Care Infrastructure Research Articles

Patients with crush syndrome and kidney disease: lessons learned from the earthquake in Kahramanmaraş, Türkiye

This study investigated in-hospital outcomes and related factors in patients diagnosed with postearthquake crush syndrome after the earthquakes in Kahramanmaraş, Türkiye. One thousand twenty-four adult patients diagnosed with crush syndrome were analyzed. Data on demographic characteristics, clinical presentation, laboratory values, treatments, and outcomes were collected. A total of 9.8% of patients died during their hospital stay. Nonsurvivors were generally older, more likely to have preexisting chronic kidney disease, and faced more severe injuries and complications, including hypotension-shock, arrhythmias, elevated markers of renal dysfunction, and higher rates of acute kidney injury (AKI) and compartment syndrome. In addition, intensive care unit needs were higher. Multivariate analysis confirmed that age, injury severity, shock, high potassium, uric acid, and lactate levels on admission, development of AKI, compartment syndrome, and intensive care unit admission were significant predictors of mortality. Better disaster preparedness and improved health care infrastructure could be potential explanations for improved in-hospital mortality in the current era, as compared to previous earthquakes.

Cross-national characteristics and differences in type 2 diabetes: Malta versus Luxembourg

Abstract Introduction Type 2 diabetes mellitus (T2DM) is a significant global health concern, requiring a thorough understanding of its population-level features and impact. This study aims to compare the characteristics of T2DM in Malta and Luxembourg, two European nations with distinctive healthcare systems and societal attributes. Methods Data from national health surveys conducted in Malta and Luxembourg, encompassing various factors such as socio-demographics, medical history, biochemical metrics, and anthropometric measurements, were analysed to investigate the features of T2DM. Comparative analyses were conducted utilizing chi-square tests, independent t-tests, and multivariable binary regression. Results Malta (8.23%) and Luxembourg (7.82%) shared similar T2DM prevalence, with a predominance of men having T2DM. Malta exhibited a higher prevalence of obesity among the individuals having T2DM. Multivariable analysis showed no significant association between living in Malta or Luxembourg and diabetes. However, being male (OR: 1.49, CI 95%: 1.07–2.08, p = 0.02), an occasional smoker (OR: 2.49, CI 95%: 1.54–4.03, p < 0.01), increasing age (OR: 1.05, CI 95%: 1.03–1.67), and larger waist circumference (OR: 1.02, CI 95%: 1.01–1.04, p = 0.01) were positively associated with diabetes. Conclusions Understanding similarities and differences in T2DM between Malta and Luxembourg is crucial for identifying common challenges to formulate effective prevention and management strategies. Despite similar T2DM prevalence rates, notable differences in obesity rates and socioeconomic factors may contribute to disparities in disease burden. The complex interplay of numerous population characteristics underscores the importance of tailored public health interventions. This study accentuates the need for interventions and evidence-based policies to address modifiable risk factors, and advocate for cross-national cooperation to reduce the T2DM epidemic, especially in the context of post-COVID public health planning and resource allocation. Key messages • Malta and Luxembourg share similar T2DM prevalence despite differences in other factors, hypothesised to be attributed to differences in risk factor profiles and health care infrastructure. • This study underscores the necessity for tailored interventions and cross-national cooperation to address common challenges in T2DM management in the two small countries.

Demographic challenges in the context of the state policy of the Russian Federation in the sphere of maternity and childhood protection

The article examines current demographic trends in Russia in comparison with population changes based on data from the Federal State Statistics Service of Russia (Rosstat) and the UN Population Division. The specifi cs of the age structure of the population of Russia, formed by a number of demographic waves, are such that changes in the number of births and the size of age groups occur in waves; this trend will continue in the coming decades. The state policy of the Russian Federation in the fi eld of family support, aimed at increasing the total fertility rate from 1.3 to 1.6 by 2030 and to 1.8 by 2036, should provide for the introduction of new health-preserving and reproductive health protection technologies, the development of childhood infrastructure, antenatal clinics and perinatal centers for high-quality and aff ordable medical care for mothers and children.

