Publications
238 results found
Blair M, 2014, Optimizing Health in the Early Years, Et Hasadeh Quarterly Jounral of Children & Youth In Situations of Risk & Their Families
Nguyen DTK, Leung KK, McIntyre L, et al., 2013, Does Integrated Management of Childhood Illness (IMCI) training improve the skills of health workers? A systematic review and meta-analysis, PLoS One, Vol: 8, Pages: 1-13, ISSN: 1932-6203
BackgroundAn estimated 6.9 million children die annually in low and middle-income countries because of treatable illneses including pneumonia, diarrhea, and malaria. To reduce morbidity and mortality, the Integrated Management of Childhood Illness strategy was developed, which included a component to strengthen the skills of health workers in identifying and managing these conditions. A systematic review and meta-analysis were conducted to determine whether IMCI training actually improves performance.MethodsDatabase searches of CIHAHL, CENTRAL, EMBASE, Global Health, Medline, Ovid Healthstar, and PubMed were performed from 1990 to February 2013, and supplemented with grey literature searches and reviews of bibliographies. Studies were included if they compared the performance of IMCI and non-IMCI health workers in illness classification, prescription of medications, vaccinations, and counseling on nutrition and admistration of oral therapies. Dersminion-Laird random effect models were used to summarize the effect estimates.ResultsThe systematic review and meta-analysis included 46 and 26 studies, respectively. Four cluster-randomized controlled trials, seven pre-post studies, and 15 cross-sectional studies were included. Findings were heterogeneous across performance domains with evidence of effect modification by health worker performance at baseline. Overall, IMCI-trained workers were more likely to correctly classify illnesses (RR = 1.93, 95% CI: 1.66–2.24). Studies of workers with lower baseline performance showed greater improvements in prescribing medications (RR = 3.08, 95% CI: 2.04–4.66), vaccinating children (RR = 3.45, 95% CI: 1.49–8.01), and counseling families on adequate nutrition (RR = 10.12, 95% CI: 6.03–16.99) and administering oral therapies (RR = 3.76, 95% CI: 2.30–6.13). Trends toward greater training benefits were observed in studies that were conducted in lower resource settings and reported greater supervision.Conc
Ellis C, Roland D, Blair ME, 2013, Professional educational interventions designed to improve knowledge and uptake of immunisation., Community practitioner : the journal of the Community Practitioners’ & Health Visitors’ Association, Vol: 86, Pages: 20-3, ISSN: 1462-2815
The Healthy Child e-Learning Programme is a modular, educational intervention to support professionals to deliver the Healthy Child Programme (HCP). A group of clinical academics was convened to design an evaluation of the HCP e-Learning Programme. This article presents the findings of the literature review to identify a method of evaluating an educational intervention designed for professionals that improves knowledge. The discussion highlights the complexities of selecting an evaluation method that could be used or adapted for evaluating the HCP e-Learning Programme. The immunisation module was selected for evaluation, offering a number of measurable outcomes, including a secondary outcome measure of any increase in immunisation uptake in the evaluation population. Very few published papers were found evaluating educational interventions that were related to our search criteria, none of these papers evaluated the transfer of learning from the intervention against practice improvement outcomes or evaluated stakeholder perspectives. Evaluating an educational intervention with the aim of attributing improvements in practice solely to that intervention is complex and resulted in the task group mapping all the factors that occurred in the literature that may influence immunisation uptake to construct a conceptual framework to inform our evaluation design.
