Publications by year
In Press
Parker C, Tejerina-Arreal M, Henley W, Goodman R, Logan S, Ford T (In Press). Are children with unrecognised psychiatric disorders being excluded from school? a secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007. Psychological Medicine
Wyatt KM, Lloyd JJ, Green C, Hurst A, McHugh C, Logan S, Taylor R, Hillsdon M, Price L, Abraham C, et al (In Press). Cluster randomised controlled trial, economic and process evaluation to determine the effectiveness and cost effectiveness of a novel intervention (Healthy Lifestyles Programme, HeLP) to prevent obesity in school children. NIHR Public Health Research
Moore D, Nunns M, Shaw L, Rogers M, Walker E, Ford T, Garside R, Ukoumunne O, Titman P, Shafran R, et al (In Press). Interventions to improve the mental health of children and young people with long-term physical conditions: Linked evidence syntheses. Health Technology Assessment
Nguyen VG, Zylbergsztejn A, Harron K, Ford T, Black-Hawkins K, Boddy K, Downs J, Doyle M, Lilliman M, Matthews J, et al (In Press). SEN support from the start of school and its impact on unplanned hospital utilisation in children with cleft lip and palate: a demonstration target trial emulation protocol using ECHILD.
Abstract:
SEN support from the start of school and its impact on unplanned hospital utilisation in children with cleft lip and palate: a demonstration target trial emulation protocol using ECHILD
AbstractSpecial Educational Needs (SEN) provision for school children provides extra support and reasonable adjustments for children and young people with additional educational, behavioural or health needs to ensure equal education opportunities; for example those born with a healthcare need such as cleft lip and palate may be provided SEN to aid with challenges in communications. However, there is limited knowledge of whether SEN provisions impact academic or health outcomes in such a population and conducting a randomised controlled trial to establish this evidence is not plausible. In lieu of randomised controlled trials, target trial emulation methods can be used in attempt to answer causal questions using observational data whilst reducing confounding and other biases likely to arise with such data. The Education and Child Health Insights from Linked Data (ECHILD) dataset could be used as part of trial emulation methods to understand the impact of SEN provisions on academic and healthcare outcomes. ECHILD is the first dataset to hold longitudinal school, health and social care data on all pupils in England, obtained by linking the National Pupil Database (NPD) with Hospital Episode Statistics (HES). In this protocol, we describe how the ECHILD dataset could be used to explore and conduct a target trial emulation to evaluate whether children who were born with cleft lip and palate would have different unplanned hospital utilisation if they received or did not receive SEN provisions by Year 1 (specifically by January in their second year of school) when they are aged 5 or 6.MethodsFocussing on the population of children who are identified as having been born with cleft lip and palate, an intervention of varying levels of SEN provision (including no SEN provision) by January of the second year of school, and an outcome of unplanned hospital utilisation, we apply a trial emulation design to reduce confounding when using observational data to investigate the causal impact of SEN on unplanned hospital admissions. Our target population is children born 2001-2014 who had a recording of cleft lip and palate in HES and who started their second year of primary school (Year 1) in a state school between 2006 and 2019; children with a first recording of cleft lip and palate after Year 1 were excluded (these were pupils who likely immigrated to England after birth). We intend to use a time window of SEN provision assignment between the start of school (reception) and by the January school census in Year 1. Using target trial emulation, we aim to estimate the average treatment effect of SEN provision on the number of unplanned hospital admissions (including admissions to accident and emergency) between the January school census in Year 1 and Year 6 (the end of primary school, when children are 10-11 years old).Ethics and disseminationPermissions to use linked, de-identified data from Hospital Episode Statistics and the National Public Database were granted by DfE (DR200604.02B) and NHS Digital (DARS-NIC-381972). Ethical approval for the ECHILD project was granted by the National Research Ethics Service (17/LO/1494), NHS Health Research Authority Research Ethics Committee (20/EE/0180) and UCL Great Ormond Street Institute of Child Health’s Joint Research and Development Office (20PE06). Stakeholders (academics, clinicians, educators and child/young people advocacy groups) will consistently be consulted to refine populations, interventions and outcomes of studies that use the ECHILD dataset to conduct target trial emulation. Scientific, lay and policy briefings will be produced to inform public health policy through partners in the Department of Education and the Department of Health and Social Care.
Abstract.
Ford TJ, Parker C, Salim J, Goodman R, Logan S, Henley W (In Press). The Relationship between Exclusion from School and Mental Health: a Secondary Analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007. Psychological Medicine
Ford TJ, Paget A, Parker C, Heron J, Logan S, Henley W, EMOMND A (In Press). Which children and young people are excluded from school? Findings from a large British birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC). Child: Care, Health and Development
2023
Garrood A, Bjornstad G, Borek A, Gillett A, Lloyd J, Brand S, Tarrant M, Ball S, Hawton A, McDonald A, et al (2023). Healthy Parent Carers: Acceptability and practicability of online delivery and learning through implementation by delivery partner organisations.
Health Expect,
26(5), 2050-2063.
Abstract:
Healthy Parent Carers: Acceptability and practicability of online delivery and learning through implementation by delivery partner organisations.
BACKGROUND: Parent carers of disabled children are at increased risk of physical and mental health problems. The Healthy Parent Carers (HPC) programme is a manualised peer-led group-based programme that aims to promote parent carer health and wellbeing. Previously, the programme had been delivered in person, with recruitment and delivery managed in a research context. This study explored implementation by two delivery partner organisations in the United Kingdom. Facilitator Training and Delivery Manuals were modified for online delivery using Zoom due to COVID-19. METHODS: the study methodology utilised the Replicating Effective Programs framework. A series of stakeholder workshops informed the development of the Implementation Logic Model and an Implementation Package. After delivering the programme, delivery partner organisations and facilitators participated in a workshop to discuss experiences of implementing the programme. A wider group of stakeholders, including commissioners, Parent Carer Forums and charity organisations representatives and researchers subsequently met to consider the sustainability and potential barriers to delivering the programme outside the research context. RESULTS: This study explored implementation by two delivery partner organisations in the United Kingdom that were able to recruit facilitators, who we trained, and they recruited participants and delivered the programme to parent carers in different localities using Zoom. The co-created Implementation Logic Model and Implementation Package were subsequently refined to enable the further roll-out of the programme with other delivery partner organisations. CONCLUSIONS: This study provides insight and understanding of how the HPC programme can be implemented sustainably outside of the research context. Further research will evaluate the effectiveness of the programme and refine the implementation processes. PATIENT AND PUBLIC CONTRIBUTION: Parent carers, delivery partner organisation staff and service commissioners were consulted on the design, delivery and reporting of the research.
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2022
Forbes C, Morley N, Liabo K, Bjornstad G, Boult H, Ahmed S, Ciesla K, Vafai Y, Bridges S, Logan S, et al (2022). Prioritising child health and maternity evidence-based interventions or service models: a stakeholder-driven process.
BMC Health Services Research,
22(1).
Abstract:
Prioritising child health and maternity evidence-based interventions or service models: a stakeholder-driven process
Abstract
. Aim
. A UK programme, led by the National Institute for Health Research (NIHR). (https://www.nihr.ac.uk) and coordinated by Applied Research Collaborations (ARC), (https://www.nihr.ac.uk/explore-nihr/support/collaborating-in-applied-health-research.htm) aimed to identify and select evidence-based, implementation-ready service innovations for evaluation. The programme focused on seven areas of health provision. We report on a prioritisation process designed to identify and assess innovations in one of these areas: child and maternal health (CH&M).
.
. Methods
. We developed a three-stage, online, stakeholder driven process to 1) identify, 2) assess and prioritise and 3) select evidence-based interventions or service models, using crowdsourcing to identify projects and the APEASE criteria to assess and select projects. A brief evidence review was conducted for all initial suggestions to identify those with the largest evidence-base to take forward for ranking by stakeholders. Stakeholder workshops considered and ranked these suggestions using the APEASE criteria. We then conducted in-depth evidence reviews for the highest ranked suggestions. The Project Management Group and Advisory Board used these reviews and the APEASE criteria to select the final projects.
.
. Results
. We received 32 initial suggestions from a range of clinicians, practitioners and researchers. Fourteen of the most evidence-based suggestions were considered and ranked at four themed stakeholder workshops. Nine suggestions were ranked for further in-depth evidence review and a final four projects were selected for implementation evaluation using the APEASE criteria. These were: 1. Maternal Mental Health Services Multidisciplinary Teams 2. Early years tooth brushing programme 3. Trauma-focused CBT for young people in care and 4. Independent Domestic Violence Advisors in maternity settings. Feedback from participants suggested that having public representatives participating in all stakeholder meetings, rather than being consulted separately, focused discussions clearly on patient benefit rather than research aims.
.
. Conclusions
. The stakeholder-driven process achieved its aim of identifying, prioritising and assessing and selecting, evidence-based projects for wider implementation and evaluation. The concurrent process could be adapted by other researchers or policy makers.
.
Abstract.
Owen N, Dew L, Logan S, Denegri S, Chappell LC (2022). Research policy for people with multiple long-term conditions and their carers.
J Multimorb Comorb,
12Abstract:
Research policy for people with multiple long-term conditions and their carers.
People with multiple long-term conditions (MLTC) are a growing population, not only in the United Kingdom but internationally. Health and care systems need to adapt to rise to this challenge. Policymakers need to better understand how medical education and training, and service configuration and delivery should change to meet the needs of people with MLTC and their carers. A series of workshops with people with MLTC and carers across the life-course identified areas of unmet need including the impact of stigma; poorly coordinated care designed around single conditions; inadequate communication and consultations that focus on clinical outcomes rather than patient-oriented goals and imperfectly integrate mental and physical wellbeing. Research which embeds the patient voice at its centre, from inception to implementation, can provide the evidence to drive the change to patient-centred, coordinated care. This should not only improve the lives of people living with MLTC and their carers but also create a health and care system which is more effective and efficient. The challenge of MLTC needs to be bought to the fore and it will require joint effort by policymakers, practitioners, systems leaders, educators, the third sector and those living with MLTC to design a health and care system from the perspective of patients and carers, and provide practitioners with the skills and tools needed to provide the highest quality care.
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Allen M, James C, Frost J, Liabo K, Pearn K, Monks T, Zhelev Z, Logan S, Everson R, James M, et al (2022). Using simulation and machine learning to maximise the benefit of intravenous thrombolysis in acute stroke in England and Wales: the SAMueL modelling and qualitative study.
Health and Social Care Delivery Research,
10(31), 1-148.
Abstract:
Using simulation and machine learning to maximise the benefit of intravenous thrombolysis in acute stroke in England and Wales: the SAMueL modelling and qualitative study
BackgroundStroke is a common cause of adult disability. Expert opinion is that about 20% of patients should receive thrombolysis to break up a clot causing the stroke. Currently, 11–12% of patients in England and Wales receive this treatment, ranging between 2% and 24% between hospitals.ObjectivesWe sought to enhance the national stroke audit by providing further analysis of the key sources of inter-hospital variation to determine how a target of 20% of stroke patients receiving thrombolysis may be reached.DesignWe modelled three aspects of the thrombolysis pathway, using machine learning and clinical pathway simulation. In addition, the project had a qualitative research arm, with the objective of understanding clinicians’ attitudes to use of modelling and machine learning applied to the national stroke audit.Participants and data sourceAnonymised data were collected for 246,676 emergency stroke admissions to acute stroke teams in England and Wales between 2016 and 2018, obtained from the Sentinel Stroke National Audit Programme.ResultsUse of thrombolysis could be predicted with 85% accuracy for those patients with a chance of receiving thrombolysis (i.e. those arriving within 4 hours of stroke onset). Machine learning models allowed prediction of likely treatment choice for each patient at all hospitals. A clinical pathway simulation predicted hospital thrombolysis use with an average absolute error of 0.5 percentage points. We found that about half of the inter-hospital variation in thrombolysis use came from differences in local patient populations, and half from in-hospital processes and decision-making. Three changes were applied to all hospitals in the model: (1) arrival to treatment in 30 minutes, (2) proportion of patients with determined stroke onset times set to at least the national upper quartile and (3) thrombolysis decisions made based on majority vote of a benchmark set of 30 hospitals. Any single change alone was predicted to increase national thrombolysis use from 11.6% to between 12.3% and 14.5% (with clinical decision-making having the most effect). Combined, these changes would be expected to increase thrombolysis to 18.3% (and to double the clinical benefit of thrombolysis, as speed increases also improve clinical benefit independently of the proportion of patients receiving thrombolysis); however, there would still be significant variation between hospitals depending on local patient population. For each hospital, the effect of each change could be predicted alone or in combination. Qualitative research with 19 clinicians showed that engagement with, and trust in, the model was greatest in physicians from units with higher thrombolysis rates. Physicians also wanted to see a machine learning model predicting outcome with probability of adverse effect of thrombolysis to counter a fear that driving thrombolysis use up may cause more harm than good.LimitationsModels may be built using data available in the Sentinel Stroke National Audit Programme only. Not all factors affecting use of thrombolysis are contained in Sentinel Stroke National Audit Programme data and the model, therefore, provides information on patterns of thrombolysis use in hospitals, but is not suitable for, or intended as, a decision aid to thrombolysis.ConclusionsMachine learning and clinical pathway simulation may be applied at scale to national audit data, allowing extended use and analysis of audit data. Stroke thrombolysis rates of at least 18% look achievable in England and Wales, but each hospital should have its own target.Future workFuture studies should extend machine learning modelling to predict the patient-level outcome and probability of adverse effects of thrombolysis, and apply co-production techniques, with clinicians and other stakeholders, to communicate model outputs.FundingThis project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full inHealth and Social Care Delivery Research; Vol. 10, No. 31. See the NIHR Journals Library website for further project information.
Abstract.
2021
McHugh C, Lloyd J, Logan S, Wyatt K (2021). Enablers and barriers English secondary schools face in promoting healthy diet and physical activity behaviours.
Health Promotion International,
37(2).
Abstract:
Enablers and barriers English secondary schools face in promoting healthy diet and physical activity behaviours
Summary
. This study sought to understand the current challenges mainstream secondary schools in England face in creating a health promoting school culture for diet and physical activity behaviours. An in-depth qualitative case study of two purposely selected state-funded schools, including interviews with teachers, observations of school activities including meal breaks and a qualitative survey with parents was done. Inductive thematic analysis was used to explore emerging themes. Additional interviews with the leadership team from four further schools were used to develop and refine emerging themes. Four main themes emerged from the data: competing pressures, school environment, personnel and policy. Results demonstrate that schools recognize they have role to play in promoting healthy lifestyle behaviours to pupils; however, several significant barriers were identified such as lack of government support and regulation, school structures and organization, focus on core subjects, business-run canteens and lack of family and community engagement. Given the importance of maintaining a healthy weight throughout the life course, schools have an important role to play in creating healthy environments in which students can easily make a healthy choice. Future school promotion initiatives need to consider addressing the barriers that schools face by working with them and the communities in which they are embedded.
Abstract.
Bjornstad G, Cuffe-Fuller B, Ukoumunne OC, Fredlund M, McDonald A, Wilkinson K, Lloyd J, Hawton A, Berry V, Tarrant M, et al (2021). Healthy Parent Carers: feasibility randomised controlled trial of a peer-led group-based health promotion intervention for parent carers of disabled children (dataset).
McHugh CA, Lloyd J, Logan S, Wyatt K (2021). Implementing a set of health promoting processes in English secondary schools: a comparative case study. Public Health in Practice, 2, 100214-100214.
Eke H, Hunt H, Ball S, Rogers M, Whear R, Allinson A, Melluish J, Lindsay C, Richardson D, Rogers J, et al (2021). Improving continence in children and young people with neurodisability: survey of current NHS practice and systematic review of effectiveness, cost-effectiveness and contextual factors that modify implementation of interventions. Health Technology Assessment
2020
Janssens A, Eke H, Price A, Blake S, Newlove-Delgado T, Logan S, Ford T (2020). Young people with Attention Deficit Hyperactivity Disorder (ADHD) in transition from children's services to adult services (CATCh-uS): a mixed methods national scoping study.
Health Services and Delivery Research, 1-184.
Abstract:
Young people with Attention Deficit Hyperactivity Disorder (ADHD) in transition from children's services to adult services (CATCh-uS): a mixed methods national scoping study
ADHD was previously seen as a childhood developmental disorder, so adult mental health services were not set up to support ADHD patients who become too old for child services. This is the first in-depth study of the transition of ADHD patients from child to adult health services in the UK. Our objectives were to explore:
o how many young people with ADHD are in need of services as an adult
o what adult ADHD services are available
o how ADHD stakeholders experience transition from child to adult services
Design
An interactive mixed method design was adopted with three study streams; (1) a twelve-month surveillance study with nine month follow-up to find out how many young people required ongoing medication when too old for child services (929 surveys completed by child clinicians); (2) a mapping study to identify and describe services for young adults with ADHD (2,686 respondents to online surveys for patients and health workers and Freedom of Information requests to service providers and commissioners); and (3) a qualitative study to explore key stakeholder experience of transition from child to adult services (144 interviews with 64 ADHD patients, 28 parents, 52 clinicians working in child or adult secondary health services and 14 general practitioners). Members of the public advised each stage of the study.
Results
Corrected for non-response and case ascertainment, the annual incidence of young people with an ongoing need for medication for ADHD lies between 270 and 599 per 100,000 people aged 17 – 19 years. of 315 eligible cases for transition, 64% of referrals were accepted but only 22% attended their first adult services appointment. Our interactive map describes 294 unique services for adults with ADHD across the UK; 44 were ‘dedicated’ ADHD services (defined chapter 4). Few services provide the full range of recommended provision, most focused on diagnosis and medication. They were unevenly distributed across the UK, with nearly all ‘dedicated’ services in England. Exploring stakeholders’ experiences revealed how invested they are in continuing ADHD treatment and the architecture of services impacted transition. An association between ADHD, education and continuance of medication into young adulthood, plus parent involvement and feeling prepared for transition and adult life with ADHD, influenced investment. However, even if invested; how accessible adult services were; how patient needs fitted with the remit of the adult service; and the level of patient information available impacted transition outcomes. The results also highlighted how GPs can end up as care-coordinator during transition by default.
Limitations
Transition estimates were based on those who want medication, so indicate a minimum level of need.
Conclusions
Few of those who need ongoing support for their ADHD successfully transfer to adult services, and a small proportion of those who transfer experience optimal transitional care. Adult ADHD service provision is patchy. Even among ‘dedicated’ services, few provide the whole range of NICE recommended treatments.
Future Work
We a need to evaluate various models of transitional care and adult ADHD provision, as well as develop and evaluate psycho-social interventions for young people and adults with ADHD.
Funding
The National Institute for Health Research - Health Services and Delivery Research Programme.
Abstract.
2019
McHugh CA, Anderson L, Lloyd J, Wyatt K, Logan S (2019). Influences on diet and physical activity choices of 11–13-year-olds in a school setting. Health Education Journal
Ford T, Kenchington R, Norman S, Hancock J, Smalley A, Henley W, Russell G, Hayes J, Logan S (2019). The agreement between the referrer, practitioner and research diagnosis of autistic spectrum conditions among children attending child and adolescent mental health services.
European Child and Adolescent Psychiatry,
28(9), 1253-1264.
Abstract:
The agreement between the referrer, practitioner and research diagnosis of autistic spectrum conditions among children attending child and adolescent mental health services
We aimed to explore the levels of agreement about the diagnoses of Autistic Spectrum Conditions between the referrer, CAMHS practitioner and a research diagnosis, as well as the stability of the practitioner’s diagnosis over time in a secondary analysis of data from 302 children attending two Child and Adolescent Mental Health Services over two years. Kappa coefficient was used to assess the agreement between the referrer and research diagnosis. Kendall’s tau b coefficient was used to assess the agreement between the practitioner and the research diagnosis assigned using the Development and Well-Being Assessment, as well as the agreement between the referrer’s indication of presenting problems and the practitioner diagnosis. Diagnostic stability was explored in children with and without a research diagnosis of Autistic Spectrum Condition. There was a moderate level of agreement between the referrer and research diagnosis (Kappa = 0.51) and between practitioner’s and research diagnosis (Kendall’s tau = 0.60) at baseline, which reduced over the subsequent two years. Agreement between the referrer and practitioner’s diagnosis at baseline was fair (Kendall’s tau = 0.36).The greatest diagnostic instability occurred among children who practitioners considered to have possible Autistic Spectrum Conditions but who did not meet research diagnostic criteria. Further studies could explore the approaches used by practitioners to reach diagnoses and the impact these may have on diagnostic stability in Autistic Spectrum Conditions. Standardised assessment using a clinically rated diagnostic framework has a potential role as an adjunct to standard clinical care and might be particularly useful where practitioners are uncertain.
Abstract.
Ford T, Hayes RA, Edwards V, Logan GS, Norwich B, Allen KL, Hansford L, Longdon BM, Norman S, Price A, et al (2019). Training teachers in classroom management to improve mental health in primary school children: the STARS cluster RCT. Public Health Research, 7
2018
Nunns M, Mayhew D, Ford T, Rogers M, Curle C, Logan S, Moore D (2018). Effectiveness of nonpharmacological interventions to reduce procedural anxiety in children and adolescents undergoing treatment for cancer: a systematic review and meta-analysis.
Psychooncology,
27(8), 1889-1899.
Abstract:
Effectiveness of nonpharmacological interventions to reduce procedural anxiety in children and adolescents undergoing treatment for cancer: a systematic review and meta-analysis.
OBJECTIVE: Children and young people (CYP) with cancer undergo painful and distressing procedures. We aimed to systematically review the effectiveness of nonpharmacological interventions to reduce procedural anxiety in CYP. METHODS: Extensive literature searches sought randomised controlled trials that quantified the effect of any nonpharmacological intervention for procedural anxiety in CYP with cancer aged 0 to 25. Study selection involved independent title and abstract screening and full text screening by two reviewers. Anxiety, distress, fear, and pain outcomes were extracted from included studies. Where similar intervention, comparator, and outcomes presented, meta-analysis was performed, producing pooled effect sizes (Cohen's d) and 95% confidence intervals (95% CI). All other data were narratively described. Quality and risk of bias appraisal was performed, based on the Cochrane risk of bias tool. RESULTS: Screening of 11 727 records yielded 56 relevant full texts. There were 15 included studies, eight trialling hypnosis, and seven nonhypnosis interventions. There were large, statistically significant reductions in anxiety and pain for hypnosis, particularly compared with treatment as usual (anxiety: d = 2.30; 95% CI, 1.30-3.30; P
Abstract.
Author URL.
Lloyd J, Creanor S, Logan S, Green C, Dean SG, Hillsdon M, Abraham C, Tomlinson R, Pearson V, Taylor RS, et al (2018). Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial.
The Lancet Child and Adolescent Health,
2(1), 35-45.
Abstract:
Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial
Background Although childhood overweight and obesity prevalence has increased substantially worldwide in the past three decades, scarce evidence exists for effective preventive strategies. We aimed to establish whether a school-based intervention for children aged 9–10 years would prevent excessive weight gain after 24 months. Methods This pragmatic cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP), a school-based obesity prevention intervention, was done in 32 schools in southwest England. All state-run primary and junior schools in Devon and Plymouth (UK) with enough pupils for at least one year-5 class were eligible. Schools were assigned (1:1) using a computer-generated sequence to either intervention or control, stratified by the number of year-5 classes (one vs more than one) and the proportion of children eligible for free school meals (
Abstract.
Borek A, McDonald B, Fredlund M, Bjornstad GJ, Logan GS, Morris C (2018). Healthy Parent Carers programme: development and feasibility of a novel group-based health-promotion intervention. BMC Public Health, 18, 270-270.
Husk K, Berry VL, Tozer R, Skipworth G, Radmore R, Ball S, Ukoumunne O, Logan S (2018). Interventions for reducing unplanned paediatric admissions: an observational study in one hospital. BMJ Paediatrics Open
Titheradge D, Hayes R, Longdon B, Allen K, Price A, Hansford L, Nye E, Ukoumunne O, Byford S, Norwich B, et al (2018). Psychological distress amongst primary school teachers: a comparison with clinical and population samples. Public Health, 166, 53-56.
Abbott RA, Martin AE, Newlove-Delgado TV, Bethel A, Whear RS, Thompson Coon J, Logan S (2018). Recurrent Abdominal Pain in Children: Summary Evidence from 3 Systematic Reviews of Treatment Effectiveness.
J Pediatr Gastroenterol Nutr,
67(1), 23-33.
Abstract:
Recurrent Abdominal Pain in Children: Summary Evidence from 3 Systematic Reviews of Treatment Effectiveness.
OBJECTIVES: Between 4% and 25% of school-aged children complain of recurrent abdominal pain (RAP) severe enough to interfere with their daily activities. METHODS: We carried out a systematic review of randomised controlled trials (RCTs) in eleven databases and 2 trials registries from inception to June 2016. An update search was run in November 2017. All screening was performed by 2 independent reviewers. Included studies were appraised using the Cochrane risk of bias tool and the evidence assessed using GRADE. We included any dietary, pharmacological or psychosocial intervention for RAP, defined by Apley or an abdominal pain-related functional gastrointestinal disorder, as defined by the Rome III criteria, in children and adolescents. RESULTS: We included 55 RCTs, involving 3572 children with RAP (21 dietary, 15 pharmacological, 19 psychosocial, and 1 multiarm). We found probiotic diets, cognitive-behavioural therapy (CBT) and hypnotherapy were reported to reduce pain in the short-term and there is some evidence of medium term effectiveness. There was insufficient evidence of effectiveness for all other dietary interventions and psychosocial therapies. There was no robust evidence of effectiveness for pharmacological interventions. CONCLUSIONS: Overall the evidence base for treatment decisions is poor. These data suggest that probiotics, CBT, and hypnotherapy could be considered as part of holistic management of children with RAP. The evidence regarding relative effectiveness of different strains of probiotics is currently insufficient to guide clinical practice. The lack of evidence of effectiveness for any drug suggests that there is little justification for their use outside of well-conducted clinical trials. There is an urgent need for high-quality RCTs to provide evidence to guide management of this common condition.