Under pressure: Care, capacity and organ donation

In this paper, I seek to theorise the concept of pressure in relation to families’ experiences of organ donation during COVID-19. Drawing on Australia-based fieldwork, I follow circuitries of pressure in and beyond interiorities of bodies, biographies and infrastructures of care to ask what happens when pressure builds to such an extent that there is no capacity left in bodies and in institutions. Pressure concentrates in some spaces and bodies more than others revealing uneven flows and restrictions to care. But how might a theorisation of pressure enable care to be imagined otherwise – to circulate differently? Extending recent care scholarship, I explore alternative versions of care enacted by families and clinicians involved in organ donation. This is an expansive and capacious care, which may offer potential to diffuse the force of pressure through radical interdependence.

Prevalence of hypertension and factors associated with the utilization of primary health care services for hypertension among hypertensive population aged 40 years and above in Pyin Oo Lwin Township, Myanmar.

Utilization of hypertension services at primary health care levels has not been assessed at township level, since launching of PEN interventions in Myanmar. This study aimed to determine the factors associating with the utilization of primary health care services for hypertension among 40 years and above hypertensive population. Community-based cross-sectional study was done in Pyin Oo Lwin Township, 2023. Multi stage sampling was conducted to recruit 40 years and above participants; response rate was 85%. Joint National Committee (JNC7) classification was used to define hypertension. Among hypertensive participants, descriptive analysis, Chi squared test and multiple logistic models were conducted, with a significance level of 0.05. Out of 1001 screening participants, prevalence of hypertension was 38.6% (386). Among 386 participants, 51.8% (200) utilized primary health care services provided by public health facilities. Rural residents (AOR = 2.79, CI = 1.68, 4.67), known hypertension (AOR = 4.36, CI = 2.39, 8.23), good perception on hypertension (AOR = 0.30, CI = 0.14, 0.62), perceived cost of travel as necessary (AOR = 0.57, CI = 0.35, 0.92) and awareness of available services (AOR = 4.11, CI = 2.55, 6.71) were associated with the utilization of primary health care services for hypertension. This study provided context-specific scientific evidence to tackle existing problems of low utilization of PHC services for hypertension. Strengthening health care infrastructure for quality hypertension care at primary health care level was also recommended.

Current Diagnosis of Bleeding Disorders in Lower Income Countries.

There have been considerable advances in diagnosing and treating bleeding disorders. But the scenario remains dismal in resource-constrained settings in low and lower-middle-income countries (LMICs). Seventy-five percent of the patients with inherited bleeding disorders do not get diagnosed in LMICs. In resource-constrained settings, infectious disease and malignancies take the major focus. Bleeding disorders do not get prioritised in LMICs, and this leads to underdiagnoses and suboptimal treatment. There are various challenges like financial status, inadequacy of health care infrastructure, lack of patient registry and lack of awareness across medical staff, general population and government stakeholders. The lack of skilled laboratory personnel and laboratory infrastructure for optimal bleeding disorder diagnosis adds on to the problem. World Federation of Hemophilia (WFH) has been at the forefront in developing strategies to overcome some of these inadequacies; however, more active participation of the stakeholders including patients, medical professionals and policy makers is the need of the hour. This review highlights the different challenges in LMICs in diagnosing bleeding disorders, the gap between high-income countries and LMICs and the possible strategies in closing the gap.

The Use of Remote Presence Robotic Tele-Presentation in Rural and Remote Canada: A Systematic Review.

Objective: One potential solution to limited health care in rural and remote regions is remote presence robotic tele-presentation to allow health care providers to care for patients in their home community via a robotic interface. We synthesized evidence regarding the use of remote presence robotic tele-presentation in rural and/or remote Canadian health settings. Methods: Medline, PubMed, and Embase were searched up to August 2023. Remote presence robotic tele-presentation refers to any robotic device used for the purpose of presenting and/or collecting patient information. Primary research was included if the patient was located in remote and/or rural Canada, featured remote presence robotic tele-presentation, and assessed patient, family, or clinician satisfaction, patient transport to nearby regional or urban center, health care costs, clinical outcomes, infrastructure outcomes, adverse events, or telementoring. Results: Six studies were included. Patients, nurses, and physicians all reported high levels of satisfaction when using the remote presence robotic tele-presentation. Fifty to sixty-three percent of patients were managed in their home community and did not require transfer to another center. Remote presence robotic sonography resulted in adequate imaging in 81% of first trimester ultrasound limited exams but was less useful for second trimester complete obstetric ultrasounds (20% adequate imaging). Two of eight laparoscopic colorectal surgeries had to be converted to open surgeries. Telerobotic ultrasound clinics resulted in a diagnosis in 70% of cases. Conclusions: Evidence suggests remote presence robotic tele-presentation is a safe and cost-effective approach to providing care in distant communities and can prevent some transfers and evacuations to tertiary hospitals.

