What makes a looked after child happy and unhappy?

What is good for a looked after child is usually decided by adults with the child’s voice often peripheral. One way to make the child central to decision-making is to ask them what makes them happy or unhappy. In doing this, the definition of happiness has to be neither a description of what has gone well in life nor an immediate state of mind, but should encompass the Aristotelian concept of eudaimonia. This is often translated as happiness but also incorporates notions of well-being and flourishing. The study reported here was undertaken as part of a children’s health needs assessment in an English local authority. It sought to understand why looked after children experience such high levels of poor mental health and make growing demands on therapeutic services. The proportion of young people displaying above average scores on validated measures, such as the Strengths and Difficulties Questionnaire (SDQ), is growing each year. The aim was to find out what looked after children say makes them happy and unhappy and what they see as likely to increase their well-being, and to compare their suggestions with those of the professionals and carers involved in their lives. Focus groups with children and professionals then discussed the same question, with the professionals also examining their understanding of SDQ results and their relevance to practice. The study found significant differences between the views of the children and professionals in both the range and emphasis of what is seen as important. Moreover, these adult assumptions were rarely tested by meaningful discussions with young people when key decisions were made; indeed, these seemed to be made about rather than with the children. In addition, the SDQ was not widely used by professionals to assess children’s emotional health and well-being needs. The study concluded that discussions about happiness can usefully support holistic understandings of looked after children’s experiences and aid planning and practice development

Expectations of bariatric surgery: myths and reality

Introduction: Obesity is a chronic condition. Demand for surgical weight loss procedures funded by the NHS is increasing. Surgery is a recommended cost effective treatment and is often viewed ‘as a quick fix’. However through surgery alone, commissioners and clinicians are struggling to resolve the complex behavioural, social and metabolic problems linked to obesity. The literature on bariatric surgery is mainly quantitative in nature, focussing on clinical and quality of life outcome measures. The social narratives, experiences and influences of an obese person undergoing weight-loss surgery are rarely investigated. Existing qualitative research is mainly non-UK based and uses conventional methodologies to capture experiences. This study seeks to highlight the myths and realities of patient experience to inform clinical and commissioning professionals and future surgical pathways. This paper presents findings from the first stage of a longitudinal study. Methods: A qualitative longitudinal study using in-depth semi-structured interviews, Photovoice and framework analysis techniques. 15 patients interviewed pre and post bariatric surgery. Results: Themes focus on the negative impacts weight has on the quality of life for the participant and close family. Behaviours, life events and lack of self-control were suggested causes of obesity. The anticipated health benefits are the main motivation for undergoing bariatric surgery. Levels of knowledge and expectation vary between participants. Photovoice methodology is proving to have a unique role in capturing insight into the lived experiences of participants. Conclusion: Findings will provide insight to inform the implementation of NCEPOD recommendations and NICE Guidance for weight loss surgery. Conflict of Interest: None Funding: Research relating to this abstract was funded by Collaboration and Leadership for Applied Health Research and Care – South Yorkshire</p

The role and nature of universal health services for pregnant women, children and families in Australia

INTRODUCTION Recent reports indicate that social policy in developed countries has seen positive results in well - child health and safety, child material security, education and socialisation (UNICEF, 2007) . In countries where child health is supported by policy, children have relatively high levels of well - being as measured by material well - being, health and safety, educational well - being, family and peer relationships, behaviours, risks and subjective well - being (UNICEF, 2007) . In Australia, the overall health, development and well - being of children is high on many indicators. Childhood mortality rates have halved over the last two decades, the incidence of vaccin e - preventable diseases has been reduced since the introduction of immunisation (92% of two - year - olds being fully vaccinated in 2004) and the proportion of households with young children in which a household member smoked inside the house has decreased over the past decade (Australian Institute of Health and Welfare, 2005) . However, concerns are emerging related to rapid social change and the associated new morbidities such as increasing levels of behaviou ral, developmental, mental health and social problems. This has resulted in early childhood becoming a priority for Australian government and non - government organizations (Australian Institute of Health a nd Welfare, 2005) . Health indicators also continue to show significant disparities between Indigenous and non - Indigenous children. The Aboriginal and Torres Strait Islander Infant mortality is three times the rate of non - Indigenous Australians and more th an 50 per cent higher than Indigenous children in the USA and New Zealand (National Aboriginal Community Controlled Health Organisation &amp; Oxfam Australia, 2007) , and Indigenous babies are more than twice as likely to be born with low birth weight or premature, wi th a negative impact on their growth and development (Australian medical Association report care series, 2005

