Health, education, and social care provision after diagnosis of childhood visual disability

Aim: To investigate the health, education, and social care provision for children newly diagnosed with visual disability.Method: This was a national prospective study, the British Childhood Visual Impairment and Blindness Study 2 (BCVIS2), ascertaining new diagnoses of visual impairment or severe visual impairment and blindness (SVIBL), or equivalent vi-sion. Data collection was performed by managing clinicians up to 1-year follow-up, and included health and developmental needs, and health, education, and social care provision.Results: BCVIS2 identified 784 children newly diagnosed with visual impairment/SVIBL (313 with visual impairment, 471 with SVIBL). Most children had associated systemic disorders (559 [71%], 167 [54%] with visual impairment, and 392 [84%] with SVIBL). Care from multidisciplinary teams was provided for 549 children (70%). Two-thirds (515) had not received an Education, Health, and Care Plan (EHCP). Fewer children with visual impairment had seen a specialist teacher (SVIBL 35%, visual impairment 28%, χ2p < 0.001), or had an EHCP (11% vs 7%, χ2p < 0 . 01).Interpretation: Families need additional support from managing clinicians to access recommended complex interventions such as the use of multidisciplinary teams and educational support. This need is pressing, as the population of children with visual impairment/SVIBL is expected to grow in size and complexity.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited

Breastfeeding is associated with reduced childhood hospitalization: evidence from a Scottish birth cohort (1997-2009)

Objective: To evaluate the risk of childhood hospitalization associated with infant feeding patterns at 6-8 weeks of age in Scotland. Study design: A retrospective population level study based on the linkage of birth, death, maternity, infant health, child health surveillance, and admission records for children born as single births in Scotland between 1997 and 2009 (n = 502 948) followed up to March 2012. Descriptive analyses, Kaplan Meier tests, and Cox regression were used to quantify the association between the mode of infant feeding and risk of childhood hospitalization for respiratory, gastrointestinal, and urinary tract infections, and other common childhood ailments during the study period. Results: Within the first 6 months of life, there was a greater hazard ratio (HR) of hospitalization for common childhood illnesses among formula-fed infants (HR 1.40; 95% CI 1.35-1.45) and mixed-fed infants (HR 1.18; 95% CI 1.11-1.25) compared with infants exclusively breastfed after adjustment for parental, maternal, and infant health characteristics. Within the first year of life and beyond, a greater relative risk of hospitalization was observed among formula-fed infants for a range of individual illnesses reported in childhood including gastrointestinal, respiratory, and urinary tract infections, otitis media, fever, asthma, diabetes, and dental caries. Conclusions: Using linked administrative data, we found greater risks of hospitalization in early childhood for a range of common childhood illnesses among Scottish infants who were not exclusively breastfed at 6-8 weeks of age

Biochemical prevalence study of smoking in pregnancy for a cross-section of women in Christchurch, New Zealand

Objective: To biochemically measure and compare the prevalence of maternal smoking by trimester in a cross-section of pregnant women residing in Christchurch, New Zealand, during 1997. Methods: Residual sera from routinely collected blood samples drawn in early and late pregnancy over a 12-month period, 1 January 1997 to 31 December 1997, was accumulated and anonymously assayed. Cotinine levels were measured by an ELISA test with a result greater than 14 ng/mL indicative of active smoking. Results: Analysis was conducted upon 4,178 samples collected from 3,082 women. Adjusted cotinine validated smoking rates in the first, second and third trimesters were 26.8% (95% CI 24.5–29.2%), 25.0% (95% CI 22.3–27.8%) and 23.0% (95% CI 20.8–25.2%), respectively. This represents an absolute reduction in smoking rates of 4.7% (p=0.02), 6.6% (p=0.04) and 3.8% (p=0.04) for the first, second and third trimesters, respectively, among pregnant women in Christchurch since 1994. Conclusion: Smoke reduction and cessation programs implemented locally and nationally have been effective in significantly reducing the biochemically measured prevalence of maternal smoking in pregnancy within a three-year period. Implications: Cigarette smoking during pregnancy is an important yet preventable factor affecting rates of prenatal, perinatal and paediatric morbidity and mortality. Reliable and repeated surveys of pregnant women are necessary to accurately measure changes in the maternal smoking prevalence and determine the efficacy of smoke reduction and cessation programs

Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial.

