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School absenteeism and its underlying causes can have negative effects on the cognitive, psychosocial and health development of a child. Research in primary education shows high rates of sickness absence. Many stakeholders are involved in addressing school absenteeism, including primary school professionals, child and youth healthcare physicians, school attendance officers and parents. This study explores these stakeholders' perspectives, their approaches and what they envisage to be necessary in order to improve. It also aims to unveil opportunities and challenges in addressing sickness absence among primary school pupils. Qualitative research was performed with six semi-structured focus group interviews and involving 27 participants from the West-Brabant and Amsterdam regions of the Netherlands. Thematic analysis was used. The overarching theme was aiming for the child's wellbeing. Each focus group interview started with low awareness of sickness absence as a threat to this wellbeing, but awareness grew during the interviews. The participating stakeholders regarded problematic sickness absence as complex due to a wide variety of causes, and felt that each other's expertise was necessary to reduce sickness absence. Schools registered absence, but only occasionally used planned steps; they based the identification of problematic sickness on gut feeling rather than any agreed-upon criteria. To be able to systematically address sickness absence and thus improve the wellbeing of children, stakeholders felt the need for a clearly structured approach, including monitoring of sickness absence of all pupils, identifying problematic absence and promoting collaboration with other stakeholders. An approach should allow for tailoring solutions to the individual child.

Objective: To evaluate longitudinal associations between recreational screen time and sleep in early childhood, and attention-deficit/hyperactivity disorder (ADHD) at age 8 to 10 years. Method: Questionnaires from 2,768 mother-child pairs from the Dutch KOALA Birth Cohort Study were used. General estimating equation logistic regression analyses examined associations between screen time and sleep at age 2, 4, and 6, and ADHD at age 8 to 10. Linear regression analysis examined associations between television time, sleep and CBCL/2-3 scores at age 2. Results: Longitudinally, neither screen time nor sleep were associated with ADHD. Cross-sectionally, CBCL/2-3 externalizing symptom scores increased by 0.03 with every hour television time (95% CI 0.002–0.05) and increased by 0.02 per hour of less sleep (95% CI −0.03–−0.01). Conclusion: Despite an association with externalizing symptoms at age 2, screen time and sleep in early childhood were not associated with ADHD. Carefulness is warranted when extrapolating cross-sectional associations at early age to an ADHD diagnosis.

AIM: We examined how gut feelings of child health care physicians' (CHCPs) contribute to the development of a suspicion of child abuse, how they act upon this suspicion and what barriers they experience in their management. To gain insight into the youth health care chain, we compared the diagnostic reasoning and management regarding this issue by CHCPs and family physicians (FPs).METHODS: Three focus groups, 20 CHCPs, thematic content analysis.RESULTS: A gut feeling acted as an early alert to look for the triggering cue(s), by observing more closely and asking relevant questions. CHCPs struggled to distinguish whether the situation involved child abuse or a lack of parenting skills, and how to communicate their concerns with parents. They tried to motivate parents to improve the situation, avoiding the term child abuse and considered involving the Child Abuse Counselling and Reporting Centre (CACRC) a measure of last resort only.CONCLUSION: As with FPs, gut feelings support CHCPs in becoming attentive to child abuse and to situations which can lead to child abuse. The next step, discussing their suspicion with the parents, is a difficult one, and the CACRC might actually help to make this step easier.

In this article, the association between parental and professional caregivers' perceptions of early life stress (ELS) and the level of preschool social participation was examined, as was the possible moderating effect of parental health. In a community-based study, both parents and professional caregivers of 346 children aged 3 years provided information about child and environmental factors. Results showed that children with ELS more often experienced distress (OR 1.3, p < 0.001), had more peer problems (SDQ: B=0.1, p < 0.01), and more often received extra support according to professional caregivers (OR 1.3, p < 0.01). Parents more often reported concerns (OR=1.3, p < 0.001), a greater number of concerns (B=0.3, p < 0.001), and perceived more difficulties in parenting ("parenting" VAS: B=-2.5, p < 0.001). Associations were stronger for children of parents with "poor health". For personalized family-centred health care, Preventive Child Health Care should systematically explore caregivers' perceptions and concerns of ELS, parental health and child social participation.

Complex public health programmes may suffer from 'teething problems' during their implementation in practice, especially when programmes are developed top-down without the participation of end-users and service providers. Trying out and optimising a new concept in practice with stakeholder ' s participation may enhance the programme ' s chance of success. In this article we describe the participatory optimisation process of a German primary prevention programme for stroke caregivers, performed before its full-scale implementation. A Participatory Action Research (PAR) approach was applied immediately after the development of the preliminary programme that was led by the professional research team. Iterative PAR-cycles were composed of: observe, reflect, plan and act. Through PAR a matured concept, containing eight Conceptual Building Blocks, was obtained. The five preliminary building blocks: `Content ', `Human resources ', `Personalised approach ', `Timing ', and `Setting ', were prioritised to be the core blocks, providing the base for individual caregiver support. Three new building blocks: `Network building ', `Communication ', and `Social safety-net ' were designated as facilitating blocks, interconnecting and safeguarding the programme. PAR was found to be vital in systematically detecting the conceptual weaknesses of the preliminary concept and in adjusting its components to the needs of the key stakeholders, before full-scale implementation.

School attendance is crucial for the development of a child. Sickness absence is the most common type of absenteeism and can be a red flag for underlying problems. To address sickness absence, the intervention Medical Advice for Sick-reported Students for Primary School (MASS-PS) was recently developed. It targets children at risk and is a school-based child and youth health care intervention. The present study is a process evaluation of the intervention. MASS-PS was implemented and evaluated in 29 schools in the West-Brabant region of the Netherlands, during three school years (2017–2020). Attendance coordinators (ACs) from the different schools were interviewed in six focus group interviews as well as in over 200 individual conversations, of which logbooks were kept. Content analysis was used based on a framework of implementation elements. During the first year of the study, the uptake was low. Changes were made by the project group to improve the uptake. The ACs generally considered the MASS-PS as compatible and relevant, but suggested improvements by adding a medical consultation function with a child and youth healthcare physician and increasing the threshold for selecting children at risk. They saw several personal benefits, although time was necessary to learn to use the intervention. An organisational barrier was the lack of teaching staff. A strength in the organisational structure was the appointment of ACs. A major event in the sociological structure was the COVID-19 pandemic. ACs felt that the intervention helped them keep track of sickness absence during the pandemic. The Medical Advice for Sick-reported Students for Primary School intervention was implemented successfully, and the process evaluation gave insight into possible improvements.