Abstract.
Author URL.
Ford T, Hayes RA, Byford S, Edwards V, Fletcher M, Logan G, Norwich B, Pritchard W, Allen K, Allwood M, et al (2018). The effectiveness and cost-effectiveness of the Incredible Years® Teacher Classroom Management programme in primary school children: results of the STARS cluster randomised controlled trial.
Psychological MedicineAbstract:
The effectiveness and cost-effectiveness of the Incredible Years® Teacher Classroom Management programme in primary school children: results of the STARS cluster randomised controlled trial
Abstract
Background. We evaluated the effectiveness and cost-effectiveness of the Incredible Years® Teacher Classroom Management (TCM) programme as a universal intervention, given schools’ important influence on child mental health.
Methods. A two-arm, pragmatic, parallel group, superiority, cluster randomised controlled trial recruited three cohorts of schools (clusters) between 2012 and 2014, randomising them to TCM (intervention) or Teaching As Usual (TAU-control). TCM was delivered to teachers
in six whole-day sessions, spread over 6 months. Schools and teachers were not masked to allocation. The primary outcome was teacher-reported Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score. Random effects linear regression and marginal logistic regression models using Generalised Estimating Equations were used to analyse the
outcomes. Trial registration: ISRCTN84130388.
Results. Eighty schools (2075 children) were enrolled; 40 (1037 children) to TCM and 40 (1038 children) to TAU. Outcome data were collected at 9, 18, and 30-months for 96, 89, and 85% of children, respectively. The intervention reduced the SDQ-Total Difficulties score at 9 months (mean (S.D.):5.5 (5.4) in TCM v. 6.2 (6.2) in TAU; adjusted mean difference
= −1.0; 95% CI−1.9 to −0.1; p = 0.03) but this did not persist at 18 or 30 months. Cost-effectiveness analysis suggested that TCM may be cost-effective compared with TAU at 30-months, but this result was associated with uncertainty so no firm conclusions can be drawn. A priori
subgroup analyses suggested TCM is more effective for children with poor mental health.
Conclusions. TCM provided a small, short-term improvement to children’s mental health particularly for children who are already struggling.
Abstract.
2017
Newlove-Delgado TV, Martin AE, Abbott RA, Bethel A, Thompson-Coon J, Whear R, Logan S (2017). Dietary interventions for recurrent abdominal pain in childhood.
Cochrane Database Syst Rev,
3(3).
Abstract:
Dietary interventions for recurrent abdominal pain in childhood.
BACKGROUND: This is an update of the original Cochrane review, last published in 2009 (Huertas-Ceballos 2009). Recurrent abdominal pain (RAP), including children with irritable bowel syndrome, is a common problem affecting between 4% and 25% of school-aged children. For the majority of such children, no organic cause for their pain can be found on physical examination or investigation. Many dietary inventions have been suggested to improve the symptoms of RAP. These may involve either excluding ingredients from the diet or adding supplements such as fibre or probiotics. OBJECTIVES: to examine the effectiveness of dietary interventions in improving pain in children of school age with RAP. SEARCH METHODS: We searched CENTRAL, Ovid MEDLINE, Embase, eight other databases, and two trials registers, together with reference checking, citation searching and contact with study authors, in June 2016. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing dietary interventions with placebo or no treatment in children aged five to 18 years with RAP or an abdominal pain-related, functional gastrointestinal disorder, as defined by the Rome III criteria (Rasquin 2006). DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We grouped dietary interventions together by category for analysis. We contacted study authors to ask for missing information and clarification, when needed. We assessed the quality of the evidence for each outcome using the GRADE approach. MAIN RESULTS: We included 19 RCTs, reported in 27 papers with a total of 1453 participants. Fifteen of these studies were not included in the previous review. All 19 RCTs had follow-up ranging from one to five months. Participants were aged between four and 18 years from eight different countries and were recruited largely from paediatric gastroenterology clinics. The mean age at recruitment ranged from 6.3 years to 13.1 years. Girls outnumbered boys in most trials. Fourteen trials recruited children with a diagnosis under the broad umbrella of RAP or functional gastrointestinal disorders; five trials specifically recruited only children with irritable bowel syndrome. The studies fell into four categories: trials of probiotic-based interventions (13 studies), trials of fibre-based interventions (four studies), trials of low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diets (one study), and trials of fructose-restricted diets (one study).We found that children treated with probiotics reported a greater reduction in pain frequency at zero to three months postintervention than those given placebo (standardised mean difference (SMD) -0.55, 95% confidence interval (CI) -0.98 to -0.12; 6 trials; 523 children). There was also a decrease in pain intensity in the intervention group at the same time point (SMD -0.50, 95% CI -0.85 to -0.15; 7 studies; 575 children). However, we judged the evidence for these outcomes to be of low quality using GRADE due to an unclear risk of bias from incomplete outcome data and significant heterogeneity.We found that children treated with probiotics were more likely to experience improvement in pain at zero to three months postintervention than those given placebo (odds ratio (OR) 1.63, 95% CI 1.07 to 2.47; 7 studies; 722 children). The estimated number needed to treat for an additional beneficial outcome (NNTB) was eight, meaning that eight children would need to receive probiotics for one to experience improvement in pain in this timescale. We judged the evidence for this outcome to be of moderate quality due to significant heterogeneity.Children with a symptom profile defined as irritable bowel syndrome treated with probiotics were more likely to experience improvement in pain at zero to three months postintervention than those given placebo (OR 3.01, 95% CI 1.77 to 5.13; 4 studies; 344 children). Children treated with probiotics were more likely to experience improvement in pain at three to six months postintervention compared to those receiving placebo (OR 1.94, 95% CI 1.10 to 3.43; 2 studies; 224 children). We judged the evidence for these two outcomes to be of moderate quality due to small numbers of participants included in the studies.We found that children treated with fibre-based interventions were not more likely to experience an improvement in pain at zero to three months postintervention than children given placebo (OR 1.83, 95% CI 0.92 to 3.65; 2 studies; 136 children). There was also no reduction in pain intensity compared to placebo at the same time point (SMD -1.24, 95% CI -3.41 to 0.94; 2 studies; 135 children). We judged the evidence for these outcomes to be of low quality due to an unclear risk of bias, imprecision, and significant heterogeneity.We found only one study of low FODMAP diets and only one trial of fructose-restricted diets, meaning no pooled analyses were possible.We were unable to perform any meta-analyses for the secondary outcomes of school performance, social or psychological functioning, or quality of daily life, as not enough studies included these outcomes or used comparable measures to assess them.With the exception of one study, all studies reported monitoring children for adverse events; no major adverse events were reported. AUTHORS' CONCLUSIONS: Overall, we found moderate- to low-quality evidence suggesting that probiotics may be effective in improving pain in children with RAP. Clinicians may therefore consider probiotic interventions as part of a holistic management strategy. However, further trials are needed to examine longer-term outcomes and to improve confidence in estimating the size of the effect, as well as to determine the optimal strain and dosage. Future research should also explore the effectiveness of probiotics in children with different symptom profiles, such as those with irritable bowel syndrome.We found only a small number of trials of fibre-based interventions, with overall low-quality evidence for the outcomes. There was therefore no convincing evidence that fibre-based interventions improve pain in children with RAP. Further high-quality RCTs of fibre supplements involving larger numbers of participants are required. Future trials of low FODMAP diets and other dietary interventions are also required to facilitate evidence-based recommendations.
Abstract.
Author URL.
Gumm R, Thomas E, Lloyd C, Hambly H, Tomlinson R, Logan G, Morris C (2017). Improving communication between staff and disabled children in hospital wards: testing the feasibility of a training intervention developed through intervention mapping. BMJ Paediatrics Open, 1e000103
Ganguli P, Ford T, Edwards V, Sharkey S, Ukoumunne OC, Norwich B, Logan S, Byford S (2017). Methods for Cost-Effectiveness Analysis of a School-Based Intervention: Evaluating the Incredible Years Teacher Classroom Management Programme.
Author URL.
Martin AE, Newlove-Delgado TV, Abbott RA, Bethel A, Thompson-Coon J, Whear R, Logan S (2017). Pharmacological interventions for recurrent abdominal pain in childhood.
Cochrane Database of Systematic Reviews,
2017(3).
Abstract:
Pharmacological interventions for recurrent abdominal pain in childhood
Background: Between 4% and 25% of school-aged children at some stage complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with their daily lives. When no clear organic cause is found, the children are managed with reassurance and simple measures; a large range of pharmacological interventions have been recommended for use in these children. Objectives: to determine the effectiveness of pharmacological interventions for RAP in children of school age. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, and eight other electronic databases up to June 2016. We also searched two trials registers and contacted researchers of published studies. Selection criteria: Randomised controlled trials involving children aged five to 18 years old with RAP or an abdominal pain-related functional gastrointestinal disorder, as defined by the Rome III criteria (Rasquin 2006). The interventions were any pharmacological intervention compared to placebo, no treatment, waiting list, or standard care. The primary outcome measures were pain intensity, pain duration or pain frequency, and improvement in pain. The secondary outcome measures were school performance, social or psychological functioning, and quality of daily life. Data collection and analysis: Two review authors independently screened titles, abstracts, and potentially relevant full-text reports for eligible studies. Two review authors extracted data and performed a 'Risk of bias' assessment. We used the GRADE approach to rate the overall quality of the evidence. We deemed a meta-analysis to be not appropriate as the studies were significantly heterogeneous. We have consequently provided a narrative summary of the results. Main results: This review included 16 studies with a total of 1024 participants aged between five and 18 years, all of whom were recruited from paediatric outpatient clinics. Studies were conducted in seven countries: seven in the USA, four in Iran, and one each in the UK, Switzerland, Turkey, Sri Lanka, and India. Follow-up ranged from two weeks to four months. The studies examined the following interventions to treat RAP: tricyclic antidepressants, antibiotics, 5-HT4 receptor agonists, antispasmodics, antihistamines, H2 receptor antagonists, serotonin antagonists, selective serotonin re-uptake inhibitors, a dopamine receptor antagonist, and a hormone. Although some single studies reported that treatments were effective, all of these studies were either small or had key methodological weaknesses with a substantial risk of bias. None of these 'positive' results have been reproduced in subsequent studies. We judged the evidence of effectiveness to be of low quality. No adverse effects were reported in these studies. Authors' conclusions: There is currently no convincing evidence to support the use of drugs to treat RAP in children. Well-conducted clinical trials are needed to evaluate any possible benefits and risks of pharmacological interventions. In practice, if a clinician chooses to use a drug as a 'therapeutic trial', they and the patient need to be aware that RAP is a fluctuating condition and any 'response' may reflect the natural history of the condition or a placebo effect, rather than drug efficacy.
Abstract.
Abbott RA, Martin AE, Newlove-Delgado TV, Bethel A, Thompson-Coon J, Whear R, Logan S (2017). Psychosocial interventions for recurrent abdominal pain in childhood.
Cochrane Database Syst Rev,
1(1).
Abstract:
Psychosocial interventions for recurrent abdominal pain in childhood.
BACKGROUND: This review supersedes the original Cochrane review first published in 2008 (Huertas-Ceballos 2008).Between 4% and 25% of school-aged children complain of recurrent abdominal pain (RAP) severe enough to interfere with their daily activities. No organic cause for this pain can be found on physical examination or investigation for the majority of such children. Although many children are managed by reassurance and simple measures, a large range of psychosocial interventions involving cognitive and behavioural components have been recommended. OBJECTIVES: to determine the effectiveness of psychosocial interventions for reducing pain in school-aged children with RAP. SEARCH METHODS: in June 2016 we searched CENTRAL, MEDLINE, Embase, eight other databases, and two trials registers. We also searched the references of identified studies and relevant reviews. SELECTION CRITERIA: Randomised controlled trials comparing psychosocial therapies with usual care, active control, or wait-list control for children and adolescents (aged 5 to 18 years) with RAP or an abdominal pain-related functional gastrointestinal disorder defined by the Rome III criteria were eligible for inclusion. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Five review authors independently selected studies, assessed them for risk of bias, and extracted relevant data. We also assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: This review includes 18 randomised controlled trials (14 new to this version), reported in 26 papers, involving 928 children and adolescents with RAP between the ages of 6 and 18 years. The interventions were classified into four types of psychosocial therapy: cognitive behavioural therapy (CBT), hypnotherapy (including guided imagery), yoga, and written self-disclosure. The studies were carried out in the USA, Australia, Canada, the Netherlands, Germany, and Brazil. The majority of the studies were small and short term; only two studies included more than 100 participants, and only five studies had follow-up assessments beyond six months. Small sample sizes and the degree of assessed risk of performance and detection bias in many studies led to the overall quality of the evidence being rated as low to very low for all outcomes.For CBT compared to control, we found evidence of treatment success postintervention (odds ratio (OR) 5.67, 95% confidence interval (CI) 1.18 to 27.32; Z = 2.16; P = 0.03; 4 studies; 175 children; very low-quality evidence), but no evidence of treatment success at medium-term follow-up (OR 3.08, 95% CI 0.93 to 10.16; Z = 1.85; P = 0.06; 3 studies; 139 children; low-quality evidence) or long-term follow-up (OR 1.29, 95% CI 0.50 to 3.33; Z = 0.53; P = 0.60; 2 studies; 120 children; low-quality evidence). We found no evidence of effects of intervention on pain intensity scores measured postintervention (standardised mean difference (SMD) -0.33, 95% CI -0.74 to 0.08; 7 studies; 405 children; low-quality evidence), or at medium-term follow-up (SMD -0.32, 95% CI -0.85 to 0.20; 4 studies; 301 children; low-quality evidence).For hypnotherapy (including studies of guided imagery) compared to control, we found evidence of greater treatment success postintervention (OR 6.78, 95% CI 2.41 to 19.07; Z = 3.63; P = 0.0003; 4 studies; 146 children; low-quality evidence) as well as reductions in pain intensity (SMD -1.01, 95% CI -1.41 to -0.61; Z = 4.97; P < 0.00001; 4 studies; 146 children; low-quality evidence) and pain frequency (SMD -1.28, 95% CI -1.84 to -0.72; Z = 4.48; P < 0.00001; 4 studies; 146 children; low-quality evidence). The only study of long-term effect reported continued benefit of hypnotherapy compared to usual care after five years, with 68% reporting treatment success compared to 20% of controls (P = 0.005).For yoga therapy compared to control, we found no evidence of effectiveness on pain intensity reduction postintervention (SMD -0.31, 95% CI -0.67 to 0.05; Z = 1.69; P = 0.09; 3 studies; 122 children; low-quality evidence).The single study of written self-disclosure therapy reported no benefit for pain.There was no evidence of effect from the pooled analyses for any type of intervention on the secondary outcomes of school performance, social or psychological functioning, and quality of daily life.There were no adverse effects for any of the interventions reported. AUTHORS' CONCLUSIONS: the data from trials to date provide some evidence for beneficial effects of CBT and hypnotherapy in reducing pain in the short term in children and adolescents presenting with RAP. There was no evidence for the effectiveness of yoga therapy or written self-disclosure therapy. There were insufficient data to explore effects of treatment by RAP subtype.Higher-quality, longer-duration trials are needed to fully investigate the effectiveness of psychosocial interventions. Identifying the active components of the interventions and establishing whether benefits are sustained in the long term are areas of priority. Future research studies would benefit from employing active control groups to help minimise potential bias from wait-list control designs and to help account for therapist and intervention time.
Abstract.
Author URL.
Paudyal P, Smith J, Robinson M, South A, Higginson I, Reuben A, Shaffee J, Black S, Logan S (2017). Tranexamic acid in major trauma: implementation and evaluation across South West England.
Eur J Emerg Med,
24(1), 44-48.
Abstract:
Tranexamic acid in major trauma: implementation and evaluation across South West England.
OBJECTIVE: to carry out a prospective evaluation of tranexamic acid (TXA) use in trauma patients. PATIENTS AND METHODS: TXA was introduced to all emergency ambulances and emergency departments in the South West, UK, on 1 December 2011. We carried out a prospective evaluation of TXA use in trauma patients in the South West Peninsula between December 2011 and December 2012. We collected prehospital and hospital data on TXA administration using the Trauma Audit Research Network database. Data on prehospital administration of TXA were cross-checked with the South Western Ambulance Service Trust. Data were analysed using SPSS (version 20). RESULTS: Altogether, 82 patients were administered TXA during the study period. The median age of the patients was 49 years (IQR 30, 66), and 72% were men. One-third of the patients arrived at hospital by air ambulance. During the first 3 months, administration of TXA was limited to one patient each month receiving the drug. However, an upward trend was observed after June until October 2012, with the increment being more than 10 fold in July, September and October 2012. CONCLUSION: This is the first study to evaluate the use of TXA in civilian practice in the UK. Our study shows that ambulance service personnel and emergency departments can effectively administer TXA.
Abstract.
Author URL.
Lloyd J, Creanor S, Price LRS, Abraham C, Dean S, Green C, Hillsdon M, Pearson V, Taylor R, Tomlinson R, et al (2017). Trial baseline characteristics of a cluster randomised controlled trial of a school-located obesity prevention programme; the Healthy Lifestyles Programme (HeLP) trial. BMC Public Health
2015
Janssens A, Thompson-Coon J, Rogers M, Allen K, Green C, Jenkinson C, Tennant A, Logan S, Morris C (2015). A Systematic Review of Generic Multidimensional Patient-Reported Outcome Measures for Children, Part I: Descriptive Characteristics. Value in Health
Janssens A, Rogers M, Thompson Coon J, Allen K, Green C, Jenkinson C, Tennant A, Logan S, Morris C (2015). A Systematic Review of Generic Multidimensional Patient-Reported Outcome Measures for Children, Part II: Evaluation of Psychometric Performance of English-Language Versions in a General Population. Value in Health, 18(2), 334-345.
Williams AJ, Wyatt KM, Williams CA, Logan S, Henley WE (2015). Exploring the Potential of a School Impact on Pupil Weight Status: Exploratory Factor Analysis and Repeat Cross-Sectional Study of the National Child Measurement Programme.
PLoS One,
10(12).
Abstract:
Exploring the Potential of a School Impact on Pupil Weight Status: Exploratory Factor Analysis and Repeat Cross-Sectional Study of the National Child Measurement Programme.
Schools are common sites for obesity prevention interventions. Although many theories suggest that the school context influences weight status, there has been little empirical research. The objective of this study was to explore whether features of the school context were consistently and meaningfully associated with pupil weight status (overweight or obese). Exploratory factor analysis of routinely collected data on 319 primary schools in Devon, England, was used to identify possible school-based contextual factors. Repeated cross-sectional multilevel analysis of five years (2006/07-2010/11) of data from the National Child Measurement Programme was then used to test for consistent and meaningful associations. Four school-based contextual factors were derived which ranked schools according to deprivation, location, resource and prioritisation of physical activity. None of which were meaningfully and consistently associated with pupil weight status, across the five years. The lack of consistent associations between the factors and pupil weight status suggests that the school context is not inherently obesogenic. In contrast, incorporating findings from education research indicates that schools may be equalising weight status, and obesity prevention research, policy and practice might need to address what is happening outside schools and particularly during the school holidays.
Abstract.
Author URL.
Morris C, Janssens A, Shilling V, Allard A, Fellowes A, Tomlinson R, Williams J, Thompson Coon J, Rogers M, Beresford B, et al (2015). Meaningful health outcomes for paediatric neurodisability: stakeholder prioritisation and appropriateness of patient reported outcome measures.
Health and Quality of Life Outcomes,
13:87Abstract:
Meaningful health outcomes for paediatric neurodisability: stakeholder prioritisation and appropriateness of patient reported outcome measures
Background
Health services are increasingly focused on measuring and monitoring outcomes, particularly those that reflect patients’ priorities. To be meaningful, outcomes measured should be valued by patients and carers, be consistent with what health professionals seek to achieve, and be robust in terms of measurement properties.
The aim of this study was (i) to seek a shared vision between families and clinicians regarding key aspects of health as outcomes, beyond mortality and morbidity, for children with neurodisability, and (ii) to appraise which multidimensional patient reported outcome measures (PROMs) could be used to assess salient health domains.
Methods
Relevant outcomes were identified from (i) qualitative research with children and young people with neurodisability and parent carers, (ii) Delphi survey with health professionals, and (iii) systematic review of PROMs. The International Classification of Functioning Disability and Health provided a common language to code aspects of health. A subset of stakeholders participated in a prioritisation meeting incorporating a Q-sorting task to discuss and rank aspects of health.
Results
A total of 33 pertinent aspects of health were identified. Fifteen stakeholders from the qualitative and Delphi studies participated in the prioritisation meeting: 3 young people, 5 parent carers, and 7 health professionals. Aspects of health that emerged as more important for families and targets for health professionals were: communication, emotional wellbeing, pain, sleep, mobility, self-care, independence, mental health, community and social life, behaviour, toileting and safety. Whilst available PROMs measure many aspects of health in the ICF, no single PROM captures all the key domains prioritised as for children and young people with neurodisability. The paucity of scales for assessing communication was notable.
Conclusions
We propose a core suite of key outcome domains for children with neurodisability that could be used in evaluative research, audit and as health service performance indicators. Future work could appraise domain-specific PROMs for these aspects of health; a single measure assessing the key aspects of health that could be applied across paediatric neurodisability remains to be developed.
Abstract.
Author URL.
Janssens A, Rogers M, Gumm R, Jenkinson C, Tennant A, Logan, Morris C (2015). Measurement properties of multidimensional patient-reported outcome measures in neurodisability: a systematic review of evaluation studies.
Developmental Medicine & Child Neurology Author URL.
Richardson M, Moore D, Gwernan-Jones R, Thompson-Coon J, Ukoumunne O, Rogers M, Whear R, Newlove-Delgado T, Logan S, Morris C, et al (2015). Non pharmacological interventions for Attention Deficit Hyperactivity Disorder (ADHD) delivered in school settings: Systematic reviews of quantitative and qualitative research. Health Technology Assessment, 19(45)
Moore, DA, Richardson, M, Gwernan-Jones, R, Thompson-Coon, J, Stein, K, Rogers, M, Garside, R, Logan, S, Ford, TJ (2015). Non-pharmacological interventions for ADHD in school settings: an overarching synthesis of systematic reviews.
Journal of Attention Disorders, 1-14.
Abstract:
Non-pharmacological interventions for ADHD in school settings: an overarching synthesis of systematic reviews
Objective: This overarching synthesis brings together the findings of four systematic reviews including 138 studies focused on non-pharmacological interventions for ADHD used in school settings. These reviews considered the effectiveness of school-based interventions for ADHD, attitudes towards and experience of school-based interventions for ADHD, and the experience of ADHD in school settings. Method: We developed novel methods to compare the findings across these reviews inductively and deductively. Results: Key contextual issues that may influence the effectiveness and implementation of interventions include the relationships that pupils with ADHD have with their teachers and peers, the attributions individuals make about the etiology of ADHD, and stigma related to ADHD or intervention attendance. Conclusion: Although we found some positive effects for some outcomes and intervention categories, heterogeneity in effect size estimates and research evidence suggests a range of diverse contextual factors potentially moderate the implementation and effectiveness of school based interventions for ADHD.
Abstract.
Shilling V, Bailey S, Logan S, Morris C (2015). Peer support for parents of disabled children part 1: Perceived outcomes of a one-to-one service, a qualitative study.
Child: Care, Health and Development,
41(4), 524-536.
Abstract:
Peer support for parents of disabled children part 1: Perceived outcomes of a one-to-one service, a qualitative study
Background: Parents of disabled children are encouraged to seek peer support. Delivering one-to-one support requires resources; therefore, investigating how these services may impact on families and those providing the service is important when evaluating such services. Methods: We carried out a qualitative study involving semi-structured interviews and focus groups. Participants were 12 parents and 23 befrienders who had contact with the Face2Face one-to-one befriending service in Devon and Cornwall during a 12-month period, and 10 professionals from health, social care and education services. Findings: Shared experience was perceived central to successful peer support and was a catalyst for other elements of support, enabling parents to (i) learn from the experience of others; (ii) speak freely in a safe and non-judgemental environment; and (iii) receive support and encouragement from their befriender. These elements underpinned perceived outcomes for both parents providing and receiving support. Outcomes for parents receiving support centred on emotional stability, personal growth and reduced isolation. Supporting parents experienced positive outcomes through their training, mutual support and the feeling that they were helping others. Parents and befrienders appeared to benefit through expanding their social network. Nevertheless providing support was reported to create emotional burden and concerns for befrienders around their performance, and also required a substantial time commitment. Conclusions: Befrienders as well as parents perceived positive outcomes from their involvement in peer support although there is also potential for less positive impact on those offering support.
Abstract.
Shilling V, Bailey S, Logan S, Morris C (2015). Peer support for parents of disabled children part 1: perceived outcomes of a one-to-one service, a qualitative study.
Child Care Health Dev,
41(4), 524-536.
Abstract:
Peer support for parents of disabled children part 1: perceived outcomes of a one-to-one service, a qualitative study.
BACKGROUND: Parents of disabled children are encouraged to seek peer support. Delivering one-to-one support requires resources; therefore, investigating how these services may impact on families and those providing the service is important when evaluating such services. METHODS: We carried out a qualitative study involving semi-structured interviews and focus groups. Participants were 12 parents and 23 befrienders who had contact with the Face2Face one-to-one befriending service in Devon and Cornwall during a 12-month period, and 10 professionals from health, social care and education services. FINDINGS: Shared experience was perceived central to successful peer support and was a catalyst for other elements of support, enabling parents to (i) learn from the experience of others; (ii) speak freely in a safe and non-judgemental environment; and (iii) receive support and encouragement from their befriender. These elements underpinned perceived outcomes for both parents providing and receiving support. Outcomes for parents receiving support centred on emotional stability, personal growth and reduced isolation. Supporting parents experienced positive outcomes through their training, mutual support and the feeling that they were helping others. Parents and befrienders appeared to benefit through expanding their social network. Nevertheless providing support was reported to create emotional burden and concerns for befrienders around their performance, and also required a substantial time commitment. CONCLUSIONS: Befrienders as well as parents perceived positive outcomes from their involvement in peer support although there is also potential for less positive impact on those offering support.
