Advances in paediatric care mean that more children with complex medical problems (heart disease, neurodevelopmental problems and so on) are surviving their early years. This has important implications for the design and delivery of healthcare given their extensive multidisciplinary requirements and susceptibility to poor outcomes when not optimally managed. Importantly, their medical needs must also be understood and addressed within the context of the child and family’s life circumstances. There is growing recognition that many other factors contribute to a child’s complex health needs (CHNs), for example, family problems, fragmentation of health and care provision, psychological difficulties or social issues.To facilitate proactive care for these patients, we must develop accurate ways to identify them. Whole Systems Integrated Care—an online platform that integrates routinely collected data from primary and secondary care—offers an example of how to do this. An algorithm applied to this data identifies children with CHNs from the entire patient population. When tested in a large inner-city GP practice, this analysis shows good concordance with clinical opinion and identifies complex children in the population to a much higher proportion than expected. Ongoing refinement of these data-driven processes will allow accurate quantification and identification of need in local populations, thus aiding the development of tailored services.
We report key learning from the public health management of the first two confirmed cases of COVID-19 identified in the UK. The first case imported, and the second associated with probable person-to-person transmission within the UK. Contact tracing was complex and fast-moving. Potential exposures for both cases were reviewed, and 52 contacts were identified. No further confirmed COVID-19 cases have been linked epidemiologically to these two cases. As steps are made to enhance contact tracing across the UK, the lessons learned from earlier contact tracing during the country's containment phase are particularly important and timely.
The relationship between child development and adolescent health, and how this may be modified by socio-economic conditions, is poorly understood. This limits cross-sector interventions to address adolescent health inequality. This review summarises evidence on the associations between child development at school starting age and subsequent health in adolescence and identifies factors affecting associations. We undertook a participatory systematic review, searching electronic databases (MEDLINE, PsycINFO, ASSIA and ERIC) for articles published between November 1990 and November 2020. Observational, intervention and review studies reporting a measure of child development and subsequent health outcomes, specifically weight and mental health, were included. Studies were individually and collectively assessed for quality using a comparative rating system of stronger, weaker, inconsistent or limited evidence. Associations between child development and adolescent health outcomes were assessed and reported by four domains of child development (socio-emotional, cognitive, language and communication, and physical development). A conceptual diagram, produced with stakeholders at the outset of the study, acted as a framework for narrative synthesis of factors that modify or mediate associations. Thirty-four studies were included. Analysis indicated stronger evidence of associations between measures of socio-emotional development and subsequent mental health and weight outcomes; in particular, positive associations between early externalising behaviours and later internalising and externalising, and negative associations between emotional wellbeing and later internalising and unhealthy weight. For all other domains of child development, although associations with subsequent health were positive, the evidence was either weaker, inconsistent or limited. There was limited evidence on factors that altered associations. Positive socio-emotional development at school starting age appears particularly important for subsequent mental health and weight in adolescence. More collaborative research across health and education is needed on other domains of development and on the mechanisms that link development and later health, and on how any relationship is modified by socio-economic context.
Children with preschool wheeze regularly attend UK emergency departments. There is no international consensus on any specific personalised management approach. This paper describes the first attempt to co-design patient-centred outcomes with families. Preschool wheezers’ parents participated in semi-structured interviews and focus-group discussions to air their concerns and identify potential additional support. Fifty-seven families participated in these interviews. From these, themes were defined through qualitative content analysis. Parental experience was mapped to the patient pathway and seven important personalised outcomes were described. These can be used to inform a tool which following further validation could potentially support management of children with preschool wheeze and provide an additional patient focused clinical outcome measure in audit and research.
Accessible Summary
Adults with learning disabilities and diabetes are more likely to have health problems than people with diabetes who do not have learning disabilities.
This research had two aims. One was to find out what stops adults with learning disabilities from getting help with their diabetes. The other was to find out what things help them get the best care for their diabetes.
We found 12 things that stop adults with learning disabilities from getting good care for their diabetes and 14 things that help them get good care.
The findings from this research can be used to improve the lives of adults living with learning disabilities and diabetes.
Abstract
Background
Individuals with diabetes and a learning disability have poorer health outcomes than those without a learning disability. In the UK, the health inequalities faced by people with learning disabilities are often the result of barriers they face in accessing timely, appropriate and effective health care. The aim of the study was to
review relevant literature to identify the barriers and enablers to optimal diabetes care for adults with learning disabilities.
Methods
Systematic review methodology was used to answer the research question: What barriers and enablers to optimal diabetes care exist for adults with learning disabilities? This review is reported according to PRISMA guidelines. Key databases were searched using relevant terms. Included studies were synthesised using thematic analysis and were quality appraised.
Findings
This review identified 12 barriers to optimal diabetes care for adults with learning disabilities and 14 enablers to optimal care from 10 diverse publications. Low level of diabetes knowledge and understanding and systems that do not allow reasonable adjustments were the barriers considered to have the greatest reliability. The enabler identified to have the highest reliability was person‐centred planning and reasonable adjustments.
Conclusion
This work highlights key actions that can be undertaken to address inequalities in diabetes care for people with learning disabilities. With additional research in this field, further progress can be made to improve the lives of those adults living with learning disabilities and diabetes.
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