'Did not attends' in children 0-10: a scoping review

Patients who do not attend (‘DNA’) health appointments have been identified as a service problem incurring significant costs to the NHS. In order to explore the causes, effects and costs of child DNAs, we carried out a scoping study to map the literature and identify gaps in the research. Given the breadth of issues underpinning DNAs, a scoping study, including research studies, audits, policy documents and conference abstracts, was the most useful way to map the field. To foster public and patient participation, we sought advice from parents participating in the National Children's Bureau's Family Research Advisory Group. From a pool of 1997 items, we found few UK studies with non-attendance of 0–10 year olds as a primary focus, though many more incidentally reported DNA rates. Overall, four topics predominated: the conceptualization of DNAs; the correlates of non-attendance; initiatives to reduce non-attendance; and the relationship between non-attendance and safeguarding. The Family Research Advisory Group identified broadly similar issues, but with a stronger emphasis on communication and practical matters. While there may be circumstances where failing to attend appointments makes little or no difference to a child (or even benefits them) it is likely that there are children whose health or well-being are compromised as a result of failing to attend appointments. Both ‘over’ and ‘under'-attendance can be a source of anxiety to health professionals. Areas where further work is needed include robust evaluation of the effectiveness, cost-effectiveness and maintenance of measures to reduce DNAs and a better understanding of the relationship of safeguarding to non-attendance

Participation or exclusion? Perspectives of pupils with autistic spectrum disorders on their participation in leisure activities

The importance of active participation in leisure activities for everybody is identified by Carr (2004) but issues around leisure in the lives of children with disabilities have received little recognition. The experience of children/young people (henceforth referred to simply as children, for brevity) with autistic spectrum disorders (ASD) in accessing and engaging in leisure pursuits is particularly lacking in the literature. This article describes a small-scale investigation of the views of children and young people with ASD around their access to leisure activities. The distinctive range of impairments characteristic of ASD is discussed in terms of their impact on the child’s possibilities for accessing this area of life. Findings indicate the significant challenges these children face in achieving an active and varied life outside of school and home environments. The importance and also the challenge of consulting with children with disabilities are discusse

Integrating the view of the public into the formal legislative process: public reading stage in the UK House of Commons

Recent years have seen increasing calls to integrate the public’s voice into the parliamentary process. This article examines the impact of public reading stage (PRS) on the UK Parliament’s scrutiny of a bill. A new stage of the legislative process piloted by the House of Commons in February 2013, PRS invited the public to comment on a bill undergoing parliamentary scrutiny (the Children and Families Bill). The PRS was designed to encourage members of the public to participate in the scrutiny of legislation through a specially designed forum on Parliament’s website. Over 1000 comments were submitted. Drawing on a content analysis of the comments given by the public to the bill, complemented by interviews with MPs, key officials and PRS participants, we find that although the public reading stage had an impressive response, it failed to make much of a tangible impact on the parliamentary scrutiny of the bill. This was largely due to the choice of bill being used for the pilot and its lack of appropriate integration into the formal legislative process

Inequalities in access to education and healthcare

The burden of disease is borne by those who suffer as patients but also by society at large, including health service providers. That burden is felt most severely in parts of the world where there is no infrastructure, or foreseeable prospects of any, to change the status quo without external support. Poverty, disease and inequality pervade all the activities of daily living in low-income regions and are inextricably linked. External interventions may not be the most appropriate way to impact on this positively in all circumstances, but targeted programmes to build social capital, within and by countries, are more likely to be sustainable. By these means, basic oral healthcare, underpinned by the primary healthcare approach, can be delivered to more equitably address needs and demands. Education is fundamental to building knowledge-based economies but is often lacking in such regions even at primary and secondary level. Provision of private education at tertiary level may also introduce its own inequities. Access to distance learning and community-based practice opens opportunities and is more likely to encourage graduates to work in similar areas. Recruitment of faculty from minority groups provides role models for students from similar backgrounds but all faculty staff must be involved in supporting and mentoring students from marginalized groups to ensure their retention. The developed world has to act responsibly in two crucial areas: first, not to exacerbate the shortage of skilled educators and healthcare workers in emerging economies by recruiting their staff; second, they must offer educational opportunities at an economic rate. Governments need to lead on developing initiatives to attract, support and retain a competent workforce. © 2008 Blackwell Munksgaard and The American Dental Education Association