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
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217 results found

Watson G, Pickard L, Williams B, Hargreaves D, Blair Met al., 2021, ‘Do I, don’t I?’ A qualitative study addressing parental perceptions about seeking healthcare during the COVID-19 pandemic, Archives of Disease in Childhood, ISSN: 0003-9888

Background Paediatric emergency departments have seen reduced attendance during the COVID-19 pandemic. Late paediatric presentations may lead to severe illness and even death. Maintaining provision of healthcare through a pandemic is essential. This qualitative study aims to identify changing care-seeking behaviours in child health during the pandemic and ascertain parental views around barriers to care.Methods Semistructured interviews were conducted with caregivers of children accessing acute paediatric services in a hospital in North-West London. Thematic content analysis was used to derive themes from the data, using a deductive approach.Results From interviews with 15 caregivers an understanding was gained of care-seeking behaviours during the pandemic. Themes identified were; influencers of decision to seek care, experience of primary care, other perceived barriers, experiences of secondary care, advice to others following lived experience. Where delays in decision to seek care occurred this was influenced predominantly by fear, driven by community perception and experience and media portrayal. Delays in reaching care were focused on access to primary care and availability of services. Caregivers were happy with the quality of care received in secondary care and would advise friends to seek care without hesitation, not to allow fear to delay them.Conclusion A pandemic involving a novel virus is always a challenging prospect in terms of organisation of healthcare provision. This study has highlighted parental perspectives around access to care and care-seeking behaviours which can inform us how to better improve service functioning during such a pandemic and beyond into the recovery period.

Journal article

Tanna NK, Alexander EC, Lee C, Lakhanpaul M, Popat RM, Almeida-Meza P, Tuck A, Manikam L, Blair Met al., 2021, Interventions to improve vitamin D status in at-risk ethnic groups during pregnancy and early childhood: a systematic review., Public Health Nutr, Pages: 1-22

OBJECTIVE: To systematically review the literature with the primary aim of identifying behavioural interventions to improve vitamin D stores in children from at-risk ethnic groups. DESIGN: Review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PROSPERO registration number: CRD42017080932. Health Behaviour Model and Behaviour Change Wheel framework constructs used to underpin evaluation of interventions. Methodological quality evaluated using Cochrane Risk of Bias, Cochrane ROBINS-I and NHLBI tools. SETTING: Databases Cochrane Library, MEDLINE, EMBASE, CINAHL with secondary search of Google Scholar. No country limits set. Papers between January 1990 and February 2018, published in English included. Anticipating study heterogeneity, outcome measures not pre-specified and identified from individual full papers. Updated literature search November 2020. PARTICIPANTS: Patient or population including pregnant women, newborns and children aged under 18 years, from Asian or African ethnic groups. RESULTS: Of 10 690 articles screened, 298 underwent full-text review, with 24 ultimately included for data extraction. All identified studies conducted a vitamin D pharmacological supplementation intervention, with two also incorporating a behavioural intervention strategy. No study explicitly defined a primary aim of evaluating a behavioural intervention, undertaken to study its effect on vitamin D supplement uptake. CONCLUSIONS: There is a need to address the paucity of data in ethnic at-risk children on how behavioural interventions ideally developed and co-produced with the community under study, affect and help improve vitamin D uptake, within the antenatal and pregnancy phase as well as during childhood.

Journal article

Zdunek K, Schroder-Back P, Alexander D, Vlasblom E, Kocken P, Rigby M, Blair Met al., 2021, Tailored communication methods as key to implementation of evidence-based solutions in primary child health care, European Journal of Public Health, Vol: 31, Pages: 92-99, ISSN: 1101-1262

