Parents in transition: Experiences of parents of young people with a liver transplant transferring to adult services

Predictors of successful transition from pediatric to adult services include ability to self-manage and engage with healthcare services. Parents have a key role in healthcare management throughout childhood and adolescence including encouraging development of self-management skills in their children. Transition to adult services can be challenging for parents and young people, yet parents' views regarding transition remain largely unexplored. Nine parents of pediatric liver transplant recipients (15.2-25.1 yr) participated in semistructured interviews. Interviews were analyzed using IPA. Analysis revealed three key themes: "emotional impact of transplantation," "protection vs. independence," and "ending relationships and changing roles." Parents expressed the dichotomous nature of the desire to promote independence in their child while still maintaining control and protection, and discussed how changing roles and relationships were difficult to navigate. Parents are important facilitators of young people's development of self-management skills for successful transfer to adult services. Parents should be supported to move from a "managerial" to a "supervisory" role during transition to help young people engage independently with the healthcare team. Findings support the development of interventions for parents to emphasize their role in transition and guide the transfer of self-management skills from parent to young person

An Examination of Concussion Legislation in the United States

There is legislation in the United States designed to protect children and adolescents from the risks associated with concussion. The scope and reach of these laws vary greatly. Purpose: It is important that health care professionals are aware of the limitations of each law. Since 2009, every state in the nation and the District of Columbia passed legislation designed to protect student-athletes who suffer from concussions resulting from participation in sport. Method: Therefore, select components of state policies were identified including: 1) Affected entities, 2) Stipulations for concussion awareness/education, 3) Requirements for removal/return to play, and 4) Requirements for return to the classroom. Results: There is significant variance between the laws and not all children/adolescents are protected equally. Conclusion: Concussion policies are a minimum standard and, when available, best practices should be followed

Random copying in space

Random copying is a simple model for population dynamics in the absence of selection, and has been applied to both biological and cultural evolution. In this work, we investigate the effect that spatial structure has on the dynamics. We focus in particular on how a measure of the diversity in the population changes over time. We show that even when the vast majority of a population's history may be well-described by a spatially-unstructured model, spatial structure may nevertheless affect the expected level of diversity seen at a local scale. We demonstrate this phenomenon explicitly by examining the random copying process on small-world networks, and use our results to comment on the use of simple random-copying models in an empirical context.Comment: 26 pages, 11 figures. Based on invited talk at AHRC CECD Conference on "Cultural Evolution in Spatially Structured Populations" at UCL, September 2010. To appear in ACS - Advances in Complex System

Investigating the association between early years foundation stage profile scores and subsequent diagnosis of an autism spectrum disorder: a retrospective study of linked healthcare and education data

Objective: We set out to test whether the early years foundation stage profile (EYFSP) score derived from 17 items assessed by teachers at the end of reception school year had any association with autism spectrum disorder (ASD) diagnosis in subsequent years. This study tested the feasibility of successfully linking education and health data. Design: A retrospective data linkage study. Setting and participants: The Born in Bradford longitudinal cohort of 13, 857 children. Outcome measures: We linked the EYFSP score at the end of reception year with subsequent diagnosis of an ASD, using all ASD general practitioner Read codes. We used the total EYFSP score and a subscore consisting of five key items in the EYFSP, prospectively identified using a panel of early years autism experts. Results: This study demonstrated the feasibility of linking education and health data using ASDs as an exemplar. A total of 8,935 children had linked primary care and education data with 20.7% scoring <25 on the total EYFSP and 15.2% scoring <10 on a EYFSP subscore proposed by an expert panel prospectively. The rate of diagnosis of ASDs at follow-up was just under 1% (84 children), children scoring <25 on the total EYFSP had a 4.1% chance of ASD compared with 0.15% of the remaining children. Using the prospectively designed subscore, this difference was greater (6.4% and 0.12%, respectively). Conclusions: We demonstrate the feasibility of linking education and health data. Performance on teacher ratings taken universally in school reception class can flag children at risk of ASDs. Further research is warranted to explore the utility of EYFSP as an initial screening tool for ASD in early school years

Prevalence, trajectories, and determinants of television viewing time in an ethnically diverse sample of young children from the UK

