Sleep Medication Use by people with Cerebral Palsy: A Population Level DataLinkage Study

Objectives To (1) compare proportions of the population dispensed sleep medication, and rate (dispensations/month) and amount (milligrams/month) of dispensed sleep medication, in individuals with and without cerebral palsy (CP); and (2) describe dispensation of sleep medication within CP and non-CP cohorts with respect to sociodemographic and clinical characteristics. Approach Individuals aged 6 -36 years (aligning with those known to the Northern Ireland CP Register [NICPR]), registered with a general practitioner at 01-January-2018, were identified within the National Health Application and Infrastructure System.  Sleep medications dispensed 01-January-2018 to 31-December-2019 were extracted from the Enhanced Prescribing Database.  Analysis was limited to melatonin due to small counts in other medications.  Routine healthcare data was sourced from the Honest Broker Service (HBS).  NICPR clinical data (CP-type, Gross Motor Function Classification System (GMFCS), gestation and birthweight) were linked to routine healthcare data using the Health and Care Number by HBS. Descriptive statistics are presented. Results Complete matching was achieved between NICPR and healthcare data using the HCN.  Final cohorts consisted of 1,598 individuals with CP and 790,097 without CP. A greater proportion of those with CP were dispensed melatonin compared to those without CP (4.6% vs 1.0%).  The CP cohort were also dispensed melatonin at a greater rate (median(IQR) CP 0.33(0.71) vs non-CP 0.25(0.54) dispensations/month) and in greater amounts (median(IQR) CP 30(74.7) vs non-CP 17.5(55.0) mg/month).  Within the CP cohort, differences in melatonin dispensation were observed across sociodemographic groups (male 5.1% vs female 3.9%; children 8.2% vs young adults 2.2%; urban 6.5% vs rural 5.0%); deprived 5.1% vs affluent 4.2%).  Clinical characteristics associated with greatest dispensation of melatonin were non-spastic CP (6.83%), GMFCS IV&V (5.29%), or extremely premature birth (6.85%). Conclusion Individuals with CP, particularly children, are more likely to be dispensed sleep medications compared to the general population.  Awareness of this disparity could encourage further research on assessment and management of sleep in CP and facilitate discussions between healthcare providers and families on underlying causes of sleep problems

The drama of Oscar Wilde : contesting Victorian gender dynamics

THESIS 10563This thesis will analyse Oscar Wilde?s dramatic characters and propose that he challenged the typical Victorian gender roles on the stage, and re-imagined more modern modes of masculinity and femininity in his plays. In his plays Wilde\u27s unconventionally strong female characters and his often passive male characters satirise the essentialist Victorian perception of gender, and suggest the need for more liberating gender roles both on the stage and in Victorian society

The effectiveness of Nurture Groups in improving outcomes for young children with social, emotional and behavioural difficulties in primary schools:An evaluation of Nurture Group provision in Northern Ireland

Concerns have grown regarding the increased prevalence of social, emotional and behavioural difficulties observed in young children in primary school settings. Contributory factors are multiple and varied but one consistent emphasis has been on the negative effects of children’s poor attachments with significant others which, due to contextual factors, may not have developed sufficiently. Some groups of children are more at risk of not developing strong attachments, particularly children in care whose ‘pre-care’ and ‘in care’ experiences make it more likely that their attachments will have been adversely impacted. Reflecting this increasing concern, there has been a growth of school-based interventions that aim to strengthen attachments in order that children can develop social and emotional skills; thus enabling them to be better placed to access learning opportunities and reach levels of educational achievement and attainment similar to their peers. One such intervention is Nurture Groups, modelled on attachment theory. Nurture Group provision is a short-term, schools-based intervention targeted at individual children beginning school who are already displaying social, emotional and/or behavioural difficulties. This article reports the findings of one of the first larger-scale evaluations of the effectiveness of Nurture Group provision in improving outcomes of children, and the first to explore the differential effects of Nurture Groups in relation to school-, pupil- and programme-level characteristics. The evaluation used a non-random control group design, involving a total sample of 384 children, aged 5–6 years, from 30 Nurture Group schools and a further 14 matched schools with no Nurture Group provision in Northern Ireland. The trial found effect sizes ranging in magnitude from g = 0.528 to 1.352 for a range of social, emotional and behavioural outcomes, using the Boxall Profile and the Strengths and Difficulties Questionnaire. However, no evidence of effects was found for academic outcomes. The article discusses the implications for policy and practice of the findings

Factors associated with parental adaptation to children with an undiagnosed medical condition

Little is known about the adaptive process and experiences of parents raising a child with an undiagnosed medical condition. The present study aims to assess how uncertainty, hope, social support, and coping efficacy contributes to adaptation among parents of children with an undiagnosed medical condition. Sixty-two parents of child affected by an undiagnosed medical condition for at least two years completed an electronically self-administered survey. Descriptive analysis suggested parents in this population had significantly lower adaptation scores when compared to other parents of children with undiagnosed medical conditions, and parents of children with a diagnosed intellectual and/or physical disability. Similarly, parents in this population had significantly lower hope, perceived social support and coping efficacy when compared to parents of children with a diagnosed medical condition. Multiple linear regression was used to identify relationships between independent variables and domains of adaptation. Positive stress response was negatively associated with emotional support (B\ua0=\ua0−0.045, p\ua0≤\ua00.05), and positively associated with coping efficacy (B\ua0=\ua00.009, p\ua0≤\ua00.05). Adaptive self-esteem was negatively associated with uncertainty towards one’s social support (B\ua0=\ua0−0.248, p\ua0≤\ua00.05), and positively associated with coping efficacy (B\ua0=\ua00.007, p\ua0≤\ua00.05). Adaptive social integration was negatively associated with uncertainty towards one’s social support (B-0.273, p\ua0≤\ua00.05), and positively associated with uncertainty towards child’s health (B\ua0=\ua00.323, p\ua0≤\ua00.001), and affectionate support (B\ua0=\ua00.110, p\ua0≤\ua00.001). Finally, adaptive spiritual wellbeing was negatively associated with uncertainty towards one’s family (B\ua0=\ua0−0.221, p\ua0≤\ua00.05). Findings from this study have highlighted the areas where parents believed additional support was required, and provided insight into factors that contribute to parental adaptation