Reading Disorders

There are two major types of reading disorder; developmental dyslexia and reading comprehension impairment. The primary difficulty in dyslexia is with the accurate and fluent reading of single words, whilst in reading comprehension impairment words can be read accurately but there is no or little understanding of what is read. Using the causal modelling framework, the underlying causes of the two disorders are reviewed together with the co-occurrence of reading and language disorders. The rationale for viewing reading as a dimensional disorder, where the difficulties experienced are on a continuum rather than using cut-off points to identify disorders is also reviewed

The School Improvement Partnership Programme: Using Collaboration and Enquiry to tackle Educational Inequity

No abstract available

Dietary value for money? Investigating how the monetary value of diets in the National Diet and Nutrition Survey (NDNS) relate to dietary energy density

Estimating the monetary value of individuals’ diets allows investigation into how costs relate to dietary quality. A number of studies(1–2), including one in Scotland(3), have reported a strong negative relationship between diet costs and energy density. Most studies of this type neglect to address the issue of mathematical coupling, where energy is both the numerator in the energy density variable (kJ/g) and the denominator in energy-adjusted diet cost (e.g. E/10 MJ). As a result, the findings could be reflecting a mathematical relationship(4). This study investigated how estimated diet costs of NDNS adults relate to dietary energy density using the ‘residuals’ regressionmethod to account for energy. Diet diary information from 2008–2010 was matched to an in-house database of national average (2004) food prices (the DANTE cost database) to assign a cost to each food and non-alcoholic beverage consumed. Mean daily diet costs and costs per 10 MJ were calculated for each participant. Energy density (g/kJ) was derived from foods and milk. The sample median diet cost was £2.84 per day (IQR £2.27, £3.64), or £4.05 per 10MJ (£3.45, £4.82). Values for energy density, food energy, and diet costs by quintiles of dietary energy density (1 = least energy dense) are presented in the table. Adjusted linear regression found a strong negative relationship: additional standard deviation above the diet cost expected for a given energy intake (the residual), there was an associated decrease in energy density of 0.46kJ/g (95% CI - 0.53, - 0.38, p<0.001). This is the first time individual-level diet costs have been characterized for a representative British population. These diet costs represent the inherent value of the diet, and are not comparable to UK expenditure data. The analyses confirm a diet cost-energy density link that is not due to mathematical artefact, and suggest that those consuming more energy-dense diets are achieving more kilojoules for their money

Am I dyslexic? Parental self-report of literacy difficulties

In the absence of criteria for the diagnosis of dyslexia, considerable weight is given to self-report, in particular in studies of children at family risk of dyslexia. The present paper uses secondary data from a previous study to compare parents who self-report as dyslexic and those who do not, in relation to objectively determined levels of ability. In general, adults are more likely to self-report as 'dyslexic' if they have poorer reading and spelling skills and also if there is a discrepancy between IQ and measured literacy. However, parents of higher social status who have mild literacy difficulties are more likely to self-report as dyslexic than parents who have weaker literacy skills but are less socially advantaged. Together the findings suggest that the judgement as to whether or not a parent considers themselves 'dyslexic' is made relative to others in the same social sphere. Those who are socially disadvantaged may, in turn, be less likely to seek support for their children

Urinary tract infections in children and the risk of ESRF.

Paediatric guidance on diagnosis and treatment of urinary tract infections (UTIs) has in the past largely focused on identifying children with vesicoureteral reflux, thought to be at greatest risk of renal scarring. This practice has been questioned, specifically the accepted association between UTI and end-stage renal failure (ESRF) through renal scarring. The aim of this article is to ascertain whether we can predict with confidence the true level of risk that a child with a first-time UTI will subsequently develop ESRF attributable to UTI

Scaling up misoprostol to prevent postpartum hemorrhage at home births in Mozambique: A case study applying the ExpandNet/WHO framework

© Hobday et al. Background: Mozambique has a high maternal mortality ratio, and postpartum hemorrhage (PPH) is a leading cause of maternal deaths. In 2015, the Mozambican Ministry of Health (MOH) commenced a program to distribute misoprostol at the community level in selected districts as a strategy to reduce PPH. This case study uses the ExpandNet/World Health Organization (WHO) scale-up framework to examine the planning, management, and outcomes of the early expansion phase of the scale-up of misoprostol for the prevention of PPH in 2 provinces in Mozambique. Methods: Qualitative semistructured interviews were conducted between February and October 2017 in 5 participating districts in 2 provinces. Participants included program stakeholders, health staff, community health workers (CHWs), and traditional birth attendants (TBAs). Interviews were analyzed using the ExpandNet/WHO framework alongside national policy and planning documents and notes from a 2017 national Ministry of Health maternal, newborn, and child health workshop. Outcomes were estimated using misoprostol coverage and access in 2017 for both provinces. Results: The study revealed a number of barriers and facilitators to scale-up. Facilitators included a supportive political and legal environment; a clear, credible, and relevant innovation; early expansion into some Ministry of Health systems and a strong network of CHWs and TBAs. Barriers included a reduction in reach due to a shift from universal distribution to application of eligibility criteria; fear of misdirecting misoprostol for abortion or labor induction; limited communication and understanding of the national PPH prevention strategy; inadequate monitoring and evaluation; challenges with logistics systems; and the inability to engage remote TBAs. Lower coverage was found in Inhambane province than Nampula province, possibly due to NGO support and political champions. Conclusion: This study identified the need for a formal review of the misoprostol program to identify adaptations and to develop a systematic scale-up strategy to guide national scale-up

