Penney Upton

Parent–child agreement across child health-related quality of life instruments: a review of the literature

AimTo systematically review the literature published since 1999 on paediatric health-related quality of life (HRQL) in relation to parent–child agreement.MethodsLiterature searches used to identify studies which evaluated parent–child agreement for child HRQL measures.ResultsNineteen studies were identified, including four HRQL instruments. The Pediatric Quality of Life Inventory™ (PedsQL™) was most commonly used. Differences in parent–child agreement were noted between domains for different measures. The impact of child and parent characteristics were not consistently considered; however parents of children in a nonclinical sample tended to report higher child HRQL scores than children themselves, while parents of children with health conditions tended to underestimate child HRQL.ConclusionDespite increasing numbers of studies considering children’s HRQL, information about variables contributing to parent–child agreement levels remains limited. Authors need to consistently provide evidence for reliability and validity of measures, and design studies to systematically investigate variables that impact on levels of parent–child agreement.

Measurement properties of the UK-English version of the Pediatric Quality of Life Inventory 4.0 (PedsQL) generic core scales.

BackgroundHealth related quality of life (HRQL) has been recognised as an important paediatric outcome measurement. One of the more promising measures to emerge in recent years is the Pediatric Quality Of Life Inventory (PedsQL™), developed in the US. Advantages of the PedsQL™ include brevity, availability of age appropriate versions and parallel forms for child and parent. This study developed a UK-English version of PedsQL™ generic module and assessed its performance in a group of UK children and their parents.MethodsPedsQL™ was translated to UK-English. The psychometric properties of the UK version were then tested following administration to 1399 children and 970 of their parents. The sample included healthy children, children diagnosed with asthma, diabetes or inflammatory bowel disease and children in remission from cancer.ResultsPsychometric properties were similar to those reported for the original PedsQL™. Internal reliability exceeded 0.70 for all proxy and self-report sub-scales. Discriminant validity was established for proxy and self-report with higher HRQL being reported for healthy children than those with health problems. Sex differences were noted on the emotional functioning subscale, with females reporting lower HRQL than males. Proxy and self-report correlation was higher for children with health problems than for healthy children.ConclusionThe UK-English version of PedsQL™ performed as well as the original PedsQL™ and is recommended for assessment of paediatric HRQL in the UK.

Knowledge and use of evidence‐based practice of GPs and hospital doctors

Rationale, aims and objectives  Clinical effectiveness and evidence-based practice (EBP) are the cornerstone of modern day health care. Although many studies have explored attitudes and perceived knowledge of individual professions few have compared the factors between professional groups and in particular in the medical profession. We report a study comparing the views, knowledge and practice of hospital doctors with their general practitioner (GP) counterparts in terms of EBP and clinical effectiveness. In this way it was hoped to highlight not only any differences between these groups but also the needs of these groups and suggest some ways of fulfilling these. Methods  A postal questionnaire survey was completed by a random sample of 500 GPs and 500 hospital medics. Results  There was a significant difference between the groups with the GPs rating their skill level as lower that their medical doctor counterparts. Similarly, GPs reported using EBP steps less frequently than hospital doctors. Barriers to implementing EBP differed between the groups with GPs reporting difficulty with accessing a library and making time available. Conclusion  A number of differences between GPs and their hospital counterparts were recorded which highlights the difference in educational and policy approach required for greater uptake of EBP.

Increasing children's lunchtime consumption of fruit and vegetables: an evaluation of the Food Dudes programme.

OBJECTIVES Although previous research has shown that the Food Dudes programme increases childrens fruit and vegetable consumption at school, there has been limited evaluation of the extent to which changes are maintained in the long term. Furthermore, despite knowledge that the nutritional content of home-supplied meals is lower than that of school-supplied meals, little consideration has been given to the programmes impact on meals provided from home. The present study therefore assessed the long-term effectiveness of the Food Dudes programme for both school- and home-supplied lunches. DESIGN Two cohorts of children participated, one receiving the Food Dudes intervention and a matched control group who did not receive any intervention. Consumption of fruit and vegetables was assessed pre-intervention, then at 3 and 12 months post-intervention. Consumption was measured across five consecutive days in each school using weighed intake (school-provided meals) and digital photography (home-provided meals). SETTING Fifteen primary schools, six intervention (n 1282) and seven control schools (n 1151). SUBJECTS Participants were children aged 4-11 years. RESULTS A significant increase in the consumption of fruit and vegetables was found at 3 months for children in the intervention schools, but only for those eating school-supplied lunches. However, increases were not maintained at 12 months. CONCLUSIONS The Food Dudes programme has a limited effect in producing even short-term changes in childrens fruit and vegetable consumption at lunchtime. Further development work is required to ensure the short- and long-term effectiveness of interventions promoting fruit and vegetable consumption in children such as the Food Dudes programme.

