Publications
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Faitna P, Harwood R, Kenny SE, et al., 2024, Impact of the COVID-19 pandemic on the clinical management trends for acute appendicitis among the under-25s: a retrospective study, Archives of Disease in Childhood: Education and Practice Edition, Vol: 109, Pages: 339-346, ISSN: 0003-9888
OBJECTIVE: To describe the COVID-19 pandemic's impact on acute appendicitis management on children and young people (CYP). DESIGN: Retrospective cohort study. SETTING: All English National Health Service hospitals. PATIENTS: Acute appendicitis admissions (all, simple, complex) by CYP (under-5s, 5-9s, 10-24s). EXPOSURE: Study pandemic period: February 2020-March 2021. Comparator pre-pandemic period: February 2015-January 2020. MAIN OUTCOME MEASURES: Monthly appendicectomy and laparoscopic appendicectomy rate trends and absolute differences between pandemic month and the pre-pandemic average. Proportions of appendicitis admissions comprising complex appendicitis by hospital with or without specialist paediatric centres were compared. RESULTS: 101 462 acute appendicitis admissions were analysed. Appendicectomy rates fell most in April 2020 for the 5-9s (-18.4% (95% CI -26.8% to -10.0%)) and 10-24s (-28.4% (-38.9% to -18.0%)), driven by reductions in appendicectomies for simple appendicitis. This was equivalent to -54 procedures (-68.4 to -39.6) and -512 (-555.9 to -467.3) for the 5-9s and 10-24s, respectively. Laparoscopic appendicectomies fell in April 2020 for the 5-9s (-15.5% (-23.2% to -7.8%)) and 10-24s (-44.8% (-57.9% to -31.6%) across all types, which was equivalent to -43 (-56.1 to 30.3) and -643 (-692.5 to -593.1) procedures for the 5-9s and 10-24s, respectively. A larger proportion of complex appendicitis admissions were treated within trusts with specialist paediatric centres during the pandemic. CONCLUSIONS: For CYP across English hospitals, a sharp recovery followed a steep reduction in appendicectomy rates in April 2020, due to concerns with COVID-19 transmission. This builds on smaller-sized studies reporting the immediate short-term impacts.
Lazzarino A, Salkind JA, Amati F, et al., 2024, Inequalities in mental health service utilisation by children and young people: a population survey using linked electronic health records from Northwest London, United Kingdom, Journal of Epidemiology and Community Health, Vol: 78, Pages: 191-198, ISSN: 0143-005X
Background: Mental healthcare services for children and young people (CYP) are a very limited resource in the UK. To prevent health inequalities, measures to increase overall capacity must sit alongside measures that ensure utilisation matches need.Aim: Our aim was to identify subgroups of CYP with unexpectedly low mental health service utilisation, presumably representing unmet need, and to assess whether there is area variation in the socioeconomic gradient of mental healthcare use.Methods: This is a cross-sectional population survey of CYP (aged 5–24 years) using electronic health records from the Discover Now research platform, covering approximately 95% of the Northwest London resident population of 2.4 million people.Results: The total sample comprised 764 327 CYP, of whom 2.1% attended a mental healthcare appointment in 2021 (95% CI 2.1% to 2.2%), our outcome measure. Lower socioeconomic status (our main exposure factor) was related to higher occurrence of mental healthcare appointments (+5% for each quintile increase in deprivation (95% CI 2% to 7%, p<0.001]). However, interaction analyses showed that the boroughs with unexpectedly low utilisation rates were also those not showing a clear trend between socioeconomic conditions and services utilisation (interaction p<0.001), suggesting that in these boroughs the occurrence of mental disorders in disadvantaged people was not captured by our analysis based on service utilisation. In some London boroughs, we found lower-than-expected activity for the most disadvantaged CYP.Conclusions: The mental healthcare needs of many CYP from socioeconomically deprived areas of Northwest London may be unmet. More information is needed to confirm our results.