Wood R, Blair M, Wilson P, 2013, Trends in emergency hospital admissions of children: observations from Scotland., Archives of disease in childhood, Vol: 98, Pages: 1024-5, ISSN: 1468-2044
McAree T, Jacobs B, Manickavasagar T, et al., 2013, Vitamin D deficiency in pregnancy - still a public health issue, Maternal and Child Nutrition, Vol: 9, Pages: 23-30, ISSN: 1740-8695
Wolfe I, Thompson M, Gill P, et al., 2013, Health services for children in western Europe, The Lancet, Vol: 381, Pages: 1224-1234, ISSN: 0140-6736
Western European health systems are not keeping pace with changes in child health needs. Non-communicable diseases are increasingly common causes of childhood illness and death. Countries are responding to changing needs by adapting child health services in different ways and useful insights can be gained through comparison, especially because some have better outcomes, or have made more progress, than others. Although overall child health has improved throughout Europe, wide inequities remain. Health services and social and cultural determinants contribute to differences in health outcomes. Improvement of child health and reduction of suffering are achievable goals. Development of systems more responsive to evolving child health needs is likely to necessitate reconfiguring of health services as part of a whole-systems approach to improvement of health. Chronic care services and first-contact care systems are important aspects. The Swedish and Dutch experiences of development of integrated systems emphasise the importance of supportive policies backed by adequate funding. France, the UK, Italy, and Germany offer further insights into chronic care services in different health systems. First-contact care models and the outcomes they deliver are highly variable. Comparisons between systems are challenging. Important issues emerging include the organisation of first-contact models, professional training, arrangements for provision of out-of-hours services, and task-sharing between doctors and nurses. Flexible first-contact models in which child health professionals work closely together could offer a way to balance the need to provide expertise with ready access. Strategies to improve child health and health services in Europe necessitate a whole-systems approach in three interdependent systems - practice (chronic care models, first-contact care, competency standards for child health professionals), plans (child health indicator sets, reliable systems for capture and an
Roland D, Ellis C, Blair ME, et al., 2013, Assisting healthcare professionals in understanding drivers and barriers to improving pre-school immunisation uptake, Community Practitioner, Vol: 86, Pages: 28-31
Oberklaid F, Baird G, Blair M, et al., 2013, Children’s health and development: approaches to early identification and intervention., Archives of disease in childhood, Vol: 98, Pages: 1008-11, ISSN: 1468-2044
Many children arrive at school with problems of development and behaviour which affect their educational achievement and social interaction and can have lifelong consequences. There is a strong association between developmental vulnerability at school entry and a well-documented series of parent and family risk factors, often linked to social disadvantage. Strategies which are likely to make a difference to these children and improve outcomes include family support, high-quality early education and care programmes in the preschool years, and early detection of emerging problems and risk factors. The evidence suggests that these services and programmes are best delivered within a framework of progressive universalism–a universal basket of services for all children and families, with additional support commensurate with additional needs. This provides the best opportunity for early identification and appropriate intervention for emerging developmental problems and family issues that impact on children’s development. While there are a number of challenges that need to be addressed and overcome, such an approach is an important investment that will yield measurable educational, social and economic benefits over the long term.
Sivalokanathan S, McAree T, Jacobs B, et al., 2012, Vitamin D deficiency in pregnancy – a failure of public health policy?, BMC Proceedings, Vol: 6
Janson S, 2012, Child Public Health, 2nd edition, EUROPEAN JOURNAL OF PUBLIC HEALTH, Vol: 22, Pages: 295-295, ISSN: 1101-1262
Wood R, Stirling A, Nolan C, et al., 2012, Trends in the coverage of ’universal’ child health reviews: observational study using routinely available data, BMJ Open, Vol: 2, Pages: e000759-e000759, ISSN: 2044-6055
OBJECTIVES: Universally offered child health reviews form the backbone of the UK child health programme. The reviews assess children’s health, development and well-being and facilitate access to additional support as required. The number of reviews offered per child has been reduced over recent years to allow more flexible provision of support to families in need: equitable coverage of the remaining reviews is therefore particularly important. This study assessed the coverage of universal child health reviews, with an emphasis on trends over time and inequalities in coverage by deprivation.$$n$$nDESIGN: Assessment of the coverage of child health reviews by area-based deprivation using routinely available data. Supplementary audit of the quality of the routine data source used.$$n$$nSETTING: Scotland.$$n$$nPARTICIPANTS: Two cohorts of around 40 000 children each. The cohorts were born in 1998/1999 and 2007/2008 and eligible for the previous programme of five and the current programme of two preschool reviews, respectively.$$n$$nOUTCOME MEASURES: Coverage of the specified child health reviews for the whole cohorts and by deprivation.$$n$$nRESULTS: Coverage of the 10 day review is high (99%), but it progressively declines for reviews at older ages (86% for the 39-42 month review). Coverage is lower in children living in the most deprived areas for all reviews, and the discrepancy progressively increases for reviews at older ages (78% and 92% coverage for the 39-42 month review in most and least deprived groups). Coverage has been stable over time: it has not increased for the remaining reviews after reduction in the number of reviews provided.$$n$$nCONCLUSIONS: The inverse care law continues to operate in relation to ’universal’ child health reviews. Equitable uptake of reviews is important to ensure maximum likely impact on inequalities in children’s outcomes.
Blair M, 2011, Healthy Child Programme e learning, London UK
This project consists of 76 discrete e-learning sessions of 20 to 30 minutes duration aimed at all health professionals working with young children under the age of five years. It was produced with 13 editors and 56 authors. It is publicly available free of charge to all NHS employees.
