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Investigating the completion rate of 12-month vaccinations and parental perspectives on vaccine services during COVID-19. Service evaluation including parental questionnaire. Uptake of 12-month vaccinations in three London general practices during three periods: pre-COVID (1/3/2018–28/2/2019, n = 826), during COVID (1/3/2019–28/2/2020, n = 775) and post-COVID first wave (1/8/2020–31/1/2021, n = 419). Questionnaire of parents whose children were registered at the practices (1/4/2019–1/22/2021, n = 1350). Comparing pre-COVID and both COVID cohorts, the completion rates of 12-month vaccines were lower. Haemophilus influenzae type B/meningococcal group C (Hib/MenC) vaccination uptake was 5.6% lower (89.0% vs 83.4%, P =<0.001), meningococcal group B (MenB) booster uptake was 4.4% lower (87.3% vs 82.9%, P = 0.006), pneumococcal conjugate vaccine (PCV) booster uptake was 6% lower (88.0% vs 82.0%, P < 0.001) and measles, mumps and rubella (MMR) vaccine uptake was 5.2% lower (89.1% vs 83.9%, P = 0.003). Black/Black-British ethnicity children had increased odds of missing their 12-month vaccinations compared to White ethnicity children (adjusted odds ratio 0.43 [95% confidence interval 0.24–0.79, P = 0.005; 0.36 [0.20–0.65], P < 0.001; 0.48 [0.27–0.87], P = 0.01; 0.40 [0.22–0.73], P = 0.002; for Hib/MenC, MenB booster, PCV booster and MMR. Comparing pre-COVID and COVID periods, vaccinations coded as not booked increased for MMR (10%), MenB (7%) and PCV booster (8%). Parents reported changes to vaccination services during COVID-19, including difficulties booking and attending appointments and lack of vaccination reminders. A sustained decrease in 12-month childhood vaccination uptake disproportionally affected Black/Black British ethnicity infants during the first wave of the pandemic. Vaccination reminders and availability of healthcare professionals to discuss parental vaccine queries are vital to maintaining uptake. [ABSTRACT FROM AUTHOR]

Parental hesitancy poses a serious threat to the success of the COVID-19 childhood vaccination campaign. We investigate whether adults' opinions on childhood vaccination can be influenced via two survey experiments in Italy (n = 3,633 participants) and the UK (n = 3,314 participants). Respondents were randomly assigned to: a "risk treatment" that highlighted the potential risks of COVID-19 to a child, a "herd immunity treatment" that emphasized the community benefits of pediatric vaccination, or a control message. Participants' probability of supporting COVID-19 childhood vaccination was then assessed on a 0–100 scale. We find that the "risk treatment" reduced the proportion of Italian parents strongly against vaccination by up to 29.6 %, while increasing the proportion of neutral parents by up to 45.0 %. The "herd immunity treatment", instead, was only effective among non-parents, resulting in a lower proportion of individuals against pediatric vaccination and a higher proportion of individuals in favor (both shifted by around 20 %). [ABSTRACT FROM AUTHOR]

Most children requiring radiotherapy receive external beam treatment and few have tumours suitable for brachytherapy. No paediatric radiotherapy centre will treat enough patients from its own normal catchment population for expertise in brachytherapy to be developed and sustained. Following discussion and agreement in the national paediatric radiotherapy group, a service for paediatric brachytherapy in the UK has been developed. We report the process that has evolved over more than 10 years, with survival and functional outcome results. Since 2009, potential patients have been referred to the central paediatric oncology multidisciplinary team meeting, where imaging, pathology and treatment options are discussed. Since 2013, the National Soft Tissue Sarcoma Advisory Panel has also reviewed most patients, with the principal aim of advising on the most suitable primary tumour management for complex patients. Clinical assessment and examination under anaesthetic with biopsies may be undertaken to confirm the appropriateness of brachytherapy, either alone or following conservative surgery. Fractionated high dose rate brachytherapy was delivered to a computed tomography planned volume after implantation of catheters under ultrasound imaging guidance. Since 2019, follow-up has been in a dedicated multidisciplinary clinic. From 2009 to 2021 inclusive, 35 patients (16 female, 19 male, aged 8 months to 17 years 6 months) have been treated. Histology was soft-tissue sarcoma in 33 patients and carcinoma in two. The treated site was pelvic in 31 patients and head and neck in four. With a median follow-up of 5 years, the local control and overall survival rates are 100%. Complications have been few, and functional outcome is good. Brachytherapy is effective for selected paediatric patients, resulting in excellent tumour control and good functional results. It is feasible to deliver paediatric brachytherapy at a single centre within a national referral service. • A national referral service for paediatric brachytherapy has been established in the UK. • Potential patients are carefully selected for suitability through a national multidisciplinary expert panel discussion and clinical evaluation. • Over 13 years, 35 patients have been treated with a median follow-up of 5 years. • All patients have achieved local control and the 5-year survival probability is 100% with good functional outcomes. [ABSTRACT FROM AUTHOR]

