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Critoph DJ, Cable M, Farmer J, Hatcher HM, Kuhn I, Taylor RM, Smith LAM. Is there scope to do better? Clinical communication with adolescents and young adults with cancer-A scoping review. Psychooncology 2024; 33:e6317. [PMID: 38573227 DOI: 10.1002/pon.6317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/05/2024] [Accepted: 02/24/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION How to communicate effectively with adolescent and young adults with cancer (AYACs) is a research priority. In a UK-wide survey of young people with cancer's research priorities, communication was a striking cross-cutting theme. It is increasingly recognised that AYACs have experiences and communication needs that differ significantly from those of younger children and older adults. The purpose of this review is to explore the features of effective clinical communication with AYACs. METHODS A literature search was undertaken to identify and map the available evidence using a broad scope to get an overview of the pertinent literature, identify knowledge gaps and clarify concepts. The searches yielded 5825 records, generating 4040 unique articles. These were screened and 71 full articles were read by four researchers with disagreements resolved by discussion leaving 29 included articles. Narrative synthesis was undertaken in relation to each of the research questions. RESULTS Three key themes were identified: being an adolescent/young adult, supporters, and healthcare professionals (HCPs). AYACs need to feel that HCPs understand their unique perspective. They want to be involved, this changes over time and in different contexts. Supporters are a central tenet, are most often parents and undertake several roles which are not always universally supportive. HCPs enable involvement of AYACs, and this needs to be actively promoted. AYACs preference for their level of involvement requires continual assessment. The three themes are interlinked and exist within the wider scope of the triadic encounter and cancer experience. CONCLUSION Supporters, most often parents were a key feature across the data and were seemingly paradoxical in nature. Triadic communication, the presence of a third person, is a central tenet of communication with AYACs and we propose a conceptual model to represent the nuances, components, and facets of this complex communication.
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Affiliation(s)
- Deborah J Critoph
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Maria Cable
- Institute of Clinical Sciences, College of Medical and Dental School, University of Birmingham, Birmingham, UK
| | - Jessica Farmer
- Haematology & Oncology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Helen M Hatcher
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - Isla Kuhn
- Isla Kuhn, Head of Medical Library Services, University of Cambridge Medical Library, Cambridge, UK
| | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Luke A M Smith
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospital NHS Trust, Cambridge, UK
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Masterson-Algar P, Egan K, Flynn G, Hughes G, Spector A, Stott J, Windle G. Hard to Reach and Hidden: Improving the Identification of Young Dementia Carers. Int J Environ Res Public Health 2023; 20:7103. [PMID: 38063533 PMCID: PMC10871087 DOI: 10.3390/ijerph20237103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/01/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023]
Abstract
Young dementia carers (YDCs) rarely receive appropriate training and support. Their visibility and identification remain dangerously low, and, consequently, support initiatives being developed are failing to reach them. This study explored the success (or failure) of YDC identification pathways as well as the barriers and enablers to their implementation. An explorative qualitative approach was followed, drawing on the experiences of parents of YDCs, dementia researchers, professionals in the field of dementia/young carers, and young adult carers. Data collection involved semi-structured interviews (n = 17) and a participatory 2-h workshop to discuss and critique preliminary themes as well as explore strategies to increase the visibility and identification of YDCs. Five themes were identified: a "whole-family approach" (as a pathway to identification), "not a carer" (self/family identification), a postcode lottery (high variability of support services), tailored support that is "fit for purpose", and the "power" of peer support. Recommendations on potential initiatives and actions that can help raise awareness and increase the identification success of YDCs are proposed. Our findings support the need for a broad and holistic approach to the identification of YDCs that runs alongside the development of support initiatives that are accessible and relatable. The support itself will play a role in improving subsequent identification or hindering it if not "fit for purpose".
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Affiliation(s)
- Patricia Masterson-Algar
- School of Medical and Health Sciences, Bangor University, Bangor LL57 2EF, UK; (G.F.); (G.H.); (G.W.)
| | - Kieren Egan
- Department of Computer and Information Science, University of Strathclyde, Glasgow G11 XH, UK;
| | - Greg Flynn
- School of Medical and Health Sciences, Bangor University, Bangor LL57 2EF, UK; (G.F.); (G.H.); (G.W.)
| | - Gwenllian Hughes
- School of Medical and Health Sciences, Bangor University, Bangor LL57 2EF, UK; (G.F.); (G.H.); (G.W.)
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK; (A.S.); (J.S.)
| | - Joshua Stott
- Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK; (A.S.); (J.S.)
| | - Gill Windle
- School of Medical and Health Sciences, Bangor University, Bangor LL57 2EF, UK; (G.F.); (G.H.); (G.W.)
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Maciver M, Dixon D, Powell D. Quality of life in young people with limb loss: a systematic review. Disabil Rehabil 2023:1-12. [PMID: 37865851 DOI: 10.1080/09638288.2023.2270908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE Life after any amputation can be significantly altered and can have a significant impact on quality of life (QoL). However, most of the evidence base involves older aged amputees, therefore there is a lack of understanding about the impact of amputation on QoL and the factors that predict QoL in younger amputees. The aim of this review is to identify the factors that predict QoL in young amputees. METHODS MEDLINE, CINAHL, EMBASE, PsycINFO, Web of Science were searched to identify articles that measured QoL in young amputees. Articles were independently assessed by two assessors. Data was extracted from the selected articles and a narrative synthesis performed. RESULTS 18 articles were included in this review. QoL outcome measures varied between studies. The quality of evidence was generally low. This review identified, gender, age, cause of amputation, level of amputation, phantom pain, ability to use a prosthesis, physical function, depression, anxiety, body image, type of prosthesis as predictors of QoL. CONCLUSION This review identified modifiable and non-modifiable predictors of QoL in young amputees. Future research needs to focus on exploring the modifiable predictors of QoL as these are the aspects that can be improved to enhance QoL.