BackgroundEvidence-based policies should underpin successful implementation of innovations within child health care. The EU-funded Models of Child Health Appraised project enabled research into effective methods to communicate research evidence. The objective of this study was to identify and categorize methods to communicate evidence-based research recommendations and means to tailor this to stakeholder audiences.MethodsWe conducted an online survey among national stakeholders in child health. Analysis of the most effective strategies to communicate research evidence and reach the target audience was carried out in order to ensure implementation of optimal child health care models at a national level.ResultsRepresentatives of stakeholders from 21 of the then 30 EU MS and EEA countries responded to the questionnaire. Three main approaches in defining the strategies for effective communication of research recommendations were observed, namely: dissemination of information, involvement of stakeholders and active attitude towards change expressed in actions. The target audience for communicating recommendations was divided into two layers: proximal, which includes those who are remaining in close contact with the child, and distal, which contains those who are institutionally responsible for high quality of child health services. They should be recipients of evidence-based results communicated by different formats, such as scientific, administrative, popular and personal.ConclusionsInfluential stakeholders impact the process of effective research dissemination and guide necessary actions to strengthen the process of effective communication of recommendations. Communication of evidence-based results should be targeted to each audience’s profile, both professional and non-professionals, by adjusting appropriate communication formats.

Journal article

Greenfield G, Blair M, Aylin P, Saxena S, Majeed F, Bottle Ret al., 2021, Characteristics of frequent paediatric users of emergency departments in England: an observational study using routine national data, Emergency Medicine Journal, Vol: 38, Pages: 146-150, ISSN: 1472-0205

BACKGROUND:Frequent attendances of the same users in emergency departments (ED) can intensify workload pressures and are common among children, yet little is known about the characteristics of paediatric frequent users in EDs. AIM:To describe the volume of frequent paediatric attendance in England and the demographics of frequent paediatric ED users in English hospitals. METHOD:We analysed the Hospital Episode Statistics dataset for April 2014-March 2017. The study included 2 308 816 children under 16 years old who attended an ED at least once. Children who attended four times or more in 2015/2016 were classified as frequent users. The preceding and subsequent years were used to capture attendances bordering with the current year. We used a mixed effects logistic regression with a random intercept to predict the odds of being a frequent user in children from different sociodemographic groups. RESULTS:One in 11 children (9.1%) who attended an ED attended four times or more in a year. Infants had a greater likelihood of being a frequent attender (OR 3.24, 95% CI 3.19 to 3.30 vs 5 to 9 years old). Children from more deprived areas had a greater likelihood of being a frequent attender (OR 1.57, 95% CI 1.54 to 1.59 vs least deprived). Boys had a slightly greater likelihood than girls (OR 1.05, 95% CI 1.04 to 1.06). Children of Asian and mixed ethnic groups were more likely to be frequent users than those from white ethnic groups, while children from black and 'other' had a lower likelihood (OR 1.03, 95% CI 1.01 to 1.05; OR 1.04, 95% CI 1.01 to 1.06; OR 0.88, 95% CI 0.86 to 0.90; OR 0.90, 95% CI 0.87 to 0.92, respectively). CONCLUSION:One in 11 children was a frequent attender. Interventions for reducing paediatric frequent attendance need to target infants and families living in deprived areas.

Journal article

Blair M, 2020, Caring for infants after hospital discharge – Are we doing enough?, Early Human Development, Vol: 150, Pages: 1-3, ISSN: 0378-3782

Journal article

Coughlan C, Liddell B, Watson M, Blair Met al., 2020, Rethinking complex needs with patient and carer perspectives, The Lancet Child & Adolescent Health, Vol: 4, Pages: 719-720, ISSN: 2352-4642

Journal article

Greenfield G, Blair M, Aylin P, Saxena S, Majeed F, Hoffman M, Bottle Aet al., 2020, Frequent attendances at emergency departments in England, Emergency Medicine Journal, Vol: 37, Pages: 597-599, ISSN: 1472-0205

