Publications
238 results found
Alis J, Blair M, 2003, Life as a medical secretary a new learning experience for the aspiring consultant, BMJ, Vol: 326
Blair M, Isaacs A, 2003, Evidence-based child health surveillance for the national child health promotion programme, Current Paediatrics, Vol: 13, Pages: 308-314, ISSN: 0957-5839
This article outlines key aspects of evidence-based child health surveillance, screening and prevention. The fourth edition of Health for All Children has recently reviewed this area in detail and proposed an evidence-based universal child health programme. Current programmes include frequent fixed-point reviews of growth and development, but many aspects do not fulfil screening criteria. There is a spectrum of methods of early detection including screening, opportunistic detection, parental concern and targeting of high-risk groups. The benefits and harms of universal versus targeted screening are discussed, as well as evidence-based interventions for three current child public health issues; obesity, developmental and behavioural problems, and injury. ?? 2003 Elsevier Science Ltd. All rights reserved.
Blair M, 2003, The consultant's view, British Medical Journal, Vol: 326, ISSN: 0959-535X
Rigby MJ, Köhler LI, Blair ME, et al., 2003, Child health indicators for Europe: a priority for a caring society., European journal of public health, Vol: 13, Pages: 38-46, ISSN: 1101-1262
BACKGROUND: Measurement of children’s health is important for two reasons: first, because young people are citizens in their own right, yet largely unable to act as self-advocates, particularly at the population level; and second, because their health determines the health of the future population. Indicators based on measurements of child health are important for identifying progress, problems and priorities, changes over time, and newly emergent issues. The European Community Health Monitoring Programme (HMP) is a comprehensive programme to develop and implement a set of national-level indicators. The Child Health Indicators of Life and Development (CHILD) project is the only population group-specific project, seeking to determine a holistic set of measures. METHODS: The project endeavoured to address all aspects of child health and its determinants, balancing positive and negative aspects. It undertook a structured search of published evidence to seek to identify, and validate, indicators of health and illness, health determinants and challenges to health, quality of healthcare support and health-promoting national policies. A systematic approach was used in identifying valid indicators, and in assembling a balanced composite list. All ages from infancy to adolescence were covered. RESULTS: The project’s final report identifies 38 core desirable national indicators, citing purpose and evidence for each. Of equal importance, it also identifies 17 key child health topics on which further research work is needed in order to identify and validate indicators appropriate across different national settings.
Blair M, 2003, Training and Education as a Means of Increasing Equity in Child Health Teaching of Undergraduates, Pediatrics, Vol: 112, Pages: 747-748
Hughes S, Brent K, Kumar S, et al., 2003, Is procalcitonin a discriminant marker of invasive bacterial infection in children?, Pediatric Research, Vol: 53, ISSN: 0031-3998
Blair M, Kohler L, Rigby M, et al., 2002, Child Health Indicators of Life and Development- Report to the European Commission Health Monitoring Programme, C, Editors: Rigby, Kohler, Publisher: EU
Blair M, 2002, Cutting edge research and its impact on future child health policy: a tension across the bridge, European Journal of Public Health, Vol: 12, Pages: 15-16, ISSN: 1101-1262
Hampshire AJ, Blair ME, Crown NS, et al., 2002, Assessing the quality of preschool child health surveillance in primary care: a pilot study in one health district, Child Care Health Dev, Vol: 28, Pages: 239-249
OBJECTIVE: To develop a framework for measuring the quality of preschool child health surveillance acceptable to primary health care teams and measurable at individual primary health care team level. DESIGN: Published research evidence was identified and criteria developed by a local multidisciplinary expert group. The criteria were discussed with primary health care teams. How well they were achieved was assessed. SETTING: Twenty-eight general practices in one health authority area. METHODS: Data collection included observation of baby clinics, interviews with health visitors and general practitioners (GPs), questionnaires to parents, collation of child health surveillance reviews recorded in personal child health records and immunization rates. RESULTS: The criteria for assessing preschool child health surveillance were thought to be acceptable and achievable by primary health care teams. Fifteen of the 22 criteria used to assess baby clinics were met by over 90 of practices. Almost all practices completed child health surveillance reviews within a standard time and achieved 90 coverage for primary immunizations. At many practices, less than 90 of parents felt welcome at the baby clinic, usually had enough time to talk to their health visitor or had the purpose or results of the 6 to 8 week child health surveillance review explained to them. GPs were less likely than health visitors to discuss health promotion at child health surveillance reviews (chi(2) 11.52, P = 0.0007). Few practices had a call-up and recall system for all reviews. CONCLUSION: The framework that we developed for assessing preschool child health surveillance was acceptable and achievable by primary health care teams.