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Affiliation(s)
- Marina Maciver
- Health Psychology Group, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, Scotland, UK
| | - Diane Dixon
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK
| | - Daniel Powell
- Health Psychology Group, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, Scotland, UK
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Geijer-Simpson E, Kaner E, Lingam R, McArdle P, McGovern R. Effectiveness of Family-Involved Interventions in Reducing Co-Occurring Alcohol Use and Mental Health Problems in Young People Aged 12-17: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2023; 20:6890. [PMID: 37835160 PMCID: PMC10572317 DOI: 10.3390/ijerph20196890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/21/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
There is a high prevalence rate of co-occurring alcohol use and mental health problems in young people. This is associated with adverse outcomes and poses a substantial public health concern. We identified and synthesized evidence on the effectiveness of family-involved interventions in reducing alcohol use and mental health problems in young people aged 12-17. Seven databases were searched from inception to January 2023. Data from 19 articles reporting on 14 trials were pooled through random-effects meta-analysis for each outcome using Review Manager 5.3. Pooled estimates resulted in non-significant findings for alcohol use (SMD -0.60; 95% CI -1.63 to 0.42; p = 0.25; 6 trials; 537 participants), internalizing symptoms (SMD -0.13; 95% CI -0.37 to 0.10; p = 0.27), externalizing symptoms (SMD -0.26; 95% CI -0.66 to 0.15; p = 0.22) and substance use (SMD -0.33; 95% CI -0.72 to 0.06; p = 0.10). In contrast, significant intervention effects were identified for the mechanism of change, family conflict (SMD -0.30; 95% CI -0.51 to -0.09; p = 0.005). Consequently, addressing family functioning may not be sufficient in reducing co-occurring alcohol use and mental health problems. Non-significant intervention effects could be due to a lack of content addressing the relationship between alcohol use and mental health problems. Future intervention development could explore whether to incorporate such content and how best to involve the family.
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Affiliation(s)
- Emma Geijer-Simpson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Raghu Lingam
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031, Australia
| | - Paul McArdle
- Northumberland, Tyne & Wear Foundation Trust, Newcastle upon Tyne NE3 3XT, UK
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
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Hodkinson R, Phillips H, Allgar V, Young A, Le Couteur A, Holwell A, Teige C, Wright B. Comparison of Diagnostic Profiles of Deaf and Hearing Children with a Diagnosis of Autism. Int J Environ Res Public Health 2023; 20:2143. [PMID: 36767509 PMCID: PMC9916080 DOI: 10.3390/ijerph20032143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
There is limited research comparing the presentation of autism in deaf and hearing children and young people. These comparisons are important to facilitate accurate diagnosis, as rates of misdiagnosis and delay in diagnosis amongst deaf children and young people are high. The aim of this study was to compare diagnostic assessment profiles of a UK cohort of autistic deaf and hearing children and young people. The Autism Diagnostic Interview-Revised-Deaf adaptation was completed with the parents of 106 children and young people (deaf children = 65; hearing children = 41). The majority of items explored showed no significant differences between deaf and hearing children and young people. Differences were found in peer relationships, where autistic deaf participants were less likely to respond to the approaches of other children or play imaginatively with peers. These findings need to be taken into consideration by clinicians in the assessment process.
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Affiliation(s)
- Rachel Hodkinson
- Leeds and York Partnership NHS Foundation Trust, Leeds LS7 3JX, UK
| | - Helen Phillips
- Leeds and York Partnership NHS Foundation Trust, Leeds LS7 3JX, UK
| | - Victoria Allgar
- Peninsula Medical School, University of Plymouth, Plymouth PL4 8AA, UK
| | - Alys Young
- School of Nursing Midwifery and Social Work, University of Manchester, Manchester M13 9PL, UK
| | - Ann Le Couteur
- Neurodevelopment and Disability Group, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Andrew Holwell
- South West London and St. Georges Mental Health Trust, London SW17 0YF, UK
| | - Catarina Teige
- Leeds and York Partnership NHS Foundation Trust, Leeds LS7 3JX, UK
| | - Barry Wright
- Leeds and York Partnership NHS Foundation Trust, Leeds LS7 3JX, UK
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Smith P, Teasdale E, Sheppard-Law S. Parents' experience of extended viewing in a paediatric hospice: a qualitative study. Int J Palliat Nurs 2023; 29:34-42. [PMID: 36692478 DOI: 10.12968/ijpn.2023.29.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The rising prevalence of life-limiting conditions in children and young people warrants an evaluation of paediatric palliative care, hospice services and delivered care. AIM First, this study aimed to develop a deeper understanding of how extended viewing is experienced by the parents of a deceased child (or young person) with a life-limiting condition, based in Australia. Second, this study aimed to evaluate the quality of bereavement care delivered during the first few days after death. FINDINGS A total of 17 bereaved parents of 13 children completed an interview. In-depth interviews were audio-recorded, transcribed verbatim and thematically analysed. While the authors acknowledge the complexity and individual nature of grief, four broad themes were identified, namely the importance of the 'physical environment' being conducive to spending time with their child; 'seeing their child'; 'time to say goodbye'; and 'supportive care'. CONCLUSION The findings of this study reinforce that extended viewing can provide therapeutic benefits for parents, as well as the importance of a skilled palliative care nursing workforce in assisting with grief management.
