Introduction Previous research has reported a rise in short-stay paediatric hospital admissions. Speculation has suggested that these admissions are often for self-limiting conditions and that failings in primary care have influenced growing demand. Methods A mixed-methods approach included a review of the current literature and analysis of Hospital Episodes Statistics. These two components formed the quantitative foundation to the project, revealing disease areas most often associated with hospital admissions in children under five years- old. A thematic synthesis of qualitative studies explored parents' views about minor illness and addressed how the concerns parents have when faced with an unwell child translate into actions around care-seeking. Finally a qualitative interview study conducted in the Children's Emergency Department investigated how paediatric clinicians make decisions regarding the treatment of children attending with episodes of minor respiratory disease. Results Respiratory illnesses were found to be the most common reason for admission in the underfives. Many admissions were made under emergency circumstances, involving children from minority ethnic groups. Parents were able to correctly identify illness in their children but had difficulty assessing severity, which triggered the request for care. Primary care factors were often responsible for influencing the families' decision to access emergency care. Clinicians did not believe that admissions rates were alarming but instead suggested that attendances contributed to the greatest demand on the Emergency Department. Clinicians were found to use the resources available in the CED to balance risk and effectively manage children with equivocal respiratory conditions. These resources were believed to be unavailable in primary care suggesting that not all episodes of acute respiratory illness are appropriate for community management. Discussion Short-stay paediatric admissions were considered to be clinically appropriate, ensuring patient safety. The issue of paediatric urgent-care use is complex and ED attendances may be where the true burden originates. Future research should focus on attendances at emergency departments in order to identify primary care solutions.

Objectives: The aim of the study is to investigate the relationship between risk of mortality at admission to a paediatric intensive care unit (PICU) and health status at six months post discharge from PICU in the United Kingdom (UK). Patients and Methods: Prospective follow-up study of children aged 6 months or more at admission to PICU between 2001 and 2002, who were discharged alive. Health status was measured using the Health Utility Index Mark II (HUI2). Risk of mortality was measured using the Paediatric Index of Mortality (PIM and PIM2) and the Pediatric Risk of Mortality (PRISM and PRISM III). The relationship between H U 12 outcomes (individual dimensions and overall Disability) and mortality risk measures was investigated using generalised ordered regression, adjusted for PICUs effect. Results: Eighty six percent (1221/1414) of children had complete data on all HUI2 dimensions. Nearly two thirds (803/1221) of the children had moderate to severe disability. PIM was significantly associated with disability. The odds ratio of having none/mild vs. moderate or severe disability was 1.4, 95% Cl 1.2 to 1.7 for each unit increase in log PIM. More than three quarters of children with severe disability were correctly classified by PIM with good discrimination (c-index = 0.60, p-value < 0.001). PIM also showed a significant relationship to the following individual HUl2 dimensions: Sensation, Mobility, Emotion, Cognition, Self-care, and Pain. Conclusions: Mortality risk tools may be adequate for predicting mortality as outcome following admission to PICU, but of these only PIM showed the potential for predicting long term health status in these children based on c-index and misclassification rate.

No description available.

The aim of the first phase of the research was to explore the self-disclosure process for children on the autistic spectrum. Self-disclosure refers to the process of an individual with autism telling others about their diagnosis. I wanted to find out what self-disclosure involved in schools and what support had been in place to create an environment where self-disclosure was considered appropriate. I thought it would be important to explore what sort of impact self-disclosure had on those involved. Case studies were carried out in order to explore the self-disclosure process in depth. Four participants (aged 13-16) from two mainstream secondary schools who had self-disclosed their autism to their peers participated in semi-structured interviews. These interviews were set up to gain an in-depth understanding of self-disclosure. I interviewed parents and staff from the schools in order to gain different perspectives of the impact of the self-disclosure process. The interviews were analysed thematically. Emerging themes from these interviews showed that self-disclosure had occurred as a result of young people feeling different and wanting to explain their differences. The self-disclosure in all cases was considered to increase understanding of autism through education both for the individual with autism and the peers they self-disclosed to. Increased understanding of autism led to an improved sense of self for the individual with autism and a positive change in behaviour and attitude of the individual’s peers. The interviews also provided some understanding of the factors that supported self-disclosure. The factors were incorporated into a model which was then used in the second phase of the research to support children with autism in the process of self-disclosure. Overall, this process supported children in gaining a more positive sense of self and educated those around them about their personal strengths.

No description available.

Childhood obesity is a problem of increasing concern worldwide. The causes of obesity are complex and varied, but it is clear that there are biological, genetic and social determinants. The Childhood Obesity in Bangladeshi Immigrants project aims to further understand how cultural and biological factors interact in a population at increased risk for obesity-related metabolic diseases. Research was based in neighbourhood primary schools and was centred on pre-adolescent girls, aged 10-12, in a Bangladeshi migrant community in the city of Sunderland in the northeast England, and white British girls of the same age, socioeconomic status and geographical location. Diet and eating behaviours were assessed using 1) a series of school lunchtime observations 2) a single 24-hour photographic food diary, and 3) researcher-administered questionnaires. Physical health has been assessed through height, weight and waist circumference measurements, health histories (as given by parents) and saliva samples for evaluation of bodily inflammation via CRP assay. In concert with these collected data, interviews with school staff, and further questionnaires and focus groups with children and parents were administered on the topics of eating and health beliefs and behaviour. A much greater number of study participants in both cohorts were identified as at risk for metabolic disease by waist circumference measurement than identified as overweight or obese by BMI (18/20 vs 6/20 for the Bangladeshi-British cohort, and 17/20 vs 11/20 for the white British cohort). A significant positive correlation was found between CRP levels and waist-to-height ratio in white British participants (p=0.006). Fruit and vegetable intake was markedly lower in the Bangladesh-British cohort during school hours: 15 servings in 40 lunches vs 40 servings in 52 lunches in the white British cohort. However, food diaries reveal that over the whole day intake is similar in both groups (median intake of 1 serving of vegetables and 2 of fruit per day for Bangladeshi British participants, and a median of 0.5 servings of each for white British participants). Cohorts engaged in very different types of physical activity outside of school hours, with Bangladeshi-British subjects engaging primarily in casual play and white British subjects primarily engaged in formal lessons or team sports. It was also found that the school lunchroom environment has significant impact on the amount and types of food consumed during the lunch period, and it appears that certain types of room arrangements are more conducive to healthy eating than others.