Abstract.
Author URL.
Shilling V, Bailey S, Logan S, Morris C (2015). Peer support for parents of disabled children part 2: How organizational and process factors influenced shared experience in a one-to-one service, a qualitative study.
Child: Care, Health and Development,
41(4), 537-546.
Abstract:
Peer support for parents of disabled children part 2: How organizational and process factors influenced shared experience in a one-to-one service, a qualitative study
Background: Parents of disabled children often seek support from their peers. The shared experience between parents appears to be a crucial mediating factor. Understanding how a sense of shared experience is fostered can help to design and evaluate services that seek to provide peer support. Methods: We carried out a qualitative study involving semi-structured interviews and focus groups. Participants were 12 parents and 23 befrienders who had contact with the Face2Face one-to-one befriending service in Devon and Cornwall during a 12-month period, and 10 professionals from health, social care and education. Findings: Formal structures and processes in place such as training and ongoing supervision and support were highly valued as was the highly personalized, confidential, flexible, one-to-one at-home nature of the service. Crucial to establishing rapport was putting the right people together and ensuring a good match between befrienders and parents. Clearly, the befriending parent has to be emotionally prepared to provide help. However, if the parent being offered support was not ready to accept help at the time it was offered or the type of support was not right for them, they are less likely to engage with the service. Conclusion: Organizational and process factors as well as characteristics of the parents offering and receiving support contribute to the sense of shared experience in one-to-one peer support. These factors interact to influence whether peer support is effective and should be explicitly considered when designing and evaluating services.
Abstract.
Shilling V, Bailey S, Logan S, Morris C (2015). Peer support for parents of disabled children part 2: how organizational and process factors influenced shared experience in a one-to-one service, a qualitative study.
Child Care Health Dev,
41(4), 537-546.
Abstract:
Peer support for parents of disabled children part 2: how organizational and process factors influenced shared experience in a one-to-one service, a qualitative study.
BACKGROUND: Parents of disabled children often seek support from their peers. The shared experience between parents appears to be a crucial mediating factor. Understanding how a sense of shared experience is fostered can help to design and evaluate services that seek to provide peer support. METHODS: We carried out a qualitative study involving semi-structured interviews and focus groups. Participants were 12 parents and 23 befrienders who had contact with the Face2Face one-to-one befriending service in Devon and Cornwall during a 12-month period, and 10 professionals from health, social care and education. FINDINGS: Formal structures and processes in place such as training and ongoing supervision and support were highly valued as was the highly personalized, confidential, flexible, one-to-one at-home nature of the service. Crucial to establishing rapport was putting the right people together and ensuring a good match between befrienders and parents. Clearly, the befriending parent has to be emotionally prepared to provide help. However, if the parent being offered support was not ready to accept help at the time it was offered or the type of support was not right for them, they are less likely to engage with the service. CONCLUSION: Organizational and process factors as well as characteristics of the parents offering and receiving support contribute to the sense of shared experience in one-to-one peer support. These factors interact to influence whether peer support is effective and should be explicitly considered when designing and evaluating services.
Abstract.
Author URL.
Blake SF, Logan G, Humphreys G, Matthews J, Rogers M, Thompson Coon J, Wyatt K, Morris C (2015). Sleep positioning systems for children with cerebral palsy.
Cochrane Database of Systematic Reviews(11:CD009257).
Author URL.
Marlow R, Hansford L, Edwards V, Ukoumunne O, Norman S, Ingarfield S, Sharkey S, Logan S, Ford T (2015). Teaching classroom management – a potential public health intervention?.
Health Education,
115(3-4), 230-248.
Abstract:
Teaching classroom management – a potential public health intervention?
Purpose – the purpose of this paper is to explore the feasibility of a classroom management course as a public health intervention. Improved socio-emotional skills may boost children’s developmental and academic trajectory, while the costs of behaviour problems are enormous for schools with considerable impact on others’ well-being. Design/methodology/approach – in total, 40 teachers attended the Incredible Years (IY) Teacher Classroom Management (TCM) intervention in groups of ten. Afterwards teachers attended focus groups and semi-structured interviews were completed with headteachers to explore whether TCM was feasible, relevant and useful, research processes were acceptable and if it influenced teachers’ practice and pupils. Teachers completed standardised questionnaires about their professional self-efficacy, burnout and well-being before and after attendance. Findings – in all, 37/40 teachers completed the course. Teachers valued sharing experiences, the support of colleagues in the group and time out to reflect on practice and rehearse new techniques. Most teachers reported that they applied the strategies with good effect in their classrooms. Teachers’ questionnaires suggested an improvement in their self-efficacy in relation to classroom management (p=0.03); other scales changed in the predicted direction but did not reach statistical significance. Research limitations/implications – Although preliminary and small, these feasibility study findings suggest that it was worthwhile proceeding to a definitive randomised controlled trial (RCT). Practical implications – Should the RCT demonstrate effectiveness, then the intervention is an obvious candidate for implementation as a whole school approach. Originality/value – Successful intervention with one teacher potentially benefits every child that they subsequently teach and may increase the inclusion of socio-economically deprived children living in challenging circumstances in mainstream education.
Abstract.
Morris C, Janssens A, Allard A, Coon JT, Shilling V, Tomlinson R, Williams J, Fellowes A, Rogers M, Allen K, et al (2015). Towards a shared vision for measureable and meaningful health outcomes for children and young people with neurodisability: qualitative research, Delphi survey, systematic review, and stakeholder prioritisation.
Author URL.
Hansford L, Sharkey S, Edwards V, Ukoumunne O, Byford S, Norwich B, Logan S, Ford T (2015). Understanding influences on teachers' uptake and use of behaviour management strategies within the STARS trial: process evaluation protocol for a randomised controlled trial.
BMC Public Health,
15Abstract:
Understanding influences on teachers' uptake and use of behaviour management strategies within the STARS trial: process evaluation protocol for a randomised controlled trial.
BACKGROUND: the 'Supporting Teachers and childRen in Schools' (STARS) study is a cluster randomised controlled trial evaluating the Incredible Years Teacher Classroom Management (TCM) programme as a public health intervention. TCM is a 6 day training course delivered to groups of 8-12 teachers. The STARS trial will investigate whether TCM can improve children's behaviour, attainment and wellbeing, reduce teachers' stress and improve their self-efficacy. This protocol describes the methodology of the process evaluation embedded within the main trial, which aims to examine the uptake and implementation of TCM strategies within the classroom plus the wider school environment and improve the understanding of outcomes. METHODS/DESIGN: the STARS trial will work with eighty teachers of children aged 4-9 years from eighty schools. Teachers will be randomised to attend the TCM course (intervention arm) or to "teach as normal" (control arm) and attend the course a year later. The process evaluation will use quantitative and qualitative approaches to assess fidelity to model, as well as explore headteachers' and teachers' experiences of TCM and investigate school factors that influence the translation of skills learnt to practice. Four of the eight groups of teachers (n = 40) will be invited to participate in focus groups within one month of completing the TCM course, and again a year later, while 45 of the 80 headteachers will be invited to take part in telephone interviews. Standardised checklists will be completed by group leaders and each training session will be videotaped to assess fidelity to model. Teachers will also complete standardised session evaluations. DISCUSSION: This study will provide important information about whether the Teacher Classroom Management course influences child and teacher mental health and well-being in both the short and long term. The process evaluation will provide valuable insights into factors that may facilitate or impede any impact. TRIAL REGISTRATION: the trial has been registered with ISCTRN (Controlled Trials Ltd) and assigned an ISRCTN number ISRCTN84130388. Date assigned: 15 May 2012.
Abstract.
Author URL.
Hansford L, Sharkey S, Edwards V, Ukoumunne O, Byford S, Norwich B, Logan S, Ford T (2015). Understanding influences on teachers' uptake and use of behaviour management strategies within the STARS trial: process evaluation protocol for a randomised controlled trial.
BMC Public Health,
15Abstract:
Understanding influences on teachers' uptake and use of behaviour management strategies within the STARS trial: process evaluation protocol for a randomised controlled trial.
The 'Supporting Teachers and childRen in Schools' (STARS) study is a cluster randomised controlled trial evaluating the Incredible Years Teacher Classroom Management (TCM) programme as a public health intervention. TCM is a 6 day training course delivered to groups of 8-12 teachers. The STARS trial will investigate whether TCM can improve children's behaviour, attainment and wellbeing, reduce teachers' stress and improve their self-efficacy. This protocol describes the methodology of the process evaluation embedded within the main trial, which aims to examine the uptake and implementation of TCM strategies within the classroom plus the wider school environment and improve the understanding of outcomes.
Abstract.
Author URL.
Shilling V, Morris C, Hawton A, Bailey S, Logan S (2015).
What are the benefits and costs of providing peer support to parents of disabled children?., Final Report: PenCLAHRC, University of Exeter Medical School.
Abstract:
What are the benefits and costs of providing peer support to parents of disabled children?
Abstract.
Author URL.
2014
Williams AJ, Wyatt KM, Williams CA, Logan S, Henley WE (2014). A repeated cross-sectional study examining the school impact on child weight status.
Prev Med,
64(100), 103-107.
Abstract:
A repeated cross-sectional study examining the school impact on child weight status.
OBJECTIVE: the aim of this study is to examine whether there is a differential impact of primary schools upon children's weight status. METHODS: a repeated cross-sectional study was undertaken using five years (2006/07-2010/11) of National Child Measurement Programme data, comprising 57,976 children (aged 4-5 (Reception) and 10-11 (Year 6) years) from 300 primary schools across Devon, England. Examining each year separately, the schools were ranked according to their observed and residual (having accounted for school and neighbourhood clustering and pupil ethnicity and socioeconomic status) school mean body mass index standard deviation score (BMI-SDS). Subtracting the Reception from the Year 6 mean residuals gave 'value-added' scores for each school which were also ranked. The rankings were compared within and across the years to assess consistency. RESULTS: Although pupil BMI-SDS was high, >97% of the variation in BMI-SDS was attributable to environments other than the school. The 'value-added' by each school was only poorly correlated with the observed and residual pupil BMI-SDS; but none of the rankings were consistent across the five years. CONCLUSION: the inconsistency of the rankings and the small variation in BMI-SDS at the level of the school suggests that there is no systematic differential impact of primary schools upon pupil weight status.
Abstract.
Author URL.
Sharkey S, Lloyd C, Tomlinson R, Thomas E, Martin A, Logan S, Morris C (2014). Communicating with disabled children when inpatients: Barriers and facilitators identified by parents and professionals in a qualitative study.
Health ExpectationsAbstract:
Communicating with disabled children when inpatients: Barriers and facilitators identified by parents and professionals in a qualitative study
Background: Communication is a fundamental part of health care, but can be more difficult with disabled children. Disabled children are more frequently admitted to hospital than other children. Aims: to explore experiences of ward staff and families to identify barriers and facilitators to effective communication with disabled children whilst inpatients. Design: This was an exploratory qualitative study. Methods: We consulted 25 staff working on paediatric wards and 15 parents of disabled children recently admitted to those wards. We had difficulty in recruiting children and evaluating their experiences. Data were collected through interviews and focus groups. A thematic analysis of the data supported by the Framework Approach was used to explore experiences and views about communication. Emerging themes were subsequently synthesised to identify barriers and facilitators to good communication. Results: Barriers to communication included time, professionals not prioritising communication in their role and poor information sharing between parents and professionals. Facilitators included professionals building rapport with a child, good relationships between professionals and parents, professionals having a family-centred approach, and the use of communication aids. Conclusions: Communication with disabled children on the ward was perceived as less than optimal. Parents are instrumental in the communication between their children and professionals. Although aware of the importance of communication with disabled children, staff perceived time pressures and lack of priority given to communicating directly with the child as major barriers. © 2014 John Wiley. &. Sons Ltd.
Abstract.
Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C, Martin AE (2014). Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
Cochrane Database of Systematic Reviews,
2014(2).
Abstract:
Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood
Background: Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. It is unclear whether the diagnosis includes children with different aetiologies for their pain. For the majority no organic cause for their pain can be found on physical examination or investigation. Although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended. Objectives: to determine the effectiveness of dietary interventions for recurrent abdominal pain in school-age children. Search methods: the Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2007), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched. Where appropriate, search filters were employed. Researchers working in this area were asked to identify relevant studies. Selection criteria: Randomised or quasi-randomised studies of any dietary treatment versus placebo or no treatment in school-age children with a diagnosis of RAP or functional gastrointestinal disorder based on the Rome II criteria. Data collection and analysis: Two authors independently assessed trials for inclusion, assessed quality and extracted data. Where appropriate studies were pooled using a random effects meta-analysis. Main results: Seven trials were included in this review. Two trials, including 83 participants, compared fibre supplements with placebo (Christensen 1982, Feldman 1985), with data from one study reported in two papers (Christensen 1982, Christensen 1986). The pooled odds ratio for improvement in the frequency of abdominal pain was 1.26 (0.25, 6.29).Two trials, including 90 participants (Lebenthal 1981, Dearlove 1983) compared lactose-containing with lactose-free diets. Neither reported data in a form which could be used in the meta-analysis and the former trial had a loss to follow-up of 45%. We were not able to obtain further data for either trial.Three trials (Bausserman 2005, Gavronska 2007, Young 1997) comparing supplementation with Lactobacillus with placebo met the inclusion criteria but only two (Bausserman 2005, Gavronska 2007), including a total of 168 children, provided analysable data. The pooled odds ratio for improvement of symptoms was 1.17 (95% CI 0.62, 2.21). Authors' conclusions: There is a lack of high quality evidence on the effectiveness of dietary interventions. This review provides no evidence that fibre supplements, lactose free diets or lactobacillus supplementation are effective in the management of children with RAP.
Abstract.
Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C, Martin AE (2014). Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood (Withdrawn Paper. 2014, CD003019).
COCHRANE DATABASE OF SYSTEMATIC REVIEWS(2).
Author URL.
Martin AE, Newlove-Delgado TV, Abbott RA, Bethel A, Thompson-Coon J, Nikolaou V, Logan S (2014). Dietary interventions for recurrent abdominal pain in childhood.
Cochrane Database of Systematic Reviews,
2014(2).
Abstract:
Dietary interventions for recurrent abdominal pain in childhood
This is the protocol for a review and there is no abstract. The objectives are as follows: to examine the effectiveness of dietary interventions for RAP in children of school age.
Abstract.
Anderson LJ, Henley W, Wyatt KM, Nikolaou V, Waldek S, Hughes DA, Lachmann RH, Logan S (2014). Effectiveness of enzyme replacement therapy in adults with late-onset Pompe disease: results from the NCS-LSD cohort study.
J Inherit Metab Dis,
37(6), 945-952.
Abstract:
Effectiveness of enzyme replacement therapy in adults with late-onset Pompe disease: results from the NCS-LSD cohort study.
OBJECTIVES: to determine the effectiveness of enzyme replacement therapy (ERT) for adults with late-onset Pompe disease. DESIGN: a longitudinal cohort study including prospective and retrospective clinical outcome data. Age- and gender-adjusted treatment effects were estimated using generalised linear mixed models. Treated patients contributed data before and during treatment. Untreated patients contributed natural history data. PARTICIPANTS: Consenting adults (N = 62) with a diagnosis of late-onset Pompe disease who attended a specialist treatment centre in England. This cohort represented 83 % of all patients in the UK with a confirmed diagnosis of this rare condition. At study entry, all but three patients were receiving ERT (range of treatment duration, 0 to 3.1 years). OUTCOME MEASURES: Percent predicted forced vital capacity (%FVC); ventilation dependency; mobility; 6 min walk test (6MWT); muscle strength and body mass index (BMI). RESULTS: an association was found between time on ERT and significant increases in the distance walked in the 6MWT (p
Abstract.
Author URL.
Janssens A, Williams J, Tomlinson R, Logan S, Morris C (2014). Health outcomes for children with neurodisability: what do professionals regard as primary targets?.
Arch Dis Child,
99(10), 927-932.
Abstract:
Health outcomes for children with neurodisability: what do professionals regard as primary targets?
AIM: to identify what aspects of health clinicians target when working with children with neurodisability, and which might be appropriate to assess the performance of health services. METHOD: Health professionals were recruited through child development teams and professional societies in England. Professionals participated in four rounds of an online Delphi survey. Open questions were used to elicit aspects of health; these were coded using the WHO International Classification of Functioning, Disability and Health for Children and Youth. Then, participants were asked to rate their agreement with statements to prioritise outcomes identified. RESULTS: Responses to all four rounds were, respectively: 233/276 (84.4%), 232/286 (81.1%), 227/285 (79.6%) and 191/284 (67.3%). The key outcome domains identified were: mental health, confidence/emotional stability, anxiety/attention, sleep, pain, toileting, movement ability, manual ability, acquiring skills, communication, mobility, self-care, recreation and leisure. Participants rated both functioning and well-being in these aspects of health as equally important. INTERPRETATION: This Delphi survey identified nine key domains that provide a professional perspective on a core set of outcomes for evaluating services for children and young people with neurodisability.
Abstract.
Author URL.
Morris C, Janssens A, Allard A, Thompson Coon J, Shilling V, Tomlinson R, Williams J, Fellowes A, Rogers M, Fellowes A, et al (2014). Informing the NHS Outcomes Framework: evaluating meaningful health outcomes for children with neurodisability using multiple methods including systematic review, qualitative research, Delphi survey and consensus meeting.
Health Serv Deliv Res,
15(2).
Author URL.
Anderson LJ, Wyatt KM, Henley W, Nikolaou V, Waldek S, Hughes DA, Pastores GM, Logan S (2014). Long-term effectiveness of enzyme replacement therapy in Fabry disease: results from the NCS-LSD cohort study.
J Inherit Metab Dis,
37(6), 969-978.
Abstract:
Long-term effectiveness of enzyme replacement therapy in Fabry disease: results from the NCS-LSD cohort study.
OBJECTIVES: to determine the effectiveness of enzyme replacement therapy (ERT) for adults and children with Fabry disease. DESIGN: Cohort study including prospective and retrospective clinical data. Age- and gender-adjusted treatment effects were estimated using generalised linear mixed models. Treated patients contributed data before and during treatment and untreated patients contributed natural history data. PARTICIPANTS: Consenting adults (N = 289) and children (N = 22) with a confirmed diagnosis of Fabry disease attending a specialist Lysosomal Storage Disorder treatment centre in England. At recruitment 211 adults and seven children were on ERT (range of treatment duration, 0 to 9.7 and 0 to 4.2 years respectively). OUTCOME MEASURES: Clinical outcomes chosen to reflect disease progression included left ventricular mass index (LVMI); proteinuria; estimated glomerular filtration rate (eGFR); pain; hearing and transient ischaemic attacks (TIA)/stroke. RESULTS: We found evidence of a statistically significant association between time on ERT and a small linear decrease in LVMI (p = 0.01); a reduction in the risk of proteinuria after adjusting for angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (p
Abstract.
Author URL.
Anderson LJ, Henley W, Wyatt KM, Nikolaou V, Hughes DA, Waldek S, Logan S (2014). Long-term effectiveness of enzyme replacement therapy in adults with Gaucher disease: results from the NCS-LSD cohort study.
J Inherit Metab Dis,
37(6), 953-960.
Abstract:
Long-term effectiveness of enzyme replacement therapy in adults with Gaucher disease: results from the NCS-LSD cohort study.
OBJECTIVES: to determine the effectiveness of enzyme replacement therapies (ERT) for adults with Gaucher disease (GD). DESIGN: a longitudinal, multi-centre cohort study, including prospective and retrospective clinical data. Age- and gender-adjusted treatment effects were estimated using generalised linear mixed models. Treated patients contributed data before and during treatment. Untreated patients contributed natural history data. PARTICIPANTS: Consenting adults (N = 150, aged 16 to 83 years) with a diagnosis of GD who attended a specialist treatment centre in England. At recruitment, 131 patients were receiving ERT (mean treatment duration, 10.8 years; range 0-18 years). OUTCOME MEASURES: Clinical outcomes chosen to reflect disease progression, included platelet count; haemoglobin; absence/presence of bone pain; spleen and liver volumes and AST levels. RESULTS: One hundred and fifty adults were recruited. Duration of ERT was associated with statistically significant improvements in platelet count (p
Abstract.
Author URL.
Anderson LJ, Henley W, Wyatt KM, Nikolaou V, Waldek S, Hughes DA, Pastores GM, Logan S (2014). Long-term effectiveness of enzyme replacement therapy in children with Gaucher disease: results from the NCS-LSD cohort study.
J Inherit Metab Dis,
37(6), 961-968.
Abstract:
Long-term effectiveness of enzyme replacement therapy in children with Gaucher disease: results from the NCS-LSD cohort study.
OBJECTIVES: to determine the effectiveness of enzyme replacement therapies (ERT) for children with Gaucher disease (GD). DESIGN: a longitudinal cohort study including prospective and retrospective clinical data. Age- and gender-adjusted treatment effects were estimated using generalised linear mixed models. Children on treatment contributed data before and during treatment. Children not on treatment contributed natural history data. PARTICIPANTS: Consenting children (N = 25, aged 1.1 to 15.6 years) with a diagnosis of GD (14 with GD1 and 11 with GD3) who attended a specialist treatment centre in England. At recruitment, 24 patients were receiving ERT (mean treatment duration, 5.57 years; range 0-13.7 years). OUTCOME MEASURES: Clinical outcomes chosen to reflect disease progression, included platelet count; haemoglobin and absence/presence of bone pain. RESULTS: Duration of ERT was associated with statistically significant improvements in platelet count (p
Abstract.
Author URL.
Wray J, Edwards V, Wyatt K, Maddick A, Logan S, Franck L (2014). Parents' attitudes toward the use of complementary therapy by their children with moderate or severe cerebral palsy.
Journal of Alternative and Complementary Medicine,
20(2), 130-135.
Abstract:
Parents' attitudes toward the use of complementary therapy by their children with moderate or severe cerebral palsy
Objective: to describe the use of, and attitudes toward, complementary therapy (CT) by parents of children with moderate to severe cerebral palsy. Methods: Parents of 32 children with cerebral palsy (age 5-12 years) enrolled in a randomized trial of cranial osteopathy prospectively participated in semi-structured interviews in the home to explore the use of CT and views regarding access to and expectations of these therapies. Interview transcripts were analyzed thematically, and content analysis was used to determine the frequency of use of different therapies. Results: Sixteen children (50%) had received one or more types of CT, although only three were currently receiving any CT. The primary reasons for trying CT were to reduce children's pain and improve physical function. Parents had limited knowledge of the range of, and possible indications for, CT and expressed concerns about CT safety and effectiveness. Practical considerations of time and cost were also identified. Some parents had strong beliefs about the benefits, and, overall, parents indicated a high level of commitment to finding any treatments, conventional or CT, to help their children. Conclusion: Parents of children with cerebral palsy want to help their child, but they need information, guidance, and practical support to facilitate their decision-making regarding the use of CT. A clearer understanding of factors predictive of optimal outcomes will enable resources to be targeted effectively. © Copyright 2014, Mary Ann Liebert, Inc. 2014.
Abstract.
Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C, Martin AE (2014). Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
Cochrane Database of Systematic Reviews,
2014(2).
Abstract:
Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood
Background: Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority, no organic cause for their pain can be found on physical examination or investigation and although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended. Objectives: to determine the effectiveness of medication for recurrent abdominal pain in school-age children. Search methods: the Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2007), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters Selection criteria: Studies on school age children with RAP (Apley or the Rome II criteria for gastrointestinal diseases) allocated by random or quasi-random methods to a drug treatment vs. placebo/ no treatment were included. Data collection and analysis: References identified by the searches were screened against the inclusion criteria by two independent reviewers. Data was extracted and analysed using RevMan 4.2.10. Main results: Three trials met the inclusion criteria. Symon et al report a cross-over trial comparing pizotifen and placebo in 16 children with "abdominal migraine". Data before cross-over was not available. Results for 14 children showed Mean fewer days in pain of 8.21 (95% CI 2.93, 13.48) while taking the active drug. Kline et al compared peppermint oil capsules with placebo in a randomised trial in 50 children with RAP and IBS. 42 children completed the study. OR for improvement was 3.33 (95% CI 0.93-12.1)See et al compared famotidine with placebo in a randomised cross-over trial in 25 children with RAP and dyspepsia. OR for improvement before cross-over was 11 (95%CI 1.6, 75.5). Authors' conclusions: This review provides weak evidence of benefit on medication in children with RAP. The lack of clear evidence of effectiveness for any of the recommended drugs suggests that there is little reason for their use outside of clinical trials. Clinicians may choose to prescribe drugs in children with severe symptoms that have not responded to simple management. However, if using drugs as a "therapeutic trial", clinicians should be aware that, RAP is a fluctuating condition and any "response" may reflect the natural history of the condition or a placebo effect rather than drug efficacy.
Abstract.
Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C, Martin AE (2014). Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood (Withdrawn Paper. 2014, art. no. CD003017).
COCHRANE DATABASE OF SYSTEMATIC REVIEWS(2).
Author URL.
Martin AE, Newlove-Delgado TV, Abbott RA, Bethel A, Thompson-Coon J, Nikolaou V, Logan S (2014). Pharmacological interventions for recurrent abdominal pain in childhood.
Cochrane Database of Systematic Reviews,
2014(2).
Abstract:
Pharmacological interventions for recurrent abdominal pain in childhood
This is the protocol for a review and there is no abstract. The objectives are as follows: to determine the effectiveness of pharmacological interventions for RAP in children of school age.
Abstract.
