Publications
238 results found
Blair M, 2018, Early Years Theme of Northwest London, CLAHRC, 1st International Eurasian Congress of Social Pediatrics
Blair M, 2018, Children and young people in primary care continue to remain relatively invisible, European Forum for Primary Care
Blair M, 2018, 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
Liyanage H, Shinneman S, Hoang U, et al., 2018, Profiling databases to facilitate comparison of child health systems across Europe using standardised quality markers, MIE 2018, Publisher: IOS Press, Pages: 61-65, ISSN: 0926-9630
Models of child primary health care vary across Europe. There are three categories, primary care paediatricians, general practitioner based, or mixed. This paper describes the metadata schema used in the profiling process of candidate data sources for appraisal for the Models of Child Health Appraised (MOCHA) project using the MOCHA International Research Opportunity Instrument (MIROI). The ten clinical indicators included: asthma, antibiotic stewardship, immunisation, rickets, diarrhea, epilepsy, depression, ADHD, enuresis and care of women during pregnancy. Our metadata allows us to identify data within included data sources concerning any of the 10 clinical indicators identified for comparative analysis within the MOCHA project. From the 30 countries we found a minimum of 5 and a maximum of 36 different databases for each indicator.
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
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
Blair M, Julies P, Lynn RM, et al., 2018, I16 Nutritional rickets presenting to secondary care in children (<16 years) – a uk surveillance study, Archives of Disease in Childhood, Vol: 103, Pages: A202-A203, ISSN: 1468-2044
Boullier M, Blair M, 2018, Adverse childhood experiences, Paediatrics and Child Health (United Kingdom), Vol: 28, Pages: 132-137, ISSN: 1751-7222
The long term poor health outcomes in people who have experienced multiple adverse events in childhood have been well documented since the original CDC-Kaiser study in the late 1990's. Those people who have experienced four or more adverse childhood experiences (ACE) are at significantly increased risk of chronic disease such as cancer, heart disease and diabetes as well as mental illness and health risk behaviours. The ACE pyramid is a model that describes the relationship between ACEs, disease and potentially early death. There is growing evidence of the ways in which adversity and toxic stress, cause these poor outcomes. Exposure to adversity has been shown to alter the molecular and genetic makeup of a child as well as changing the way the neurological, immune and endocrine systems develop and function. Adverse events in childhood are of great public health concern given the evidence of their long term impact on health. This article describes the significant impact of ACEs on the health of future generations outlining the research background to ACEs. It also explores how we are finding ways to mitigate their adverse effects by prevention and promotion of resilience against the effects of adversity.
Blair ME, Rigby M, Deshpande S, 2018, The presence of ehealth support for childhood obesity guidance, Studies in Health Technology and Informatics, Vol: 247, ISSN: 0926-9630
A rising global obesity epidemic in children has implications for an increase in other chronic diseases and a negative social impact, which should not be ignored. A useful resource in this context could be eHealth due to its popularity amongst children. Additionally, telephone guidance is also considered a powerful health promotion tool. The aim of this study was to investigate the availability of mobile applications (apps), websites, helplines, and advice lines for child obesity guidance, in European countries. A survey was conducted in 28 European Member States and 2 European Economic Area countries, in 2017. Twenty-three responses were collected. Fourteen countries stated the presence of an obesity management website.
Rigby M, Kühne G, Greenfield R, et al., 2018, Extent of use of electronic records in children's primary care and public health in Europe, Studies in Health Technology and Informatics, Vol: 247, Pages: 930-934, ISSN: 0926-9630
EHRs are widely seen as a key resource in modern health care. For children not only is primary care vital, but also case-based public health systems can help ensure that all children receive immunisation and other preventive programmes. A European study showed that in 2016 in the 30 EU and EEA countries, 19 countries had widespread use of EHRs in children's primary care, while 20 countries had case-based child public health systems. However, the results show a bias of disadvantage for poorer or smaller countries. More study is needed in this area.