Eye conditions associated with visual impairment and blindness in children, such as congenital cataract, can lead to long lasting visual problems if treatment is delayed. There is need to determine which method can be more effective in identifying blind and visual impaired children. In this study, two methods of identifying blind and visual impaired children (using key informants versus using health surveillance assistants) were compared in a randomised community study conducted in three districts in Southern Malawi. The ministry of Health was advocating for the training of Health Surveillance Assistants (HSAs) in primary eye care, which included case detection and refer of blind and visually impaired children; and the alternative was the training of key informants (KIs). The study was done to compare the effectiveness of the two methods of case identification and to provide guidelines on optimal approaches of identifying blind and severely visually impaired children in Malawi. Twelve clusters (group of villages) were selected, and six were randomly assigned to each group. After training in case identification and referral, Key informants and Heath surveillance assistant identified children from the clusters, within a six-week period, and the number of blind and visual impaired children identified in each group was determined and compared. In total, 159 Key informants and 151 Health Surveillance Assistants were selected and trained, and they identified 550 children with eye problems, among whom, after examination, only 15.1 % were blind or severely visually impaired. Key informants identified one and half times more blind/severally visual impaired children than HSAs (37 vs 22).The prevalence estimates of blindness among children identified by KIs was 3.3 per 10,000 (95% CI 2.7-3.9), while the prevalence estimates of blindness among children identified by HSAs was 1.9 per 10,000 (95% CI 1.3-2.5).The difference was statistically significant (P=0.03), but overall the number of children identified by both groups was lower than was the expected from prevalence estimates of 8.0 per 10,000. False positives between HSAs and KIs were comparable, with 68.8% of children identified by HSAs as blind, confirmed blind on examination, in comparison to 72.5% of children identified by KIs, also confirmed as blind on examination. Cortical blindness seconded by cataract were the commonest causes of blindness. In conclusion, Keys informants were more effective than Health Surveillance assistants in identifying blind and visually impaired children in Malawi, and this study supports and confirms findings from other areas.

No description available.

This thesis examines the impact on child and adolescent psychotherapists within CAMHS of the introduction of routine outcome measures (ROMs) associated with the Children and Young People’s Improving access to Psychological Therapies programme (CYP-IAPT). All CAMHS therapists working within a particular NHS mental health Trust1 were required to trial CYP-IAPT ROMs as part of their everyday clinical practice from October 2013-September 2014. During this period considerable freedom was allowed as to which of the measures each therapist used and at what frequency. In order to assess the impact of CYP-IAPT ROMs on child psychotherapy, I conducted semi-structured interviews with eight psychotherapists within a particular CAMHS partnership within one NHS Trust. Each statement was coded and grouped according to whether it related to initial (generic) assessment, goal setting/monitoring, monitoring on-going progress, therapeutic alliance, or to issues concerning how data might be used or interpreted by managers and commissioners. Analysis of interviews revealed greatest concern about session-by session ROMs, as these are felt to impact most significantly on psychotherapy; therapists felt that session-by-session ROMs do not take account of negative transference relationships, they are overly repetitive and used to reward / punish the therapist. Measures used at assessment and review were viewed as most compatible with psychotherapy, although often experienced as excessively time consuming. The Goal Based Outcome Measure was generally experienced as compatible with psychotherapy so long as goals are formed collaboratively between therapist and young person. There was considerable anxiety about how data may be (mis)used and (mis)interpreted by managers and commissioners, for example to end treatment prematurely, trigger change of therapist in the face of negative ROMs data, or to damage psychotherapy. Use of ROMs for short term and generic work was experienced as less intrusive and contentious.

Behavioural problems exhibited by children with Intellectual and Developmental Disabilities (IDD) have been identified as a significant stressor for family members in both cross-sectional and longitudinal research. However, the extent to which family members are affected by child behavioural problems is variable which may be due to moderating factors between these relationships, including resilience. There is a lack of conceptual clarity in defining what resilience is in existing research, and it is unclear how resilience may improve well-being outcomes in this population. This thesis presented four studies. One study investigated mothers’ reporting on their child’s resilience where it was found that maternal depression had a significant effect on child behavioural and emotional problems. The study found that child resilience functioned as a compensatory factor, being associated with fewer child behavioural problems. Three studies investigated resilience and related constructs in mothers of children with IDD. Social support was found to function as a protective factor between child behavioural problems and maternal depression, life satisfaction and when mothers reported the positive affect of having a child with IDD on themselves and their family. There was also some evidence of the role of practical coping and positive perceptions acting as protective factors between child behavioural and emotional problems and maternal well-being. Consistent evidence was found that maternal resilience functioned as a compensatory factor, improving maternal outcomes; including stress, anxiety, depression, perceptions of positive gain and family satisfaction. One study focused only on mothers of children with Autism Spectrum Disorder (ASD) where the severity of the child’s current ASD symptoms was found to have a significant main effect on maternal depression. Longitudinally maternal resilience did not act as a significant predictor of maternal well-being outcomes over time. Finally, findings from the empirical studies were discussed along with their implications for future research and interventions.