Nezafat Maldonado B, Lanoue J, Allin B, et al., 2024, Place of birth and postnatal transfers in infants with Congenital Diaphragmatic Hernia (CDH) in England and Wales: an observational cohort study, Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN: 1359-2998
Objective: To describe clinical pathways for infants with congenital diaphragmatic hernia (CDH) and short-term outcomes.Design: Retrospective observational cohort study using the UK National Neonatal Research Database (NNRD).Patients: Babies with a diagnosis of CDH admitted to a neonatal unit in England and Wales between 2012 and 2020.Main outcome measures: Clinical pathways defined by place of birth (with or without colocated neonatal and surgical facilities), transfers, clinical interventions, length of hospital stay and discharge outcome.Results: There were 1319 babies with a diagnosis of CDH cared for in four clinical pathways: born in maternity units with (1) colocated tertiary neonatal and surgical units (‘neonatal surgical units’), 50% (660/1319); (2) designated tertiary neonatal unit and transfer to stand-alone surgical centre (‘tertiary designated’), 25% (337/1319); (3) non-designated tertiary neonatal unit (‘tertiary non-designated’), 7% (89/1319); or (4) non-tertiary unit (‘non-tertiary’), 18% (233/1319)—the latter three needing postnatal transfers. Infant characteristics were similar for infants born in neonatal surgical and tertiary designated units. Excluding 149 infants with minimal data due to early transfer (median (IQR) 2.2 (0.4–4.5) days) to other settings, survival to neonatal discharge was 73% (851/1170), with a median (IQR) stay of 26 (16–44) days.Conclusions: We found that half of the babies with CDH were born in hospitals that did not have on-site surgical services and required postnatal transfer. Similar characteristics between infants born in neonatal surgical units and tertiary designated units suggest that organisation rather than infant factors influence place of birth. Future work linking the NNRD to other datasets will enable comparisons between care pathways.
Nugawela MD, Pinto Pereira SM, Rojas NK, et al., 2024, Data Resource Profile: the Children and Young People with Long COVID (CLoCk) Study., Int J Epidemiol, Vol: 53
Porras-Segovia A, Pascual-Sanchez A, Greenfield G, et al., 2023, Early risk factors for self-injurious thoughts and behaviours: a UK population-based study of 219,581 people, Behavioral Sciences, Vol: 14, ISSN: 2076-328X
Mental disorders are a major problem among young people. To identify early risk factors of self-injurious thoughts and behaviours (SITB) among young adults with mental health problems, this case-control study drew data from the Clinical Practice Research Datalink (CPRD), a primary care database covering 8% of the UK population. We explored the role of early factors (presenting at 8-14 years old) for suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI) in young adulthood (age 18-25 years) by performing logistic regressions. Our sample consisted of 219,581 participants, of which 6.51% had at least one SITB in young adulthood. Early risk factors for SITB included early NSSI, suicidal ideation, sexual abuse, behavioural problems, and mood and psychotic symptoms. Frequency of GP visits had a protective effect. Lack of access to mortality data, ethnicity, and socioeconomic status was a limitation of the current study. In conclusion, early symptoms in late childhood/early adolescence can be the start of long-standing problems going into adult life. The training of primary care providers in suicide risk assessment and proper co-ordination with child and adolescent mental health services are crucial for suicide prevention.
Hope S, Stepanova E, Lloyd-Houldey O, et al., 2023, This needs to be a journey that we're actually on together'-the introduction of integrated care systems for children and young people in England: a qualitative study of the views of local system stakeholders during winter 2021/22, BMC Health Services Research, Vol: 23, ISSN: 1472-6963
BACKGROUND: Integrated care has become a central feature of health system reform worldwide. In England, Integrated Care Systems (ICS) are intended to improve integration across public health, the National Health Service (NHS), education and social care. By April 2021, England had been divided into 42 geographical areas, each tasked with developing local ICS provision. However, it was not clear how ICSs would address the specific needs of children and young people (CYP). This study elicited the views of senior professional stakeholders in the first year of the ICS national roll out, to learn how integrated care for CYP was being implemented within the ICSs and future plans for service provision. METHODS: A qualitative analysis of in-depth interviews with stakeholders, including healthcare professionals, NHS managers and local authority leaders (n = 25) selected from a diverse sample of ICSs (n = 7) across England, conducted during winter 2021/22. Reflexive thematic analysis involving a collaborative coding approach was used to analyse interview transcripts. RESULTS: Four themes were identified, indicating challenges and opportunities for ICSs in relation to the health of CYP: 1) Best start in life (a more holistic approach to health afforded by integrated care); 2) Local and national contexts (tensions between local and national settings and priorities); 3) Funding and planning (instituting innovative, long-term plans using limited existing CYP funding streams); 4) Organisational complexities (integrating the work of diverse organisations). CONCLUSIONS: The views of stakeholders, provided at the beginning of the journey towards developing local ICS CYP provision, revealed a common aspiration to change focus from provision of acute, largely adult-orientated services towards one with a broader, population health remit, including prevention and early intervention. This would be delivered by integration of a range of local services, inclu