Blair M, Poots A, Lim V, et al., 2017, Pre-school children who are frequent attenders in Emergency Departments: an observational study of associated demographics and clinical characteristics, Archives of Disease in Childhood, Vol: 103, Pages: 19-23, ISSN: 0003-9888
Background: Unscheduled visits to emergency departments (ED) have increased in the UK in recent years. Children who are repeat attenders are relatively understudied. Aims: To describe the socio-demographic and clinical characteristics of pre-schoolers who attend ED a large District General Hospital.Method/Study Design: Observational study analysing routinely collected ED operational data. Children attending 4 or more visits per year were considered as “frequent attenders”. Poisson regression was used with demographic details (age, sex, ethnicity, socio-demographic status), to predict number of attendances seen in the year. We further analysed detailed diagnostic characteristics of a random sample of 10% of attendees. Main findings: 10,169 patients visited in the 12 month period with 16,603 attendances. 655 individuals attended on 3,335 occasions. 6.4% of this population accounted for 20.1% of total visits. In the 10% sample, there were 304 attendances, and 69(23%) had an underlying chronic longstanding illness. This group were 2.4 times more likely to be admitted as in-patients compared to those without such conditions , median length of stay of 6.2 hours vs. 2.5 hrs (p=NS).Conclusions: Frequent ED attenders fall broadly into two distinct clinical groups: those who habitually return with self- limiting conditions and those with or without exacerbation of underlying chronic longstanding illness. Both groups may be amenable to both additional nursing and other forms of community support to enhance self-care and continuity of care. Further research is required to increase our understanding of specific individual family and health system factors that predict repeat attendance in this age group.
Rigby M, Kühne G, Greenfield R, et al., 2017, Enabling Good Healthcare for Children in Europe Through Fit-For-Purpose Electronic Records - Advantage Lost and Significant Work Needed., Studies in Health Technology and Informatics, Vol: 244, Pages: 90-90, ISSN: 0926-9630
Kuhne G, Rigby M, Majeed A, et al., 2017, Child Health Informatics - a Neglected Area of European E-Health Activity, EUPHA, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262
Stubbe Østergaard L, Norredam M, Mock-Munoz de Luna C, et al., 2017, Restricted health care entitlements for child migrants in Europe and Australia, European Journal of Public Health, Vol: 27, Pages: 869-873, ISSN: 1101-1262
Liyanage H, Hoang U, Ferreira F, et al., 2017, Availability of computerised medical record system data to compare models of child health care in primary care across Europe, European Federation for Medical Informatics Special Topic Conference (EFMI STC 2017), Publisher: IOS Press, Pages: 8-12, ISSN: 0926-9630
Computerised medical record (CMR) system data can be used to compare different models of health care for children. We identified sources of data from the Models of Child Health Appraised (MOCHA) project that compares family doctor led with paediatrician led and mixed models of child care using index conditions. Asthma and immunisation coverage are the first of these. We explored the extent to which an established Patient Registries Initiative (PARENT); MOCHA's own survey (MIROI); the European Centre for Disease Control (ECDC) immunisation information system survey and the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) registry of data sources provided data to make comparisons of child health care. Five countries had data repositories for our index conditions from paediatrician lead services, compared with 14 for mixed, and 11 for family doctor led services. PARENT identified 212 sources, MIROI 148 sources, ECDC 17 sources and ENCePP 42; with immunisation related data sources found in all four but asthma in only three. There are less sources of electronic data available to study paediatrician led systems than other models; this risks unequal sample size bias.
