the 25th anniversary of the UN Convention on the Rights of the Child (UNCRC, 1989) and the 55th a... more the 25th anniversary of the UN Convention on the Rights of the Child (UNCRC, 1989) and the 55th anniversary of the Declaration of the Rights of the Child (1959). Twenty-five years after the UNCRC, this article explores the rights of children and young people (CYP) to participate in decisions about their healthcare, and the benefits of doing so; we then examine where we are now with respect to the voices of CYP in health. This article addresses this final question through three aspects: first, by celebrating the progress made over the last quarter of a century-particularly with respect to policy development-both in the UK and internationally; second, by identifying ongoing areas of concern, with suggestions as to where to focus our efforts next; and finally, by calling for a change in culture. This change of culture is suggested through four positive concrete steps: a greater dissemination of guidance and examples of good practice, greater evaluation of the participatory process, app...
Supplementary Table A. The Bristol Girls Dance Project intervention details - TIDieR checklist. S... more Supplementary Table A. The Bristol Girls Dance Project intervention details - TIDieR checklist. Supplementary Table B. Data provision for participants at each time point by trial arm. Supplementary Table C. Means (SD) for physical activity variables intervention girls attending and not attending dance classes during measurement period between 3 and 5 pm. Supplementary Table D. After-school activity engagement of girls at T0. Supplementary Table E. Engagement in dance activities at T1 and T2. Supplementary Table F. Afterschool (3.30pm-bedtime) activity engagement during the last week. Supplementary Table G. Health outcomes measured in BGDP - responses to the EQ-5D-Y descriptive system. (DOCX 47 kb)
ObjectivesUsing the National Child Mortality Database (NCMD), this work aims to investigate and q... more ObjectivesUsing the National Child Mortality Database (NCMD), this work aims to investigate and quantify the characteristics of children dying of COVID-19, and to identify any changes in rate of childhood mortality during the pandemic.DesignWe compared the characteristics of the children who died in 2020, split by SARS-CoV-2 status. A negative binomial regression model was used to compare mortality rates in lockdown (23 March–28 June), with those children who died in the preceding period (6 January–22 March), as well as a comparable period in 2019.SettingEngland.ParticipantsChildren (0–17 years).Main outcome measuresCharacteristics and number of the children who died in 2020, split by SARS-CoV-2 status.Results1550 deaths of children between 6th of January and 28 June 2020 were notified to the NCMD; 437 of the deaths were linked to SARS-CoV-2 virology records, 25 (5.7%) had a positive PCR result. PCR-positive children were less likely to be white (37.5% vs 69.4%, p=0.003) and were ol...
Childhood Sleep Duration in an English Cohort-Blair et al Sleep duration is likely to be determin... more Childhood Sleep Duration in an English Cohort-Blair et al Sleep duration is likely to be determined through an interaction between genetic and environmental factors, but the degree of contribution from these determinants is unknown. 11 There has been a suggestion that sleep duration has decreased over time, leading to sleep deprivation in contemporary children. The Sleep in America Poll (2004) reported that a significant percentage of children slept less than 9 hours per night (http:// www.sleepfoundation.org). Iglowstein and colleagues reported a decline in sleep duration in Swiss children, 12 a finding that has been confirmed by more recent studies. 13,14 Sleep duration has been studied in several populations of children using different methods. The majority of data available are from cross-sectional population studies. Few studies have prospectively examined sleep duration in well-characterized cohorts of children across early childhood. 12,15-17 This is the first report on normative sleep patterns in a large, unselected, ongoing, population-based cohort of English children born in 1991-1992 and followed until they were 11 years old. We present data on the children's daytime and nighttime sleep duration and timings, as well as the number of nighttime awakenings. We have specifically identified demographic characteristics associated with sleep duration throughout childhood. PATIENTS AND METHODS The ALSPAC Study The Avon Longitudinal Study of Parents and Children (AL-SPAC) is a prospective birth-cohort study that aimed to enroll the infants of all pregnant women who resided in the 3 Bristol-based health districts of the county of Avon (population INTRODUCTION Sleep occupies a substantial proportion of childhood life. The importance of childhood sleep duration and quality for future health and performance is increasingly appreciated. In particular, it has been proposed that insufficient sleep in childhood is associated with obesity, 1,2 lower academic performance, 3,4 and emotional and behavior problems. 5-7 Sleep problems are common in childhood, affecting up to one third of children, but are underreported by parents. 8,9 Furthermore, disturbed sleep in childhood impinges on parental sleep, health, and quality of life. Sleep problems tend to be age specific and include bedtime resistance, difficulty falling asleep, frequent nighttime awakenings, parasomnias (bruxism, sleep walking and sleep talking, night terrors, enuresis, and body rocking), and noisy breathing, snoring, and obstructive sleep apnea. 10 Sleep duration is of clinical importance since parental concerns are often about duration or continuity of their child's sleep. An understanding of the normal variation in sleep during childhood is essential to the definition of sleep problems or initiation of any intervention strategy to modify sleep.