Martin A, Ford T, Goodman R, Meltzer H, Logan S (2014). Physical illness in looked-after children: a cross-sectional study.
Arch Dis Child,
99(2), 103-107.
Abstract:
Physical illness in looked-after children: a cross-sectional study.
OBJECTIVE: to compare the reported point prevalence of chronic physical illness among children looked after by local authorities with those living in their own homes. DESIGN: Cross-sectional study, using questionnaire data from a national survey. SETTING: the UK. PARTICIPANTS: Random samples of children aged 5-15 years. Children looked after were selected from Department of Health databases, stratified according to placement type. The child benefit register was the sampling frame for children in their own homes, weighted to match the child population demographic and compensate for response variability. MAIN OUTCOME: Carer-reported prevalence of 10 physical illnesses. RESULTS: Data were collected on 1253 looked-after children and 10 438 children in their own homes. There were lower rates of asthma, eczema and hay fever reported among looked-after children compared with children at home (ORs, adjusted for age, gender and ethnicity, were 0.63, 0.61 and 0.36, respectively). Epilepsy, cystic fibrosis and cerebral palsy were more commonly reported in looked-after children (adjusted ORs 4.13, 4.2 and 7.26, respectively). There was no difference in the proportions of children in the two groups reporting glue ear, diabetes mellitus, spina bifida or cancer. CONCLUSIONS: Looked-after children have an increased prevalence of some physical illnesses. The results also suggest that there may be significant unmet need, with health professionals and carers failing to identify other illnesses. The lower reported prevalence of atopic conditions may reflect a truly lower occurrence of such diseases in looked-after children; this requires further work to explore.
Abstract.
Author URL.
Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C (2014). Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
Cochrane Database of Systematic Reviews,
2014(2).
Abstract:
Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood
Background: Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority of such children, no organic cause for their pain can be found on physical examination or investigation. Although most children are managed by reassurance and simple measures, a large range of psychosocial interventions including cognitive and behavioural treatments and family therapy have been recommended. Objectives: to determine the effectiveness of psychosocial interventions for recurrent abdominal pain or IBS in school-age children. Search methods: the Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2006), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters. Selection criteria: Any study in which the majority of participants were school-age children fulfilling standard criteria for RAP (Apley or the Rome II criteria for functional gastrointestinal diseases) , randomly allocated to any psychosocial treatment compared to standard care or waiting list, were selected. Data collection and analysis: References identified by the searches were independently screened against the inclusion criteria by two reviewers. Data were extracted and analysed using RevMan 4.2.10. Main results: Six randomised trials (including a total of 167 participants) of cognitive behavioural interventions were identified, with data reported in ten papers. Five studies reported statistically significant improvements in pain, measured in a variety of ways, in children randomised to receive interventions based on cognitive behavioural therapy compared to children on wait lists or receiving standard medical care (Duarte 2006; Humphreys 1998; Robins 2005; Sanders 1989; Sanders 1994). The remaining trial (Hicks 2003) included a wider group of children with recurrent pain and too few with only RAP to provide interpretable data. Authors' conclusions: the included trials were small, with methodological weaknesses and a number failed to give appropriate detail regarding numbers of children assessed. In spite of these methodological weaknesses and the clinical heterogeneity, the consistency and magnitude of the effects reported provides some evidence that cognitive behavioural therapy may be a useful intervention for children with recurrent abdominal pain although most children, particularly in primary care, will improve with reassurance and time.
Abstract.
Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C (2014). Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood (Withdrawn Paper. 2014, art. no. CD003014).
COCHRANE DATABASE OF SYSTEMATIC REVIEWS(2).
Author URL.
Martin AE, Newlove-Delgado TV, Abbott RA, Bethel A, Thompson-Coon J, Nikolaou V, Logan S (2014). Psychosocial interventions for recurrent abdominal pain in childhood.
Cochrane Database of Systematic Reviews,
2014(2).
Abstract:
Psychosocial interventions for recurrent abdominal pain in childhood
This is the protocol for a review and there is no abstract. The objectives are as follows: to determine the effectiveness of psychosocial interventions for RAP in children of school age.
Abstract.
Henley WE, Anderson LJ, Wyatt KM, Nikolaou V, Anderson R, Logan S (2014). The NCS-LSD cohort study: a description of the methods and analyses used to assess the long-term effectiveness of enzyme replacement therapy and substrate reduction therapy in patients with lysosomal storage disorders.
J Inherit Metab Dis,
37(6), 939-944.
Abstract:
The NCS-LSD cohort study: a description of the methods and analyses used to assess the long-term effectiveness of enzyme replacement therapy and substrate reduction therapy in patients with lysosomal storage disorders.
Lysosomal storage disorders (LSDs) comprise more than 50 extremely rare, inherited metabolic diseases resulting from a deficiency of specific lysosomal enzymes required for normal macromolecular metabolism. The National Collaborative Study for Lysosomal Storage Disorders (NCS-LSD), was a longitudinal cohort study which collected prospective and retrospective clinical data, and patient-reported data from adults and children with a confirmed diagnosis of Gaucher disease, Fabry disease, mucopolysaccharidosis type I (MPS I), mucopolysaccharidosis type II (MPS II), Pompe disease and Niemann Pick disease type C (NPC) in the UK. The study aimed to determine the natural history of these conditions and estimate the effectiveness and cost of therapies. Clinical outcomes were chosen to reflect disease progression. Age- and gender-adjusted treatment effects were estimated using generalised linear mixed models. Treated patients contributed data before and during treatment while untreated patients contributed natural history data. A total of 711 adults and children were recruited to this study from the seven LSD treatment centres in England. Data was collected from 2008 to 2011. This paper describes the methods used to collect and analyse clinical data for this study. The clinical findings are reported separately in a series of condition-specific articles in this issue.
Abstract.
Author URL.
2013
Davis J, Banks I, Wrigley D, Peedell C, Pollock A, McPherson K, McKee M, Irving WL, Crome P, Greenhalgh T, et al (2013). Act now against new NHS competition regulations: an open letter to the BMA and the Academy of Medical Royal Colleges calls on them to make a joint public statement of opposition to the amended section 75 regulations.
BMJ,
346 Author URL.
Lin NX, Logan GS, Henley WE (2013). Bias and sensitivity analysis when estimating treatment effects from the Cox Model with omitted covariates. Biometrics
Lin NX, Logan S, Henley WE (2013). Bias and sensitivity analysis when estimating treatment effects from the cox model with omitted covariates.
Biometrics,
69(4), 850-860.
Abstract:
Bias and sensitivity analysis when estimating treatment effects from the cox model with omitted covariates
Summary: Omission of relevant covariates can lead to bias when estimating treatment or exposure effects from survival data in both randomized controlled trials and observational studies. This paper presents a general approach to assessing bias when covariates are omitted from the Cox model. The proposed method is applicable to both randomized and non-randomized studies. We distinguish between the effects of three possible sources of bias: omission of a balanced covariate, data censoring and unmeasured confounding. Asymptotic formulae for determining the bias are derived from the large sample properties of the maximum likelihood estimator. A simulation study is used to demonstrate the validity of the bias formulae and to characterize the influence of the different sources of bias. It is shown that the bias converges to fixed limits as the effect of the omitted covariate increases, irrespective of the degree of confounding. The bias formulae are used as the basis for developing a new method of sensitivity analysis to assess the impact of omitted covariates on estimates of treatment or exposure effects. In simulation studies, the proposed method gave unbiased treatment estimates and confidence intervals with good coverage when the true sensitivity parameters were known. We describe application of the method to a randomized controlled trial and a non-randomized study. © 2013 the Authors. Biometrics published by the International Biometric Society.
Abstract.
Telford C, Green C, Logan S, Langley K, Thapar A, Ford T (2013). Estimating the costs of ongoing care for adolescents with attention-deficit hyperactivity disorder.
Soc Psychiatry Psychiatr Epidemiol,
48(2), 337-344.
Abstract:
Estimating the costs of ongoing care for adolescents with attention-deficit hyperactivity disorder.
PURPOSE: Attention-deficit hyperactivity disorder (ADHD) is associated with increased use of health, social and education services. There is a lack of data to quantify the economic burden of ADHD in the UK. The aim of this study was to estimate additional education, health and social care costs amongst adolescents in the UK diagnosed with ADHD. METHODS: Participants were 143, 12- to 18-year-olds from the Cardiff longitudinal ADHD study. Service use relating to mental health over the previous year was measured using the children's service interview. Individual resource use was combined with unit cost data, from national sources, to calculate costs per patient and subsequently the mean cost per patient. Mean costs, 95% confidence intervals and median use were calculated using nonparametric bootstrapping methods. RESULTS: the mean cost per adolescent for NHS, social care and education resources used in a 12-month period related to ADHD was £5,493 (£4,415.68, £6,678.61) in 2010 prices and the median was £2,327. Education and NHS resources accounted for approximately 76 and 24%, respectively. Estimated annual total UK costs are £670 million. CONCLUSIONS: the additional costs to the NHS and education system of treating adolescents remain substantial for several years after the initial ADHD diagnosis. There exists a need to develop and evaluate early interventions which have the potential to reduce the longer-term burden, particularly on education resource use.
Abstract.
Author URL.
Shilling V, Morris C, Thompson-Coon J, Ukoumunne O, Rogers M, Logan S (2013). Peer support for parents of children with chronic disabling conditions: a systematic review of quantitative and qualitative studies.
Dev Med Child Neurol,
55(7), 602-609.
Abstract:
Peer support for parents of children with chronic disabling conditions: a systematic review of quantitative and qualitative studies.
AIM: to review the qualitative and quantitative evidence of the benefits of peer support for parents of children with disabling conditions in the context of health, well-being, impact on family, and economic and service implications. METHOD: We comprehensively searched multiple databases. Eligible studies evaluated parent-to-parent support and reported on the psychological health and experience of giving or receiving support. There were no limits on the child's condition, study design, language, date, or setting. We sought to aggregate quantitative data; findings of qualitative studies were combined using thematic analysis. Qualitative and quantitative data were brought together in a narrative synthesis. RESULTS: Seventeen papers were included: nine qualitative studies, seven quantitative studies, and one mixed-methods evaluation. Four themes were identified from qualitative studies: (1) shared social identity, (2) learning from the experiences of others, (3) personal growth, and (4) supporting others. Some quantitative studies reported a positive effect of peer support on psychological health and other outcomes; however, this was not consistently confirmed. It was not possible to aggregate data across studies. No costing data were identified. CONCLUSION: Qualitative studies strongly suggest that parents perceive benefit from peer support programmes, an effect seen across different types of support and conditions. However, quantitative studies provide inconsistent evidence of positive effects. Further research should explore whether this dissonance is substantive or an artefact of how outcomes have been measured.
Abstract.
Author URL.
Williams AJ, Henley WE, Williams CA, Hurst AJ, Logan S, Wyatt KM (2013). Systematic review and meta-analysis of the association between childhood overweight and obesity and primary school diet and physical activity policies. International Journal of Behavioural Nutrition and Physical Activity, 10
Wyatt KM, Lloyd JJ, Abraham C, Creanor S, Dean S, Densham E, Daurge W, Green C, Hillsdon M, Pearson V, et al (2013). The Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children: study protocol for a randomised controlled trial.
Trials,
14Abstract:
The Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children: study protocol for a randomised controlled trial.
BACKGROUND: over the last three decades there has been a substantial increase in the proportion of children who are overweight or obese. The Healthy Lifestyles Programme (HeLP) is a novel school-based intervention, using highly interactive and creative delivery methods to prevent obesity in children. METHODS/DESIGN: We describe a cluster randomised controlled trial to evaluate the effectiveness and cost effectiveness of HeLP. The intervention has been developed using intervention mapping (involving extensive stakeholder involvement) and has been guided by the Information, Motivation, Behavioural Skills model. HeLP includes creating a receptive environment, drama activities, goal setting and reinforcement activities and runs over three school terms. Piloting showed that 9 to 10 year olds were the most receptive and participative. This study aims to recruit 1,300 children from 32 schools (over half of which will have ≥19% of pupils eligible for free school meals) from the southwest of England. Participating schools will be randomised to intervention or control groups with baseline measures taken prior to randomisation. The primary outcome is change in body mass index standard deviation score (BMI SDS) at 24 months post baseline. Secondary outcomes include, waist circumference and percent body fat SDS and proportion of children classified as overweight or obese at 18 and 24 months and objectively measured physical activity and food intake at 18 months. Between-group comparisons will be made using random effects regression analysis taking into account the hierarchical nature of the study design. An economic evaluation will estimate the incremental cost-effectiveness of HeLP, compared to control, from the perspective of the National Health Service (NHS)/third party payer. An in-depth process evaluation will provide insight into how HeLP works, and whether there is any differential uptake or engagement with the programme. DISCUSSION: the results of the trial will provide evidence on the effectiveness and cost effectiveness of the Healthy Lifestyles Programme in affecting the weight status of children. TRIAL REGISTRATION: ISRCTN15811706.
Abstract.
Author URL.
Morris C, Janssens A, Tomlinson R, Williams J, Logan S (2013). Towards a definition of neurodisability: a Delphi survey.
Dev Med Child Neurol,
55(12), 1103-1108.
Abstract:
Towards a definition of neurodisability: a Delphi survey.
AIM: the aim of this study was to develop, systematically, a consensus-based definition for 'neurodisability' that is meaningful to health professionals and parents of children with neurological conditions. METHOD: a multidisciplinary group of health professionals was recruited through child development teams and professional societies in the UK; several parents of children with neurological conditions worked with the research team. Professionals participated in three rounds of a Delphi survey. Participants rated their agreement with a proposed definition in each round, and feedback was used to refine the definition. Finally, a perspective was sought from international experts. RESULTS: Responses to the three rounds were as follows: round 1,245 out of 290 (84.4%); round 2,242 out of 300 (80.6%); and round 3,237 out of 297 (79.7%). Agreement with the proposed definition was extremely high in every round (89.0%, 90.1%, and 93.6% respectively). The final version of the definition was widely endorsed among professionals, parents, and a small number of international colleagues. The final definition is as follows: 'Neurodisability describes a group of congenital or acquired long-term conditions that are attributed to impairment of the brain and/or neuromuscular system and create functional limitations. A specific diagnosis may not be identified. Conditions may vary over time, occur alone or in combination, and include a broad range of severity and complexity. The impact may include difficulties with movement, cognition, hearing and vision, communication, emotion, and behaviour'. INTERPRETATION: an agreed definition of neurodisability will be useful for conducting research or clinical evaluations with people affected by neurological problems.
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Author URL.
2012
Gilbert R, Woodman J, Logan S (2012). Developing services for a public health approach to child maltreatment.
International Journal of Children's Rights,
20(3), 323-342.
Abstract:
Developing services for a public health approach to child maltreatment
Calls for a public health approach to child maltreatment - a strategy that aims primarily to reduce risk factors for maltreatment - have been based on four main arguments. (O'Donnell et al. 2008; Reading et al. 2009; Barlow and Calam, 2011) the right of children to be protected from harm in the first place. The frequency of child maltreatment, which, if all occurrences were notified, would overwhelm child protection systems. The inaccuracy of identification systems, which miss the large majority of maltreated children. and fourth, the effectiveness and cost effectiveness of intervening to prevent child maltreatment comparing with intervention once child maltreatment has occurred. We review the evidence to support these arguments and trace the development of UK policy and health services towards a public health approach. © 2012 by Koninklijke Brill N.V. Leiden, the Netherlands.
Abstract.
Coon JT, Martin A, Abdul-Rahman AK, Boddy K, Whear R, Collinson A, Stein K, Logan S (2012). Interventions to reduce acute paediatric hospital admissions: a systematic review.
Archives of Disease in Childhood,
97(4), 304-311.
Abstract:
Interventions to reduce acute paediatric hospital admissions: a systematic review
Objective: to compare the effectiveness of interventions aimed at reducing the rate of acute paediatric hospital admissions. Design: Systematic review. Data sources: Medline, Embase, PsychINFO, the Cochrane Library, Science Citation Index Expanded from inception to September 2010; hand searches of the reference lists of included papers and other review papers identified in the search. Review methods: Controlled trials were included. Articles were screened for inclusion independently by two reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Results: Seven papers were included. There is some evidence to suggest that short stay units may reduce admission rates. However, there is a general lack of detail in the reporting of interventions and the methods used in their evaluation which precludes detailed interpretation and extrapolation of the results. The authors found no evidence that the use of algorithms and guidelines to manage the admission decision was effective in reducing acute admission rates. Furthermore, the authors were unable to locate any eligible papers reporting the effects on admission rates of admission decision by paediatric consultant, telephone triage by paediatric consultant or the establishment of next day emergency paediatric clinics. Conclusion: There is little published evidence upon which to base an optimal strategy for reducing paediatric admission rates. The evidence that does exist is subject to substantial bias. There is a pressing need for high quality, well conducted research to enable informed service change.
Abstract.
Coon JT, Martin A, Abdul-Rahman A-K, Boddy K, Whear R, Collinson A, Stein K, Logan S (2012). Interventions to reduce acute paediatric hospital admissions: a systematic review.
Arch Dis Child,
97(4), 304-311.
Abstract:
Interventions to reduce acute paediatric hospital admissions: a systematic review.
OBJECTIVE: to compare the effectiveness of interventions aimed at reducing the rate of acute paediatric hospital admissions. DESIGN: Systematic review. DATA SOURCES: Medline, Embase, PsychINFO, the Cochrane Library, Science Citation Index Expanded from inception to September 2010; hand searches of the reference lists of included papers and other review papers identified in the search. REVIEW METHODS: Controlled trials were included. Articles were screened for inclusion independently by two reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. RESULTS: Seven papers were included. There is some evidence to suggest that short stay units may reduce admission rates. However, there is a general lack of detail in the reporting of interventions and the methods used in their evaluation which precludes detailed interpretation and extrapolation of the results. The authors found no evidence that the use of algorithms and guidelines to manage the admission decision was effective in reducing acute admission rates. Furthermore, the authors were unable to locate any eligible papers reporting the effects on admission rates of admission decision by paediatric consultant, telephone triage by paediatric consultant or the establishment of next day emergency paediatric clinics. CONCLUSION: There is little published evidence upon which to base an optimal strategy for reducing paediatric admission rates. The evidence that does exist is subject to substantial bias. There is a pressing need for high quality, well conducted research to enable informed service change.
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Author URL.
Logan S, Signatories (2012). Paediatricians oppose Health and Social Care Bill.
LANCET,
379(9817), 707-707.
Author URL.
Ford T, Edwards V, Sharkey S, Ukoumunne OC, Byford S, Norwich B, Logan S (2012). Supporting teachers and children in schools: the effectiveness and cost-effectiveness of the Incredible Years teacher classroom management programme in primary school children: a cluster randomised controlled trial, with parallel economic and process evaluations.
BMC Public Health,
12Abstract:
Supporting teachers and children in schools: the effectiveness and cost-effectiveness of the Incredible Years teacher classroom management programme in primary school children: a cluster randomised controlled trial, with parallel economic and process evaluations.
BACKGROUND: Childhood antisocial behaviour has high immediate and long-term costs for society and the individual, particularly in relation to mental health and behaviours that jeopardise health. Managing challenging behaviour is a commonly reported source of stress and burn out among teachers, ultimately resulting in a substantial number leaving the profession. Interventions to improve parenting do not transfer easily to classroom-based problems and the most vulnerable parents may not be easily able to access them. Honing teachers' skills in proactive behaviour management and the promotion of socio-emotional regulation, therefore, has the potential to improve both child and teacher mental health and well-being and the advantage that it might potentially benefit all the children subsequently taught by any teacher that accesses the training. METHODS/DESIGN: Cluster randomised controlled trial (RCT) of the Incredible Years teacher classroom management (TCM) course with combined economic and process evaluations.One teacher of children aged 4-9 years, from 80 schools in the South West Peninsula will be randomised to attend the TCM (intervention arm) or to "teach as normal" (control arm). The primary outcome measure will be the total difficulties score from the Strengths and Difficulties Questionnaire (SDQ) completed by the current class teachers prior to randomisation, and at 9, 18 and 30 months follow-up, supplemented by parent SDQs. Secondary measures include academic attainment (teacher report supplemented by direct measurement in a sub-sample), children's enjoyment of school, and teacher reports of their professional self-efficacy, and levels of burn out and stress, supplemented by structured observations of teachers classroom management skills in a subsample. Cost data for the economic evaluation will be based on parental reports of services accessed. Cost-effectiveness, using the SDQ as the measure of effect, will be examined over the period of the RCT and over the longer term using decision analytic modelling. The process evaluation will use quantitative and qualitative approaches to assess fidelity to model, as well as explore Head teacher and teachers' experiences of TCM and investigate school factors that influence the translation of skills learnt to practice. DISCUSSION: This study will provide important information about whether the Teacher Classroom Management course influences child and teacher mental health and well-being in both the short and long term. It will also provide valuable insights into factors that may facilitate or impede any impact.The trial has been registered with ISCTRN (Controlled Trials Ltd) and assigned an ISRCTN number ISRCTN84130388. (http://www.controlled-trials.com/isrctn/search.html?srch=ISRCTN84130388&sort=3&dir=desc&max=10).
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Author URL.
Wyatt K, Henley W, Anderson L, Anderson R, Nikolaou V, Stein K, Klinger L, Hughes D, Waldek S, Lachmann R, et al (2012). The effectiveness and cost-effectiveness of enzyme and substrate replacement therapies: a longitudinal cohort study of people with lysosomal storage disorders.
HEALTH TECHNOLOGY ASSESSMENT,
16(39), V-+.
Author URL.
2011
Logan S (2011). Authors' reply. Focus on Alternative and Complementary Therapies, 16(3).
Edwards V, Wyatt K, Logan S, Britten N (2011). Consulting parents about the design of a randomized controlled trial of osteopathy for children with cerebral palsy.
Health Expect,
14(4), 429-438.
Abstract:
Consulting parents about the design of a randomized controlled trial of osteopathy for children with cerebral palsy.
BACKGROUND: Although the UK Department of Health has advocated the involvement of service users and carers in health research for several years, there is little evidence about their contribution to the design of randomized controlled trials (RCTs). OBJECTIVE: to demonstrate how consulting parents about the design of a study, including which outcomes to use, led to the design and successful delivery of a RCT of osteopathy for children with cerebral palsy (CP). DESIGN: Semi-structured interviews were carried out with 20 parents of children with CP and other neurological conditions, asking them to choose between four different trial designs, to talk about noticeable changes in their child's condition and their views about payment for trial treatment. SETTING AND PARTICIPANTS: the parents interviewed were all members of Cerebra, a charity for 'brain-injured' children and young people. All interviews were carried out at the parents' homes. RESULTS: Parents had mixed views about possible trial designs; however, a waitlist design which allowed all children eventually to receive the treatment emerged as a clear favourite. Parents did not focus on isolated outcomes, but suggested a range of factors relevant to their child's quality of life. They expressed a clear preference for the costs of treatment to be funded by the trial. CONCLUSIONS: Involvement of parents helped design a trial which was acceptable to families and addressed outcomes that mattered to them. By consulting parents about the design of the research, the subsequent trial achieved excellent recruitment and retention rates.
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Author URL.
Wyatt K, Edwards V, Franck L, Britten N, Creanor S, Maddick A, Logan S (2011). Cranial osteopathy for children with cerebral palsy: a randomised controlled trial.
Arch Dis Child,
96(6), 505-512.
Abstract:
Cranial osteopathy for children with cerebral palsy: a randomised controlled trial.
OBJECTIVES: to estimate the effect of cranial osteopathy on the general health and wellbeing, including physical functioning, of children with cerebral palsy. DESIGN: Pragmatic randomised controlled trial. PARTICIPANTS: 142 children from Greater London and the South West of England, aged 5-12 years with cerebral palsy. INTERVENTION: Participants were randomised to six sessions of cranial osteopathy with a registered osteopath or a waiting list with partial attention control (parents invited to participate in two semistructured interviews). PRIMARY OUTCOME MEASURES: Blind assessment of motor function by physiotherapists using the Gross Motor Function Measure-66 (GMFM-66) and quality of life using the Child Health Questionnaire (CHQ) PF50 at 6 months. SECONDARY OUTCOME MEASURES: Parents' assessment of global health and sleep at 6 months, pain and sleep diaries at 10 weeks and 6 months, CHQ PF50 at 10 weeks and quality of life of main carer (Short Form 36) at 10 weeks and 6 months. RESULTS: Compared with children in the control group, children in the osteopathy group demonstrated no statistically significant differences in GMFM-66 (mean difference 4.9, 95% CI -4.4 to 14.1), CHQ Physical Summary Score (mean difference 2.2, 95% CI -3.5 to 8.0) or CHQ Psychological Summary Score (mean difference 3.4, 95% CI -0.8 to 7.7). There were no significant differences between groups with respect to pain; sleep (either 'time asleep' or 'time to sleep'); or main carer's quality of life. Compared with children in the control group, carers of children receiving cranial osteopathy were nearly twice as likely to report that their child's global health had 'improved' at 6 months rather than 'decreased' or 'remained the same' (38% vs 18%; odds ratio 2.8, 95% CI 1.1 to 6.9). CONCLUSIONS: This trial found no statistically significant evidence that cranial osteopathy leads to sustained improvement in motor function, pain, sleep or quality of life in children aged 5-12 years with cerebral palsy nor in quality of life of their carers.
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Lloyd JJ, Logan S, Greaves CJ, Wyatt KM (2011). Evidence, theory and context--using intervention mapping to develop a school-based intervention to prevent obesity in children.
Int J Behav Nutr Phys Act,
8Abstract:
Evidence, theory and context--using intervention mapping to develop a school-based intervention to prevent obesity in children.