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Affiliation(s)
- Philippa Smith
- Registered Nurse, Sydney Children's Hospital Network, Australia
| | | | - Suzanne Sheppard-Law
- Senior Research Fellow (Nursing), University of Technology Sydney; Sydney Children's Hospitals Network, Australia
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Mavragani A, Rivas C, Stokes G. Nigerian and Ghanaian Young People's Experiences of Care for Common Mental Disorders in Inner London: Protocol for a Multimethod Investigation. JMIR Res Protoc 2022; 11:e42575. [PMID: 36485025 PMCID: PMC9789493 DOI: 10.2196/42575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The Care Quality Commission published a review in 2018 in England titled "Are We Listening," which revealed that child and adolescent mental health services are not responsive to the specific needs of young Black people and other ethnic minorities even in areas with ethnically diverse populations. It found that commissioners and service planners failed to engage with these young people and their families to understand their needs and expectations. OBJECTIVE The purpose of this study is to engage Nigerian and Ghanaian young people (NAGYP) with experiences of care for common mental disorders (CMDs) in London, to increase understanding of their needs, and to give voice to their views and preferences. Their parents', caregivers', and practitioners' views will also be sought for service improvement. METHODS Three combined contemporary complementary methodologies-thematic analysis, interpretative phenomenological analysis (IPA), and intersectionality-based policy analysis (IBPA)-will be used across 3 comprehensive phases. First, a scoping review where relevant themes will be critically analyzed will inform further phases of this study. Detailed mapping of community and mental health care services in 13 inner London boroughs to investigate what professionals actually do rather than what they say they do. Second, IBPA will be used to scrutinize improving access to psychological therapies and other legislations and policies relevant to NAGYP to undertake an intersectional multileveled analysis of power, models, and constraints. Third, IPA will "give voice" and "make sense" of NAGYP lived experiences of CMDs via a representative sample of NAGYP participants' (n=30) aged 16-25 years, parents or caregivers' (n=20), and practitioners' (n=20) perspectives will be captured. RESULTS The study has been approved by the UCL Institute of Education Research Ethics Committee (Z6364106/2022/02/28; health research) and University College London (Z6364106/2022/10/24; social research). Recruitment has begun in 13 inner boroughs of London. Data collection through observation, semistructured interviews, and focus groups are expected to be finalized by early 2024, and the study will be published by early 2025. CONCLUSIONS Combining multiple qualitative methodologies and methods will enable rigorous investigation into NAGYP's lived experiences of care received for CMDs in London. Findings from this study should enable a reduction in the negative connotations and harmful superstitions associated with mental health-related issues in this group, inform evidence-based interventions, and facilitate preventive or early access to interventions. There may also be an indirect impact on problems resulting from mental illness such as school dropout, antisocial behaviors, knife crimes, juvenile detention centers, and even death. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/42575.
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Affiliation(s)
| | - Carol Rivas
- Social Research Institute, Institute of Education, University College London's Faculty of Education and Society, University College London, London, United Kingdom
| | - Gillian Stokes
- Social Research Institute, Institute of Education, University College London's Faculty of Education and Society, University College London, London, United Kingdom
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Juurlink TT, Betts JK, Nicol K, Lamers F, Beekman ATF, Cotton SM, Chanen AM. Characteristics and Predictors of Educational and Occupational Disengagement Among Outpatient Youth With Borderline Personality Disorder. J Pers Disord 2022; 36:116-128. [PMID: 34427492 DOI: 10.1521/pedi_2021_35_534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to investigate predictors of vocational disengagement (referred to as Not in Employment, Education, or Training [NEET]) in young people with borderline personality disorder (BPD). The sample comprised 112 outpatients with a BPD diagnosis, aged 15-25 years, who participated in a randomized controlled trial (ANZCTR12610000100099). The proportion of participants who were NEET (39.3%) at study entry did not improve after 18 months and NEET status frequently changed. Therefore, multinomial regression analyses were used to study three groups: Non-NEET, NEET, and Unstable NEET status. NEET status was predicted by not achieving expected age-appropriate educational milestones, greater instability in identity, and emptiness. Greater instability in interpersonal relationships and identity predicted Unstable NEET status. The findings suggest that specific vocational interventions, that also incorporate a focus on interpersonal functioning, emptiness, and identity disturbance, are needed to improve functioning in youth with BPD, especially when educational milestones are not achieved.
