Exploring eleven year old children's understanding of well-being using well-being maps: Commonalities and divergences across areas of varying levels of deprivation and ethnic diversity in an English Qualitative Study

YesThe aim of this paper is to explore eleven year old children's understanding of well-being through their completion of Well-Being Maps and subsequent interviews on their content. The children were asked to describe the people, places and things which they viewed as important to their sense of well-being. The subsequent interviews explored their rationalisations for their choices. Ninety-two eleven year old children attending four schools with varying levels of deprivation and ethnic diversity took part in the study. This is the first section of an English study which is a part of the Multi-National Children's Understanding of Well-Being Study involving 26 countries which aims to explore how children conceptualise and experience well-being from a comparative and global perspective. Commonalities and divergences in the English children's responses were explored. Across the entire sample of 92 children, there were clear commonalities. Relationships with family, predominantly parents, were viewed as very important. The reasons provided were consistent love and affection; constant support, encouragement and protection; fun to be with. The duration of this quality of parent-child interaction appeared to be the key. Trust and a sense of security were the result. Relationships with friends were deemed important by over two thirds of the children. The qualities of these relationships mirrored those with the parents with a sense of trust and security being present. Where places and activities were included on their maps, they were often linked to important relationships. Activities appeared to be important in acknowledging the relationship but also maintaining it. Activities were also valued by the children for skill development. There were some differences across the sample with relationships with friends and grandparents being more reported as important in the two areas of high deprivation, irrespective of ethnic diversity. The level of material possessions and holidays abroad were much more frequently reported in the school serving the low deprivation area. At times, the explanations for differences appeared to be an interplay of socio-economic factors and religious and cultural traditions. Suggestions for further research on children's perspectives on factors important to their well-being are made.Health Foundation, Englan

The impact of COVID-19 on well-being: Welsh children’s perspectives

The COVID-19 pandemic saw drastic and unprecedented actions by governments to mitigate the spread of the virus. Often, the restrictions limited in-person interaction and included the closure of schools. To investigate the impact of both the pandemic and resulting restrictions, the International Society of Child Indicators developed the Childrens Worlds: COVID-19 Supplement. This paper reports on the results of that survey in Wales in 2021. Seven hundred and twenty seven children from 18 schools participated from years 6 and 8. They received an anonymous survey asking about their circumstances and well-being across a range of domains, and how these have changes during the pandemic. The children had experienced significant changes in their lives with the onset of the pandemic. The majority could not attend school, were confined to their homes, and were unable to see wider family and friends in person. Almost a half of both groups felt that their relationships with family they lived with had improved, with many becoming closer to members. Over one-fifth of both groups thought their relationships with friends were affected, with younger children more likely to think they had improved. The pattern throughout the survey was that the older children were less positive in their responses. The disparity between the groups was markedly so regarding school with the secondary schoolchildren being particularly dissatisfied with the content of their learning. Whereas there was a trend for less disparity between the groups during COVID-19, the only area where the disparity increased was regarding satisfaction with school. These findings are then placed in the context of developments in education in Wales and research on the impact of COVID on Welsh schools and schoolchildren. As in other countries, the pandemic would appear to have exacerbated existing educational inequalities

Poverty and its impact on parenting in the UK: Re-defining the critical nature of the relationship through examining lived experiences in times of austerity

Current political rhetoric and some media commentaries suggest there is a yawning gap of understanding between policymakers and the reality of families living in poverty in 21st century Britain. A key reason identified for the disconnect between policymakers and families is the absence of the voices of the families in public discourse. In this paper accounts of the lived experiences of parents in poverty are examined in four UK qualitative studies published in the period 1998-2016. Their accounts highlight how problems of disadvantage can be cumulative, compounding and enduring. The struggle to provide the basics of family life and the role of supportive communities and relationships are explored. The impact on parents of financial stress, the sense of shame and stigma often experienced and the consequences for their physical and mental health are highlighted. Under the government’s austerity policy, there is an increase in poverty even in working families, an increase in homelessness and considerable evidence emerging on the damaging consequences of food and fuel poverty on the health of children and parents. Listening to the lived realities of individual families provides a much greater understanding of family poverty and its causes and consequences, provides a corrective to the critical pejorative rhetoric and lays the foundation for the provision of appropriate government support