Assessing the frontline competency gap: Emergency care perceptions among nurses in Yemen's conflict zone.

Nursing competencies in armed conflict situations are critical for effective response and recovery. This study explores nurses' perceptions regarding their competencies in armed conflict zones to identify areas of proficiency and those requiring further emphasis in training. This cross-sectional descriptive study adhered to the STROBE reporting guidelines. It used a validated questionnaire examining 47 different competencies for nursing in armed conflict zones, which were subsequently ranked to identify those that were valued most and least. In total, 102 questionnaires were returned (85% response rate). The highest-ranked competencies focused on immediate life-saving interventions and personal safety. In contrast, competencies involving broader disaster management, such as understanding organizational disaster plans, post-death care, and risk identification, ranked lower. This observation may indicate a tendency to prioritize direct clinical care over strategic planning and long-term recovery in disaster nursing education. This study highlights the critical need to strengthen emergency care competencies among nurses working in armed conflict zones in Yemen. Its findings underscore the importance of targeted training programs, particularly in complex trauma management and psychological first aid, to address nurses' self-identified competency gaps. Policy implications include prioritizing resource allocation for emergency care infrastructure, implementing competency-based deployment strategies, and ensuring access to mental health support for nurses in working conflict zones. These actions are essential for building a resilient nursing workforce capable of providing quality care amidst the unique challenges of armed conflict.

Austerity Measures and the Resilience of Zimbabwe's Healthcare System: Challenges and Solutions.

Austerity measures have become a contentious topic, shaping the landscape of health care systems around the world. As governments grapple with economic challenges, the impact of austerity on health care has emerged as a critical concern. This study focuses on the consequences of austerity actions adopted by the Zimbabwean government under the Transitional Stabilization Program (TSP) from August 2018 to December 2025. This research examines the impact of austerity measures on Zimbabwe's health care sector, exploring its connections with health infrastructure and resources, accessibility and affordability of health care, health funding, health care inequalities, and the health care workforce. Using a quantitative approach and data from 970 participants, including the general populace, health care providers, and government officials, significant positive correlations between austerity measures and these health care variables were identified. The findings indicated a noteworthy positive correlation between the independent variable "austerity measures" and five dependent variables: health care accessibility and affordability, health care inequalities, infrastructure and resources, health care funding, and health care workforce. The t-statistics values exceeded the threshold of 1.96, with values of 5.085, 3.120, 6.459, 8.517, and 3.830, respectively. These findings highlight the importance of considering the effects of austerity on health care access, health funding, health care inequalities, health workforce, health infrastructure and resources development. Policymakers should prioritize equitable resource allocation and targeted investments to strengthen the resilience of the health care system during economic challenges. Understanding these associations is crucial for evidence-based policy decisions and fostering a more equitable and resilient health care system in Zimbabwe.

Which factors influence the decision of hospitals to provide procedures on an outpatient basis? –Mixed-methods evidence from Germany

Shifting care from the resource-intensive inpatient setting to the more economically efficient outpatient sector is being promoted internationally by policymakers. Financial incentives are a major focus of such efforts because low levels of hospital outpatient care are attributed to differences in payment for inpatient and outpatient services. In Germany, however, there is significant variation in the extent to which hospitals provide outpatient care despite a uniform payment system. Therefore, other factors must be influencing German hospitals’ strategic decisions whether to offer outpatient care. While most research has focused on specific procedures or lacks empirical support, our study provides a comprehensive analysis of the factors beyond financial incentives that influence the provision of hospital outpatient services in Germany. We employed a mixed-methods approach, first contacting health care experts with in-depth knowledge of the hospital outpatient landscape to identify possible influencing factors and then conducting a comprehensive quantitative analysis of all German hospitals. Our findings suggest that policymakers seeking to promote hospital outpatient care should consider a broad range of factors. We found that a hospital's service mix, size, procedure volume, and emergency care infrastructure significantly affected the proportion of outpatient services it offered. Strategic hospital planning emphasizing specialization and adherence to minimum volume standards might therefore be a valuable policy tool. Our analysis also highlights the importance of demographic and socioeconomic factors, such as the regional share of single-person households, suggesting that a comprehensive policy framework should account for broader population characteristics and not just elements directly related to hospital care.

