Claire Schofield
University of London
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The Lancet | 2004
Ann Ashworth; Mickey Chopra; David McCoy; David Sanders; Debra Jackson; Nadina Karaolis; Nonzwakazi Sogaula; Claire Schofield
BACKGROUND WHO case-management guidelines for severe malnutrition aim to improve the quality of hospital care and reduce mortality. We aimed to assess whether these guidelines are feasible and effective in under-resourced hospitals. METHODS All children admitted with a diagnosis of severe malnutrition to two rural hospitals in Eastern Cape Province from April, 2000 to April, 2001, were studied and their case-fatality rates were compared with the rates in a period before guidelines were implemented (March, 1997 to February, 1998). Quality of care was assessed by observation of medical and nursing practices, review of medical records, and interviews with carers and staff. A mortality audit was used to identify cause of death and avoidable contributory factors. FINDINGS At Mary Theresa Hospital, case-fatality rates fell from 46% before implementation to 21% after implementation. At Sipetu Hospital, the rates fell from 25% preimplementation to 18% during 2000, but then rose to 38% during 2001, when inexperienced doctors who were not trained in the treatment of malnutrition were deployed. This rise coincided with less frequent prescribing of potassium (13% vs 77%, p<0.0001), antibiotics with gram-negative cover (15% vs 46%, p=0.0003), and vitamin A (76% vs 91%, p=0.018). Most deaths were attributed to sepsis. For the two hospitals combined, 50% of deaths in 2000-01 were due to doctor error and 28% to nurse error. Weaknesses within the health system--especially doctor training, and nurse supervision and support--compromised quality of care. INTERPRETATION Quality of care improved with implementation of the WHO guidelines and case-fatality rates fell. Although major changes in medical and nursing practice were achieved in these under-resourced hospitals, not all tasks were done with adequate care and errors led to unnecessary deaths.
Obesity Reviews | 2013
Laurits Rohden Skov; Sofia Lourenço; Gitte Laub Hansen; Bent Egberg Mikkelsen; Claire Schofield
The primary objective of this review was to investigate the current evidence base for the use of choice architecture as a means to change eating behaviour in self‐service eating settings, hence potentially reduce calorie intake. Twelve databases were searched systematically for experimental studies with predefined choice architecture interventions in the period of June 2011–March 2012. The 12 included studies were grouped according to type of interventions and underwent a narrative synthesis. The evidence indicates that (i) health labelling at point of purchase is associated with healthier food choice, while (ii) manipulating the plate and cutlery size has an inconclusive effect on consumption volume. Finally, (iii) assortment manipulation and (iv) payment option manipulation was associated with healthier food choices. The majority of studies were of very weak quality and future research should emphasize a real‐life setting and compare their results with the effect of other more well‐established interventions on food behaviour in self‐service eating settings.
Archives of Disease in Childhood | 2007
Nadina Karaolis; Debra Jackson; Ann Ashworth; David Sanders; Nonzwakazi Sogaula; David McCoy; Mickey Chopra; Claire Schofield
Aims: To assess the feasibility of implementing and sustaining the WHO guidelines for inpatient management of severe malnutrition in under-resourced rural South African hospitals, and to identify any constraints. Intervention: Three 2-day training workshops were held in 1998, followed by monthly 1-day visits for 5 months, ending in March 1999, in two rural district hospitals with limited resources in Eastern Cape Province, South Africa. Methods: A 12-month observational study was conducted from April 2000 to April 2001 in Mary Theresa and Sipetu hospitals (Eastern Cape Province, South Africa), including 1011 child-hours of observation on the wards, medical record reviews, interviews with carers and staff, and inventories of essential supplies. All admissions (n = 193) for severe malnutrition to the two hospitals were studied. The main outcomes were the extent to which the 10 steps for routine care of severely malnourished children were implemented, proficiency of performance and constraining factors. Results: The hospitals made the changes required in clinical and dietary management, but the tasks were not always performed fully or with sufficient care. Play and stimulation and an effective system of follow-up were not implemented. Doctors’ poor knowledge, nurses’ inattentiveness and insufficient interaction with carers were constraints to optimal management. The underlying factors were inadequate undergraduate training, understaffing, high doctor turnover and low morale. Conclusions: Guidelines for severe malnutrition are largely feasible but training workshops are insufficient to achieve optimal management as staff turnover and an unsupportive health system erode the gains made and doctors treat cases without having being trained. Medical and nursing curricula in Africa must include treatment of severe malnutrition.