Field D, Draper ES, Gompels MJ, et al., 2001, Measuring later health status of high risk infants: randomised comparison of two simple methods of data collection, BMJ-BRITISH MEDICAL JOURNAL, Vol: 323, Pages: 1276-1280, ISSN: 1756-1833
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- Citations: 7
Elkan R, Robinson J, Williams D, et al., 2001, Universal vs. selective services: the case of British health visiting, JOURNAL OF ADVANCED NURSING, Vol: 33, Pages: 113-119, ISSN: 0309-2402
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- Citations: 21
Field D, Draper ES, Gompels MJ, et al., 2001, Measuring later health status of high risk infants: randomised comparison of two simple methods of data collection, BMJ : British Medical Journal, Vol: 323, Pages: 1276-1276, ISSN: 0959-8138
OBJECTIVE: To test two methods of providing low cost information on the later health status of survivors of neonatal intensive care. DESIGN: Cluster randomised comparison. SETTING: Nine hospitals distributed across two UK health regions. Each hospital was randomised to use one of two methods of follow up. Participants: All infants born </=32 weeks’ gestation during 1997 in the study hospitals. METHOD: Families were recruited at the time of discharge. In one method of follow up families were asked to complete a questionnaire about their child’s health at the age of 2 years (corrected for gestation). In the other method the children’s progress was followed by clerks in the local community child health department by using sources of routine information. RESULTS: 236 infants were recruited to each method of follow up. Questionnaires were returned by 214 parents (91%; 95% confidence interval 84% to 97%) and 223 clerks (95%; 86% to 100%). Completed questionnaires were returned by 201 parents (85%; 76% to 94%) and 158 clerks (67%; 43% to 91%). Most parents found the forms easy to complete, but some had trouble understanding the concept of "corrected age" and hence when to return the form. Community clerks often had to rely on information that was out of date and difficult to interpret. CONCLUSION: Neither questionnaires from parents nor routinely collected health data are adequate methods of providing complete follow up data on children who were born preterm and required neonatal intensive care, though both methods show potential.
Elkan R, Robinson J, Williams D, et al., 2001, Universal vs. selective services: The case of British health visiting, Journal of Advanced Nursing, Vol: 33, Pages: 113-119, ISSN: 0309-2402
AIMS: This paper discusses whether there should be universal or selective provision of health visiting services. The aim is to show the central relevance of the work of the late epidemiologist, Geoffery Rose, to arguments advocating the retention of a universal health visiting service. BACKGROUND: In the United Kingdom (UK), health visiting moved, in the early years of the twentieth century, from being focused on the needs of poor families to becoming a universally provided service. Recent debates about the future of British health visiting have again raised the issue of whether health visiting remains a universal service, or should be targeted only on the most needy. STRUCTURE: Following an exposition of Rose’s work, two kinds of problems with which health visitors are concerned, depression and child abuse, are used to illustrate the ways in which Rose’s approach can be applied to health visiting. CENTRAL THESIS: Rose argued that the bulk of problems in society arise in the many who are not at especially high risk, rather than in the few who are at high risk. This is because of a very large number of people who are not at especially high risk. Consequently, following Rose, this paper argues that in relation to such problems as depression or child abuse, to target health visiting services only on those at high risk would be to leave untouched a vast burden of health and social problems. In the context of identifying people who are at greatest risk, Rose argued that no screening instrument can ever be sufficiently precise to accurately identify those most likely to suffer problems. In corroboration of Rose’s argument, this paper illustrates the pitfalls of health visitors’ attempts to screen for families at greatest risk through the use of such instruments as checklists of risk factors. CONCLUSIONS: It is concluded that it is neither possible to screen accurately for those at greatest risk, nor desirable to target services only on those at gre
Hampshire AJ, Blair ME, Crown NS, et al., 2001, Infant and pre-school child health promotion: What do health visitors and general practitioners think is important and what do they record?, Ambulatory Child Health, Vol: 7, Pages: 191-201, ISSN: 1355-5626