Background: A small proportion of patients referred to as ‘frequent attenders’ account for a large proportion of hospital activity such as emergency departments (ED) attendances and admissions. There is lack of recent, national estimates of the volume of frequent ED attenders. We aimed to estimate the volume and age distribution of frequent ED attenders in English hospitals.Method: We included all attendances at all major EDs across England in the financial year 2016–2017. Patients who attended 3 times or more were classified as frequent attenders. We used a logistic regression model to predict the odds of being a frequent attender by age group.Results: 14,829,519 attendances were made by 10,062,847 patients who attended at least once. 73.5% of ED attenders attended once and accounted for 49.8% of the total ED attendances. 9.5% of ED attenders attended 3 times or more; they accounted for 27.1% of the ED attendances. While only 1.2% attended 6 times or more, their contribution was 7.6% of the total attendances. Infants and adults aged over 80 years were significantly more likely to be frequent attenders than adults aged 30-59 years (OR=2.11, 95% CI 2.09 to 2.13, OR=2.22, 95% CI 2.20 to 2.23, respectively). The likelihood of hospital admission rose steeply with the number of attendances a patient had.Conclusion: One in ten patients attending the ED are frequent attenders and account for over a quarter of attendances. Emergency care systems should consider better ways of reorganising health services to meet the needs of patients who attend EDs frequently.

Journal article

Rigby M, Deshpande S, Blair M, 2020, Child health research and planning in Europe disadvantaged by major gaps and disparities in published statistics, European Journal of Public Health, Vol: 30, Pages: 693-697, ISSN: 1101-1262

BackgroundPopulation data, such as mortality and morbidity statistics, are essential for many reasons, including giving context for research, supporting action on health determinants, formulation of evidence-based policy for health care and outcome evaluation. However, when considering children, it is difficult to find such data, despite children comprising one-fifth of the European population and being in a key formative life stage and dependent on societal support. Moreover, it would be expected that there should be confidence in the key child health data available, with little to no discrepancy between recognized health statistic databases.MethodsThis study explored the main health databases in or including Europe to collate child mortality data, for both all-cause and specific-cause mortality. Tables were constructed for comparison of values and rankings.ResultsThe results show that there are major differences in reported mortality data between two prominent health statistic databases, difference in coding systems, and unannounced changes within one of the databases.ConclusionsThe lack of health data for children seems compounded by challenges to the trust and credibility, which are vital if these data are to have utility. Children and society are the losers, and resolution is needed as a priority.

Journal article

Rigby MJ, Chronaki CE, Deshpande SS, Altorjai P, Brenner M, Blair MEet al., 2020, European Union initiatives in child immunization-the need for child centricity, e-health and holistic delivery, European Journal of Public Health, Vol: 30, Pages: 449-455, ISSN: 1101-1262

BACKGROUND: Low childhood immunization rates in Europe are causing concern and have triggered several EU initiatives. However, these are counter-factual as they make immunization a stand-alone issue and cut across best practice in integrated child health services. They also focus unduly on 'anti-vax' pressures, generalize 'vaccine hesitancy' and overlook practical difficulties and uncertainties encountered by parents in real world situations about presenting children for immunization. Meanwhile European expertize in child health electronic record systems and relevant standards are ignored despite their being a potentially sound foundation ripe for enhancement. METHODS: Situation and literature reviews, and cohesion of two European research projects, led to shared investigation. As a result, two cross-sectoral expert workshops were held to consider digital health standards for harmonizing integrated preventive child health including immunization, and the work of other stakeholders such as the World Health Organisation and the European Centre for Disease Control. RESULTS: Progress in child health information models and digital health standards was assessed, areas needing further standards development identified and desirable steps towards innovation in service delivery and record keeping agreed. CONCLUSION: The European Commission, member states and child health stakeholders should take an integrated approach to child health with immunization as a component. Service delivery should be sensitive to parental concerns and challenges, and the way child- and family-centric data are recorded and used should be enhanced. Services should be enabled by the International Patient Summary and related electronic health record standards and linkages, and evaluated to assess most effective systems and practice.