Chandaria K, Daud KM, Syed F, et al., 2011, What are the views of local people about vitamin D and its health effects: a community focus group study, Archives of Disease in Childhood, Vol: 96, Pages: A11-A11, ISSN: 0003-9888
AimsThe aims of this project were to:Ascertain local perceptions about Vitamin D. Raise awareness about Vitamin D and its health effects. Explore how health information is obtained by members of the local community. Use local views to help direct future public health policy. MethodsMothers attending a local community centre were invited to participate in an interactive discussion and teaching session with local paediatricians about Vitamin D. Data were collected on demographics of the group, awareness of Vitamin D sources, and where they obtained health information. Participants were asked to feedback on the information gained from the session. Responses were collated and thematic analysis used to identify key themes. Results47 people attended the focus group. The group was mainly female and aged between 12-84 years. 33 (70%) participants were South Asian. The remainder were Black African or White. At the start of the session, 23 (50%) participants were aware of Vitamin D. 19 (40%) participants were aware of its sources and only 8 (17%) knew about the consequences of insufficiency. 12 (25%) of the group spent less than 1 h in the sun daily. Three major themes emerged during and following the session from the participants:Improved awareness of sources of Vitamin D. Improved knowledge about the consequences Vitamin D deficiency. Increased awareness of national Vitamin D recommendations. Participants suggested word-of-mouth, community websites and the local Gujarati newspapers as preferred information sources. GP and NHS branded materials were perceived as reliable and accurate sources. Participants reported that conflicting information given by health professionals and the use of jargon caused confusion and worry. The group reported specifically not being told about the importance of Vitamin D in breastfeeding infants and children. ConclusionA community based focus group discussion is an informative way to explore perceptions about Vitamin D. Public health
Kumar R, Lorenc A, Robinson N, et al., 2011, Parents’ and primary healthcare practitioners’ perspectives on the safety of honey and other traditional paediatric healthcare approaches, Child: Care, Health and Development, Vol: 37, Pages: 734-743, ISSN: 0305-1862
Traditional and complementary healthcare approaches (TCA) are widely used for children, often because of perceived safety. Honey is a traditional remedy for upper respiratory tract symptoms in infants. Health officials currently advise limiting honey use because of the risk of botulism.
McAree T, Manickavasagar T, Sivalokanathan S, et al., 2011, High levels of vitamin D deficiency in pregnancy - a failure of public health policy?, Archives of Disease in Childhood, Vol: 96, Pages: A1-A1, ISSN: 0003-9888
Aim: To assess Vitamin D status in a multiethnic pregnant population and to explore the effect of skin colour as a risk factor. Methods: The study was conducted at a large District General Hospital with approximately 5000 births per year. Self assigned ethnicity and other demographic data including age, body mass index, parity gestation and date of sampling, was extracted from the maternity database. Skin colour was derived from this self-declared ethnicity. Specimens were obtained from existing serum serology samples collected from pregnant women at their booking appointments. A data list was obtained for the 4864 deliveries between April 2008 and March 2009. A random anonymised sample of 384 women was selected using Microsoft Excel of which 346 had sufficient serum for analysis. Samples were analysed for 25 hydroxyvitamin D by Liquid Chromatography, tandem mass spectrometry. Levels <25 nmol/l were defi ned as deficient. Results: 76 (22%) of the women were Black, 165 (48%) Asian, and 105 (30%) were Caucasian. There was no statistically significant difference in ethnicity between women selected and not selected in the sample. Black and Asian were classified as ’dark’ and Caucasian as ’light’ skinned. 91% of the samples were taken in the fi rst or second trimester. 125 of 346 (36%) had Vitamin deficiency. 80% of dark skinned women and 29% of light skinned women had levels below 50 nmol/l. The median levels of 25 hydroxyvitamin D were significantly lower in the dark skinned group; median 25.70 nmol/l compared to the light skinned group; 70.5 nmol/l (p<0.0005; fi gure 1) There was no significant association with deficiency and gestation, obesity or parity in this sample. Conclusion: This is the fi rst multi ethnic population versus clinic sample in England which describes widespread vitamin D deficiency in pregnancy. Over a third of our population were deficient (<25 nmol/l), dark skinned mothers having more than double the risk of ligh
Blair M, DeBell D, 2011, Reconceptualising health services for school-age children in the 21st century., Archives of disease in childhood, Vol: 96, Pages: 616-618, ISSN: 0003-9888
