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Soley-Bori M, Forman JR, Cecil E, Newham J, Lingam R, Wolfe I, Fox-Rushby J. Cost-effectiveness of the children and young People's health partnership (CYPHP) model of integrated care versus enhanced usual care: analysis of a pragmatic cluster randomised controlled trial in South London. THE LANCET REGIONAL HEALTH. EUROPE 2024; 42:100917. [PMID: 38779297 PMCID: PMC11108964 DOI: 10.1016/j.lanepe.2024.100917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024]
Abstract
Background Integration of paediatric health services across primary and secondary care holds great promise for the management of chronic conditions, yet limited evidence exists on its cost-effectiveness. This paper reports the results of the economic evaluation of the Children and Young People's Health Partnership (CYPHP) aimed at integrating care for children with common chronic conditions (asthma, eczema, and constipation). Methods Cost-effectiveness, cost-utility and cost-benefit analyses were conducted alongside a pragmatic cluster randomised controlled trial involving 97,970 children in 70 general practices in South London, including 1,731 participants with asthma, eczema and or constipation with self-reported health-related quality of life measures. Analyses considered the National Health Service (NHS)/Personal Social Service (PSS) and societal perspectives, and time horizons of 6 and 12-months. Costs included intervention delivery, health service use (primary and secondary care), referrals to social services, and time lost from work and school. Health outcomes were measured through the Paediatric Quality of Life Inventory, the Child Health Utility 9-Dimensions, and monetarised benefit combining Quality-Adjusted Life Years (QALYs) for children and parental mental well-being. Results present incremental cost-effectiveness ratios (ICERs), compared to a willingness to pay threshold (WTP) of £20,000-30,000/QALY, and net monetary benefit (NMB), with deterministic sensitivity analyses. Findings At 6 months, from the NHS/PSS perspective, CYPHP is not cost-effective (ICER = £721,000/QALY), and this result holds at 12 months (ICER = £45,586/QALY). However, under the societal perspective CYPHP falls within WTP thresholds (ICER = £22,966/QALY), with a probability of being cost-effective between 0.4 and 0.6 at £20,000/QALY and £30,000/QALY, respectively. The cost-benefit analysis yields a positive NMB of CYPHP at 12 months £109 under the societal perspective, with similar probabilistic results. Interpretation CYPHP was not cost-effective at 6 months or under the NHS/PSS perspective. Trends towards cost-effectiveness are observed once a longer time horizon and a more inclusive perspective on effects is considered. Further research beyond 12 months is needed as the model becomes firmly embedded into the paediatric healthcare delivery system. Funding This research was funded by Guy's and St Thomas' Charity, Lambeth and Southwark Clinical Commissioning Groups. The funders had no role in the writing of the manuscript, decision to submit it for publication, or any other process involved in the research.
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Affiliation(s)
- Marina Soley-Bori
- Department of Population Health Sciences, King's College London, London, UK
| | - Julia R. Forman
- Department of Women and Children's Health, King's College London, London, UK
| | - Elizabeth Cecil
- Department of Women and Children's Health, King's College London, London, UK
| | - James Newham
- Department of Psychology, Northumbria University, Newcastle, UK
| | - Raghu Lingam
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ingrid Wolfe
- Department of Women and Children's Health, King's College London, London, UK
| | - Julia Fox-Rushby
- Department of Population Health Sciences, King's College London, London, UK
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Luengo-Fernandez R. How to assess whether a complex intervention for chronic conditions is cost-effective? THE LANCET REGIONAL HEALTH. EUROPE 2024; 42:100953. [PMID: 38873191 PMCID: PMC11169529 DOI: 10.1016/j.lanepe.2024.100953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Ramon Luengo-Fernandez
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, OX3 7LF, Oxford, United Kingdom
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Wolfe I, Forman J, Cecil E, Newham J, Hu N, Satherley R, Soley-Bori M, Fox-Rushby J, Cousens S, Lingam R. Effect of the Children and Young People's Health Partnership model of paediatric integrated care on health service use and child health outcomes: a pragmatic two-arm cluster randomised controlled trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:830-843. [PMID: 37866369 DOI: 10.1016/s2352-4642(23)00216-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/26/2023] [Accepted: 08/08/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Paediatric health systems across high-income countries are facing avoidable adverse outcomes and increasing demands and costs. The aim of this study was to compare the effect of an enhanced usual care model with that of an integrated health-care model that offers local health clinics for general paediatric problems and early intervention and care for children and young people with tracer conditions. METHODS In this pragmatic two-arm cluster randomised controlled trial, we compared the Children and Young People's Health Partnership (CYPHP) model of care versus enhanced usual care (EUC) among children registered at general practices in south London, UK. The CYPHP trial intervention was delivered between April 1, 2018, and June 30, 2021, and children younger than 16 years during the intervention period and registered at study practices on June 30, 2021, were included in the analysis. A restricted randomisation (1:1) following a computer-generated sequence was done by a masked independent statistician at the level of general practice cluster, stratified by borough (Lambeth or Southwark). Cluster allocation and data collection were masked, with unmasking of trial statisticians before analysis. The CYPHP model comprised all elements of EUC (electronic decision support, a primary care hotline, health checks, self-management support and health promotion, and resilience building and mental health first aid) plus local child health clinics delivered by paediatricians and general practitioners, and a nurse-led early intervention service for children with tracer conditions (asthma, eczema, and constipation). Primary outcomes were non-elective admissions (NELA; admissions coded as an emergency) among the whole trial population up to June 30, 2021, and paediatric quality of life (Pediatric Quality of Life Inventory [PedsQL]) among participants with tracer conditions at 6 months after recruitment. Secondary outcomes were primary and secondary care use, child mental health, parental wellbeing, standardised symptom scores for asthma, eczema, and constipation, health-care quality, and child absences from school and parent absences from work. The trial was registered on ClinicalTrials.gov, NCT03461848, and is complete. FINDINGS The trial was conducted between April 1, 2018, and Dec 31, 2021. In total, 23 general practice clusters, consisting of 70 practices with 97 970 registered children, were randomised to CYPHP (n=11) or EUC (n=12). We found no effect, at the population level, of CYPHP versus EUC on non-elective admissions during the intervention period (adjusted mean incidence rate ratio [IRR] 1·00 [95% CI 0·91 to 1·10], p=0·99). Among children with tracer conditions, we found no difference in paediatric quality of life (PedsQL score) at 6 months (adjusted mean difference -0·033 [95% CI -0·122 to 0·055], p=0·46). As a secondary outcome, among children with tracer conditions and requiring care, NELA rates at 12 months did not differ between the CYPHP and EUC groups (66·1 per 1000 person-years vs 75·3 per 1000 person-years; adjusted mean IRR 0·87 [0·61-1·22], p=0·42). In children requiring care, a statistically significant improvement was observed in eczema symptoms at 6 months from baseline in the CYPHP group versus the EUC group (adjusted mean difference -1·370 [-2·630 to -0·122], p=0·032). Quality of asthma care significantly improved among children in the CYPHP group compared with children in the EUC group. No significant improvement was seen for all other secondary outcomes. INTERPRETATION Although the CYPHP trial found a null effect for the primary outcomes, we found clinically important improvements in some secondary outcomes including care quality. Previous research has shown that large-scale system change requires time to observe a potential positive effect. FUNDING Guy's and St Thomas Charity, the Lambeth and Southwark Clinical Commissioning Groups, and Evelina London Children's Hospital.
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Affiliation(s)
- Ingrid Wolfe
- Department of Women and Children's Health, King's College London, London, UK.
| | - Julia Forman
- Department of Women and Children's Health, King's College London, London, UK
| | - Elizabeth Cecil
- Department of Women and Children's Health, King's College London, London, UK
| | - James Newham
- Department of Psychology, Northumbria University, Newcastle, UK
| | - Nan Hu
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Marina Soley-Bori
- Department of Population Health Sciences, King's College London, London, UK
| | - Julia Fox-Rushby
- Department of Population Health Sciences, King's College London, London, UK
| | - Simon Cousens
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Raghu Lingam
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
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张 佳, 姚 梦, 王 晶, 王 秀, 王 偲, 张 越, 李 艳, 池 霞. [Relationship between home literacy environment and emotional regulation in children: the mediating effect of the parent-child relationship]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1180-1185. [PMID: 37990465 PMCID: PMC10672956 DOI: 10.7499/j.issn.1008-8830.2303078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/02/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To study the impact of the home literacy environment on children's emotional regulation skills and the mediating role of the parent-child relationship between them. METHODS A stratified cluster sampling approach was employed to select 1 626 preschool children from five kindergartens in Nanjing. Questionnaires were used to collect detailed information on the home literacy environment, children's emotional regulation skills, and the parent-child relationship. A mediation model was established using the Process program in SPSS macro, and the significance of the mediation effect was tested using the Bootstrap method. RESULTS The findings revealed a positive correlation between the home literacy environment and children's emotional regulation skills (r=0.217, P<0.001), as well as parent-child intimacy (r=0.065, P<0.01). Conversely, a negative correlation was found between the home literacy environment and parent-child conflict (r=-0.129, P<0.001). Additionally, parent-child conflict demonstrated a negative correlation with children's emotional regulation skills (r=-0.443, P<0.001), while parent-child intimacy exhibited a positive correlation (r=0.247, P<0.001). The home literacy environment exerted a significant direct effect on children's emotional regulation skills (β=0.162, P<0.001), and the mediating effect of the parent-child relationship accounted for 25.54% of the total effect. CONCLUSIONS The home literacy environment significantly influences children's emotional regulation skills, with the parent-child relationship partially mediating this relationship.
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Byrne P. Meeting the challenges of rising premature mortality in people with severe mental illness. Future Healthc J 2023; 10:98-102. [PMID: 37786630 PMCID: PMC10540805 DOI: 10.7861/fhj.2023-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
People with severe mental illness are 4.5 times more likely to die prematurely than the general UK population. We review the drivers of poorer physical health across mental health conditions and propose some practical approaches to addressing this in the clinic.
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Affiliation(s)
- Peter Byrne
- Royal London Hospital, London, UK, and co-director, Public Mental Health Implementation Centre, Royal College of Psychiatrists, UK
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Prokupek L, Cohen F, Oppermann E, Anders Y. Families with young children during the COVID-19 pandemic-The importance of family type, perceived partnership roles, parental stress, and social support for changes in the home learning environment during lockdown. Front Psychol 2023; 14:1119950. [PMID: 36824302 PMCID: PMC9941160 DOI: 10.3389/fpsyg.2023.1119950] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Beginning in March 2020, the lockdown precipitated by the COVID-19 pandemic resulted in many challenges, especially for families with young children. Many children had little or no access to institutional education. Therefore, they were even more dependent on their parents providing them with home learning activities (HLA) to support their development. We examined the adaptability of families with regard to changes in parents' provision of HLA in traditional two-parent families, single parent families, and large families compared to before the lockdown. We focused on family resources, such as a supportive distribution of roles within the partnership, or social support, as predicting factors of adaptability in N = 8,513 families with children aged 18-69 months. In addition, we considered parental stress as a further influencing factor. The cross-sectional data depicts families from a nationwide online survey, which we conducted during spring 2020 in Germany. We found that (a) all three family types offered their children more learning activities at home, albeit with slight differences between the families. However, (b) we identified differences in the factors influencing families' adaptability: Across all family types, we found slight to medium negative relations between adaptability and parental stress. The relations were most evident in large families. Furthermore, social support exhibits somewhat positive relations to the adaptability of large families. For adaptability in single-parent families, gender differences were initially evident. Among single fathers, the change in parental HLA was stronger than among single mothers. However, this relation disappeared when we took parental stress and social support into account. For traditional two-parent families and single parents, our analyses revealed (c) barely significant relations between the investigated predictors and changes in HLA during lockdown. Overall, our study confirms that high stress limits the adaptability of providing HLA in families and that social support mitigates negative relations between stress and the provision of HLA, especially in large families. In order to develop effective and needs-based family support programs, it is therefore important to help parents cope with stress and provide them with low-threshold social support. The extent to which these services need to be adapted to different family types must be surveyed in more depth.