Family care-givers are the backbone of the long-term support system for care receivers at home. Care for stroke survivors after rehabilitation primarily rests on the shoulders of family members, often of older age themselves. We report the outcomes of a new complex support programme, the Care-givers’ Guide, on both individual and system levels. Psycho-social support and personalised information were the main ingredients of this intervention. A two-level multi-methodological approach was needed, with two concurrent interconnected studies. Family care-givers reflected on outcomes at an individual level in a quant-QUAL study with a pre–post quantitative questionnaire and a post-intervention qualitative semi-structured interview. Practitioners participated in a QUAL-QUAL study ex post interview, reflecting on the outcomes on the care-givers and on their own stroke care system. Individual family care-givers showed an increase in health literacy and level of psycho-social health. Qualitative analysis revealed improvement in knowledge, capability to act and individual empowerment; and stabilisation of sense of certainty, life balance and emotional wellbeing. Practitioners observed an optimisation of the stroke support system by improving professionals’ daily routine, augmenting the institutional support offer, securing the quality of patient care and increasing inter-institutional co-operation attempts. Positive outcomes of the support programme were observed on both evaluation levels: family care-givers showed improved health literacy and psycho-social health, whereas the professionals noticed an optimisation of the support system.

Introduction: Lower urinary tract symptoms (LUTS) and gastrointestinal (GI) problems are common in Duchenne muscular dystrophy (DMD), but not systematically assessed in regular care. We aimed to determine the prevalence of bladder and bowel dysfunction (BBD) in DMD patients compared with healthy controls (HC). Methods: The Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ) based on the International Rome III criteria and the International Children’s Continence Society was filled out by 57 DMD patients and 56 HC. Additionally, possible associations of BBD with, for example, medication use or quality of life were evaluated in an additional questionnaire developed by experts. Results: In 74% of patients versus 56% of HC ≥ 1 LUTS (n.s.) were reported, 68% of patients versus 39% of HC reported ≥1 bowel symptom (p = 0.002) and 53% of patients versus 30% of HC reported combined LUTS and bowel symptoms (p = 0.019). A negative impact of BBD on daily life functioning was reported by 42% of patients. Conclusions: These data underscore that standard screening for BBD is needed and that the CBBDQ could be of added value to optimize DMD care.

Background Stakeholders are important contributors in the implementation of a complex public health intervention. During the development phase of an implementation, alongside careful design of its components and investing in the exploration of the dynamic multi-stakeholder stroke rehabilitation setting, it is essential to assess possible implementation risks. Systematic stakeholder and risk analyses can guide the exploration process and enable teams involved in complex interventions to develop context-tailored implementation management instruments. Purpose To develop instruments that facilitate the implementation of the complex stroke caregiver intervention project in the real-life support system. Methods Systematic stakeholder and risk analyses were conducted composing five activities. Project stakeholders were identified, classified and assessed using a top-down approach, while implementation risks were identified and assessed by applying a bottom-up approach. Data were collected through interviews and focus groups. Results Based on the knowledge provided by the stakeholders, two context-tailored implementation management instruments were designed with a top-down approach: (1) a comprehensive 'stakeholder-risk atlas' providing individual stakeholder information, such as role, access, contribution, power and interest, expectations, perceived risks and specific engagement activities and (2) an overall 'project implementation strategy' concentrating on communication, transparency, network building and professionalism. Conclusion Complex interventions will benefit from early and comprehensive stakeholder and risk analyses. The early involvement of stakeholders, with their insightful knowledge, enables the research team to develop context-tailored implementation management instruments. Instruments will support the team during implementation and may impact positively on the outcome of the intervention. Knowledge can be obtained by combining top-down and bottom-up working approaches.

Background A new dashboard, the 360ºCHILD-profile, was developed to adopt personalized health care within preventive child health care. On this profile, holistic health data are visualized in a single image to provide parents, adolescents, and caregivers direct access to a manageable résumé of a child’s medical record. Theoretical ordering, conforming to “International Classification of Functioning, Disability and Health for Children and Youth”, guides clinical reasoning toward the biopsychosocial concept of health. It is yet unknown if and how this promising tool functions in practice, and a variety of feasibility questions must be addressed. Objective This paper describes the design and methods of a feasibility randomized controlled trial (RCT), with the aim of evaluating the RCT’s feasibility (recruitment, response, measure completion, and intervention allocation) and 360ºCHILD-profile’s feasibility (usability and potential effectiveness). Methods A pragmatic mixed methods study design was chosen, starting with an RCT to measure feasibility and health literacy in 2 parallel groups (1:1). Qualitative research will then be used to understand and explain quantitative findings and to explore the stakeholders' perspectives on the potential of the 360ºCHILD-profile. Participants will include child health care professionals (n≥30), parents (n≥30), and caregivers (n≥10) of children who experience developmental problems (age 0-16 years). Children will only be able to participate if they are older than 11 years (adolescents, n≥10). The 2 groups included in the study will receive standard care. The experimental group will additionally receive personalized 360ºCHILD-profiles. Results After an intervention period of 6 months, quantitative outcomes will be measured, analyzed (descriptive feasibility statistics and preliminary between-group differences) and used to purposively sample for semistructured interviews. Conclusions Study results will provide knowledge for building theory on the 360ºCHILD-profile and designing future (effect) studies. Trial Registration Netherlands Trial Register NTR6909; https://www.trialregister.nl/trial/6731 International Registered Report Identifier (IRRID) DERR1-10.2196/21942

Contains fulltext : 229296.pdf (Publisher’s version ) (Closed access) BACKGROUND: Even though a lot of research has been done on postnatal growth and the occurrence of catch-up growth in small-for-gestational age (SGA) neonates, this phenomenon has not been studied well in appropriate-for-gestational age (AGA) neonates. Postnatal catch-up growth may also occur in AGA neonates indicating a compensatory mechanism for undiagnosed intrauterine growth restriction, especially in AGA neonates with reduced fetal growth velocity. AIMS: To describe postnatal growth during the first 5 years of life in SGA and AGA neonates and evaluating the role of fetal growth velocity in catch-up growth. STUDY DESIGN: Retrospective study in a Dutch tertiary hospital. SUBJECTS: 740 singleton neonates, without congenital anomalies, with ultrasound fetal growth data from 20 weeks and 32 weeks of pregnancy. OUTCOME MEASURES: Postnatal growth measurements of height (cm) and weight (kg) from birth until five years of age. Postnatal catch-up growth defined as difference (delta) in both height and weight between 4 weeks and 3 years of age. RESULTS AND CONCLUSIONS: SGA neonates had a significantly lower height and weight compared to the AGA group for all available measurement moments till 3 years. The catch-up growth between the SGA and AGA groups from 4 weeks up to 3 years after birth was not different between the two groups. However, neonates with reduced fetal growth velocity had a significantly higher risk for catch-up growth in height during the first 3 years after birth. This suggests a role for fetal growth velocity measurement in predicting fetal and subsequent postnatal growth potential.