Young families under stress: outcomes and costs of Home-Start support

Supporting parents is central to the current government’s approach to improving children’s lives. However, little is as yet known about the effectiveness and cost-effectiveness of family support services. This study evaluates one of these – Home-Start – which is currently one of the largest family support organisations in the UK. Established over thirty years ago, it offers volunteer home visiting support to families with children under five years of age.Comparing a study group of young families who received Home-Start support with a comparison group who did not, the study explores the mothers’ views and needs at the outset of the study. It reports their views one year later, and considers the outcomes at that stage. The economic situation of the families and their receipt of services over time are analysed, and the cost-effectiveness of Home-Start is addressed. The concluding chapter summarises the key findings of the study.The authors found that although the mothers who had received the support of a Home-Start volunteer obviously valued the service, there was no clear evidence that it had made a positive difference to them in terms of outcomes, relative to those of the families in the comparison group. They suggest that the results did not therefore point to a cost-effectiveness advantage for Home-Start. Given that the support was offered only on a low intensity basis (one home visit per week), the authors suggest that a longer term follow up would be advisable before reaching firm conclusions about the impact of the service

Repair of Acute Respiratory Distress Syndrome in COVID-19 by Stromal Cells (REALIST-COVID Trial):A Multicentre, Randomised, Controlled Trial

RationaleMesenchymal stromal cells (MSCs) may modulate inflammation, promoting repair in COVID-19-related Acute Respiratory Distress Syndrome (ARDS).ObjectivesWe investigated safety and efficacy of ORBCEL-C (CD362-enriched, umbilical cord-derived MSCs) in COVID-related ARDS.MethodsThis multicentre, randomised, double-blind, allocation concealed, placebo-controlled trial (NCT03042143) randomised patients with moderate-to-severe COVID-related ARDS to receive ORBCEL-C (400million cells) or placebo (Plasma-Lyte148).MeasurementsThe primary safety and efficacy outcomes were incidence of serious adverse events and oxygenation index at day 7 respectively. Secondary outcomes included respiratory compliance, driving pressure, PaO2/FiO2 ratio and SOFA score. Clinical outcomes relating to duration of ventilation, length of intensive care unit and hospital stays, and mortality were collected. Long-term follow up included diagnosis of interstitial lung disease at 1 year, and significant medical events and mortality at 2 years. Transcriptomic analysis was performed on whole blood at day 0, 4 and 7.Main results60 participants were recruited (final analysis n=30 ORBCEL-C, n=29 placebo: 1 in placebo group withdrew consent). 6 serious adverse events occurred in the ORBCEL-C and 3 in the placebo group, RR 2.9(0.6-13.2)p=0.25. Day 7 mean[SD] oxygenation index did not differ (ORBCEL-C 98.357.2], placebo 96.667.3). There were no differences in secondary surrogate outcomes, nor mortality at day 28, day 90, 1 or 2 years. There was no difference in prevalence of interstitial lung disease at 1year nor significant medical events up to 2 years. ORBCEL-C modulated the peripheral blood transcriptome.ConclusionORBCEL-C MSCs were safe in moderate-to-severe COVID-related ARDS, but did not improve surrogates of pulmonary organ dysfunction. Clinical trial registration available at www.Clinicaltrialsgov, ID: NCT03042143. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/)

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Safeguarding children: addressing the issue of placement choice and creating a vision for looked after children in Northern Ireland

Three-and-a-half years into the Children (NI) Order 1995, government reports have confirmed that there are serious concerns about the sufficiency of placement within both residential and foster care services. Colette McAuley argues that the ensuing issue of placement choice and its impact upon care planning and child safety needs to be urgently addressed. She calls for regional strategic leadership coupled with resource management and investment to bring about significant changes for looked after children in Northern Ireland