Child Contact Research Articles

Young children’s contact with their parents in jail and child behavior problems

Contact between incarcerated parents and their children can help maintain family relationships. However, links between parent–child contact and child behavior problems are understudied in young children, especially the contexts in which visits and other forms of contact occur. Data were collected from 157 parents incarcerated in one of two jails regarding contact with their young children (age 2–6), as well as children’s behavior problems. Findings indicated that jail site moderated the association between visit frequency and child behavior problems. At the jail that offered both on-site video and Plexiglas visits, with no security procedures for the on-site video visits, more frequent parent–child visits were associated with fewer child externalizing problems; however, in the jail that offered primarily Plexiglas visits, more frequent visits were associated with more child externalizing problems. Additionally, more phone calls related to more child externalizing behavior problems. This research has implications for policies and practices regarding contact between incarcerated parents and their young children.

The Association between Contact with Children and the Clinical Course of COVID-19.

Abstract We examined the association between contact with children and the clinical course of COVID-19 among COVID-19-positive adult patients. Participants completed a survey to assess demographics, medical information related to their COVID-19 diagnosis, contact with children at home and at the workplace. Patients were aged 45.68 ± 14.38 years, mostly female (72.1%), 842 were not hospitalized and 167 were hospitalized. At home, there were no differences between groups for the number of child contact hours or total child hours (hours × number of children) per week (Ps > 0.05). The number of children at home was greater among patients not hospitalized (P < 0.05), however this was no longer significant after controlling for covariates (P > 0.05). At the workplace, there were no differences between groups (all Ps > 0.05). Sub-group analysis found the proportion of patients that were treated in the intensive care unit (ICU) was greater among patients with no child contact (P < 0.05). A secondary analysis found that patients with no child contact had an increased likelihood of thromboembolism (P < 0.05) and a trend towards more overall COVID-19-related complications (P = 0.076). Overall, an association between contact with children and hospitalization was not found when adjusting for covariates. Sub-group analysis indicated a possible protective effect for more severe disease; however, these findings need further study.

Russko-Nemeckie Kontakty V Detskoy Literature XVIII-XX Vv [Russian-German Contacts in Children’s Literature, 18th-20th Century] ed. by Svetlana Maslinskaya

Russko-Nemeckie Kontakty V Detskoy Literature XVIII-XX Vv [Russian-German Contacts in Children’s Literature, 18th-20th Century] ed. by Svetlana Maslinskaya

Prevalence of Tuberculosis Infection among Adults of Thiruvananthapuram District of Kerala as Measured by Interferon Gamma Release Assay - A Cross-Sectional Study.

To achieve the goals of the end tuberculosis (TB) strategy, strategies for management of TB infection (TBI) have to be expanded. The first step to devise policies is to understand the distribution and determinants of TBI in the community. The objectives of the study were to estimate the prevalence of TBI using Interferon Gamma Release Assay (IGRA) and its determinants among the adult population of Thiruvananthapuram district, Kerala. A community-based, cross-sectional study using the stratified cluster sampling was carried out among the adults. TBI was detected using IGRA conducted on whole blood sample. Data on determinants were collected using a structured questionnaire by the face-to-face interview. The prevalence of TBI was estimated. Univariate and multivariate analysis was conducted to identify the determinants. Age standardized prevalence of TBI among 396 adults was 20.5% (95% confidence interval [CI] 16.52-24.48). On adjusting for the possible confounders, increasing age (adjusted odds ratio [OR] 1.028; 95% CI 1.008-1.048; P = 0.005), history of contact with active TB disease (adjusted OR 7.61; 95% CI 4.43-13.05; P < 0.001), childhood contact (adjusted OR 8.20; 95% CI 3.14-21.41; P < 0.001), and household contact (adjusted OR 10.12; 95% CI 5.39-18.98; P < 0.001) were found to be the determinants of TBI in this population. The present study observed that nearly one-fifth of the adult population in the Thiruvananthapuram district has TBI. For the programmatic management, factors such as increasing age and contact history may be considered for the elimination of TBI in the state.