Blair M, 2001, Training of primary care workers in child protection, Child Protection in Primary Care, Editors: Carter, Bannon, Publisher: Radcliffe, ISBN: 9781857752243
Elkan R, Kendrick D, Dewey M, et al., 2001, Effectiveness of home based support for older people: systematic review and meta-analysis., BMJ (Clinical research ed.), Vol: 323, Pages: 719-25, ISSN: 0959-8138
OBJECTIVE: To evaluate the effectiveness of home visiting programmes that offer health promotion and preventive care to older people. DESIGN: Systematic review and meta-analysis of 15 studies of home visiting. PARTICIPANTS: older people living at home, including frail older people at risk of adverse outcomes. OUTCOME MEASURES: Mortality, admission to hospital, admission to institutional care, functional status, health status. RESULTS: Home visiting was associated with a significant reduction in mortality. The pooled odds ratio for eight studies that assessed mortality in members of the general elderly population was 0.76 (95% confidence interval 0.64 to 0.89). Five studies of home visiting to frail older people who were at risk of adverse outcomes also showed a significant reduction in mortality (0.72; 0.54 to 0.97). Home visiting was associated with a significant reduction in admissions to long term institutional care in members of the general elderly population (0.65; 0.46 to 0.91). For three studies of home visiting to frail, "at risk" older people, the pooled odds ratio was 0.55 (0.35 to 0.88). Meta-analysis of six studies of home visiting to members of the general elderly population showed no significant reduction in admissions to hospital (odds ratio 0.95; 0.80 to 1.09). Three studies showed no significant effect on health (standardised effect size 0.06; -0.07 to 0.18). Four studies showed no effect on activities of daily living (0.05; -0.07 to 0.17). CONCLUSION: Home visits to older people can reduce mortality and admission to long term institutional care.
Blair M, Nandasoma M, Crown N, 2001, What do the parents of tomorrow know about child care? A survey of 14–16 year olds., Children & Society, Vol: 15, Pages: 158-169, ISSN: 0951-0605
What do the parents of tomorrow know about child care? This study aimed to obtain a baseline measurement of child care knowledge, to ascertain any differences in knowledge between adolescents with and without mild to moderate learning difficulties (MLD). In addition, we were interested to establish the effect of school nurse health education health input on knowledge in the learning difficulties subgroup. Assessment was by self-completed questionnaire and interview of a random sample of 14–16 year olds attending mainstream and special schools. Sixty pupils from secondary school and 33 from a MLD school took part in the study. Pupil knowledge in basic parenting and child care was dependent on the type of school attended, reading ability of those attending the MLD school and the provision of health education in the special school by the school nurse. No associations were found between pupils knowledge and their gender, family position or family size. Pupils from both schools scored lower in the areas of health service organisation and personnel, health promotion and management of common childhood conditions. Adolescents have insufficient knowledge of basic child care and services available for new parents. The effect of school based health education in these areas is promising. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]
Blair M, 2001, The need for and the role of a coordinator in child health surveillance/promotion., Archives of disease in childhood, Vol: 84, Pages: 1-5, ISSN: 0003-9888
Blair ME, Pullan CR, Rands CE, et al., 2000, Community paediatrics moves on - an analysis of changing work patterns 1994-97, PUBLIC HEALTH, Vol: 114, Pages: 61-64, ISSN: 0033-3506
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Blair M, 2000, Taking a population perspective on child health., Archives of disease in childhood, Vol: 83, Pages: 7-9, ISSN: 0003-9888
Elkan R, Robinson JJA, Blair M, et al., 2000, The effectiveness of health services: the case of health visiting, Health and Social Care in the Community, Vol: 8, Pages: 74-78, ISSN: 0966-0410
Blair ME, Pullan CR, Rands CE, et al., 2000, Community paediatrics moves on–an analysis of changing work patterns 1994-97., Public health, Vol: 114, Pages: 61-64, ISSN: 0033-3506
