Imperial College London

Professor Mitch Blair

Faculty of MedicineSchool of Public Health

Professor of Paediatrics & Child Public Health
 
 
 
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Contact

 

+44 (0)20 8869 3881m.blair Website

 
 
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Location

 

River Island Academic Centre for Paediatrics and Child HealthNorthwick ParkNorthwick Park and St Marks Site

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Summary

 

Publications

Publication Type
Year
to

183 results found

Rigby M, Deshpande S, Blair M, 2019, Another blow to credibility in published data sources., Lancet, Vol: 394, Pages: 26-27

Journal article

Michaud P-A, Visser A, Vervoort J, Kocken P, Reijneveld S, Blair M, Alexander D, Rigby M, Weber M, Jansen Det al., 2019, Do European Union countries adequately address the healthcare needs of adolescents in the area of sexual reproductive health and rights?, Arch Dis Child

BACKGROUND AND OBJECTIVES: Adolescent sexual and reproductive health and rights (SRHR) are of particular relevance given their potential short-term or long-term health consequences. This study evaluates recommendations and policies regarding access to care in this area in 31 European countries (European Union (EU) plus Iceland, Norway and Switzerland). METHODS: As part of the EU funded Models of Child Health Appraised project, data were gathered using a 43-item questionnaire sent to experts responsible for collecting information in each country. RESULTS: Ten countries have not developed any formal policy or recommendation that guarantee the respect of confidentiality and the possibility of consulting a physician without parents knowing. Nearly half of the countries do not have centres specialised in adolescent healthcare, tackling comprehensive health issues or focusing specifically on SRH. Access to emergency contraception and information regarding pregnancy, including testing, is easy in most countries. However, oral contraception is delivered free of charge in only 10 countries. Twenty-three countries do not meet current standards in terms of providing policy-based pregnancy care, and only 13 have set up special programmes for pregnant adolescents. In only seven countries can adolescents definitely have their pregnancy terminated without their parents knowing (and in another seven countries in selected situations). CONCLUSION: The provision and availability of adolescent-friendly SRHR care are far from optimal in around half of the surveyed countries. These results call for the review and implementation of policies, specialised healthcare centres and training initiatives for primary care providers.

Journal article

Zdunek K, Schröder-Bäck P, Alexander D, Rigby M, Blair Met al., 2019, Contextual determinants of CHILDREN'S health care and policy in Europe, BMC Public Health, Vol: 19, ISSN: 1471-2458

BACKGROUND: The main objective of this study was to explore the contextual determinants of child health policies. METHODS: The Horizon 2020 Models of Child Health Appraised (MOCHA) project has one Country Agent (CA) in all 30 EU and EEA countries. A questionnaire designed by MOCHA researchers as a semi-structured survey instrument asked CAs to identify and report the predominating public and professional discussions related to child health services within the last 5 years in their country and the various factors which may have influenced these. The survey was issued to CAs following validation by an independent Expert Advisory Board. The data were collected between July and December 2016. The data was qualitatively analysed using software Nvivo11 for data coding and categorization and constructing the scheme for identified processes or elements. RESULTS: Contextual determinants of children's health care and policy were grouped into four categories. 1) Socio-cultural determinants: societal activation, awareness, communication, trust, freedom, contextual change, lifestyle, tolerance and religion, and history. 2) Structural determinants which were divided into: a) external determinants related to elements indirectly correlated with health care and b) internal determinants comprising interdependent health care and policy processes. 3) International determinants such as cross-nationality of child health policy issues. 4) The specific situational determinants: events which contributed to intensification of debates which were reflected by behavioural, procedural, institutional and global factors. CONCLUSIONS: The influence of context across European countries, in the process of children's health policy development is clearly evident from our research. A number of key categories of determinants which influence child health policy have been identified and can be used to describe this context. Child health policy is often initiated in reaction to public discontentment.