King T, Hui GC, Muschialli L, et al., 2023, Mental health interventions for children and young people with long-term health conditions in Children and Young People's Mental Health Services in England., Clin Child Psychol Psychiatry
BACKGROUND: Almost a quarter of children and young people (CYP) in England have a long-term health condition (LTC), which increases the risk of developing mental health difficulties. There is a lack of understanding regarding the routine provision and efficacy of mental health interventions for CYP with LTCs within Children and Young People's Mental Health Services (CYPMHS). METHODS: This study analysed national service-reported data in England from two secondary datasets. Data were submitted by services between 2011 and 2019. We evaluated data on the presence or absence of a serious physical health or neurological issue, and which interventions were offered. RESULTS: A total of 789 CYP had serious physical health issues and 635 had neurological issues. The most common interventions delivered to CYP in either group have some evidence in the literature. Most CYP showed improvements across a range of outcomes. CONCLUSIONS: This study found that prevalence rates and psychological intervention and outcome data were widely under-reported across both datasets, posing questions about their utility for this population. Such data would benefit from triangulation with data from other sources to understand pathways of care for these young people and the extent to which clinical datasets underreport the number of CYP with LTCs.
Hargreaves D, 2023, Integrated child health care: from policy to evidence-based practice., Lancet Child Adolesc Health, Vol: 7, Pages: 816-817
Navein A, Gonzalez-Viana E, Mehmeti A, et al., 2023, Barriers and facilitators to continuity and co-ordination of healthcare for under 18 years old: a systematic review., Arch Dis Child, Vol: 108, Pages: 783-788
OBJECTIVE: To determine views and experiences of babies, children and young people relating to continuity of their healthcare. DESIGN: Qualitative systematic review. SETTING: Primary research from UK settings where NHS-commissioned or local authority-commissioned healthcare is provided. Systematic reviews from UK and non-UK high-income countries. POPULATION: Babies, children and young people under 18 years old with experience of healthcare. Parental and/or carer perspectives only included if children are under 5 years old or unable to express their own view. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Thematic analysis of the benefits and facilitators to continuity of care for babies, children and young people. RESULTS: 20 047 abstracts were screened; 186 full-text articles were reviewed; 11 papers fulfilled the review criteria. From these, four main themes and 14 subthemes were identified. The theme 'individuals' had four subthemes: 'knowledge of healthcare system', 'support', 'personal lives' and 'results'. The theme 'healthcare professionals' had four subthemes: 'interservice communication', 'collaboration with babies, children and young people', 'communications' and 'relationships with healthcare professionals'. The theme 'practical' had four subthemes: 'colocation', 'appointment times', 'referrals' and 'waiting times'. The theme 'technological' had two subthemes: 'ease of use' and 'complements current healthcare management'. CONCLUSIONS: Continuity of healthcare for babies, children and young people can enhance clinical outcomes but requires active facilitation by healthcare providers and services, especially in circumstances where individuals or their families are less able to advocate for themselves. A range of barriers and facilitators were identified together with recommendations for enhancing continuity of care. PROSPERO REGISTRATION NUMBER: CRD42019145566.
Ram B, Van Sluijs E, Chalkley A, et al., 2023, Real-world application of a scalable school-based physical activity intervention: A cross-sectional survey of the implementation of The Daily Mile in Greater London primary schools, PLOS ONE, Vol: 18, ISSN: 1932-6203
Pinto Pereira SM, Mensah A, Nugawela MD, et al., 2023, Long COVID in children and young after infection or reinfection with the Omicron variant: a prospective observational study, Journal of Pediatrics, Vol: 259, Pages: 113463-113463, ISSN: 0022-3476
To describe the prevalence of long COVID in children infected for the first time (n = 332) or reinfected (n = 243) with Omicron compared with test-negative children (n = 311). Overall, 12%-16% of those infected with Omicron met the research definition of long COVID at 3 and 6 months after infection, with no evidence of difference between cases of first positive and reinfected (Pχ2 = 0.17).