BACKGROUND: Excessive screen viewing in early childhood is associated with poor physical and psycho-social health and poor cognitive development. This study aimed to understand the prevalence, trajectory and determinants of television viewing time in early childhood to inform intervention development. METHODS: In this prospective longitudinal study, mothers of 1558 children (589 white British, 757 Pakistani heritage, 212 other ethnicities) completed questionnaires when their children were approximately 6, 12, 18, 24 and 36 months old. Mothers answered questions about their own and their child's TV-time. TV-time trajectories were estimated by linear longitudinal multilevel modeling, potential determinants were considered in models. RESULTS: The modelled trajectory estimated that 75% of children aged 12 months exceeded guidelines of zero screen-time. At 12 months of age an accelerated increase in TV-time was observed (2 h/day by 30 months old). For every hour of mothers' TV-time and every hour the TV was on in the home, children's TV-time was 8 min and 1 min higher respectively at 6 months old (P < 0.05), and 15 min and 3 min higher respectively at 36 months old (P < 0.05). Children whose mothers did not agree that it was important their child did not watch too much TV, had 17 min more TV-time than their counterparts (P < 0.05). Children of first time mothers had 6 min more TV-time (P < 0.05). At 12 months of age, children of mothers experiencing stress watched 8 min more TV (P < 0.05). By 36 months, children of Pakistani heritage mothers had 22 min more TV-time than those of white British mothers (P < 0.05), and an additional 35 min of TV-time if their mother was not born in the UK (P < 0.05). CONCLUSIONS: High levels of TV-time were prevalent. Intervention developers should consider targeting interventions before 12 months of age. Modifiable determinants included mothers' own TV-time, the time the television is on in the home and mothers' attitude towards child TV-time. These behaviours may be key components to address in interventions for parents. Mothers experiencing stress, first time mothers, and Pakistani heritage mothers (particularly those born outside of the UK), may be priority groups for intervention

Effects of Prenatal Social Stress and Maternal Dietary Fatty Acid Ratio on Infant Temperament: Does Race Matter?

Background: Infant temperament predicts a range of developmental and behavioral outcomes throughout childhood. Both maternal fatty acid intake and psychosocial stress exposures during pregnancy may influence infant temperament. Furthermore, maternal race may modify prenatal diet and stress effects. The goals of this study are to examine the joint effects of prenatal diet and stress and the modifying effects of race on infant behavior. Methods: Analyses included N=255 mother-infant dyads, primarily minorities (21% Blacks; 42% Hispanics), enrolled in an urban pregnancy cohort. Maternal prenatal stress was indexed by a negative life events (NLEs) score on the Crisis in Family Systems-Revised survey. Prenatal total daily intakes of polyunsaturated fatty acids (PUFAs) (n3, n6) were estimated from a food frequency questionnaire; n3:n6 ratios were calculated. Mothers completed the Infant Behavior Questionnaire-Revised (IBQ-R), a measure of infant temperament, when the children were 6 months old. Three commonly used dimensions were derived: Orienting & Regulation, Extraversion, and Negative Affectivity. Associations among prenatal stress, maternal n3:n6 ratio, and race/ethnicity on infant temperament, controlling for maternal education and age and child sex, were examined. Results: Among Blacks, prenatal stress effects on infant Orienting & Regulation scores were modified by maternal n3:n6 ratios (p=0.03): As NLEs increased, lower n3:n6 ratios predicted lower infant Orienting & Regulation scores, whereas higher n3:n6 ratios attenuated the effect of prenatal stress. There were no main or interaction effects predicting Extraversion or Negative Affectivity. Conclusions: An optimal PUFA ratio may protect the fetus from stress effects on infant behavior, particularly among Blacks. These findings may have implications for later neurodevelopment and social functioning predicted by early temperamental characteristics

Pharmacist Empathy in Smoking Cessation Counseling

Cigarette smoking and nicotine addiction are prevalent in today’s society. Approximately 19% of American adults (43.8 million people) smoke cigarettes. Smoking is associated with health risks such as Chronic Obstructive Pulmonary Disease (COPD), infertility, low birth weight, respiratory symptoms, heart disease, and lung cancer and is responsible for roughly $96 billion in health care costs. Provider empathy has been proven effective in other treatments like cold and cancer; however, its effectiveness in smoking cessation has not yet been studied. Empathy is defined in two realms: cognitive and affective. In the cognitive domain, individuals have the ability to understand and view the world from another’s perspective, and in the affective domain, they can connect to the experiences or feelings of others. The twofold objective of this study is (1) to validate a modified Kiersma-Chen Empathy Scale to measure patient perceptions of provider empathy and (2) to determine if patients who view their pharmacists as empathetic achieve a higher quit rate in smoking cessation. The original Kiersma-Chen Empathy Scale is a previously-validated measure of provider empathy. Patients who are utilizing smoking cessation clinical services and meet inclusion criteria and whose quit date was at least 6 months prior, will complete three surveys 6 months after their quit date. The surveys conducted will measure patient demographics, quit status, and the patient’s perceptions of their pharmacist’s empathy (modified KCES). The collected data will be analyzed via a psychometric test to show the validity of the modified empathy scale and via a Spearman correlation to demonstrate the association between provider empathy and smoking cessation rates. The results of this study will provide beneficial information about how pharmacist’s can best assist their patients in smoking cessation, specifically regarding the empathy shown to the patient