Governance intricacies in implementing regional shared care records: A qualitative study in the national health service, England.

This study explores the governance intricacies in establishing a large-scale information infrastructure for integrated care within the National Health Service of England. By focusing on the initial 5years of a regional interoperability program, we examine the challenges and dynamics of creating a unified system across organizational boundaries. A longitudinal multi-methods approach was utilized, collecting data through interviews with health and social care personnel involved in project governance, meeting observations, and document analysis. This provided an in-depth understanding of the processes and challenges of developing the regional interoperability program. This study reveals a dynamic negotiation process and evolving governance structures that must continuously adapt to integrate diverse systems. Key findings include challenges in reconciling multiplicity and heterogeneity, the importance of social learning and stakeholder adaptation, and the role of ongoing negotiation and collaborative group construction in implementing interorganizational infrastructures. This study underscores the necessity of continuous adaptation and negotiation among stakeholders in establishing effective governance of integrated care infrastructures. Social learning and active participation play pivotal roles in overcoming the challenges associated with system integration. Strategic insights from this research can guide stakeholders in developing sociotechnical solutions for digital interorganizational infrastructures in integrated care.

Managing Patients With COVID-19 in Armenia Using a Remote Monitoring System: Descriptive Study.

The COVID-19 pandemic has imposed immense stress on global health care systems, especially in low- and middle-income countries (LMICs). Armenia, a middle-income country in the Caucasus region, contended with the pandemic and a concurrent war, resulting in significant demand on its already strained health care infrastructure. The COVID@home program was a multi-institution, international collaboration to address critical hospital bed shortages by implementing a home-based oxygen therapy and remote monitoring program. The objective of this study was to describe the program protocol and clinical outcomes of implementing an early discharge program in Armenia through a collaboration of partner institutions, which can inform the future implementation of COVID-19 remote home monitoring programs, particularly in LMICs or low-resource settings. Seven hospitals in Yerevan participated in the COVID@home program. A web app based on OpenMRS was developed to facilitate data capture and care coordination. Patients meeting eligibility criteria were enrolled during hospitalization and monitored daily while on oxygen at home. Program evaluation relied on data extraction from (1) eligibility and enrollment forms, (2) daily monitoring forms, and (3) discharge forms. Over 11 months, 439 patients were screened, and 221 patients were managed and discharged. Around 94% (n=208) of participants safely discontinued oxygen therapy at home, with a median home monitoring duration of 26 (IQR 15-45 days; mean 32.33, SD 25.29) days. Women (median 28.5, mean 35.25 days) had similar length of stay to men (median 26, mean 32.21 days; P=.75). Despite challenges in data collection and entry, the program demonstrated feasibility and safety, with a mortality rate below 1% and low re-admission rate. Opportunities for operational and data quality improvements were identified. This study contributes practical evidence on the implementation and outcomes of a remote monitoring program in Armenia, offering insights into managing patients with COVID-19 in resource-constrained settings. The COVID@home program's success provides a model for remote patient care, potentially alleviating strain on health care resources in LMICs. Policymakers can draw from these findings to inform the development of adaptable health care solutions during public health crises, emphasizing the need for innovative approaches in resource-limited environments.

Compound Crises: The Impact of Emergencies and Disasters on Mental Health Services in Puerto Rico