Aims-To investigate patterns of infant growth that may influence the risk of sudden infant death ... more Aims-To investigate patterns of infant growth that may influence the risk of sudden infant death syndrome (SIDS). Design-Three year population based case control study with parental interviews for each death and four age matched controls. Growth was measured from prospective weight observations using the British 1990 Growth Reference. Setting-Five regions in England (population greater than 17 million, more than 470 000 live births over three years). Subjects-247 SIDS cases and 1110 controls. Results-The growth rate from birth to the final weight observation was significantly poorer among the SIDS infants despite controlling for potential confounders (SIDS mean change in weight z score (zw) = −0.38 (SD 1.40) v controls = +0.22 (SD 1.10), multivariate: p < 0.0001). Weight gain was poorer among SIDS infants with a normal birth weight (above the 16th centile: odds ratio (OR) = 1.75, 95% confidence interval (CI) 1.48-2.07, p < 0.0001) than for those with lower birth weight (OR = 1.09, 95% CI 0.61-1.95, p = 0.76). There was no evidence of increased growth retardation before death. Conclusions-Poor postnatal weight gain was independently associated with an increased risk of SIDS and could be identified at the routine six week assessment.
To establish severity banding ranges, bother assessment and key item content in principal patient... more To establish severity banding ranges, bother assessment and key item content in principal patient reported outcomes measures (PROMs) in men seeking therapy for lower urinary tract symptoms (LUTS).
SIDS Sudden infant and early childhood death: The past, the present and the future, 2018
The University of Adelaide Press publishes peer reviewed scholarly books. It aims to maximise acc... more The University of Adelaide Press publishes peer reviewed scholarly books. It aims to maximise access to the best research by publishing works through the internet as free downloads and for sale as high quality printed volumes.
Breastfeeding and the place of sleep for the mother and the infant have been controversial intern... more Breastfeeding and the place of sleep for the mother and the infant have been controversial internationally due to reported concerns regarding infant deaths despite the known benefits of exclusive and prolonged breastfeeding, which are increased by breastfeeding at night. The aims of this integrated analysis were to (a) review breastfeeding and maternal and infant sleep research literature via historical, epidemiological, anthropological, and methodological lenses; (b) use this information to determine where we are currently in safeguarding both infant lives and breastfeeding; and (c) postulate the direction that research might take from this point forward to improve our knowledge and inform our policy and practice. Despite well-meaning but unsuccessful campaigns in some countries to dissuade parents from sleeping with their babies, many breastfeeding mothers and caregivers do sleep with their infants whether intentionally or unintentionally. Taking cultural contexts and socio-ecolog...