British Journal of Nutrition | 1987
Claire Schofield; Erica F. Wheeler; Judy Stewart
1. Dietary records were obtained twice in pregnancy and once post-partum from 265 women from all social classes in London and Edinburgh. 2. The London women always had higher mean energy, protein, fat and fibre intakes. Significant between-region differences emerged. 3. Some between-social classes differences occurred, but were not consistently significant. 4. All mean energy and fibre intakes were lower, and protein and fat intakes were higher, than current recommendations. 5. Of lactating women 15% claimed to be dieting. 6. The percentage dietary energy derived from fat varied from 36 (in a dieting group) to 42.
Revista Panamericana De Salud Publica-pan American Journal of Public Health | 1997
Claire Schofield; Ann Ashworth
A review of the literature that has appeared over the past five decades indicates that the median case fatality from severe malnutrition has remained unchanged over this period and is typically 20-30%, with the highest levels (50-60%) being among those with oedematous malnutrition. A likely cause of this continuing high mortality is faulty case-management. A survey of treatment centres worldwide (n = 79) showed that for acutely ill children, inappropriate diets that are high in protein, energy and sodium and low in micronutrients are commonplace. Practices that could have fatal consequences, such as prescribing diuretics for oedema, were found to be widespread. Evidence of outmoded and conflicting teaching manuals also emerged. Since low mortality levels from malnutrition can be achieved using appropriate treatment regimens, updated treatment guidelines, which are practical and prescriptive rather than descriptive, need to be implemented as part of a comprehensive training programme.
Ecology of Food and Nutrition | 1988
Judith Stewart; Erica F. Wheeler; Claire Schofield
Interviews were carried out with 242 pregnant women in England and Scotland. Attitudes to food, health, and self, in pregnancy were recorded and analysed. The English women articulated a wider range of concepts regarding foetal growth and maternal diet, displayed more concern about weight gain and appearance and reported more physiological disturbances. The Scottish women displayed more pragmatic and less health‐seeking attitudes. The womens categorisation of foods as “good” and “bad” were broadly in agreement with current health education advice; but equally were in agreement with the mainstream dietary traditions of their culture.
Archives of Disease in Childhood | 2012
Claire Schofield; Anne Ashworth; Reginald Annan; Alan A. Jackson
The International Pediatric Association has resolved that the identification and treatment of severe malnutrition should be a core competency for paediatricians and related health professionals worldwide. The Resolution is in response to the urgent need to reduce deaths and disability among young children. The Resolution has implications for the training of doctors, nurses and other health workers as current curricula are often insufficient to confer competency. Results of a survey of national paediatric societies suggest that training institutions need assistance in teaching about malnutrition treatment. Formation of national multidisciplinary teams for advocacy, strategic planning and action are proposed and it is anticipated that paediatricians will play a major role.
Obesity Reviews | 2013
Laurits Rohden Skov; Sofia Lourenço; Gitte Laub Hansen; Bent Egberg Mikkelsen; Claire Schofield
The primary objective of this review was to investigate the current evidence base for the use of choice architecture as a means to change eating behaviour in self‐service eating settings, hence potentially reduce calorie intake. Twelve databases were searched systematically for experimental studies with predefined choice architecture interventions in the period of June 2011–March 2012. The 12 included studies were grouped according to type of interventions and underwent a narrative synthesis. The evidence indicates that (i) health labelling at point of purchase is associated with healthier food choice, while (ii) manipulating the plate and cutlery size has an inconclusive effect on consumption volume. Finally, (iii) assortment manipulation and (iv) payment option manipulation was associated with healthier food choices. The majority of studies were of very weak quality and future research should emphasize a real‐life setting and compare their results with the effect of other more well‐established interventions on food behaviour in self‐service eating settings.
Obesity Reviews | 2013
Laurits Rohden Skov; Sofia Lourenço; Gitte Laub Hansen; Bent Egberg Mikkelsen; Claire Schofield
The primary objective of this review was to investigate the current evidence base for the use of choice architecture as a means to change eating behaviour in self‐service eating settings, hence potentially reduce calorie intake. Twelve databases were searched systematically for experimental studies with predefined choice architecture interventions in the period of June 2011–March 2012. The 12 included studies were grouped according to type of interventions and underwent a narrative synthesis. The evidence indicates that (i) health labelling at point of purchase is associated with healthier food choice, while (ii) manipulating the plate and cutlery size has an inconclusive effect on consumption volume. Finally, (iii) assortment manipulation and (iv) payment option manipulation was associated with healthier food choices. The majority of studies were of very weak quality and future research should emphasize a real‐life setting and compare their results with the effect of other more well‐established interventions on food behaviour in self‐service eating settings.
Guidelines for the inpatient treatment of severely malnourished children. | 2003
Ann Ashworth; Sultana Khanum; Alan A. Jackson; Claire Schofield