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Affiliation(s)
- Trees T Juurlink
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jennifer K Betts
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Katie Nicol
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Femke Lamers
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Sue M Cotton
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Andrew M Chanen
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
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Abstract
INTRODUCTION Patient groups who pose behavioral challenges during dental attendance may be offered more restricted dental treatment options. Unsuccessful participation with dental visit tasks and demands has been commonly reported for autistic children. OBJECTIVES This study aimed to examine parental perceptions of difficulties associated with dental attendance and oral care for autistic children and young adults, to highlight reported challenges and potential adaptations, and to identify interventions that will encourage positive experiences of dental attendance. METHODS Qualitative data were gathered through 2 focus groups with parents of primary school and secondary school pupils with autism, interviewed in separate groups. Questions about parents' perceptions of dental attendance and oral care were asked. The groups were audio-recorded and transcribed verbatim. The transcripts were analyzed and initial codes generated. Development of subthemes and themes followed a process of thematic analysis. RESULTS Parental perceptions, which confirmed data from other studies, included the need for understanding and training, awareness of sensory issues, recognition of the individuality of autistic traits, time and clarity for communication, and factors affecting the confidence of parents to advocate in the clinical environment. Focus group participants identified the critical value of empathizing with an autistic perspective and highlighted the importance of positive oral health messages. They also noted the lack of understanding regarding the complexity of altering self-imposed, ritualistic dietary regimes and attempting to enact good dental preventive habits for their children. CONCLUSIONS Analysis of data from parent focus groups provided a greater understanding of the needs and responsivity required for successful dental visits for autistic children and young adults. A range of potential interventions was identified and incorporated within a model of needs. Interventions based on Partnership Working, System Change, and Training of Dental Staff could be effective in reducing challenges posed by dental attendance for many children with autism. KNOWLEDGE TRANSFER STATEMENT Sensory sensitivities, communication difficulties, comorbid intellectual disability, and dental anxiety are barriers to successful participation during dental attendance for autistic children. This research proposes that interventions supporting Partnership Working, System Change, and Training of Dental Staff can reduce challenges posed by dental attendance. The model of interventions developed as part of this project can be used by oral care teams to help reduce barriers and improve the success of dental visits for autistic children.
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Affiliation(s)
- J.A. Parry
- School of Applied Psychology, University College Cork, Cork, Ireland
- Special Care Dental Service, Sussex Community NHS Foundation Trust, Haywards Heath Health Centre, Haywards Heath, UK
| | - T. Newton
- Centre for Oral, Clinical and Translational Sciences, King’s College London, London, UK
| | - C. Linehan
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - C. Ryan
- School of Applied Psychology, University College Cork, Cork, Ireland
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Allgar V, Wright B, Taylor A, Couter AL, Phillips H. Diagnosing Autism Spectrum Disorders in Deaf Children Using Two Standardised Assessment Instruments: The ADIR-Deaf Adaptation and the ADOS-2 Deaf Adaptation. J Clin Med 2021; 10:4374. [PMID: 34640392 DOI: 10.3390/jcm10194374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
The aim was to investigate the agreement between the ADI-R Deaf adaptation and ADOS-2 Deaf adaptation overall diagnostic categorisation for autism (AUT) and a wider threshold to include autism spectrum (ASD) in a cohort of deaf children with and without ASD. We compared results of the instruments used on their own and when combined and propose standard criteria for the combined use of the ADI-R Deaf adaptation and ADOS-2 Deaf adaptation for use with deaf children. In total, 116 deaf children had a Gold standard NICE guideline assessment; 58 diagnosed with ASD and 58 without ASD, and for both groups a blinded informant based ADI-R Deaf adaptation and direct assessment using the ADOS-2 Deaf adaptation were separately completed. There was moderate agreement between the ADI-R Deaf adaptation and ADOS-2 Deaf adaptation for the wider threshold of ASD (Kappa, 0.433). To achieve the lowest number of false negatives, the most successful assessment tool approach is using the wider threshold of ASD with either ADI-R Deaf adaptation or ADOS-2-Deaf adaptation (95% sensitivity). This compares with 88% for the ADI-R Deaf adaptation alone and 74% for the ADOS-2-Deaf adaptation alone (wider threshold of ASD). To achieve a low number of false positives, the most successful assessment tool approach is a combination of ADI-R Deaf adaptation and ADOS-2- Deaf adaptation (using the narrow threshold of autism for both) (95% specificity). This compares with 83% for the ADI-R Deaf adaptation alone and 81% for the ADOS-2-Deaf adaptation (narrow threshold) alone. This combination is therefore recommended in specialist clinics for diagnostic assessment in deaf children.
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McNeilly P, Macdonald G, Kelly B. Rights Based, Participatory Interviews with Disabled Children and Young People: Practical and Methodological Considerations. Compr Child Adolesc Nurs 2021:1-10. [PMID: 33856235 DOI: 10.1080/24694193.2021.1874078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/06/2021] [Indexed: 10/21/2022]
Abstract
There has been an increased emphasis on the voice of the child since the ratification of the United Nations Convention on the Rights of the Child in 1991. Since that time, health and social care researchers have increasingly involved disabled children and young people in research, rather than relying on the views of adults as proxies, for example, parents and professionals. Drawing on doctoral research and the extensive experience of the authors, the aim of this article is to critically reflect on "what worked" along with the challenges of interviewing the children and young people who took part. Practical and methodological issues, such as the need for thorough preparation, the interview process, understanding the children and young people and managing the presence of others are discussed. Finally, recommendations are made for future researchers, including making participation fun, using a sensitive and individualized approach and conducting multiple visits. It is only by considering these factors that we can meaningfully involve disabled children and young people and facilitate their participation in research interviews. Emphasis here is on the practical issues rather than ethical issues that have been published elsewhere.
