Promoting health in children and young people: identifying priorities.
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Adolescent↗
Biomedical subjects
Sarah Stewart-Brown
Publications and source records attributed to Sarah Stewart-Brown.
Randomised controlled trial of physiotherapy compared with advice for low back pain.
OBJECTIVE: To measure the effectiveness of routine physiotherapy compared with an assessment session and advice from a physiotherapist for patients with low back pain. DESIGN: Pragmatic, multicentre, randomised controlled trial. SETTING: Seven British NHS physiotherapy departments. PARTICIPANTS: 286 patients with low back pain of more than six weeks' duration. INTERVENTION: Routine physiotherapy or advice on remaining active from a physiotherapist. Both groups received an advice book. MAIN OUTCOME MEASURES: Primary outcome was scores on the Oswestry disability index at 12 months. Secondary outcomes were scores on the Oswestry disability index (two and six months), scores on the Roland and Morris disability questionnaire and SF-36 (2, 6 and 12 months), and patient perceived benefit from treatment (2, 6, and 12 months). RESULTS: 200 of 286 patients (70%) provided follow up information at 12 months. Patients in the therapy group reported enhanced perceptions of benefit, but there was no evidence of a long term effect of physiotherapy in either disease specific or generic outcome measures (mean difference in change in Oswestry disability index scores at 12 months -1.0%, 95% confidence interval -3.7% to 1.6%). The most common treatments were low velocity spinal joint mobilisation techniques (72%, 104 of 144 patients) and lumbar spine mobility and abdominal strengthening exercises (94%, 136 patients). CONCLUSIONS: Routine physiotherapy seemed to be no more effective than one session of assessment and advice from a physiotherapist.
Adult↗
The effectiveness of individual and group-based parenting programmes in improving outcomes for teenage mothers and their children: a systematic review.
There is evidence from a range of studies showing adverse child outcomes for the children of teenage parents. Parenting programmes are increasingly being used to promote the well-being of parents and children, and this review aims to establish whether they can improve outcomes for teenage parents and their children. The findings of the review are based on 14 studies that used varying study designs, and are therefore limited. The results suggest, however, that parenting programmes can be effective in improving a range of psychosocial and developmental outcomes for teenage mothers and their children. Further research is needed.
Adolescent↗
Maltreatment in childhood and future health.
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Adolescent↗
Research in relation to equity: extending the agenda.
An appreciation of the role of social and emotional well-being in determining health outcomes is important in advancing the equity agenda.(1) These aspects of health are adversely affected by inequity. They also are important as potential causal factors. Low levels of emotional and social well-being among the rich may be important in perpetuating health and social inequity. In the past, most research on inequity has focused on the negative end of the continuum of emotional and social health (eg, child abuse, conduct disorder, mental illness, drug and alcohol abuse) and concentrated on the problems of the poor, not the rich. The prevalence of emotional and social well-being has not been well studied. At the other end of the spectrum, emotional and behavioral problems now are the most important cause of disability in childhood,(2) affecting between 10% and 20% of children.(3) In between these 2 extremes, some children are socially competent, are liked by their peers, are resilient in the face of problems, know their own minds, are kind to others, and are able to handle conflict in a way that leads to resolution. Others are prone to aggression and deceit, are ostracized by their peer group, and create conflict and distress. These children may have very low self-esteem. They often are manifestly unhappy and anxious and certainly make others unhappy and anxious. This group may not meet the Diagnostic and Statistical Manual of Mental Disorders-defined criteria for emotional and behavioral problems; teachers therefore may be more aware of them and their impact on others than physicians. As a result, teachers and educational psychologists have been at the forefront of developing interventions to help this group.
Adult↗
Will changing the emphasis from 'pulseless' to 'no signs of circulation' improve the recall scores for effective life support skills in children?