Outcome of the first survey of atrazine in drinking water from Ijebu-North, South-West, Nigeria: Human health risk and neurotoxicological implications

No recognised study has been conducted to monitor atrazine residue in drinking water from rural agricultural areas in Nigeria and its potential health implications. In this ecotoxicological study, we monitored atrazine residue in 69 hand-dug wells (HDW), 40 boreholes (BH) and 4 major streams from all the 6 communities (Ago-Iwoye, Ijebu-Igbo, Oru, Awa, Ilaporu and Mamu) in Ijebu North Local Government Area, Southwest Nigeria. Values of atrazine obtained were further used to evaluate the non-carcinogenic risk associated with ingestion and dermal contact in adults and children as well as neurotoxicity assessment. A total of 41 HDW, 22 BH and the 4 streams were tested positive for atrazine, which was higher in HDW than BH and stream. Ago-Iwoye recorded the highest concentration of 0.08 mg/L in its HDW while the lowest concentration of 0.01 mg/L was recorded in HDW from Oru. Hazard Index values associated with ingestion and dermal for children and adults were below the acceptable limit. Atrazine at 0.01, 0.03 and 0.04 mg/L concentrations appears to trigger defence mechanisms capable of protecting the structural integrity of the brain, but significant (p < 0.05) alterations in the oxidative stress parameters, acetylcholinesterase activity, membrane-bound ATPase enzymes, neurotransmitters as well as mild degenerative changes were observed in the brain of rats exposed to atrazine at 0.08 mg/L. Atrazine at 0.01, 0.03 and 0.04 mg/L concentrations found in drinking water from Ijebu-North may not pose any threat to brain function, but concern should be raised at 0.08 mg/L.

Research on the Impact of Smart Phone Use on Children's Socialization

With the development of mobile Internet technology, smart phones play an increasingly important role in people's social life, and also gradually become an important companion in children's life. But at present, the content of children's access to mobile phones is mainly adult information with adults as the target group. Children's access to smart phones means that they are exposed to the adult information world without protection, which has an important impact on their socialization. This paper investigates children's smart phone contact behavior in the form of questionnaire, analyzes the impact of smart phone contact on children's socialization, and thinks that smart phone can help children understand society more comprehensively, cultivate calm personality, improve safety awareness, form correct communication concept, and clarify career ideal, At the same time, there are also some negative effects such as excessive use of mobile phones leading to children's personality loneliness, moral decline, social value distortion, Internet addiction and so on. Finally, from the family, school, society, government, media five aspects put forward corresponding strategies to reduce the negative impact of smart phones on children's socialization, so as to promote the development of children's socialization.

Computational approaches to understanding interaction and development.

Audio-visual recording and location tracking produce enormous quantities of digital data with which researchers can document children's everyday interactions in naturalistic settings and assessment contexts. Machine learning and other computational approaches can produce replicable, automated measurements of these big behavioral data. The economies of scale afforded by repeated automated measurements offer a potent approach to investigating linkages between real-time behavior and developmental change. In our work, automated measurement of audio from child-worn recorders-which quantify the frequency of child and adult speech and index its phonemic complexity-are paired with ultrawide radio tracking of children's location and interpersonal orientation. Applications of objective measurement indicate the influence of adult behavior in both expert ratings of attachment behavior and ratings of autism severity, suggesting the role of dyadic factors in these "child" assessments. In the preschool classroom, location/orientation measures provide data-driven measures of children's social contact, fertile ground for vocal interactions. Both the velocity of children's movement toward one another and their social contact with one another evidence homophily: children with autism spectrum disorder, other developmental disabilities, and typically developing children were more likely to interact with children in the same group even in inclusive preschool classrooms designed to promote interchange between all children. In the vocal domain, the frequency of peer speech and the phonemic complexity of teacher speech predict the frequency and phonemic complexity of children's own speech over multiple timescales. Moreover, children's own speech predicts their assessed language abilities across disability groups, suggesting how everyday interactions facilitate development.

Transmission of SARS-CoV-2 among children and staff in German daycare centres.