Ward JL, Harwood R, Kenny S, et al., 2023, Pediatric Hospitalizations and ICU Admissions Due to COVID-19 and Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 in England, JAMA PEDIATRICS, ISSN: 2168-6203
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Nezafat Maldonado B, Singhal G, Chow LY, et al., 2023, Association between birth location and short-term outcomes for babies with gastroschisis, congenital diaphragmatic hernia and oesophageal fistula: a systematic review, BMJ Paediatrics Open, Vol: 7, Pages: 1-14, ISSN: 2399-9772
Background Neonatal care is commonly regionalised, meaning specialist services are only available at certain units. Consequently, infants with surgical conditions needing specialist care who are born in non-surgical centres require postnatal transfer. Best practice models advocate for colocated maternity and surgical services as the place of birth for infants with antenatally diagnosed congenital conditions to avoid postnatal transfers. We conducted a systematic review to explore the association between location of birth and short-term outcomes of babies with gastroschisis, congenital diaphragmatic hernia (CDH) and oesophageal atresia with or without tracheo-oesophageal fistula (TOF/OA).Methods We searched MEDLINE, CINAHL, Web of Science and SCOPUS databases for studies from high income countries comparing outcomes for infants with gastroschisis, CDH or TOF/OA based on their place of delivery. Outcomes of interest included mortality, length of stay, age at first feed, comorbidities and duration of parenteral nutrition. We assessed study quality using the Newcastle-Ottawa Scale. We present a narrative synthesis of our findings.Results Nineteen cohort studies compared outcomes of babies with one of gastroschisis, CDH or TOF/OA. Heterogeneity across the studies precluded meta-analysis. Eight studies carried out case-mix adjustments. Overall, we found conflicting evidence. There is limited evidence to suggest that birth in a maternity unit with a colocated surgical centre was associated with a reduction in mortality for CDH and decreased length of stay for gastroschisis.Conclusions There is little evidence to suggest that delivery in colocated maternity-surgical services may be associated with shortened length of stay and reduced mortality. Our findings are limited by significant heterogeneity, potential for bias and paucity of strong evidence. This supports the need for further research to investigate the impact of birth location on outcomes for babies with congenital
Shah R, Ram B, Hargreaves D, 2023, Childcare support and early education., BMJ: British Medical Journal, Vol: 382, Pages: 1-2, ISSN: 0959-535X
Creese H, Saxena S, Nicholls D, et al., 2023, The role of dieting, happiness with appearance, self-esteem, and bullying in the relationship between mental health and body-mass index among UK adolescents: a longitudinal analysis of the Millennium Cohort Study., EClinicalMedicine, Vol: 60, Pages: 1-13, ISSN: 2589-5370
BACKGROUND: Mental illness and obesity are among the biggest challenges to population health, they are linked, and may be modifiable during adolescence. We aimed to determine intervening pathways between mental health and BMI z-score symptoms across adolescence. METHODS: In this longitudinal cohort study, we used path models to examine self-reported dieting, happiness with appearance, self-esteem and bullying at 14 years as potential mediators of the cross-lagged relationship between mental health (via the Strengths and Difficulties Questionnaire) and Body Mass Index (BMI) z-score at 11 and 17 years by sex in the UK Millennium Cohort Study, a prospective cohort study of 18,818 children born in the UK between September 1st, 2000, and January 31st, 2002. Full, incomplete data on all singleton children still participating in the study by age 11 years were analysed in GSEM via maximum likelihood estimation (N = 12,450). FINDINGS: We found happiness with appearance and self-esteem, but not dieting or bullying, mediated the relationship between BMI age 11 and mental health age 17. Each increase in BMI z-score at 11 years was associated with 0.12 increase for boys and a 0.19 increase for girls in scores of unhappiness with appearance (boys: b 0.12, 95% C.I.; girls b 0.19, C.I. 0.14 to 0.23) and a 16% increase for boys and a 22% increase for girls in odds of low self-esteem (boys OR 1.16, 95% C.I. 1.07 to 1.26; girls: OR 1.22, 95% C.I. 1.15 to 1.30) at 14 years. In turn, for both boys and girls, being unhappy with appearance and low self-esteem at 14 years were associated with a greater likelihood of emotional and externalizing symptoms at 17 years. INTERPRETATION: Early prevention strategies to encourage healthy physical and mental development of children need to focus on the promotion of positive body-mage and self-esteem. FUNDING: The National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR).
