the physical effectiveness of breastfeeding were not part of the routine approach to any feeding difficulty on the part of either mothers or health visitors. Using anthropological theory, the character of weighing as a ritual occasion is explored. Weighing sessions are shown to provide occasions to mark the rite of passage through the liminal time of early motherhood. Building on the observation of this ritual experience, it is suggested that the experience of breastfeeding is 'even more liminal', as our society treats formula feeding routines and growth as the implied norm for infants. Weight gain which conforms to chart centiles has become the measure and arbiter of breastfeeding adequacy. Minor fluctuations in weight were treated as potentially serious threats to infant health, while the maintenance of breastfeeding was considered secondary. Recommendations are offered for improving the practical conduct of routine weight monitoring to improve its ability to identify growth which should genuinely spark concern. At the same time, the need for rituals to ease women through their early months of motherhood and the experience of breastfeeding is highlighted. Currently breastfeeding as a method of feeding milk to babies is poorly supported with suggestions for improving physical effectiveness, while at the same time, breastfeeding as a social practice is pushed to the margins of normal everyday experience. This lived dilemma for women and the health visitors who support them deserves attention at national policy level and serious consideration in overall planning of services.

Proefschrift--Utrecht. / Vita. Includes bibliographical references.

Proefschrift--Utrecht. / Vita. Includes bibliographical references.

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No description available.

Introduction: Research suggests that parents of disabled children are dissatisfied with inpatient care delivery to their children. Objectives: - To explore the inpatient care of disabled children - To determine the rewards and challenges of working with disabled children and young people and those with complex health needs - To analyse contemporary nursing curricula in order to ascertain areas of teaching pertinent to disabled children and young people and those with complex health needs - To consider compliance with policy benchmarks for disabled children and young people and those with complex health needs Methods: This project is part of a service evaluation for disabled children and their families that utilises different approaches. Three components of the project were designed: 1. To conduct focus group meetings using the Nominal Group Technique (NGT) with nursing staff 2. To conduct an in-depth content analysis of contemporary nursing curricula 3. To conduct an audit of compliance with policy benchmarks for disabled children and young people and those with complex health needs Results: Four themes have been generated from the integrated data analysis of the current service evaluation, namely: effective communication, provision of training, provision of equipment, unfavourable environment. Conclusion: This service evaluation has revealed that nursing staff need to improve their knowledge and expertise in the field of communication with disabled children and their families, and also enhance the quality of care delivered to this population. Additionally, it is vital that more equipment be provided, and the number of expert nursing staff caring for disabled children increased, in order to improve the quality of care for disabled children and their families.