BACKGROUND: Only limited data are available on the development and feasibility piloting of school-based interventions to prevent and reduce obesity in children. Clear documentation of the rationale, process of development and content of such interventions is essential to enable other researchers to understand why interventions succeed or fail. METHODS: This paper describes the development of the Healthy Lifestyles Programme (HeLP), a school-based intervention to prevent obesity in children, through the first 4 steps of the Intervention Mapping protocol (IM). The intervention focuses on the following health behaviours, i) reduction of the consumption of sweetened fizzy drinks, ii) increase in the proportion of healthy snacks consumed and iii) reduction of TV viewing and other screen-based activities, within the context of a wider attempt to improve diet and increase physical activity. RESULTS: Two phases of pilot work demonstrated that the intervention was acceptable and feasible for schools, children and their families and suggested areas for further refinement. Feedback from the first pilot phase suggested that the 9-10 year olds were both receptive to the messages and more able and willing to translate them into possible behaviour changes than older or younger children and engaged their families to the greatest extent. Performance objectives were mapped onto 3 three broad domains of behaviour change objectives--establish motivation, take action and stay motivated--in order to create an intervention that supports and enables behaviour change. Activities include whole school assemblies, parents evenings, sport/dance workshops, classroom based education lessons, interactive drama workshops and goal setting and runs over three school terms. CONCLUSION: the Intervention Mapping protocol was a useful tool in developing a feasible, theory based intervention aimed at motivating children and their families to make small sustainable changes to their eating and activity behaviours. Although the process was time consuming, this systematic approach ensures that the behaviour change techniques and delivery methods link directly to the Programme's performance objectives and their associated determinants. This in turn provides a clear framework for process analysis and increases the potential of the intervention to realise the desired outcome of preventing and reducing obesity in children.
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Author URL.
Wyatt KM, Lloyd, Creanor S, Logan GS (2011). The development, feasibility and acceptability of a school-based obesity prevention programme: results from three phases of piloting. British Medical Journal
2010
MacLennan S, Augood C, Cash-Gibson L, Logan S, Gilbert RE (2010). Cisapride treatment for gastro-oesophageal reflux in children.
COCHRANE DATABASE OF SYSTEMATIC REVIEWS(4).
Author URL.
2009
Eccles MP, Armstrong D, Baker R, Cleary K, Davies H, Davies S, Glasziou P, Ilott I, Kinmonth A-L, Leng G, et al (2009). An implementation research agenda.
Implement Sci,
4Abstract:
An implementation research agenda.
In October 2006, the Chief Medical Officer (CMO) of England asked Professor Sir John Tooke to chair a High Level Group on Clinical Effectiveness in response to the chapter 'Waste not, want not' in the CMOs 2005 annual report 'On the State of the Public Health'. The high level group made recommendations to the CMO to address possible ways forward to improve clinical effectiveness in the UK National Health Service (NHS) and promote clinical engagement to deliver this. The report contained a short section on research needs that emerged from the process of writing the report, but in order to more fully identify the relevant research agenda Professor Sir John Tooke asked Professor Martin Eccles to convene an expert group - the Clinical Effectiveness Research Agenda Group (CERAG) - to define the research agenda. The CERAG's terms of reference were 'to further elaborate the research agenda in relation to pursuing clinically effective practice within the (UK) National Health Service'. This editorial presents the summary of the CERAG report and recommendations.
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Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C (2009). Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
COCHRANE DATABASE OF SYSTEMATIC REVIEWS(1).
Author URL.
2008
McIntosh N, Helms P, Smyth R, Logan S (2008).
Forfar and Arneil's Textbook of Pediatrics.Abstract:
Forfar and Arneil's Textbook of Pediatrics
Abstract.
Ellis J, Logan GS, Pumphrey R, Tan HK, Henley W, Edwards V, Moy R, Gilbert R (2008). Inequalities in provision of Disability Living Allowance for Down Syndrome. Arch Dis Child, 93, 14-16.
Huertas-Ceballos A, Logan S, Bennett C, Macarthur C (2008). Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
Cochrane Database of Systematic Reviews(1).
Abstract:
Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood
Background: Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority no organic cause for their pain can be found on physical examination or investigation and although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended. Objectives: to determine the effectiveness of medication for recurrent abdominal pain in school-age children. Search strategy: the Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2007), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters Selection criteria: Studies on school age children with RAP (Apley or the Rome II criteria for gastrointestinal diseases) allocated by random or quasirandom methods to a drug treatment vs. placebo/ no treatment were included. Data collection and analysis: References identified by the searches were screened against the inclusion criteria by two independent reviewers. Data was extracted and analysed using RevMan 4.2.10. Main results: Three trials met the inclusion criteria. Symon et al report a cross-over trial comparing pizotifen and placebo in 16 children with "abdominal migraine". Data before cross-over was not available. Results for 14 children showed Mean fewer days in pain of 8.21 (95% CI 2.93, 13.48) while taking the active drug. Kline et al compared peppermint oil capsules with placebo in a randomised trial in 50 children with RAP and IBS. 42 children completed the study. OR for improvement was 3.33 (95% CI 0.93-12.1) See et al compared famotidine with placebo in a randomised cross-over trial in 25 children with RAP and dyspepsia.OR for improvement before cross-over was 11 (95%CI 1.6, 75.5). Authors' conclusions: This review provides weak evidence of benefit on medication in children with RAP. The lack of clear evidence of effectiveness for any of the recommended drugs suggests that there is little reason for their use outside of clinical trials. Clinicians may choose to prescribe drugs in children with severe symptoms that have not responded to simple management. However, if using drugs as a "therapeutic trial", clinicians should be aware that, RAP is a fluctuating condition and any "response" may reflect the natural history of the condition or a placebo effect rather than drug efficacy. Copyright © 2008 the Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Abstract.
Huertas-Ceballos A, Logan S, Bennett C, Macarthur C (2008). Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
Cochrane Database Syst Rev(1).
Abstract:
Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
BACKGROUND: Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority no organic cause for their pain can be found on physical examination or investigation and although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended. OBJECTIVES: to determine the effectiveness of medication for recurrent abdominal pain in school-age children. SEARCH STRATEGY: the Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2007), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters SELECTION CRITERIA: Studies on school age children with RAP (Apley or the Rome II criteria for gastrointestinal diseases) allocated by random or quasi-random methods to a drug treatment vs. placebo/ no treatment were included. DATA COLLECTION AND ANALYSIS: References identified by the searches were screened against the inclusion criteria by two independent reviewers. Data was extracted and analysed using RevMan 4.2.10. MAIN RESULTS: Three trials met the inclusion criteria. Symon et al report a cross-over trial comparing pizotifen and placebo in 16 children with "abdominal migraine". Data before cross-over was not available. Results for 14 children showed Mean fewer days in pain of 8.21 (95% CI 2.93, 13.48) while taking the active drug. Kline et al compared peppermint oil capsules with placebo in a randomised trial in 50 children with RAP and IBS. 42 children completed the study. OR for improvement was 3.33 (95% CI 0.93-12.1)See et al compared famotidine with placebo in a randomised cross-over trial in 25 children with RAP and dyspepsia. OR for improvement before cross-over was 11 (95%CI 1.6, 75.5). AUTHORS' CONCLUSIONS: This review provides weak evidence of benefit on medication in children with RAP. The lack of clear evidence of effectiveness for any of the recommended drugs suggests that there is little reason for their use outside of clinical trials. Clinicians may choose to prescribe drugs in children with severe symptoms that have not responded to simple management. However, if using drugs as a "therapeutic trial", clinicians should be aware that, RAP is a fluctuating condition and any "response" may reflect the natural history of the condition or a placebo effect rather than drug efficacy.
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Author URL.
Huertas-Ceballos A, Logan S, Bennett C, Macarthur C (2008). Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
Cochrane Database Syst Rev(1).
Abstract:
Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
BACKGROUND: Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority of such children, no organic cause for their pain can be found on physical examination or investigation. Although most children are managed by reassurance and simple measures, a large range of psychosocial interventions including cognitive and behavioural treatments and family therapy have been recommended. OBJECTIVES: to determine the effectiveness of psychosocial interventions for recurrent abdominal pain or IBS in school-age children. SEARCH STRATEGY: the Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2006), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters. SELECTION CRITERIA: Any study in which the majority of participants were school-age children fulfilling standard criteria for RAP (Apley or the Rome II criteria for functional gastrointestinal diseases) , randomly allocated to any psychosocial treatment compared to standard care or waiting list, were selected. DATA COLLECTION AND ANALYSIS: References identified by the searches were independently screened against the inclusion criteria by two reviewers. Data were extracted and analysed using RevMan 4.2.10. MAIN RESULTS: Six randomised trials (including a total of 167 participants) of cognitive behavioural interventions were identified, with data reported in ten papers. Five studies reported statistically significant improvements in pain, measured in a variety of ways, in children randomised to receive interventions based on cognitive behavioural therapy compared to children on wait lists or receiving standard medical care (Duarte 2006; Humphreys 1998; Robins 2005; Sanders 1989; Sanders 1994). The remaining trial (Hicks 2003) included a wider group of children with recurrent pain and too few with only RAP to provide interpretable data. AUTHORS' CONCLUSIONS: the included trials were small, with methodological weaknesses and a number failed to give appropriate detail regarding numbers of children assessed. In spite of these methodological weaknesses and the clinical heterogeneity, the consistency and magnitude of the effects reported provides some evidence that cognitive behavioural therapy may be a useful intervention for children with recurrent abdominal pain although most children, particularly in primary care, will improve with reassurance and time.
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Ellis J, Tan HK, Gilbert R, Muller D, Henley W, Moy R, Pumphrey R, Ani C, Davies S, Edwards V, et al (2008). Supplementation with antioxidants and folinic acid for children with Down's syndrome: randomised controlled trial. BMJ, on line
2007
Logan S, Gilbert R (2007). Asking Questions. In (Ed) Evidence-Based Pediatrics and Child Health with CD-ROM, 9-12.
Gilbert R, Logan S (2007). Assessing Diagnostic and Screening Tests. In (Ed) Evidence-Based Pediatrics and Child Health with CD-ROM, 31-43.
Baldwin C, Parsons T, Logan S (2007). Dietary advice for illness-related malnutrition in adults.
Cochrane Database Syst Rev(1).
Abstract:
Dietary advice for illness-related malnutrition in adults.
BACKGROUND: Illness-related malnutrition has been reported in 10% to 55% of ill people in hospital and the community in areas of food sufficiency. Dietary advice encouraging the use of energy- and nutrient-rich foods rather than oral nutritional supplements has been suggested for managing illness-related malnutrition. OBJECTIVES: to examine evidence that dietary advice to improve nutritional intake in adults with illness-related malnutrition improves survival, weight and anthropometry; to estimate the size of any additional effect of nutritional supplements given in combination with dietary advice. SEARCH STRATEGY: Relevant publications were identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Additional studies were sought by contacting dietitians, clinicians and the manufacturers of nutritional supplements. Last search: October 2006 SELECTION CRITERIA: Randomised controlled trials of dietary advice in people with illness-related malnutrition compared with:(1) no advice;(2) oral nutritional supplements; and(3) dietary advice plus oral nutritional supplements. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial eligibility, methodological quality and extracted data. MAIN RESULTS: Thirty-five studies (37 comparisons) met the inclusion criteria with 2648 randomised participants. Twelve trials (comparing dietary advice plus supplements if required with no advice) identified during searching are included as a separate comparison. Follow up ranged from 18 days to 24 months. No comparison showed a significant difference in mortality. Significant improvements in weight at three months were found for groups receiving dietary advice plus nutritional supplements compared with dietary advice alone, WMD 1.68 kg (95% CI 0.14 to 3.21) or no additional advice, WMD 1.97 (95% CI 0.07 to 3.86). There were significant improvements in grip strength and mid-arm muscle circumference in the advice plus supplement groups compared with dietary advice alone. It is uncertain whether nutritional supplements and dietary advice produce the same effects. No significant differences were found between groups for clinical outcomes. Few data were available for other outcomes. AUTHORS' CONCLUSIONS: This review highlights the lack of evidence for the provision of dietary advice in managing illness-related malnutrition. Dietary advice plus nutritional supplements may be more effective than dietary advice alone or no advice in enhancing short-term weight gain, but whether this is sustainable, or whether survival and morbidity are improved remains uncertain. A large adequately-powered randomised controlled trial is needed comparing the efficacy of different therapies to increase dietary intake in people with illness-related malnutrition and examining the impact of this on clinical function and survival.
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Moyer VA, Elliott EJ, Gilbert R, Klassen T, Logan S, Mellis C, Henderson-Smart DJ, Williams K (2007).
Evidence-Based Pediatrics and Child Health with CD-ROM.Abstract:
Evidence-Based Pediatrics and Child Health with CD-ROM
Abstract.
Dutta S, Logan S, Gilbert R (2007). Impact of newborn skin-cleansing with chlorhexidine on neonatal mortality in southern Nepal.
Pediatrics,
120(3), 693-694.
Author URL.
2006
Spencer N, Wallace A, Sundrum R, Bacchus C, Logan S (2006). Child abuse registration, fetal growth, and preterm birth: a population based study.
J Epidemiol Community Health,
60(4), 337-340.
Abstract:
Child abuse registration, fetal growth, and preterm birth: a population based study.
OBJECTIVES: to study the relation of intra-uterine growth and gestational age with child protection registration in a 20 year whole population birth cohort. SETTING: West Sussex area of England. STUDY DESIGN: Retrospective whole population birth cohort. OUTCOMES: Child protection registration; individual categories of registration-sexual abuse, physical abuse, emotional abuse, and neglect. Population and PARTICIPANTS: 119,771 infants born in West Sussex between January 1983 and December 2001 with complete data including birth weight, gestational age, maternal age, and postcode. RESULTS: in all categories of registration a linear trend was noted such that the lower the birth weight z score the higher the likelihood of child protection registration. Similar trends were noted for gestational age. All these trends were robust to adjustment for maternal age and socioeconomic status. CONCLUSIONS: the results of this study suggest that lower levels of fetal growth and shorter gestational duration are associated with increased likelihood of child protection registration in all categories including sexual abuse independent of maternal age or socioeconomic status. This study does not permit comment on whether poor fetal growth or preterm birth predispose to child abuse and neglect or the association arises because they share a common pathway.
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Nayak K, Spencer N, Shenoy M, Rubithon J, Coad N, Logan S (2006). How useful is the presence of petechiae in distinguishing non-accidental from accidental injury?.
Child Abuse Negl,
30(5), 549-555.
Author URL.
Mytton J, DiGuiseppi C, Gough D, Taylor R, Logan S (2006). School-based secondary prevention programmes for preventing violence.
Cochrane database of systematic reviews (Online),
3Abstract:
School-based secondary prevention programmes for preventing violence.
BACKGROUND: Early aggressive behaviour is a risk factor for later violence and criminal behaviour. Despite over 20 years of violence prevention interventions being delivered in the school setting, questions remain regarding the effectiveness of different interventions for children exhibiting aggressive behaviour. OBJECTIVES: to examine the effect of school based violence prevention programmes for children identified as aggressive or at risk of being aggressive. SEARCH STRATEGY: We searched CENTRAL, Cochrane Injuries Group specialised register, MEDLINE, EMBASE, other specialised databases and reference lists of articles. We also contacted authors and organisations to identify any further studies. SELECTION CRITERIA: We included trials meeting the following criteria; 1) participants were randomly assigned to intervention and control groups; 2) outcome data were collected concurrently; 3) participants comprised children in mandatory education identified as exhibiting, or at risk of, aggressive behaviour; 4) interventions designed to reduce aggression, violence, bullying, conflict or anger; 5) school based interventions; 6) outcomes included aggressive behaviour, school and agency responses to acts of aggression, or violent injuries. DATA COLLECTION AND ANALYSIS: Data were collected on design, participants, interventions, outcomes and indicators of study quality. Results of any intervention to no intervention were compared immediately post-intervention and at 12 months using meta-analysis where appropriate. MAIN RESULTS: of 56 trials identified, none reported data on violent injuries. Aggressive behaviour was significantly reduced in intervention groups compared to no intervention groups immediately post intervention in 34 trials with data, (Standardised Mean Difference (SMD) = -0.41; 95% confidence interval (CI) -0.56 to -0.26). This effect was maintained in the seven studies reporting 12 month follow-up (SMD = -0.40, (95% CI -0.73 to -0.06)). School or agency disciplinary actions in response to aggressive behaviour were reduced in intervention groups for nine trials with data, SMD = -0.48; 95% CI -1.16 to 0.19, although this difference may have been due to chance and was not maintained, based on two studies reporting follow-up to two to four months (SMD = 0.03; 95% CI -0.42 to 0.47). Subgroup analyses suggested that interventions designed to improve relationship or social skills may be more effective than interventions designed to teach skills of non-response to provocative situations, but that benefits were similar when delivered to children in primary versus secondary school, and to groups of mixed sex versus boys alone. AUTHORS' CONCLUSIONS: School-based secondary prevention programmes to reduce aggressive behaviour appear to produce improvements in behaviour greater than would have been expected by chance. Benefits can be achieved in both primary and secondary school age groups and in both mixed sex groups and boys-only groups. Further research is required to establish whether such programmes reduce the incidence of violent injuries or if the benefits identified can be maintained beyond 12 months.
Abstract.
2005
Sundrum R, Logan S, Wallace A, Spencer N (2005). Cerebral palsy and socioeconomic status: a retrospective cohort study.
Arch Dis Child,
90(1), 15-18.
Abstract:
Cerebral palsy and socioeconomic status: a retrospective cohort study.
AIMS: to study the relation between risk of cerebral palsy and socioeconomic status. METHODS: a total of 293 children with a diagnosis of cerebral palsy out of 105,760 live births between 1 January 1982 and 31 December 1997 were identified from the special conditions sub-file of the West Sussex Computerised Child Health System. RESULTS: There was a linear association between risk of cerebral palsy and socioeconomic status (SES) measured by the Registrar General's social class (RGSC) and enumeration district (ED) ranked into quintiles by the Townsend Deprivation Index derived from 1991 census data. Fifty one per cent and 30% of cases of cerebral palsy were statistically "attributable" to inequality in SES using the RGSC and ED quintile respectively. A linear association was also noted for singleton live births. The association between risk of cerebral palsy and ED quintile persisted in a logistic regression model that included birth weight and gestational age, although that between RGSC and cerebral palsy no longer reached conventional levels of statistical significance after adjustment. CONCLUSIONS: a strong association was observed between socioeconomic status and the risk of cerebral palsy, which was only partly accounted for by the known social gradients in birth weight and gestational age.
Abstract.
Author URL.
Logan S, Devereux E, Spencer N, Wallace A (2005). Disabling conditions and registration for child abuse and neglect: a population based study. PEDIATRICS, 116(3), 609-613.
Rudolf MCJ, Logan S (2005). What is the long term outcome for children who fail to thrive? a systematic review.
Arch Dis Child,
90(9), 925-931.
Abstract:
What is the long term outcome for children who fail to thrive? a systematic review.
AIMS: to ascertain the long term outcomes in children diagnosed as having failure to thrive (FTT). METHODS: Systematic review of cohort studies. Medline, Psychinfo, Embase, Cinahl, Web of Science, Cochrane, and DARE databases were searched for potentially relevant studies. INCLUSION CRITERIA: cohort studies or randomised controlled trials in children
Abstract.
Author URL.
2004
Marinho VCC, Higgins JPT, Sheiham A, Logan S (2004). Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev,
2004(1).
Abstract:
Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents.
BACKGROUND: Topical fluoride therapy (TFT) in the form of toothpastes, mouthrinses, varnishes and gels are effective caries preventive measures. However, there is uncertainty about the relative value of these interventions when used together. OBJECTIVES: to compare the effectiveness of two TFT modalities combined with one of them alone (mainly toothpaste) when used for the prevention of dental caries in children. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride varnish, gel, mouthrinse, or toothpaste in combination with each other in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the 'treatment' and 'control' groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled. MAIN RESULTS: Eleven of the 12 included studies contributed data for the meta-analyses. For the nine trials that provided data for the main meta-analysis on the effect of fluoride mouthrinses, gels or varnishes used in combination with toothpaste (involving 4026 children) the D(M)FS pooled PF was 10% (95% CI, 2% to 17%; p = 0.01) in favour of the combined regimens. Heterogeneity was not substantial in these results (I square = 32%). The separate meta-analyses of fluoride gel or mouthrinse combined with toothpaste versus toothpaste alone favour the combined regimens, but differences were not statistically significant; the significant difference in favour of the combined use of fluoride varnish and toothpaste accrues from a very small trial and appears likely to be a spurious result. Not all other combinations of possible practical value were tested in the included studies. The only other statistically significant result was in favour of the combined use of fluoride gel and mouthrinse in comparison to gel alone (pooled DMFS PF 23%; 95% CI, 4% to 43%; p = 0.02), based on two trials. No other combinations of TFT were consistently superior to a single TFT. REVIEWER'S CONCLUSIONS: Topical fluorides (mouthrinses, gels, or varnishes) used in addition to fluoride toothpaste achieve a modest reduction in caries compared to toothpaste used alone. No conclusions about any adverse effects could be reached, because data were scarcely reported in the trials.
Abstract.
Author URL.
Marinho VCC, Higgins JPT, Logan S, Sheiham A (2004). Fluoride mouthrinses for preventing dental caries in children and adolescents. Praxis, 93(5).
French R, Vliet H, Cowan F, Mansour D, Morris S, Hughes D, Robinson A, Proctor T, Summerbell C, Logan GS, et al (2004). Hormonally impregnated intrauterine systems (IUSs)versus othe forms of reversible contraceptives as effective methods of preventing pregnancy. Cochrane Database Syst Rev, 3
Marinho VCC, Higgins JPT, Sheiham A, Logan S (2004). One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes) versus another for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev,
2004(1).
Abstract:
One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes) versus another for preventing dental caries in children and adolescents.
BACKGROUND: Topical fluorides in the form of toothpaste, mouthrinse, varnish and gel are effective caries preventive measures. However, there is uncertainty about the relative value of these interventions. OBJECTIVES: to compare the effectiveness of one form of topical fluoride intervention with another when used for the prevention of dental caries in children. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride varnish, gel, mouthrinse, or toothpaste with each other in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the 'experimental' and 'control' groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled. MAIN RESULTS: There were 17 studies included, and 15 contributed data for the meta-analyses. Fluoride toothpaste was not significantly different from mouthrinse (pooled DMFS PF 0%; 95% CI, -18% to 19%; p = 0.94), or gel (pooled DMFS PF 0%; 95% CI, -21% to 21%; p = 1), or both gel and mouthrinse (pooled DMFS PF 1%; 95% CI, -13% to 14%; p = 0.94); heterogeneity was substantial. Results from the single trial comparing toothpaste with varnish (in deciduous teeth) were inconclusive (dfs PF 5%; CI not obtainable). The pooled results from the comparisons of fluoride varnish with mouthrinse was a non-significant difference favouring varnish (DMFS PF 10%; 95% CI, -12% to 32%; p = 0.40), but this result was not robust to sensitivity analysis performed, and heterogeneity was considerable. Results from the single trial comparing varnish with gel (14%, 95% CI, -12% to 40%; p = 0.30) and the single trial comparing gel with mouthrinse (-14% DMFS PF; 95% CI, -40% to 12%; p = 0.30) were inconclusive (favoured varnish and mouthrinse respectively). REVIEWER'S CONCLUSIONS: Fluoride toothpastes in comparison to mouthrinses or gels appear to have a similar degree of effectiveness for the prevention of dental caries in children. There is no clear suggestion that fluoride varnish is more effective than mouthrinses and the evidence for the comparative effectiveness of fluoride varnishes and gels, and mouthrinses and gels is inconclusive. No conclusions about adverse effects could be reached, because no data were reported on in the trials. Acceptance is likely to be greater for fluoride toothpaste.
Abstract.
Author URL.
Spencer N, Logan S (2004). Sudden unexpected death in infancy and socioeconomic status: a systematic review.
J Epidemiol Community Health,
58(5), 366-373.
Abstract:
Sudden unexpected death in infancy and socioeconomic status: a systematic review.
This paper aimed to systematically review observational studies documenting the relation between sudden unexpected death in infancy and socioeconomic status. A search of two electronic databases (Medline 1966 to November 2002; Embase 1981 to November 2002) yielded 52 case-control or cohort studies meeting the inclusion criteria. An increased risk of sudden unexpected death in infancy was reported in 51 studies and 32 of 33 studies reporting graded measures of socioeconomic status showed a dose-response relation of sudden death with socioeconomic status. of the 10 studies in which adjustment was made for maternal smoking, socioeconomic status retained an independent effect on infant death in nine. The effect of socioeconomic status was also independent of birth weight in 10 of 11 studies and independent of sleeping position in two. The included studies reported a significant association of socioeconomic status with sudden unexpected death in infancy with risk of infant death increasing with greater exposure to adverse social circumstances. The findings support a significant role for adverse social circumstances in the pathways to sudden unexpected death in infancy.
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Author URL.
Hemmelgarn BR, Zarnke KB, Campbell NRC, Feldman RD, McKay DW, McAlister FA, Khan N, Schiffrin EL, Myers MG, Bolli P, et al (2004). The 2004 Canadian Hypertension Education Program recommendations for the management of hypertension: Part I - Blood pressure measurement, diagnosis and assessment of risk.
Canadian Journal of Cardiology,
20(1), 31-40.