Creese H-M, Creese H-M, 2023, Risk factors of persistent adolescent thinness: findings from the UK millennium cohort study, BMC Public Health, Vol: 23, Pages: 1-12, ISSN: 1471-2458
BackgroundThinness during adolescence can increase the risk of adverse health outcomes across the life-course and impede development. There is limited research examining the prevalence and determinants of persistent adolescent thinness in the United Kingdom (UK). We used longitudinal cohort data to investigate determinants of persistent adolescent thinness.MethodsWe analyzed data from 7,740 participants in the UK Millennium Cohort Study at ages 9 months, 7, 11, 14 and 17 years. Persistent thinness was defined as thinness at ages 11, 14 and 17; thinness was defined as an age- and sex-adjusted Body Mass Index (BMI) of less than 18.5 kg/m2. In total, 4,036 participants, classified either as persistently thin or at a persistent healthy weight, were included in the analyses. Logistic regression analyses were conducted to examine associations between 16 risk factors and persistent adolescent thinness by sex.ResultsThe prevalence of persistent thinness among adolescents was 3.1% (n = 231). Among males (n = 115), persistent adolescent thinness was significantly associated with non-white ethnicity, low parental BMI, low birthweight, low breastfeeding duration, unintended pregnancy, and low maternal education. Among females (n = 116), persistent adolescent thinness was significantly associated with non-white ethnicity, low birthweight, low self-esteem, and low physical activity. However, after adjusting for all risk factors, only low maternal BMI (OR: 3.44; 95% CI:1.13, 10.5), low paternal BMI (OR: 22.2; 95% CI: 2.35, 209.6), unintended pregnancy (OR: 2.49; 95% CI: 1.11, 5.57) and low self-esteem (OR: 6.57; 95% CI: 1.46,29.7) remained significantly associated with persistent adolescent thinness among males. After adjustment for all risk factors, not reaching the recommended physical activity levels (OR: 4.22; 95% CI: 1.82, 9.75) remained significantly associated with persistent adolescent thinness among females. No appreciable associa
Dedat Z, Hope S, Hargreaves D, et al., 2023, Measurement Instruments for Integration within Children and Young People Healthcare Systems and Networks: A Rapid Review of the International Literature, INTERNATIONAL JOURNAL OF INTEGRATED CARE, Vol: 23, ISSN: 1568-4156
Coscini N, Heyes P, Bedford H, et al., 2023, Multicountry review: developmental surveillance, assessment and care by outpatient paediatricians., Arch Dis Child, Vol: 108, Pages: 153-159
BACKGROUND: Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups. METHODS: Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0-5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points. RESULTS: Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking. CONCLUSION: Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.