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Affiliation(s)
- Patricia McNeilly
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Berni Kelly
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
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Doyle AM, Bandason T, Dauya E, McHugh G, Grundy C, Dringus S, Dziva Chikwari C, Ferrand RA. Mobile Phone Access and Implications for Digital Health Interventions Among Adolescents and Young Adults in Zimbabwe: Cross-Sectional Survey. JMIR Mhealth Uhealth 2021; 9:e21244. [PMID: 33439136 PMCID: PMC7840276 DOI: 10.2196/21244] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/08/2020] [Accepted: 10/30/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Mobile phones may help young people (YP) access health information and support health service engagement. However, in low-income settings there is limited knowledge on YP's phone and internet access to inform the feasibility of implementing digital health interventions. OBJECTIVE We investigated access to information and communication technologies among adolescents and young adults in Zimbabwe. METHODS A cross-sectional population-based survey was conducted from October to December 2018 among YP aged 13-24 years in 5 communities in urban and peri-urban Harare and Mashonaland East, Zimbabwe. Consenting YP completed a self-completed tablet-based questionnaire on mobile phone ownership and use, and use of the internet. The primary outcome was the proportion who reported owning a mobile phone. Secondary outcomes included phone and internet access and use behavior, and ownership and use of other technological devices. Multivariable logistic regression was used to investigate factors associated with mobile phone ownership and with internet access, with adjustment for the one-stage cluster sampling design. A priori exploratory variables were age, sex, marital status, and urban/peri-urban residence. RESULTS A total of 634/719 (88.2%) eligible YP, mean age 18.0 years (SD 3.3) and 62.6% (397/634) females, participated. Of the YP interviewed, 62.6% (396/633; 95% CI 58.5-66.5) reported owning a phone and a further 4.3% (27/633) reported having access to a shared phone. Phone ownership increased with age: 27.0% (43/159) of 13-15-year olds, 61.0% (72/118) of 16-17-year olds, 71.5% (103/144) of 18-19-year olds, and 84.7% (171/202) of 20-24-year olds (odds ratio [OR] 1.4, 95% CI 1.3-1.5) per year increase. Ownership was similar among females and males: 61.0% (236/387; 95% CI 55.6-66.1) versus 64.8% (153/236; 95% CI 57.8-71.2), age-adjusted OR 0.7 (95% CI 0.5-1.1); higher in those with secondary level education compared to primary or no education: 67.1% (346/516; 95% CI 62.6-71.2) versus 26% (21/82; 95% CI 16.4-37.7), age-adjusted OR 2.3 (95% CI 1.1-4.8); and similar across other sociodemographic factors. YP reported that 85.3% (361/423) of phones, either owned or shared, were smartphones. Among phone owners, the most commonly used phone app was WhatsApp (71.2%, 282/396), and 16.4% (65/396) reported having ever used their phone to track their health. A total of 407/631 (64.5%; 95% CI 60.3-68.5) currently had access to the internet (used in last 3 months on any device) with access increasing with age (OR 1.2, 95% CI 1.2-1.3 per year increase). In age-adjusted analysis, internet access was higher among males, the unmarried, those with a higher level of education, phone owners, and those who had lived in the community for more than 1 year. The aspect of the internet that YP most disliked was unwanted sexual (29.2%, 136/465) and violent (13.1%, 61/465) content. CONCLUSIONS Mobile phone-based interventions may be feasible in this population; however, such interventions could increase inequity, especially if they require access to the internet. Internet-based interventions should consider potential risks for participants and incorporate skill-building sessions on safe internet and phone use.
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Affiliation(s)
- Aoife M Doyle
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Ethel Dauya
- Biomedial Resarch and Training Institute, Harare, Zimbabwe
| | - Grace McHugh
- Biomedial Resarch and Training Institute, Harare, Zimbabwe
| | - Chris Grundy
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Stefanie Dringus
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chido Dziva Chikwari
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Biomedial Resarch and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rashida A Ferrand
- Biomedial Resarch and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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13
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Hayes D, Moore A, Stapley E, Humphrey N, Mansfield R, Santos J, Ashworth E, Patalay P, Bonin E, Boehnke JR, Deighton J. School-based intervention study examining approaches for well-being and mental health literacy of pupils in Year 9 in England: study protocol for a multischool, parallel group cluster randomised controlled trial (AWARE). BMJ Open 2019; 9:e029044. [PMID: 31481370 PMCID: PMC6731836 DOI: 10.1136/bmjopen-2019-029044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The prevalence of emotional difficulties in young people is increasing. This upward trend is largely accounted for by escalating symptoms of anxiety and depression. As part of a public health response, there is increasing emphasis on universal prevention programmes delivered in school settings. This protocol describes a three-arm, parallel group cluster randomised controlled trial, investigating the effectiveness and cost-effectiveness of two interventions, alongside a process and implementation evaluation, to improve mental health and well-being of Year 9 pupils in English secondary schools. METHOD A three-arm, parallel group cluster randomised controlled trial comparing two different interventions, the Youth Aware of Mental Health (YAM) or the Mental Health and High School Curriculum Guide (The Guide), to Usual Provision. Overall, 144 secondary schools in England will be recruited, involving 8600 Year 9 pupils. The primary outcome for YAM is depressive symptoms, and for The Guide it is intended help-seeking. These will be measured at baseline, 3-6 months and 9-12 months after the intervention commenced. Secondary outcomes measured concurrently include changes to: positive well-being, behavioural difficulties, support from school staff, stigma-related knowledge, attitudes and behaviours, and mental health first aid. An economic evaluation will assess the cost-effectiveness of the interventions, and a process and implementation evaluation (including a qualitative research component) will explore several aspects of implementation (fidelity, quality, dosage, reach, participant responsiveness, adaptations), social validity (acceptability, feasibility, utility), and their moderating effects on the outcomes of interest, and perceived impact. ETHICS AND DISSEMINATION This trial has been approved by the University College London Research Ethics Committee. Findings will be published in a report to the Department for Education, in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER ISRCTN17631228. PROTOCOL V1 3 January 2019. Substantial changes to the protocol will be communicated to the trials manager to relevant parties (eg, ISRCTN).