Journal article

Martakis K, Alexander D, Schloemer T, Blair M, Rigby M, Schröder-Bäck Pet al., 2019, Human papillomavirus vaccination and respect for children’s developing autonomy: Results from an European Union wide study, Journal of Child Health Care, ISSN: 1367-4935

Children’s rights to autonomy of choice are differently expressed throughout Europe. We explored differences regarding expressions of respect for children’s autonomy throughout Europe, using the procedure of human papillomavirus (HPV) vaccination offer as indicator. We used a mixed methods approach, utilizing an expert survey within the frame of “Models of Child Health Appraised” (MOCHA), among all 30 European Union (EU) and European Economic Area states. A questionnaire was designed using vignettes regarding the vaccine provision. Thirty MOCHA country agents were invited to respond from June 2017 to April 2018. In total, 28 country agents responded. We studied the following themes: (i) provision of informed consent, (ii) parental and medical paternalism, (iii) relevance of the child’s chronological age or maturity, and (iv) vaccination programs targeting boys. These are being handled differently across the region. We explored associations of these implemented practices with the national vaccine coverage rate across Europe. We used the processes of HPV vaccination to study child’s autonomy, the paradigm change toward libertarian paternalism and issues of sex-equity. Interestingly, greater respect for children’s autonomy tends to be associated with medium or high vaccination coverage rates and lower respect with lower rates. Respect and empowerment seem to have practical as well as moral benefits. Identifying and transferring the most suitable ethical approaches is crucial and should be strengthened.

Journal article

Blair M, Rigby M, Alexander D, 2019, Issues and Opportunities in Primary Health Care for Children in Europe The Final Summarised Results of the Models of Child Health Appraised (MOCHA) Project, Publisher: Emerald Publishing Limited, ISBN: 9781789733549

This book presents the scientific findings of a three-year project across 30 EU and EEA countries assessing primary care for children throughout the life-course, drawing from 20 academic partners' analysis of evidence produced by agents in ...

Book

Zdunek K, Schröder-Bäck P, Alexander D, Rigby M, Blair Met al., 2019, How does societal reaction to children's health issues contribute to health policy in Europe? Results of a survey., Child Care Health Dev, Vol: 45, Pages: 364-370

BACKGROUND: In the European context the awareness of societal responsibility for children's health has increased with greater attention to children's rights and child empowerment processes. Child health issues are considered particularly sensitive; thus, they often provoke strong societal reactions, which, as a consequence, influence national health policies across Europe. Effectiveness of societal influences increases with the involvement of various actors in the context. METHODS: A qualitative approach was used to identify the level of societal involvement in health decision-making. A questionnaire was sent to the Country Agents (CAs) of the Models of Child Health Appraised (MOCHA) project. CAs are contact points in each of the 30 participating in the project countries and were asked to identify strong public and professional discussions related to child health services in their countries. Data collection was undertaken between July and December 2016. RESULTS: Based on 71 case studies, we identified eight thematic patterns, which characterize societal reactions to the currently worrisome child health issues across Europe. We devoted our attention to the three most controversial: child vaccination, child poverty and child abuse. The cases described by the CAs show the broad perspective in the perception of child health problems. Child health issues involve the public and raise nationwide debates. Public concerns were directly or indirectly related to child health and depicted the national overtone. CONCLUSIONS: Concerns in Europe about child health care are twofold: they are devoted to systemic issues (indirect patient orientation) and to child health and well-being (direct patient orientation). The phenomenon of societal responsibility for children's health is important for the support of public acceptance of child health policy.

Journal article

Schröder-Bäck P, Schloemer T, Clemens T, Alexander D, Brand H, Martakis K, Rigby M, Wolfe I, Zdunek K, Blair Met al., A heuristic governance framework for the implementation of child primary health care interventions in different contexts in the European Union, INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Vol: 56, Pages: 46958019833869-46958019833869, ISSN: 1945-7243

To adopt and implement innovative good practices across the European Union requires developing policies for different political and constitutional contexts. Health policies are mostly decided by national political processes at different levels. To attain effective advice for policy making and good practice exchange, one has to take different models of governance for health into account. We aimed to explore which concepts of governance research are relevant for implementing child health policies in a European Union context. We argue that taking into account the insights of good intersectoral and multilevel governance in research and practice is essential and promising for future analyses. These governance concepts help to understand what actors and institutions are potentially of relevance for developing and implementing child-centric health care approaches not only within health care but also outside health care. The framework we developed has the potential to advise on and thus support effectively the spreading and implementation of good practices of child-centric health policy approaches across the European Union. With this heuristic framework, the variety of relevant stakeholders and institutions can better be mapped and taken into account in implementation processes. Also, the normative side-particularly stressing values that make governance "good governance"-is to be taken into account.

Journal article

Hoang U, James AC, Liyanage H, Jones S, Joy M, Blair M, Rigby M, Lusignan SDet al., 2019, Determinants of inter-practice variation in ADHD diagnosis and stimulant prescribing: Cross-sectional database study of a national surveillance network, BMJ Evidence-Based Medicine, ISSN: 2515-446X

Early recognition, identification and treatment of children with attention deficit hyperactivity disorder (ADHD) can reduce detrimental outcomes and redirect their developmental trajectory. We aimed to describe variations in age of ADHD diagnosis and stimulant prescribing among general practitioner practices in a nationwide network and identify child, parental, household and general practice factors that might account for these variations. Cross-sectional study of children aged under 19 years registered within a general practice in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network in 2016, RCGP RSC has a household key allowing parent and child details to be linked. Data from 158 general practices and 353 774 children under 19 were included. The mean age of first ADHD diagnosis was 10.5 years (95% CI 10.1 to 10.9, median 10, IQR 9.0-11.9) and the mean percentage of children with ADHD prescribed stimulant medications among RCGP RSC practices was 41.2% (95% CI 38.7 to 43.6). There was wide inter-practice variation in the prevalence of diagnosis of ADHD, the age of diagnosis and stimulant prescribing. ADHD diagnosis is more likely to be made later in households with a greater number of children and with a larger age difference between adults and children. Stimulant prescribing for children with ADHD was higher in less deprived practices. Older parents and families with more children fail to recognise ADHD and may need more support. Practices in areas of higher socio-economic status are associated with greater prescribing of stimulants for children with ADHD.

Journal article

Hoang U, Liyanage H, Coyle R, Godden C, Jones S, Blair M, Rigby M, de Lusignan Set al., 2019, Determinants of inter-practice variation in childhood asthma and respiratory infections: cross-sectional study of a national sentinel network, BMJ Open, Vol: 9, ISSN: 2044-6055

OBJECTIVES: Respiratory infections are associated with acute exacerbations of asthma and accompanying morbidity and mortality. In this study we explore inter-practice variations in respiratory infections in children with asthma and study the effect of practice-level factors on these variations. DESIGN: Cross-sectional study. SETTING: We analysed data from 164 general practices in the Royal College of General PractitionersResearch and Surveillance Centresentinel network in England. PARTICIPANTS: Children 5-12 years. INTERVENTIONS: None. In this observational study, we used regression analysis to explore the impact of practice-level determinants on the number of respiratory infections in children with asthma. PRIMARY AND SECONDARY OUTCOME MEASURES: We describe the distribution of childhood asthma and the determinants of upper/lower respiratory tract infections in these children. RESULTS: 83.5% (137/164) practices were in urban locations; the mean number of general practitioners per practice was 7; and the mean duration since qualification 19.7 years. We found almost 10-fold difference in the rate of asthma (1.5-11.8 per 100 children) and 50-fold variation in respiratory infection rates between practices. Larger practices with larger lists of asthmatic children had greater rates of respiratory infections among these children. CONCLUSION: We showed that structural/environmental variables are consistent predictors of a range of respiratory infections among children with asthma. However, contradictory results between measures of practice clinical care show that a purely structural explanation for variability in respiratory infections is limited. Further research is needed to understand how the practice factors influence individual risk behaviours relevant to respiratory infections.

Journal article

Rigby M, Deshpande S, Blair M, 2019, Credibility in published data sources, LANCET, Vol: 393, Pages: 225-226, ISSN: 0140-6736

Journal article

Deshpande S, Rigby M, Blair M, 2019, The Limited Extent of Accreditation Mechanisms for Websites and Mobile Applications in Europe, Pages: 158-161, ISSN: 0926-9630

© 2019 The authors and IOS Press. All rights reserved. A potentially useful resource for health promotion and guidance is eHealth. However, this field also presents challenges, and one of the most important obstacles is the lack of regulation, without which citizens including young people may be exposed to misleading or risky information and applications. The aim of this study was to investigate the extent of accreditation processes for mobile applications (apps) and websites in European countries, to determine whether regulation is on the agenda. A survey was conducted in 28 European Member States and 2 European Economic Area countries, between 2017 and 2018. Twenty-seven responses were collected. Six countries have accreditation processes for apps and eight countries have accreditation processes for websites. However, processes are fragmented and there is variety within and amongst countries.

Conference paper

Rigby M, Deshpande S, Blair M, 2018, Published Mortality Datasets – is Perfection the Enemy of Credibility?, European Journal of Public Health, Vol: 28, ISSN: 1101-1262

Journal article

Rigby M, Greenfield R, Deshpande S, Blair Met al., 2018, Are we Serious – and Ethical – about HPV Vaccination in Europe?, European Journal of Public Health, Vol: 28, ISSN: 1101-1262

Journal article

Rigby M, Greenfield R, Deshpande S, Blair Met al., 2018, Who holds Tetanus Records when they are Needed?, European Journal of Public Health, Vol: 28, ISSN: 1101-1262

Journal article

Blair M, Rigby M, Alexander D, 2018, Critical Factors for Child Primary: Child-Centricity, Core Principles and Context Sensitivity, European Journal of Public Health, Vol: 28, ISSN: 1101-1262

Journal article

Visser A, Kocken P, Reijneveld SA, Vervoort JPM, Michaud PA, Blair ME, Rigby Met al., 2018, Primary care in Europe: starting points to improve primary care from school health services and adolescent health services for children and adolescents, European Journal of Public Health, Vol: 28, ISSN: 1101-1262

Journal article

Zdunek K, Schröder-Bäck P, Vlasblom E, Lijster-van Kampen G, Kocken P, Rigby M, Blair Met al., 2018, European capacity to implement evidence-based child health policy, European Journal of Public Health, Vol: 28, ISSN: 1101-1262

Journal article

Brenner M, O'Shea MP, Larkin P, Luzi D, Pecoraro F, Tomburis O, Berry J, Alexander D, Rigby M, Blair Met al., 2018, Management and integration of care for children living with complex care needs at the acute-community interface in Europe, LANCET CHILD & ADOLESCENT HEALTH, Vol: 2, Pages: 822-831, ISSN: 2352-4642

Journal article

Brenner M, O'Shea MP, McHugh R, Clancy A, Larkin P, Luzi D, Pecoraro F, Olaso EM, Lignou S, Alma M, Satherley R-M, Tamburis O, Warters A, Wolfe I, Hilliard C, Berry J, Alexander D, Rigby M, Blair Met al., 2018, Principles for provision of integrated complex care for children across the acute-community interface in Europe, LANCET CHILD & ADOLESCENT HEALTH, Vol: 2, Pages: 832-838, ISSN: 2352-4642

Journal article

Blair M, Jansen D, Vervoort H, Visser A, Rigby M, Reijneveld M, Michaud P-A, Kocken Pet al., 2018, Integrated school health services in Europe: an overview, International Journal of Integrated Care, Vol: 18, Pages: 289-289, ISSN: 1568-4156

Journal article

Blair M, Well Child Care and Preventive Services in Europe, International Society for Social Paediatrics and Child Health

Conference paper

Blair M, Well Child Care in Europe - A Comparison of 26 Countries - A MOCHA Project, European Academy of Paediatric Societies

Conference paper

Blair M, Assessing Which Models of Child Health Services Provide Best Outcomes for Children and Young People in Europe - MOCHA Evaluation and Key Findings, European Academy of Paediatric Societies

Conference paper

Blair M, What Can European Community Pharmacies Offer Children and Young People? - A MOCHA Survey, European Academy of Paediatric Societies

Conference paper

Blair ME, Menon A, 2018, Community pharmacy use by children across Europe: a narrative literature review, Pharmacy, Vol: 6, ISSN: 2226-4787

The use of community pharmacies across Europe has potential to alleviate the burden on overstretched healthcare providers. Children and young people (0–18 years) account for a large number of primary care attendances. This narrative literature review between January 2000 and December 2017 examines the use of community pharmacy by paediatric patients in Europe. The results report both positive and negative perceptions of community pharmacy by parents and children, opportunities for an extended role in Europe, as well as the need for further training. The main limitations were the inclusion of English language papers only and an initial review of the literature carried out by a single researcher. It remains to be seen whether a ‘new-look’ role of the community pharmacist is practical and in alignment with specific European Commission and national policies

Journal article

Blair M, Early Years Theme of Northwest London, CLAHRC, 1st International Eurasian Congress of Social Pediatrics

Conference paper

Blair M, Which models of primary child health services provide best outcomes for children and young people in Europe? – MOCHA evaluation and key findings, European Forum for Primary Care

Conference paper

Blair M, Children and young people in primary care continue to remain relatively invisible, European Forum for Primary Care

Conference paper

Watson M, Blair M, 2018, Emergency departments and minor illness: Some behavioural insights, Archives of Disease in Childhood, Vol: 103, Pages: 309-310, ISSN: 0003-9888

Journal article

Blair M, Plumptre I, Tolppa T, 2018, G431(P) An audit of vaccination adherence and acceptability of opportunistic vaccination in inpatient paediatrics, Archives of Disease in Childhood, Vol: 103, Pages: A176-A176, ISSN: 1468-2044

Journal article

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