A 3600Child-profile, with theoretically ordered, integral child-information visualized in one image, is designed by the Dutch preventive Child and Youth Health Care (CYHC). The introduction of this new data/information carrier gives an important incentive to enhance a transformation towards personalized health care for children and adolescents by supporting the complex medical thought process of CYHCmedical doctors (MD's). This information tool aims to effectively estimate child's functioning, detect emerging health problems and inform parents and caregivers.This pilot study evaluated aspects of inter- and intra-rater reliability and concurrent validity of the 3600Child-profile when used by MD's to estimate functioning and needed intervention of 4-year-old children. After the development process, in January 2015, 3600Child-profiles (n=26) were assessed by MD's, in the Netherlands. Each MD assessed two Childprofiles twice and was matched to another MD receiving exactly the same two profiles. The paired scores and rater's scores of both time-points were compared. Rater's scores also were compared with the 26 reference tests scores.Reliability results showed Intraclass correlation coefficients between 0.71 and 0.82 (overall functioning), Cohen's kappa's between 0.61 and 0.80 (psychosocial functioning) and 0.46–0.47 (needed intervention). Validity results showed a Spearman's correlation coefficient of 0.78 (overall functioning), Cohen's kappa's of 0.43 and 0.77 (psychosocial functioning) and 0.52 (needed intervention).In conclusion, in some domains, acceptable results regarding reliability and validity are found for the visualization of integral childinformation used by CYHC-MD's to assess child-functioning after only a short training. The 3600Child-profile's value on tracking change in functioning and decision-making on intervention needs further exploration. Keywords: Reliability and validity, Decision support techniques, Child care, Preventive health services, Public health, International classification of functioning, disability and health

Background We evaluated the effectiveness of different recruitment strategies used in a study aimed at eliminating/reducing second-hand smoke (SHS) exposure in Dutch children 0–13 years of age with a high risk of asthma. Methods The different strategies include: 1) questionnaires distributed via home addresses, physicians or schools of the children; 2) cohorts from other paediatric studies; 3) physicians working in the paediatric field (family physicians, paediatricians and Youth Health Care (YHC) physicians); and 4) advertisements in a local newsletter, at child-care facilities, and day-care centres. Results More than 42,782 families were approached to take part in the screening of which 3663 could be assessed for eligibility. Of these responders, 196 families met the inclusion criteria for the study. However, only 58 (one third) could be randomised in the trial, mainly because of no interest or time of the parents. The results showed that recruiting families who expose their children to SHS exposure is very challenging, which may be explained by lack of ‘recognition’ or awareness that SHS occurs in homes. The presence of asthma in the family, respiratory symptoms in the children, and even incentives did not increase parental motivation for participation in the study. Conclusions The recruitment process for an intervention program addressing SHS exposure in children was considerably more challenging and time consuming than anticipated. Barriers at both a parents level and a doctor’s level can be discriminated. Electronic supplementary material The online version of this article (10.1186/s12887-018-0983-4) contains supplementary material, which is available to authorized users.

OBJECTIVE: Current data about Attention Deficit Hyperactivity Deficiency (ADHD) guideline use in the Netherlands are absent. This study analysed ADHD guideline use among different healthcare workers, and the use of key elements from these guidelines to diagnose ADHD.METHOD: A survey assessing ADHD guideline use was distributed throughout the Netherlands to various health care professionals. Only professionals involved during the diagnostic process were included.RESULTS: Response rate among GPs was low (111/1450), but high among other health care professionals (251/287). A total of 362 surveys were analysed, 186 responders (51%) were involved during the diagnostic process. Overall guideline use was 64.5%; the national multidisciplinary guideline or a guideline made by a professional's own institution were most used. Psychiatrists, psychologists and paediatricians reported compliance with key elements of the guidelines such as gathering information from a third party (> 90%) and carrying out a developmental history (> 88%). Use of a standardized interview (CONCLUSION: Despite low general use of guidelines, psychiatrists, psychologists and paediatricians use similar key elements of ADHD guidelines. This study provides opportunities to improve care through increasing familiarity with ADHD guidelines and the use of standardized interviews.

Systematically exploring parental as well as other caregivers’ concerns is a main component in preventive child health care (PCHC) for family-centred practice and personalized health care. To facilitate communication and early identification of emerging mental health problems, a PCHC toolkit based on short instruments was developed. This article investigates the reliability and validity of (1) two visual analogue scales (VAS) to assess parent-reported ‘parenting’ and ‘child behaviour’, (2) a professional caregiver-reported VAS to assess ‘child competence’ and (3) the parents’ evaluation of developmental status (PEDS) in Dutch PCHC. Parents as well as child care, kindergarten and preschool teachers completed instruments in a community-based sample of children ( N = 346) aged 3 years at baseline. The three VAS and PEDS were associated with standardized questionnaires assessing the same constructs. Overall predictive accuracy showed: good to excellent for ‘parenting’ VAS, fair to good for ‘child behaviour’ VAS and poor for ‘child competence’ VAS. The PEDS, ‘parenting’ VAS and ‘child behaviour’ VAS, demonstrated high sensitivity at various cut-off points of index test and reference standard. At follow-up, approximately 1 year later, results were similar. Although the ‘child competence’ VAS scored lower on one aspect of validity, the PEDS and the different VAS are reliable, valid and useful as brief monitoring tools in daily Dutch PCHC practice.

Background: HIV/AIDS has had a significant impact on maternal and child health in South Africa. It is thus of vital importance to implement interventions to prevent mother-to-child transmission of HIV (PMTCT) as early as possible during pregnancy. Negative interactions between patients and health care providers (HCPs) can be an important barrier to antenatal care, PMTCT use and PMTCT adherence. Research about respectful maternity care has focused more on the patient perspective. We therefore compared the patient and HCP perspectives and reflected on how interactions between HCPs and patients can be improved. Objective: To obtain insights into the attitudes of HCPs in the context of HIV and PMTCT-related care, by studying patient and HCP perceptions of their interactions, in a peri-urban hospital setting in Gauteng province, South Africa. Methods: A qualitative study was conducted in a public tertiary-level hospital. Fourteen semi-structured in-depth interviews were conducted with nurses and doctors in the antenatal clinic and postnatal ward. Thirty-one semi-structured in-depth interviews and two focus group discussions were conducted with HIV positive and negative women on the postnatal ward. Results: HCPs experienced a difficult work environment due to a high workload. This was combined with frustrations when they felt that patients did not take responsibility for their own or their child’s health. They were motivated by the need to help the child. Patients experienced judging comments by HCPs especially towards younger, older and foreign women. They expressed fear to ask questions and self-blame, which in some cases delayed health care seeking. No discrimination or isolation of HIV infected patients was reported by patients and HCPs. Conclusion: We hypothesize that more humane working conditions for obstetric HCPs and a caring, personalised approach to patient management can improve patient-provider interactions and access to respectful care. These are critical to preventing mother-to-child transmission of HIV.

