Henri Temianka Correspondence; (pearce)

https://digitalcommons.chapman.edu/temianka_correspondence/2546/thumbnail.jp

The Problem of Adherence in Paediatric Asthma

Non-adherence to inhaled corticosteroids (ICS) is a key barrier in asthma management. However, few studies have explored patterns of non-adherence and the reasons for variations in adherence in young people with problematic asthma. The aim of this thesis is to explore the potentially modifiable determinants of non-adherence in young people with problematic severe asthma in a tertiary care setting. This PhD comprises a systematic review of interventions to improve adherence in children with asthma; an analysis of patterns of non-adherence; a qualitative study of patients with poor adherence; and an adaptation study of the Beliefs About Medicine Questionnaire (BMQ). Each of these informs identification of interventions to improve adherence. The review found that current interventions have limited effectiveness, with only half of the included trials able to improve ICS adherence (9/18). More complex interventions, tailored to the patient, which addressed both perceptions and practical aspects of non-adherence were more likely to be effective. Secondary analysis of electronic adherence data from this population (n=93) identified adherence patterns which have implications for intervention development. The interview study (n=20) identified perceptual determinants (e.g. poor understanding of asthma and ICS) and practical determinants (e.g. no routine and forgetfulness) of non-adherence. These findings informed an adaption of the BMQ to identify beliefs underlying treatment non-adherence in this population; initial piloting (n=30) revealed high overall internal reliability but further research is needed to validate the questionnaire. This PhD highlights the need for a tailored intervention for non-adherent young people with problematic asthma which addresses perceptual and practical barriers to adherence. The PhD identified new barriers to adherence including key differences between adults and young children. A belief-based questionnaire could be used to identify modifiable beliefs for inclusion in a tailored intervention addressing both perceptual and practical barriers for adherence to ICS

Free and Open-Source Automated Open Access Preprint Harvesting

Universities are attempting to ensure that all of their research is publicly accessible because of funding mandates. Many universities have established campus open access (OA) repositories but are struggling with how to upload millions of manuscripts under numerous license agreements while also linking metadata to make them discoverable. To do this manually requires around 15 minutes per manuscript from an experienced librarian. The time and cost to do this campus-wide is prohibitive. To radically reduce the time and costs of this process and to harvest all past work, this article reports on the development and testing of a free and open source (FOSS) JavaScript-based application, aperta-accessum, which does the following: 1) harvests names and emails from a department’s faculty webpage; 2) identifies scholars’ Open Researcher and Contributor IDentifiers (ORCID iDs); 3) obtains digital object identifiers (DOIs) of publications for each scholar; 4) checks for existing copies in an institution’s OA repository; 5) identifies the legal opportunities to provide OA versions of all of the articles not already in the OA repository; 6) sends authors emails requesting a simple upload of author manuscripts; and 7) adds link-harvested metadata from DOIs with uploaded preprints into a bepress repository; the code can be modified for additional repositories. The results of this study show that, in the administrative time needed to make a single document OA manually, aperta-accessum can process approximately five entire departments worth of peer-reviewed articles. Following best practices discussed, it is clear that this opensource OA harvester enables institutional library’s stewardship of OA knowledge on a mass scale for radically reduced costs

Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention

Background: Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes. Although most guidance on pregnancy weight is focused on the pre-pregnancy period, pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health. Method: The hospital-based Bumps and Beyond intervention invited all pregnant women with a BMI of over 35 kg/m2 to take part in a programme of health education around diet and exercise, accompanied by one-to-one guidance and monitoring of dietary change. This service evaluation compares 89 women who completed at a programme of 7 sessions with healthy lifestyle midwives and advisors (intervention) with a group of 89 women who chose not to attend (non-intervention). Results: Weight gain in the intervention group (4.5±4.6 kg) was less than in the non-intervention group (10.3±4.4 kg) between antenatal booking and 36 weeks gestation (<0.001). This was associated with a 95% reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications. There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage (reduced 55%). The impact of the intervention on gestational weight gain was greater in women with BMI over 40 kg/m2 at booking. There were no adverse effects of the intervention, even though 21% of the intervention group lost weight during their pregnancy. Conclusion: Intensive, personalised weight management intervention may be an effective strategy for prevention of hypertensive disorders during pregnancy

Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention

Background: Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes. Although most guidance on pregnancy weight is focused on the pre-pregnancy period, pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health. Method: The hospital-based Bumps and Beyond intervention invited all pregnant women with a BMI of over 35 kg/m2 to take part in a programme of health education around diet and exercise, accompanied by one-to-one guidance and monitoring of dietary change. This service evaluation compares 89 women who completed at a programme of 7 sessions with healthy lifestyle midwives and advisors (intervention) with a group of 89 women who chose not to attend (non-intervention). Results: Weight gain in the intervention group (4.5±4.6 kg) was less than in the non-intervention group (10.3±4.4 kg) between antenatal booking and 36 weeks gestation (<0.001). This was associated with a 95% reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications. There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage (reduced 55%). The impact of the intervention on gestational weight gain was greater in women with BMI over 40 kg/m2 at booking. There were no adverse effects of the intervention, even though 21% of the intervention group lost weight during their pregnancy. Conclusion: Intensive, personalised weight management intervention may be an effective strategy for prevention of hypertensive disorders during pregnancy