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Affiliation(s)
- Daniel Hayes
- Evidence Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families (AFNCCF), London, UK
| | - Anna Moore
- Evidence Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families (AFNCCF), London, UK
| | - Emily Stapley
- Evidence Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families (AFNCCF), London, UK
| | - Neil Humphrey
- Institute of Education, University of Manchester, Manchester, UK
| | - Rosie Mansfield
- Institute of Education, University of Manchester, Manchester, UK
| | - Joao Santos
- Institute of Education, University of Manchester, Manchester, UK
| | - Emma Ashworth
- Institute of Education, University of Manchester, Manchester, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing and the Centre for Longitudinal Studies, University College London, London, UK
| | - Eva Bonin
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | | | - Jessica Deighton
- Evidence Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families (AFNCCF), London, UK
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14
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Abstract
The perception of risk comprises a social dimension which makes its prevention complex. Individuals are exposed to risk in an unequal manner with the younger population notably being most concerned. It is essential that individuals are provided with better support with regard to taking risks. This means being aware of all the different aspects of the risk.
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Affiliation(s)
- Jean-Pascal Assailly
- Ifsttar, laboratoire de psychologie des comportements et des mobilités, 25, allée des Marronniers, 78000 Versailles, France.
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15
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Gaillard S, Malik S, Preston J, Escalera BN, Dicks P, Touil N, Mardirossian S, Claverol-Torres J, Kassaï B. Involving children and young people in clinical research through the forum of a European Young Persons' Advisory Group: needs and challenges. Fundam Clin Pharmacol 2018; 32:357-362. [PMID: 29457267 DOI: 10.1111/fcp.12360] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/01/2018] [Accepted: 02/09/2018] [Indexed: 11/28/2022]
Abstract
Children and young people are seen as fundamental to the design and delivery of clinical research as active and reflective participants. In Europe, involvement of children and young people in clinical research is promoted extensively in order to engage young people in research as partners and to give them a voice to raise their own issues or opinions and for their involvement in planning and decision making in addition to learning research skills. Children and young people can be trained in clinical research through participation in young person advisory groups (YPAGs). Members of YPAGs assist other children and young people to learn about clinical research and share their experience and point of view with researchers, thereby possibly influencing all phases of research including the development and prioritization of research questions, design and methods, recruitment plans, and strategies for results dissemination. In the long term, the expansion of YPAGs in Europe will serve as a driving force for refining pediatric clinical research. It will help in a better definition of research projects according to the patients' needs. Furthermore, direct engagement of children and young people in research will be favorable to both researchers and young people.
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Affiliation(s)
- Segolene Gaillard
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, 69677, Bron, France.,Laboratoire de Biométrie et Biologie Evolutive, Service de Pharmacologie Clinique, Université de Lyon, CNRS, UMR 5558, Université Lyon 1, 69622, Villeurbanne, France.,RIPPS (Réseau d'investigations pédiatriques des produits de santé)-KIDS France Groupement Hospitalier Est - Bâtiment "Les Tilleuls", 59 Boulevard Pinel, 69677, Bron, France
| | - Salma Malik
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, 69677, Bron, France.,Laboratoire de Biométrie et Biologie Evolutive, Service de Pharmacologie Clinique, Université de Lyon, CNRS, UMR 5558, Université Lyon 1, 69622, Villeurbanne, France.,RIPPS (Réseau d'investigations pédiatriques des produits de santé)-KIDS France Groupement Hospitalier Est - Bâtiment "Les Tilleuls", 59 Boulevard Pinel, 69677, Bron, France.,European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | - Jenny Preston
- Institute in the Park, National Institute for Health Research (NIHR) Alder Hey Clinical Research Facility, Eaton Road, Liverpool, L12 2AP, UK
| | - Begonya Nafria Escalera
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.,Innovation and Research Department, Hospital Sant Joan de Déu Pg, Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Pamela Dicks
- NHS NRS Children's Research Network, Summerfield House, 2 Eday Road, Aberdeen, AB15 6RE, UK
| | - Nathalie Touil
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, 69677, Bron, France.,RIPPS (Réseau d'investigations pédiatriques des produits de santé)-KIDS France Groupement Hospitalier Est - Bâtiment "Les Tilleuls", 59 Boulevard Pinel, 69677, Bron, France
| | - Sandrine Mardirossian
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, 69677, Bron, France.,RIPPS (Réseau d'investigations pédiatriques des produits de santé)-KIDS France Groupement Hospitalier Est - Bâtiment "Les Tilleuls", 59 Boulevard Pinel, 69677, Bron, France
| | - Joana Claverol-Torres
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.,Clinical Research Unit, Fundació Sant Joan de Déu, C/Santa Rosa 39-57, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Behrouz Kassaï
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, 69677, Bron, France.,Laboratoire de Biométrie et Biologie Evolutive, Service de Pharmacologie Clinique, Université de Lyon, CNRS, UMR 5558, Université Lyon 1, 69622, Villeurbanne, France.,RIPPS (Réseau d'investigations pédiatriques des produits de santé)-KIDS France Groupement Hospitalier Est - Bâtiment "Les Tilleuls", 59 Boulevard Pinel, 69677, Bron, France
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16
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Murphy MA, McFerran K. Exploring the literature on music participation and social connectedness for young people with intellectual disability: A critical interpretive synthesis. J Intellect Disabil 2017; 21:297-314. [PMID: 27226260 DOI: 10.1177/1744629516650128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND This article explores the literature on social connectedness and music for young people with disability. It then critically examines the level of congruence between the reported literature to date and current rights-based disability studies discourse. METHOD A critical interpretive synthesis was used to examine 27 articles referencing the use of music for social connectedness. Areas of focus in the review are the nature of connections being fostered in music programs, the use of voice and collaboration. RESULTS The majority of music programs reported on closed groups. Outdated 'expert' models of working persist. The use of participants' voice in the literature is growing, although there is a lack of collaboration and negative reporting. CONCLUSION A shift in thinking heralds greater collaboration with participants, although this could be broadened to include decisions on research agendas, planning and evaluation. There is also need for active fostering of broader socio-musical pathways.