Background Within the Dutch Child Health Care (CHC), an online tool (360° CHILD-profile) is designed to enhance prevention and transformation toward personalized health care. From a personalized preventive perspective, it is of fundamental importance to timely identify children with emerging health problems interrelated to multiple health determinants. While digitalization of children’s health data is now realized, the accessibility of data remains a major challenge for CHC professionals, let alone for parents/youth. Therefore, the idea was initiated from CHC practice to develop a novel approach to make relevant information accessible at a glance. Objective This paper describes the stepwise development of a dashboard, as an example of using a design model to achieve visualization of a comprehensive overview of theoretically structured health data. Methods Developmental process is based on the nested design model with involvement of relevant stakeholders in a real-life context. This model considers immediate upstream validation within 4 cascading design levels: Domain Problem and Data Characterization, Operation and Data Type Abstraction, Visual Encoding and Interaction Design, and Algorithm Design. This model also includes impact-oriented downstream validation, which can be initiated after delivering the prototype. Results A comprehensible 360° CHILD-profile is developed: an online accessible visualization of CHC data based on the theoretical concept of the International Classification of Functioning, Disability and Health. This dashboard provides caregivers and parents/youth with a holistic view on children’s health and “entry points” for preventive, individualized health plans. Conclusions Describing this developmental process offers guidance on how to utilize the nested design model within a health care context.

BACKGROUND: Metabolic health in people with obesity is determined by body composition. In this study, we examined the influence of a combined strength exercise and motivational programme -embedded in the school curriculum- on adolescents body composition and daily physical activity.METHODS: A total of 695 adolescents (11-15y) from nine Dutch secondary schools participated in a one year cluster randomised controlled trial (RCT). In the intervention schools, physical education teachers were instructed to spend 15-30 min of all physical education lessons (2× per week) on strength exercises. Monthly motivational lessons were given to stimulate students to be more physically active. Control schools followed their usual curriculum. The primary outcome measure was body composition assessed by the deuterium dilution technique. Daily physical activity and sedentary behaviour measured by accelerometry served as a secondary outcome.RESULTS: After 1 year, a 1.6% fat mass difference was found in favour of the intervention group (p = .007). This reflected a 0.9 kg difference in fat free mass (intervention>control; p = .041) and 0.7 kg difference in fat mass (interventionCONCLUSION: In 11-15 year olds, the combination of strength exercises plus motivational lessons contributed to an improvement in body composition and a smaller decrease in physical activity level. TRIAL REGISTRATION ID: ( NTR5676 - retrospectively registered 8 February 2016; enrolment of first participant: 2 March 2015).

Objective: A new Dutch Child and Youth Act should reduce specialized mental health care for children with symptoms of ADHD. Characteristics of children referred to a specialized ADHD clinic are explored to give direction to this intention. Method: Data of 261 children who underwent a multidisciplinary best practice evaluation (including rating scales, and demographic, psychological, and somatic findings) were analyzed. Univariable and multivariable logistic regression models were used to find predictive variables for the need of specialized mental health care. Results: Collected data were heterogeneous. (Sub)clinical total scores on the Teacher Report Form (TRF) and Child Behavior Checklist (CBCL) were predictive variables for specialized mental health care. Also children with divorced parents were more often referred to specialized care. Conclusion: (Sub)clinical scores on the CBCL and TRF increased the need for specialized care, but comprehensive assessment of every child with ADHD symptoms was necessary to differentiate between levels of care.

This article studies the construction of children at risk in the introduction process of a novel ICT system in Dutch child welfare, the Child Index. This early warning electronic information system enables early reporting of children at risk to stimulate multidisciplinary collaboration among the different professionals involved with a particular child. We followed the introduction of the Child Index in practice. Our empirical analysis provides insight into the co-production of this ICT system and risk in child welfare practices. The analysis shows that the interaction between local and national, and disciplinary and organisational differences induces various constructions of risk, making the decision to signal and the act of signalling risk complex and the status of a signalled risk vague. Moreover, the analysis illustrates that the Child Index's goal of early signals for all children at risk does not fit professionals' daily practices and highlights the need to discuss whether the risk signalling ambitions of the Child Index are not a larger risk to children than the risks that are being targeted. (C) 2015 Elsevier Ltd. All rights reserved.

An adequate approach to reducing school absenteeism should focus on medical absenteeism as this is the most prevalent form of school absenteeism. The objective of this study is to explore the health condition of pre-vocational secondary students with extensive medical absenteeism from a biopsychosocial perspective. Data were obtained from medical assessments and Strengths and Difficulties Questionnaires (SDQs) of students with medical absence above threshold criteria (i.e. reported sick four times in 12 school weeks or more than six consecutive school days) who were referred to a youth health care physician. The results showed that the students had a mean absence rate of 14% in 12 school weeks. Of all students, 43.5% had a diagnosed disease and 81.5% had problems such as physical complaints not yet diagnosed, psychosocial problems, lifestyle problems and sleeping difficulties. Four groups could be distinguished: 13.4% with a diagnosed disease and no problem, 30.1% with a diagnosed disease and a problem, 51.5% with a problem and no diagnosed disease and 5.1% without a diagnosed disease or problem. Significantly higher scores of the Total difficulties-scale on the SDQ were found (mean 10.5; SD 5.8) in the study group, compared to a reference group (mean 9.1; SD 4.9). In conclusion, this study shows that when using the aforementioned criteria for extensive medical absenteeism to intervene with the absence, students with a mean absence rate of 14% in 12 school weeks are identified. If there was a diagnosed disease, it was accompanied by problems about twice as often. More than half of the students’ absence was caused by problems rather than a disease. The great diversity of these problems calls for a personalized approach. A broad perspective, including medical expertise, is needed to distinguish between emerging mental and physical diseases, psychosocial and lifestyle problems.Keywords: Adolescent Health, Preventive Pediatric Primary Care, School Absenteeism, Public Health, Psychosocial Problems