OBJECTIVES: To describe the current clinical workload of the modern community paediatrician; to outline the changes in this role over recent years and examine the reasons for these. DESIGN AND SETTING: The design is a retrospective analysis of data routinely collected for contracting purposes. Nottingham community paediatric service 1994-97 is the setting. MAIN OUTCOME MEASURES: These are the characteristics of patients seen, sources of referral, locations of clinical contact, referral rates by area. RESULTS: 36,710 appointments were offered over the time period studied. The non-attendance rate was 17%. Pre-school children made up the largest group seen. Most referrals were from health visitors (23%) and school nurses (29%). There has been a small but significant increase in the numbers of children seen who have developmental problems and disability, and due to child protection issues between the time periods. There has been a shift in the proportions of children seen in a local health centre referral clinic (9.8% increase during 1994-97) rather than in a school setting. Twice as many children are referred to the community paediatrician from inner city areas than from the surrounding county areas. CONCLUSION: The transfer of child health surveillance to the primary health care team and the increased training of community paediatricians, has resulted in community paediatricians developing an increasingly specialised role particularly in the areas of child growth and development, disability, social and behavioural paediatrics.
Kendrick D, Hewitt M, Dewey M, et al., 2000, The effect of home visiting programmes on uptake of childhood immunization: A systematic review and meta-analysis, Journal of Public Health Medicine, Vol: 22, Pages: 90-98, ISSN: 0957-4832
BACKGROUND: The aim of the study was to evaluate the effectiveness of home visiting programmes on the uptake of childhood immunization. METHODS: A systematic review was carried out of the literature of controlled studies evaluating home visiting programmes involving at least one post-natal visit, which included tasks within the remit of British health visiting and reporting outcomes relevant to British health visiting. Eleven studies were considered, nine of which used socio-economically disadvantaged families. The outcome measure was uptake of a range of childhood immunizations. RESULTS: Eleven studies reported uptake of immunization. Effect sizes from nine studies were included in the meta-analysis. Fixed effects models demonstrated a significant effect of home visiting for all studies and also for several subgroups of studies, but with significant heterogeneity of effect sizes. A random effects model failed to demonstrate an effect of home visiting. CONCLUSIONS: Home visiting programmes have not been shown to be effective in increasing the uptake of immunization. Other methods of increasing uptake and reducing inequalities in uptake will need to be explored.
Elkan R, Blair M, Robinson JJ, 2000, Evidence-based practice and health visiting: the need for theoretical underpinnings for evaluation., Journal of advanced nursing, Vol: 31, Pages: 1316-1323, ISSN: 0309-2402
In this paper we argue that evidence-based practice, which is being introduced throughout the British National Health Service to make decisions about the allocation of limited resources, provides a welcome opportunity for health visitors to demonstrate their efficacy, skills and professionalism. However, the paper argues that to view health visiting as evidence-based is not to reduce health visiting merely to a technology through which scientific solutions are applied to social problems. Rather, health visiting needs to be viewed as a political movement, based on a particular model of society, which shapes the goals which health visitors pursue and influences the strategies they adopt to achieve their goals. The paper describes various models of health visiting as a way of showing how the goals of health visiting are always framed within a particular set of assumptions and causal explanations. The paper then turns to look at the issue of evaluating health visiting services. It is argued that evaluation should properly take account of the models which shape health visitors’ goals and intervention strategies, and in turn, health visitors need to be explicit about the theoretical frameworks underpinning their interventions. Finally, it is argued that health visitors’ knowledge and understanding of a range of models of society enables them to move between the various models to choose the most appropriate and effective means of intervention. Hence it is concluded that the emphasis on evidence-based practice provides health visitors with a valuable opportunity to show that their unique, professional skills and understanding are the preconditions for effective intervention.