Development of a parent version of the Manchester-Minneapolis quality of life survey for use by parents and carers of UK children: MMQL-UK (PF)

BackgroundAlthough it is now widely endorsed that children should as far as possible rate their own health related quality of life (HRQL), there are situations where proxy information on child HRQL may be useful, especially where a child is too ill or young to provide their own HRQL assessment. There is limited availability of generic HRQL scales that have a parallel child and parent version and that are reliable, valid, brief, comprehensible and suitable for use in UK populations. The aims of this study were therefore to develop and validate a parent version of the anglicised Manchester-Minneapolis Quality of Life child form (MMQL-UK (CF)) and to determine the level of association between the child and parent versions of this form.MethodsThis study was undertaken concurrently with the anglicisation and validation of the MMQL, a measure of HRQL developed for use with children in North America. At that time, no parent version existed, so the MMQL form for children (MMQL-UK (CF)) was used as the basis for the development of the MMQL-UK parent form (PF). The sample included a control group of healthy children and their parents and five exemplar groups; children diagnosed with asthma, diabetes or inflammatory bowel disease and their parents, children in remission from cancer and their parents and children in public care and their carers. Consistency of the MMQL-UK (PF) components were assessed by calculating Cronbachs alpha. Validation of the parent questionnaire was undertaken by comparing MMQL-UK (PF) component scores with comparable components on the proxy PedsQL™ quality of life scales, comparing MMQL-UK (PF) component scores between parents of healthy and chronic disease children and by comparison of component scores from children and their parents or carers. Reproducibility and responsiveness were assessed by retesting parents by follow-up questionnaires.ResultsA total of 874 children (completing MMQL-UK (CF)) and 572 parents or carers (completing MMQL-UK (PF)) took part in the study. The internal consistency of all the MMQL-UK (PF) components exceeding the accepted criterion of 0.70 and the construct validity was good with moderate correlations being evident between comparable components of the MMQL-UK (PF) and the proxy PedsQL™. Discriminant validity was demonstrated with significant differences being identified between parents of healthy children and those with chronic conditions. Intra-class correlations exceeded 0.65 for all MMQL-UK (PF) components demonstrating good reproducibility. Weak to moderate levels of responsiveness were demonstrated for all but social functioning. The MMQL-UK (PF) showed moderate parent-child correlation with the MMQL-UK (CF) for all components. The best correlations were seen for those components measuring the same construct (Pearsons r ranged from 0.31 to 0.61, p < 0.01 for equivalent components).ConclusionThe MMQL-UK (PF) showed moderate to good correlations with the MMQL-UK (CF) component scores. The MMQL-UK (PF) will be of use when comparing child and parent/carer perception of the impact of a childs condition on their HRQL or where the child is too ill or young to provide their own report.

Making friends at antenatal classes: a qualitative exploration of friendship across the transition to motherhood.

This study explored how friendships made at antenatal classes preserve new mothers’ well-being, postnatally. Eight women from the United Kingdom who had attended antenatal classes in the third trimester were interviewed following the birth of their first baby. Transcripts were analyzed using a constant comparative method. Findings suggest that friendships made at antenatal classes are not only unique but also support women’s mental health and enhance self-efficacy because the women give and gain reassurance that their babies are developing normally. Such friendships may reduce demands on overstretched social and health-care services. Childbirth educators, midwives, and nurses can be encouraged to capitalize on the opportunity provided by antenatal classes to facilitate the formation of friendships that can help mothers to find “a new equilibrium.”

The timing of medical examination following an allegation of sexual abuse - Is this an emergency?

Aim: To ascertain the frequency of significant anogenital signs, at medical examination, following an allegation of sexual abuse, in relation to the timing of the examination. Method: A case series of 331 children, who were referred by the police or social services for examination, following an allegation of child sexual abuse or suspicion of this, over a 3½-year period in a defined geographical area. Results: Two hundred and fifty-seven children alleged penetrative abuse, of whom 114 were seen within 7 days of the abuse. Twenty-three children alleged penetrative anal abuse within the previous 7 days; 13 of these had abnormal findings (56.5%) compared with 9 (18%) of the 50 children seen more than 7 days after anal abuse. Ninety-two girls alleged penetrative vaginal abuse within the previous 7 days and of these 46 (50%) had abnormal findings, compared with 31 (30.7%) of the 101 girls seen more than 7 days after the alleged abuse. In addition 33 girls seen within 7 days had other signs associated with probable assault. Abnormal findings were more common in post-pubertal girls. Conclusion: Pubertal and post-pubertal girls are more likely to have significant genital signs if they are examined within 7 days of the last episode of sexual abuse. Our findings suggest that abnormal anal signs are more likely to be present in the acute phase. This study indicates that children should be examined as soon as possible following a referral. This will have implications for clinical practice. Regardless of the lack of accurate history it will always be important to examine the child as soon as possible after disclosure.