This study analyses, retrospectively, an established data set to measure the effect of the circulation change in European Resuscitation Council Guidelines. This prospective matched control study examined the extent to which Year 6 (10-11 years) children retained and were able to demonstrate the sequencing and assessment skills of Basic Life Support (BLS) techniques 5 months after BLS training through the Injury Minimization Programme for Schools (I.M.P.S.). A total of 1292 children were enrolled at the beginning of the study: 657 in the intervention group received BLS through I.M.P.S., 635 children in the control group received no planned intervention. Children in both groups were tested 5 months after intervention using small portable manikins. Chi-square analysis of individual variables indicated that the intervention group was better (P<0.0005) than controls in almost all areas of basic life support (BLS). 'Adequate' BLS skills, the minimum skills considered to be effective, were also demonstrated in both groups, intervention 4.1%, controls 0.5%. Recalculation of these variables removing the check on the carotid pulse resulted in an increase to 24% of adequate BLS skills in the intervention group. Conversely, only 2.1% of controls performed to this standard. With strict adherence to Resuscitation Council guidelines, 'optimal' life saving procedures (all primary BLS steps performed optimally), were initiated by very few, marginally better in the intervention than the control group, intervention 6 (1.1%) controls 0 (0%). Some children in both groups performed the cardio-pulmonary resuscitation (CPR) element of BLS in an ineffective manner. Changing the circulation assessment would seem appropriate and allow recognition of life support attempts that are beneficial if not optimal.
Cardiopulmonary Resuscitation↗
Health status of people using complementary and alternative medical practitioner services in 4 English counties.
OBJECTIVES: This study was undertaken to establish the health status of users of complementary and alternative medicine (CAM) services in England. METHODS: A postal questionnaire (response rate: 64%) covering long-standing illness, use of conventional medical and CAM services, and the United Kingdom Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was sent to more than 14 000 adults in 4 counties. RESULTS: Sixty percent of CAM users reported having a chronic illness or disability; back pain and bowel problems were the conditions most commonly reported. Regardless of whether chronic illness was reported, CAM users reported poorer health than nonusers, particularly in the dimensions of pain and physical disability, and made more visits to general practitioners. CONCLUSIONS: In England, users of CAM services have poorer physical health than nonusers and make more frequent use of conventional medical services.
Adolescent↗
Meta-analysis of the effectiveness of parenting programmes in improving maternal psychosocial health.
The purpose of this study was to determine whether group-based parenting programmes are effective in improving maternal psychosocial health. Data sources used were English and non-English language articles published between January 1970 and July 2000, retrieved using a keyword search of a number of biomedical, social science, educational, and general reference electronic databases. Two independent reviewers selected the relevant abstracts and articles. Only controlled trials were included in which participants had been randomly allocated to an experimental and a control group, the latter being a waiting-list, no-treatment or a placebo control group. Studies had to include at least one group-based parenting programme and one standardised instrument measuring maternal psychosocial health. Means, standard deviations, and information regarding study quality were selected from the included studies by two independent reviewers. The treatment effect for each outcome in each study was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment group, by the pooled standard deviation, to produce an effect size. The results were then combined in a meta-analysis using a fixed-effect model. A total of 23 studies met all the inclusion criteria and 17 of these provided sufficient data with which to calculate effect sizes. Fifteen of these studies provided data on the five main outcomes of interest: depression, anxiety/stress, self-esteem, social support, and relationship with partner. The meta-analyses show statistically significant results favouring the intervention group for depression (-0.3, 95% confidence interval [CI] = -0.4 to -0.1), anxiety/stress (-0.5, 95% CI = -0.7 to -0.3), self-esteem (-0.4, 95% CI = -0.6 to -0.1), and relationship with partner (-0.4, 95% CI = -0.7 to -0.2). However, the meta-analysis of the social support data showed no evidence of effectiveness (-0.04, 95% CI = -0.3 to 0.2). Follow-up data were available for only three of the five outcomes. The results show that there were changes favouring the intervention group for self-esteem (-0.4, 95% CI = -0.7 to -0.2), the mother's relationship with her partner (-0.3, 95% CI = -0.8 to 0.1), and depression (-0.2, 95% CI = -0.4 to 0.002), although the confidence intervals for the mother's relationship with her partner and depression both cross zero. It is concluded that parenting programmes can make a significant contribution to the short-term psychosocial health of mothers. While the limited follow-up data are promising, further evidence of their effectiveness in improving maternal mental health is required. It is also suggested that some caution should be exercised before the results are generalised to parents irrespective of the level of pathology present.
Anxiety↗