How Do Practitioners Create Inclusive Environments For Children With Chronic Health Conditions? An Exploratory Case Study

The concept of inclusion within the English education system is often taken for granted. There are a number of factors that can impact on inclusive practice and this demands careful exploration. Chronic health conditions (CHCs), such as anaphylaxis, asthma, diabetes, epilepsy and eczema, pose particular challenges to inclusion for practitioners who teach, educate and care for children under the age of five years in day care settings. These conditions can have a significant effect on children’s health, especially in the minority world. However, there is a paucity of research about how the symptoms affect children’s early education. This mixed-methods study collected quantitative data by sending a postal survey to 60 settings in order to find out how many children are affected by these conditions in day care settings. Four of the surveyed settings went on to participate in the qualitative aspect of the study. Qualitative data were also collected from parents of children with CHCs and the study included observations of a child in his early childhood setting over the course of a year. The findings revealed that 11% of children attending the settings in this study had been diagnosed with one or more CHCs and that CHCs had a profound effect on children and their parents. Parents reported that knowledge of the specific conditions is important for practitioners to have in order to create inclusive relationships with them. Practitioners in this study demonstrated a collaborative approach to leadership when creating inclusive environments. However, the findings revealed tensions for practitioners regarding the inclusion of all children in the curriculum. The findings suggest that achieving inclusion may therefore be problematic for some children. However, the communication skills, knowledge of CHCs and willingness of practitioners were vital to the inclusion of children with CHCs in their early education

Research Brief: working in partnership with parents to create inclusive environments for children, aged 0-3 years, with chronic health conditions: parents’ perspectives

This research brief reports on one aspect of the findings from a doctoral research study which explored how practitioners create inclusive environments for children with chronic health conditions. The first stage of the Case Study surveyed 60 day care settings in a geographical area in the West Midlands (UK). There was a 31.5% return rate from the survey and 4 of the respondents went on to the second stage of the study. This briefing reports the findings from a small sample about parents and practitioners working in partnership to create an inclusive environment for children with on-going conditions

A real thirst?

It's not all about healthy eating – what about healthy drinking? Dr Kristy Howells and Dr Jackie Musgrave explain how to ensure young children are achieving good hydratio

Early Childhood Health Promotion: A Toolkit for Early Childhood Education and Care Practitioners

This document, Child Health Promotion: A Toolkit for Early Childhood Education and Care Practitioners, has been written to foreground the valuable role that you have in promoting the health of the children in your setting. Early Childhood and Education and Care (ECEC) is provided by a range of private, voluntary, independent and state-maintained settings, which can include day care nurseries, childminders and nursery schools. Early Childhood practitioners are ideally placed to promote the health of the children in out of home settings. The Toolkit includes the 5 Step approach to support practitioners to identify, implement and evaluate health promoting interventions that are relevant to the children and families in their setting

Proposing a model for promoting Children's Health in Early Childhood Education and Care Settings

This pilot study was conducted in one early childhood pre‐school nursery setting in an area of high deprivation in England to explore the under‐researched area of how practitioners promote the health of children. The research used an original tool, Child Health Promotion: A Toolkit for Early Childhood Education and Care Practitioners, containing a 5 Step Programme as a model to guide practitioners in identifying and implementing a health promotion activity. The findings will help to set the onward agenda for a larger scale study which will foreground the voices of practitioners and highlight the role that ECEC practitioners can play in promoting the health of children

‘Early childhood studies is more than a degree; it is an experience’: undergraduate students’ motivations, professional aspirations and attributes

This mixed methods study sought the views of early childhood studies students from three universities in England. The research explored motivations, professional aspirations and the attributes they believed were required to work in early childhood. Findings highlighted that the holistic study of early childhood is valued by students and placements offered a space where they grew and flourished, as they made sense of where their personal intersected with wider theoretical, practice and political systems embedded in early childhood. Students follow a range of career trajectories, either by choice or because there is no specific practitioner role underpinned by the holistic study of early childhood. This study also revealed factors that led to their choice and place of study, as well as the ways that students’ personal circumstances affected their studies, reinforcing the importance of academic and pastoral support. Very significantly, this research led to discussions about the core purpose of the early childhood studies degree and helped to inform the development of the Graduate Competencies as an addition to ECS degrees that included placements

Where measurement stops: A review of systematic reviews exploring international research evidence on the impact of staff qualification levels in ECEC on the experiences of, and outcomes for, children and families.