Pinto Pereira SM, Shafran R, Nugawela MD, et al., 2023, Natural course of health and well-being in non-hospitalised children and young people after testing for SARS-CoV-2: a prospective follow-up study over 12 months., Lancet Reg Health Eur, Vol: 25
BACKGROUND: Despite high numbers of children and young people (CYP) having acute COVID, there has been no prospective follow-up of CYP to establish the pattern of health and well-being over a year following infection. METHODS: A non-hospitalised, national sample of 5086 (2909 SARS-COV-2 Positive; 2177 SARS-COV-2 Negative at baseline) CYP aged 11-17 completed questionnaires 6- and 12-months after PCR-tests between October 2020 and March 2021 confirming SARS-CoV-2 infection (excluding CYP with subsequent (re)infections). SARS-COV-2 Positive CYP was compared to age, sex and geographically-matched test-negative CYP. FINDINGS: Ten of 21 symptoms had a prevalence less than 10% at baseline, 6- and 12-months post-test in both test-positives and test-negatives. Of the other 11 symptoms, in test-positives who had these at baseline, the prevalence of all symptoms declined greatly by 12-months. For CYP first describing one of these at 6-months, there was a decline in prevalence by 12-months. The overall prevalence of 9 of 11 symptoms declined by 12-months. As many CYP first described shortness of breath and tiredness at either 6- or 12-months, the overall prevalence of these two symptoms in test-positives appeared to increase by 6-months and increase further by 12-months. However, within-individual examination demonstrated that the prevalence of shortness of breath and tiredness actually declined in those first describing these two symptoms at either baseline or 6-months. This pattern was also evident for these two symptoms in test-negatives. Similar patterns were observed for validated measures of poor quality of life, emotional and behavioural difficulties, poor well-being and fatigue. Moreover, broadly similar patterns and results were noted for the sub-sample (N = 1808) that had data at baseline, 3-, 6- and 12-months post-test. INTERPRETATION: In CYP, the prevalence of adverse symptoms reported at the time of a positive PCR-test declined over 12-months. Some test-
Hofer S, Otis M, Barber S, et al., 2023, Evaluating the implementation and impact of a new model of care for integrating children and young people’s acute mental healthcare in a paediatric setting: A protocol for a realist, mixed methods approach, BMJ Open, Vol: 13, Pages: 1-9, ISSN: 2044-6055
IntroductionThe mental health of children and young people in the UK has been declining, and has continued to worsen throughout the pandemic, leading to an increase in mental health related emergencies. In response, the Best for You programme was developed as a new service designed to integrate mental health care for children and young people between acute hospital and community services. The programme is comprised of four new services: a rapid assessment young people’s centre with dual trained staff, a co-located day service offering family-based care and a digital hub, designed to integrate with the fourth element of the model, namely community support and mental health services. This evaluation aims to assess the development, implementation and outcomes of the Best for You programme and develop a scalable model that could be implemented in other parts of the National Health Service (NHS).Methods and analysisThis mixed-methods realist evaluation aims to delineate the components of the system to assess their interdependent relationships within a wider context. Data collection will include interviews, participant observations, focus group discussions and the collection of local quantitative service data. The research will be conducted across four phases. Phase 1-captures the development of the underlying programme theory. Phase 2-a process evaluation testing the programme theory. Phase 3- an outcome and economic evaluation. Phase 4-consolidatation of learning from phases 1-3 to identify barriers, facilitators, and wider contextual factors that have shaped implementation drawing on the Consolidated Framework for Implementation Research.Ethics and disseminationEthical approval for the evaluation was received from the NHS local ethics committee. Embedded within the evaluation is a formative review to feedback and share learning with stakeholders to scale-up the programme. Findings from this study will be disseminated in peer-reviewed journals as well as presentat
Schneider V, Norris T, Nugawela M, et al., 2023, Loneliness Trajectories, Associated Factors and Subsequent Health in Children and Young People During the COVID-19 Pandemic: A National Matched Cohort Study., Psychol Res Behav Manag, Vol: 16, Pages: 4461-4477, ISSN: 1179-1578
PURPOSE: Loneliness is common amongst children and young people (CYP) and is an independent risk factor for poor health. This study aimed to i) determine whether subgroups of CYP with different loneliness trajectories (during the second year of the pandemic) exist; ii) examine associations with socio-demographic characteristics and subsequent health; and iii) understand whether associations between loneliness and subsequent health were modified by SARS-CoV-2 infection. METHODS: A total of 5851 CYP (N=3260 SARS-CoV-2 positive and 2591 SARS-CoV-2 negative) provided data on loneliness (via the validated 3-item version of the UCLA Loneliness Scale for Children) at least twice in a 12-month period post PCR index-testing (conducted October 2020-March 2021). Latent class growth analyses were used to identify distinct classes of loneliness trajectories. Multinomial logistic regression was used to identify socio-demographic characteristics associated with class membership. Logistic regression models assessed the odds of reporting impairing symptoms 12-months post index-test. RESULTS: Four distinct loneliness trajectories were identified: three mostly stable (low, medium, high) and one low-increasing trajectory. Being older, female, living in more deprived areas and testing negative were associated with greater odds of being in the highest vs lowest loneliness trajectory; eg OR for female vs male: 5.6 (95% CI:4.1,7.8); OR for 15-17 vs 11-14 years: 4.5 (95% CI:3.4,6.0). Following higher loneliness trajectories was associated with higher odds of experiencing impairing symptoms 12-months post index-test: ORadjusted (compared to lowest loneliness trajectory) were 15.9 (95% CI:11.9,21.3) (high loneliness), 6.5 (5.3,7.9) (medium loneliness) and 2.3 (1.9,2.8) (low-increasing loneliness). There was no evidence that this association was modified by PCR index-test result. CONCLUSION: About 5.3% of CYP were classified into a group experiencing (chronically) high loneliness. Being female
Navein A, McTaggart J, Hodgson X, et al., 2022, Effective healthcare communication with children and young people: a systematic review of barriers and facilitators., Arch Dis Child, Vol: 107, Pages: 1111-1116
OBJECTIVE: To identify children and young people's preferences for effective healthcare communication. DESIGN: A systematic review of qualitative studies was conducted to identify evidence from children and young people on effective healthcare communication. Electronic databases and reference lists of relevant articles were searched to July 2020. RESULTS: A total of 13 studies were included. Five major themes were identified: medical information (timing, amount, coordination and futures), person not patient (creating relationships, time, nurse involvement, sensitivity), type of communication (creative and interactive, behavioural, talking and listening, written communication), consultations (first impressions, with and without parents, actively promoting involvement, open and honest, age appropriate) and communication with parents (using parental knowledge, support). CONCLUSIONS: Research in this area remains sparse and consistent implementation is debateable. Children and young people articulate a preference for two-way healthcare communication. General principles for effective communication are identified as well as the need to avoid making assumptions and to tailor approaches to individuals. Establishing and maintaining relationships is essential and requires time and resources. Parents and carers have a positive role in healthcare communication which needs to be balanced with the needs and rights of children. All these factors also apply to children with communication difficulties or from marginalised groups, but additional extra support may be required. PROSPERO REGISTRATION NUMBER: CRD42019145539.
Papoutsi C, Hargreaves D, Hagell A, et al., 2022, Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings, BMC Medicine, Vol: 20, ISSN: 1741-7015
BACKGROUND: Young people with diabetes experience poor clinical and psychosocial outcomes, and consider the health service ill-equipped in meeting their needs. Improvements, including alternative consulting approaches, are required to improve care quality and patient engagement. We examined how group-based, outpatient diabetes consultations might be delivered to support young people (16-25 years old) in socio-economically deprived, ethnically diverse settings. METHODS: This multi-method, comparative study recruited a total of 135 young people with diabetes across two implementation and two comparison sites (2017-2019). Informed by a 'researcher-in-residence' approach and complexity theory, we used a combination of methods: (a) 31 qualitative interviews with young people and staff and ethnographic observation in group and individual clinics, (b) quantitative analysis of sociodemographic, clinical, service use, and patient enablement data, and (c) micro-costing analysis. RESULTS: Implementation sites delivered 29 group consultations in total. Overall mean attendance per session was low, but a core group of young people attended repeatedly. They reported feeling better understood and supported, gaining new learning from peers and clinicians, and being better prepared to normalise diabetes self-care. Yet, there were also instances where peer comparison proved difficult to manage. Group consultations challenged deeply embedded ways of thinking about care provision and required staff to work flexibly to achieve local tailoring, sustain continuity, and safely manage complex interdependencies with other care processes. Set-up and delivery were time-consuming and required in-depth clinical and relational knowledge of patients. Facilitation by an experienced youth worker was instrumental. There was indication that economic value could derive from preventing at least one unscheduled consultation annually. CONCLUSIONS: Group consulting can provide added value when tailored to m
Hiremath S, Doukrou M, Flannery H, et al., 2022, Key Features of a Multi-Disciplinary Hospital-Based Rehabilitation Program for Children and Adolescents with Moderate to Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS., Int J Environ Res Public Health, Vol: 19
PURPOSE OF THE STUDY: There is limited published data on treatment or outcomes of children and young people (CYP) with moderate or severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Here, we describe outcomes of moderate and severe ME/CFS in CYP treated in a tertiary adolescent service. This information is useful when planning services for CYP and families affected by moderate/severe ME/CFS and to guide future management trials and commissioning decisions. STUDY DESIGN: A retrospective review was conducted of medical records of the 27 CYP who received ward-based treatment in 2015. Notes were retrospectively reviewed to assess progress in four markers of wellbeing over the period of treatment: (i) mobility, (ii) education, (iii) sleep and (iv) involvement in social/recreational activities. RESULTS: A total of 23/27 (85%) showed improvement in one or more domains over their period of ward-based therapy. 19/27 (70%) of patients showed improvement in physical ability. In 15/23 patients (65%), there was an improvement in ability to access education, in 12/24 (50%) sleep improved, and 16/27 (59%) demonstrated an improvement in socialising/ability perform recreational activities. CONCLUSION/IMPLICATIONS: A multidisciplinary hospital-based rehabilitation programme for moderate and severe ME/CFS was associated with improvement in at least one area of wellbeing in 85% of the CYP we reviewed. These data may be used as a baseline to evaluate the impact of other models of delivering care for this patient group. It may be useful when considering other groups such as those affected by Post-COVID Syndrome.