Clinical and patient reported outcome measures in men referred for consideration of surgery to tr... more Clinical and patient reported outcome measures in men referred for consideration of surgery to treat LUTS: baseline results and diagnostic findings of the UPSTREAM trial
Journal of Reproductive and Infant Psychology, 2005
... Alan Emond b , Peter Blair b & Pauline Emmett b pages 309-317. ... Kelleher, K., Casey, P... more ... Alan Emond b , Peter Blair b & Pauline Emmett b pages 309-317. ... Kelleher, K., Casey, P., Bradley, R., Pope, S., Whiteside, L., Barrett, K., Swanson, ME and Kirby, RS 1993. Risk factors and outcomes for failure to thrive in low birth weight preterm infants.. Pediatrics , 91: 941948. ...
Objective To investigate the risks of the sudden infant death syndrome and factors that may contr... more Objective To investigate the risks of the sudden infant death syndrome and factors that may contribute to unsafe sleeping environments. Design Three year, population based case-control study. Parental interviews were conducted for each sudden infant death and for four controls matched for age, locality, and time of sleep. Setting Five regions in England with a total population of over 17 million people. Subjects 325 babies who died and 1300 control infants. Results In the multivariate analysis infants who shared their parents' bed and were then put back in their own cot had no increased risk (odds ratio 0.67; 95% confidence interval 0.22 to 2.00). There was an increased risk for infants who shared the bed for the whole sleep or were taken to and found in the parental bed (9.78; 4.02 to 23.83), infants who slept in a separate room from their parents (10.49; 4.26 to 25.81), and infants who shared a sofa (48.99; 5.04 to 475.60). The risk associated with being found in the parental bed was not significant for older infants (> 14 weeks) or for infants of parents who did not smoke and became non-significant after adjustment for recent maternal alcohol consumption (> 2 units), use of duvets (> 4 togs), parental tiredness (infant slept <4 hours for longest sleep in previous 24 hours), and overcrowded housing conditions (> 2 people per room of the house). Conclusions There are certain circumstances when bed sharing should be avoided, particularly for infants under four months old. Parents sleeping on a sofa with infants should always be avoided. There is no evidence that bed sharing is hazardous for infants of parents who do not smoke.
To examine the relationship between failure to thrive in preterm and term infants and postnatal d... more To examine the relationship between failure to thrive in preterm and term infants and postnatal depression in their mothers. In a whole population birth cohort of 12,391 infants (excluding those born after term or with major congenital abnormalities) failure to thrive over the first nine months was identified using a conditional weight gain criterion which identified the slowest-gaining 5%. Depression symptoms were recorded using the Edinburgh Postnatal Depression Scale (EPDS) at 18 and 32 weeks of pregnancy and at 8 weeks and 8 months after delivery. After the birth, high depression scores were significantly more common in the mothers of infants born preterm, and controlling for depression scores in pregnancy did not eliminate this association after the birth. Failure to thrive was identified in 4.5% of the children born at term (531/11718) and in 8.3% of those born preterm (56/673). The difference was highly significant (chi2 = 20.25 with 1 df, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Using a conventional cut-off on the EPDS (score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 12) to identify mothers as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;depressed&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;, the prevalence of failure to thrive in the term infants of mothers depressed at 8 weeks postpartum was 5.0%; in the remainder of the population (controls) it was 4.3%. In mothers depressed at 8 months the prevalence was 4.3% in both groups. The prevalence of failure to thrive in the preterm infants of mothers depressed at 8 weeks was 8.8% (7.0% in controls) and in those depressed at 8 months it was 12.3% (6.7% in controls). None of these differences in prevalence was statistically significant, and significant differences did not emerge from further analyses using more stringent criteria for depression. Preterm births are specifically associated with high maternal depression scores in the postpartum period, and with a higher prevalence of failure to thrive. High depression scores in the postpartum period are not themselves associated with a higher prevalence of failure to thrive, however, either in infants born at term or in those born preterm.