Abstract:
The 2004 Canadian Hypertension Education Program recommendations for the management of hypertension: Part I - Blood pressure measurement, diagnosis and assessment of risk
Objective: to provide updated, evidence-based recommendations for the assessment of the diagnosis, cardiovascular risk and identifiable causes for adults with high blood pressure. Options: for persons in whom a high blood pressure value is recorded, the assignment of a diagnosis of hypertension is dependent on the appropriate measurement of blood pressure, the level of the blood pressure elevation and the duration of follow-up. In addition, the presence of concomitant vascular risk factors, target organ damage and established atherosclerotic diseases should be assessed to determine the urgency, intensity and type of treatment. For persons diagnosed as having hypertension, defining overall risk of adverse cardiovascular outcomes requires an assessment of concomitant vascular risk factors, including laboratory testing, a search for target organ damage and an assessment for modifiable causes of hypertension. Home and ambulatory blood pressure assessment and echocardiography are options for selected patients. Outcomes: the identification of persons at increased risk of adverse cardiovascular outcomes; the quantification of overall cardiovascular risk; and the identification of persons with potentially modifiable causes of hypertension. Evidence: Medline searches were conducted from November 2001, one year before the period of the last revision of the Canadian recommendations for the management of hypertension, to October 2003. Reference lists were scanned, experts were polled, and the personal files of subgroup members and authors were used to identify other studies. Identified articles were reviewed and appraised using prespecified levels of evidence by content experts and methodological experts. Values: a high value was placed on the identification of persons at increased risk of cardiovascular morbidity and mortality, and persons with identifiable and potentially modifiable causes of hypertension. Benefits, Harms and Costs: the identification of persons at higher risk of cardiovascular disease will permit counselling for lifestyle maneuvers and introduction of antihypertensive drugs to reduce blood pressure for patients with sustained hypertension. The identification of specific causes of hypertension may permit the use of cause-specific interventions. For certain subgroups of patients and specific classes of drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity and/or mortality. Recommendations: the document contains recommendations for blood pressure measurement, diagnosis of hypertension and assessment of cardiovascular risk for adults with high blood pressure. These include the accurate measurement of blood pressure, criteria for diagnosis of hypertension, and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory blood pressure monitoring, and the role of echocardiography for those with hypertension. Validation: all recommendations were graded according to strength of evidence and voted on by the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. Only the recommendations that achieved high levels of consensus are reported. These guidelines will be updated annually. ©2004 Pulsus Group Inc. All rights reserved.
Abstract.
2003
Augood C, MacLennan S, Gilbert R, Logan S (2003). Cisapride treatment for gastro-oesophageal reflux in children.
Cochrane Database Syst Rev(4).
Abstract:
Cisapride treatment for gastro-oesophageal reflux in children.
BACKGROUND: Gastro-oesophageal reflux (GOR) is an extremely common and usually self-limiting condition in infants. When treatment is required, Cisapride, a pro-kinetic agent, has been commonly prescribed for the symptomatic management of GOR. There have been recent reports of possibly serious adverse events, e.g. an increased QTc interval, cardiac arrhythmias, and death, associated with the use of Cisapride. OBJECTIVES: to determine the effectiveness of Cisapride for symptoms of GOR compared with placebo or any other non-surgical treatments. SEARCH STRATEGY: Searches were conducted of the Cochrane Central Trials Register and the specialised Trials register of the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group, MEDLINE and Embase up till April 2002. Reference lists of relevant review articles and identified trials were scrutinised and forward citation searches were performed in the Science Citation Index on all trials identified. The search was re-run in August 2003 and no new trials were found. SELECTION CRITERIA: Randomised controlled trials that compared oral Cisapride therapy with placebo or with other non-surgical treatments for children with a diagnosis of GOR were included. Only studies in which Cisapride was administered orally for a minimum of one week and which documented at least one of the primary outcomes were included. We excluded trials in which the majority of participants were aged less than 28 days. DATA COLLECTION AND ANALYSIS: the primary outcomes were defined as a change in symptoms at the end of treatment, presence of adverse events, occurrence of clinical complications, and weight gain. The secondary outcomes included physiological measures of GOR or histological evidence of oesophagitis. We dichotomised symptoms into 'same or worse' vs 'improved' and calculated summary odds ratios. Continuous measures of GOR (e.g. reflux index) were summarised as a weighted mean difference. All outcomes were analysed using a random effects method. MAIN RESULTS: Searches identified nine trials which met the inclusion criteria. Eight trials compared Cisapride with placebo, of which seven (236 participants) reported data on symptoms of gastro-oesophageal reflux, and one reported data on the QTc interval (49 patients). The odds ratio for 'same or worse' vs 'improved symptoms' at the end of treatment of 0.34 (95%CI 0.10, 1.19) did not show a statistically significant difference between the two interventions. There was significant heterogeneity between the studies and the funnel plot suggested publication bias. In a sensitivity analysis, the definition of outcomes was changed to 'any symptoms' vs 'no symptoms'. This resulted in the exclusion of three trials (one of them the largest, best quality trial). The resulting pooled odds ratio showed a significant effect of Cisapride (OR 0.19, 95%CI 0.08, 0.44). Five studies reported adverse events. Four reported adverse events (mainly diarrhoea) but the difference was not statistically significant (OR 1.80, 95%CI 0.87, 3.70). One trial found no difference in the QTc after 3 to 8 weeks of treatment. Cisapride was associated with a statistically significant reduction in the reflux index (weighted mean difference -6.49, 95%CI -10.13, -2.85), but as reflux index and clinical symptoms are poorly correlated, the clinical importance of this finding is uncertain. Other measures of oesophageal pH monitoring did not reach significance. One included study compared Cisapride with Gaviscon (or Gaviscon and Carobel). The odds ratio for 'same or worse' vs 'improvement' in the Cisapride group compared with Gaviscon was 3.26 (95%CI 0.93-11.38). REVIEWER'S CONCLUSIONS: We found no clear evidence that Cisapride reduces symptoms of GOR. The results suggested substantial publication bias favouring studies showing a positive effect of Cisapride. This finding is supported by the report of one unpublished multi-centre study of 134 patients, which was reported to show no evidence of a significant effect of Cisapride. Due to reports of fatal cardiac arrhythmias or sudden death, from July Due to reports of fatal cardiac arrhythmias or sudden death, from July 2000, cisapride was restricted to a limited access programme supervised by a paediatric gastrologist in the USA and in Europe, to patients treated within a clinical trial or safety study or registry programme.
Abstract.
Author URL.
Marinho VCC, Higgins JPT, Logan S, Sheiham A (2003). Fluoride mouthrinses for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev(3).
Abstract:
Fluoride mouthrinses for preventing dental caries in children and adolescents.
BACKGROUND: Fluoride mouthrinses have been used extensively as a caries-preventive intervention in school-based programmes and individually at home. OBJECTIVES: to determine the effectiveness and safety of fluoride mouthrinses in the prevention of dental caries in children and to examine factors potentially modifying their effect. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials with blind outcome assessment, comparing fluoride mouthrinse with placebo or no treatment in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects metaregression analyses. MAIN RESULTS: Thirty-six studies were included. For the 34 that contributed data for meta-analysis (involving 14,600 children) the D(M)FS pooled PF was 26% (95% confidence interval (CI), 23% to 30%; p < 0.0001). Heterogeneity was not substantial, but confirmed statistically (p = 0.008). No significant association between estimates of D(M)FS prevented fractions and baseline caries severity, background exposure to fluorides, rinsing frequency and fluoride concentration was found in metaregression analyses. A funnel plot of the 34 studies indicated no relationship between prevented fraction and study precision. There is little information concerning possible adverse effects or acceptability of treatment in the included trials. REVIEWER'S CONCLUSIONS: This review suggests that the supervised regular use of fluoride mouthrinse at two main strengths and rinsing frequencies is associated with a clear reduction in caries increment in children. In populations with caries increment of 0.25 D(M)FS per year, 16 children will need to use a fluoride mouthrinse (rather than a non-fluoride rinse) to avoid one D(M)FS; in populations with a caries increment of 2.14 D(M)FS per year, 2 children will need to rinse to avoid one D(M)FS. There is a need for complete reporting of side effects and acceptability data in fluoride mouthrinse trials.
Abstract.
Author URL.
Marinho VC, Higgins JP, Logan S, Sheiham A (2003). Fluoride mouthrinses for preventing dental caries in children and adolescents.
Cochrane database of systematic reviews (Online)(3).
Abstract:
Fluoride mouthrinses for preventing dental caries in children and adolescents.
BACKGROUND: Fluoride mouthrinses have been used extensively as a caries-preventive intervention in school-based programmes and individually at home. OBJECTIVES: to determine the effectiveness and safety of fluoride mouthrinses in the prevention of dental caries in children and to examine factors potentially modifying their effect. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials with blind outcome assessment, comparing fluoride mouthrinse with placebo or no treatment in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects metaregression analyses. MAIN RESULTS: Thirty-six studies were included. For the 34 that contributed data for meta-analysis (involving 14,600 children) the D(M)FS pooled PF was 26% (95% confidence interval (CI), 23% to 30%; p < 0.0001). Heterogeneity was not substantial, but confirmed statistically (p = 0.008). No significant association between estimates of D(M)FS prevented fractions and baseline caries severity, background exposure to fluorides, rinsing frequency and fluoride concentration was found in metaregression analyses. A funnel plot of the 34 studies indicated no relationship between prevented fraction and study precision. There is little information concerning possible adverse effects or acceptability of treatment in the included trials. REVIEWER'S CONCLUSIONS: This review suggests that the supervised regular use of fluoride mouthrinse at two main strengths and rinsing frequencies is associated with a clear reduction in caries increment in children. In populations with caries increment of 0.25 D(M)FS per year, 16 children will need to use a fluoride mouthrinse (rather than a non-fluoride rinse) to avoid one D(M)FS; in populations with a caries increment of 2.14 D(M)FS per year, 2 children will need to rinse to avoid one D(M)FS. There is a need for complete reporting of side effects and acceptability data in fluoride mouthrinse trials.
Abstract.
Marinho VC, Higgins JP, Sheiham A, Logan S (2003). Fluoride toothpastes for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev,
2003(1).
Abstract:
Fluoride toothpastes for preventing dental caries in children and adolescents.
BACKGROUND: Fluoride toothpastes have been widely used for over three decades and remain a benchmark intervention for the prevention of dental caries. OBJECTIVES: to determine the effectiveness and safety of fluoride toothpastes in the prevention of caries in children and to examine factors potentially modifying their effect. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride toothpaste with placebo in children up to 16 years during at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in caries increments between the treatment and control groups expressed as a percentage of the increment in the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects meta-regression analyses. MAIN RESULTS: Seventy-four studies were included. For the 70 that contributed data for meta-analysis (involving 42,300 children) the D(M)FS pooled PF was 24% (95% confidence interval (CI), 21 to 28%; p
Abstract.
Author URL.
Logan S (2003). Research and equity in child health.
Abstract:
Research and equity in child health.
Abstract.
Author URL.
Marinho VCC, Higgins JPT, Logan S, Sheiham A (2003). Systematic review of controlled trials on the effectiveness of fluoride gels for the prevention of dental caries in children.
J Dent Educ,
67(4), 448-458.
Abstract:
Systematic review of controlled trials on the effectiveness of fluoride gels for the prevention of dental caries in children.
Fluoride gels have been widely used since the 1970s. The aim of this review was to assess the effectiveness and safety of fluoride gels in the prevention of dental caries in children and to examine factors potentially modifying their effectiveness. Relevant randomized or quasi-randomized trials were identified without language restrictions by searching multiple databases, reference lists of articles, and journals and by contacting selected authors and manufacturers. Trials with blind outcome assessment comparing fluoride gel with placebo or no treatment for at least one year and involving children under seventeen years of age were selected. Inclusion decisions, quality assessment, and data extraction were duplicated in a random sample of one third of studies, and consensus was achieved by discussion or a third party. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects meta-regression analyses. The main outcome was caries increment measured by the change in decayed, missing, and filled permanent tooth surfaces (D(M)FS). The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increment between the treatment and control groups expressed as a percentage of the mean increment in the control group. Potential adverse effects and unacceptability of treatment were also recorded. Twenty-five studies were included, involving 7,747 children. For the twenty-three that contributed data for meta-analysis, the D(M)FS pooled prevented fraction estimate was 28 percent (95 percent CI, 19 percent to 37 percent; p < 0.0001). There was clear heterogeneity, confirmed statistically (p < 0.0001). The effect of fluoride gel varied according to type of control group used, with D(M)FS PF on average being 19 percent (95 percent CI, 5 percent to 33 percent; p < 0.009) higher in non-placebo controlled trials. Only two trials reported on adverse events. There is clear evidence of a caries-inhibiting effect of fluoride gel. The best estimate of the magnitude of this effect, based on the fourteen placebo-controlled trials, is a 21 percent reduction (95 percent CI, 14 to 28 percent) in D(M)FS. This corresponds to an NNT of two (95 percent CI, 1 to 3) to avoid one D(M)FS in a population with a caries increment of 2.2 D(M)FS/year, or an NNT of twenty-four (95 percent CI, 18 to 36) based on an increment of 0.2 D(M)FS/year. However, further work is needed to identify and quantify potential harmful effects of fluoride gels.
Abstract.
Author URL.
Marinho VCC, Higgins JPT, Logan S, Sheiham A (2003). Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev,
2003(4).
Abstract:
Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents.
BACKGROUND: Topical fluoride therapy (TFT) in the form of varnish, gel, mouthrinse or toothpaste has been used extensively as a caries-preventive intervention for over three decades. OBJECTIVES: to determine the effectiveness and safety of fluoride varnishes, gels, mouthrinses, and toothpastes in the prevention of dental caries in children and to examine factors potentially modifying their effect. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (May 2000), CENTRAL (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride varnish, gel, mouthrinse, or toothpaste with placebo or no treatment in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects metaregression analyses. MAIN RESULTS: There were 144 studies included. For the 133 that contributed data for meta-analysis (involving 65,169 children) the D(M)FS pooled prevented fraction estimate was 26% (95% CI, 24% to 29%; p < 0.0001). There was substantial heterogeneity, confirmed statistically (p < 0.0001), but the direction of effect was consistent. The effect of topical fluoride varied according to type of control group used, type of TFT used, mode/setting of TFT use, initial caries levels and intensity of TFT application, but was not influenced by exposure to water fluoridation or other fluoride sources. D(M)FS PF was on average 14% (95% CI, 5% to 23%; p = 0.002) higher in non-placebo controlled trials, 14% (95% CI, 2% to 26%; p = 0.25) higher in fluoride varnish trials compared with all others, and 10% (95% CI, -17% to -3%; p = 0.003) lower in trials of unsupervised home use compared with self applied supervised and operator-applied. There was a 0.7% increase in the PF per unit increase in baseline caries (95% CI, 0.2% to 1.2%; p = 0.004). REVIEWER'S CONCLUSIONS: the benefits of topical fluorides have been firmly established on a sizeable body of evidence from randomized controlled trials. While the formal examination of sources of heterogeneity between studies has been important in the overall conclusions reached, these should be interpreted with caution. We were unable to reach definite conclusions about any adverse effects that might result from the use of topical fluorides, because data reported in the trials are scarce.
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Author URL.
McConachie H, Logan S, Measure of Process of Care UK Validation Working Group (2003). Validation of the measure of processes of care for use when there is no Child Development Centre.
Child Care Health Dev,
29(1), 35-45.
Abstract:
Validation of the measure of processes of care for use when there is no Child Development Centre.
INTRODUCTION: Clinical governance requires measurement of the outcomes of health care. The Measure of Processes of Care (MPOC; King, Rosenbaum & King 1995) is a postal questionnaire developed in Canada to reflect parents' perceptions of the quality of services received. AIM: to examine the usefulness of the MPOC for the evaluation of services for children with disabilities and their families. METHODS: the MPOC was revised minimally for British idiom, taking out explicit references to a 'Centre'. Surveys of parents using child disability services were carried out in three rural and two urban communities, where there are no Child Development Centres, with a total of 495 analysable questionnaires returned. In addition, 32 parents using a home nursing service for children with multiple disabilities completed questionnaires. RESULTS: the rate of return ranged from 49% to 67%. Factor analysis confirmed a five-factor solution but only one factor mapped clearly onto the Canadian structure. Using the revised structure, the surveys provide evidence of the discriminating potential of the MPOC, comparing the perceptions of parents who do or do not have a care coordinator, and comparing recipients of a home nursing service with matched users of general services. CONCLUSIONS: the MPOC can be used as a measure of outcome for child disability services of differing organizational structures.
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Author URL.
2002
Logan S (2002). A new loof for the journal. Child: Care, Health and Development, 28(1).
Huertas-Ceballos A, MacArthur C, Logan GS (2002). Dietary interventions for recurrent abdominal pain (RAP) in childhood. The Cochrane Library(4).
Laing GJ, Law J, Levin A, Logan S (2002). Evaluation of a structured test and a parent led method for screening for speech and language problems: prospective population based study.
BMJ,
325(7373).
Abstract:
Evaluation of a structured test and a parent led method for screening for speech and language problems: prospective population based study.
OBJECTIVE: to evaluate two methods for identifying speech and language problems in preschool children. DESIGN: Prospective population based study. SETTING: Inner London. PARTICIPANTS AND METHODS: 37 health visitors were randomly assigned to use a structured screening test (18) or a parent led method (19). of 623 eligible children aged 30-36 months, the parents of 582 agreed to participate (353 using the structured test and 229 the parent led method). MAIN OUTCOME MEASURES: Children were assessed by a speech and language therapist blinded to the test result, using the Reynell developmental language scales. Children were classified as having "severe language problems" if the Reynell score was below the third centile for receptive language and as "needing therapy" if the Reynell score was below the seventh centile for receptive or expressive language and clinical opinion. RESULTS: Reference assessments and usable scores were obtained for 458 (97%) of the 474 children screened. 98 (21%) children had severe language problems and 131 (29%) needed therapy. The sensitivity and specificity for the structured screening test were 66% (95% confidence interval 53% to 76%) and 89% (85% to 93%) respectively for severe language problems and 54% (43% to 65%) and 90% (85% to 93%) for those needing therapy. The sensitivity and specificity for referral by the parent led method were 56% (40% to 71%) and 85% (78% to 90%) for severe language problems and 58% (44% to 71%) and 90% (83% to 94%) for those needing speech and language therapy. CONCLUSIONS: Both approaches failed to detect a substantial proportion of children with severe language problems and led to over-referral for diagnostic assessments. Screening is likely to be an ineffective approach to the management of speech and language problems in preschool children in this population.
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Author URL.
Marinho VC, Higgins JP, Logan S, Sheiham A (2002). Fluoride gels for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev(2).
Abstract:
Fluoride gels for preventing dental caries in children and adolescents.
BACKGROUND: Topically applied fluoride gels have been widely used as a caries-preventive intervention in dental surgeries and school-based programs for over two decades. OBJECTIVES: to determine the effectiveness and safety of fluoride gels in the prevention of dental caries in children and to examine factors potentially modifying their effect. SEARCH STRATEGY: Multiple electronic database searches, reference lists of articles, journal handsearch, selected authors and manufacturers. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride gel with placebo or no treatment in children up to 16 years during at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Study authors were contacted for missing data. The primary outcome measure was the prevented fraction (PF), that is the caries increment in the treatment group expressed as a percentage of the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects meta-regression analyses. MAIN RESULTS: Twenty-five studies were included, involving 7747 children. For the 23 that contributed data for meta-analysis, the D(M)FS pooled prevented fraction estimate was 28% (95% CI, 19% to 37%; p
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Author URL.
Marinho VC, Higgins JP, Logan S, Sheiham A (2002). Fluoride varnishes for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev(3).
Abstract:
Fluoride varnishes for preventing dental caries in children and adolescents.
BACKGROUND: Topically applied fluoride varnishes have been used extensively as an operator-applied caries-preventive intervention for over two decades. OBJECTIVES: to determine the effectiveness and safety of fluoride varnishes in the prevention of dental caries in children and to examine factors potentially modifying their effect. SEARCH STRATEGY: Multiple electronic database searches, reference lists of articles, journal handsearch, selected authors and manufacturers. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride varnish with placebo or no treatment in children up to 16 years during at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Study authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF), that is the difference in caries increments between the treatment and control groups expressed as a percentage of the increment in the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects meta-regression analyses. MAIN RESULTS: Nine studies were included, involving 2709 children. For the seven that contributed data for the main meta-analysis, the D(M)FS pooled prevented fraction estimate was 46% (95% CI, 30% to 63%; p
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Little CV, Parsons T, Logan S (2002). Herbal therapy for treating osteoarthritis. Praxis, 91(34).
Little CV, Parson T, Logan GS (2002). Herbal treatment for osteoarthritis. The Cochrane Library(2).
Rahi JS, Logan GS, Borja MC, Tomms C, Taylor D (2002). Likelihood and factors predictive of improved vision in the amblyopic eye after visual loss in the non-amblyopic eye. Lancet(360), 621-623.
Huertas-Ceballos A, Macarthur C, Logan S (2002). Pharmacological interventions for recurrent abdominal pain (RAP) in childhood.
Cochrane database of systematic reviews (Online : Update Software)(1).
Abstract:
Pharmacological interventions for recurrent abdominal pain (RAP) in childhood.
BACKGROUND: Between 4% and 25% of school age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority of such children no organic cause for their pain can be found on physical examination or investigation. Although most children are likely managed by reassurance and simple measures, a large range of interventions has been recommended. OBJECTIVES: to determine the effectiveness of medication for recurrent abdominal pain in school-age children. SEARCH STRATEGY: the Cochrane Library (CENTRAL), MEDLINE, EMBASE, CINAHL, ERIC, PsycLIT, LILACS and JICST were searched using a strategy combining (Recurrent OR synonyms) AND (Abdomen OR synonyms) AND (Pain OR synonyms). Where appropriate search filters were employed. In addition, researchers working in this area were asked to identify relevant studies. SELECTION CRITERIA: Any study in which the majority of participants were school age children fulfilling standard criteria for RAP, and who were allocated by random or quasi-random methods to any drug treatment compared with a placebo or no treatment. DATA COLLECTION AND ANALYSIS: References identified by the searches were screened against the inclusion criteria by two independent reviewers. MAIN RESULTS: Only one trial met the inclusion criteria. This cross-over trial in 14 children who met suggested criteria for "abdominal migraine" compared pizotifen and placebo, each given for one month with no washout period. Participants reported a mean of 8.21 (95% CI 2.93, 13.48) fewer days of pain while taking the active drug. They also reported that the mean difference on an "Index of Severity" was -16.21 (95% CI -26.51, -5.90) and on an "Index of Misery" was -56.07 (95% CI -94.07, -18.07). REVIEWER'S CONCLUSIONS: There is little evidence to suggest that recommended drugs are effective in the management of RAP. At present there seems little justification for the use of these drugs other than in clinical trials. There is an urgent need for trials of all suggested pharmacologic interventions in children with RAP.
Abstract.
Huertas-Ceballos A, Macarthur C, Logan S (2002). Pharmacological interventions for recurrent abdominal pain (RAP) in childhood.
Cochrane Database Syst Rev(1).
Abstract:
Pharmacological interventions for recurrent abdominal pain (RAP) in childhood.
BACKGROUND: Between 4% and 25% of school age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority of such children no organic cause for their pain can be found on physical examination or investigation. Although most children are likely managed by reassurance and simple measures, a large range of interventions has been recommended. OBJECTIVES: to determine the effectiveness of medication for recurrent abdominal pain in school-age children. SEARCH STRATEGY: the Cochrane Library (CENTRAL), MEDLINE, EMBASE, CINAHL, ERIC, PsycLIT, LILACS and JICST were searched using a strategy combining (Recurrent OR synonyms) AND (Abdomen OR synonyms) AND (Pain OR synonyms). Where appropriate search filters were employed. In addition, researchers working in this area were asked to identify relevant studies. SELECTION CRITERIA: Any study in which the majority of participants were school age children fulfilling standard criteria for RAP, and who were allocated by random or quasi-random methods to any drug treatment compared with a placebo or no treatment. DATA COLLECTION AND ANALYSIS: References identified by the searches were screened against the inclusion criteria by two independent reviewers. MAIN RESULTS: Only one trial met the inclusion criteria. This cross-over trial in 14 children who met suggested criteria for "abdominal migraine" compared pizotifen and placebo, each given for one month with no washout period. Participants reported a mean of 8.21 (95% CI 2.93, 13.48) fewer days of pain while taking the active drug. They also reported that the mean difference on an "Index of Severity" was -16.21 (95% CI -26.51, -5.90) and on an "Index of Misery" was -56.07 (95% CI -94.07, -18.07). REVIEWER'S CONCLUSIONS: There is little evidence to suggest that recommended drugs are effective in the management of RAP. At present there seems little justification for the use of these drugs other than in clinical trials. There is an urgent need for trials of all suggested pharmacologic interventions in children with RAP.
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Author URL.
Logan S, Borja MC, Rahi JS, Timms C (2002). Prediction of improved vision in the amblyopic eye after visual loss in the non-amblyopic eye. The Lancet, 360(9333), 621-623.
Logan S, Eggit IR, Rahi JS, Timms C (2002). Risk, causes and outcomes of visual impairment after loss of vision in the non-amblyopic eye: a population-based study. The Lancet, 360(9333), 597-600.
Mytton JA, DiGuiseppi C, Gough DA, Taylor RS, Logan S (2002). School-based violence prevention programs: systematic review of secondary prevention trials.
Arch Pediatr Adolesc Med,
156(8), 752-762.
Abstract:
School-based violence prevention programs: systematic review of secondary prevention trials.
OBJECTIVE: to quantify the effectiveness of school-based violence prevention programs for children identified as at risk for aggressive behavior. DESIGN: Systematic review and meta-analysis of randomized controlled trials. Electronic databases and bibliographies were systematically searched and authors and organizations were contacted to identify randomized controlled trials. Standardized, weighted mean effect sizes were assessed by meta-analysis. SETTING: Elementary, middle, and high schools. PARTICIPANTS: Children at risk for aggressive behavior. MAIN OUTCOME MEASURES: Violent injuries, observed or reported aggressive or violent behaviors, and school or agency responses to aggressive behaviors. RESULTS: of the 44 trials identified, none reported data on violent injuries. For the 28 trials that assessed aggressive behaviors, the pooled difference between study groups was -0.36 (95% confidence interval, -0.54 to -0.19) in favor of a reduction in aggression with intervention. For the 9 trials that reported data on school or agency responses to aggression, the pooled difference was -0.59 (95% confidence interval, -1.18 to 0.01). Subgroup analyses suggested greater effectiveness in older students and when administered to mixed-sex groups rather than to boys alone. CONCLUSIONS: School-based violence prevention programs may produce reductions in aggressive and violent behaviors in children who already exhibit such behavior. These results, however, need to be confirmed in large, high-quality trials.