Foley KA, Maile EJ, Bottle A, et al., 2022, How did the covid-19 pandemic affect lower respiratory tract infections in young children in England?, EUROPEAN JOURNAL OF PUBLIC HEALTH, Vol: 32, ISSN: 1101-1262
Papoutsi C, Hargreaves D, Hagell A, et al., 2022, Group clinics for young adults living with diabetes in an ethnically diverse, socioeconomically deprived population: mixed-methods evaluation, Health and Social Care Delivery Research, Vol: 10, Pages: 1-124, ISSN: 2755-0060
BackgroundOur research was based on the expressed need to evaluate the potential for group clinics to enhance care within the NHS for people with long-term conditions.ObjectivesWe aimed to explore the scope, feasibility, impact and potential scalability of group clinics for young adults with diabetes who have poor experiences of care and clinical outcomes. We applied a participatory approach to the entire research process, where appropriate.SettingFour NHS trusts delivering diabetes care to young adults in ethnically diverse and socioeconomically deprived communities.ParticipantsWe involved 135 young adults as participants in our research (73 at two intervention sites and 62 at two control sites).MethodsA realist review synthesised existing evidence for group clinics to understand ‘what works, for whom, under what circumstances’. Using the realist review findings and a scoping exercise, we used co-design to develop a model of group clinic-based care, which we then implemented and evaluated using primarily qualitative methods, with quantitative and costs analyses to inform future evaluations.ResultsYoung adults reported positive experiences from the group clinics. However, across the group clinics delivered, only one-third (on average) of those invited to specific clinics attended, despite substantial efforts to encourage attendance, and only 37 out of 73 (51%) participants attended any group clinics. Social learning helped the acquisition of new knowledge and normalisation of experiences. Group clinics met previously unreached emotional needs, and the relationships that formed between young adults, and between them and the staff facilitating the clinics, were key. Clinical staff delivered the clinics using a facilitatory approach, and a youth worker helped to ensure that the care model was developmentally appropriate. Existing organisational structures presented substantial challenges to the delivery of group clinics, and there was considerable hidden wo
Bottle A, Neale FK, Foley KA, et al., 2022, Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study, BMJ OPEN, Vol: 12, ISSN: 2044-6055
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Foley KA, Saxena SK, Majeed A, et al., 2022, Author response., Br J Gen Pract, Vol: 72, Pages: 318-318
Maile EJ, Singh R, Black GB, et al., 2022, Back to the future? Lessons from the history of integrated child health services in England., Future Healthc J, Vol: 9, Pages: 183-187, ISSN: 2514-6645
The UK has a long history of attempts to integrate child health services to improve outcomes, an ambition renewed in the recent The NHS Long Term Plan. It's therefore timely to review the history of integration to inform future initiatives. Key milestones include the Platt report (1959), Court report (1976), Sure Start (1999), National service framework (2004) and Facing the future report (2015). These stand against a backdrop of national NHS policy changes, with a myriad of local integration initiatives and research efforts in parallel. We suggest lessons for future integration initiatives: integration may support the quadruple aim; integration depends on addressing divides between primary and secondary care; workforce and funding challenges need to be resolved before integration can thrive; high-quality research and evaluation of integrated interventions is required; strong relationships between professional groups are key to integration; and integration can help address health inequalities.
Nachiappan N, Mackinnon S, Ndayizeye JP, et al., 2022, Barriers to accessing health care among young people in 30 low-middle income countries, HEALTH SCIENCE REPORTS, Vol: 5
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