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Affiliation(s)
- Luisa Prokupek
- Chair of Early Childhood Education, Institute for Educational Science University, University of Bamberg, Bamberg, Germany,*Correspondence: Luisa Prokupek, ✉
| | - Franziska Cohen
- Department of Early Childhood Education, Institute for Educational Science, University of Education Freiburg, Freiburg, Germany
| | - Elisa Oppermann
- Chair of Early Childhood Education, Institute for Educational Science University, University of Bamberg, Bamberg, Germany
| | - Yvonne Anders
- Chair of Early Childhood Education, Institute for Educational Science University, University of Bamberg, Bamberg, Germany
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Gentry SV, Paterson BA. Does screening or routine enquiry for adverse childhood experiences (ACEs) meet criteria for a screening programme? A rapid evidence summary. J Public Health (Oxf) 2022; 44:810-822. [PMID: 34231848 DOI: 10.1093/pubmed/fdab238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are traumatic events in childhood that can have impacts throughout life. It has been suggested that ACEs should be 'screened' for, or routinely enquired about, in childhood or adulthood. The aim of this work is to review evidence for this against the United Kingdom National Screening Committee (UKNSC) programme criteria. METHODS A rapid review of evidence on ACEs screening was conducted using the approach of the UKNSC. RESULTS Good quality evidence was identified from meta-analyses for associations between ACEs and a wide range of adverse outcomes. There was no consistent evidence on the most suitable screening tool, setting of administration, and time or frequency of use. Routine enquiry among adults was feasible and acceptable to service users and professionals in various settings. A wide range of potentially effective interventions was identified. Limited evidence was available on the potential for screening or routine enquiry to reduce morbidity and mortality or possible harms of screening. CONCLUSIONS Based on the application of available evidence to UKNSC screening criteria, there is currently insufficient evidence to recommend the implementation of a screening programme for ACEs. Further research is needed to determine whether routine enquiry can improve morbidity, mortality, health and wellbeing.
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Affiliation(s)
- S V Gentry
- Public Health England East of England Centre, Fulbourn, Cambridge CB21 5XA, UK.,Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - B A Paterson
- Public Health England East of England Centre, Fulbourn, Cambridge CB21 5XA, UK
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Burgemeister FC, Crawford SB, Hackworth NJ, Hokke S, Nicholson JM. Place-based approaches to improve health and development outcomes in young children: A scoping review. PLoS One 2021; 16:e0261643. [PMID: 34941941 PMCID: PMC8700019 DOI: 10.1371/journal.pone.0261643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
This scoping review examines the strength of evidence for the effectiveness of public policy-led place-based initiatives designed to improve outcomes for disadvantaged children, their families and the communities in which they live. Study designs and methods for evaluating such place-based initiatives were assessed, along with the contexts in which initiatives were implemented and evaluated. Thirty-two reports relating to 12 initiatives were included. Eleven initiatives used a quasi-experimental evaluation to assess impact, although there were considerable design variations within this. The remaining initiative used a pre- and post- evaluation design. Place-based initiatives by definition aim to improve multiple and interrelated outcomes. We examined initiatives to determine what outcomes were measured and coded them within the five domains of pregnancy and birth, child, parent, family and community. Across the 83 outcomes reported in the 11 studies with a comparison group, 30 (36.4%) demonstrated a positive outcome, and all but one initiative demonstrated a positive outcome in at least one outcome measure. Of the six studies that examined outcomes more than once post baseline, 10 from 38 outcomes (26.3%) demonstrated positive sustained results. Many initiatives were affected by external factors such as policy and funding changes, with unknown impact on their effectiveness. Despite the growth of place-based initiatives to improve outcomes for disadvantaged children, the evidence for their effectiveness remains inconclusive.
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Affiliation(s)
| | | | - Naomi J. Hackworth
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- Parenting Research Centre, East Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Stacey Hokke
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Jan M. Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
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Ford T, Degli Esposti M, Crane C, Taylor L, Montero-Marín J, Blakemore SJ, Bowes L, Byford S, Dalgleish T, Greenberg MT, Nuthall E, Phillips A, Raja A, Ukoumunne OC, Viner RM, Williams JMG, Allwood M, Aukland L, Casey T, De Wilde K, Farley ER, Kappelmann N, Lord L, Medlicott E, Palmer L, Petit A, Pryor-Nitsch I, Radley L, Warriner L, Sonley A, Kuyken W. The Role of Schools in Early Adolescents' Mental Health: Findings From the MYRIAD Study. J Am Acad Child Adolesc Psychiatry 2021; 60:1467-1478. [PMID: 33677037 PMCID: PMC8669152 DOI: 10.1016/j.jaac.2021.02.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 01/18/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Recent studies suggest mental health in youths is deteriorating. The current policy in the United Kingdom emphasizes the role of schools for mental health promotion and prevention, but little data exist on what aspects of schools influence mental health in pupils. This study explored school-level influences on the mental health of young people in a large school-based sample from the United Kingdom. METHOD Baseline data from a large cluster randomized controlled trial collected between 2016 and 2018 from mainstream secondary schools selected to be representative in relation to their quality rating, size, deprivation, mixed or single-sex pupil population, and country were analyzed. Participants were pupils in their first or second year of secondary school. The study assessed whether school-level factors were associated with pupil mental health. RESULTS The study included 26,885 pupils (response rate = 90%; age range, 11‒14 years; 55% female) attending 85 schools in the United Kingdom. Schools accounted for 2.4% (95% CI: 2.0%‒2.8%; p < .0001) of the variation in psychopathology, 1.6% (95% CI: 1.2%‒2.1%; p < .0001) of depression, and 1.4% (95% CI: 1.0%‒1.7%; p < .0001) of well-being. Schools in urban locations, with a higher percentage of free school meals and of White British, were associated with poorer pupil mental health. A more positive school climate was associated with better mental health. CONCLUSION School-level variables, primarily related to contextual factors, characteristics of pupil population, and school climate, explain a small but significant amount of variability in mental health of young people. This information might be used to identify schools that are in need of more resources to support mental health of young people. CLINICAL TRIAL REGISTRATION INFORMATION MYRIAD: My Resilience in Adolescence, a Study Examining the Effectiveness and Cost-Effectiveness of a Mindfulness Training Programme in Schools Compared With Normal School Provision; https://www.isrctn.com/; 86619085.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tim Dalgleish
- University of Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, United Kingdom
| | | | | | | | - Anam Raja
- University of Oxford, United Kingdom
| | | | | | | | | | | | | | | | | | - Nils Kappelmann
- Max Planck Institute of Psychiatry and International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Liz Lord
- University of Oxford, United Kingdom
| | | | - Lucy Palmer
- University of Texas Southwestern Medical Center, Dallas
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Hu Z, Kaminga AC, Yang J, Liu J, Xu H. Adverse childhood experiences and risk of cancer during adulthood: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2021; 117:105088. [PMID: 33971569 DOI: 10.1016/j.chiabu.2021.105088] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Research findings on the relationship between adverse childhood experiences (ACEs) and the risk of cancer were inconsistent. OBJECTIVE The purpose of this study was to perform a quantitative synthesis of the preceding research findings. PARTICIPANTS AND SETTING System review and meta-analysis. METHODS Electronic database of PubMed, Embase, Web of Science and Cochrane Library were systematically searched to identify relevant observational studies published not later than September 9, 2020. Specifically, original articles that reported the risk of cancer in adult populations that experienced ACEs before the age of 18 were selected. All pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated using a random-effects model. Publication bias was examined using funnel plots, and sensitivity analysis was used to explore the stability of the pooled results. RESULTS A total of 18 studies involving 406,210 participants were included in this review. Individuals with 2 or 3 kinds of ACEs (OR = 1.35, 95%CI:1.12,1.62) or at least 4 ACEs (OR = 2.17, 95%CI: 1.76,2.68) were at increased risk of cancer when compared with individuals with no ACEs. Of the different types of ACEs examined, physical abuse (OR = 1.23, 95%CI:1.05,1.43), sexual abuse (OR = 1.26, 95%CI:1.02,1.56), exposure to intimate partner violence (OR = 1.26, 95%CI:1.12,1.41) and financial difficulties in the family (OR = 1.16, 95%CI:1.00,1.33) were associated with the risk of any cancer. CONCLUSIONS These findings suggest that multiple ACEs may be a risk factor for cancer development. Therefore, prevention of ACEs and interventions for supporting those affected by ACEs are necessary.
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Affiliation(s)
- Zhao Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Atipatsa Chiwanda Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China; Department of Mathematics and Statistics, Mzuzu University, Luwinga, Mzuzu, Malawi
| | - Jun Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jiefeng Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.
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11
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Mason KE, Alexiou A, Bennett DL, Summerbell C, Barr B, Taylor-Robinson D. Impact of cuts to local government spending on Sure Start children's centres on childhood obesity in England: a longitudinal ecological study. J Epidemiol Community Health 2021; 75:860-866. [PMID: 34376587 PMCID: PMC8372393 DOI: 10.1136/jech-2020-216064] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/22/2021] [Indexed: 11/05/2022]
Abstract
Background Childhood obesity is rising in disadvantaged areas in England. Sure Start children’s centres provide community-based services for children <5 years and their parents, including many services that can support healthy weight, directly or indirectly. Since 2010, austerity-driven cuts to local authority (LA) budgets have led to substantially reduced public expenditure on Sure Start services. We assessed whether childhood obesity prevalence has increased more since 2010 in those areas in England that experienced greater cuts to spending on Sure Start. Methods This longitudinal ecological study covers the period 2010/2011–2017/2018. Our exposure was LA expenditure on Sure Start, using Department for Education data. Our main outcome was LA obesity prevalence at age 4–5 years, using National Child Measurement Programme data. We used fixed-effects panel regression to quantify the association between change in spending and change in the prevalence of childhood obesity. Results Spending on Sure Start children’s centres decreased on average 53% over the study period, with deeper cuts in more deprived LAs. Each 10% spending cut was associated with a 0.34% relative increase in obesity prevalence the following year (95% CI 0.15% to 0.53%). We estimated there were an additional 4575 children with obesity (95% CI 1751 to 7399) and 9174 overweight or obese (95% CI 2689 to 15 660) compared with expected numbers had funding levels been maintained. Conclusions Cuts to spending on Sure Start children’s centres were associated with increased childhood obesity. With deprived areas experiencing bigger spending cuts, reinvesting in these services may, alongside wider benefits for child development, contribute to reducing inequalities in childhood obesity.
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Affiliation(s)
- Kate E Mason
- Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Alexandros Alexiou
- Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Davara Lee Bennett
- Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, School of Medicine and Health, Durham University, Stockton-on-Tees, UK
| | - Ben Barr
- Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Hope S, Pearce A, Cortina-Borja M, Chittleborough C, Barlow J, Law C. Modelling the potential for parenting skills interventions to reduce inequalities and population prevalence of children's mental health problems: Evidence from the Millennium Cohort Study. SSM Popul Health 2021; 14:100817. [PMID: 34169135 PMCID: PMC8209401 DOI: 10.1016/j.ssmph.2021.100817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/30/2021] [Accepted: 05/08/2021] [Indexed: 12/03/2022] Open
Abstract
Parenting programmes can improve parenting quality and, in turn, children's mental health. If scaled-up, they have the potential to reduce population inequalities and prevalence in child mental health problems (MHP). However, this cannot be investigated with trials. Using data from the UK Millennium Cohort Study (18,000 children born 2000-2002), we simulated population impact of scale-up of seven parenting programmes. Predicted probabilities of child MHP (Strengths and Difficulties Questionnaire) by household income quintile (Risk ratios [RRs] and differences [RDs], 95% confidence intervals [CI]) were estimated from logistic marginal structural models, adjusting for parenting quality scores (Child-Parent Relationship Scale at 3 years) and confounders. The impact of scaling-up parenting programmes was simulated by re-estimating predicted probabilities of child MHP after increasing parenting scores according to intervention intensity, targeting mechanisms and programme uptake levels. Analyses included data from 14,399 children, with survey weights and multiple imputation addressing sampling design, attrition and item missingness. Prevalence of child MHP at 5 years was 11.3% (11.4% unadjusted), with relative and absolute income inequalities (RR = 4.8[95%CI:3.6-5.9]; RD = 15.8%[13.4-18.2]). In simulations, universal, non-intensive parenting programmes reduced prevalence (9.4%) and absolute inequalities (RR = 5.0[95%CI:3.8-6.2]; RD = 13.6%[11.5-15.7]). Intensive programmes, targeting a range of potential risk criteria (e.g. receipt of means-tested benefits), reduced inequalities (RR = 4.0[95%CI:3.0-4.9]; RD = 12.4%[10.3-14.6] and, to a lesser extent, prevalence (10.3%). By simulating implementation of parenting programmes, we show that universal non-intensive and targeted intensive approaches have the potential to reduce child MHP at population level, and to reduce but not eliminate inequalities, with important implications for future policy and practice.
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Affiliation(s)
- Steven Hope
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Catherine Law
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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User fees removal and community-based management of undernutrition in Burkina Faso: what effects on children's nutritional status? Public Health Nutr 2021; 24:3768-3779. [PMID: 33593454 DOI: 10.1017/s1368980021000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine the effect of an intervention combining user fees removal with community-based management of undernutrition on the nutrition status in children under 5 years of age in Burkina Faso. DESIGN The study was a non-equivalent control group post-test-only design based on household survey data collected 4 years after the intervention onset in the intervention and comparison districts. Additionally, we used propensity score weighting to achieve balance on covariates between the two districts, followed by logistic multilevel modelling. SETTING Two health districts in the Sahel region. PARTICIPANTS Totally, 1116 children under 5 years of age residing in 41 intervention communities and 1305 from 51 control communities. RESULTS When comparing children living in the intervention district to children living in a non-intervention district, we determined no differences in terms of stunting (OR = 1·13; 95 % CI 0·83, 1·54) and wasting (OR = 1·21; 95 % CI 0·90, 1·64), nor in severely wasted (OR = 1·27; 95 % CI 0·79, 2·04) and severely stunted (OR = 0·99; 95 % CI 0·76, 1·26). However, we determined that 3 % of the variance of wasting (95 % CI 1·25, 10·42) and 9·4 % of the variance of stunting (95 % CI 6·45, 13·38) were due to systematic differences between communities of residence. The presence of the intervention in the communities explained 2 % of the community-level variance of stunting and 3 % of the community-level variance of wasting. CONCLUSIONS With the scaling-up of the national free health policy in Africa, we stress the need for rigorous evaluations and the means to measure expected changes in order to better inform health interventions.
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Black M, Barnes A, Baxter S, Beynon C, Clowes M, Dallat M, Davies AR, Furber A, Goyder E, Jeffery C, Kritsotakis EI, Strong M. Learning across the UK: a review of public health systems and policy approaches to early child development since political devolution. J Public Health (Oxf) 2020; 42:224-238. [PMID: 30799501 PMCID: PMC7251421 DOI: 10.1093/pubmed/fdz012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/20/2018] [Accepted: 01/22/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Giving children the best start in life is critical for their future health and wellbeing. Political devolution in the UK provides a natural experiment to explore how public health systems contribute to children's early developmental outcomes across four countries. METHOD A systematic literature review and input from a stakeholder group was used to develop a public health systems framework. This framework then informed analysis of public health policy approaches to early child development. RESULTS A total of 118 studies met the inclusion criteria. All national policies championed a 'prevention approach' to early child development. Political factors shaped divergence, with variation in national conceptualizations of child development ('preparing for life' versus 'preparing for school') and pre-school provision ('universal entitlement' or 'earned benefit'). Poverty and resourcing were identified as key system factors that influenced outcomes. Scotland and Wales have enacted distinctive legislation focusing on wider determinants. However, this is limited by the extent of devolved powers. CONCLUSION The systems framework clarifies policy complexity relating to early child development. The divergence of child development policies in the four countries and, particularly, the explicit recognition in Scottish and Welsh policy of wider determinants, creates scope for this topic to be a tracer area to compare UK public health systems longer term.
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Affiliation(s)
- Michelle Black
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Amy Barnes
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Susan Baxter
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Claire Beynon
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, UK
| | - Mark Clowes
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Mary Dallat
- Public Health Agency Northern Ireland, Linenhall Street Unit, 12-22 Linenhall Street, Belfast BT2 8BS, UK
| | - Alisha R Davies
- Division of Population Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Andrew Furber
- Public Health England (Yorkshire and the Humber), Blenheim House, Duncombe Street, Leeds LS1 4PL, UK
| | - Elizabeth Goyder
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Catherine Jeffery
- NHS Borders, Borders General Hospital, Melrose, Roxburghshire TD69BS, UK
| | - Evangelos I Kritsotakis
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Mark Strong
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
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McLuckie A, Landers AL, Curran JA, Cann R, Carrese DH, Nolan A, Corrigan K, Carrey NJ. A scoping review of mental health prevention and intervention initiatives for infants and preschoolers at risk for socio-emotional difficulties. Syst Rev 2019; 8:183. [PMID: 31337424 PMCID: PMC6651971 DOI: 10.1186/s13643-019-1043-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Infant mental health has emerged as a unique area of practice and research distinguished from child and youth sub-specialties by its advocacy for a relational practice framework with an emphasis on parents/caregivers being integral to assessment, treatment, and prevention initiatives. A diverse array of initiatives offered across a broad spectrum of delivery methods is available to clinicians. However, to date, a large-scale mapping of the research evidence regarding these interventions has yet to be completed to help inform clinician's decisions regarding the best approaches for their clients. To address this knowledge gap, this study aimed to report on the landscape of research pertaining to mental health interventions for infants and preschoolers (0-5 years), and their families at risk for socio-emotional difficulties and negative developmental outcomes. METHOD A scoping review methodology was used to conduct a large-scale mapping of the intervention research pertaining to infants and preschoolers (0-5) at risk for socio-emotional difficulties. We searched MEDLINE, PsycINFO, EMBASE, Web of Science, The Cochrane Library, CINAHL, LILACS, ProQuest Nursing & Allied Health Source, World Cat, and ClinicalTrials.gov , from inception to December 31, 2012. We extracted information regarding publication date, geographical location, study design, level of risk, population, key intervention mechanism, and outcome measures. RESULTS We identified 533 potential studies from 1233 title and abstracts after the first round of screening. Full text article review in the second round of screening resulted in a total of 162 included articles for the final analysis. Results indicated that over 50% of interventions evaluated were randomized controlled trials conducted in Westernized countries. Most studies could be subdivided by level of risk within a preventative public health framework including universal, selected, indicated, and direct treatment for children formally diagnosed with a mental disorder. Risk factors experienced by children and their families were heterogeneously defined and numerous outcome measures across included studies. The results of this study are limited to the last search date of 2012. CONCLUSIONS Key intervention mechanisms spanned a range of approaches including parenting groups, dyadic, in-home, cognitive-behavioral therapy, and day care-based interventions. The findings are discussed in terms of implications for broad trends and gaps in research and policy for this population.
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Affiliation(s)
| | - Ashley L Landers
- Department of Human Development, Virginia Polytechnic Institute & State University, 7054 Haycock Road, Falls Church, VA, 22043, USA.
| | | | | | - Domenica H Carrese
- Department of Human Development, Virginia Polytechnic Institute & State University, 7054 Haycock Road, Falls Church, VA, 22043, USA
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Abstract
Purpose
The purpose of this paper is to extend a theory of health promoting schools (Markham and Aveyard, 2003) that draws heavily upon Nussbaum’s Aristotelian interpretation of good human functioning (Nussbaum, 1990). This theory of health promoting schools proposed that health is grounded in the meeting of identified fundamental human needs and the realisation of identified essential human capacities (Markham and Aveyard, 2003).
Design/methodology/approach
The extension of this theory is achieved through the application of influential social theories with practical tenets to Nussbaum’s insights (Nussbaum, 1990). This extension includes additional essential human capacities, a description and definition of how good human functioning may be recognised, potential limitations of the capabilities approaches and a discussion of major factors inhibiting good human functioning.
Findings
The potential contribution of the outlined framework to discussions of health and health promotion is highlighted in two ways. First, this paper considers how the outlined framework may contribute to discussions of quality of life, morbidity/premature mortality and health-related behaviours. Second, this paper briefly considers how the outlined framework may contribute to discussions of public health policy, and the planning, delivery and evaluation of health promotion initiatives. Basic exemplar pre- and post-questionnaires for a hypothetical health promoting community development programme are offered.
Originality/value
This paper attempts to contribute to discussions of the application of Nussbaum’s Aristotelean interpretation of good human functioning to both public health and health promotion.
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Davidson R, Randhawa G, Cash S. Identification of Complex Health Interventions Suitable for Evaluation: Development and Validation of the 8-Step Scoping Framework. JMIR Res Protoc 2019; 8:e10075. [PMID: 30835240 PMCID: PMC6423464 DOI: 10.2196/10075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/24/2018] [Accepted: 11/10/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is extensive literature on the methodology of evaluation research and the development and evaluation of complex interventions but little guidance on the formative stages before evaluation and how to work with partner organizations that wish to have their provision evaluated. It is important to be able to identify suitable projects for evaluation from a range of provision and describe the steps required, often with academic institutions working in partnership with external organizations, in order to set up an evaluation. However, research evaluating programs or interventions rarely discusses these stages. OBJECTIVE This study aimed to extend work on evaluability assessment and pre-evaluation planning by proposing an 8-Step Scoping Framework to enable the appraisal of multiple programs in order to identify interventions suitable for evaluation. We aimed to add to the literature on evaluability assessment and more recent evaluation guidance by describing the processes involved in working with partner organizations. METHODS This paper documents the steps required to identify multiple complex interventions suitable for process and outcome evaluation. The steps were developed using an iterative approach by working alongside staff in a local government organization, to build an evidence base to demonstrate which interventions improve children's outcomes. The process of identifying suitable programs for evaluation, thereby establishing the pre-evaluation steps, was tested using all Flying Start provision. RESULTS The 8-Step Scoping Framework was described using the example of the local government organization Flying Start to illustrate how each step contributes to finding projects suitable for process and outcome evaluation: (1) formulating overarching key questions that encompass all programs offered by an organization, (2) gaining an in-depth understanding of the work and provision of an organization and engaging staff, (3) completing a data template per project/program offered, (4) assessing the robustness/validity of data across all programs, (5) deciding on projects suitable for evaluation and those requiring additional data, (6) negotiating with chosen project leads, both within and outside the organization, (7) developing individual project evaluation protocols, and (8) applying for ethical approval from the university and partner organization. CONCLUSIONS This paper describes the processes involved in identifying suitable projects for evaluation. It adds to the existing literature on the assessment of specific programs suitable for evaluation and guidance for conducting evaluations by establishing the formative steps required to identify suitable programs from a range of provision. This scoping framework particularly relates to academic partners and organizations tasked with delivering evidence-based services designed to meet local needs. The steps identified have been described in the context of early years provision but can be applied to a range of community-based evaluations, or more generally, to cases where an academic partner is working with external stakeholders to identify projects suitable for academic evaluation.
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Affiliation(s)
- Rosemary Davidson
- Institute for Health Research, University of Bedfordshire, Luton, United Kingdom
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, United Kingdom
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Deidda M, Geue C, Kreif N, Dundas R, McIntosh E. A framework for conducting economic evaluations alongside natural experiments. Soc Sci Med 2019; 220:353-361. [PMID: 30513485 PMCID: PMC6323352 DOI: 10.1016/j.socscimed.2018.11.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 11/30/2022]
Abstract
Internationally, policy makers are increasingly focussed on reducing the detrimental consequences and rising costs associated with unhealthy diets, inactivity, smoking, alcohol and other risk factors on the health of their populations. This has led to an increase in the demand for evidence-based, cost-effective Population Health Interventions (PHIs) to reverse this trend. Given that research designs such as randomised controlled trials (RCTs) are often not suited to the evaluation of PHIs, Natural Experiments (NEs) are now frequently being used as a design to evaluate such complex, preventive PHIs. However, current guidance for economic evaluation focusses on RCT designs and therefore does not address the specific challenges of NE designs. Using such guidance can lead to sub-optimal design, data collection and analysis for NEs, leading to bias in the estimated effectiveness and cost-effectiveness of the PHI. As a consequence, there is a growing recognition of the need to identify a robust methodological framework for the design and conducting of economic evaluations alongside such NEs. This paper outlines the challenges inherent to the design and conduct of economic evaluations of PHIs alongside NEs, providing a comprehensive framework and outlining a research agenda in this area.
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Affiliation(s)
- Manuela Deidda
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, United Kingdom.
| | - Claudia Geue
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, United Kingdom
| | - Noemi Kreif
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, United Kingdom
| | - Emma McIntosh
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, United Kingdom
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Blanson Henkemans OA, Keij M, Grootjen M, Kamphuis M, Dijkshoorn A. Design and evaluation of the StartingTogether App for home visits in preventive child health care. BMC Nurs 2018; 17:41. [PMID: 30237751 PMCID: PMC6139149 DOI: 10.1186/s12912-018-0310-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/24/2018] [Indexed: 12/31/2022] Open
Abstract
Background The StartingTogether program (in Dutch SamenStarten) is a family-centred method for early identification of social-emotional and behavioural problems in young children. Nurses in preventive child health care find it challenging to: determine family issues and need for care; provide education; refer to social services; increase parent empowerment. To mitigate these challenges, we developed and evaluated the StartingTogether App, offering nurses and parents conversational support, tailored education and information on social services. Methods A mixed method design, consisting of a qualitative evaluation of the StartingTogether App, with group discussions with nurses (N = 14) and a pilot test (N = 5), and a randomized controlled trial, evaluating the effectiveness of the app. Nurses (N = 33) made home visits to parents (N = 194), in teams with or without the app. Nurses were surveyed on the challenges experienced during visits. Parents (N = 166) were surveyed on their satisfaction with health care and app. Nurses were interviewed on the benefits and barriers to use the app. Results Parents with the StartingTogether App were more satisfied with the visits than parents without (p = .002). Parents with a high educational level were more satisfied with the visits than the parents with a low educational level. With the app, their satisfaction level was similar (p < .001). Nurses using the app felt more equipped to communicate with parents (p = .012) and experienced that parents were more knowledgeable and skilled (p = .001). Parents felt that with the app the nurse was more polite (p = .02), listened more carefully (p = .03), and had more time (p = .02). Nurses with the app gave parents more opportunity to ask questions (p = .001) and gave clearer answers (p < .001). The qualitative evaluation indicated that some nurses needed extra time to develop the habit of using the app. Conclusions The StartingTogether App contributes to parents’ satisfaction with home visits. An interaction effect between parents’ educational level and rating of home visits indicated that the app has an additional value for parents with a lower educational level. Applying mobile applications, such as the StartingTogether App, potentially has a positive effect on communication between nurses and parents about the family situation in relation to parent empowerment and the child’s development. Trial registration The study is registered with ISRCTN under the number ISRCTN12491485, on August 23, 2018. Retrospectively registered.
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Affiliation(s)
| | - Marjolein Keij
- Pharos, Arthur van Schendelstraat 620, 3511 MJ Utrecht, The Netherlands
| | - Marc Grootjen
- Eaglescience B.V. , Naritaweg 12K, 1043 BZ Amsterdam, The Netherlands
| | - Mascha Kamphuis
- JGZ Zuid-Holland West, Croesinckplein, 24-26 2722 EA Zoetermeer, The Netherlands
| | - Anna Dijkshoorn
- 1TNO, Child Health, Schipholweg 77-89, 2316 ZL, Leiden, The Netherlands
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Admon Livny K, Katz C. Schools, Families, and the Prevention of Child Maltreatment: Lessons That Can Be Learned From a Literature Review. TRAUMA, VIOLENCE & ABUSE 2018; 19:148-158. [PMID: 27207764 DOI: 10.1177/1524838016650186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Child maltreatment is a worldwide social problem that receives considerable attention. However, prevention efforts remain rare, allowing the phenomenon to continue and spread. The aim of the current article is to systematically review evidence-based prevention efforts that address schools and families as key stakeholders for preventing child maltreatment. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a thorough literature review revealed that only five programs matched the inclusion criteria for the current article. These programs were analyzed for several domains, including level of prevention, target population, participants, and the programs' outcomes. The current review highlights the urgent needs to develop, modify, and further evaluate prevention programs for child maltreatment in the context of the ecological model. More specifically, it illuminates the need to create and champion programs that enhance the collaboration between families and schools, both of which are key stakeholders within the phenomenon of child maltreatment. Collaboration between policymakers, researchers, and practitioners should guide future efforts by promoting cultural adaptation to such programs and by integrating children's perceptions to improve these efforts and to benefit everyone involved.
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Affiliation(s)
- Karen Admon Livny
- 1 Bob Shapell School of Social Work, Tel Aviv University, Ramat Aviv, Israel
| | - Carmit Katz
- 1 Bob Shapell School of Social Work, Tel Aviv University, Ramat Aviv, Israel
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Stack RJ, Meredith A. The Impact of Financial Hardship on Single Parents: An Exploration of the Journey From Social Distress to Seeking Help. JOURNAL OF FAMILY AND ECONOMIC ISSUES 2018; 39:233-242. [PMID: 29755247 PMCID: PMC5932102 DOI: 10.1007/s10834-017-9551-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Single parent families are at high risk of financial hardship which may impact on psychological wellbeing. This study explored the impact of financial hardship on wellbeing on 15 single parents. Semi-structured interviews were conducted and analysed using constructivist thematic analysis. Participants described food and fuel poverty, and the need to make sacrifices to ensure that children's basic needs were met. In some cases, participants went without food and struggled to pay bills. Isolation, anxiety, depression, paranoia, and suicidal thoughts were described. However, participants reported that psychological services not able to take the needs of single parents in to account. Support for single parents must acknowledge the impact of social circumstances and give more consideration economic drivers of distress.
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Affiliation(s)
- Rebecca Jayne Stack
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Alex Meredith
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
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Pillay J. Early Education of orphans and vulnerable children: A crucial aspect for social justice and African development. KOERS - BULLETIN FOR CHRISTIAN SCHOLARSHIP 2018. [DOI: 10.19108/koers.83.1.2335] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the last decade there has been a significant escalation in the number of orphans and vulnerable children (OVC) in various parts of the world, more particularly, in Sub- Saharan Africa. The author strongly asserts that early childhood education is the main vehicle to address the concerns of OVC in order for them to develop skills and human capital as future adults in order to improve the outcomes for governance and economic development in Africa. He argues on the basis of inclusion that a social justice framework is essential in taking the rights of OVC into consideration. Adopting a bio- ecological systems theoretical model the author presents research findings on the educational, psychological and social experiences of OVC to motivate the need for African governments to take on the responsibility of addressing the plight of OVC through early childhood development and education interventions if they are serious about economic sustainability and prosperity. Although the research discussed in this paper was conducted in South Africa the author believes that the findings could easily depict what happens in the rest of Africa. In concluding, the author considers the implications of the findings in relation to future policies and directions needed for crucial development in Africa.
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Bärnighausen T, Tugwell P, Røttingen JA, Shemilt I, Rockers P, Geldsetzer P, Lavis J, Grimshaw J, Daniels K, Brown A, Bor J, Tanner J, Rashidian A, Barreto M, Vollmer S, Atun R. Quasi-experimental study designs series—paper 4: uses and value. J Clin Epidemiol 2017; 89:21-29. [DOI: 10.1016/j.jclinepi.2017.03.012] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/18/2017] [Accepted: 03/21/2017] [Indexed: 01/20/2023]
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Maternal breastfeeding and children's cognitive development. Soc Sci Med 2017; 187:101-108. [DOI: 10.1016/j.socscimed.2017.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/30/2017] [Accepted: 06/11/2017] [Indexed: 01/28/2023]
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Kendrick D, Ablewhite J, Achana F, Benford P, Clacy R, Coffey F, Cooper N, Coupland C, Deave T, Goodenough T, Hawkins A, Hayes M, Hindmarch P, Hubbard S, Kay B, Kumar A, Majsak-Newman G, McColl E, McDaid L, Miller P, Mulvaney C, Peel I, Pitchforth E, Reading R, Saramago P, Stewart J, Sutton A, Timblin C, Towner E, Watson MC, Wynn P, Young B, Zou K. Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundUnintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.AimTo increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.MethodsSix work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.ResultsModifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.LimitationsOur case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.ConclusionsOur studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.Future workFurther randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.Trial registrationCurrent Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Joanne Ablewhite
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Achana
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Penny Benford
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Rose Clacy
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Frank Coffey
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Trudy Goodenough
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Adrian Hawkins
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mike Hayes
- Child Accident Prevention Trust, London, UK
| | - Paul Hindmarch
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephanie Hubbard
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Bryony Kay
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Arun Kumar
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - Elaine McColl
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa McDaid
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Phil Miller
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Isabel Peel
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Richard Reading
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norfolk Community Health and Care NHS Trust, Norwich, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - Jane Stewart
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Clare Timblin
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Elizabeth Towner
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Michael C Watson
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Persephone Wynn
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Kun Zou
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Hu Y, van Lenthe FJ, Hoffmann R, van Hedel K, Mackenbach JP. Assessing the impact of natural policy experiments on socioeconomic inequalities in health: how to apply commonly used quantitative analytical methods? BMC Med Res Methodol 2017; 17:68. [PMID: 28427353 PMCID: PMC5397741 DOI: 10.1186/s12874-017-0317-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The scientific evidence-base for policies to tackle health inequalities is limited. Natural policy experiments (NPE) have drawn increasing attention as a means to evaluating the effects of policies on health. Several analytical methods can be used to evaluate the outcomes of NPEs in terms of average population health, but it is unclear whether they can also be used to assess the outcomes of NPEs in terms of health inequalities. The aim of this study therefore was to assess whether, and to demonstrate how, a number of commonly used analytical methods for the evaluation of NPEs can be applied to quantify the effect of policies on health inequalities. METHODS We identified seven quantitative analytical methods for the evaluation of NPEs: regression adjustment, propensity score matching, difference-in-differences analysis, fixed effects analysis, instrumental variable analysis, regression discontinuity and interrupted time-series. We assessed whether these methods can be used to quantify the effect of policies on the magnitude of health inequalities either by conducting a stratified analysis or by including an interaction term, and illustrated both approaches in a fictitious numerical example. RESULTS All seven methods can be used to quantify the equity impact of policies on absolute and relative inequalities in health by conducting an analysis stratified by socioeconomic position, and all but one (propensity score matching) can be used to quantify equity impacts by inclusion of an interaction term between socioeconomic position and policy exposure. CONCLUSION Methods commonly used in economics and econometrics for the evaluation of NPEs can also be applied to assess the equity impact of policies, and our illustrations provide guidance on how to do this appropriately. The low external validity of results from instrumental variable analysis and regression discontinuity makes these methods less desirable for assessing policy effects on population-level health inequalities. Increased use of the methods in social epidemiology will help to build an evidence base to support policy making in the area of health inequalities.
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Affiliation(s)
- Yannan Hu
- Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | | | - Rasmus Hoffmann
- Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
- European University Institute, Florence, Italy
| | - Karen van Hedel
- Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
- Max Planck Institute for Demographic Research, Rostock, Germany
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Craig P, Katikireddi SV, Leyland A, Popham F. Natural Experiments: An Overview of Methods, Approaches, and Contributions to Public Health Intervention Research. Annu Rev Public Health 2017; 38:39-56. [PMID: 28125392 PMCID: PMC6485604 DOI: 10.1146/annurev-publhealth-031816-044327] [Citation(s) in RCA: 244] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Population health interventions are essential to reduce health inequalities and tackle other public health priorities, but they are not always amenable to experimental manipulation. Natural experiment (NE) approaches are attracting growing interest as a way of providing evidence in such circumstances. One key challenge in evaluating NEs is selective exposure to the intervention. Studies should be based on a clear theoretical understanding of the processes that determine exposure. Even if the observed effects are large and rapidly follow implementation, confidence in attributing these effects to the intervention can be improved by carefully considering alternative explanations. Causal inference can be strengthened by including additional design features alongside the principal method of effect estimation. NE studies often rely on existing (including routinely collected) data. Investment in such data sources and the infrastructure for linking exposure and outcome data is essential if the potential for such studies to inform decision making is to be realized.
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Affiliation(s)
- Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G2 3QB, United Kingdom; , , ,
| | | | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G2 3QB, United Kingdom; , , ,
| | - Frank Popham
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G2 3QB, United Kingdom; , , ,
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Hu Y, van Lenthe FJ, Judge K, Lahelma E, Costa G, de Gelder R, Mackenbach JP. Did the English strategy reduce inequalities in health? A difference-in-difference analysis comparing England with three other European countries. BMC Public Health 2016; 16:865. [PMID: 27558269 PMCID: PMC4995654 DOI: 10.1186/s12889-016-3505-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Between 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique. Previous evaluations have produced mixed results. None of these evaluations have, however, compared the trends in health inequalities within England with those in other European countries. We carried out an innovative analysis to assess whether changes in trends in health inequalities observed in England after the implementation of its programme, have been more favourable than those in other countries without such a programme. METHODS Data were obtained from nationally representative surveys carried out in England, Finland, the Netherlands and Italy for years around 1990, 2000 and 2010. A modified difference-in-difference approach was used to assess whether trends in health inequalities in 2000-2010 were more favourable as compared to the period 1990-2000 in England, and the changes in trends in inequalities after 2000 in England were then compared to those in the three comparison countries. Health outcomes were self-assessed health, long-standing health problems, smoking status and obesity. Education was used as indicator of socioeconomic position. RESULTS After the implementation of the English strategy, more favourable trends in some health indicators were observed among low-educated people, but trends in health inequalities in 2000-2010 in England were not more favourable than those observed in the period 1990-2000. For most health indicators, changes in trends of health inequalities after 2000 in England were also not significantly different from those seen in the other countries. CONCLUSIONS In this rigorous analysis comparing trends in health inequalities in England both over time and between countries, we could not detect a favourable effect of the English strategy. Our analysis illustrates the usefulness of a modified difference-in-difference approach for assessing the impact of policies on population-level health inequalities.