In daycare centres, the close contact of children with other children and employees favours the transmission of infections. The majority of children <6 years attend daycare programmes in Germany, but the role of daycare centres in the SARS-CoV-2 pandemic is unclear. We investigated the transmission risk in daycare centres and the spread of SARS-CoV-2 to associated households. 30 daycare groups with at least one recent laboratory-confirmed SARS-CoV-2 case were enrolled in the study (10/2020-06/2021). Close contact persons within daycare and households were examined over a 12-day period (repeated SARS-CoV-2 PCR tests, genetic sequencing of viruses, symptom diary). Households were interviewed to gain comprehensive information on each outbreak. We determined primary cases for all daycare groups. The number of secondary cases varied considerably between daycare groups. The pooled secondary attack rate (SAR) across all 30 daycare centres was 9.6%. The SAR tended to be higher when the Alpha variant was detected (15.9% vs. 5.1% with evidence of wild type). The household SAR was 53.3%. Exposed daycare children were less likely to get infected with SARS-CoV-2 than employees (7.7% vs. 15.5%). Containment measures in daycare programmes are critical to reduce SARS-CoV-2 transmission, especially to avoid spread to associated households.

An evaluation of the isoniazid preventive therapy program performance for under-fives in Kwekwe City, January 2019 - December 2020: a descriptive cross-sectional study.

Childhood tuberculosis (TB) is underserved in resource-constrained endemic areas. Zimbabwe National Tuberculosis Program recommends tuberculosis prevention treatment for children aged <5 years who are close contacts of smear-positive TB cases. The Isoniazid Preventive Therapy (IPT) program performance had never been evaluated since its inception in 2010. We therefore, assessed the IPT program's inputs, processes, outputs, and outcomes. We conducted a process evaluation using the logic model in Kwekwe City. We recruited twenty-seven health care workers from all the five municipal health facilities. Smear-positive guardians of under 5 children, health care workers, and registers were the study population. Data were collected using a questionnaire and checklists and presented as frequencies and proportions. The IPT program met requirements in provision of guidelines (10/10), screening tools (15/15) and on-the-job trainings done in all five health facilities. Isoniazid tablets supply and quarterly budgeting did not meet meeting program requirements. Fifty-nine out of 231 (25.5%) children contacts of sputum-positive TB patients were screened. Fifty-one of the 59 (86.4%) children were initiated on IPT, 42/51 (82.4%) completed the course, one developed TB, 3/51 were still on treatment and 5/51 were lost to follow up. No dropouts and deaths were recorded. Unavailability of drugs was a barrier to the IPT and negatively impacts the TB elimination program. Contact screening was the bottleneck in the successful implementation of the program. Adequate staff and provision of drugs might improve the program. We recommended the recruitment of more healthcare workers and the budget for the program.

Asymptomatic Scalp Carriage among Household Contacts of Children Affected by Tinea Capitis: A Prospective Study in the Metropolitan Area of Brussels, Belgium

Introduction: Tinea capitis (TC) is a superficial fungal infection affecting the scalp. The existence of asymptomatic carriers (ACs) could represent a potential reservoir responsible of (re)contamination and failure of treatment. No prospective studies on ACs in household contacts of TC patients in Europe have been published to date. Objectives: The aim of this study was to assess the prevalence of ACs in a cohort of household contacts of children who were diagnosed with TC in the metropolitan area of Bruxelles, Belgium. Methods: This prospective observational study was conducted from October 2015 to April 2016 at the Dermatology Department of the University Hospitals Brugmann, Saint-Pierre, Queen Fabiola Children Hospital. Results: Ninety-nine cases of TC from 95 different family circles were included. The main infectious agent identified was Microsporum audouinii in 53 cases. The mean age of TC patients was 5.8 years. Male/female ratio was 2.8. Eighty-one household contacts of TC patients were enrolled in the study. Two cases of ACs (5%) were identified. Conclusions: M. audouinii was the most common pathogen identified. The prevalence of ACs we report is on average higher compared to other European large cities. Larger prospective studies including all close contacts of affected patients are required in order to establish guidelines regarding identification and management of ACs.

Children between 9 and 13 years old as internet users

The paper presents the new new media as a contemporary and dominant space in children's lives. Most children begin to use the Internet when they are a few years old, for example, while watching cartoons. The online world can be both an opportunity and a threat to young users. The aim of the research was to determine whether children's growing interest in the Internet has a limiting impact on traditional ways of communication with peers and whether the increasing use of social networking sites by children is determined by the fear of exclusion from their circle of peers. The study was conducted with the use of an online survey distributed among children from the third, fifth, and seventh years of two Polish primary schools. The results include several conclusions regarding children's contact with the new media and their peers. The study showed that the majority of primary school pupils are regular users of the new new media, and their interest in new technologies increases with age.