Healthy eating in the early years : a qualitative exploration of food provision in the childminder setting

Purpose – A nutritious diet is critical to the health and development of pre-school children. Children in the UK consume much food outside the home yet day-care food provision is unregulated, and informed by disparate and conflicting dietary guidelines. Factors affecting nursery food provision have been much studied, but less is known about food provision in the child-minder setting. The purpose of this paper is to examine factors influencing child-minders’ food provision. Design/methodology/approach – Qualitative methods were employed, combining participant observation with semi-structured interviews. Participants were selected via purposive and convenience sampling. Eight child-minders from an English borough were interviewed. Findings – The food provided by child-minders was not consistent with dietary guidelines for young children, following menu plans was reported to be difficult, and knowledge about healthy eating guidelines for young children was various. Child-minders reported limited time for food preparation, and problems catering for fussy children. Some child-minders obtained support through an informal peer network group. Only one child-minder reported availing of professional nutritional advice on healthy food provision. Communication with parents about food was considered important, although there was some evidence of discord between providers and parents in dietary objectives. Research limitations/implications – The study was small in size and regionally based. Due to the local nature of the study, it is not possible to make generalisations to the wider national context. Corroboration of the findings is necessary in a larger study. Practical implications – Child-minders have a pivotal role to play in the nutritional health and development of young children, and whilst their interest in provision of nutritious food was great, outside support was lacking. Support should include provision of one clear set of authoritative guidelines, practical guidance that accommodates the realities of providing food in the child-minder setting, investment to strengthen support structures at local level and the development of network groups. Originality/value – Whilst the factors underpinning food provision in nurseries have been examined in various regions of the UK, little attention has been given to child-minder settings. The current study addresses this gap

The patient experience of bariatric surgery: a longitudinal qualitative study

Morbid obesity is a major public health concern. It is associated with a range of physical and psychological comorbidities including cardiovascular disease, stroke, depression and experiences of psychological distress and stigma. In the UK, treatment for morbid obesity is provided through a tiered pathway of services including bariatric surgery. Outcomes of surgery are not universally positive, with some regaining weight following surgery or experiencing unintended outcomes. This study explored what influences outcomes of bariatric surgery from the patients’ perspective. It aimed to identify how patients measure the success of bariatric surgery, the support needs and mechanisms which influence success and the implications for clinicians, commissioners and policy makers. Using qualitative interviews and modified Photovoice methodology alongside validated quality of life (QoL) measures this longitudinal study explored the expectations and experiences of patients undergoing bariatric surgery. Data was collected in five cycles across the bariatric patients' journey: pre-surgery (n=18); three months post-surgery (n=16); nine months post-surgery (n=15); 18 months post-surgery (QoL measures only) (n=10); and, two years post-surgery (n=13). This is the first study to investigate the experience of more than one service of a tiered obesity pathway. It found that the burdens of living with obesity and expectation of life post-surgery affected the way in which patients determined the success of bariatric surgery. Achieving normality was as important as the standard clinical measures of weight loss and reduced comorbidities. Psychological, physical and social support needs influence the potential for success in these terms. There was clear evidence of temporality, as the measures of success and support needs changed along participants’ bariatric surgery journey. Mechanisms which could address or hinder these support needs included: what participants believed to be a successful outcome; the obesity service pathway; support networks; physical activity and exercise; and excess skin. The findings inform the understanding of what influences the success of bariatric surgery. They are then used to develop practice and policy recommendations including: measures of success should be determined by individual patients and revisited across the journey; health care professionals supporting people living with morbid obesity to lose weight require training to understand the physiological and psychological impacts of bariatric surgery; specialist input from psychological and exercise specialists needs to be available and accessible across the pathway; and clinicians, commissioners and policy makers need to consider the levels of the socio ecological system and respond to the changing support needs in order to maximise chances of long-term successful outcomes for patients