BACKGROUND: As school dropout is an important public health problem that needs to be addressed, we set out to examine whether and how, beyond the well-known effects of sex, gender beliefs and self-reported masculinity and femininity are related to school dropout. METHODS: The study used a case-control design, consisting of 330 dropout cases and 330 controls still attending school. The respondents, aged between 18 and 23 years, living in the south-east of the Netherlands, were sent a self-administered questionnaire. Separate logistic regression analyses for the male and female participants were used to explore the relation between dropout and gender, controlling for sociodemographic determinants. RESULTS: As indicated by significant curvilinearity, young women were less likely to drop out when they occupied an intermediate positions on the gender variables. Odds of dropout were elevated among highly masculine women (odds ratio = 2.1, 95% confidence interval: 1.1-4.1), and, as indicated by significant interactions, also among highly masculine men with strong normative masculine beliefs and in feminine men who simultaneously considered themselves low on masculinity. CONCLUSIONS: Beyond sex, gender is important in the explanation of school dropout. To prevent dropout, public health professionals should assess, monitor and intervene on the basis of gender characteristics.

Doel:de nederlandse overheid trekt zich steeds verder terug. Daarom hebben we onderzocht of zieke mensen met een laag inkomen voldoende sociale contacten hebben om op eigen kracht met hun ziekte om te kunnen gaan en of er een verschuiving zichtbaar is tussen 2009 en 2012.methode:we hebben gebruik gemaakt van de in 2009 en 2012 gehouden gezondheidsenqueˆte onder volwassenen (17-65 jaar) van alle limburgse gemeenten (2009: n=11.945; 2012: n= 24.978). Het percentage zieke personen dat ernstige eenzaamheid of zeer weinig contacten rapporteert is naar inkomenscategorie geanalyseerd, voor 2009 en 2012 afzonderlijk.resultaten:zieke personen met een laag inkomen rapporteren vaker ernstige eenzaamheid en zeer weinig persoonlijke contacten dan zieke personen met een hoog inkomen. In 2012 zegt 6% van de zieken met hoog inkomen ernstig eenzaam te zijn tegenover 20,7% van de zieken met laag inkomen; in 2009 is dit 3,2% versus 16,2%. In 2012 zegt 4,3% van de zieken met hoog inkomen zeer weinig persoonlijke contacten te hebben tegenover 11,9% van de zieken met laag inkomen; in 2009 is dit 1,6% versus 11,3% (chi2-test, p= 0,05).conclusie:de gegevens laten een beeld zien van ernstige eenzaamheid en zeer weinig persoonlijke contacten bij een aanzienlijk deel van de zieke bevolking met een laag inkomen. De situatie is in de periode 2009-2012 licht verslechterd. In een samenleving waar mensen steeds meer op zichzelf en hun sociale netwerk worden teruggeworpen raden we gemeenten en ggd’en aan extra toe te zien op deze kwetsbare groepen. Samenwerking tussen gemeenten en ggd is noodzakelijk bij de uitvoering van de zorgplicht voor langdurig zieken en het terugdringen van sociaaleconomische gezondheidsverschillen. De gemeentelijke monitor voor het sociaal domein in combinatie met de gezondheidsmonitor van de ggd biedt de mogelijkheid om vroegtijdig knelpunten te signaleren.

We tested the effectiveness of a program consisting of motivational interviewing (MI) and feedback of urine cotinine to stop passive smoking (PS) in children at risk for asthma. Fifty-eight families with children 0–13 years with a high risk of asthma and PS exposure were randomised in a one-year follow-up study. The intervention group received the intervention program during 6 sessions (1/month) and the control group received measurements (questionnaires, urine cotinine, and lung function) only. The primary outcome measure was the percentage of families stopping PS (parental report verified and unverified with the child’s urine cotinine concentration

A 3600Child-profile, with theoretically ordered, integral child-information visualized in one image, is designed by the Dutch preventive Child and Youth Health Care (CYHC). The introduction of this new data/information carrier gives an important incentive to enhance a transformation towards personalized health care for children and adolescents by supporting the complex medical thought process of CYHCmedical doctors (MD's). This information tool aims to effectively estimate child's functioning, detect emerging health problems and inform parents and caregivers. This pilot study evaluated aspects of inter- and intra-rater reliability and concurrent validity of the 3600Child-profile when used by MD's to estimate functioning and needed intervention of 4-year-old children. After the development process, in January 2015, 3600Child-profiles (n = 26) were assessed by MD's, in the Netherlands. Each MD assessed two Childprofiles twice and was matched to another MD receiving exactly the same two profiles. The paired scores and rater's scores of both time-points were compared. Rater's scores also were compared with the 26 reference tests scores. Reliability results showed Intraclass correlation coefficients between 0.71 and 0.82 (overall functioning), Cohen's kappa's between 0.61 and 0.80 (psychosocial functioning) and 0.46–0.47 (needed intervention). Validity results showed a Spearman's correlation coefficient of 0.78 (overall functioning), Cohen's kappa's of 0.43 and 0.77 (psychosocial functioning) and 0.52 (needed intervention). In conclusion, in some domains, acceptable results regarding reliability and validity are found for the visualization of integral childinformation used by CYHC-MD's to assess child-functioning after only a short training. The 3600Child-profile's value on tracking change in functioning and decision-making on intervention needs further exploration., Highlights • First reliability and validity data of a new tool, the 3600Child-profile, are obtained. • This original 3600Child-profile is reliable and seems valid to distinguish child-functioning. • This information tool for professionals and parents, seems rather easy to implement. • The profile's value on decision-making towards intervention needs further exploration.

Background: Stroke affects the entire family system. Failure to meet the needs of caregivers leads to physical and mental overburdening. Stroke caregivers may benefit from professional support. The literature reviews have shown that there is still no clarity concerning the most appropriate set-up of a support programme. In Germany, there is no stroke caregiver support programme that operates throughout the course of rehabilitation.Aim: The aim was to develop a complex intervention programme for stroke caregivers in North-Rhine Westphalia, Germany.Methods: A naturalistic enquiry approach, using a mixed-methods design, was applied. Within one overarching qualitative study, three separate, explorative, inductive, qualitative substudies were conducted: (i) seven explorative interviews with experienced stroke caregivers, (ii) six semi-structured interviews with professionals working within stroke rehabilitation and (iii) seventeen participant observations with focus on professional-caregiver interactions. Regional stroke units, rehabilitation centres, outpatient services and the home environment of caregivers were included. By means of a four-step qualitative content analysis, all three data sets were coded, categorised and subsequently condensed into subthemes, clustered into main themes, and finally translated into 'Conceptual Building Blocks' of the programme.Results: The need for a personalised, holistic and multicomponent caregiver support programme emerged from all three substudies. Fourteen themes were condensed from the subthemes. Caregivers should be approached directly after stroke using outreach counselling. Support should be provided by a specially trained focal person across the entire patient's rehabilitation trajectory. The newly developed support programme consists of five flexible 'Conceptual Building Blocks': Content, Human Resources, Personalised Approach, Timing and Setting.Conclusion: Through a qualitative mixed-methods design, an in-depth contextual understanding of stroke caregiver needs within the rehabilitative support system was reached. This allowed the development of a context tailored comprehensive caregiver support programme consisting of five 'Conceptual Building Blocks'.