Transmission of SARS-CoV-2 by children and young people in households and schools: A meta-analysis of population-based and contact-tracing studies

BackgroundThe role of children and young people (CYP) in transmission of SARS-CoV-2 in household and educational settings remains unclear. We undertook a systematic review and meta-analysis of contact-tracing and population-based studies at low risk of bias.MethodsWe searched 4 electronic databases on 28 July 2021 for contact-tracing studies and population-based studies informative about transmission of SARS-CoV-2 from 0 to 19 year olds in household or educational settings. We excluded studies at high risk of bias, including from under-ascertainment of asymptomatic infections. We undertook multilevel random effects meta-analyses of secondary attack rates (SAR: contact-tracing studies) and school infection prevalence, and used meta-regression to examine the impact of community SARS-CoV-2 incidence on school infection prevalence.Findings4529 abstracts were reviewed, resulting in 37 included studies (16 contact-tracing; 19 population studies; 2 mixed studies). The pooled relative transmissibility of CYP compared with adults was 0.92 (0.68, 1.26) in adjusted household studies. The pooled SAR from CYP was lower (p = 0.002) in school studies 0.7% (0.2, 2.7) than household studies (7.6% (3.6, 15.9) . There was no difference in SAR from CYP to child or adult contacts. School population studies showed some evidence of clustering in classes within schools. School infection prevalence was associated with contemporary community 14-day incidence (OR 1.003 (1.001, 1.004), p<0.001).InterpretationWe found no difference in transmission of SARS-CoV-2 from CYP compared with adults within household settings. SAR were markedly lower in school compared with household settings, suggesting that household transmission is more important than school transmission in this pandemic. School infection prevalence was associated with community infection incidence, supporting hypotheses that school infections broadly reflect community infections. These findings are important for guiding policy decisions on shielding, vaccination school and operations during the pandemic.

Child Contact Case Management-A Major Policy-Practice Gap in High-Burden Countries.

The 2021 Global Tuberculosis (TB) report shows slow progress towards closing the pediatric TB detection gap and improving the TB preventive treatment (TPT) coverage among child and adolescent contacts. This review presents the current knowledge around contact case management (CCM) in low-resource settings, with a focus on child contacts, which represents a key priority population for CCM and TPT. Compelling evidence demonstrates that CCM interventions are a key gateway for both TB case finding and identification of those in need of TPT, and their yield and effectiveness should provide a strong rationale for prioritization by national TB programs. A growing body of evidence is now showing that innovative models of care focused on community-based and patient-centered approaches to household contact investigation can help narrow down the CCM implementation gaps that we are currently facing. The availability of shorter and child-friendly TPT regimens for child contacts provide an additional important opportunity to improve TPT acceptability and adherence. Prioritization of TB CCM implementation and adequate resource mobilization by ministries of health, donors and implementing agencies is needed to timely close the gap.

Isoniazid preventive therapy in child household contacts of adults with active TB in Bamako, Mali.

Isoniazid preventive therapy (IPT) is known to reduce the risk of developing active TB in about 59% in children aged ⩽15 years. We assessed adherence, completion and adverse events among children who were household contacts of a newly diagnosed adult with smear-positive TB in Bamako, Mali. Children aged <15 years living in the same house with an adult smear-positive index case were enrolled in the study in the Bamako Region after consent was obtained from the parent or legal guardian. Adherence was assessed based on the number of tablets consumed during 6 months. A total of 260 children aged <15 years were identified as household contacts of 207 adult patients with smear-positive TB during the study period. Among all child contacts, 130/260 (50.0%) were aged 0-4 years and were eligible for IPT; 128/130 (98.5%) were started on IPT and 83/128 (64.8%) completed with good adherence at the end of the 6 months, and without any significant adverse events. We successfully implemented IPT with good acceptance, but low completion rate. The Mali National TB Program and partners should expand this strategy to reach more children in Bamako and the whole country and create greater awareness in the population.

Comprehensive Contact Tracing, Testing and Sequencing Show Limited Transmission of SARS-CoV-2 between Children in Schools in Norway, August 2020 to May 2021.