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Affiliation(s)
- Yannan Hu
- Department of Public Health, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ken Judge
- Department of Health, University of Bath, Bath, UK
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Giuseppe Costa
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Rianne de Gelder
- Department of Public Health, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Tonge KL, Jones RA, Okely AD. Correlates of children's objectively measured physical activity and sedentary behavior in early childhood education and care services: A systematic review. Prev Med 2016; 89:129-139. [PMID: 27235604 DOI: 10.1016/j.ypmed.2016.05.019] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/06/2016] [Accepted: 05/20/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To systematically review the correlates of physical activity and sedentary behavior among children in Early Childhood Education and Care (ECEC) services. Appropriate levels of physical activity and sedentary behavior are important to promote in ECEC services. METHODS A systematic search of 8 databases identified 27 studies published between 1992 and 2015 that met the inclusion criteria. The data were collected and analyzed in 2014 and 2015, and variables were categorized using a Social Ecological Framework. RESULTS Sixty-six variables were identified. The domains of child characteristics (18 studies) and physical environmental factors (17 studies) were most consistently studied, and, for physical activity had the most positive associations. The strongest associations of physical activity were: child's sex and age, children's gross motor coordination, provision of active opportunities for physical activity, and features of outdoor environments (size, use of and presence). The only strong association for sedentary behavior was the presence of outdoor environments. CONCLUSION The correlates of physical activity and sedentary behavior in ECEC services vary. It appears that the most significant influence from within these settings is the physical environments for both physical activity and sedentary behavior. There was an absence of consistent evidence at the educator and organizational levels. Further research in this area should focus on effective use of space, intentional teaching opportunities and well as professional development for educators with an emphasis on their role as a facilitator of quality experiences. This review has been registered with Prospero, #CRD42014013660.
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Affiliation(s)
- Karen L Tonge
- Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, NSW, Australia.
| | - Rachel A Jones
- Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, NSW, Australia.
| | - Anthony D Okely
- Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia.
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Eastwood JG, Kemp LA, Jalaludin BB. Realist theory construction for a mixed method multilevel study of neighbourhood context and postnatal depression. SPRINGERPLUS 2016; 5:1081. [PMID: 27468381 PMCID: PMC4945545 DOI: 10.1186/s40064-016-2729-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/30/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND We have recently described a protocol for a study that aims to build a theory of neighbourhood context and postnatal depression. That protocol proposed a critical realist Explanatory Theory Building Method comprising of an: (1) emergent phase, (2) construction phase, and (3) confirmatory phase. A concurrent triangulated mixed method multilevel cross-sectional study design was described. The protocol also described in detail the Theory Construction Phase which will be presented here. METHODS The Theory Construction Phase will include: (1) defining stratified levels; (2) analytic resolution; (3) abductive reasoning; (4) comparative analysis (triangulation); (5) retroduction; (6) postulate and proposition development; (7) comparison and assessment of theories; and (8) conceptual frameworks and model development. THEORY CONSTRUCTION The stratified levels of analysis in this study were predominantly social and psychological. The abductive analysis used the theoretical frames of: Stress Process; Social Isolation; Social Exclusion; Social Services; Social Capital, Acculturation Theory and Global-economic level mechanisms. Realist propositions are presented for each analysis of triangulated data. Inference to best explanation is used to assess and compare theories. A conceptual framework of maternal depression, stress and context is presented that includes examples of mechanisms at psychological, social, cultural and global-economic levels. Stress was identified as a necessary mechanism that has the tendency to cause several outcomes including depression, anxiety, and health harming behaviours. The conceptual framework subsequently included conditional mechanisms identified through the retroduction including the stressors of isolation and expectations and buffers of social support and trust. CONCLUSION The meta-theory of critical realism is used here to generate and construct social epidemiological theory using stratified ontology and both abductive and retroductive analysis. The findings will be applied to the development of a middle range theory and subsequent programme theory for local perinatal child and family interventions.
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Affiliation(s)
- John G. Eastwood
- />Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Road, Croydon, NSW 2132 Australia
- />School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- />School of Women’s and Children’s Health, The University of New South Wales, Sydney, NSW 2052 Australia
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
- />School of Public Health, The University of Sydney, Sydney, NSW 2006 Australia
- />School of Medicine, Griffith University, Gold Coast, QLD 4222 Australia
| | - Lynn A. Kemp
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
- />School of Nursing and Midwifery, Western Sydney University, Campbelltown, NSW 2560 Australia
| | - Bin B. Jalaludin
- />School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
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Welsh J, Strazdins L, Ford L, Friel S, O'Rourke K, Carbone S, Carlon L. Promoting equity in the mental wellbeing of children and young people: a scoping review. Health Promot Int 2016; 30 Suppl 2:ii36-76. [PMID: 26420811 DOI: 10.1093/heapro/dav053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
There is increasing emphasis on wellbeing as a target for mental health promotion, especially during the formative period of childhood. Despite growing research on the importance of mental wellbeing, there is little information on how to effectively promote it or how to promote it equitably. This article presents a scoping review of interventions which seek to promote mental wellbeing and reduce inequities in children and young people living in high income countries. We used Fair Foundations: The VicHealth framework for health equity (VicHealth (2013) Melbourne, Australia: The Victorian Health Promotion Foundation) to identify points of entry at three layers of influence: (i) socioeconomic, cultural and political contexts, (ii) daily living conditions, and (iii) individual and family health-related factors. We identified more than 1000 interventions which aimed to prevent or treat childhood mental illness, but there were far fewer that aimed to promote children's or young people's mental wellbeing. The interventions we studied were either universal or specifically targeted children from disadvantaged families: none explicitly used an equity framework to guide their design or evaluation or addressed social gradients in wellbeing. Most interventions remained focused on proximate factors, although we also identified a handful of interventions that sought to address children's access to services and their educational and neighbourhood environments. However, we found encouraging evidence that interventions in family and educational settings were successful in building children's strengths and supporting positive parenting, universally and within disadvantaged groups. Such positive programme evaluations signal the potential for using a proportionate universalism approach that emphasizes equity in the promotion of mental wellbeing.
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Affiliation(s)
- Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Lyndall Strazdins
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Laura Ford
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Sharon Friel
- Regulatory Institutions Network (RegNet), Australian National University, Canberra, ACT 2601, Australia
| | - Kerryn O'Rourke
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC 3053, Australia
| | - Stephen Carbone
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC 3053, Australia
| | - Leanne Carlon
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC 3053, Australia
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Applying for, reviewing and funding public health research in Germany and beyond. Health Res Policy Syst 2016; 14:43. [PMID: 27297230 PMCID: PMC4907007 DOI: 10.1186/s12961-016-0112-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/17/2016] [Indexed: 11/10/2022] Open
Abstract
Public health research is complex, involves various disciplines, epistemological perspectives and methods, and is rarely conducted in a controlled setting. Often, the added value of a research project lies in its inter- or trans-disciplinary interaction, reflecting the complexity of the research questions at hand. This creates specific challenges when writing and reviewing public health research grant applications. Therefore, the German Research Foundation (DFG), the largest independent research funding organization in Germany, organized a round table to discuss the process of writing, reviewing and funding public health research. The aim was to analyse the challenges of writing, reviewing and granting scientific public health projects and to improve the situation by offering guidance to applicants, reviewers and funding organizations. The DFG round table discussion brought together national and international public health researchers and representatives of funding organizations. Based on their presentations and discussions, a core group of the participants (the authors) wrote a first draft on the challenges of writing and reviewing public health research proposals and on possible solutions. Comments were discussed in the group of authors until consensus was reached. Public health research demands an epistemological openness and the integration of a broad range of specific skills and expertise. Applicants need to explicitly refer to theories as well as to methodological and ethical standards and elaborate on why certain combinations of theories and methods are required. Simultaneously, they must acknowledge and meet the practical and ethical challenges of conducting research in complex real life settings. Reviewers need to make the rationale for their judgments transparent, refer to the corresponding standards and be explicit about any limitations in their expertise towards the review boards. Grant review boards, funding organizations and research ethics committees need to be aware of the specific conditions of public health research, provide adequate guidance to applicants and reviewers, and ensure that processes and the expertise involved adequately reflect the topic under review.
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Robling M, Bekkers MJ, Bell K, Butler CC, Cannings-John R, Channon S, Martin BC, Gregory JW, Hood K, Kemp A, Kenkre J, Montgomery AA, Moody G, Owen-Jones E, Pickett K, Richardson G, Roberts ZES, Ronaldson S, Sanders J, Stamuli E, Torgerson D. Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial. Lancet 2016; 387:146-55. [PMID: 26474809 PMCID: PMC4707160 DOI: 10.1016/s0140-6736(15)00392-x] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Many countries now offer support to teenage mothers to help them to achieve long-term socioeconomic stability and to give a successful start to their children. The Family Nurse Partnership (FNP) is a licensed intensive home-visiting intervention developed in the USA and introduced into practice in England that involves up to 64 structured home visits from early pregnancy until the child's second birthday by specially recruited and trained family nurses. We aimed to assess the effectiveness of giving the programme to teenage first-time mothers on infant and maternal outcomes up to 24 months after birth. METHODS We did a pragmatic, non-blinded, randomised controlled, parallel-group trial in community midwifery settings at 18 partnerships between local authorities and primary and secondary care organisations in England. Eligible participants were nulliparous and aged 19 years or younger, and were recruited at less than 25 weeks' gestation. Field-based researchers randomly allocated mothers (1:1) via remote randomisation (telephone and web) to FNP plus usual care (publicly funded health and social care) or to usual care alone. Allocation was stratified by site and minimised by gestation (<16 weeks vs ≥16 weeks), smoking status (yes vs no), and preferred language of data collection (English vs non-English). Mothers and assessors (local researchers at baseline and 24 months' follow-up) were not masked to group allocation, but telephone interviewers were blinded. Primary endpoints were biomarker-calibrated self-reported tobacco use by the mother at late pregnancy, birthweight of the baby, the proportion of women with a second pregnancy within 24 months post-partum, and emergency attendances and hospital admissions for the child within 24 months post-partum. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN23019866. FINDINGS Between June 16, 2009, and July 28, 2010, we screened 3251 women. After enrolment, 823 women were randomly assigned to receive FNP and 822 to usual care. All follow-up data were retrieved by April 25, 2014. 304 (56%) of 547 women assigned to FNP and 306 (56%) of 545 assigned to usual care smoked at late pregnancy (adjusted odds ratio [AOR] 0·90, 97·5% CI 0·64-1·28). Mean birthweight of 742 babies with mothers assigned to FNP was 3217·4 g (SD 618·0), whereas birthweight of 768 babies assigned to usual care was 3197·5 g (SD 581·5; adjusted mean difference 20·75 g, 97·5% CI -47·73 to 89·23. 587 (81%) of 725 assessed children with mothers assigned to FNP and 577 (77%) of 753 assessed children assigned to usual care attended an emergency department or were admitted to hospital at least once before their second birthday (AOR 1·32, 97·5% CI 0·99-1·76). 426 (66%) of 643 assessed women assigned to FNP and 427 (66%) 646 assigned to usual care had a second pregnancy within 2 years (AOR 1·01, 0·77-1·33). At least one serious adverse event (mainly clinical events associated with pregnancy and infancy period) was reported for 310 (38%) of 808 participants (mother-child) in the usual care group and 357 (44%) of 810 in the FNP group, none of which were considered related to the intervention. INTERPRETATION Adding FNP to the usually provided health and social care provided no additional short-term benefit to our primary outcomes. Programme continuation is not justified on the basis of available evidence, but could be reconsidered should supportive longer-term evidence emerge. FUNDING Department of Health Policy Research Programme.
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Affiliation(s)
- Michael Robling
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - Marie-Jet Bekkers
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kerry Bell
- York Trials Unit, University of York, York, UK
| | - Christopher C Butler
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Rebecca Cannings-John
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Sue Channon
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Kerry Hood
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Alison Kemp
- School of Medicine, Cardiff University, Cardiff, UK
| | - Joyce Kenkre
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK; Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Gwenllian Moody
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Eleri Owen-Jones
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kate Pickett
- Department of Health Sciences, University of York, York, UK
| | | | | | | | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Santana P, Costa C, Cardoso G, Loureiro A, Ferrão J. Suicide in Portugal: Spatial determinants in a context of economic crisis. Health Place 2015; 35:85-94. [PMID: 26277771 DOI: 10.1016/j.healthplace.2015.07.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/05/2015] [Accepted: 07/09/2015] [Indexed: 11/15/2022]
Abstract
This study compares the existing statistical association between suicide mortality and the characteristics of places of residence (municipalities), before and during the current economic crisis, in Portugal. We found that (1) the traditional culture-based North/South pattern of suicidal behaviour has faded away, while the socioeconomic urban/rural divide has become more pronounced; (2) suicide is associated with higher levels of rurality and material deprivation; and (3) recent shifts in suicidal trends may result from the current period of crisis. Strategies targeting rural areas combined with public policies that address area deprivation may have important implications for tackling suicide.
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Affiliation(s)
- Paula Santana
- Centre of Studies on Geography and Spatial Planning, Department of Geography, University of Coimbra, Portugal.
| | - Cláudia Costa
- Centre of Studies on Geography and Spatial Planning, University of Coimbra, Portugal
| | - Graça Cardoso
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, NOVA Medical School, New University of Lisbon, Portugal
| | - Adriana Loureiro
- Centre of Studies on Geography and Spatial Planning, University of Coimbra, Portugal
| | - João Ferrão
- Institute of Social Sciences, University of Lisbon, Portugal
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Maheswaran H, Kupek E, Petrou S. Self-reported health and socio-economic inequalities in England, 1996-2009: Repeated national cross-sectional study. Soc Sci Med 2015; 136-137:135-46. [PMID: 26004207 PMCID: PMC4510149 DOI: 10.1016/j.socscimed.2015.05.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Tackling social inequalities in health has been a priority for recent UK governments. We used repeated national cross-sectional data for 155,311 participants (aged ≥16 years) in the Health Survey of England to examine trends in socio-economic inequalities in self-reported health over a recent period of sustained policy focus by successive UK governments aimed at tackling social inequalities in health. Socio-economic related inequalities in self-reported health were estimated using the Registrar General's occupational classification (1996-2009), and for sensitivity analyses, the National Statistics Socio-Economic Classification (NS-SEC; 2001-2011). Multi-level regression was used to evaluate time trends in General Health Questionnaire (GHQ-12) scores and bad or very bad self-assessed health (SAH), as well as EQ-5D utility scores. The study found that the probability of reporting GHQ-12 scores ≥4 and ≥ 1 was higher in those from lower social classes, and decreased for all social classes between 1997 and 2009. For SAH, the probability of reporting bad or very bad health remained relatively constant for social class I (professional) [0.028 (95%CI: 0.026, 0.029) in 1996 compared to 0.028 (95%CI: 0.024, 0.032) in 2009], but increased in lower social classes, with the greatest increase observed amongst those in social class V (unskilled manual) [0.089 (95%CI: 0.085, 0.093) in 1996 compared to 0.155 (95%CI: 0.141, 0.168) in 2009]. EQ-5D utility scores were lower for those in lower social classes, but remained comparable across survey years. In sensitivity analyses using the NS-SEC, health outcomes improved from 2001 to 2011, with no evidence of widening socio-economic inequalities. Our findings suggest that socio-economic inequalities have persisted, with evidence of widening for some adverse self-reported health outcomes.
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Affiliation(s)
- Hendramoorthy Maheswaran
- Division of Health Sciences, University of Warwick Medical School, Coventry, UK; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
| | - Emil Kupek
- Department of Public Health, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Stavros Petrou
- Division of Health Sciences, University of Warwick Medical School, Coventry, UK
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Anderson LM, Adeney KL, Shinn C, Safranek S, Buckner‐Brown J, Krause LK. Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database Syst Rev 2015; 2015:CD009905. [PMID: 26075988 PMCID: PMC10656573 DOI: 10.1002/14651858.cd009905.pub2] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Racial and ethnic disparities in health status are pervasive at all stages of the life cycle. One approach to reducing health disparities involves mobilizing community coalitions that include representatives of target populations to plan and implement interventions for community level change. A systematic examination of coalition-led interventions is needed to inform decision making about the use of community coalition models. OBJECTIVES To assess effects of community coalition-driven interventions in improving health status or reducing health disparities among racial and ethnic minority populations. SEARCH METHODS We searched MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index, Dissertation Abstracts, System for Information on Grey Literature in Europe (SIGLE) (from January 1990 through September 30, 2013), and Global Health Library (from January 1990 through March 31, 2014). SELECTION CRITERIA Cluster-randomized controlled trials, randomized controlled trials, quasi-experimental designs, controlled before-after studies, interrupted time series studies, and prospective controlled cohort studies. Only studies of community coalitions with at least one racial or ethnic minority group representing the target population and at least two community public or private organizations are included. Major outcomes of interest are direct measures of health status, as well as lifestyle factors when evidence indicates that these have an effect on the direct measures performed. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias for each study. MAIN RESULTS Fifty-eight community coalition-driven intervention studies were included. No study was considered to be at low risk of bias. Behavioral change outcomes and health status change outcomes were analyzed separately. Outcomes are grouped by intervention type. Pooled effects across intervention types are not presented because the diverse community coalition-led intervention studies did not examine the same constructs or relationships, and they used dissimilar methodological designs. Broad-scale community system level change strategies led to little or no difference in measures of health behavior or health status (very low-certainty evidence). Broad health and social care system level strategies leds to small beneficial changes in measures of health behavior or health status in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions led to beneficial changes in health behavior measures of moderate magnitude in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions may lead to beneficial changes in health status measures in large samples of community residents; however, results were not consistent across studies (low-certainty evidence). Group-based health education led by professional staff resulted in moderate improvement in measures of health behavior (very low-certainty evidence) or health status (low-certainty evidence). Adverse outcomes of community coalition-led interventions were not reported. AUTHORS' CONCLUSIONS Coalition-led interventions are characterized by connection of multi-sectoral networks of health and human service providers with ethnic and racial minority communities. These interventions benefit a diverse range of individual health outcomes and behaviors, as well as health and social care delivery systems. Evidence in this review shows that interventions led by community coalitions may connect health and human service providers with ethnic and racial minority communities in ways that benefit individual health outcomes and behaviors, as well as care delivery systems. However, because information on characteristics of the coalitions themselves is insufficient, evidence does not provide an explanation for the underlying mechanisms of beneficial effects. Thus, a definitive answer as to whether a coalition-led intervention adds extra value to the types of community engagement intervention strategies described in this review remains unattainable.
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Affiliation(s)
- Laurie M Anderson
- University of WashingtonDepartment of Epidemiology, School of Public HealthP.O. Box 357236SeattleWAUSA98195‐7236
| | - Kathryn L Adeney
- Washington State Institute for Public PolicyEpidemiology and Public Health110 Fifth Avenue SE, Suite 214SeattleWAUSA98504
| | - Carolynne Shinn
- New Hampshire Department of Health and Human ServicesNew Hampshire Division of Public Health ServicesConcordNew HampshireUSA03301‐3852
| | - Sarah Safranek
- University of WashingtonHealth Sciences Library1959 NE Pacific StreetSeattleWAUSA98195‐7155
| | - Joyce Buckner‐Brown
- Centers for Disease Control and PreventionNational Center for Chronic Disease Prevention and Health Promotion, Division of Community Health, Research Surveillance & Evaluation Branch4770 Buford Hwy NE, Mailstop K81AtlantaGeorgiaUSA30341
| | - L Kendall Krause
- Bill & Melinda Gates FoundationEpidemiology and Surveillance DivisionSeattleWAUSA
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Falster K, Jorm L, Eades S, Lynch J, Banks E, Brownell M, Craven R, Einarsdóttir K, Randall D. What factors contribute to positive early childhood health and development in Australian Aboriginal children? Protocol for a population-based cohort study using linked administrative data (The Seeding Success Study). BMJ Open 2015; 5:e007898. [PMID: 25986640 PMCID: PMC4442193 DOI: 10.1136/bmjopen-2015-007898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Australian Aboriginal children are more likely than non-Aboriginal children to have developmental vulnerability at school entry that tracks through to poorer literacy and numeracy outcomes and multiple social and health disadvantages in later life. Empirical evidence identifying the key drivers of positive early childhood development in Aboriginal children, and supportive features of local communities and early childhood service provision, are lacking. METHODS AND ANALYSIS The study population will be identified via linkage of Australian Early Development Census data to perinatal and birth registration data sets. It will include an almost complete population of children who started their first year of full-time school in New South Wales (NSW), Australia, in 2009 and 2012. Early childhood health and development trajectories for these children will be constructed via linkage to a range of administrative data sets relating to birth outcomes, congenital conditions, hospital admissions, emergency department presentations, receipt of ambulatory mental healthcare services, use of general practitioner services, contact with child protection and out-of-home care services, receipt of income assistance and fact of death. Using multilevel modelling techniques, we will quantify the contributions of individual-level and area-level factors to variation in early childhood development outcomes in Aboriginal and non-Aboriginal children. Additionally, we will evaluate the impact of two government programmes that aim to address early childhood disadvantage, the NSW Aboriginal Maternal and Infant Health Service and the Brighter Futures Program. These evaluations will use propensity score matching methods and multilevel modelling. ETHICS AND DISSEMINATION Ethical approval has been obtained for this study. Dissemination mechanisms include engagement of stakeholders (including representatives from Aboriginal community controlled organisations, policy agencies, service providers) through a reference group, and writing of summary reports for policy and community audiences in parallel with scientific papers.
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Affiliation(s)
- Kathleen Falster
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- The Sax Institute, Sydney, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
- Centre for Health Research, School of Medicine, University of Western Sydney, Campbelltown, Australia
| | - Sandra Eades
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - John Lynch
- School of Population Health, University of Adelaide, Adelaide, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- The Sax Institute, Sydney, Australia
| | - Marni Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Rhonda Craven
- Institute of Positive Psychology and Education, Australian Catholic University, Sydney, Australia
| | | | - Deborah Randall
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
- Centre for Health Research, School of Medicine, University of Western Sydney, Campbelltown, Australia
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The rise of multiple imputation: a review of the reporting and implementation of the method in medical research. BMC Med Res Methodol 2015; 15:30. [PMID: 25880850 PMCID: PMC4396150 DOI: 10.1186/s12874-015-0022-1] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/18/2015] [Indexed: 12/16/2022] Open
Abstract
Background Missing data are common in medical research, which can lead to a loss in statistical power and potentially biased results if not handled appropriately. Multiple imputation (MI) is a statistical method, widely adopted in practice, for dealing with missing data. Many academic journals now emphasise the importance of reporting information regarding missing data and proposed guidelines for documenting the application of MI have been published. This review evaluated the reporting of missing data, the application of MI including the details provided regarding the imputation model, and the frequency of sensitivity analyses within the MI framework in medical research articles. Methods A systematic review of articles published in the Lancet and New England Journal of Medicine between January 2008 and December 2013 in which MI was implemented was carried out. Results We identified 103 papers that used MI, with the number of papers increasing from 11 in 2008 to 26 in 2013. Nearly half of the papers specified the proportion of complete cases or the proportion with missing data by each variable. In the majority of the articles (86%) the imputed variables were specified. Of the 38 papers (37%) that stated the method of imputation, 20 used chained equations, 8 used multivariate normal imputation, and 10 used alternative methods. Very few articles (9%) detailed how they handled non-normally distributed variables during imputation. Thirty-nine papers (38%) stated the variables included in the imputation model. Less than half of the papers (46%) reported the number of imputations, and only two papers compared the distribution of imputed and observed data. Sixty-six papers presented the results from MI as a secondary analysis. Only three articles carried out a sensitivity analysis following MI to assess departures from the missing at random assumption, with details of the sensitivity analyses only provided by one article. Conclusions This review outlined deficiencies in the documenting of missing data and the details provided about imputation. Furthermore, only a few articles performed sensitivity analyses following MI even though this is strongly recommended in guidelines. Authors are encouraged to follow the available guidelines and provide information on missing data and the imputation process. Electronic supplementary material The online version of this article (doi:10.1186/s12874-015-0022-1) contains supplementary material, which is available to authorized users.