Promoting smoking cessation in Pakistani and Bangladeshi men in the UK: pilot cluster randomised controlled trial of trained community outreach workers

BackgroundSmoking prevalence is high among Pakistani and Bangladeshi men in the UK, but there are few tailored smoking cessation programmes for Pakistani and Bangladeshi communities. The aim of this study was to pilot a cluster randomised controlled trial comparing the effectiveness of Pakistani and Bangladeshi smoking cessation outreach workers with standard care to improve access to and the success of English smoking cessation services.MethodsA pilot cluster randomised controlled trial was conducted in Birmingham, UK. Geographical lower layer super output areas were used to identify natural communities where more than 10% of the population were of Pakistani and Bangladeshi origin. 16 agglomerations of super output areas were randomised to normal care controls vs. outreach intervention. The number of people setting quit dates using NHS services, validated abstinence from smoking at four weeks, and stated abstinence at three and six months were assessed. The impact of the intervention on choice and adherence to treatments, attendance at clinic appointments and patient satisfaction were also assessed.ResultsWe were able to randomise geographical areas and deliver the outreach worker-based services. More Pakistani and Bangladeshi men made quit attempts with NHS services in intervention areas compared with control areas, rate ratio (RR) 1.32 (95%CI: 1.03-1.69). There was a small increase in the number of 4-week abstinent smokers in intervention areas (RR 1.30, 95%CI: 0.82-2.06). The proportion of service users attending weekly appointments was lower in intervention areas than control areas. No difference was found between intervention and control areas in choice and adherence to treatments or patient satisfaction with the service. The total cost of the intervention was £124,000; an estimated cost per quality-adjusted life year (QALY) gained of £8,500.ConclusionsThe intervention proved feasible and acceptable. Outreach workers expanded reach of smoking cessation services in diverse locations of relevance to Pakistani and Bangladeshi communities. The outreach worker model has the potential to increase community cessation rates and could prove cost-effective, but needs evaluating definitively in a larger, appropriately powered, randomised controlled trial. These future trials of outreach interventions need to be of sufficient duration to allow embedding of new models of service delivery.Trial registrationCurrent Controlled Trials ISRCTN82127540

Adaptation of the Manchester-Minneapolis Quality of Life instrument for use in the UK population

Introduction: The availability of health-related quality of life (HRQL) measures that are reliable, valid, brief and comprehensible and appropriate for use with UK children is limited. We report the validation of a HRQL measure suitable for UK use in healthy children, children with chronic disease conditions and socially disadvantaged children. Patients: A total of 1238 children took part in the study, including healthy children as controls (n = 824) and five exemplar groups: children diagnosed with asthma (n = 87), diabetes (n = 103) or inflammatory bowel disease (IBD; n = 69), children in remission from cancer (n = 68) and children in public care (n = 87). Methods: In phase I, the Manchester-Minneapolis Quality of Life instrument (MMQL) Child Form was translated into UK English. In phases II and III, the questionnaire was shortened and validated. Results: MMQL was anglicised and shortened to five components comprising 29 items. Good internal reliability was found with &agr; reaching at least 0.69 for all subscales. Construct validity was established through moderate correlations with comparable PedsQL subscales (Pearson’s r ranged from 0.38 to 0.58, p<0.01). Discriminant validity was also demonstrated in children with asthma and IBD, children in remission from cancer and children in public care, all of whom reported significantly lower HRQL than healthy children. Children with diabetes showed similar HRQL to their healthy peers. Good reproducibility and moderate responsiveness were demonstrated for the new measure. Conclusions: The anglicised and shortened MMQL was shown to be valid and reliable and could be a valuable new tool for the assessment of HRQL in children.

Fruit and vegetable intake of primary school children: a study of school meals.

BACKGROUND Despite an increasing focus on the nutritional content of school meals and initiatives such as the School Fruit and Vegetable Scheme, children are not meeting the recommended levels of fruit and vegetable consumption. The present study aimed to examine childrens fruit and vegetable consumption in 15 primary schools across the West Midlands region. METHODS A total of 1296 children, aged 4-11 years, were observed for five consecutive days and the consumption of all food items was measured using the weighed intake method. Differences in the mean intake of fruit, vegetables and foods high in fat and sugar between Key Stages 1 and 2 were determined. RESULTS Two-thirds of the children in the present study did not consume any fruit at lunchtime and only 3% of children consumed at least one portion as part of their school meal. The proportion of children consuming some quantity of vegetable at lunchtime was more than double that consuming fruit. Children in Key Stage 1 consumed significantly more vegetables on average than children in Key Stage 2 (P ≤ 0.05); however, no significant differences were found for the consumption of fruit. CONCLUSIONS Despite the introduction of food-based standards for school meal provision; children are not consuming adequate portions of fruit and vegetables at lunchtime. The importance of strategies used by catering staff to promote the consumption of fruit and vegetables should be harnessed to encourage children to taste fruit and vegetables provided. Further research is recommended to increase the evidence base on strategies aiming to promote fruit and vegetable consumption in children.