"My job is to get pregnant women to the hospital": a qualitative study of the role of traditional birth attendants in the distribution of misoprostol to prevent post-partum haemorrhage in two provinces in Mozambique

© 2018 The Author(s). Background: Post-partum haemorrhage is the leading cause of maternal deaths in Mozambique. In 2015, the Mozambican Ministry of Health launched the National Strategy for the Prevention of Post-Partum Haemorrhage at the Community Level. The strategy included the distribution of misoprostol to women in advance at antenatal care and via Traditional Birth Attendants who directly administer the medication. The study explores the role of Traditional Birth Attendants in the misoprostol program and the views of women who used misoprostol to prevent post-partum haemorrhage. Methods: This descriptive study collected data through in-depth interviews and focus group discussions. Traditional Birth Attendants between the ages of 30-70 and women of reproductive age participated in the study. Data was collected between June-October 2017 in Inhambane and Nampula Provinces. Line by line thematic analysis was used to interpret the data using Nvivo (v.11). Results: The majority of TBAs in the study were satisfied with their role in the misoprostol program and were motivated to work with the formal health system to encourage women to access facility based births. Women who used misoprostol were also satisfied with the medication and encouraged family and friends to access it when needed. Women in the community and Traditional Birth Attendants requested assistance with transportation to reach the health facility to avoid home births. Conclusions: This study contributes to the evidence base that Traditional Birth Attendants are an appropriate channel for the distribution of misoprostol for the prevention of post-partum haemorrhage at the community level. More support and resources are needed to ensure Traditional Birth Attendants can assist women to have safe births when they are unable to reach the health facility. A consistent supply of misoprostol is needed to ensure women at the community level receive this life saving medication

Misoprostol for the prevention of post-partum haemorrhage in Mozambique: an analysis of the interface between human rights, maternal health and development.

BACKGROUND:Mozambique has high maternal mortality which is compounded by limited human resources for health, weak access to health services, and poor development indicators. In 2011, the Mozambique Ministry of Health (MoH) approved the distribution of misoprostol for the prevention of post-partum haemorrhage (PPH) at home births where oxytocin is not available. Misoprostol can be administered by a traditional birth attendant or self-administered. The objective of this paper is to examine, through applying a human rights lens, the broader contextual, policy and institutional issues that have influenced and impacted the early implementation of misoprostol for the prevention of PPH. We explore the utility of rights-based framework to inform this particular program, with implications for sexual and reproductive health programs more broadly. METHODS:A human rights, health and development framework was used to analyse the early expansion phase of the scale-up of Mozambique's misoprostol program in two provinces. A policy document review was undertaken to contextualize the human rights, health and development setting in Mozambique. Qualitative primary data from a program evaluation of misoprostol for the prevention of PPH was then analysed using a human rights lens; these results are presented alongside three examples where rights are constrained. RESULTS:Structural and institutional challenges exacerbated gaps in the misoprostol program, and sexual and reproductive health more generally. While enshrined in the constitution and within health policy documents, human rights were not fully met and many individuals in the study were unaware of their rights. Lack of information about the purpose of misoprostol and how to access the medication contributed to power imbalances between the state, health care workers and beneficiaries. The accessibility of misoprostol was further limited due to dynamics of power and control. CONCLUSIONS:Applying a rights-based approach to the Mozambican misoprostol program is helpful in contextualising and informing the practical changes needed to improve access to misoprostol as an essential medicine, and in turn, preventing PPH. This study adds to the evidence of the interconnection between human rights, health and development and the importance of integrating the concepts to ensure women's rights are prioritized within health service delivery

Remuneration of primary dental care in England: a qualitative framework analysis of perspectives of a new service delivery model incorporating incentives for improved access, quality and health outcomes

Objective: This study aimed to describe stakeholder perspectives of a new service delivery model in primary care dentistry incorporating incentives for access, quality and health outcomes. Design: Data were collected through observations, interviews and focus groups. Setting: This was conducted under six UK primary dental care practices, three working under the incentive-driven contract and three working under the traditional activity-based contract. Participants: Observations were made of 30 dental appointments. Eighteen lay people, 15 dental team staff and a member of a commissioning team took part in the interviews and focus groups. Results: Using a qualitative framework analysis informed by Andersen’s model of access, we found oral health assessments influenced patients’ perceptions of need, which led to changes in preventive behaviour. Dentists responded to the contract, with greater emphasis on prevention, use of the disease risk ratings in treatment planning, adherence to the pathways and the utilisation of skill-mix. Participants identified increases in the capacity of practices to deliver more care as a result. These changes were seen to improve evaluated and perceived health and patient satisfaction. These outcomes fed back to shape people’s predispositions to visit the dentist. Conclusion: The incentive-driven contract was perceived to increase access to dental care, determine dentists’ and patients’ perceptions of need, their behaviours, health outcomes and patient satisfaction. Dentists face challenges in refocusing care, perceptions of preventive dentistry, deployment of skill mix and use of the risk assessments and care pathways. Dentists may need support in these areas and to recognise the differences between caring for individual patients and the patient-base of a practice