OBJECTIVE To examine effectiveness, cost effectiveness, generalisability, and acceptability of financial incentives for smoking cessation during pregnancy in addition to variously organised UK stop smoking services. DESIGN Pragmatic, multicentre, single blinded, phase 3, randomised controlled trial (Cessation in Pregnancy Incentives Trial phase 3 (CPIT III)). SETTING Seven UK stop smoking services provided in primary and secondary care facilities in Scotland, Northern Ireland, and England. PARTICIPANTS 944 pregnant women (age ≥16 years) who self-reported as being smokers (at least one cigarette in the past week) when asked at first maternity visit, less than 24 weeks' gestation, and notified to the trial team by routine stop smoking services. INTERVENTIONS Participants in the control group were offered the standard stop smoking services, which includes the offer of counselling by specially trained workers using withdrawal orientated therapy and the offer of free nicotine replacement therapy. The intervention was the offer of usual support from the stop smoking services and the addition of up to £400 ($440; €455) of LoveToShop financial voucher incentives for engaging with current stop smoking services or to stop smoking, or both, during pregnancy. MAIN OUTCOME MEASURES Self-reported smoking cessation in late pregnancy (between 34 and 38 weeks' gestation) corroborated by saliva cotinine (and anabasine if using nicotine replacement products). Results were adjusted for age, smoking years, index of multiple deprivation, Fagerström score, before or after covid, and recruitment site. Secondary outcomes included point and continuous abstinence six months after expected date of delivery, engagement with stop smoking services, biochemically validated abstinence from smoking at four weeks after stop smoking date, birth weight of baby, cost effectiveness, generalisability documenting formats of stop smoking services, and acceptability to pregnant women and their carers. RESULTS From 9 January 2018 to 4 April 2020, of 4032 women screened by stop smoking services, 944 people were randomly assigned to the intervention group (n=471) or the control group (n=470). Three people asked for their data to be removed. 126 (27%) of 471 participants stopped smoking from the intervention group and 58 (12%) of 470 from the control group (adjusted odds ratio 2.78 (1.94 to 3.97) P<0.001). Serious adverse events were miscarriages and other expected pregnancy events requiring hospital admission; all serious adverse events were unrelated to the intervention. Most people who stopped smoking from both groups relapsed after their baby was born. CONCLUSIONS The offer of up to £400 of financial voucher incentives to stop smoking during pregnancy as an addition to current UK stop smoking services is highly effective. This bolt-on intervention supports new guidance from the UK National Institute for Health and Care Excellence, which includes the addition of financial incentives to support pregnant women to stop smoking. Continuing incentives to 12 months after birth is being examined to prevent relapse. TRIAL REGISTRATION ISRCTN Registry ISRCTN15236311

Financial voucher incentives provided with UK Stop Smoking Services for pregnant women : a phase III Randomised Controlled Trial

Objective: To examine effectiveness, cost-effectiveness, generalizability and acceptability of financial incentives for smoking cessation during pregnancy ‘bolted-on’ to variously organised UK SSSs. This paper reports effectiveness. Design: A prospective pragmatic, multi-centre, parallel group, single-blinded, individually randomised controlled superiority trial with 1:1 allocation augmented by embedded cost-benefit and mixed methods studies of generalisability and acceptability. Setting: Seven UK SSSs provided in primary and secondary care facilities in Scotland, Northern Ireland and England. Participants: 944 pregnant self-reported smokers (at least 1 cigarette in the last week) when asked at first maternity visit, ≥16 years, <24 weeks gestation notified to the trial team by routine SSSs entered the study. 941 (471 intervention, 470 control) completed the study as 3 asked for their data to be removed. Interventions: The offer of usual SSS support for control participants with the addition of up to £400 ($523, 583 euros) of LoveToShop financial voucher incentives for engaging with current SSSs and/or quitting smoking during pregnancy ‘bolted-on’ with intervention (bolted-on - current services changed as little as possible). Outcomes: The primary outcome was self-reported smoking cessation in late pregnancy (random date between 34-38 weeks gestation) corroborated by saliva cotinine (and anabasine if using nicotine replacement products). Secondary outcomes included point and continuous abstinence 6 months after expected date of delivery, engagement with SSS, biochemically validated abstinence 4 weeks later, birth weight, cost-effectiveness, generalisability documenting SSS formats and acceptability to pregnant women and their carers. Results: 126/471(26.8%) quit from the intervention group and 58/470(12.3%) from the control group AOR 2.78 (1.94 to 3.97) p<0.001 - adjusted for age, smoking years, Index of Multiple Deprivation, Fagerström score, pre or post COVID, recruitment site. Serious Adverse Events (SAEs) were early miscarriages and other ‘expected’ pregnancy events requiring hospital admission and all SAEs were unrelated to the intervention. Most who quit from both groups relapsed after their baby was born. Conclusions: The offer of up to £400 of financial voucher incentives to stop smoking during pregnancy ‘bolted-on’ to current heterogeneous UK Stop Smoking Services is highly effective. This bolt-on intervention will help implement new NICE guidance which includes the addition of financial incentives to support pregnant women to stop smoking. Continuing incentives to 12 months after birth are being examined to prevent relapse