The risk associated with parental perinatal depressive symptoms and the continuum of emotional and behavioural problems in offspring is unclear. This study aimed to investigate the association between maternal and paternal perinatal depressive symptoms and behavioural problem trajectories in offspring aged 3–16 years. We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) in Bristol, Avon, United Kingdom (UK). Parental perinatal depressive symptoms in the first three years of a child's life were measured using the Edinburgh Postnatal Depression Scale (EPDS). Offspring emotional- and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ) when the child was 3.5, 7, 9, 11, and 16 years. A group-based trajectory modelling was used to identify the distinct trajectories of emotional and behavioural problems. Multinomial logistic regression analyses were used to examine associations, and z-scores were calculated to compare maternal and paternal associations. We identified three trajectories of emotional and behavioural problems in offspring between the ages of 3.5 and 16: low, moderate and high symptom trajectories. We found that maternal and paternal antenatal and postnatal depressive symptoms were associated with high levels of emotional and behavioural problem trajectories in offspring. We also found that children exposed to maternal (adjusted RR = 8.11; 95% CI: 5.26–12.48) and paternal (adjusted RR = 2.32; 1.05–5.14) persistent depressive symptoms were more likely to be in high levels of total behavioural problem trajectory group than in the normal trajectory group. The maternal-effect was stronger (p < 0.001). Our findings suggest that exposure to parental depressive symptoms were associated with high levels of emotional and behavioural problem trajectories in offspring, with the maternal effect being stronger than the paternal effect. • Parental perinatal depressive symptoms were associated with high levels of behavioural problem trajectories in offspring. • The maternal-effect of depressive symptoms is stronger than the paternal effect. • Persistent depressive symptoms were associated with a greater risk of behavioural problems. [ABSTRACT FROM AUTHOR]

To explore acceptability of and preferences for the introduction of varicella vaccination to the UK childhood immunisation schedule. We conducted an online cross-sectional survey exploring parental attitudes towards vaccines in general, and varicella vaccine specifically, and their preferences for how the vaccine should be administered. 596 parents (76.3% female, 23.3% male, 0.4% other; mean age 33.4 years) whose youngest child was aged 0–5 years. Willingness to accept the vaccine for their child and preferences for how the vaccine should be administered (in combination with the MMR vaccine [MMRV], on the same day as the MMR vaccine but as a separate injection [MMR + V], on a separate additional visit). 74.0% of parents (95% CI 70.2% to 77.5%) were extremely/somewhat likely to accept a varicella vaccine for their child if one became available, 18.3% (95% CI 15.3% to 21.8%) were extremely/somewhat unlikely to accept it and 7.7% (95% CI 5.7% to 10.2%) were neither likely nor unlikely. Reasons provided by parents likely to accept the vaccine included protection from complications of chickenpox, trust in the vaccine/healthcare professionals, and wanting their child to avoid their personal experience of chickenpox. Reasons provided by parents who were unlikely included chickenpox not being a serious illness, concern about side effects, and believing it is preferable to catch chickenpox as a child rather than as an adult. A combined MMRV vaccination or additional visit to the surgery were preferred over an additional injection at the same visit. Most parents would accept a varicella vaccination. These findings highlight parents' preferences for varicella vaccine administration, information needed to inform vaccine policy and practice and development of a communication strategy. [ABSTRACT FROM AUTHOR]

Sleep duration and disturbances in typically developing (TD) children have been found to vary across countries. Given the impact of culture on sleep patterns in TD children, it is also necessary to examine the impact of culture on sleep patterns in children with atypical development. However, previous studies have often relied only on parent reports of children's sleep. Hence, the present study conducted a cross-cultural comparison of sleep duration and disturbances of school-aged TD children and autistic children in the UK and South Korea (hereafter Korea) using both subjective and objective sleep measurements. Cultural differences were observed in both actigraphy measures and parent reports of children's sleep duration and disturbances. Both TD children and autistic children in Korea had a later bedtime, later getting up time and shorter nocturnal sleep duration than their peers in the UK (p < .05). Furthermore, greater parent-reported sleep disturbances were reported in TD children in Korea compared to TD children in the UK and in autistic children in the UK compared to autistic children in Korea. Correlational analyses indicated that most parent-reported measures of children's sleep did not significantly correlate with objective measures and child reports, suggesting that studies on children's sleep can benefit by collecting data from multiple sources. Taken together, these findings suggest a cultural influence on sleep duration and disturbances of both TD children and autistic children. This study raises questions for further research to identify factors underlying cultural differences in children's sleep duration and disturbances. [ABSTRACT FROM AUTHOR]