ObjectivesIn 2008, new statutory national procedures for responding to unexpected child deaths we... more ObjectivesIn 2008, new statutory national procedures for responding to unexpected child deaths were introduced throughout England. There has, to date, been no national audit of these procedures.Study designFamilies bereaved by the unexpected death of a child under 4 years of age since 2008 were invited to participate. Factors contributing to the death and investigations after the death were explored. Telephone interviews were conducted, and coroners’ documents were obtained. The nature and quality of investigations was compared with the required procedures; information on each case was reviewed by a multiagency panel; and the death was categorised using the Avon clinicopathological classification.ResultsData were obtained from 91 bereaved families (64 infant deaths and 27 children aged 1–3 years); 85 remained unexplained after postmortem examination. Documentation of multiagency assessments was poorly recorded. Most (88%) families received a home visit from the police, but few (37%)...
The sudden and unexpected death of an infant or child is devastating. An inability to explain why... more The sudden and unexpected death of an infant or child is devastating. An inability to explain why an infant or child died is difficult to accept for both families and professionals. No reliable national dataset exists to estimate precisely how many infants and children die unexpectedly each year in England. This lack of accurate epidemiological data belies the scale of this public health problem. Detailed controlled observational studies of infant deaths identifying risk factors and providing evidence-based advice for parents has seen a dramatic reduction in incidence over the last 30 years by almost 80% but greater knowledge is needed if future deaths of infants and older children are to be prevented and families optimally supported. We propose that a national registry of sudden unexpected deaths in infancy and childhood would accurately determine incidence, identify unknown risk factors and highlight good care practices, ensuring these can be standardised nationally. For such a pr...
The international journal of behavioral nutrition and physical activity, Jun 7, 2018
Most adolescent girls in the UK do not meet government physical activity recommendations and effe... more Most adolescent girls in the UK do not meet government physical activity recommendations and effective interventions are needed. This study reports the results of a feasibility trial of PLAN-A, a novel school-based peer-led physical activity intervention for adolescent girls. A two-arm cluster randomised controlled feasibility study was conducted in six English secondary schools (4 intervention & 2 control). Year 8 (age 12-13) girls were eligible and randomisation was at school-level. The intervention involved training Year 8 girls (out of school for two consecutive days, plus one top-up day 5 weeks later), who were identified by their peers as influential, to provide informal support to their friends to increase their physical activity. Feasibility of the intervention and the research was examined, including: recruitment, training attendance and data provision rates, evidence of promise of the intervention to affect weekday moderate-to-vigorous physical activity (MVPA), interventio...
The British journal of general practice : the journal of the Royal College of General Practitioners, Jan 10, 2018
Clinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presentin... more Clinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presenting in primary care with cough and respiratory symptoms, despite limited meaningful evidence of impact on these outcomes. To estimate the effect of children's antibiotic prescribing on adverse outcomes within 30 days of initial consultation. Secondary analysis of 8320 children in a multicentre prospective cohort study, aged 3 months to <16 years, presenting in primary care across England with acute cough and other respiratory symptoms. Baseline clinical characteristics and antibiotic prescribing data were collected, and generalised linear models were used to estimate the effect of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations and reconsultation for deterioration), controlling for clustering and clinicians' propensity to prescribe antibiotics. Sixty-five (0.8%) children were hospitalised and 350 (4%) reconsulted for deterioration. Clinicia...
Little is known about respiratory tract infection (RTI) severity in children following consultati... more Little is known about respiratory tract infection (RTI) severity in children following consultation. To investigate post-consultation symptom trajectories in children with acute cough and RTI and whether baseline characteristics predict trajectory group. Prospective cohort study of 2296 children (3 months-16 years) whose parents were invited to report cough severity and duration using a 7-point Likert scale. Longitudinal latent class analysis (LLCA) was used to identify post-consultation symptom trajectories in the first 15 days, and multinomial models to predict class membership. Complete data were available for 1408 children (61%). The best LLCA model identified five post-consultation symptom trajectory groups: 'very rapid recovery' (28.5%), 'rapid recovery' (37.7%), 'intermediate recovery' (18.2%), 'persistent symptoms' (9.5%) and 'initial deterioration with persistent symptoms' (6.0%). Compared with very rapid recovery, parent-reported sev...