The role of children in the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in schools has been a topic of controversy. In this study among school contacts of SARS-CoV-2 positive children in 43 contact-investigations, we investigated SARS-CoV-2 transmission in Norway, August 2020–May 2021. All participants were tested twice within seven to ten days, using SARS-CoV-2 PCR on home-sampled saliva. Positive samples were whole genome sequenced. Among the 559 child contacts, eight tested positive (1.4%, 95% CI 0.62–2.80), with no significant difference between primary (1.0%, 95% CI 0.27–2.53) and secondary schools (2.6%, 95% CI 0.70–6.39), p = 0.229, nor by viral strain, non-Alpha (1.4%, 95% CI 0.50–2.94) and Alpha variant (B.1.1.7) (1.7%, 95% CI 0.21–5.99), p = 0.665. One adult contact (1/100) tested positive. In 34 index cases, we detected 13 different SARS-CoV-2 Pango lineage variants, with B.1.1.7 being most frequent. In the eight contact-investigations with SARS-CoV-2 positive contacts, four had the same sequence identity as the index, one had no relation, and three were inconclusive. With mitigation measures in place, the spread of SARS-CoV-2 from children in schools is limited. By excluding contact-investigations with adult cases known at the time of enrolment, our data provide a valid estimate on the role of children in the transmission of SARS-CoV-2 in schools.

Effectiveness of Neem Oil Upon Pediculosis

Background: It is widely accepted that the school environment favors in the spread of the infestation simply be- cause it affords opportunity for continual close contact of children. So the investigator motivated to try out neem oil application and to see its effect in children with pediculosis. Neem oil is available locally, is of low cost and effective for treating head lice. Objective: To test whether the neem oil is effective in the treatment of pediculosis among school children. Methods: An experimental research approach with true experimental design was used. The present study was conducted in the Don Bosco Beatitudes Orphanage, Vyasarpady, for control group and Dazzling Stone Orphanage for experimental group, Kundrathur. The sample size was 60 and was selected through simple random sampling method, 30 were assigned to control group and 30 were assigned to experimental group. The investigator used a demographic variable proforma, degree of pediculosis, observational checklist on signs and symptoms of pediculosis, and interview schedule on knowledge regarding prevention of pediculosis and a rating scale on the level of satisfaction on application of neem oil. Results In control group, there was no significant difference in the degree of pediculosis before neem oil application (M=2.70, SD=0.450) and after neem oil application (M=2.73, SD=0.450). In contrast, in the experimental group, degree of pediculosis was decreased (M=0.70, SD=0.466) when compared to the degree of pediculosis before neem oil application (M=2.73, SD=0.450). The difference was found to be statistically significant at p&lt; 0.001 degree of pediculosis and it can be attributed to the effectiveness of neem oil application. Most of the children (73.3%) were highly satisfied and only a significant percentage of children (26.7%) were satisfied with the neem oil application in the experimental group. Conclusion: It is possible to reduce pediculosis by the application of neem oil among school children.

Provision of Decentralized TB Care Services: A Detect-Treat-Prevent Strategy for Children and Adolescents Affected by TB.

In this review, we discuss considerations and successful models for providing decentralized diagnosis, treatment, and prevention services for children and adolescents. Key approaches to building decentralized capacity for childhood TB diagnosis in primary care facilities include provider training and increased access to child-focused diagnostic tools and techniques. Treatment of TB disease should be managed close to where patients live; pediatric formulations of both first- and second-line drugs should be widely available; and any hospitalization should be for as brief a period as medically indicated. TB preventive treatment for child and adolescent contacts must be greatly expanded, which will require home visits to identify contacts, building capacity to rule out TB, and adoption of shorter preventive regimens. Decentralization of TB services should involve the private sector, with collaborations outside the TB program in order to reach children and adolescents where they first enter the health care system. The impact of decentralization will be maximized if programs are family-centered and designed around responding to the needs of children and adolescents affected by TB, as well as their families.