Background: Selective serotonin reuptake inhibitors (SSRIs) have been associated with type 2 diabetes mellitus (T2DM) in youths, possibly via 5-HT2C, H1 receptors and serotonin transporter (SERT). SSRIs have similar affinity for SERT but variable affinity for 5-HT2C and H1. This study assessed whether SSRIs with strong affinity for 5-HT2C and H1 (relative to SERT) were associated with T2DM risk compared with weak-affinity SSRIs.Methods: Using the UK Clinical Practice Research Datalink, we assembled a cohort of patients aged 5-24, newly prescribed a strong-affinity SSRI (citalopram, escitalopram, fluoxetine) or weak affinity (paroxetine, sertraline, fluvoxamine) between 1990 and 2019. We controlled for confounding using standardized mortality ratio weighting, estimated from calendar time-specific propensity scores. We used weighted Cox proportional hazards models to estimate hazard ratios (HRs) of incident T2DM with 95 % confidence intervals (CIs).Results: The cohort included 347,368 new users of strong-affinity SSRIs and 131,359 of weak-affinity SSRIs. Strong-affinity SSRIs were not associated with an increased T2DM risk compared with weak-affinity SSRIs (incidence rate 2.8 vs 2.7 per 1000 person-years; HR 1.03, 95 % CI 0.85-1.25). T2DM risk did not vary with duration of use, age or sex. However, the HR was numerically higher in youths with normal or low weight (HR 1.30, 95 % CI 0.85-1.98) and with prior antipsychotic use (HR 1.62, 95 % CI 0.83-3.18).Limitations: Median duration of SSRI use, in line with real-world SSRI prescribing, was relatively short.Conclusion: T2DM risk did not differ between strong- and weak-affinity SSRIs, providing reassurance for clinicians when choosing between SSRIs in youths. [ABSTRACT FROM AUTHOR]

• Evaluated children's antibody responses prior to and following the receipt of the dTaP5-IPV preschool booster, to all of the antigenic component of the vaccine (pertussis toxin, filamentous haemagglutinin, fimbriae 2 & 3, pertactin, diphtheria toxoid and tetanus toxoid). • Evaluated and compared the impact of two antenatal pertussis-containing vaccines, dTaP3-IPV and dTaP5-IPV, on children's own vaccine responses to the receipt of the dTaP5-IPV preschool booster. • Evaluated the blunting effect of antenatal pertussis vaccination on children's own vaccine responses persisting up to around the age of 3 and a half years old. • The first study to evaluate on the impact of antenatal pertussis vaccination on children's own vaccine responses beyond the age of 2 years old. An antenatal pertussis vaccination programme was introduced in 2012 in the UK in the context of a national outbreak of pertussis. It has been shown that a lower antibody response to primary immunisation can be seen for certain pertussis antigens in infants born to women who received pertussis-containing antenatal vaccines, a phenomenon known as blunting. The longer-term impact of this has not been documented previously, and accordingly was evaluated in this study. Children were predominantly recruited from a previous study in which their mothers had received acellular pertussis-containing antenatal vaccines (dTaP 3 -IPV [diphtheria toxoid, tetanus toxoid, three antigen acellular pertussis and inactivated polio] or dTaP 5 -IPV [diphtheria toxoid, tetanus toxoid, five antigen acellular pertussis and inactivated polio]), or no pertussis-containing vaccine. Blood samples were obtained prior to and one month after the acellular pertussis-containing preschool booster (dTaP 5 -IPV) was given at around age 3 years 4 months. Pre- and post-booster immunoglobulin G (IgG) geometric mean concentrations (GMCs) against pertussis toxin, filamentous haemagglutinin, fimbriae 2 & 3, and pertactin, were compared. Prior to the receipt of the preschool booster, there was no difference in the IgG GMCs against pertussis-specific antigens between children born to women vaccinated with dTaP 3 -IPV and dTaP 5 -IPV; however, IgG GMCs against pertussis toxin were significantly lower in children born to women vaccinated with dTaP 3 -IPV compared with children born to unvaccinated women (geometric mean ratio 0.42 [95 % CI 0.22–0.78], p = 0.03). One month after the receipt of the preschool booster there was no differences between the groups. The blunting effect of antenatal pertussis vaccine on pertussis responses in children can persist until preschool age, although it is overcome by the administration of a booster dose. ClinicalTrials.gov registration number: NCT03578120 [ABSTRACT FROM AUTHOR]