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Gilbert RE, Augood C, Gupta R, Logan S, Ades AE, Sculpher M, van den Meulen JHP (2002). Screening for Down's syndrome - Reply.
BRITISH MEDICAL JOURNAL,
324(7329), 112-112.
Author URL.
Venn-Treloar J, Whittle M, Reynolds T, Howe D, Gilbert RE, Augood C, Gupta R, Logan S, Ades AE, Sculpher M, et al (2002). Screening for down's syndrome [3] [multiple letters]. British Medical Journal, 324(7329), 110-112.
Spencer N, Logan S (2002). Social influences on birth weight.
J Epidemiol Community Health,
56(5), 326-327.
Author URL.
Hrytsiuk I, Gilbert R, Logan S, Pindoria S, Brook CGD (2002). Starting dose of levothyroxine for the treatment of congenital hypothyroidism: a systematic review.
Arch Pediatr Adolesc Med,
156(5), 485-491.
Abstract:
Starting dose of levothyroxine for the treatment of congenital hypothyroidism: a systematic review.
OBJECTIVE: to determine the effect of levothyroxine sodium starting dose on cognitive development, growth, or behavior in children with congenital hypothyroidism identified by neonatal screening. DESIGN: Systematic review of cohort studies. Two analyses were performed: a between-study comparison of mean starting dose with mean developmental score and an analysis of the within-study effects of starting dose on cognitive development, growth, or behavior. RESULTS: the between-study comparison (14 cohort studies based on 1321 patients) found that the standardized mean IQ or developmental quotient scores ranged from 90 to 115 but were not associated with the mean starting dose of levothyroxine (P =.48). The within-study comparison of 4 cohort studies (based on 558 patients) that reported the effect of the starting dose of levothyroxine on cognitive development found no consistent effects. There was weak evidence for an effect of starting dose on growth (1 study) and on behavior problems (1 study). CONCLUSIONS: the evidence for an effect of starting dose of levothyroxine on cognitive development, growth, or behavior is too weak to justify recommendations in favor of high- or standard-dose regimens. More reliable information, based on a randomized controlled trial of starting dose or a meta-analysis of the individual patient data currently available, is required to inform treatment policies.
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2001
Gilbert R, Logan S, Moyer VA, Elliott EJ (2001). Assessing diagnostic and screening tests: Part 1. Concepts.
West J Med,
174(6), 405-409.
Author URL.
Gilbert R, Logan S, Moyer VA, Elliott EJ (2001). Assessing diagnostic and screening tests: Part 2. How to use the research literature on diagnosis.
West J Med,
175(1), 37-41.
Author URL.
French R, Cowan F, Mansour D, Morris S, Hughes D, Robinson A, Proctor T, Summerbell C, Logan S, Guillebaud J, et al (2001). Hormonally impregnated intrauterine systems (IUSs), versus other forms of reversible contraceptives as effective methods of preventing pregnancy.
Cochrane Database Syst Rev(2).
Abstract:
Hormonally impregnated intrauterine systems (IUSs), versus other forms of reversible contraceptives as effective methods of preventing pregnancy.
OBJECTIVES: to assess the contraceptive efficacy, tolerability and acceptability of hormonally impregnated intrauterine systems (IUSs) in comparison to other reversible contraceptive methods. SEARCH STRATEGY: Literature was identified through database searches, reference lists and individuals/organisations working in the field. SELECTION CRITERIA: all randomised controlled trials comparing IUSs with other forms of reversible contraceptives and reporting on pre-determined outcomes in women of reproductive years. The primary outcomes were pregnancy due to method/user failure and continuation rate. DATA COLLECTION AND ANALYSIS: the quality assessment of studies and data extraction were completed independently by two blinded reviewers. A quality checklist was designed to identify general methodological and contraceptive specific factors which could bias results. Events per women months and single decrement life table rates were extracted where possible for pregnancy, continuation, adverse events and reasons for discontinuation. Events per total number of women at follow up were collected for hormonal side effects and menstrual disturbance. When appropriate, data were pooled at the same points of follow up to calculate rate ratios in order to determine the relative effectiveness of one method compared to another. For the single decrement life table rates, the rate differences were pooled to determine the absolute difference in effectiveness of one method compared to another. Interventions were only combined if the contraceptive methods were similar. Non-hormonal IUDs were divided into three categories for the purpose of comparison with IUSs: IUDs >250mm2 (i.e. CuT 380A IUD and CuT 380 Ag IUD), IUDs 250mm2 users. However, women using the LNG-20 IUS were significantly less likely to become pregnant than those using the IUD 250mm2. LNG-20 users were significantly more likely than all the IUD users to discontinue because of hormonal side effects and menstrual disturbance, which on further breakdown of the data was due to amenorrhoea. When the LNG-20 IUS was compared to Norplant-2, the LNG-20 users were significantly more likely to experience amenorrhoea and oligomenorrhoea, but significantly less likely to experience prolonged bleeding and spotting. No other significant differences were observed. Progestasert users were significantly less likely to become pregnant and less likely to continue on the method than non-medicated IUD users after one year, but no significant differences was noted for these two outcomes when Progestasert users were compared to IUD
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Logan S, Martins S, Gilbert R (2001). Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia.
Cochrane Database Syst Rev(2).
Abstract:
Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia.
BACKGROUND: Iron deficiency and iron deficiency anaemia (IDA) are common in young children. It has been suggested that the lack of iron may have important effects on children's psychomotor development and cognitive function. OBJECTIVES: to determine the effects of iron therapy on psychomotor development and cognitive function in iron deficient children less than 3 years of age. SEARCH STRATEGY: the following databases were searched: COCHRANE LIBRARY (2000 ISSUE 4) MEDLINE (1966-August 2000) EMBASE (1980-August 2000) Latin American Database (LILACS) PsycLIT Journal articles (1974-August 2000) PsycLIT Chapters and Books (1987-August 2000) the references of identified trials and of important review articles were scrutinised. Citation searches on trials from the primary search were performed within the Science Citation Index. Key authors were contacted. SELECTION CRITERIA: Studies were included if children less than 3 years of age with evidence of iron deficiency anaemia were randomly allocated to iron or iron and vitamin C versus a placebo or vitamin C alone and assessment of developmental status or cognitive function was carried out using standardised tests by observers blind to treatment allocation. DATA COLLECTION AND ANALYSIS: Abstracts and titles of studies identified on searches of electronic databases were read to determine whether they might meet the inclusion criteria. Full copies of those possibly meeting these criteria from electronic or other searches were assessed by two independent reviewers. Differences of opinion about suitability for inclusion were resolved by discussion. Data were analysed separately depending on whether participants had iron assessments were performed within one month of beginning iron therapy or later. MAIN RESULTS: Five trials, including 180 children with IDA, examined the effects of iron therapy on measures of psychomotor development between 5 and 11 days of commencement of therapy. Data from four trials could be pooled. The pooled difference in pre to post treatment change in Bayley Scale PDI between iron treated and placebo groups was -3.2 (95%CI -7.24, 0.85) and in Bayley Scale MDI, 0.55 (95% CI -2.84, 1.75). Two studies, including 160 randomised children with IDA, examined the effects of iron therapy on measures of psychomotor development more than 30 days after commencement of therapy. Aukett et al reported the mean number of skills gained after two months of iron therapy, using the Denver test. The intervention group gained 0.8 (95% CI -0.18, 1.78) more skills on average than the control group. Idjrandinata et al reported that the difference in pre to post treatment change in Bayley Scale PDI between iron treated and placebo groups after 4 months was 18.40 (95%CI 10.16, 26.64) and in Bayley Scale MDI, 18.80 (95% CI 10.19, 27.41). REVIEWER'S CONCLUSIONS: There is no convincing evidence that iron treatment of young children with IDA has an effect on psychomotor development discernable within 5-11 days. The effect of longer term treatment remains unclear but the data would be compatible with clinically significant benefit. There is urgent need for further randomised controlled trials with long term follow up.
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Gilbert RE, Augood C, Gupta R, Ades AE, Logan S, Sculpher M, van Der Meulen JH (2001). Screening for Down's syndrome: effects, safety, and cost effectiveness of first and second trimester strategies.
BMJ,
323(7310), 423-425.
Abstract:
Screening for Down's syndrome: effects, safety, and cost effectiveness of first and second trimester strategies.
OBJECTIVE: to compare the effects, safety, and cost effectiveness of antenatal screening strategies for Down's syndrome. DESIGN: Analysis of incremental cost effectiveness. SETTING: United Kingdom. MAIN OUTCOME MEASURES: Number of liveborn babies with Down's syndrome, miscarriages due to chorionic villus sampling or amniocentesis, health care costs of screening programme, and additional costs and additional miscarriages per additional affected live birth prevented by adopting a more effective strategy. RESULTS: Compared with no screening, the additional cost per additional liveborn baby with Down's syndrome prevented was 22 000 pound sterling for measurement of nuchal translucency. The cost of the integrated test was 51 000 pound sterling compared with measurement of nuchal translucency. All other strategies were more costly and less effective, or cost more per additional affected baby prevented. Depending on the cost of the screening test, the first trimester combined test and the quadruple test would also be cost effective options. CONCLUSIONS: the choice of screening strategy should be between the integrated test, first trimester combined test, quadruple test, or nuchal translucency measurement depending on how much service providers are willing to pay, the total budget available, and values on safety. Screening based on maternal age, the second trimester double test, and the first trimester serum test was less effective, less safe, and more costly than these four options.
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Peckham C, Tookey P, Logan S, Giaquinto C (2001). Screening options for prevention of congenital cytomegalovirus infection.
J Med Screen,
8(3), 119-124.
Author URL.
2000
Bambang S, Spencer NJ, Logan S, Gill L (2000). Cause-specific perinatal death rates, birth weight and deprivation in the West Midlands, 1991-93.
Child Care Health Dev,
26(1), 73-82.
Abstract:
Cause-specific perinatal death rates, birth weight and deprivation in the West Midlands, 1991-93.
OBJECTIVES: to study the relationship between cause-specific perinatal death rates, material deprivation and birthweight among births in 3 consecutive years in the West Midlands Health Region. STUDY DESIGN: Retrospective cohort study. SETTING: West Midlands Health Region (WMHR). STUDY POPULATION: all births (live and stillbirths) to mothers with addresses in the WMHR in 1991, 1992 and 1993. MAIN OUTCOME MEASURES: Cause-specific perinatal death rates--crude and stratified by birthweight. METHODS: Perinatal deaths in the WMHR in 1991-93, collected as part of the national Confidential Enquiry into Stillbirths and Deaths in Infancy, were classified into causes of death by the extended Wigglesworth classification. Crude rates for cause-specific perinatal deaths and rates stratified by birthweight < 2500 g and > or = 2500 g were calculated for each enumeration district (ED) quintile derived by ranking enumeration districts for the whole of the region by Townsend Deprivation Index. Cause-specific rates of death were investigated for a linear trend across ED quintiles. The relative risk of death (most vs least deprived) from specific causes was calculated. Using rates for the least deprived quintile as the reference, deaths from each cause 'attributable' to social inequality were calculated. RESULTS: Positive linear trends in perinatal deaths were noted with increasing deprivation for each specific cause of death except those classified as 'other causes' (Wigglesworth Class E). Relative risk (most vs least deprived) of perinatal death with a congenital anomaly was 1.98 (confidence interval, CI: 1.36,2.89). For deaths related to antepartum events, intrapartum events and immaturity the risks were 1.81 (CI: 1.39,2.38), 1.48 (CI: 1.10,1.98) and 1.92 (CI 1.45,2.56), respectively. Forty-three (35.7%) perinatal deaths per year were due to congenital anomalies, 63 (29.7%) antepartum events, 36 (21.9%) intrapartum events and 61 (32.7%) immaturity and these were statistically 'attributable' to social inequality. Cause-specific perinatal death rates for babies < 2500 g showed no correlation with deprivation; however, for babies > or = 2500 g the association with deprivation persisted. CONCLUSIONS: all cause-specific rates except those due to 'other causes' showed a positive linear trend with increasing deprivation. These trends were found for infants born > or = 2500 g but were not seen for low birthweight infants (< 2500 g). Almost 30% of deaths were statistically 'attributable' to social inequality. The results of this study suggest that material deprivation plays an important role in the causal pathway leading to perinatal death and needs to be addressed in preventive programmes aimed at the reduction of perinatal deaths.
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Gilbert RE, Augood C, MacLennan S, Logan S (2000). Cisapride treatment for gastro-oesophageal reflux in children: a systematic review of randomized controlled trials.
J Paediatr Child Health,
36(6), 524-529.
Abstract:
Cisapride treatment for gastro-oesophageal reflux in children: a systematic review of randomized controlled trials.
The aim of the systematic review was to determine the effect of cisapride compared with placebo or other non-surgical therapies for the treatment of symptoms of gastro-oesophageal reflux in children. We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Science Citation Index and reference lists for randomized controlled trials which compared cisapride with placebo or other non-surgical therapy in children. We included only trials which reported reflux-related symptoms as an outcome, provided that cisapride was administered orally for at least I week. Seven trials (286 children in total) compared cisapride with placebo. Two trials reported good concealment of treatment allocation. The pooled odds ratio for the 'same or worse' symptoms was 0.34 (95% CI 0.10, 1.19). There was substantial heterogeneity between studies (P < 0.00001) and the funnel plot was asymmetrical. Adverse effects (mainly diarrhoea) were not significantly increased with cisapride (pooled odds ratio (OR) 1.80: 0.87, 3.70). The reflux index was significantly reduced in children treated with cisapride (weighted mean difference -6.49: -10.13, -2.85). One study (50 children) compared cisapride with gaviscon plus carobel: the OR for the 'same or worse' symptoms was 3.26 (0.93, 11.38). There was no clear evidence that cisapride reduced symptoms of gastro-oesophageal reflux. As smaller, poorer quality studies were biased in favour of a positive treatment effect, the pooled OR overestimated the potential benefits of cisapride. There was some evidence to suggest that gaviscon plus carobel may be a more effective option than cisapride.
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Logan S, Bedford H, Elliman D, Blair PS, Fleming PJ, Platt MW (2000). Consider absolute risks in SIDS prevention [4] (multiple letters). Archives of Disease in Childhood, 83(5).
Logan S, Bedford H, Elliman D (2000). Consider absolute risks in SIDS prevention.
Arch Dis Child,
83(5).
Author URL.
Logan S, Spencer N (2000). Inequality and children's health.
Child Care Health Dev,
26(1), 1-3.
Author URL.
Garner P, Panpanich R, Logan S (2000). Is routine growth monitoring effective? a systematic review of trials.
Arch Dis Child,
82(3), 197-201.
Abstract:
Is routine growth monitoring effective? a systematic review of trials.
BACKGROUND: Growth monitoring consists of routine measurements to detect abnormal growth, combined with some action when this is detected. It aims to improve nutrition, reduce the risk of death or inadequate nutrition, help educate carers, and lead to early referral for conditions manifest by growth disorders. As primary care workers world wide invest time in this activity, evidence for its benefits and harms was sort. STUDIES: randomised or quasi-randomised controlled trials of growth monitoring. INTERVENTIONS: regular growth monitoring, combined with some intervention targeted at abnormal growth, compared with controls. OUTCOMES: anthropometric measures; referrals to primary and specialist care, or community services; maternal knowledge, anxiety, and satisfaction; child morbidity and mortality. COMPARISONS: Routine growth monitoring compared with no routine growth monitoring; routine growth monitoring by plotting onto a standard chart compared with monitoring with no chart. SEARCH STRATEGY: Cochrane controlled trials register; World Health Organisation and World Bank publications; contact with specialist community paediatricians working in the field. RESULTS: Two trials met the inclusion criteria. One compared growth monitoring with no growth monitoring, in a cluster randomised trial nested in a nutritional intervention programme, and detected no difference in nutritional outcomes between the two groups. Another trial compared growth monitoring with and without a standard chart, measuring maternal knowledge of women about nutrition. It showed small numerical differences in test scores. DISCUSSION AND IMPLICATIONS: Current policies appear to be based on the opinion that investment in the activity has worthwhile health benefits, and does no harm. No reliable evidence was found to support or refute this.
Abstract.
Author URL.
1999
Goodhart C, Logan S (1999). Acceptability of screening young children for anaemia.
Br J Gen Pract,
49(448), 907-908.
Abstract:
Acceptability of screening young children for anaemia.
Although anaemia is common among young children and may be detrimental to health and development, few blood tests are done in this age group. We found that thumb-prick blood tests were not stressful to most young children and, despite the high mobility of the population, achieved an 81% uptake of screening for anaemia (273 out of 335 eligible children).
Abstract.
Author URL.
Li PL, Logan S, Yee L, Ng S (1999). Barriers to meeting the mental health needs of the Chinese community.
J Public Health Med,
21(1), 74-80.
Abstract:
Barriers to meeting the mental health needs of the Chinese community.
BACKGROUND: This study aimed to identify the barriers encountered by Chinese people with mental health needs in England which hindered their obtaining appropriate help from the National Health Service (NHS). METHODS: Attenders at Chinese community centres in health authority districts with resident Chinese population in excess of 2000 were invited to fill in a 12-item Chinese Health Questionnaire (12-CHQ). Individuals who scored two or above, indicating a high probability of a mental health problem, were invited to undertake a semi-structured interview. RESULTS: a total of 401 completed the 12-CHQ. Eighty-six (21.4 per cent) screened positive and 71 (82.6 per cent) agreed to be interviewed. Although 70 (98.6 per cent) were registered with a general practitioner (GP), there were long delays before they made contact with health professionals, and the GP was the first port of call for help in only 27 (38.6 per cent) interviewees. Fifty-two (74.3 per cent) had encountered difficulties when they sought professional help. The main barriers were language, interviewees' perceptions of symptoms as somatic rather than psychiatric in origin, lack of knowledge about statutory services, and lack of access to bilingual health professionals. Doctors, particularly GPs, were pivotal in the management of their conditions. The majority were prescribed psychiatric medication with only a small number in contact with community psychiatric services. Unemployment and social exclusion were common. Stigma associated with mental illness and limited knowledge in the community were identified as the causes for the widespread discrimination experienced by the interviewees. CONCLUSION: the mental health needs of these Chinese people were not adequately met by statutory services, nor could they rely on family and friends for care and support. Training for health service staff and access to health advocates are essential to maximize the effectiveness of health professional-patient contacts. The promotion of better understanding of mental illness by the Chinese community is important, and greater flexibility within the NHS is required to ensure those professionals with bilingual skills are used to the best effect.
Abstract.
Author URL.
Parsons TJ, Power C, Logan S, Summerbell CD (1999). Childhood predictors of adult obesity: a systematic review.
Int J Obes Relat Metab Disord,
23 Suppl 8, S1-107.
Abstract:
Childhood predictors of adult obesity: a systematic review.
OBJECTIVE: to identify factors in childhood which might influence the development of obesity in adulthood. BACKGROUND: the prevalence of obesity is increasing in the UK and other developed countries, in adults and children. The adverse health consequences of adult obesity are well documented, but are less certain for childhood obesity. An association between fatness in adolescence and undesirable socio-economic consequences, such as lower educational attainment and income, has been observed, particularly for women. Childhood factors implicated in the development of adult obesity therefore have far-reaching implications for costs to the health-services and economy. SEARCH STRATEGY: in order to identify relevant studies, electronic databases--Medline, Embase, CAB abstracts, Psyclit and Sport Discus-were searched from the start date of the database to Spring 1998. The general search structure for electronic databases was (childhood or synonyms) AND (fatness or synonyms) AND (longitudinal or synonyms). Further studies were identified by citations in retrieved papers and by consultation with experts. INCLUSION CRITERIA: Longitudinal observational studies of healthy children which included measurement of a risk factor in childhood (
Abstract.
Author URL.
Logan S (1999). Commentary: iron deficiency and developmental deficit-the jury is still out.
BMJ,
318(7185), 697-698.
Author URL.
Logan S (1999). Evaluating services for children with disabilities and their families.
Child Care Health Dev,
25(2), 81-83.
Author URL.
McConachie HR, Salt A, Chadury Y, McLachlan A, Logan S (1999). How do Child Development Teams work? Findings from a UK national survey.
Child Care Health Dev,
25(2), 157-168.
Abstract:
How do Child Development Teams work? Findings from a UK national survey.
The area of child disability is the 'Cinderella' of community child health services. It lacks a clear commissioning model, agreed quality standards or guidance on the level of resources required. In this climate of uncertainty, a national survey of Child Development Teams was undertaken in order to describe their basic structure and processes. The paper reports information from 242 multidisciplinary teams providing local services, with statutory funding, to children with neurodevelopmental disability and their families. The picture presented is encouraging in part. For example, 79% of teams operate from a Child Development Centre, which may be expected to enhance team communication. In terms of the initial assessment process for a developmentally delayed child, most teams (91%) report that they would hold a case discussion afterwards, although only 74% would always include parents, and only 70% always give their report(s) to parents. The impression of management practices is weak, with only 62% giving a clear answer about who manages the team, and less than half having a written policy or contract for the team's work. The survey findings provide a sampling framework from which further evaluative research can be generated.
Abstract.
Author URL.
Logan S (1999). Iron deficiency and developmental deficit - the jury is still out - Commentary.
BRITISH MEDICAL JOURNAL,
318(7185), 697-698.
Author URL.
Laing GJ, Logan S (1999). Patterns of unintentional injury in childhood and their relation to socio-economic factors.
Public Health,
113(6), 291-294.
Abstract:
Patterns of unintentional injury in childhood and their relation to socio-economic factors.
OBJECTIVE: to estimate the rate of childhood injury resulting in attendance at Accident and Emergency Departments, to describe the types of accidents and injuries seen and to relate these to socio-economic indices for ward of residence. METHODS: Data were collected from Accident and Emergency records, on every fifth day for a year, for children 0-14 y, who attended following unintentional injury and were resident within the study area. RESULTS: 1147 children fulfilled the inclusion criteria. The annual rate of attendance was 138.2 per 1000. There was a higher rate of attendance in boys than in girls in all age groups and the gender difference was particularly marked for severe injuries. Social deprivation, measured by Townsend score, of ward of residence was a powerful predictor of risk of attendance; accounting for 33% of the variance between wards. CONCLUSION: Unintentional injury results in high rates of attendance at Accident and Emergency Departments although the rates in this community were substantially lower than those reported from elsewhere in the United Kingdom. Risk of injury was strongly related to social disadvantage. District based data collection can be used to facilitate the development of priorities and a locally applicable safety agenda for children.
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Author URL.
Linnane E, Paul A, Parry R, Clayton PT, Logan S (1999). Screening of newborn infants for cholestatic hepatobiliary disease (multiple letters) [12]. British Medical Journal, 319(7222), 1435-1436.
Clayton PT, Logan S (1999). Screening of newborn infants for cholestatic hepatobiliary disease - Does test fufil screening criteria? Reply.
BRITISH MEDICAL JOURNAL,
319(7222), 1436-1436.
Author URL.
Mushtaq I, Logan S, Morris M, Johnson AW, Wade AM, Kelly D, Clayton PT (1999). Screening of newborn infants for cholestatic hepatobiliary disease with tandem mass spectrometry.
BMJ,
319(7208), 471-477.
Abstract:
Screening of newborn infants for cholestatic hepatobiliary disease with tandem mass spectrometry.
OBJECTIVE: to assess the feasibility of screening for cholestatic hepatobiliary disease and extrahepatic biliary atresia by using tandem mass spectrometry to measure conjugated bile acids in dried blood spots obtained from newborn infants at 7-10 days of age for the Guthrie test. SETTING: Three tertiary referral clinics and regional neonatal screening laboratories. DESIGN: Unused blood spots from the Guthrie test were retrieved for infants presenting with cholestatic hepatobiliary disease and from the two cards stored on either side of each card from an index child. Concentrations of conjugated bile acids measured by tandem mass spectrometry in the two groups were compared. MAIN OUTCOME MEASURES: Concentrations of glycodihydroxycholanoates, glycotrihydroxycholanoates, taurodihydroxycholanoates, and taurotrihydroxycholanoates. Receiver operator curves were plotted to determine which parameter (or combination of parameters) would best predict the cases of cholestatic hepatobiliary disease and extrahepatic biliary atresia. The sensitivity and specificity at a selection of cut off values for each bile acid species and for total bile acid concentrations for the detection of the two conditions were calculated. RESULTS: 218 children with cholestatic hepatobiliary disease were eligible for inclusion in the study. Two children without a final diagnosis and five who presented at 33 micromol/l. Taurotrihydroxycholanoate and total bile acid concentrations were the best predictors of both conditions. For all cholestatic hepatobiliary disease, a cut off level of total bile acid concentration of 30 micromol/l gave a sensitivity of 62% and a specificity of 96%, while the corresponding values for extrahepatic biliary atresia were 79% and 96%. CONCLUSION: Most children who present with extrahepatic biliary atresia and other forms of cholestatic hepatobiliary disease have significantly raised concentrations of conjugated bile acids as measured by tandem mass spectrometry at the time when samples are taken for the Guthrie test. Unfortunately the separation between the concentrations in these infants and those in the general population is not sufficient to make mass screening for cholestatic hepatobiliary disease a feasible option with this method alone.
Abstract.
Author URL.
Spencer N, Bambang S, Logan S, Gill L (1999). Socioeconomic status and birth weight: comparison of an area-based measure with the Registrar General's social class.
J Epidemiol Community Health,
53(8), 495-498.
Abstract:
Socioeconomic status and birth weight: comparison of an area-based measure with the Registrar General's social class.