Blair ME, Hiscock H, 2017, Themes emerging from State of Child Health: UK and Australia, Archives of Disease in Childhood, ISSN: 1468-2044
Tanna N, Oligbu G, Boullier M, et al., 2017, Vitamin D mobile healthcare applications for consumer use - are they any good?, Journal of Food and Nutrition Research, Vol: 5, Pages: 522-530, ISSN: 1336-8672
Introduction: Members of the public interested in changing their health behaviour and comfortable with use of social media can download and purchase commercially developed lifestyle and or healthcare computer software. This is facilitated by the increase in technologically advanced, often elegantly designed, small screen portable in-built computerised systems on mobile smart-phones. Aims: With increasing awareness of use of Vitamin D for improved health outcomes, the aims for this study were to identify and evaluate any Vitamin D mobile smart-phone healthcare applications (apps) available for public or consumer use. Methods: Incorporating a multi-phase mixed study design, in phase one Vitamin D apps on mobile smart-phones were identified and categorised by consensus using the Delphi technique. In phase two a database search was undertaken to gain an understanding of research undertaken on use of healthcare apps and any evaluation of outcomes. In phase three a modified validated mobile applications rating scale (MARS) was utilised to evaluate the apps identified in phase one. Each app that provided some health information was assigned objective scores for information quality, and subjective quality and app specific rating scores. Discussion: No Vitamin D apps were identified where evaluation in research trial settings has shown significant beneficial health outcomes. However the literature search helped to identify criteria that form a potential checklist for any future development of a Vitamin D app for consumer use. Use of the modified MARS, with scores assigned for validated information quality criteria, identified two apps which were rated highly but with use restricted to medical teams, and seven apps focusing on dietary intake. Results: Nine apps were identified supporting some level of healthcare delivery and assigned MARS scores. Seven of these apps focused primarily on Vitamin D nutritional support. There were no high quality Vitamin D apps identified that c
Zulf MM, Calder A, Blair M, et al., 2017, Dietary calcium deficiency contributes to the causation of nutritional rickets (NR) in the United Kingdom (UK): data from the British Paediatric Surveillance Unit (BPSU) NR survey, Bone Abstracts
Blair ME, Brenner M, Larkin P, et al., 2017, OC-52 Delivering optimum complex care for in the community: a multidisciplinary approach, Archives of Disease in Childhood
Blair ME, Kuhne G, Rigby M, et al., 2017, P321 The current digital divide in primary child health care in europe, Archives of Disease in Childhood, ISSN: 1468-2044
Blair ME, Luzi D, Pecoraro F, et al., 2017, OC-9 Well child care in europe – an inter-country comparison using unified modelling language (UML) methods, Archives of Disease in Childhood, ISSN: 1468-2044
Blair ME, Julies P, Pall K, et al., 2017, OC-73 Nutritional rickets presenting to secondary care in children (<16 years) – a uk surveillance study, Archives of Disease in Childhood, ISSN: 1468-2044
Brenner M, OShea M, J Larkin P, et al., 2017, Exploring Integration of Care for Children Living with Complex Care Needs across the European Union and European Economic Area, International Journal of Integrated Care, Vol: 17, Pages: 1-5, ISSN: 1568-4156
Heys M, Rajan M, Blair M, 2017, Length of paediatric inpatient stay, socio-economic status and hospital configuration: a retrospective cohort study., BMC Health Services Research, Vol: 17, ISSN: 1472-6963
BACKGROUND: Variation in paediatric inpatient length of stay exists - whether this is driven by differences in patient characteristics or health service delivery is unclear. We will test the hypotheses that higher levels of deprivation are associated with prolonged length of stay and that differences in prolonged length of stay across 2 hospitals will be explained by demographic, clinical and process factors. METHODS: This is a retrospective cohort study of 2889 children aged less than 16 years admitted from 1st April 2009 to 30th March 2010. Administrative data were used from two UK hospitals whose Accident and Emergency (A&E) departments were paediatric and adult physician led respectively. The main outcome was prolonged length of stay defined as greater than or equal to the mean (1.8 days). Sensitivity analyses defined prolonged length of stay as greater than the median (1 day). Demographic, clinical and process characteristics were examined. Socio-economic position was measured by Income Deprivation Affecting Children Index. Multivariable logistic and linear regression analyses were performed. RESULTS: We did not find a consistent association between length of stay and socio-economic position, using a variety of definitions of length of stay. In contrast, adjusted for age, gender, socio-economic position, ethnicity, final diagnosis, number of hospital admissions, source of admission, and timing of admission, admission to the adult led A&E hospital was more strongly associated with prolonged length of stay (Odds Ratio 1.41, 95% Confidence Interval 1.16, 1.71). CONCLUSION: Local variation in paediatric inpatient length of stay was not explained by demographic, clinical or process factors, but could have been due to residual confounding by medical complexity. Length of stay was not consistently associated with socio-economic position suggesting that length of stay is a function of health service not the determinants of health. Analyses of the
Kühne G, Rigby MJ, Majeed A, et al., 2017, Towards safe and efficient child primary care - gaps in the use of unique identifiers in Europe., Studies in Health Technology and Informatics, Vol: 235, Pages: 53-57, ISSN: 0926-9630
In order to provide for best possible child health care, timely access to all relevant medical data is of vital importance. The aim of this study is to investigate the use of unique identifiers, a key instrument in this regard, in the countries of Europe. A survey was carried out in all 28 European Member States plus 2 European Economic Area countries in 2015, and refreshed in 2016. In 23 countries unique identifiers are used to link children's health records. Five countries indicated they currently do not link child health records, and two have no such plans. There is variety as regards the type of number and the issuing process.