Infektionsgeschehen und Eind\xe4mmungsma\xdfnahmen in Kitas w\xe4hrend der COVID-19-Pandemie\xa0\u2013 Erkenntnisse aus der Corona-KiTa-Studie

ZusammenfassungHintergrundKindertageseinrichtungen (Kitas) spielen eine wichtige gesellschaftspolitische Rolle; gleichzeitig begünstigt der enge Kontakt der Kinder in Kitagruppen untereinander und mit Beschäftigten die Übertragung von Infektionen. In der COVID-19-Pandemie ergaben sich die Fragen, wie Infektionsgeschehen in Kitas verlaufen, welche Rolle Kitakinder in der Pandemie spielen und welche Schutz- und Hygienemaßnahmen in Kitas umgesetzt werden. Von 06/2020 bis 12/2021 wird die „Corona-KiTa-Studie“ durchgeführt, in der pädagogische und infektionsepidemiologische Themen gemeinsam bearbeitet werden.MethodenIn der Studie werden Daten aus unterschiedlichen Quellen erhoben. Es werden amtliche Meldedaten sowie wöchentliche Angaben von Kitas im sog. KiTa-Register kontinuierlich ausgewertet. Zudem werden SARS-CoV-2-Ausbrüche in Kitas vor Ort durch wiederholte Probengewinnung und Befragungen untersucht.ErgebnisseDas SARS-CoV-2-Infektionsgeschehen in Kitas bzw. bei Kindern im Kitaalter war von 03/2020 bis 05/2021 sehr dynamisch. In der 2. und 3. Pandemiewelle stiegen SARS-CoV-2-Ausbrüche in Kitas deutlich an, begleitet von einer erheblichen Zunahme an Kita- und Gruppenschließungen. Zuletzt erhöhte sich der Anteil der betroffenen Kinder bei den Ausbrüchen kontinuierlich. Allerdings ergab die erste Untersuchung von SARS-CoV-2-Ausbrüchen (n = 28), dass bei kindlichen Indexfällen im Schnitt nur ein Bruchteil der Kitakontakte (6,8 %) angesteckt wurde. Die Übertragungshäufigkeiten unterschieden sich zwischen einzelnen Kitas deutlich.DiskussionDie Zusammenführung von regelmäßig erhobenen Melde- und Befragungsdaten sowie Ausbruchsuntersuchungen ermöglicht ein vielschichtiges Monitoring des Infektionsgeschehens in Kitas, dessen Ergebnisse in Empfehlungen für Public-Health-Maßnahmen einfließen können.

Intercountry adoption swimming against the tide: Restitution in Samoa

Intercountry adoption (ICA) is a contested practice represented by competing discourses of humanitarianism, exploitation, poverty and wealth. Multiple factors have contributed to decreasing numbers of adoption globally including documented incidents of fraud which have accumulated over the last two decades. There is little recompense for families subjected to the fraudulent removal of their children, the children, and adoptive parents who are also defrauded. This article reports on the troubled progression of fraudulent ICA, presents a case of fraud and novel restitution in Samoa and concludes that restitution pathways should also facilitate contact and reunification of children with their families.

Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark: a nationwide register study

BackgroundWhile underlying mechanisms and pathways of social inequalities in cancer survival have been extensively examined in adults, this is less so for children with cancer. Hypothesized mechanisms include prediagnostic utilization of and navigation through the health care system, which may differ by socioeconomic resources of the families. In this nationwide register-based study we investigated the association between measures of family socioeconomic position in relation to prediagnostic health care contacts and stage of disease at diagnosis in children with cancer in Denmark.MethodsWe identified all children diagnosed with a cancer at ages 0–15 years in 1998–2016 (N = 3043) from the Danish Childhood Cancer Registry. We obtained comprehensive information on measures of socioeconomic position, parental health and prediagnostic contacts to both general practitioners and hospitals 24 months prior to diagnosis from various national registries. We fitted multivariable conditional logistic regression models for the association of family socioeconomic and health-related variables with firstly, frequent health care contacts and secondly, advanced stage.ResultsWe found higher odds ratios (OR) of frequent both overall and emergency health care contacts in the last 3 months before diagnosis in children from households with short parental education and mixed affiliation to work market, when compared to children with high family socioeconomic position. Further, children of parents with depression or of non-Western origin, respectively, had higher OR for frequent overall and emergency contacts. We found no association between socioeconomic position, parental health and stage of disease.ConclusionFamilies with socioeconomic disadvantage, non-Western origin or depression more frequently utilize prediagnostic health care services, both generally and in the acute setting, indicating that some disadvantaged families may struggle to navigate the health care system when their child is sick. Reassuringly, this was not reflected in disparities in stage at diagnosis. In order to improve the diagnostic process and potentially reduce health care contacts, attention and support should be given to families with a high number of health care contacts over a short period of time.