the 25th anniversary of the UN Convention on the Rights of the Child (UNCRC, 1989) and the 55th a... more the 25th anniversary of the UN Convention on the Rights of the Child (UNCRC, 1989) and the 55th anniversary of the Declaration of the Rights of the Child (1959). Twenty-five years after the UNCRC, this article explores the rights of children and young people (CYP) to participate in decisions about their healthcare, and the benefits of doing so; we then examine where we are now with respect to the voices of CYP in health. This article addresses this final question through three aspects: first, by celebrating the progress made over the last quarter of a century-particularly with respect to policy development-both in the UK and internationally; second, by identifying ongoing areas of concern, with suggestions as to where to focus our efforts next; and finally, by calling for a change in culture. This change of culture is suggested through four positive concrete steps: a greater dissemination of guidance and examples of good practice, greater evaluation of the participatory process, app...
Supplementary Table A. The Bristol Girls Dance Project intervention details - TIDieR checklist. S... more Supplementary Table A. The Bristol Girls Dance Project intervention details - TIDieR checklist. Supplementary Table B. Data provision for participants at each time point by trial arm. Supplementary Table C. Means (SD) for physical activity variables intervention girls attending and not attending dance classes during measurement period between 3 and 5 pm. Supplementary Table D. After-school activity engagement of girls at T0. Supplementary Table E. Engagement in dance activities at T1 and T2. Supplementary Table F. Afterschool (3.30pm-bedtime) activity engagement during the last week. Supplementary Table G. Health outcomes measured in BGDP - responses to the EQ-5D-Y descriptive system. (DOCX 47 kb)
ObjectivesUsing the National Child Mortality Database (NCMD), this work aims to investigate and q... more ObjectivesUsing the National Child Mortality Database (NCMD), this work aims to investigate and quantify the characteristics of children dying of COVID-19, and to identify any changes in rate of childhood mortality during the pandemic.DesignWe compared the characteristics of the children who died in 2020, split by SARS-CoV-2 status. A negative binomial regression model was used to compare mortality rates in lockdown (23 March–28 June), with those children who died in the preceding period (6 January–22 March), as well as a comparable period in 2019.SettingEngland.ParticipantsChildren (0–17 years).Main outcome measuresCharacteristics and number of the children who died in 2020, split by SARS-CoV-2 status.Results1550 deaths of children between 6th of January and 28 June 2020 were notified to the NCMD; 437 of the deaths were linked to SARS-CoV-2 virology records, 25 (5.7%) had a positive PCR result. PCR-positive children were less likely to be white (37.5% vs 69.4%, p=0.003) and were ol...
Childhood Sleep Duration in an English Cohort-Blair et al Sleep duration is likely to be determin... more Childhood Sleep Duration in an English Cohort-Blair et al Sleep duration is likely to be determined through an interaction between genetic and environmental factors, but the degree of contribution from these determinants is unknown. 11 There has been a suggestion that sleep duration has decreased over time, leading to sleep deprivation in contemporary children. The Sleep in America Poll (2004) reported that a significant percentage of children slept less than 9 hours per night (http:// www.sleepfoundation.org). Iglowstein and colleagues reported a decline in sleep duration in Swiss children, 12 a finding that has been confirmed by more recent studies. 13,14 Sleep duration has been studied in several populations of children using different methods. The majority of data available are from cross-sectional population studies. Few studies have prospectively examined sleep duration in well-characterized cohorts of children across early childhood. 12,15-17 This is the first report on normative sleep patterns in a large, unselected, ongoing, population-based cohort of English children born in 1991-1992 and followed until they were 11 years old. We present data on the children's daytime and nighttime sleep duration and timings, as well as the number of nighttime awakenings. We have specifically identified demographic characteristics associated with sleep duration throughout childhood. PATIENTS AND METHODS The ALSPAC Study The Avon Longitudinal Study of Parents and Children (AL-SPAC) is a prospective birth-cohort study that aimed to enroll the infants of all pregnant women who resided in the 3 Bristol-based health districts of the county of Avon (population INTRODUCTION Sleep occupies a substantial proportion of childhood life. The importance of childhood sleep duration and quality for future health and performance is increasingly appreciated. In particular, it has been proposed that insufficient sleep in childhood is associated with obesity, 1,2 lower academic performance, 3,4 and emotional and behavior problems. 5-7 Sleep problems are common in childhood, affecting up to one third of children, but are underreported by parents. 8,9 Furthermore, disturbed sleep in childhood impinges on parental sleep, health, and quality of life. Sleep problems tend to be age specific and include bedtime resistance, difficulty falling asleep, frequent nighttime awakenings, parasomnias (bruxism, sleep walking and sleep talking, night terrors, enuresis, and body rocking), and noisy breathing, snoring, and obstructive sleep apnea. 10 Sleep duration is of clinical importance since parental concerns are often about duration or continuity of their child's sleep. An understanding of the normal variation in sleep during childhood is essential to the definition of sleep problems or initiation of any intervention strategy to modify sleep.