Journal article

Julies P, Lynn RM, Pall K, Leoni M, Calder A, Mughal Z, Shaw N, McDonnell C, McDevitt H, Blair Met al., 2020, Nutritional rickets under 16 years: UK surveillance results, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 105, Pages: 587-592, ISSN: 0003-9888

Journal article

Ruzangi J, Blair M, Cecil E, Greenfield G, Bottle R, Hargreaves D, Saxena Set al., 2020, Trends in healthcare use in children aged less than 15 years; a population-based cohort study in England from 2007 to 2017, BMJ Open, Vol: 10, ISSN: 2044-6055

Objective To describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017Design Population-based retrospective cohort study.Methods We used linked data from the Clinical Practice Research Datalink to study children’s primary care consultations and use of hospital care including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists.Results Between 1 April 2007 and 31 March 2017, there were 7 604 024 general practitioner (GP) consultations, 981 684 ED visits, 287 719 emergency hospital admissions, 2 253 533 outpatient visits and 194 034 elective admissions among 1 484 455 children aged less than 15 years. Age-standardised GP consultation rates fell (−1.0%/year) to 1864 per 1000 child-years in 2017 in all age bands except infants rising by 1%/year to 6722 per 1000/child-years in 2017. ED visit rates increased by 1.6%/year to 369 per 1000 child-years in 2017, with steeper rises of 3.9%/year in infants (780 per 1000 child-years in 2017). Emergency hospital admission rates rose steadily by 3%/year to 86 per 1000 child-years and outpatient visit rates rose to 724 per 1000 child-years in 2017.Conclusions Over the past decade since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children’s use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children.

Journal article

Plumptre I, Tolppa T, Blair M, 2020, Parent and staff attitudes towards in-hospital opportunistic vaccination, Public Health, Vol: 182, Pages: 39-44, ISSN: 0033-3506

ObjectivesRecent trends of ‘vaccine hesitancy’ have resulted in calls for public health campaigns to improve immunisation uptake to World Health Organisation (WHO) targets. One potential strategy to improve uptake is to offer opportunistic vaccination to those hospital in-patients who have missed them. We aimed to evaluate parental and staff attitudes about introducing such a service for hospitalised children.Study designCross sectional questionnaire-based design.MethodsWe developed and distributed a questionnaire for parents/guardians of paediatric inpatients aged 5 years and under, and a questionnaire for frontline paediatric staff (including medical, nursing and allied health professionals). Vaccination rates were assessed through discussion with parents and by reviewing the personal child health record.ResultsOne-hundred families and 100 paediatric staff participated. Local vaccination rates were significantly below the WHO target (P < 0.001), particularly for the Bacille Calmette-Guerine (BCG) vaccination (P = 0.001). Both parents (89/100, 89%) and staff (87/100, 87%) regarded inpatient opportunistic vaccination acceptable. Parents of children with chronic disease reported a potentially higher rate of missed vaccinations, stating reasons of frequent illness and inpatient stays. The majority of staff (81/95, 85.3%) would be willing to support inpatient vaccination if appropriately trained. A significant minority had reservations.ConclusionsOpportunistic vaccination is a strategy deemed acceptable by the majority of parents and staff. Children with chronic disease would especially benefit from opportunistic inpatient immunisation. In order to facilitate this, improved digital access to primary care vaccination records and investment in staff training, education and support would be required.

Journal article

Blair M, Wortley E, McGuff K, 2020, Placing education at the centre of the outpatient clinic improves learning and experiences for everyone using the multilevel attainment of learning, teaching and support (MALTS) approach, Archives of disease in childhood - Education & practice edition, Vol: 105, Pages: 2-6, ISSN: 1743-0585

A large proportion of consultant time is spent in outpatient practice. This setting provides an excellent learning environment for different levels of a trainee if well organised. This article describes an evidence-based teaching approach and its evaluation by trainees, patients and carers in a typical district general hospital setting which it is hoped others might find helpful.