Old and Cold: Challenges in the Design of Personalised Thermal Comfort at Home

The link between winter cold and illness is a major health concern because 'cold kills'. Worse still, old and frail older people can feel cold at any time of year. Solutions need to be found to increase thermal comfort. Whilst clothing manufacturers have produced garment solutions for people to enjoy outdoor activities in the cold, there is a gap in our understanding about how to protect frail/older people from becoming chilled and cold at home. To date no evidence exists on the benefit of innovative clothing interventions for keeping older adults warm (and healthy) in the home. Our aim therefore was to first understand the behaviours of older adults at risk of indoor cold, living in different domestic environments. Focus groups/semi-structured interviews were used to identify body regions where old/frail older people feel cold and to learn about their attitudes to traditional and modern fabrics and garments for keeping warm at home. Findings from a funded pilot study (RDSYH, Public Involvement grant) are presented. The body regions most vulnerable to thermal discomfort are trunk and extremities (feet, hands). Given the anxiety, discomfort, pain, reduced activity (including taking to their bed to keep warm in early evening) design/engineering-led solutions for a ‘smart’ warm clothing 'wardrobe' for today’s and tomorrow’s older people are needed. Feedback suggests that older people are open to fresh ideas about garments and technology; important to them being fabric weight. Older people do not, as often thought, wear outdoor clothes (hats, gloves, scarves) indoors, and are not averse to ‘modern’ fabrics and garments. Style remains important to many. These findings provide the first step towards identifying 'candidate' fabric, material and garment designs preferred and acceptable to older people for the next stage of work; development of ‘smart’ personalised thermal comfort solutions for health and wellbeing at home

Weight gain following stroke : its everybody's business

Introduction: Approximately 900,000 people in England live with the effects of stroke (NICE 2010). Health behaviour modification can be crucial in stroke rehabilitation. Local stakeholders identified a problem of increased numbers of patients experiencing long term weight gain following a stroke. Method: Mixed method study incorporating i) survey of South Yorkshire Health Cohort participants (n=87); ii) interviews with staff (n=18) and stroke patients (n=10). Data analysed using framework analysis. Results: Weight gain post stroke is not monitored routinely and prevalence is therefore unknown. Findings from this study indicate that post-stroke weight gain is a problem for some people. Contributing factors identified include social isolation, depression and loss of control in cognition and communication affecting ability to manage diet and weight. Ambiguity was seen to arise because weight gain following stroke can be both a sign of progress and of a problem. Results indicate fragmented communication between health care professionals across care pathways limits opportunities to address weight gain. Additional limiting factors include limited availability of specialist support and funding cuts to community based services. Conclusion: Health care professionals need to be mindful of the risk of long term weight gain following stroke. Whether in acute, intermediate, rehabilitation or primary care settings, systems should be in place to identify opportunities for advice and support regarding diet and physical activity by, for example, embracing initiatives such as Making Every Contact Count (MECC). A large cohort study would provide population based data on prevalence and causes of weight gain following a stroke

Seeking normality from bariatric surgery

Introduction: Eligibility for bariatric surgery (BS) is assessed using medical criteria. Body Mass Index (BMI) is the main condition for selection. Primary outcomes of success for BS are weight loss and reductions of comorbidities e.g. diabetes. Psychosocial outcomes are not consistently monitored in the UK. Associated service provision of BS varies and do not always contain a strong psychological component offering support pre or post BS. Obese patients may have faced a lifetime of psychosocial and physical challenges which influence their expectations of BS. Failure to address unrealistic expectations prior to surgery may undermine any promising clinical outcomes. Methods: A qualitative study using in-depth semi-structured interviews, Photovoice and Framework Analysis techniques. 18 participants interviewed pre bariatric surgery. Results: Patients have high expectations of how their lives will change following BS. Whilst patients have weight loss and health goals, seeking to be 'normal' can override their desire to become a healthy weight. Participants described feelings of shame, stigma and low self-esteem linked to anger at themselves and others. Space in the home offered them a form of protection from the outside world but often increased social isolation. Navigating the physical space inside and outside the home was challenging and often negative experiences exacerbated feelings of shame and humiliation. Patients felt they did not belong to the 'normal' world and anticipated they would regain this place following surgery. Conclusion: Patients weight loss expectation maybe achievable from BS. However services need to identify and address unrealistic psychosocial expectations of normality after BS.</p