Background: Mental health in Puerto Rico is a complex and multifaceted issue that has been shaped by the island’s unique history, culture, and political status. Recent challenges, including disasters, economic hardships, and political turmoil, have significantly affected the mental well-being of the population, coupled with the limitations in the accessibility of mental health services. Thus, Puerto Rico has fewer mental health professionals per capita than any other state or territory in the United States. Objective: This comprehensive review examines the impact of disasters on mental health and mental health services in Puerto Rico. Given the exodus of Puerto Ricans from the island, this review also provides an overview of mental health resources available on the island, as well as in the continental United States. This review identifies efforts to address mental health issues, with the intent of gaining a proper understanding of the available mental health services, key trends, as well as observable challenges and achievements within the mental health landscape of the Puerto Rican population. Design: A comprehensive search using the PRIMO database of the University of Central Florida (UCF) library database was conducted, focusing on key terms related to disasters and mental healthcare and services in Puerto Rico. The inclusion criteria encompassed studies on Puerto Rican individuals, both those who remained on the island and those who migrated post-disaster, addressing the mental health outcomes and services for adults and children. We included peer-reviewed articles published from 2005 onwards in English and/or Spanish, examining the impact of disasters on mental health, accessibility of services, and/or trauma-related consequences. Results: In this scoping review, we identified 39 studies addressing the mental health profile of Puerto Ricans, identifying significant gaps in service availability and accessibility and the impact of environmental disasters on mental health. The findings indicate a severe shortage of mental health services in Puerto Rico, exacerbated by disasters such as Hurricanes Irma and Maria, the earthquakes of late 2019 and early 2020 that followed, and the COVID-19 pandemic, resulting in substantial delays in accessing care, and limited insurance coverage, particularly in rural regions. Despite these challenges, efforts to improve mental health services have included substantial federal funding and community initiative aimed at enhancing care availability and infrastructure. Limitations include the use of a single database, language restrictions, and potential variability in data extraction and synthesis. Conclusions: This scoping review highlights the significant impact of disasters on mental health in Puerto Rico and the challenges in accessing mental health services exacerbated by disasters. Despite efforts, significant gaps in mental healthcare and services persist, emphasizing the need for more rigorous research and improvements in infrastructure and workforce to enhance mental health outcomes for Puerto Ricans both on the island and in the continental United States.

Un/met: a mixed-methods study on primary healthcare needs of the poorest population in Khyber Pakhtunkhwa province, Pakistan

BackgroundAccess of all people to the healthcare they need, without financial hardship is the goal of Universal Health Coverage (UHC). As UHC initiatives expand, assessing the needs of vulnerable populations can reveal gaps in the system which may be covered by relevant policies. In this study we (i) identify the met and unmet primary healthcare needs of the poorest population of Khyber Pakhtunkhwa province (KP), Pakistan, and (ii) explore why the gaps exist.MethodsWe used Leveque’s Framework of Patient-centred Access to Healthcare to examine unmet primary healthcare (PHC) needs and their underlying causes for the poorest population in four districts of Khyber Pakhtunkhwa province, Pakistan. Using a triangulation mixed methods design, we analysed data from a quantitative household survey of744 households, 17 focus group discussions with household members and, 11 interviews with healthcare providers.ResultsOur results show that indicate that despite service utilization, PHC needs were not met, primarily due to prohibitively high costs at each stage of access. Furthermore, gaps in outreach and information (approachability), and varying availability of medicines and diagnostics at facilities (appropriateness) the supply side as well as difficulties in navigating the system (inability to perceive) and adhering to prescriptions (inability to engage) on the demand side, also led to unmet PHC needs. Going beyond utilization, our findings highlight that engagement with care is an important determinant of met needs for vulnerable populations.ConclusionSocial health protection policies can contribute to advancing UHC for primary care. However, in our setting, enhancing communication and outreach, addressing gender and age disparities, and improving quality of care and health infrastructure are necessary to fully meet the needs of the poorest populations.

Exploring the Relationship Between COVID-19 Transmission and Population Mobility over Time

This study explores the dynamic relationship between COVID-19 transmission and transportation mobility, with an emphasis on understanding the time-varying bidirectional interplay across the different phases of the pandemic. To gain insight into this relationship, we analyzed county-level data on transmission and mobility patterns from the United States over a 74-week period using a comprehensive list of factors including: temporal factors, socio-demographics, health indicators, health care infrastructure attributes, and spatial factors. For our analysis, we proposed a simultaneous econometric model system that explicitly accounts for the bidirectional relationship between COVID-19 transmission and mobility patterns while also accounting for the influence of common unobserved factors on the two variables. The model results strongly support our hypothesis that COVID-19 transmission and mobility patterns are interconnected. Further, our findings show distinct phases of the bidirectional relationship influenced by behavior changes, vaccine availability, and the emergence of new variants. Additionally, we conducted a validation exercise on a hold-out sample to assess the robustness of our model. The results confirm the superiority of the simultaneous model system with enhanced interpretability and prediction capability. By analyzing data from several weeks for the COVID-19 pandemic, our study provides valuable insights into the evolving dynamics and potential strategies for future pandemics.