Child and Youth Health Care (CYHC) is the branch of primary care that aims at an early identification of paediatric health problems with a special focus on developmental conditions. Recent advances in genetics and neuroscience reveal that developmental conditions are in most cases multifactorial: they do not have one single cause but rather develop due to longitudinal interplay between biological and environmental factors. In order to incorporate new scientific knowledge into the daily practice of CYHC important changes are necessary. The CYHC system should move away from a purely diagnostic approach and instead focus on the early identification of children at risk, the prevention of developmental problems at various stages and the provision of personalised interventions. To that end, it should follow the principles of personalised care, adapt its interventions to each individual child and work together with parents. This shift also calls for a more active involvement of parents within CYHC.

Aim School dropout is a multidimensional problem with negative consequences for socio-economic status. Most interventions to reduce school dropout have been implemented in education rather than in preventive healthcare. Our goal was to determine whether measurements used in preventive healthcare surveillance enabled us to detect internalising and externalising problems in relation to later school dropouts. Methods Using a case–control design, we compared Dutch dropouts (n = 301) and nondropouts (n = 270), who were aged 18–23 in 2008, by examining their youth healthcare, socio-medical records from birth onwards. Logistic regression models were estimated. Results Young adults with externalising problems in their earlier life had 56% higher odds of dropping out compared to those without externalising problems (OR = 1.56; 95% CI: 1.02–2.37), when data were adjusted for sex, socio-economic and ethnic background and family composition. Internalising problems did not differ between the cases and controls. Conclusion Our findings suggest that early life symptoms of emerging behavioural problems, as detected by preventive healthcare surveillance, are related to later school dropout. Preventive healthcare professionals can play a role in helping to prevent school dropouts, and this study underlines that school dropout is an important preventive healthcare issue.

Background: While the prevalence of childhood wheeze continues to increase in many countries, decreasing trends have also been reported. This may be explained by increased use of asthma medication, which effectively suppresses wheeze symptoms. In this study we investigated trends in wheeze in Dutch school children between 1989 and 2005, and their association with medication use. Methods: In five repeated cross-sectional surveys between 1989 and 2005, parents of all 5- to 6-year-old and 8- to 11-year-old children eligible for a routine physical examination were asked to complete a questionnaire on their child's respiratory health. We identified all children for whom a questionnaire was completed in two successive surveys. Children were grouped according to birth year and classified into one out of four wheeze categories: "no wheeze," "discontinued wheeze," "continued wheeze," or "new-onset wheeze." Results: In total, 3,339 children, born in 1983 (N = 670), 1988 (N = 607), 1992 (N = 980), and 1995 (N = 1,082), participated twice. Over the study period, the proportion of children with "no wheeze" increased from 73.8% to 86.1% (P-trend 0.05 for all wheeze categories). Conclusion: An increasing trend of Dutch school children with " no wheeze," and decreasing trends of children with "discontinued" and "continued" wheeze between 1989 and 2005 could not be explained by (increased) medication use. This suggests that wheeze prevalence is not masked by medication use, but is truly declining. (C) 2014 Wiley Periodicals, Inc.

Aim Many child-onset mental health diseases have strong epigenetic links, but no genetic tests are yet available for them. Family history (FH) information in paediatric primary care should be promoted to assist decision-making. This study aims to explore the extent of the real-life use of the FH for mental health issues by paediatric physicians. Methods The medical records of 474 children (31.5% female), referred to the specialised mental health care services in the Netherlands, were used. Data were retrospectively extracted from the medical files, according to a list of 15 criteria regarding the use of FH information. Results The FH was explored in the form of a diagnosis and was presented at birth in 88.3% of cases and in half of the files at 5 years. Negative FH and the age of relatives at the time of diagnosis were virtually not mentioned. FH was present in more reports from the specialists, than in referral letters. Conclusion Despite the high importance of FH for primary paediatric care, this study shows that FH is underreported in practice. We should promote structural FH taking to increase how often it is used to treat children who do not meet criteria for definitive diagnosis.

• The aim was to examine whether ill people with a low income report less social resources than ill people with a high income.

Introduction: Many childhood-onset diseases and developmental disorders have a strong genetic basis. However, up till now, the knowledge of this genetic component within multifactorial diseases is not frequently used in paediatric practice. A good family history collection can facilitate the link between the present paediatric practice and the advances in genetics. This paper explores the benefits and drawbacks of the existing validated family history tools from the viewpoint of paediatric primary practice, with special attention for the mental health issues. Methodology: A literature search was conducted in the following directories: PubMed, Cochrane, Embase and Google Scholar. The timeframe was 01.01.2000 - 01.09.2011. The articles meeting the following criteria were included: original research papers in English, containing description or validation of the family history tool, for multifactorial/complex common disorders. The data were extracted from the full text of the articles. They were classified according to 14 criteria including diseases in question, level of healthcare, validation sample characteristics and results of usability analysis. Results: The majority of the family history tools, described in the literature, deal with a narrow range of diseases (some cancers, diabetes and coronary heart disease). None were tested in the paediatric healthcare. The cost-effectiveness analysis was never reported. Conclusions: The major finding of the present study is the absence of the validated tools for the family history collection for the paediatric primary care in general and in mental health in particular. The existing advances create a solid base for composition of the unified tool for paediatric primary care.