Aims-To investigate patterns of infant growth that may influence the risk of sudden infant death ... more Aims-To investigate patterns of infant growth that may influence the risk of sudden infant death syndrome (SIDS). Design-Three year population based case control study with parental interviews for each death and four age matched controls. Growth was measured from prospective weight observations using the British 1990 Growth Reference. Setting-Five regions in England (population greater than 17 million, more than 470 000 live births over three years). Subjects-247 SIDS cases and 1110 controls. Results-The growth rate from birth to the final weight observation was significantly poorer among the SIDS infants despite controlling for potential confounders (SIDS mean change in weight z score (zw) = −0.38 (SD 1.40) v controls = +0.22 (SD 1.10), multivariate: p < 0.0001). Weight gain was poorer among SIDS infants with a normal birth weight (above the 16th centile: odds ratio (OR) = 1.75, 95% confidence interval (CI) 1.48-2.07, p < 0.0001) than for those with lower birth weight (OR = 1.09, 95% CI 0.61-1.95, p = 0.76). There was no evidence of increased growth retardation before death. Conclusions-Poor postnatal weight gain was independently associated with an increased risk of SIDS and could be identified at the routine six week assessment.
To establish severity banding ranges, bother assessment and key item content in principal patient... more To establish severity banding ranges, bother assessment and key item content in principal patient reported outcomes measures (PROMs) in men seeking therapy for lower urinary tract symptoms (LUTS).
SIDS Sudden infant and early childhood death: The past, the present and the future, 2018
The University of Adelaide Press publishes peer reviewed scholarly books. It aims to maximise acc... more The University of Adelaide Press publishes peer reviewed scholarly books. It aims to maximise access to the best research by publishing works through the internet as free downloads and for sale as high quality printed volumes.
Breastfeeding and the place of sleep for the mother and the infant have been controversial intern... more Breastfeeding and the place of sleep for the mother and the infant have been controversial internationally due to reported concerns regarding infant deaths despite the known benefits of exclusive and prolonged breastfeeding, which are increased by breastfeeding at night. The aims of this integrated analysis were to (a) review breastfeeding and maternal and infant sleep research literature via historical, epidemiological, anthropological, and methodological lenses; (b) use this information to determine where we are currently in safeguarding both infant lives and breastfeeding; and (c) postulate the direction that research might take from this point forward to improve our knowledge and inform our policy and practice. Despite well-meaning but unsuccessful campaigns in some countries to dissuade parents from sleeping with their babies, many breastfeeding mothers and caregivers do sleep with their infants whether intentionally or unintentionally. Taking cultural contexts and socio-ecolog...