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Leijten P, Shaw DS, Gardner F, Wilson MN, Matthys W, Dishion TJ. The family check-up and service use in high-risk families of young children: a prevention strategy with a bridge to community-based treatment. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 16:397-406. [PMID: 24643281 PMCID: PMC4169741 DOI: 10.1007/s11121-014-0479-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Integration of empirically supported prevention programs into existing community services is a critical step toward effecting sustainable change for the highest-risk members in a community. We examined if the Family Check-Up--known to reduce disruptive behavior problems in young children--can provide a bridge to the use of community treatment services among high-risk indigent families. The study's 731 income-eligible families with a 2-year-old child were screened and randomized to the Family Check-Up (FCU) intervention or a control condition. Families were provided yearly FCUs from age 2 through age 5. Regression analyses on families' service use at child age 7.5 revealed increased service use, compared with that of the control group. Child disruptive behavior and socioeconomic status moderated the effect of the intervention on service use. Families who reported higher levels of disruptive child behavior and lower socioeconomic status showed more service use, suggesting the intervention increased service use among the highest-risk families. Greater use of community services did not mediate the effect of the FCU on reduced oppositional-defiant child behavior. Implications of these findings for the design and ecology of community treatment services in the context of evidence-based practices are discussed.
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Pickett KE, Wilkinson RG. The ethical and policy implications of research on income inequality and child well-being. Pediatrics 2015; 135 Suppl 2:S39-47. [PMID: 25733724 DOI: 10.1542/peds.2014-3549e] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Child well-being is important for lifelong health and well-being. Although there is a robust evidence base linking social determinants of health (eg, relative poverty and income inequality) to child well-being, social and public health policy tends to focus on interventions to mitigate their effects, rather than remove the root causes. The goal of this study was to examine associations between child well-being and income inequality. METHODS We compared reported rates of childhood well-being in the 2007 and 2013 UNICEF reports on child well-being in wealthy countries. Twenty indicators of child well-being (excluding child poverty) were defined consistently in both the 2007 and 2013 reports. These variables were used to create an indicator of change in child well-being over the approximate decade 2000 to 2010. For our analyses of income inequality, we used the Organization for Economic Cooperation and Development Gini coefficient of income inequality for 2009 and change between 2000 and 2009, respectively. RESULTS The overall index of child well-being in 2013 was closely and negatively correlated with income inequality (r = -0.60, P = .004) but not with average income (r = -0.3460, P = .12). Adjustment for income inequality, children in relative poverty, and the child poverty gap did not change the lack of association between average income and child well-being in 2013 in wealthy countries. Between 2000 and 2010, child well-being scores improved most in Italy, Norway, Portugal, the United Kingdom, and Germany. The biggest declines were seen in Sweden, Canada, Japan, Switzerland, and France. Countries that experienced the largest increases in income inequality had significantly greater declines in child well-being (r = -0.51, P = .02). CONCLUSIONS Children born into socioeconomically disadvantaged families suffer worse child well-being and its lifelong implications, in all societies, worldwide. Our analyses show, however, that some wealthy societies are able to mitigate these inequalities; these societies have better child well-being, on average. This outcome has less to do with specific welfare policies or targeted interventions for poor children than to a societal commitment to greater equality.
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Affiliation(s)
- Kate E Pickett
- Department of Health Sciences, University of York, York, United Kingdom; and
| | - Richard G Wilkinson
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
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Gardiner J, Sutcliffe AG, Melhuish E, Barnes J. Paternal Age, Paternal Presence and Children's Health: An Observational Study. Pediatr Rep 2015; 7:5659. [PMID: 25918623 PMCID: PMC4387328 DOI: 10.4081/pr.2015.5659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/17/2014] [Indexed: 11/30/2022] Open
Abstract
In an observational study of 31,257 children we investigated the effects of paternal age at the time of the child's birth, paternal absence and non-biological fathers on children's health. Results are per 5 year change in paternal age. Older fathers were associated with lower rates of unintentional injuries, odds ratio (OR)=0.966, P=0.0027. There was a quadratic association between paternal age and risk of hospital admission, β=0.0121, P=0.0109, with minimum risk at paternal age 37.7. Absent fathers were associated with increased risk of hospital admission, OR=1.19, P<10(-3), lower rates of complete immunizations to 9 months, OR=0.562, P<10(-3), higher Strength and Difficulties Questionnaire (SDQ) difficulties scores: β=0.304, P=0.0024 (3 year olds), β=0.697, P<10(-3) (5 year olds). Non-biological fathers were associated with increased risk of unintentional injury, OR=1.16, P=0.0319 and hospital admission, OR=1.26, P=0.0166; lower rates of complete immunizations to 9 months, OR=0.343, P=0.0309 and higher SDQ difficulties scores: β=0.908, P<10(-3).
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Affiliation(s)
- Julian Gardiner
- Institute for the Study of Children, Families and Social Issues, Birkbeck University of London; London, UK
| | | | - Edward Melhuish
- Institute for the Study of Children, Families and Social Issues, Birkbeck University of London; London, UK
- University of Oxford; London, UK
| | - Jacqueline Barnes
- Institute for the Study of Children, Families and Social Issues, Birkbeck University of London; London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
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[Evidence-based health promotion and prevention in settings: which types of study designs are needed?]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2015; 109:40-5. [PMID: 25839364 DOI: 10.1016/j.zefq.2014.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 11/24/2022]
Abstract
Health promotion and health prevention are cornerstones of public health. In Germany, a draft health prevention law was rejected in 2013, partly because it almost exclusively focused on measures at the individual level. Many health promotion and prevention measures, by contrast, (also) address the societal level and the environment, but there are few robust studies on their effectiveness, not least because of a lack of resources, the complexity of the measures, or randomisation problems. For example, regulations that protect non-smokers from smoke are subject to political processes where the majority of decision-makers would decline consent for randomisation. In a workshop at the 15(th) Annual Meeting of the German Network for Evidence-based Medicine (DNEbM) two case studies on controlled before-and-after studies (CBA) and interrupted time series (ITS) were developed by the audience as possible alternatives to randomised controlled trials for the evaluation of health promotion and health prevention programmes. The suggestions made by the audience were compared to the study designs chosen in published studies, and the strengths and weaknesses of the different study designs were discussed. The wide array of suggestions for effectiveness studies illustrated the potential of evidence-based health promotion and prevention, but also the specific challenges to be faced.
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Investigating 'place effects' on mental health: implications for population-based studies in psychiatry. Epidemiol Psychiatr Sci 2015; 24:27-37. [PMID: 25424460 PMCID: PMC6998143 DOI: 10.1017/s204579601400050x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background. Interest in features of our local environments that may promote better mental health and wellbeing continues to rise among decision makers. Our purpose was to highlight a selection of these challenges and some promising avenues for enhancing the quality of evidence. Method. An analysis of approximately 267, 000 people was used to test the local relative deprivation hypothesis, wherein the shortfall of a person's socioeconomic circumstances from their neighbours is said to impact negatively upon mental health. This case was used to anchor further discussion of challenges to identifying and interpreting genuine 'place effects' from spurious correlations. Results. A Median Odds Ratio of 1.29 computed via multilevel logistic regression showed that the odds of experiencing psychological distress (as measured by the Kessler score) varied by geographical area. Approximately 67% of this was attributed to a cross-classified measure of household income and neighbourhood deprivation. Compared to people on high incomes living in affluent neighbourhoods, the odds ratio of psychological distress for people on low incomes in affluent areas was 4.73 (95% confidence interval (95% CI) 4.39, 5.09), whereas that for people on low incomes in deprived areas was significantly higher at 5.83 (95% CI 5.41, 6.28). Conclusions. While no evidence was found to support local relative deprivation hypothesis, the pattern suggests that more affluent areas may contain features that are conducive to better mental health. Selection of bespoke geographical boundaries, use of directed acyclic graphs and more evaluations of natural experiments are likely to be important in taking the field of enquiry onwards.
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Gridley N, Hutchings J, Baker-Henningham H. The Incredible Years Parent-Toddler Programme and parental language: a randomised controlled trial. Child Care Health Dev 2015; 41:103-11. [PMID: 24841947 DOI: 10.1111/cch.12153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Parental language is associated with children's later language development. Parenting programmes, based on social learning theory, enhance a range of parenting behaviours, yet there is limited evidence for their effect on parental language. AIM To assess the benefits of a behavioural-based parenting programme, which features components of language and communication, to enhance parental language. METHOD Parents of toddlers, aged 12 to 36 months, were recruited from eight Flying Start early intervention centres across Wales. Participants were randomised 2:1 either to a parenting programme (n = 60) or to a wait-list control group (n = 29). Researchers were blind to participant allocation throughout the trial. Fifteen-minute video-recorded observations of parents and children interacting during free-play, both at a pre-intervention and at 6-month follow-up, provided the data for the study. Five observed measures of parental language were assessed; quantity and variety, encouraging, critical, child-led and parent led interactions. INTERVENTION The Incredible Years Parent-Toddler Programme (IYPTP) is a 12-week group-based behavioural intervention that teaches effective relationship and behavioural management skills including social, emotional and persistence coaching to enable parents to better support their children's development. RESULTS Of 89 dyads that completed pre-intervention assessments 81 (54 intervention and 27 control) met the criteria for the current study. Intention to treat analysis indicated that child-led language interactions significantly benefited from the intervention [regression coefficient (B) = -1.44, 95% confidence intervals (CI) = -2.59 to -0.29, P = 0.015, effect size (ES) = 0.47] and a positive trend for encouraging language in favour of the intervention sample was evident. Per-protocol sample analysis replicated these findings with encouraging language reaching statistical significance (B = 1.07, 95% CI = 0.11 to 2.03, P = 0.03, ES = 0.52). No further benefits were evident. CONCLUSIONS The IYPTP has limited evidence as an effective programme for enhancing some aspects of parental language.
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Affiliation(s)
- N Gridley
- School of Psychology, Bangor University, Bangor, Gwynedd, UK
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Smith E, Koerting J, Latter S, Knowles MM, McCann DC, Thompson M, Sonuga-Barke EJ. Overcoming barriers to effective early parenting interventions for attention-deficit hyperactivity disorder (ADHD): parent and practitioner views. Child Care Health Dev 2015; 41:93-102. [PMID: 24814640 PMCID: PMC4283979 DOI: 10.1111/cch.12146] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2014] [Indexed: 12/03/2022]
Abstract
BACKGROUND The importance of early intervention approaches for the treatment of attention-deficit hyperactivity disorder (ADHD) has been increasingly acknowledged. Parenting programmes (PPs) are recommended for use with preschool children with ADHD. However, low 'take-up' and high 'drop-out' rates compromise the effectiveness of such programmes within the community. METHODS This qualitative study examined the views of 25 parents and 18 practitioners regarding currently available PPs for preschool children with ADHD-type problems in the UK. Semi-structured interviews were undertaken to identify both barriers and facilitators associated with programme access, programme effectiveness, and continued engagement. RESULTS AND CONCLUSIONS Many of the themes mirrored previous accounts relating to generic PPs for disruptive behaviour problems. There were also a number of ADHD-specific themes. Enhancing parental motivation to change parenting practice and providing an intervention that addresses the parents' own needs (e.g. in relation to self-confidence, depression or parental ADHD), in addition to those of the child, were considered of particular importance. Comparisons between the views of parents and practitioners highlighted a need to increase awareness of parental psychological barriers among practitioners and for better programme advertising generally. Clinical implications and specific recommendations drawn from these findings are discussed and presented.