Limburg, en vooral Zuid-Limburg, heeft een ongunstig sociaaleconomisch en epidemiologisch profiel. Daarbij wordt vaak gewezen op de opeenstapeling van achterstanden in stadsregio Parkstad (welke ook de voormalige Oostelijke Mijnstreek omvat). Met nieuwe gegevens en analysemethoden onderzochten wij of dit beeld van Parkstad als gezondheidsachterstandsgebied kon worden bevestigd. De onderzoeksopzet was cross-sectioneel. Gebruik werd gemaakt van bijna 12.000 ingevulde vragenlijsten van de Volwassenmonitor 2009 van de GGD-en in Limburg, alsmede van postcodegegevens (gemiddelde inkomen en stedelijkheid) van het CBS. Multilevel modellen zijn geschat (niveau 1: individu en niveau 2: postcodegebied). De intraklasse-correlaties indiceerden dat de meeste gezondheidsverschillen binnen postcodegebieden (99 procent) bestaan, niet tussen postcodegebieden (1 procent). De gezondheid van Parkstadinwoners bleek niet veel slechter dan die van andere (Zuid-) Limburgers en werd vooral bepaald doordat er meer minder-gezonde bijstandsgerechtigden en arbeidsongeschikten wonen en niet door contextuele gebiedskenmerken. Een post-hoc, exploratieve analyse bevestigde bovenstaande beeld en wees tevens op het bestaan van andere “risicogebieden” in Zuid-Limburg. De gegevens suggereren vooral dat de volksgezondheid, ook in stadsregio Parkstad, naast de meer collectieve, buurt- en regiogerichte aanpak, baat zou kunnen hebben bij een meer gepersonaliseerde preventie-aanpak in de vorm van additioneel, individueel-georienteerd maatwerk door de GGD. Er bestaat dan minder gevaar dat de minder draagkrachtige medemensen die (toevallig) in een rijkere buurt of regio wonen, worden gemist.

BackgroundStudents’ health and school absenteeism affect educational level, with adverse effects on their future health. This interdependence is reflected in medical absenteeism. In the Netherlands, a public health intervention has been developed to address medical absenteeism in pre-vocational secondary education. This study aims to investigate the effectiveness of this intervention on students’ medical absenteeism, compared to “medical absenteeism policy as usual”.MethodsA quasi-experimental design with an intervention group (493 students) and a control group (445 students) was applied. Multilevel analysis was used to study differences in the development of the level of a student’s medical absence over time (after 3 and 12 months).ResultsIn the intervention group, the level of absenteeism decreased from 8.5 days reported sick in 12 school weeks to 5.7 days after 3 months, and to 4.9 days after 12 months. The number of absence periods fell from 3.9 in 12 school weeks to 2.5 after 3 months, and to 2.2 after 12 months. In the control group, the absence days initially decreased from 9.9 days reported sick in 12 school weeks to 8.4 days after 3 months, after which an increase to 8.9 days was measured. The number of absence periods initially decreased from 4.5 in 12 school weeks to 3.5, after which an increase to 3.7 was measured. The number of absence days per period remained about the same in both groups.ConclusionsThe study provides first indications for the intervention to be effective for Dutch pre-vocational secondary students with increased medical absence rates. The intervention, which consists of personalised management of medical absenteeism by systematic identification of students with extensive medical absenteeism and consistent referral to youth health care physicians, appears to reduce the absence rates more effectively than “medical absenteeism policy as usual”. The effectiveness of the intervention is shown primarily by a decrease in the number of periods reported sick.

This study examines inter-individual differences in how presentation modality affects verbal learning performance. Children aged 5 to 16 performed a verbal learning test within one of three presentation modalities: pictorial, auditory, or textual. The results indicated that a beneficial effect of pictures exists over auditory and textual presentation modalities and that this effect increases with age. However, this effect is only found if the information to be learned is presented once (or at most twice) and only in children above the age of 7. The results may be explained in terms of single or dual coding of information in which the phonological loop is involved. Development of the (sub)vocal rehearsal system in the phonological loop is believed to be a gradual process that begins developing around the age of 7. The developmental trajectories are similar for boys and girls. Additionally, auditory information and textual information both seemed to be processed in a similar manner, namely without labeling or recoding, leading to single coding. In contrast, pictures are assumed to be processed by the dual coding of both the visual information and a (verbal) labeling of the pictures.

Introductieomvangrijk schoolverzuim kan leiden tot uitstroom naar een lager onderwijsniveau of voortijdig schoolverlaten. Beiden hangen sterk samen met gezondheidsproblemen en hogere sterftecijfers. In het huidige onderzoek werd nagegaan hoe studieloopbaanbegeleiders (slb’ers) de begeleiding bij ziekteverzuim van mbo’ers inhoud en vorm geven en waarom ze dat zo doen.methodekwalitatief onderzoek met semigestructureerde interviews, afgenomen bij elf slb’ers werkzaam op drie mbo-scholen in west-brabant.resultatenvolgens slb’ers zijn er drie vormen van ziekteverzuim: verzuim vanwege ziekte, vanwege psychosociale problemen en vanwege ‘niet naar school willen komen’. In de verzuimbegeleiding hanteren slb’ers drie soorten rollen: een controlerende, een structurerende en een empathische rol. Omdat er volgens de slb’ers vaak sprake is van ziekteverzuim vanwege ‘niet naar school willen komen’, wat ze niet legitiem verzuim vinden, hanteren ze vooral een controlerende rol, terwijl ze met deze rol weinig affiniteit hebben. De slb’ers benoemen de randvoorwaarden die volgens hen nodig zijn om de rollen bij ziekteverzuimbegeleiding goed in te kunnen vullen. Deze randvoorwaarden zijn niet specifiek voor bepaalde rollen.conclusieshoewel slb’ers in hun visie op ziekteverzuim onderscheid maken in drie vormen van ziekteverzuim, blijken ze in hun werkwijze vooral onderscheid te maken tussen legitiem en niet legitiem verzuim. Door deze focus op legitimiteit hanteren ze vooral een controlerende rol. Ze voelen zich echter niet prettig bij deze rol en nemen liever een structurerende of een empathische rol op zich. Hierdoor ervaren slb’ers ziekteverzuimbegeleiding als een ambigue taak.

BackgroundReducing school absenteeism benefits the health and educational opportunities of young people. The Dutch intervention Medical Advice for Sick-reported Students (abbreviated as MASS) was developed to address school absenteeism due to sickness reporting, also called medical absenteeism. This study is part of a research project on the effectiveness of MASS and explores factors that influence the implementation and dissemination of the intervention, from schools' perspectives. The research questions include reasons schools have to implement MASS, their experiences in the implementation of MASS and their views on what is needed to ensure sustainable implementation.MethodsA qualitative research method was used. Semi-structured interviews were held with nine principals and eight special education needs coordinators, working in nine secondary schools that apply MASS. Inductive content analysis was carried out.FindingsThe main reasons for schools to address medical absenteeism were their concerns about students' well-being and future prospects and their wish to share these concerns with students' parents. Participants also mentioned the wish to raise the threshold for reporting sick. According to the participants, MASS makes it easier for teachers to enter into conversation with students and their parents about medical absence. MASS prevents damage to the relationship with parents and medical problems being missed. In implementing MASS the main obstacles are teachers' dialogue about medical absence with students and their parents, teachers' follow-up of the feedback of the youth health care physicians (YHCPs), and correct registration. The participants were convinced that MASS also improves collaboration with parents regarding the optimization of care for students.ConclusionsMASS allows schools to identify students at risk of dropout at an early stage and to optimise guidance of these students. The intervention matches schools' need to address medical absenteeism by providing a clear framework, an approach from concern rather than control, and socio-medical expertise through the collaboration with YHCPs. MASS can support schools to maximize the number of students graduating and to improve parental involvement in school. These outcomes may help to put the subject of addressing medical absenteeism on the agenda of all schools, and contribute to prioritization, support adoption and secure sustainable implementation and dissemination of MASS.