Clinical and patient reported outcome measures in men referred for consideration of surgery to tr... more Clinical and patient reported outcome measures in men referred for consideration of surgery to treat LUTS: baseline results and diagnostic findings of the UPSTREAM trial
Journal of Reproductive and Infant Psychology, 2005
... Alan Emond b , Peter Blair b & Pauline Emmett b pages 309-317. ... Kelleher, K., Casey, P... more ... Alan Emond b , Peter Blair b & Pauline Emmett b pages 309-317. ... Kelleher, K., Casey, P., Bradley, R., Pope, S., Whiteside, L., Barrett, K., Swanson, ME and Kirby, RS 1993. Risk factors and outcomes for failure to thrive in low birth weight preterm infants.. Pediatrics , 91: 941948. ...
Objective To investigate the risks of the sudden infant death syndrome and factors that may contr... more Objective To investigate the risks of the sudden infant death syndrome and factors that may contribute to unsafe sleeping environments. Design Three year, population based case-control study. Parental interviews were conducted for each sudden infant death and for four controls matched for age, locality, and time of sleep. Setting Five regions in England with a total population of over 17 million people. Subjects 325 babies who died and 1300 control infants. Results In the multivariate analysis infants who shared their parents' bed and were then put back in their own cot had no increased risk (odds ratio 0.67; 95% confidence interval 0.22 to 2.00). There was an increased risk for infants who shared the bed for the whole sleep or were taken to and found in the parental bed (9.78; 4.02 to 23.83), infants who slept in a separate room from their parents (10.49; 4.26 to 25.81), and infants who shared a sofa (48.99; 5.04 to 475.60). The risk associated with being found in the parental bed was not significant for older infants (> 14 weeks) or for infants of parents who did not smoke and became non-significant after adjustment for recent maternal alcohol consumption (> 2 units), use of duvets (> 4 togs), parental tiredness (infant slept <4 hours for longest sleep in previous 24 hours), and overcrowded housing conditions (> 2 people per room of the house). Conclusions There are certain circumstances when bed sharing should be avoided, particularly for infants under four months old. Parents sleeping on a sofa with infants should always be avoided. There is no evidence that bed sharing is hazardous for infants of parents who do not smoke.
To examine the relationship between failure to thrive in preterm and term infants and postnatal d... more To examine the relationship between failure to thrive in preterm and term infants and postnatal depression in their mothers. In a whole population birth cohort of 12,391 infants (excluding those born after term or with major congenital abnormalities) failure to thrive over the first nine months was identified using a conditional weight gain criterion which identified the slowest-gaining 5%. Depression symptoms were recorded using the Edinburgh Postnatal Depression Scale (EPDS) at 18 and 32 weeks of pregnancy and at 8 weeks and 8 months after delivery. After the birth, high depression scores were significantly more common in the mothers of infants born preterm, and controlling for depression scores in pregnancy did not eliminate this association after the birth. Failure to thrive was identified in 4.5% of the children born at term (531/11718) and in 8.3% of those born preterm (56/673). The difference was highly significant (chi2 = 20.25 with 1 df, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Using a conventional cut-off on the EPDS (score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 12) to identify mothers as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;depressed&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;, the prevalence of failure to thrive in the term infants of mothers depressed at 8 weeks postpartum was 5.0%; in the remainder of the population (controls) it was 4.3%. In mothers depressed at 8 months the prevalence was 4.3% in both groups. The prevalence of failure to thrive in the preterm infants of mothers depressed at 8 weeks was 8.8% (7.0% in controls) and in those depressed at 8 months it was 12.3% (6.7% in controls). None of these differences in prevalence was statistically significant, and significant differences did not emerge from further analyses using more stringent criteria for depression. Preterm births are specifically associated with high maternal depression scores in the postpartum period, and with a higher prevalence of failure to thrive. High depression scores in the postpartum period are not themselves associated with a higher prevalence of failure to thrive, however, either in infants born at term or in those born preterm.