Blair M, Stewart-Brown S, Waterston T, et al., 2010, Key concepts and definitions, Child Public Health, Publisher: Oxford University Press, Pages: 129-184, ISBN: 9780199547500
Blair M, Stewart-Brown S, Waterston T, et al., 2010, Child public health in practice – case scenarios, Child Public Health, Publisher: Oxford University Press, Pages: 237-294, ISBN: 9780199547500
Blair M, Stewart-Brown S, Waterston T, et al., 2010, Techniques and resources for child public health practice, Child Public Health, Publisher: Oxford University Press, Pages: 207-236, ISBN: 9780199547500
Blair M, Stewart-Brown S, Waterston T, et al., 2010, Child health and adult health, Child Public Health, Publisher: Oxford University Press, Pages: 185-206, ISBN: 9780199547500
Blair M, Stewart-Brown S, Waterston T, et al., 2010, Child public health—lessons from the past, Child Public Health, Publisher: Oxford University Press, Pages: 103-128, ISBN: 9780199547500
Blair M, Stewart-Brown S, Waterston T, et al., 2010, Why child public health?, Child Public Health, Publisher: Oxford University Press, Pages: 1-14, ISBN: 9780199547500
Blair M, Stewart-Brown S, Waterston T, et al., 2010, Child health in the UK and Europe, Child Public Health, Publisher: Oxford University Press, Pages: 15-32, ISBN: 9780199547500
Blair M, Stewart-Brown S, Waterston T, et al., 2010, Determinants of child health, Child Public Health, Publisher: Oxford University Press, Pages: 47-102, ISBN: 9780199547500
Blair M, Stewart-Brown S, Waterston T, et al., 2010, Child health in developing countries/the majority world, Child Public Health, Publisher: Oxford University Press, Pages: 33-46, ISBN: 9780199547500
Blair M, 2010, Promoting Children's Health, Paediatrics and Child Health, Pages: 174-178
Rudolf MCJ, Hunt C, George J, et al., 2010, HENRY: Development, pilot and long-term evaluation of a programme to help practitioners work more effectively with parents of babies and pre-school children to prevent childhood obesity, Child: Care, Health and Development, Vol: 36, Pages: 850-857, ISSN: 0305-1862
Despite epidemic numbers of obese and overweight pre-school children, professionals report a lack of confidence and self-efficacy in working with parents around lifestyle change. HENRY–Health Exercise Nutrition for the Really Young–trains health and community practitioners to work more sensitively and effectively with parents of babies and pre-school children around obesity and lifestyle concerns. Underpinned by the Family Partnership Model, reflective practice and solution-focused techniques, it offers face-to-face training and e-learning. This paper describes the development, pilot and evaluation of HENRY Sure Start Children’s Centres.
Lorenc A, Blair M, Robinson N, 2010, Parents’ and practitioners’ differing perspectives on traditional and complementary health approaches (TCAs) for children, European Journal of Integrative Medicine, Vol: 2, Pages: 9-14, ISSN: 1876-3820
Aim: To compare parents’ and practitioners’ perspectives on traditional and complementary healthcare approaches (TCAs) used for children in a multi-ethnic community. TCA includes not only complementary and alternative medicine (CAM) but also folk/ethno-medicine. Methodology: An exploratory qualitative study in multi-ethnic community settings and primary care in Northwest London. Eleven focus groups explored parents’ use of TCA for their children, sources of information, decision-making processes and communication with healthcare practitioners about TCA use. Translation was available. Semi-structured individual interviews were conducted with 30. GPs, nurses, health visitors and midwives to explore their attitudes, beliefs and knowledge. Sampling was purposive and iterative to capture the range of ethnicities. Data were analysed using Framework Analysis and Atlas.ti software. Results: A wide range of TCA was used for children. Parents’ and practitioners’ perspectives on TCA differed, including: definition, categorisation, plausibility, efficacy, epistemology and evidence. Parents’ perspectives were generally more pragmatic, including what was classified as TCA and how they evaluated effectiveness. Practitioners focussed on more theoretical issues, in particular approving of TCA with plausible mechanisms of action and research evidence. Parents relied on family members and other mothers to inform their TCA use. Discussion: Mismatch in perspectives and criteria regarding TCA may create communication problems during consultation. Practitioners need to appreciate the range and extent of TCA used for children and understand reasons behind this use. Discussions with families on whether these can be integrated with current medical treatment in a safe and acceptable way can then occur. ?? 2010 Elsevier GmbH.
Blair M, Stewart-Brown S, Waterston T, et al., 2010, Child public health., ISBN: 0-19-263192-6
Lorenc A, Robinson N, Blair M, et al., 2010, Paediatric outpatients’ use of CM, Focus on Alternative and Complementary Therapies, Vol: 11, Pages: 28-28, ISSN: 1465-3753
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