OBJECTIVE: to compare the relation of birth weight with socioeconomic status measured by an area-based measure of material deprivation and by the Registrar General's social class. SETTING: West Midlands Health Region 1991-93. STUDY DESIGN: Retrospective cohort study. METHOD: Birthweight data by enumeration district deciles ranked by Townsend Deprivation Index based on 1991 census data for all live births in the West Midlands Health Region were studied in three consecutive whole year birth cohorts, 1991 to 1993 and by Registrar General's social class in a 10% sample of live births (within marriage and jointly registered, provided by the Office of National Statistics) in the same region for the same period. Estimated proportions of births < 2500 g and < 3500 g "attributable" to social inequalities were compared for both socioeconomic status measures. The proportion of infants in each birthweight group were calculated for both measures. Relative risk (95% confidence intervals) of birth in each birthweight group for lowest versus highest socioeconomic status groups were calculated. RESULTS: the estimated proportions of births < 2500 g "attributable" to social inequalities were 30% using the area-based measure and 27% using the Registrar General's social class. For births < 3500 g, the estimated proportions were 12% for the area-based measure and 7% for social class. There was a positive linear relation between the proportion of babies weighing > or = 3500 g and increasing socio-economic status measured by either method. Gradients in the opposite direction were noted for the proportion of babies born in the other birth weight groups. Relative risk of birth weight < 3500 g was 1.30 (95% CIs 1.28, 1.32) for most versus least deprived decile and 1.17 (95% CIs 1.10, 1.25) for social class V versus I. For birth weight < 2500 g the risks were 1.99 (95% CIs 1.85, 2.18) and 2.04 (95% CIs 1.53, 2.73) respectively and for birth weight < 1500 g, 2.11 (95% CIs 1.73, 2.57) for most versus least deprived decile (numbers too small for analysis in the Office of National Statistics sample). CONCLUSION: a substantial proportion of births < 2500 g and < 1500 g are statistically "attributable" to social inequality. The results demonstrate that, using either socioeconomic measure, the likelihood of being born weighing > or = 3500 g, the most advantageous group, is substantially greater in the socially advantaged. Using the area-based measure, an estimated 12% of births < 3500 g could be ascribed to social inequalities whereas the same figure using social class was 7%. These findings suggest that this proxy measure of socioeconomic status may be a better discriminator in the study of pregnancy outcomes in this population than classification by occupational social class. Another advantage is its almost universal availability in routine records and its universal population coverage.
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Author URL.
Spencer NJ, Logan S, Gill L (1999). Trends and social patterning of birthweight in Sheffield, 1985-94.
Arch Dis Child Fetal Neonatal Ed,
81(2), F138-F140.
Abstract:
Trends and social patterning of birthweight in Sheffield, 1985-94.
AIM: to describe the trends in birthweight and their association with socioeconomic status in a 10 year birth cohort in Sheffield. METHODS: Data for all live singleton births were extracted from the Sheffield Child Development Study (SCDS) database for 1985-94. Enumeration districts (EDs), derived from postcodes, were ranked into deciles by Townsend Deprivation Index (TDI), based on the 1991 census. Birthweight by 500 g group and mean birthweights for the city and by ED decile were calculated by year. chi2 analyses for linear trend were calculated. The proportion of variance in birthweight explained by ED decile and raw TDI score was estimated by year. Absolute risk difference of birthweight
Abstract.
Author URL.
Logan S (1999). Working together for children.
CHILD CARE HEALTH AND DEVELOPMENT,
25(1), 1-2.
Author URL.
1998
Lee JW, Melgaard B, Clements CJ, Kane M, Mulholland EK, Olivé J-M (1998). Autism, inflammatory bowel disease, and MMR vaccine. The Lancet, 351(9106), 905-905.
Lee J, Melgaard B, Clements CJ, Kane M, Mulholland EK, Olive JM, Black D, Prempeh H, Baxter T, Beale AJ, et al (1998). Autism, inflammatory bowel disease, and MMR vaccine (multiple letters) [1]. Lancet, 351(9106), 905-909.
Bedford H, Booy R, Dunn D, DiGuiseppi C, Gibb D, Gilbert R, Logan S, Peckham C, Roberts I, Tookey P, et al (1998). Autism, inflammatory bowel disease, and MMR vaccine.
Lancet,
351(9106).
Author URL.
Logan S (1998). Nocturnal enuresis in children - Editor's comment.
CHILD CARE HEALTH AND DEVELOPMENT,
24(4), 288-288.
Author URL.
Logan S (1998). Systematic reviews and making decisions.
Child Care Health Dev,
24(4), 255-257.
Author URL.
1997
Logan S (1997). Child health and the Cochrane Collaboration.
Child Care Health Dev,
23(5), 367-368.
Author URL.
Logan S (1997). Delayed motor milestones are relatively poor predictors of cerebral palsy in high risk pre-term infants.
Child Care Health Dev,
23(5), 424-426.
Author URL.
Logan S (1997). Even young children's assessments provide useful information about asthma control.
Child Care Health Dev,
23(4), 355-356.
Author URL.
James JA, Laing GJ, Logan S, Rossdale M (1997). Feasibility of screening toddlers for iron deficiency anaemia in general practice.
BMJ,
315(7100), 102-103.
Author URL.
Logan S (1997). In the UK the transition from youth to adulthood of people with cerebral palsy is poorly planned and co-ordinated.
Child Care Health Dev,
23(6), 480-482.
Author URL.
Logan S (1997). Increasing prevalence of cerebral palsy amongst low birthweight neonatal survivors 1966-1989.
CHILD CARE HEALTH AND DEVELOPMENT,
23(2), 201-202.
Author URL.
Logan S (1997). Injuries and the risk of disability in teenagers and young adults.
Child Care Health Dev,
23(4), 357-358.
Author URL.
Logan S (1997). Iron deficiency anaemia in infancy and early childhood - Commentary.
ARCHIVES OF DISEASE IN CHILDHOOD,
76(6), 553-554.
Author URL.
Logan S (1997). No convincing evidence of benefit from process-oriented treatment or a standard occupational therapy approach in children with developmental co-ordination disorder.
Child Care Health Dev,
23(1), 103-104.
Author URL.
Logan S (1997). Quantitative vs qualitative methods.
Child Care Health Dev,
23(4), 283-285.
Author URL.
Logan S (1997). Two years on.
CHILD CARE HEALTH AND DEVELOPMENT,
23(1), 1-2.
Author URL.
Logan S (1997). Urinary antimony levels in infants are low and unrelated to age or passive smoking.
Child Care Health Dev,
23(5), 423-424.
Author URL.
Gilbert R, Logan S (1997). Use of decision analysis in clinical practice and policy. Evidence-based Healthcare, 1(2), 25-26.
1996
Williams K, Chambers M, Logan S, Robinson D (1996). Association of common health symptoms with bullying in primary school children.
BMJ,
313(7048), 17-19.
Abstract:
Association of common health symptoms with bullying in primary school children.
OBJECTIVE: to estimate the prevalence of bullying in primary school children and to examine its association with common symptoms in childhood. DESIGN: Semistructured health interview conducted by school nurses as part of a school medical. SETTING: Newham, east London. SUBJECTS: all children in year 4 of school during the academic year 1992-93. MAIN OUTCOME MEASURES: Reported bullying and common health symptoms. RESULTS: 2962 children (93.1% of those on the school roll) were interviewed (ages 7.6 to 10.0 years). Information about bullying was not recorded for 114 children, 22.4% (95% confidence interval 20.9 to 24.0) of children for whom information was available reported that they had been bullied. There was an association between children reporting being bullied sometimes or more often and reporting not sleeping well (odds ratio 3.6, 2.5 to 5.2), bed wetting (1.7, 1.3 to 2.4), feeling sad (3.6, 1.9 to 6.8), and experiencing more than occasional headaches (2.4, 1.8 to 3.4) and tummy aches (2.4, 1.8 to 3.3). A significant trend for increasing risk of symptoms with increased frequency of bullying was shown for all reported health symptoms (P < 0.001). CONCLUSIONS: Health professionals seeing primary schoolchildren who present with headaches, tummy ache, feeling sad or very sad, bed wetting, and sleeping difficulties should consider bullying as a possible contributory factor.
Abstract.
Author URL.
Spencer N, Logan S, Scholey S, Gentle S (1996). Deprivation and bronchiolitis.
Arch Dis Child,
74(1), 50-52.
Abstract:
Deprivation and bronchiolitis.
OBJECTIVE: to test the hypothesis that socioeconomic deprivation is associated with an increased risk of admission with clinically suspected bronchiolitis. DESIGN: Case-control study. SETTING: Children under 1 year living in Sheffield in 1989-90. SUBJECTS: 307 children resident in Sheffield admitted to Sheffield hospitals with clinically suspected bronchiolitis between 1 October 1989 and 28 February 1990. METHODS: Children admitted with clinically suspected bronchiolitis were ascertained from laboratory records of nasopharyngeal aspirates cultured for respiratory syncytial virus. Case notes were examined to determine whether these children had required medical intervention and postcode of residence was recorded. Controls were selected from the Sheffield child development study (SCDS) data. Postcodes were converted to electoral wards which were assigned Townsend deprivation index scores. Electoral wards were then categorised by Townsend score into five levels of deprivation. Data on family smoking for cases and controls were extracted from the SCDS. RESULTS: of the 307 children admitted with suspected bronchiolitis during the study period, 127 required one or more medical intervention. The risk of admission with clinically suspected bronchiolitis and with bronchiolitis requiring medical intervention rose with increasing level of deprivation score of electoral ward of residence. Children living in electoral wards in the two more deprived groups were more than 1.5 times as likely to be admitted (odds ratio (OR) 1.67, 95% confidence interval (CI) 1.25 to 2.24) or admitted requiring a medical intervention (OR 1.74, 95% CI 1.16 to 2.62) than children living in other parts of the city. Similar results were obtained after exclusion of children living in homes classified as smoky by the health visitor. CONCLUSION: Residence in an area of social and material deprivation increases the risk of admission with bronchiolitis even after taking account of parental smoking and when only more severe cases were considered.
Abstract.
Author URL.
Logan S, Moromisato D, Cooper DM (1996). Effects of hypoxia and nutritional deprivation on lung size and mechanics.
FASEB JOURNAL,
10(3), 4559-4559.
Author URL.
Gilbert R, Logan S (1996). Evidence-based child health and the health care research and development industry.
Journal of Clinical Effectiveness,
1(4), 146-148.
Abstract:
Evidence-based child health and the health care research and development industry
What does evidence-based health care add to the numerous initiatives in the UK over the last 10 years to improve the quality, effectiveness and efficiency of health care? the health care research and development industry has evolved into a patchwork of activities — clinical audit, clinical effectiveness, health services research, health outcomes, health technology assessment, quality in health care, clinical guidelines, systematic reviews, and medical informatics — with many blurred boundaries. Is evidence-based health care just an old product in a new package, or does it offer new concepts?. © 1996, MCB UP Limited
Abstract.
Gilbert R, Logan S (1996). Future prospects for evidence-based child health.
Arch Dis Child,
75(6), 465-468.
Author URL.
Logan S, Spencer N (1996). Smoking and other health related behaviour in the social and environmental context.
Arch Dis Child,
74(2), 176-179.
Abstract:
Smoking and other health related behaviour in the social and environmental context.
It seems clear that parental smoking is harmful, although the magnitude of its effect may be smaller than sometimes suggested. However, smoking and other behaviours detrimental to health must be seen within a social and historical context. Individuals are not 'free choosing actors' and their behaviour is determined, at least in part, by their social and environmental circumstances. Smoking might better be regarded as a 'proximal' cause. 'Proximal' causes such as infectious or toxic agents are themselves subject to 'causes of causes' which are the determinants of exposure to these agents. Smoking may act as the 'proximal' cause, directly harming the fetus, but is itself caused by factors in the social and environmental circumstances. The complexity of the relationship between social and environmental circumstances, health related behaviours, and adverse outcomes cannot be resolved by the search for single causative agents. As Rutter points out, in order to begin to understand causal complexity 'it is necessary to examine distal causal relationships in the form of chains and of linked sequences involving several different, relatively short-term effects or operations' (p 2). Health promotion programmes sensitive to social context avoid 'victim blaming' and acknowledge that it is not enough to exhort mothers to 'stop smoking before and during pregnancy because this will harm your baby' (p 99). Mothers know that smoking can harm themselves and their babies and the vast majority want to give up. Their choice is limited by their social circumstances, and failure to recognise this has ensured the failure of health promotion initiatives aimed at smoking reduction during pregnancy. There are limitations in the techniques available to control for confounding in multivariate analysis and results must be interpreted with caution. Misinterpretation can lead to overemphasis of the role of single factors, diverting attention from complex pathways. While health related behaviours may be a 'proximal' cause of ill health, there is a duty on researchers, health promoters, and health policy makers to take account of the complex causal pathways in which these 'proximal' causes lie.
Abstract.
Author URL.
Macfarlane A, Logan S, Spencer N, Blackburn C, De Jonge GA, Engelberts AC, Fleming PJ, Blair PS, Smith I, Berry PJ, et al (1996). Sudden infant death syndrome [7]. British Medical Journal, 313(7068), 1332-1334.
Logan S, Spencer N, Blackburn C (1996). Sudden infant death syndrome. Smoking is part of a causal chain.
BMJ,
313(7068), 1332-1333.
Author URL.
Li PL, Logan S (1996). The current state of screening in general practice.
J Public Health Med,
18(3), 350-356.
Abstract:
The current state of screening in general practice.
BACKGROUND: the aim of this study was to describe the range of screening services offered by general practitioners (GPs). METHODS: a postal questionnaire survey was sent to a random sample of one in four GPs in general practices within the geographical boundaries of North (East) Thames Region. The questionnaire was divided into five sections, the first covering practice details and the other four covering screening directed at different groups of patients. Each GP in the sample was sent the general section and two other sections. RESULTS: the overall response rate was 67.7 per cent. There was inter-practitioner variability in screening practice in all four patient groups. A number of GPs did not undertake all screening tests required by the national GP contract or recommended by national or local policy, and some had introduced screening programmes of uncertain benefit. There was little evidence of systematic audit of screening programmes. Differences in screening provision were observed between GPs in Greater London and nonmetropolitan areas, but there was little difference between single-handed and group practice, or between fundholding and non-fundholding GPs, except in the provision of child health surveillance. CONCLUSION: Primary care teams carry out screening for a wide range of conditions but the lack of uniformity of practice and of evaluation makes it unclear to what extent the population benefits from these activities. The importance of national and international screening policies is obvious, but there is a need to go beyond publication and dissemination of guidelines to develop implementation strategies which take account of the variations in the way GPs actually address screening in their practices.
Abstract.
Author URL.
1995
LOGAN S (1995). COMMENTARY - EVALUATION OF SPECIALIST PEDIATRIC RETRIEVAL TEAMS.
BRITISH MEDICAL JOURNAL,
311(7009), 839-839.
Author URL.
James JA, Laing GJ, Logan S (1995). Changing patterns of iron deficiency anaemia in the second year of life.
BMJ,
311(6999).
Author URL.
LOGAN S (1995). NEW BEGINNINGS.
CHILD CARE HEALTH AND DEVELOPMENT,
21(1), 1-2.
Author URL.
Logan S, Speer CP, Gefeller O (1995). Need to avoid bias in controlled trials [1]. Archives of Disease in Childhood, 73(2 SUPPL.).
Logan S (1995). Need to avoid bias in controlled trials.
Arch Dis Child Fetal Neonatal Ed,
73(2).
Author URL.
Zwi KJ, Zwi AB, Smettanikov E, Söderlund N, Logan S (1995). Patterns of injury in children and adolescents presenting to a South African township health centre.
Inj Prev,
1(1), 26-30.
Abstract:
Patterns of injury in children and adolescents presenting to a South African township health centre.
OBJECTIVES: to describe the patterns and causes of childhood injury presenting to a South African township health centre in 1991. DESIGN: Retrospective review of clinic held case notes. SETTING: Typical South-African urban township within Greater Johannesburg. SUBJECTS: 695 subjects aged 0-19 years presenting as a direct result of injury. RESULTS: Overall rates of presentation for injury were 6297/100,000/year (95% confidence interval 5463 to 7131); 35% of injuries were caused by violence, 14% by traffic, and 51% by other unintentional causes (such as falls and sport injuries). Males had higher rates of presentation than females for violent (p < 0.001) and unintentional injuries (p < 0.01), but rates were similar for traffic injuries. The highest rates were for injuries caused by violence in 15-19 year-old males and were 9319/100,000/year. CONCLUSIONS: Rates are lower than in more developed countries. However, they appear to represent the more severe end of the spectrum of injury severity. The rates are similar for those below age 10 years and higher for those above age 10 years compared with severe injury rates in other studies. These data are likely to underestimate true rates. The risk of injuries caused by violence increase with age and these injuries are more serious than those due to other causes. Males are at higher risk for all types of injury except traffic injury.
Abstract.
Author URL.
1994
Laing G, Thompson M, Logan S (1994). Child resistant packaging and accidental child poisoning.
Arch Dis Child,
70(4).
Author URL.
Tookey P, Logan S (1994). Occupational risk of cytomegalovirus.
Reviews in Medical Microbiology,
5(1), 33-38.
Abstract:
Occupational risk of cytomegalovirus
Cytomegalovirus (CMV) infection is common throughout the world, and in healthy individuals it rarely causes serious illness. However, congenital CMV is animportant cause of disability and we estimate that currently in the United Kingdom about 250 infants a year are bom with CMV-related damage. Many women work duringpregnancy and it is possible that some pregnant women acquire infection in the workplace. Studies carried out in the USA have concluded that day-care staff lookingafter young children are at occupational risk of acquiring CMV infection. There is conflicting evidence about health workers and occupational risk. This review outlines the main modes of transmission of CMV infection and considers the evidence for occupational risk. © 1994 Chapman and Hall.
Abstract.
Voss LD, Betts PR (1994). Screening for growth disorders.
J Med Screen,
1(2).
Author URL.
Preece M, Logan S (1994). Screening for growth disorders.
J Med Screen,
1(2).
Author URL.
1993
Singh A, Logan S (1993). Audit of screening for congenital hypothyroidism.
Arch Dis Child,
68(3), 432-433.
Author URL.
Spencer N, Logan S (1993). Community indicators of child health.
Soz Praventivmed,
38(2), 90-95.
Abstract:
Community indicators of child health.
Indicators of health in child populations are critically reviewed and the potential for routinely collected morbidity and life quality data discussed. A short list of currently available, routinely collected child health data is proposed which, if available for all European countries, would form the basis of a useable and comparable European child health data base. A European consensus group on child health indicators is proposed and further research into morbidity and life quality measures relevant to children recommended.
Abstract.
Author URL.
Spencer NJ, Lewis MA, Logan S (1993). Diagnostic and socio-demographic changes in multiple hospital admission in children under two over a five-year period.
J Public Health Med,
15(4), 332-336.
Abstract:
Diagnostic and socio-demographic changes in multiple hospital admission in children under two over a five-year period.
Diagnostic and socio-demographic changes for children experiencing multiple hospital admissions (three or more) before the age of two years in two whole-year birth cohorts five years apart-1980 and 1985-are reported. The increase in multiple admissions between 1980 and 1985 was distributed evenly throughout the diagnostic groups. Although a disproportionate increase in admissions per child for asthma was noted, the results suggest that the increase accounts for only a small proportion of the total increase. A marked trend to earlier age of first admission is reported. Low-birthweight infants, infants of young mothers and infants from deprived areas of the city are overrepresented in the multiple admission groups in both cohorts. There was a marked increase in the proportion of low-birthweight infants in the multiple admissions group between 1980 and 1985 compared with a decrease in the percentage of low-birthweight infants in the control group over the same period. The study results are discussed with particular reference to the unexplained increase in early childhood admissions.
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(1993). Effects of Smoking on the Fetus, Neonate, and the Child. Archives of disease in childhood, 69(2), 266-267.
Spencer NJ, Lewis MA, Logan S (1993). Multiple admission and deprivation.
Arch Dis Child,
68(6), 760-762.
Abstract:
Multiple admission and deprivation.
The relationship between multiple hospital admission (three or more) in early childhood and social deprivation was explored using data from two Sheffield whole year birth cohorts (1980 and 1985). The findings demonstrate a strong relationship between multiple admission for mainly, and exclusively, organic reasons and residence in an area of deprivation. The relationship persists when low birthweight infants and those with young mothers are excluded from the analysis. The results suggest a dual effect of deprivation on early childhood hospital admission; an increase in admissions associated with organic pathology and those associated with impaired parental coping.
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Logan S, Stanton A (1993). Screening for biliary atresia.
Lancet,
342(8866).
Author URL.
Peckham CS, Logan S (1993). Screening for toxoplasmosis during pregnancy.
Arch Dis Child,
68(1 Spec No), 3-5.
Author URL.
1992
Salzman MB, Sood SK, Rubin LG, Morris DJ, Logan S, Tookey P, Ades T, Fowler KB, Stagno S, Pass RF, et al (1992). Congenital Cytomegalovirus Infection and Maternal Antibody Status.
New England Journal of Medicine,
327(7), 495-496.
Abstract:
Congenital Cytomegalovirus Infection and Maternal Antibody Status
To the Editor: the study by Fowler et al. (March 5 issue)1 on the outcome of congenital cytomegalovirus (CMV) infection according to whether the infants' mothers had primary or recurrent disease during pregnancy provides valuable data for use in counseling parents. One of the criteria the authors used to distinguish between primary and recurrent infection was the presence of CMV-specific IgM antibodies in the mother during pregnancy. Among 132 infants in the primary-infection group, the assignment of 58 to the group was based solely on the presence of a CMV-specific IgM antibody in the mother, without documentation of IgG sero-conversion… © 1992, Massachusetts Medical Society. All rights reserved.
Abstract.
Logan S, Tookey P, Ades T (1992). Congenital cytomegalovirus infection and maternal antibody status.
N Engl J Med,
327(7).
Author URL.
1991
Logan S, Tookey P (1991). Controversy breeds ignorance.
BMJ,
302(6787).
Author URL.
Bess FH, Lichtenstein MJ, Logan SA (1991). Making hearing impairment functionally relevant: Linkages with hearing disability and handicap. Acta Oto-Laryngologica, 111(S476), 226-231.
Bess FH, Lichtenstein MJ, Logan SA (1991). Making hearing impairment functionally relevant: Linkages with hearing disability and handicap. Acta Oto-Laryngologica, 111(S476), 226-231.
Logan S (1991). Outcome measures in child health.
Arch Dis Child,
66(6), 745-748.
Author URL.
1990
LOGAN S, PECKHAM C (1990). INTELLECTUAL OUTCOME IN CONGENITAL CYTOMEGALOVIRUS-INFECTION.
PEDIATRIC RESEARCH,
28(3), 308-308.
Author URL.
TOOKEY P, LOGAN S, PECKHAM CS (1990). MATERNAL AND FETAL SCREENING.
BRITISH MEDICAL JOURNAL,
300(6738), 1526-1527.
Author URL.
LOGAN S (1990). NEONATAL INFECTIONS IN THE NONINDUSTRIALIZED WORLD.
CURRENT OPINION IN INFECTIOUS DISEASES,
3(4), 480-483.
Author URL.
1989
DEZATEUX C, LOGAN S, PECKHAM C (1989). AN INADEQUATE QUESTIONNAIRE ON PREMATURE BIRTHS.
BRITISH MEDICAL JOURNAL,
298(6668), 258-258.
Author URL.
Bess FH, Lichtenstein MJ, Logan SA (1989). In Reply. Journal of the American Geriatrics Society, 37(11), 1100-1100.
1988
Logan S, Newell ML, Ades T, Peckham CS, Brierley J, Roth C, Warwick C (1988). BREAST-FEEDING AND HIV INFECTION. The Lancet, 331(8598).
LOGAN S, NEWELL ML, ADES T, PECKHAM CS (1988). BREAST-FEEDING AND HIV INFECTION.
LANCET,
1(8598), 1346-1346.
Author URL.
Lichtenstein MJ, Bess FH, Logan SA (1988). In Reply. JAMA: the Journal of the American Medical Association, 260(24), 3589-3590.
Logan SA, Hedley A (1988). The elderly and hearing loss.
Seminars in Hearing,
9(3), 225-230.
Abstract:
The elderly and hearing loss
As the number of elderly persons in our society continues to increase, it becomes more imperative that health care professionals accomodate the medical and health care needs with which this population presents. With hearing loss so prevalent among elder adults, audiologists must adapt their hearing assessment and hearing aid protocols to best serve these persons.
Abstract.
Lichtenstein MJ, Bess FH, Logan SA (1988). Validation of Screening Tools for Identifying Hearing-Impaired Elderly in Primary Care.
JAMA: the Journal of the American Medical Association,
259(19), 2875-2878.
Abstract:
Validation of Screening Tools for Identifying Hearing-Impaired Elderly in Primary Care
Two instruments for the detection of hearing impairment, the Welch-Allyn audioscope (Welch-Allyn Inc, Skaneateles Falls, NY) and the Hearing Handicap Inventory for the Elderly—Screening Version (HHIE-S), were validated against pure tone audiometry in 178 patients over 65 years old screened in primary care practice. The prevalence of hearing impairment in this sample was 30%. The audioscope yielded reproducible results in the physicians’ offices and a hearing center. The sensitivity of the audioscope was 94% in both locations, while its specificity was 90% in the hearing center and 72% in the physicians’ offices. The HHIE-S yielded reproducible results between the two test locations. An HHIE-S score from 0 to 8 resulted in a likelihood ratio of 0.36 (95% confidence interval, 0.19 to 0.68), and a score of 26 or more yielded a likelihood ratio of 12.00 (95% confidence interval, 2.62 to 55.00) for predicting the presence of hearing impairment. Used together, the two instruments had a test accuracy of 83%. The audioscope and HHIE-S are valid, reliable, inexpensive tools for detecting hearing impairment in the elderly. © 1988, American Medical Association. All rights reserved.
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