ObjectivesIn 2008, new statutory national procedures for responding to unexpected child deaths we... more ObjectivesIn 2008, new statutory national procedures for responding to unexpected child deaths were introduced throughout England. There has, to date, been no national audit of these procedures.Study designFamilies bereaved by the unexpected death of a child under 4 years of age since 2008 were invited to participate. Factors contributing to the death and investigations after the death were explored. Telephone interviews were conducted, and coroners’ documents were obtained. The nature and quality of investigations was compared with the required procedures; information on each case was reviewed by a multiagency panel; and the death was categorised using the Avon clinicopathological classification.ResultsData were obtained from 91 bereaved families (64 infant deaths and 27 children aged 1–3 years); 85 remained unexplained after postmortem examination. Documentation of multiagency assessments was poorly recorded. Most (88%) families received a home visit from the police, but few (37%)...
The sudden and unexpected death of an infant or child is devastating. An inability to explain why... more The sudden and unexpected death of an infant or child is devastating. An inability to explain why an infant or child died is difficult to accept for both families and professionals. No reliable national dataset exists to estimate precisely how many infants and children die unexpectedly each year in England. This lack of accurate epidemiological data belies the scale of this public health problem. Detailed controlled observational studies of infant deaths identifying risk factors and providing evidence-based advice for parents has seen a dramatic reduction in incidence over the last 30 years by almost 80% but greater knowledge is needed if future deaths of infants and older children are to be prevented and families optimally supported. We propose that a national registry of sudden unexpected deaths in infancy and childhood would accurately determine incidence, identify unknown risk factors and highlight good care practices, ensuring these can be standardised nationally. For such a pr...
The international journal of behavioral nutrition and physical activity, Jun 7, 2018
Most adolescent girls in the UK do not meet government physical activity recommendations and effe... more Most adolescent girls in the UK do not meet government physical activity recommendations and effective interventions are needed. This study reports the results of a feasibility trial of PLAN-A, a novel school-based peer-led physical activity intervention for adolescent girls. A two-arm cluster randomised controlled feasibility study was conducted in six English secondary schools (4 intervention & 2 control). Year 8 (age 12-13) girls were eligible and randomisation was at school-level. The intervention involved training Year 8 girls (out of school for two consecutive days, plus one top-up day 5 weeks later), who were identified by their peers as influential, to provide informal support to their friends to increase their physical activity. Feasibility of the intervention and the research was examined, including: recruitment, training attendance and data provision rates, evidence of promise of the intervention to affect weekday moderate-to-vigorous physical activity (MVPA), interventio...
The British journal of general practice : the journal of the Royal College of General Practitioners, Jan 10, 2018
Clinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presentin... more Clinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presenting in primary care with cough and respiratory symptoms, despite limited meaningful evidence of impact on these outcomes. To estimate the effect of children's antibiotic prescribing on adverse outcomes within 30 days of initial consultation. Secondary analysis of 8320 children in a multicentre prospective cohort study, aged 3 months to <16 years, presenting in primary care across England with acute cough and other respiratory symptoms. Baseline clinical characteristics and antibiotic prescribing data were collected, and generalised linear models were used to estimate the effect of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations and reconsultation for deterioration), controlling for clustering and clinicians' propensity to prescribe antibiotics. Sixty-five (0.8%) children were hospitalised and 350 (4%) reconsulted for deterioration. Clinicia...
Little is known about respiratory tract infection (RTI) severity in children following consultati... more Little is known about respiratory tract infection (RTI) severity in children following consultation. To investigate post-consultation symptom trajectories in children with acute cough and RTI and whether baseline characteristics predict trajectory group. Prospective cohort study of 2296 children (3 months-16 years) whose parents were invited to report cough severity and duration using a 7-point Likert scale. Longitudinal latent class analysis (LLCA) was used to identify post-consultation symptom trajectories in the first 15 days, and multinomial models to predict class membership. Complete data were available for 1408 children (61%). The best LLCA model identified five post-consultation symptom trajectory groups: 'very rapid recovery' (28.5%), 'rapid recovery' (37.7%), 'intermediate recovery' (18.2%), 'persistent symptoms' (9.5%) and 'initial deterioration with persistent symptoms' (6.0%). Compared with very rapid recovery, parent-reported sev...
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Papers by Peter Blair