Journal article

Dharmarajah K, Fawcett M, Blackstock S, Soni A, Watson M, Blair Met al., 2020, Tackling childhood obesity in the community using a participatory action research project with local children and young people, Health Education and Care, Vol: 4, Pages: 1-5, ISSN: 2398-8517

Introduction: Co-production of health services is becoming more routine with young people but such involvement in research lags behind, especially in the field of health promotion research. Our aim was to co-design and test a community intervention with parents and children focused on changing lifestyle behaviours which might contribute to childhood obesity on a deprived local housing estate in London.Methods: Within the context of an established integrated care collaborative, we supported parent and child volunteers to co-design and deliver a health and well-being intervention for local children. This was in the form of a 6-week “sprint” of exercise and healthy living activities. The subsequent evaluation was carried out by two children who were trained in basic qualitative and quantitative research methods by us. They designed, conducted and analysed data from intervention participants with repeat follow-up and analysis at 2 years.Results: Twenty-six children were recruited with 12 completing the programme and 7 followed up for 2 years. Young people aged 12 and older universally felt they could communicate their views better in a focus group led by a local young person with established trust and agency. We observed the value of our peer evaluator’s contribution to the design process and their insights during analysis.Post programme there were improvements in physical activity and nutrition scores in participants using validated scores, and themes relating to healthy living which were retained at 2 years.Discussion: The use of participatory evaluation in a citizen-driven intervention allowed us to breakdown barriers such as ?? within hard to reach communities, as well as enabling more meaningful results. We have demonstrated the desirability and acceptability of participatory research with children and young people. This intervention also reinforces that small, community–designed and delivered initiatives have the power to effect behaviour c

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?, Archives of Disease in Childhood, Vol: 105, Pages: 40-46, ISSN: 0003-9888

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

Lee C, Tanna N, Blair M, Yusuf Y, Khalief H, Lakhanpaul Met al., 2019, Getting underneath the skin: A community engagement event for optimal vitamin D status in an 'easily overlooked' group, Health Expectations, Vol: 22, Pages: 1322-1330, ISSN: 1369-6513

BACKGROUND: Patient and public involvement and engagement (PPIE) is recognized as important for improved quality in health service provision and research. Vitamin D is one area where PPIE has potential to benefit public health initiatives, particularly for women and children with increased skin pigmentation (ie at high risk of deficiency) who are easily overlooked. OBJECTIVE: We report findings from a community PPIE event that explored the knowledge, barriers and promoters for optimal vitamin D status amongst an exemplar high-risk and easily overlooked population group. METHODS: Two researchers and one PPIE lead facilitated a single group discussion with twenty members of the Somali community from across west London. All attendees were women of reproductive age, or knew a mother and child that could benefit from a targeted initiative. The discussion was recorded, transcribed verbatim, organized and coded using NVivo 12 Pro to identify emergent themes underpinned by the Health Behaviour Model. RESULTS: Attendees thought community safety and competing demands of technology and education impacted on sun exposure and lifestyle activity. Language barriers impacted on access to health care. Attendees also felt the mother figure was 'the most important' influencer of both child and wider community health. DISCUSSION: Although further discourse is needed, this event emphasizes that it is important that the public voice is heard in informing, designing and evaluating appropriate public health interventions amongst specific ethnic groups. Insights from this Somali population have suggested benefit from using verbal health messages that are specifically targeted at mothers, compared with the general population.

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, Vol: 24, Pages: 155-161, 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

Rigby M, Deshpande S, Blair M, 2019, Another blow to credibility in published data sources, LANCET, Vol: 394, Pages: 26-27, 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., Medinfo 2019, Pages: 158-161

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

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, Vol: 23, Pages: 343-357, 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&#39; 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 and Development, Vol: 45, Pages: 364-370, ISSN: 0305-1862

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., 2019, 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, 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, The Lancet, Vol: 393, Pages: 225-226, ISSN: 0140-6736

Journal article

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

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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

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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

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