Rigby MJ, Kühne G, Majeed A, et al., 2017, Why Are children's interests invisible in European national e-Health strategies?, Studies in Health Technology and Informatics, Vol: 235, Pages: 58-62, ISSN: 0926-9630
Harnessing the power of IT solutions in child primary care requires strategic thought at national level, and good health care delivery needs this support. The aim of this study was to investigate whether children's needs are considered in national e-health strategies in Europe. In 2016, a survey was carried out in all 28 European Member States plus 2 European Economic Area countries. Sixteen countries fail to mention children's needs at all. Only eleven of 27 countries mention children and adolescents in their national e-health strategy documents ranging from mere data protection concerns to comprehensive IT approaches for the improvement of child primary care.
Blair ME, Oligbu G, Tewari R, et al., 2017, OPTIMISING BONE HEALTH AND VITAMIN D IN THE COMMUNITY-INSIGHTS FROM A COMMUNITY PHARMACY SURVEY, Osteoporosis International, ISSN: 1433-2965
Blair M, 2016, Pregnant women need vitamin D for neonatal health., BMJ, Vol: 355, Pages: i6685-i6685, ISSN: 0959-8138
Klaber RE, Blair M, Lemer C, et al., 2016, Whole population integrated child health: moving beyond pathways, Archives of Disease in Childhood, Vol: 102, Pages: 5-7, ISSN: 0003-9888
Abou El Fadl R, Blair M, Hassounah S, 2016, Integrating maternal and children's oral health promotion into nursing and midwifery practice- a systematic review, PLoS ONE, Vol: 11, Pages: 1-15, ISSN: 1932-6203
BackgroundGlobally, oral diseases contribute to major disease problems and oral health disparities persistentlyexist amongst vulnerable population groups. Two contributory factors to these challengesare the shortage of dental practitioners and the characteristic separation betweenthe medical and dental professions. Nurses and midwives, in particular, are in a potentiallyexcellent position to assist in basic oral health services such as dental health education andintraoral screening. We aimed to assess the effectiveness of integrating promotion of oralhealth of young children and their mothers into nursing and midwifery practice.Methods and FindingsSeven electronic databases including CENTRAL, EMBASE, MEDLINE, GLOBAL HEALTH,CINHAL, Scopus, and Web of Science were systematically searched whereas conferenceproceedings and theses were retrieved via PROQUEST. Only randomized, non-randomizedtrials and observational studies on preventive oral health programs delivered by nurses ormidwives in healthcare settings or through home visits were included. Two investigatorsreviewed full-text articles independently to decide on eligibility for inclusion. Quality assessmentwas done using Cochrane tool for risk of bias for randomized trials and Downs andBlack assessment tool for all other studies. Out of 3162 retrieved records, twenty one trialson oral health interventions incorporated into standard nursing practice were reviewed.Eighteen programs reported significant positive outcomes including reduction in cariesexperience, better oral hygiene and dietary habits and increased rates of dental visitsamongst young children as reported by their caregivers.ConclusionsIncorporating oral health promotion into nursing practice is a promising initiative for reducingoral health disparities by contributing to a downward trend in caries experience andincreased access to dental care especially amongst the poor disadvantaged communities.
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