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17
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Gray NJ, Wood DM. The Role of Medication in Supporting Emotional Wellbeing in Young People with Long-Term Needs. Healthcare (Basel) 2017; 5:E84. [PMID: 29099742 PMCID: PMC5746718 DOI: 10.3390/healthcare5040084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/20/2017] [Accepted: 10/29/2017] [Indexed: 11/20/2022] Open
Abstract
Young people frequently use and access prescribed medications for a range of health problems. Medications aimed at treating both common health problems and long-term physical and mental health needs in adolescence can have a significant effect on a young person's emotional well-being. We use a series of case studies to illustrate the challenges for healthcare professionals supporting young people with medication use. The studies illustrate the efficacy and limitations of medication on improving emotional well-being by alleviating illness and distress, and how this efficacy must be balanced against both the adverse effects and the burden of treatment. There are specific challenges for medication management during adolescence including issues of adherence/concordance, facilitating autonomy and participation in decision making, and promoting independence.
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Affiliation(s)
- Nicola J Gray
- Green Line Consulting Limited, Manchester M28 7FF, UK.
| | - Damian M Wood
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham NG7 2UH, UK.
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18
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Judd A, Collins IJ, Parrott F, Hill T, Jose S, Ford D, Asad H, Gibb DM, Sabin C. Growing up with perinatal HIV: changes in clinical outcomes before and after transfer to adult care in the UK. J Int AIDS Soc 2017; 20:21577. [PMID: 28530042 PMCID: PMC5577702 DOI: 10.7448/ias.20.4.21577] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/14/2017] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION With improved survival, adolescents with perinatal HIV (PHIV) are transitioning from paediatric to adult care, but there are few published data on clinical outcomes post-transfer. Using linked data from patients in the national UK/Ireland paediatric cohort (CHIPS) and an adult UK cohort of outpatient clinics (UK CHIC), we describe mortality and changes in immunological status post-transfer. METHODS Participants in CHIPS aged ≥13 years by the end of 2013 were linked to the UK CHIC database. Mixed effects models explored changes in CD4 count before and after transfer, including interactions between time and variables where interaction p < 0.05. RESULTS Of 1,215 paediatric participants aged ≥13 years, 271 (22%) had linked data in UK CHIC. One hundred and forty-six (53%) were female, median age at last visit in paediatric care was 17 [interquartile range, IQR 16,18] years, median duration in paediatric care was 11.8 [6.6,15.5] years, and in adult care was 2.9 [1.5,5.9] years. At last visit in paediatric care, 74% (n = 200) were on ART, increasing to 84% (n = 228, p = 0.001) at last visit in adult care. In the 12 months before leaving paediatric care, 92 (47%) had two consecutive viral loads >400 copies/mL or one viral load >10,000 copies/mL, and likewise 102 (52%) in the 12 months post-transfer (p = 0.79). Seven (3%) people died in adult care. In multivariable analysis, CD4 declined as patients approached transition with a greater decline in those with higher nadir CD4 count (mean rates of decline of 3, 13, 15, 30 cells/mm3 per year for those with nadir CD4 < 100, 100-199, 200-299 and ≥300 cells/mm3, respectively). Post-transition, CD4 continued to decline in some groups (e.g. black males, -20 (-34, -5) cells/mm3 per year post transition, p = 0.007)) while it improved in others. Overall CD4 was higher with later year of birth (14 (7, 21) cells/mm3 per later year). There was no effect of age at transfer or changing hospital at transfer on CD4. CONCLUSIONS Our findings suggest that CD4 in adolescents with perinatal HIV in the UK was declining in the period before transition to adult care, and there was some reversal in this trend post-transfer in some groups. Across the transition period, CD4 was higher in those with later birth years, suggesting improvements in clinical care and/or transition planning over time.
