The association between parent's and healthcare professional's behavior and children's coping and distress during venepuncture

Objectives: Examine the association between children’s distress and coping during venepuncture with parent’s and healthcare professional’s behavior in a sample from the UK. Methods: Fifty children aged 7–16 years accompanied by a carer were videotaped while having venepuncture. Verbalizations of children, parents, and healthcare professionals were coded using the Child–Adult Medical Procedure Interaction Scale-Revised. Results: Children’s distress was associated with child’s age, anxiety, and distress promoting behavior of adults (R2 = .91). Children’s coping was associated with age, anxiety, and coping promoting behaviors of adults (R2 = .57). Associations were stronger between healthcare professional’s behavior and child coping; and between parent’s behaviors and child distress. Empathizing, apologizing, and criticism were not frequently used by adults in this sample (<12%). Conclusion: This study supports and extends previous research showing adult’s behavior is important in children’s distress and coping during needle procedures. Clinical implications and methodological issues are discussed

Understanding needle-related distress in children with cystic fibrosis

Objective. To explore the nature and management of needle-related distress in children and adolescents with cystic fibrosis (CF). Design. Qualitative study using semi-structured interviews. Methods. Fourteen child–parent dyads took part. Children (5 male; 9 female) had a mean age of 12.4 years (range 7–17) and were mostly diagnosed with CF at birth (N= 11). Frequency of needle procedures ranged from once to six times a year. Parents (3 male; 11 female) had a mean age of 41.5 years and were from a variety of socio-economic backgrounds. Interviews were transcribed and analysed using thematic analysis. Results. Most participants identified previous needle experiences and pain as related to their needle anxiety. Over half of parents and children considered ‘taking control’ to be the optimum coping strategy. The majority of parents and children thought inhaled nitrous oxide gas during needle procedures was helpful in managing needle-related distress. Parent and staff influences on needle-related distress are also examined. Conclusions. Needle-related distress in children with CF has a substantial impact on children and their parents, and may lead to management problems and treatment refusal. Psychological and pharmacological interventions could reduce distress and aid management

Prevention work with children disaffected from school: Findings from the evaluation of two innovative community-based projects

Purpose - To report on findings from the evaluation of two innovative community-based prevention projects in the UK targeted at children disaffected from school, one involving football the other horticulture. Design/methodology/ approach - Qualitative inquiry focusing on three areas: "theories of change" underpinning the projects; referral and operational processes; inter-agency partnerships. Main methods were: an interactive event for 50 practitioners; semi-structured interviews with project staff, project participants and other stakeholders; review of project documentation; observations. Findings - Both the projects evaluated had clear and plausible "theories of change". Referral processes were effective. Strong variations in "dosage" and length of project involvement appeared to be linked to differences in the effectiveness of the two projects. Research limitations/implications - The principal limitation to the research was the lack of case monitoring and outcome data that prevented any quantitative assessment of the projects. Further research is needed to establish the long-term impact of this kind of targeted prevention work. Practical implications - Prevention work targeted at children disaffected from school needs to be underpinned by clear "theories of change". Effective work requires good relationships with referring schools, the delivery of multi-faceted interventions and interventions to be of an adequate length. Originality/value - The focus on "theories of change" or mechanisms is an original contribution to the prevention literature. The paper will be valuable for those working in drug action teams and local authorities in planning prevention work for young people. The two projects were highly innovative in involving pupils in two very different activities - football and horticulture. © Emerald Group Publishing Limited

EXPLORING THE ORGANIZATIONAL STRUCTURE AND COORDINATION OF MULTI-NATIONAL IT OUTSOURCING VENDORS

This paper explores the organizational structure and coordination mechanisms used by large ITO-vendor organizations. Five global ITO-vendor organizations were studied. The results show that all five use a “front-back hybrid” structure. All five vendors divide their front-end labor pool according to the types of customers that they serve. On the back-end, their labor pools are organized around the functions offered by the company. Such a front-back structure enables them to focus simultaneously on developing distinctive capabilities, capturing scale and nurturing long-lasting relationships with their customers. To deliver each customer’s requirements, resources from the various front and back-end units are coordinated using a hybrid-matrix approach. This structure enables quick response to a client’s shifting requirements. The primary contribution of this paper is its finding that, consistent with the theory proposed by Galbraith et al. (2002) for organizations of this type, all five global ITO vendors had adopted both front-back hybrid and cross-business-team approaches

Fine-scale movement of the European hedgehog: An application of spool-and-thread tracking