Improving quality through clinical governance in primary health care

Ensuring health care that is safe and of high quality is as much a priority for the primary care sector as it is for hospitals. The National Health and Hospital Reform Commission has made a number of recommendations which foreground the need for accountable services that have overarching quality improvement systems. However, attempts to integrate quality assurance and improvement programs into the everyday work of the Australian primary care sector must contend with the diversity of service types, the lack of systematised communication within and between these service types, and variation of managerial structures. This review explores clinical governance, a systematic and integrated approach to ensuring services are accountable for delivering quality services. Clinical governance as a policy framework was part of the National Health Service reforms of the early 1990s, but similar initiatives have also been developed in the US and Europe. The applicability of these initiatives to the diverse Australian primary care sector has not previously been studied.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Features of successful interventions to improve adherence to Inhaled Corticosteroids in children with asthma

INTRODUCTION: Non-adherence to inhaled corticosteroids (ICS) in children with asthma leads to significant morbidity and mortality. Few adherence interventions have been effective, and little is known about what contributes to intervention effectiveness. This systematic review summarises the efficacy and the characteristics of effective interventions. METHODS: Six databases were systematically searched on 3rd October 2020 for randomised control trials measuring adherence to ICS in children with asthma. A narrative synthesis was conducted focusing on intervention efficacy and study reliability. Intervention content was coded based on the NICE guidelines for medicines adherence (The Perceptions and Practicalities Approach, PAPA) and Behaviour Change Techniques (BCT), to determine the effective aspects of the intervention. RESULTS: Of 240 studies identified, 25 were eligible for inclusion. Thirteen of the twenty-five studies were categorised as being highly reliable. Nine of the thirteen interventions were effective at increasing adherence and six of those met the criteria for a PAPA intervention. Techniques targeting perceptions and practicalities in successful interventions included rewards; reminders; feedback and monitoring of adherence; pharmacological support; instruction on how to take their ICS/adhere and information about triggers for symptoms and non-adherence. CONCLUSION: Adherence interventions in children with asthma have mixed effectiveness. Effective intervention studies were more frequently of higher quality, were tailored to individuals' perceptual and practical adherence barriers, and used multiple BCTs. However, due to the small number of included studies and varying study design quality, conclusions drawn here are preliminary. Future research is needed to test a PAPA-based intervention with a rigorous study design. This article is protected by copyright. All rights reserved

Using administrative data to evaluate national policy impacts on child and maternal health: a research framework from the Maternal and Child Health Network (MatCHNet)

Reducing health inequalities by addressing the social circumstances in which children are conceived and raised is a societal priority. Early interventions are key to improving outcomes in childhood and long-term into adulthood. Across the UK nations, there is strong political commitment to invest in the early years. National policy interventions aim to tackle health inequalities and deliver health equity for all children. Evidence to determine the effectiveness of socio-structural policies on child health outcomes is especially pressing given the current social and economic challenges facing policy-makers and families with children. As an alternative to clinical trials or evaluating local interventions, we propose a research framework that supports evaluating the impact of whole country policies on child health outcomes. Three key research challenges must be addressed to enable such evaluations and improve policy for child health: (1) policy prioritisation, (2) identification of comparable data and (3) application of robust methods

Identifying opportunities for upstream evaluations relevant to child and maternal health:a UK policy-mapping review

Objective: Interventions to tackle the social determinants of health can improve outcomes during pregnancy and early childhood, leading to better health across the life course. Variation in content, timing and implementation of policies across the 4 UK nations allows for evaluation. We conducted a policy-mapping review (1981–2021) to identify relevant UK early years policies across the social determinants of health framework, and determine suitable candidates for evaluation using administrative data. Methods: We used open keyword and category searches of UK and devolved Government websites, and hand searched policy reviews. Policies were rated and included using five criteria: (1) Potential for policy to affect maternal and child health outcomes; (2) Implementation variation across the UK; (3) Population reach and expected effect size; (4) Ability to identify exposed/eligible group in administrative data; (5) Potential to affect health inequalities. An expert consensus workshop determined a final shortlist. Results: 336 policies and 306 strategy documents were identified. Policies were mainly excluded due to criteria 2–4, leaving 88. The consensus workshop identified three policy areas as suitable candidates for natural experiment evaluation using administrative data: pregnancy grants, early years education and childcare, and Universal Credit. Conclusion: Our comprehensive policy review identifies valuable opportunities to evaluate sociostructural impacts on mother and child outcomes. However, many potentially impactful policies were excluded. This may lead to the inverse evidence law, where there is least evidence for policies believed to be most effective. This could be ameliorated by better access to administrative data, staged implementation of future policies or alternative evaluation methods

Factors associated with universal infant free school meal take up and refusal in a multicultural urban community

BackgroundUniversal infant free school meals (UIFSM) were introduced in September 2014 and are available to all key stage 1 (4–7 years) children attending state-maintained infant and primary schools in England. The present study aimed to investigate the school-based factors, child and family socio-demographic characteristics, and parental beliefs associated with UIFSM take up in an urban community.MethodsA cross-sectional questionnaire survey was completed in October to November 2015, amongst parents whose children attended eligible schools in Leicester, England. A questionnaire about school meals was also completed by each school.ResultsParents reported their child did not take (non-UIFSM, n = 159) or took (UIFSM, n = 517) a UIFSM on most days. The non-UIFSM group were more likely to be White-British, have a higher socio-economic status, have English as a first language, and involve their child in the decision over whether or not to take UIFSM, compared to the UIFSM group. Cluster analysis revealed that non-UIFSM parents were either concerned over quality of meals and what/how much their child ate, concerned only by what/how much their child ate or whether their child did not like the food provided. Two subsets of parents in the UIFSM group were either very positive about UIFSM or appeared to take meals because they were free. Schools used a variety of measures to increase and maintain UIFSM take up.ConclusionsParents like to have control over what their child eats at school and children need to enjoy their school meals. Using a range of interventions to target subsets of parents may help local authorities, schools and caterers to increase UIFSM take up