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Affiliation(s)
- E Smith
- Institute for Disorders of Impulse and Attention, Developmental Brain-Behaviour Laboratory, School of Psychology, University of Southampton, Southampton, UK
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Law C, Cole T, Cummins S, Fagg J, Morris S, Roberts H. A pragmatic evaluation of a family-based intervention for childhood overweight and obesity. PUBLIC HEALTH RESEARCH 2014. [DOI: 10.3310/phr02050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BackgroundChildhood overweight is unequally distributed by ethnicity and socioeconomic circumstances. Weight management interventions are moderately effective under research conditions. We evaluated the Mind, Exercise, Nutrition, Do it! (MEND) 7–13 programme, a multicomponent family-based intervention for children aged 7–13 years who are overweight or obese. The programme was tested in a randomised controlled trial (RCT) and then delivered at scale under service conditions.ObjectivesThe aims of this study were to describe the characteristics of children who take part in MEND, when implemented at scale and under service conditions; assess how the outcomes associated with participation in MEND vary with the characteristics of children (sex, socioeconomic circumstances and ethnicity), MEND centres (type of facility, funding source and programme group size) and areas where children live (in relation to area-level deprivation and the obesogenic environment); examine the cost of providing MEND, per participant, to the NHS and personal social services, including how this varies and how variation in cost is related to variation in outcome; evaluate the salience and acceptability of MEND to those who commission it, those who participate in full, those who participate but drop out and those who might benefit but do not take up the intervention; and investigate what types of costs, if any, are borne by families (and by which members) when participating in MEND, and in sustaining a healthy lifestyle afterwards.Data and methodsWe compared the sociodemographic characteristics of all children referred to MEND (‘referrals’,n = 18,289), those who started the programme (‘starters’,n = 13,998) and those who completed it (‘completers’,n = 8311) with comparable overweight children in England. Associations between participant, programme and neighbourhood characteristics and change in body mass index (BMI) and other outcomes associated with participation in MEND 7–13 were estimated using multilevel models. Economic costs were estimated using published evaluations in combination with service data. We used qualitative methods to explore salience and acceptability to commissioners (n = 27 interviews) and families (n = 23 family interviews and eight individual interviews), and costs to families.FindingsLess than 0.5% of children eligible for MEND were referred to, participated in or completed the programme. Compared with the MEND-eligible population, proportionally more MEND 7–13 starters and completers were girls, Asian or from families with a lone parent, and lived in social or private rented rather than owner-occupied accommodation, in families where the primary earner was unemployed, and in urban and deprived areas. Compared with the MEND-eligible population, proportionally less MEND 7–13 starters and completers were white or from ‘other’ ethnic groups. Having started the programme, boys and participants who were psychologically distressed, lived in socioeconomically deprived circumstances, or attended large groups or groups whose managers had delivered several programmes were less likely to complete the programme.Multilevel multivariable models showed that, on average, BMI reduced by 0.76 kg/m2over the period of the programme (10-week follow-up). BMI reduced on average in all groups, but the reduction was greater for boys, as well as children who were of higher baseline BMI, younger, white or living in less socioeconomically deprived circumstances, and for those who attended more sessions and participated in smaller programmes. BMI reductions under service and RCT conditions were of a similar order of magnitude. Reported participant self-esteem, psychological distress, physical activity and diet improved overall and were also moderated by participant-, family-, neighbourhood- and programme-level covariates.Based on previous studies the cost per programme was around £4000. The mean cost per starter is £463 and the mean cost per completer is £773. The estimated costs varied according to costs associated with local programmes and MEND Central (the organisation which sells MEND interventions to commissioners and delivery partners), and the number of participants per programme.Commissioners liked the fact that the programme was evidence-informed, involved families and was ‘implementation-ready’. However, recruitment and retention of families influenced their view on the extent to which the programme offered value for money. They wanted longer-term outcome data and had concerns in relation to skills for delivery to diverse populations with complex health and social needs.At least one individual in every family felt that participation in MEND had been beneficial, but few had managed long-term change. Most families had self-referred via the mother on the basis of weight concerns and/or bullying and anxiety about the transition to secondary school. Exercising with others of a similar build, tips for parents and cooking lessons for children were all valued. Less positively, timings could be difficult for parents and children, who reported competing after-school activities, and feeling tired and hungry. Getting to venues was sometimes difficult. Although families described liking the facilitators who delivered the programme, concerns were expressed about their skills levels. Engagement with the behaviours MEND recommends was challenging, as were the family dynamics relating to support for participants. The costs families mostly associated with the programme were for higher quality food or ‘treats’, time and transport costs, and the emotional cost of making and maintaining changes to lifestyle behaviours generally unsupported by the wider environment.ConsiderationsFurther research should focus on the sustainability, costs (including emotional costs to families) and cost-effectiveness of behaviour change. However, weight management schemes are only one way that overweight and obese children can be encouraged to adopt healthier lifestyles. We situate this work within a social model of health with reference to inequalities, obesogenic environments, a lifecourse approach and frameworks of translational research.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Catherine Law
- Institute of Child Health, University College London, London, UK
| | - Tim Cole
- Institute of Child Health, University College London, London, UK
| | - Steven Cummins
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - James Fagg
- Institute of Child Health, University College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Helen Roberts
- Institute of Child Health, University College London, London, UK
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Barr B, Bambra C, Whitehead M. The impact of NHS resource allocation policy on health inequalities in England 2001-11: longitudinal ecological study. BMJ 2014; 348:g3231. [PMID: 24865459 PMCID: PMC4035504 DOI: 10.1136/bmj.g3231] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate whether the policy of increasing National Health Service funding to a greater extent in deprived areas in England compared with more affluent areas led to a reduction in geographical inequalities in mortality amenable to healthcare. DESIGN Longitudinal ecological study. SETTING 324 lower tier local authorities in England, classified by their baseline level of deprivation. INTERVENTION Differential trends in NHS funds allocated to local areas resulting from the NHS resource allocation policy in England between 2001 and 2011. MAIN OUTCOME MEASURE Trends in mortality from causes considered amenable to healthcare in local authority areas in England. Using multivariate regression, we estimated the reduction in mortality that was associated with the allocation of additional NHS resources in these areas. RESULTS Between 2001 and 2011 the increase in NHS resources to deprived areas accounted for a reduction in the gap between deprived and affluent areas in male mortality amenable to healthcare of 35 deaths per 100,000 population (95% confidence interval 27 to 42) and female mortality of 16 deaths per 100,000 (10 to 21). This explained 85% of the total reduction of absolute inequality in mortality amenable to healthcare during this time. Each additional £10 m of resources allocated to deprived areas was associated with a reduction in 4 deaths in males per 100,000 (3.1 to 4.9) and 1.8 deaths in females per 100,000 (1.1 to 2.4). The association between absolute increases in NHS resources and improvements in mortality amenable to healthcare in more affluent areas was not significant. CONCLUSION Between 2001 and 2011, the NHS health inequalities policy of increasing the proportion of resources allocated to deprived areas compared with more affluent areas was associated with a reduction in absolute health inequalities from causes amenable to healthcare. Dropping this policy may widen inequalities.
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Affiliation(s)
- Ben Barr
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GB, UK
| | - Clare Bambra
- Department of Geography, Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton on Tees, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GB, UK
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Kendrick D, Young B, Mason-Jones AJ, Ilyas N, Achana FA, Cooper NJ, Hubbard SJ, Sutton AJ, Smith S, Wynn P, Mulvaney C, Watson MC, Coupland C. Home safety education and provision of safety equipment for injury prevention (Review). ACTA ACUST UNITED AC 2014; 8:761-939. [PMID: 23877910 DOI: 10.1002/ebch.1911] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group. OBJECTIVES We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009. SELECTION CRITERIA Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals. MAIN RESULTS Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD. There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92). Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96). Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury. AUTHORS' CONCLUSIONS Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.
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Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M. Cochrane review: behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Review). ACTA ACUST UNITED AC 2014; 8:318-692. [PMID: 23877886 DOI: 10.1002/ebch.1905] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early-onset child conduct problems are common and costly. A large number of studies and some previous reviews have focused on behavioural and cognitive-behavioural group-based parenting interventions, but methodological limitations are commonplace and evidence for the effectiveness and cost-effectiveness of these programmes has been unclear. OBJECTIVES To assess the effectiveness and cost-effectiveness of behavioural and cognitive-behavioural group-based parenting programmes for improving child conduct problems, parental mental health and parenting skills. SEARCH METHODS We searched the following databases between 23 and 31 January 2011: CENTRAL (2011, Issue 1), MEDLINE (1950 to current), EMBASE (1980 to current), CINAHL (1982 to current), PsycINFO (1872 to current), Social Science Citation Index (1956 to current), ASSIA (1987 to current), ERIC (1966 to current), Sociological Abstracts (1963 to current), Academic Search Premier (1970 to current), Econlit (1969 to current), PEDE (1980 to current), Dissertations and Theses Abstracts (1980 to present), NHS EED (searched 31 January 2011), HEED (searched 31 January 2011), DARE (searched 31 January 2011), HTA (searched 31 January 2011), mRCT (searched 29 January 2011). We searched the following parent training websites on 31 January 2011: Triple P Library, Incredible Years Library and Parent Management Training. We also searched the reference lists of studies and reviews. SELECTION CRITERIA We included studies if: (1) they involved randomised controlled trials (RCTs) or quasi-randomised controlled trials of behavioural and cognitive-behavioural group-based parenting interventions for parents of children aged 3 to 12 years with conduct problems, and (2) incorporated an intervention group versus a waiting list, no treatment or standard treatment control group. We only included studies that used at least one standardised instrument to measure child conduct problems. DATA COLLECTION AND ANALYSIS Two authors independently assessed the risk of bias in the trials and the methodological quality of health economic studies. Two authors also independently extracted data. We contacted study authors for additional information. MAIN RESULTS This review includes 13 trials (10 RCTs and three quasi-randomised trials), as well as two economic evaluations based on two of the trials. Overall, there were 1078 participants (646 in the intervention group; 432 in the control group). The results indicate that parent training produced a statistically significant reduction in child conduct problems, whether assessed by parents (standardised mean difference (SMD) -0.53; 95% confidence interval (CI) -0.72 to -0.34) or independently assessed (SMD -0.44; 95% CI -0.77 to -0.11). The intervention led to statistically significant improvements in parental mental health (SMD -0.36; 95% CI -0.52 to -0.20) and positive parenting skills, based on both parent reports (SMD -0.53; 95% CI -0.90 to -0.16) and independent reports (SMD -0.47; 95% CI -0.65 to -0.29). Parent training also produced a statistically significant reduction in negative or harsh parenting practices according to both parent reports (SMD -0.77; 95% CI -0.96 to -0.59) and independent assessments (SMD -0.42; 95% CI -0.67 to -0.16). Moreover, the intervention demonstrated evidence of cost-effectiveness. When compared to a waiting list control group, there was a cost of approximately $2500 (GBP 1712; EUR 2217) per family to bring the average child with clinical levels of conduct problems into the non-clinical range. These costs of programme delivery are modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. AUTHORS' CONCLUSIONS Behavioural and cognitive-behavioural group-based parenting interventions are effective and cost-effective for improving child conduct problems, parental mental health and parenting skills in the short term. The cost of programme delivery was modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Further research is needed on the long-term assessment of outcomes.
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Affiliation(s)
- Mairead Furlong
- Department of Psychology, John Hume Building, National University of Ireland Maynooth, Ireland. Mairead.M.Furlong@nuim
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Sutcliffe AG, Melhuish E, Barnes J, Gardiner J. Health and development of children born after assisted reproductive technology and sub-fertility compared to naturally conceived children: data from a national study. Pediatr Rep 2014; 6:5118. [PMID: 24711911 PMCID: PMC3977159 DOI: 10.4081/pr.2014.5118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 11/28/2022] Open
Abstract
In a non-matched case-control study using data from two large national cohort studies, we investigated whether indicators of child health and development up to 7 years of age differ between children conceived using assisted reproductive technology (ART), children born after sub-fertility (more than 24 months of trying for conception) and other children. Information on ART use/sub-fertility was available for 23,649 children. There were 227 cases (children conceived through ART) and two control groups: 783 children born to sub-fertile couples, and 22,639 children born to couples with no fertility issues. In models adjusted for social and demographic factors there were significant differences between groups in rate of hospital admissions before the children were 9 months old (P=0.029), with the ART group showing higher rates of hospital admission than the no fertility issues control group, the sub-fertile control group being intermediate between the two. Children born after ART had comparable health and development beyond 9 months of age to their naturally conceived peers. This applied to the whole sample and to a sub-sample of children from deprived neighborhoods.
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Affiliation(s)
| | - Edward Melhuish
- Institute for the Study of Children, Families and Social Issues, Birkbeck, University of London , London, UK ; University of Oxford , London, UK
| | - Jacqueline Barnes
- Institute for the Study of Children, Families and Social Issues, Birkbeck, University of London , London, UK ; Tavistock and Portman NHS Foundation Trust , London, UK
| | - Julian Gardiner
- Institute for the Study of Children, Families and Social Issues, Birkbeck, University of London , London, UK
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