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Affiliation(s)
- Ali Judd
- MRC Clinical Trials Unit, University College London (UCL), UCL, London, UK
| | | | - Francesca Parrott
- MRC Clinical Trials Unit, University College London (UCL), UCL, London, UK
| | - Teresa Hill
- MRC Clinical Trials Unit, University College London (UCL), UCL, London, UK
- Research Department of Infection and Population Health, UCL, London, UK
| | - Sophie Jose
- Research Department of Infection and Population Health, UCL, London, UK
| | - Deborah Ford
- MRC Clinical Trials Unit, University College London (UCL), UCL, London, UK
| | - Hibo Asad
- MRC Clinical Trials Unit, University College London (UCL), UCL, London, UK
| | - Diana M. Gibb
- MRC Clinical Trials Unit, University College London (UCL), UCL, London, UK
| | - Caroline Sabin
- Research Department of Infection and Population Health, UCL, London, UK
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19
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Abstract
As all human beings are consumers of health care provision across the life span and in receipt of care delivered by accountable health care professionals, all should have the right to be involved in shaping the future of their own health care. Rights-based participation, when applied successfully, has the potential to inform and influence the delivery of child health care, the child's experience of health care, plus children's nursing education (Coyne & Gallagher, 2011). The "right" of every child and young person to participate in research that relates to their own health care is also sustained by the author's lead position as a Senior Lecturer in Higher Education for pre-registration children's nursing in Northern Ireland and the appreciation of their voice when practicing as a registered children's nurse and ward sister. The report provides an insight into seminal work on human and child rights; the historical context of children in Western society, and the evolution of children's nursing amid the child's right to participate in shaping their own health care.
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Affiliation(s)
- Sonya Clarke
- a School of Nursing and Midwifery, Queen's University Belfast , Belfast , Northern Ireland
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20
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Chand DH, Swartz S, Tuchman S, Valentini RP, Somers MJG. Dialysis in Children and Adolescents: The Pediatric Nephrology Perspective. Am J Kidney Dis 2016; 69:278-286. [PMID: 27940060 DOI: 10.1053/j.ajkd.2016.09.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/16/2016] [Indexed: 11/11/2022]
Abstract
The care of children with end-stage renal disease (ESRD) is highly specialized and often poorly understood by nonpediatric providers and facility/institution administrators. As such, this position paper has been created to offer provider, facility, and institutional guidance regarding the components of care necessary for children receiving dialysis. Key differences between adult and pediatric dialysis units are highlighted. Responsibilities and expectations of the members of the interdisciplinary dialysis team are outlined as they pertain specifically to the care of pediatric dialysis patients. Physical and staffing requirements of the dialysis facility are reviewed, again focusing on unique needs and challenges faced by the pediatric dialysis care team. Among these, vascular access options and proper planning of ESRD care are underscored. Pediatric quality-of-life metrics differ significantly from adult quality variables, and proper tools for assessment must be used. Endorsed by the Council of the American Society of Pediatric Nephrology (ASPN), this position paper serves as a reference tool for the provision of care to pediatric patients with ESRD.
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Affiliation(s)
- Deepa H Chand
- Abbvie, Chicago, IL; University of Illinois College of Medicine-Peoria, Peoria, IL.
| | - Sarah Swartz
- Renal Services, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | | | - Rudolph P Valentini
- Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit, MI
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21
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Edwards D, Noyes J, Lowes L, Haf Spencer L, Gregory JW. An ongoing struggle: a mixed-method systematic review of interventions, barriers and facilitators to achieving optimal self-care by children and young people with type 1 diabetes in educational settings. BMC Pediatr 2014; 14:228. [PMID: 25213220 PMCID: PMC4263204 DOI: 10.1186/1471-2431-14-228] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 08/22/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Type 1 diabetes occurs more frequently in younger children who are often pre-school age and enter the education system with diabetes-related support needs that evolve over time. It is important that children are supported to optimally manage their diet, exercise, blood glucose monitoring and insulin regime at school. Young people self-manage at college/university. METHOD Theory-informed mixed-method systematic review to determine intervention effectiveness and synthesise child/parent/professional views of barriers and facilitators to achieving optimal diabetes self-care and management for children and young people age 3-25 years in educational settings. RESULTS Eleven intervention and 55 views studies were included. Meta-analysis was not possible. Study foci broadly matched school diabetes guidance. Intervention studies were limited to specific contexts with mostly high risk of bias. Views studies were mostly moderate quality with common transferrable findings.Health plans, and school nurse support (various types) were effective. Telemedicine in school was effective for individual case management. Most educational interventions to increase knowledge and confidence of children or school staff had significant short-term effects but longer follow-up is required. Children, parents and staff said they struggled with many common structural, organisational, educational and attitudinal school barriers. Aspects of school guidance had not been generally implemented (e.g. individual health plans). Children recognized and appreciated school staff who were trained and confident in supporting diabetes management.Research with college/university students was lacking. Campus-based college/university student support significantly improved knowledge, attitudes and diabetes self-care. Self-management was easier for students who juggled diabetes-management with student lifestyle, such as adopting strategies to manage alcohol consumption. CONCLUSION This novel mixed-method systematic review is the first to integrate intervention effectiveness with views of children/parents/professionals mapped against school diabetes guidelines. Diabetes management could be generally improved by fully implementing and auditing guideline impact. Evidence is limited by quality and there are gaps in knowledge of what works. Telemedicine between healthcare providers and schools, and school nurse support for children is effective in specific contexts, but not all education systems employ onsite nurses. More innovative and sustainable solutions and robust evaluations are required. Comprehensive lifestyle approaches for college/university students warrant further development and evaluation.
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Affiliation(s)
- Deborah Edwards
- />School of Healthcare Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jane Noyes
- />School of Social Sciences, Bangor University, Bangor, LL57 2EF UK
| | - Lesley Lowes
- />School of Healthcare Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Llinos Haf Spencer
- />School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - John W Gregory
- />Department of Child Health, Wales School of Medicine, Cardiff University, Cardiff, UK
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