SWOT Analysis as the Basis for Marketing Strategy Formulation at RSIA YPK Mandiri Jakarta to Increase Patient Visits in 2016

This study examines the SWOT analysis conducted at RSIA YPK Mandiri Jakarta to develop effective marketing strategies aimed at increasing patient visits. Facing stiff competition within Jakarta’s healthcare sector, the hospital needs to strengthen its position to sustain its operations and growth. By focusing on internal strengths, such as specialized healthcare services in maternity and pediatric care and strategic infrastructure, the hospital can address some of the challenges posed by external factors like low public perception and economic fluctuations. The analysis identifies key weaknesses, including a limited service range and underutilization of hospital resources. Opportunities for collaboration with insurance providers like BPJS and the possibility of expanding service offerings to appeal to a broader demographic are also highlighted. Recommendations include service diversification, digital marketing strategies, and enhancing patient satisfaction through improved care quality. By leveraging its strengths and mitigating threats, RSIA YPK Mandiri is better positioned to boost patient engagement and meet evolving healthcare demands.

Urban social infrastructure and care: Japanese examples

ABSTRACT In response to the crisis of care created by the neoliberal capitalist era, many new concepts have emerged as part of the collective search for solutions to the care crisis, including care commons, caring cities and caring infrastructures. Care infrastructures as part of the urban social infrastructure are understood in this work as “everyday non-institutional care spaces” (Merkel, 2023). This study focuses on the infrastructures of care in contemporary Japanese cities. Based on six months of fieldwork in Japan in the spring of 2023, it explores the potential of the socio-economic endeavors of mostly Japanese women in major Japanese cities as a care infrastructure to support the care needs of different social groups. The paper presents two cases as culturally specific examples of Japanese care infrastructure. It contributes to the literature by showing that care is intertwined with the economy as a new social business model in contemporary Japan, in a different way from the more volunteer-based care infrastructures in other countries.

Cybersecurity Lessons From the Change Healthcare Attack

This Viewpoint describes the consequences of the ransomware attack on Change Healthcare and the need for increased cybersecurity measures in the health care infrastructure.

Disability, culture, and erased sexuality: curated raw narratives of disabled women with significant impairments in India

Disabled women with significant impairments (DWSI) are not adequately recognised within feminist disability studies. They face stigma, carnal taboos, and systemic exclusion from economies of desire and sexuality. Their voices are seldom heard, and their stories, when captured, are whitewashed. There is an urgent need for these women to gain voice and visibility as a unique category within the political spectrum of women with disabilities so that their unique challenges can be identified and their rights restored. In-depth research aimed at spotlighting their unique challenges and vulnerabilities using ‘raw narratives’ as a novel method, exposed their tabooed and otherwise censored embodied experiences. This paper presents a candid case study of one such woman in India using narrative inquiry and autoethnography. Carol Thomas’ notion of ‘impairment effects’ and Margrit Shildrick’s concept of ‘embodied precarity’ are used to highlight how impairment effects, coupled with inadequate care infrastructure in India, force disabled women with significant impairments into chronic states of dependency and precarity, leading to an internalised loss of self-worth and agency. The wider use of raw narratives as a lens to probe unspoken elements of human experience and further study of DWSI as a community could enrich feminist disability studies.

Rational or emotional decisions? Parents’ nonstandard work hours and the justifications for using informal childcare

ABSTRACT This study examined whether the number of weekly childcare arrangements for under-school-aged children is associated with parental nonstandard hours (e.g. evenings, nights, or irregular schedules) and the reasons and justifications parents working nonstandard hours give for using informal care arrangements. Using cross-sectional survey data of 359 Finnish parents with children aged 0–6 years, we found that nonstandard work hours, compared with standard daytime hours, were associated with a higher number of weekly care arrangements for children under 5 years old. Qualitative parental interviews (N = 27) further revealed three justifications for using informal care: ‘Leaning on parents’ values and desires’, ‘Disclaiming from actions potentially harming the child’, and ‘Balancing parents’ needs and the moral aspects of using informal childcare’. Our findings highlight that parents of young children tend to rely on multiple childcare arrangements during nonstandard work hours even in a country with a comprehensive institutional early childhood education and care (ECEC) infrastructure and affordable tax-based provision of around-the-clock care (i.e. extended hours ECEC). Furthermore, emotional-based reasons related to ensuring child well-being were emphasised over rational-based ones when parents provided justifications for using informal arrangements during nonstandard hours.