Qualifications vary widely for those employed within the ECEC sector; this is of particular concern within the English context where questions are raised about sustainability. An inconsistent approach to training and qualifications has contributed to a perception of ECEC as low skilled work. Apprenticeships and part-time distance learning courses have become commonplace, enabling practitioners to work and study concurrently; however, this strategy has blurred the boundaries between initial training and CPD. There is a persistent concern about how to improve educational attainment for young children. In the English context, the Early Years Workforce Strategy (DfE 2017) acknowledged the impact of specialised graduates. Other evidence notes that better qualified practitioners provide higher quality provision (Mathers et al. 2011) and that such provision is positively associated with children’s attainment and progress throughout primary school (Sylva et al. 2011). More recently, Bonetti and Blanden (2020) found a small positive association between the presence of graduate level staff in private, voluntary, and independent settings and 5-year-olds’ attainment on the Early Years Foundation Stage Profile (EYFSP) (DfE 2018) although the authors note that improved outcomes were modest. It is widely accepted that quality in ECEC matters to the families of young children. In the context of England, successive governments have committed to the expansion of fully subsidised ‘15-hour’ and ‘30-hour’ provision for 2-4 year olds, not only to promote children’s development, but also to support parental employment, particularly for disadvantaged families. Previous initiatives to support parents and families, such as the Sure Start local programmes, found positive impacts for parents and families yet spending cuts have led to more than 30% of Sure Start Centres (more than 1000) closing since 2009 (Smith et al. 2018). A renewed interest in impact on families has been referenced recently in the enhancement of Family Hubs and a discussion of how they may build on existing Sure Start provision (DHSC 2021). In 2021, it is impossible to consider the experiences of young children and their families without acknowledging the ongoing context of Covid-19. The pandemic situation has impacted both children and families in many ways, including their access to quality education and care, thus worsening an already precarious situation. A further layer of complexity and concern is the impact of pervasive inequalities on the lives of many young children and their families; around 4.3 million children were noted as living in poverty in the UK in 2020 with numbers rising to include the impact of the pandemic (Hirsch and Stone 2021). Our findings are based on the analysis of 25 reviews which included over 764 research studies. These reviews focused on research evidence of the relationship between practitioner qualifications/training and their links to better outcomes for young children and their families. Reviews were included in the study following a systematic review process based on protocols established by the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) (Gough, Oliver, and Thomas 2012). Internationally published literature (written in English) was searched using EBSCO (to include ASC, BEI, ERC and ERIC) and SCOPUS. The search took place in October 2020 and fields included were titles, abstracts and keywords; the search strategy is set out in Appendix 1. Publications were limited to those published between 2002-2020. Inclusion and exclusion criteria were applied to the initial 18579 articles to arrive at the 25 articles analysed for our report

Copy number variants as modifiers of breast cancer risk for BRCA1/BRCA2 pathogenic variant carriers

The risk of germline copy number variants (CNVs) in BRCA1 and BRCA2 pathogenic variant carriers in breast cancer is assessed, with CNVs overlapping SULT1A1 decreasing breast cancer risk in BRCA1 carriers.The contribution of germline copy number variants (CNVs) to risk of developing cancer in individuals with pathogenic BRCA1 or BRCA2 variants remains relatively unknown. We conducted the largest genome-wide analysis of CNVs in 15,342 BRCA1 and 10,740 BRCA2 pathogenic variant carriers. We used these results to prioritise a candidate breast cancer risk-modifier gene for laboratory analysis and biological validation. Notably, the HR for deletions in BRCA1 suggested an elevated breast cancer risk estimate (hazard ratio (HR) = 1.21), 95% confidence interval (95% CI = 1.09-1.35) compared with non-CNV pathogenic variants. In contrast, deletions overlapping SULT1A1 suggested a decreased breast cancer risk (HR = 0.73, 95% CI 0.59-0.91) in BRCA1 pathogenic variant carriers. Functional analyses of SULT1A1 showed that reduced mRNA expression in pathogenic BRCA1 variant cells was associated with reduced cellular proliferation and reduced DNA damage after treatment with DNA damaging agents. These data provide evidence that deleterious variants in BRCA1 plus SULT1A1 deletions contribute to variable breast cancer risk in BRCA1 carriers.Peer reviewe

Validation of the BOADICEA model in a prospective cohort of BRCA1/2 pathogenic variant carriers.

Background: No validation has been conducted for the BOADICEA multifactorial breast cancer risk prediction model specifically in BRCA1/2 pathogenic variant (PV) carriers to date. Here, we evaluated the performance of BOADICEA in predicting 5-year breast cancer risks in a prospective cohort of BRCA1/2 PV carriers ascertained through clinical genetic centres. Methods: We evaluated the model calibration and discriminatory ability in the prospective TRANsIBCCS cohort study comprising 1614 BRCA1 and 1365 BRCA2 PV carriers (209 incident cases). Study participants had lifestyle, reproductive, hormonal, anthropometric risk factor information, a polygenic risk score based on 313 SNPs and family history information. Results: The full multifactorial model considering family history together with all other risk factors was well calibrated overall (E/O=1.07, 95% CI: 0.92 to 1.24) and in quintiles of predicted risk. Discrimination was maximised when all risk factors were considered (Harrell's C-index=0.70, 95% CI: 0.67 to 0.74; area under the curve=0.79, 95% CI: 0.76 to 0.82). The model performance was similar when evaluated separately in BRCA1 or BRCA2 PV carriers. The full model identified 5.8%, 12.9% and 24.0% of BRCA1/2 PV carriers with 5-year breast cancer risks of <1.65%, <3% and <5%, respectively, risk thresholds commonly used for different management and risk-reduction options. Conclusion: BOADICEA may be used to aid personalised cancer risk management and decision-making for BRCA1 and BRCA2 PV carriers. It is implemented in the free-access CanRisk tool (https://www.canrisk.org/)

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation