Moving from a universal to targeted child health programme: which children receive enhanced care? A population-based study using routinely available data

The U-Shaped Effect and Its Reversal Mechanism of Export and Innovation—Evidence From Chinese Industrial Enterprises

Chinese firms are advancing their internationalization process at a surprisingly rapid pace, which is at odds with the descriptions of mainstream theories of corporate internationalization, such as the internalization theory and the eclectic theory of international production. In this context, a large number of existing literatures have examined the learning-by-export effect but have not agreed on its advantages. In the framework of recombinatory view of innovation, we integrate the resource-based view and the institution-based view, taking Chinese industrial enterprises as the research object, taking the export intensity and the output value of new products as the main indicators. We using the fixed effect model based on the Chinese Industrial Enterprise Database construction with China’s Marketization Index. Then this study aims to examine the relationship between exports and innovation. Research results show a non-linear effect, that is U-shaped relationship between exports and innovation; furthermore, the relationships are influenced by institutional factors at the provincial level. The institutional development level is a reverse mechanism of relationship between exports and innovation; when the institutional development level is higher, the relationship between exports and innovation has an inverted U shape. The findings enhance the understanding of export innovation from the perspective of resources and institutions, and export enterprise innovation management can benefit from its significant insights.

Perceived needs for team-based visits in Swedish child healthcare services exceed its existence-A mixed-methods study targeting healthcare professionals

AIM

To investigate both quantitatively and qualitatively the differences between participation in team-based visits (TBVs) and perceived needs for TBVs from the perspectives of healthcare professionals, in the context of the Swedish 3-tier national Child Healthcare programme.

METHODS

A study-specific questionnaire, including multiple-choice questions with fixed and free-text response options, was developed, and used. To capture healthcare professionals' experiences and find explanations for the quantitative results in qualitative data, a convergent parallel mixed-methods study design was used. Descriptive statistics and McNemar's test were used to analyse the quantitative data, and content analysis was used to analyse the qualitative data.

RESULTS

Healthcare professionals perceived the need for TBVs in the Swedish Child Healthcare Services (CHS) to a high extent. The largest difference between the perceived need for TBVs and experienced TBVs was for indications associated with psychosocial problems. The quantitative findings were explored by the qualitative findings. Both individual and organisational factors influenced TBVs.

CONCLUSION

Perceived needs for TBVs in Swedish CHS exceed its existence. Healthcare professionals require TBVs delivered by interprofessional teams, in line with proportionate universalism. Accordingly, organisational structures (e.g. colocation and clear instructions on how to distribute TBVs) and human resources (e.g. psychologists and social worker) are needed.

Realist evaluation of an enhanced health visiting programme

Background

The health visitors’ role in many countries is changing. In Scotland, the role has undergone substantial changes through the introduction of an enhanced health visiting programme, which includes increased, structured home visits. This evaluation was conducted within NHS Ayrshire and Arran, one of the 14 Scottish Health Boards. Our aim was to understand and explain how, and why, the programme could contribute to improving health and wellbeing outcomes for children and families.

Methods

We used a realist evaluation approach, conducted in three phases. In phase one, eight managerial staff involved in developing and implementing the programme provided data, which were used to develop initial programme theories. In phase two, the programme theories were tested using qualitative data from 25 health visitors and 22 parents. The programme theories were refined through analyses and interpretation of data in phase three.

Results

The home visiting context provided by the programme interacted with the mechanisms of the programme and produced outcomes such as early identification of health and wellbeing issues amongst families who needed more support, leading to referral and engagement with sources of additional help. The home visits facilitated development of parent-health visitor relationships, and parents considered health visitors as their first point of contact on children’s wellbeing and developmental-related issues. Moreover, the programme provided more clarity to health visitors’ role, which in turn enhanced partnership working. However, there were aspects of the programme that may require further development. For instance, both parents and health visitors were concerned about the wide gaps between some home visits.

Conclusions

The enhanced health visiting programme increased opportunities for monitoring and early identification of health and wellbeing concerns. It created structures for a more efficient partnership working and ensured that the needs of children and families were supported. These benefits need to be evaluated further in an effectiveness study.

Improving team-based care for children: shared well child care involving family practice nurses

INTRODUCTION

Well child care (WCC) is the provision of routine preventative care and vaccinations to infants and children. In Canada, physicians provide the majority of this type of care, whereas in other developed countries, nurses provide most WCC. New models of shared care between nurses and family physicians should be explored.

OBJECTIVE

This pilot project aimed to evaluate the feasibility and acceptability of shared nurse-physician WCC for a cohort of healthy children.

METHODS

A total of 20 participants had nurse-physician alternating WCC visits, which were compared with physician-provided WCC visits. The feasibility was evaluated through chart audits and the acceptability was evaluated through interviews with the physicians, nurses, and the patients' parents.

RESULTS

The results showed that physicians and nurses discuss a similar percentage of Rourke Baby Record topics, and that families and clinic staff were accepting of this new model of care.

CONCLUSION

This intervention could liberate time for Canadian family physicians, thereby improving access to care.

Effects of simulated interventions to improve school entry academic skills on socioeconomic inequalities in educational achievement

Randomized controlled trial evidence shows that interventions before age 5 can improve skills necessary for educational success; the effect of these interventions on socioeconomic inequalities is unknown. Using trial effect estimates, and marginal structural models with data from the Avon Longitudinal Study of Parents and Children (n = 11,764, imputed), simulated effects of plausible interventions to improve school entry academic skills on socioeconomic inequality in educational achievement at age 16 were examined. Progressive universal interventions (i.e., more intense intervention for those with greater need) to improve school entry academic skills could raise population levels of educational achievement by 5% and reduce absolute socioeconomic inequality in poor educational achievement by 15%.