Elkan R, Kendrick D, Hewitt M, et al., 2000, The effectiveness of domiciliary health visiting: a systematic review of international studies and a selective review of the British literature., Health technology assessment (Winchester, England), Vol: 4, ISSN: 1366-5278
James DK, Telfer FM, Keating NA, et al., 2000, Reduced fetal movements and maternal medication - new pregnancy risk factors for neurodevelopmental disability in childhood., Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, Vol: 20, Pages: 226-234, ISSN: 0144-3615
A case-control study was undertaken of 471 children on the Nottingham Special Needs Register (SNR) who were born in one of the two maternity units in the city between 1987 and 1993 (inclusive). Controls were selected as the next infant born at the same hospital following each index case. The aim of the study was to identify risk factors on the Nottingham Obstetric Database for a baby subsequently appearing on the SNR. Disability was analysed by both ICD-9 coding and functional assessment. Factors which independently and significantly predicted a child’s likelihood of being on the SNR were breech presentation (adjusted odds ratio (OR) = 4.0), congenital abnormality (OR=4.9), intrapartum fetal distress (OR=1.7), fetal growth restriction (OR=2.0), socioeconomic deprivation (OR=1.8), prematurity (OR=2.2), reduced fetal movements (OR=2.5) and medication in pregnancy (OR=10.4). To our knowledge the last two factors have not previously been reported as risk predictors for neurodevelopmental disability.
Kendrick D, Elkan R, Hewitt M, et al., 2000, Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis., Archives of disease in childhood, Vol: 82, Pages: 443-451, ISSN: 0003-9888
AIMS: To evaluate the effectiveness of home visiting programmes on parenting and quality of the home environment. DESIGN: Systematic review of the literature of randomised controlled trials and quasi-experimental studies evaluating home visiting programmes involving at least one postnatal visit. SUBJECTS: Thirty four studies reported relevant outcomes; 26 used participants considered to be at risk of adverse maternal or child health outcomes; two used preterm or low birth weight infants; and two used infants with failure to thrive. Only eight used participants not considered to be at risk of adverse child health outcomes. RESULTS: Seventeen studies reported Home Observation for Measurement of the Environment (HOME) scores, 27 reported other measures of parenting, and 10 reported both types of outcome. Twelve studies were entered into the meta analysis. This showed a significant effect of home visiting on HOME score. Similar results were found after restricting the analyses to randomised controlled trials and to higher quality studies. Twenty one of the 27 studies reporting other measures of parenting found significant treatment effects favouring the home visited group on a range of measures. CONCLUSIONS: Home visiting programmes were associated with an improvement in the quality of the home environment. Few studies used UK health visitors, so caution must be exercised in extrapolating the results to current UK health visiting practice. Further work is needed to evaluate whether UK health visitors can achieve similar results. Comparisons with similar programmes delivered by paraprofessionals or community mothers are also needed.
Elkan R, Kendrick D, Hewitt M, et al., 2000, The effectiveness of domiciliary health visiting : a systematic review of, Health Technology Assessment, Vol: 4
Blair M, Heussler H, Polnay L, 2000, Eating behaviors in childhood and adolescence: Continuities and associations from a 16 year longitudinal study of over 6,500 infants, Pediatric Research, Vol: 47, ISSN: 0031-3998
Polnay J, Blair M, 1999, A model programme for busy learners, Child Abuse Review, Vol: 8, Pages: 284-288, ISSN: 0952-9136
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