Taking a population perspective on child health

Knowledge of Postgraduate Medical Trainees Regarding Epidemiology

Introduction An understanding of epidemiology is fundamental for designing research and understanding evidence-based medicine (EBM). The purpose of our study was to determine the knowledge of epidemiology among postgraduate medical trainees. Methods We carried out a cross-sectional study from January 2017 to June 2017 at the Regional Centre Islamabad, College of Physicians and Surgeons Pakistan. About 204 postgraduate medical trainee were enrolled in the study after taking written consent. All of the participants were working as a postgraduate medical trainee in different hospitals of Rawalpindi and Islamabad. A self-designed structured questionnaire containing 20 multiple choice questions regarding knowledge of epidemiology was given to all the participants. Knowledge of epidemiology was measured and compared with gender, hospital, and previous history of research. Statistical Package for the Social Sciences (SPSS), version 21.0 (IBM, Armonk, NY) was used for data analysis. Results Out of 204 participants, 46.1% participants were males while 53.9% were females. The mean age of the participant was 28.5 ± 2.5. Majority fo the trainees (33.8%) were training in an Internal Medicine residency program. Most of the trainees (76%) had average knowledge of epidemiology while 18.6% of the trainees had good knowledge. Only 17.6% had some experience of research projects in the past, but this was not related to knowledge of epidemiology (p > 0.05). Conclusion Only 18.6% of the postgraduate trainees had good knowledge regarding epidemiology and 76% had average knowledge. This knowledge did not relate to their gender, hospital settings, and previous experience of conducting research proposals and articles.

Development of the EQ-5D-Y: a child-friendly version of the EQ-5D

Purpose

To develop a self-report version of the EQ-5D for younger respondents, named the EQ-5D-Y (Youth); to test its comprehensibility for children and adolescents and to compare results obtained using the standard adult EQ-5D and the EQ-5D-Y.

Methods

An international task force revised the content of EQ-5D and wording to ensure relevance and clarity for young respondents. Children’s and adolescents’ understanding of the EQ-5D-Y was tested in cognitive interviews after the instrument was translated into German, Italian, Spanish and Swedish. Differences between the EQ-5D and the EQ-5D-Y regarding frequencies of reported problems were investigated in Germany, Spain and South Africa.

Results

The content of the EQ-5D dimensions proved to be appropriate for the measurement of HRQOL in young respondents. The wording of the questionnaire had to be adapted which led to small changes in the meaning of some items and answer options. The adapted EQ-5D-Y was satisfactorily understood by children and adolescents in different countries. It was better accepted and proved more feasible than the EQ-5D. The administration of the EQ-5D and of the EQ-5D-Y causes differences in frequencies of reported problems.

Conclusions

The newly developed EQ-5D-Y is a useful tool to measure HRQOL in young people in an age-appropriate manner.

Research around practice partnerships: an example of building partnerships to address overweight and obesity in children

Prevention and management of childhood overweight and obesity is a health priority for governments and communities throughout the developed world. A conceptual model, Research around Practice in Childhood Obesity (RAPICO), has been developed to guide capacity building in a coordinated ‘bench to fieldwork’ initiative to address this public health problem. Translation of research findings into sustainable responses with optimal fit requires consideration of context-specific relevance, cost-effectiveness, feasibility and levels of available support. The RAPICO model uses program theory to describe a framework for progressing practitioner–community–research partnerships to address low, medium and high levels of risk for childhood overweight and obesity within community settings. A case study describing the development of a logic model to inform risk-linked responses to childhood overweight and obesity is presented for the Ipswich community in south-east Queensland.

Parental experiences and preferences which influence subsequent use of post-discharge health services for children born very preterm

AIM

Parents are ultimately responsible for organising and accessing health services for their children. How parents experience those services are likely to influence subsequent use. Understanding parental preference for service provision can inform compliance strategies with recommended child health recommendations. The aim of this study was to explore parental experiences and preferences which influence subsequent use of post-discharge health services for children born preterm with a birthweight < or =1250 g.

METHODS

Focus groups consisted of randomly selected families recruited from a population-based cross-sectional cohort study of 2-, 4- and 7-year-old children corrected age for prematurity. Parents were asked to consider which aspects of childhood health service delivery influenced subsequent use. Transcripts were analysed and themes constructed. SWOT analysis evaluated health service practices by systematically mapping parents' accounts of the perceived strengths (S), weaknesses (W), opportunities (O) and threats (T) of services in relation to subsequent use.

RESULTS

Fifteen parents participated in three groups (by children's age). Three dominant themes emerged and included (i) assistance with accessing appropriate services; (ii) provision of consistent information and comprehensive child health records; and (iii) support of parental self-efficacy in the health care of their child.

CONCLUSION

Primary health carers are ideally suited to co-ordinate and provide continuity to improve parental involvement and compliance with health promoting recommendations for their preterm children. This approach may improve interagency co-operation and access to services enabling early identification and intervention. Adopting these strategies may be effective in optimising child health follow-up strategies and improve uptake of recommended intervention and prevention programmes.

Retrospective review of the epidemiology of epilepsy in special schools for children with cerebral palsy, learning difficulties, and language and communication difficulties

PURPOSE OF THE STUDY

To determine in children the proportion and characteristics of epilepsy associated with cerebral palsy, learning difficulties and language and communication difficulties in a specific population of two special schools.

BASIC PROCEDURES

Retrospective review of case notes for 142 children in two special schools (school A and school B) in Newcastle, UK MAIN FINDINGS: School A had more children with learning difficulties (X2=32.41, p<0.01) and active epilepsy (X2=3.03, p=0.08) than school B. There were more children with cerebral palsy (X2=9.56, p<0.01) and language and communication problems (X2=4.25, p=0.03) at school B compared to school A. Active epilepsy is significantly more common in children with cerebral palsy (X2=7.58, p=0.01). All children with cerebral palsy and learning difficulties had epilepsy (n=6). Although not statistically significant, those children who developed epilepsy within the first 24 hours of life were more likely to have cerebral palsy than those who developed epilepsy later in life (X2=3.10, p=0.08). Those children with cerebral palsy tended to have a lower birth weight (t=3.15, p<0.01) and a shorter gestation (t=3.17, p<0.01) than children without cerebral palsy.

PRINCIPAL CONCLUSIONS

The data supports evidence from previous studies, demonstrating that epilepsy commonly accompanies cerebral palsy, thus complicating this difficult chronic condition. We show an association between both low birth weight and gestational age, and early age of onset of seizures, in children with cerebral palsy. This illustrates the importance, in these children, of past medical history from birth to determine risk factors for epilepsy later in life.