The European hedgehog is a significant predator species of rare and endangered ground-nesting birds in the riverbeds of the Waitaki Basin, South Island, New Zealand. Studies focusing on the movements and habits of this species have generally been limited to broad-scale radio-tracking studies or incidental trap-catch data. Within our study, we aimed to investigate the finer scale movement patterns of the hedgehog in relation to vegetation structure by using spool-and-thread tracking. We captured 30 hedgehogs (15 female, 15 male) within the study area, and spool-and-thread-tracked the movements of each over a single night. Only two of the 30 animals moved onto the gravel areas of the riverbeds where birds nest - hedgehogs may therefore not target birds' nests as a primary prey source, but rather as a secondary prey item. The movement paths were all non-random, and males demonstrated particular linearity in their tracks. This straighter and more directed movement may be due to more intensive male search at this time of the year. We also assessed habitat use using a very high resolution habitat map (derived from Ikonos 4-m-resolution satellite image). Dense grassland was the most selected habitat type, perhaps because insect prey are at a higher density in this vegetation type. Hedgehogs (particularly males) also used boundaries of all habitat types significantly more than the centre of habitat patches. We found the spool-and-thread tracking technique does have limitations: (1) it could be inappropriate for animals exhibiting a significant escape response; (2) the data do not include a temporal dimension. However, these problems were not considered relevant for this study. Fine-scale studies such as this can provide increased power when investigating the ecology of species at a scale relevant to trap placement

The association of children's distress during venepuncture with parent and staff behaviours

Venepuncture and other needle-related procedures can distress children and have a lasting negative impact. Adults' behaviour during these procedures may affect children's reactions. However, the literature is contradictory and rarely considers verbal and non-verbal behaviour together. This study therefore examined the effect of adults' verbal and non-verbal behaviour on children's distress during venepuncture. Participants comprised 51 child and carer dyads and 10 staff members. Child anxiety was measured before the procedure. The procedure was recorded. The resulting audio-visual data were coded using the Child-Adult Medical Procedure Interaction Scale-Revised. Correlation analysis identified variables that were significantly associated with child distress: child anxiety, carer distress-promoting behaviour, staff distress-promoting behaviour and intimate distance. These were included in a path diagram of child distress. Exploration of the diagram identified that children's anxiety was mostly strongly associated with children's distress during venepuncture. Staff and carer behaviour did not increase children's distress. The results suggest interventions to reduce children's distress during venepuncture may be more effective if they focus on reducing children's anxiety beforehand

Acceptability of orodispersible films for delivery of medicines to infants and preschool children

Orodispersible films (ODFs) possess potential to facilitate oral drug delivery to children; however, documentation of their acceptability in this age group is lacking. This study is the first to explore the initial perceptions, acceptability and ease of use of ODFs for infants and preschool children, and their caregivers through observed administration of the type of dosage form. Placebo ODFs were administered to children stratified into aged 6 to 12 months, 1 year, 2 years, 3 years, 4 years and 5 years old and into those with an acute illness or long-term stable condition in hospital setting. Acceptability of the dosage form and end-user views were assessed by (a) direct observation of administration, (b) questionnaires to caregivers and nurses, and (c) age-adapted questionnaires for children aged 3 years and over. The majority of children (78%) aged 3 years and over gave the ODF a positive rating both on verbal and non-verbal scales. Despite little prior experience, 78% of caregivers expressed positive opinion about ODFs before administration. After the ODFs were taken, 79% of infant caregivers and 86% caregivers of preschool children positively rated their child’s acceptance of the ODF. The intraclass correlation coefficient value was 0.92 showing good agreement between ratings of caregivers and nurses. ODFs showed a high degree of acceptability among young children and their caregivers. If drug loading permits, pharmaceutical companies should consider developing pediatric medicines in this format. The methodology described here is useful in assessing the acceptability of active ODF preparations and other dosage forms to children

Association Between Perifoveal Drusen Burden Determined by OCT and Genetic Risk in Early and Intermediate Age-Related Macular Degeneration

Purpose: The purpose of this study was to determine associations between macular drusen parameters derived from an automatic optical coherence tomography (OCT) algorithm, nonadvanced age-related macular degeneration (AMD) stage, and genetic variants. Methods: Eyes classified as early or intermediate AMD with OCT imaging and genetic data were selected (n = 239 eyes). Drusen area and volume measurements were estimated using the Zeiss Cirrus advanced retinal pigment epithelium analysis algorithm in a perifoveal zone centered on the fovea. Associations between drusen measurements and common genetic variants in the complement and high-density lipoprotein (HDL) lipid pathways and the ARMS2/HTRA1 variant were calculated using generalized estimating equations and linear mixed models adjusting for age, sex, smoking, body mass index, and education. Results: Drusen area \u3e /= the median was independently associated with a higher number of risk alleles for CFH risk score and risk variants in C3 and ARMS2/HTRA1 compared with eyes with no measurable drusen. Similar results were obtained for drusen volume. When all genes were analyzed in the same model, only CFH score and ARMS2/HTRA1 were associated with drusen measurements. HDL pathway genes were not significantly related to drusen parameters. Nonadvanced AMD stages were associated with OCT-derived drusen area and volume. Conclusions: Variants in CFH and ARMS2/HTRA1, commonly associated with advanced AMD, were independently associated with an increase in drusen burden determined by OCT in an allele dose dependent manner, in eyes with early and intermediate AMD. Biomarkers such as a quantitative classification of nonadvanced AMD and other OCT-derived subphenotypes could provide earlier anatomic endpoints for clinical trials and facilitate the development of new therapies for AMD