OBJECTIVES: Various terms and definitions are used to describe personalised approaches to medicine and healthcare, but in ambiguous and inconsistent ways. They mostly have been defined in a top-down manner. However, actual practices might take different paths. Here, we aimed to provide a 'practice-based' perspective on the debate by analysing the content of 'personalised' practices published in the literature. METHODS: The search in PubMed and EMBASE (April 2014) using the terms frequently used for personalised approaches resulted in 5333 records. 2 independent researchers used different strategies for screening, resulting in 157 articles describing 88 'personalised' practices that were implemented/presented on at least 1 individual/patient case. The content analysis was grounded on these data and did not have a priori analytical frameworks. RESULTS: 'Personalised medicine/healthcare' can be a commodity in the healthcare market, a way how health services are provided, or a keyword for emerging applications. It can help individuals/patients to gain control of their health, health professionals to provide better services, healthcare organisations to increase effectiveness and efficiency, or national health systems to increase performance. Country examples indicated that for integration of practices into health services, attitude towards innovations and health system and policy context is important. Categorisation based on the terms or the technologies used, if any, was not possible. CONCLUSIONS: This study is the first to provide a comprehensive content analysis of the 'personalised' practices in the literature. Unlike the top-down definitions, our findings highlighted not the technologies but real-life issues faced by the practices. 'Personalised medicine' and 'personalised healthcare' can be differentiated by using the former for specific tools available and the latter for health services with a holistic approach, implemented in certain contexts. To realise integration of 'personalised medicine/healthcare' into real life, science, technology, health policy and practice, and society domains must work together.

Sociaal economische gezondheidsverschillen kunnen worden gereduceerd door het verminderen van gezondheidsrisico’s en het verhogen van onderwijskansen. Bij dit laatste is omvangrijk schoolverzuim een risicofactor. Door aandacht te besteden aan schoolverzuim wegens ziekte levert de jeugdgezondheidszorg een bijdrage aan de gezondheid, het welbevinden en de onderwijskansen van jongeren en daarmee aan het terugdringen van sociaal economische gezondheidsverschillen. De GGD West-Brabant heeft in een pilot de interventie M@ZL (Medische Advisering Ziekgemelde Leerling) voor de aanpak van ziekteverzuim door scholieren in het voortgezet onderwijs ontwikkeld. In dit artikel worden methodiek en pilotresultaten beschreven. Van de leerlingen met omvangrijk ziekteverzuim werd 98% bereikt door de jeugdarts of de leerplichtambtenaar; 50% had lichamelijke klachten, veel leerlingen hadden psychosociale problemen. Bij 63% van de leerlingen die in het begeleidingstraject kwamen nam de verzuimomvang af. Het ziekteverzuim op schoolniveau nam af met gemiddeld 1,1 ziektedagen per leerling per schooljaar. Uit de pilot wordt voorlopig geconcludeerd dat de interventie M@ZL veelbelovend is voor het terugdringen van ziekteverzuim op het voortgezet onderwijs. Er worden aanknopingspunten voor verdere ontwikkeling gegeven.

Genomic and neuro-scientific research into the causes and course of antisocial behaviour triggers bioethical debate. Often, these new developments are met with reservation, and possible drawbacks and negative side-effects are pointed out. This article reflects on these scientific developments and the bioethical debate by means of an exploration of the perspectives of one important stakeholder group: juveniles convicted of a serious crime who stay in a juvenile justice institution. The views of juveniles are particularly interesting, as possible applications of current and future scientific findings are considered to be most effective if applied early in life. Based on their statements we come to the following provisional conclusions. Concerns about labelling and stigmatization are recognized and widely shared. Possible effects on one's identity are acknowledged too. Yet, a possible biological underpinning of one's antisocial behaviour is not considered to result in the development of a criminal identity. Nonetheless, psychopharmacological interventions are experienced as endangering one's current self. Concerns regarding the refusal of responsibility and the blaming of one's genes or brain can be put into perspective. Instead, participants emphasize the motive of own choice as underlying their criminal behaviour. Moreover, bioethical debate should pay attention to the role of parents of children at risk and the parent-child relationship in families at-risk. We argue that the short-term and long-term interests of children at risk, as well as their interests and those of society at large, may conflict. In order to deal appropriately with newly arising dilemmas, a normative framework needs to be developed.

Background In the last decades we have seen a constant growth in the fields of science related to the use of genome-based health information. However, there is a gap between basic science research and the Public Health everyday practice. For a successful introduction of genome-based technologies policy actions on the international level are needed. This work represents the initial stage of the PHGEN II (Public Health Genomics European Network II) project. In order to prepare a base for bridging genomics and Public Health, an inventory study of the existing legislative base dealing with controversies of genome-based knowledge was conducted. The work results in the mapping of the most and the least legislatively covered areas and some preliminary conclusions about the existing gaps. Design and Methods The collection of the evidence-based policies was done through the PHGEN II project. The mapping covered the meta-level (international, European general guidelines). The expert opinion of the partners of the project was required to reflect on and grade the collected evidence. Results An analysis of the evidence was made by the area of coverage: using the list of important policy areas for successful introduction of genome-based technologies into Public Health and the Public Health Genomics Wheel (originally Public Health Wheel developed by Institute of Medicine). Conclusions Severe inequalities in coverage of important issues of Public Health Genomics were found. The most attention was paid to clinical utility and clinical validity of the screening and the protection of human subjects. Important areas such as trade agreements, Public Health Genomics literacy, insurance issues, behaviour modification in response to genomics results etc. were paid less attention to. For the successful adoption of new technologies on the Public Health level the focus should be not only on the translation to clinical practice, but the translation from bench to Public Health policy and back. Coherent and consistent coverage of all aspects of the translation of genome based information and technologies is of outmost importance.