• Many mental health disorders first emerge during early childhood or adolescence. • Wait times for children's mental health services have been an international and widespread problem. • Long wait times prolong the emotional distress of children and/or adolescents and their caregivers which can exacerbate mental health difficulties. • The majority of research in this area has been conducted in the United Kingdom and Canada and focus on one waitlist strategy. • Common strategies include alternative service delivery models, increasing system capacity, and improving intake and assessment processes. Background: Although many mental health disorders first emerge during early childhood or adolescence, there is a significant gap between demand and availability of mental health resources, leading to long waitlists for services. Objective: The objective of this scoping review was to identify and characterize the research literature related to the range of waitlist management strategies that have been implemented in outpatient child and adolescent mental health care. Methods: Electronic databases reviewed included: Medline (Ovid), Embase (Ovid), PubMed, PsychINFO, SCOPUS, CINAHL, and ISI Web of Science. Grey literature databases included: OpenGrey, Conference Papers Index, and Proquest Digital Dissertations. Articles were screened by two reviewers in two steps: first by title and abstract, then full text level. Data were extracted using an a-priori developed data extraction framework, which was piloted and modified iteratively. Results: A total of 119 papers related to waitlist interventions in child and adolescent mental health were reviewed. Of these 119 papers, 11% were reviews, summary, or theoretical papers; 8% used a randomized control trial design and 2.5% were trial protocols. Most studies used less rigorous designs, such as uncontrolled before-and- after designs. The large majority focused on just one waitlist strategy each. The most commonly used approaches included: prioritization/triage and initial assessment; brief consultation and advice or brief therapy approaches; group-based models; interim services; increasing capacity; and strategies to decrease non-attendance. Most studies were conducted in the United Kingdom or Canada. Discussion: While mental health systems are complex, most studies examining waitlist initiatives explored the implementation of single initiatives. It is unlikely that a single waitlist strategy can be effective in managing wait times for children's mental health. Rather, consistent and systemic approaches to address wait times that consider the impact of the reduction approach on the patient, the program, and the community are needed. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic has been dominated by discussions of mild and short-lasting cases or acutely serious or lethal forms of the disease; less attention has been paid to long-term Covid-19 symptoms ('Long Covid'), particularly in children. This analysis of the experiences of children and adolescents with Long Covid, and those of their parents/caregivers, argues that children with Long Covid encounter a 'double invisibility' due to the condition's limited social currency and their status as the youngest members of society. We draw on 39 narrative interviews about children's and adolescents' experiences, conducted in 2021–2022 in the United Kingdom. The occurrence of Long Covid in children challenges key aspects of a dominant pandemic narrative, some of which have persisted from the early stages of the pandemic into 2023. Analysis of our qualitative interviews demonstrates that participant experiences were shaped and undermined by the convergence of three elements of the dominant pandemic narrative: that Covid-19 is mild, and everyone recovers; that children are not badly affected by Covid-19; and that worst of the pandemic was essentially 'over' as early as 2021/2022. In the face of these characterisations of Covid-19 experience, young people and their families reported significant additional challenges in making the illness experiences of children and adolescents visible, and thus in gaining appropriate support from medical and educational professionals. We interpret this in relation to 'social currency' - the extent to which an illness elicits understanding and acceptance by wider society. Children and adolescents with Long Covid struggled to signal the severity of their condition and elicit care in the manner expected for other debilitating illnesses. This was exacerbated by assumptions and stereotypes about unwell children and adolescents, and their parents, and questioning of their candidacy as reliable, trustworthy patients. • Little public attention has been paid to Long Covid, particularly in children. • Covid was publicly represented as mild, not affecting children, and 'over' by 2022. • The invisibility of Long Covid means it receives poor social currency. • Children face a 'double invisibility' due to their age and associated stereotypes. [ABSTRACT FROM AUTHOR]

Accurate diagnosis and treatment depend upon detailed knowledge of both the child's presenting symptoms and their past medical history. However, the process of soliciting past medical history has never been subject to systematic scrutiny in actual clinical practice. To examine the function of the question "are you otherwise fit and well?" to elicit a child's general medical history in UK paediatric allergy outpatient consultations. Examination of 30 video-recorded UK paediatric outpatient consultations involving children (2–10 years), caregivers, and one doctor. We identified, transcribed, and interrogated 13 examples, deploying the systematic and rigorous method of conversation analysis to elucidate the question's micro-design elements and their consequences for the consultation's trajectory. Asking "Are you otherwise fit and well?" is built to efficiently solicit a problem-free report of good health. Nonetheless patients can and do raise other relevant matters. In practice, the question initiates several interactional matters simultaneously: establishing/resolving (mis)understandings of "fitness" and "wellness"; negotiating opportunities for children's participation; and importantly, a shift towards discussing more general wellbeing. Past medical history questions unavoidably generate broader interactional matters which are skilfully resolved in real-time between clinicians, caregivers, and children. Clinical training could be greatly enhanced by integrating insights into the interactional consequences of asking questions, particularly in the complex multiparty environment of paediatrics. While the question 'Are you otherwise fit and well' clearly serves an important function, clinicians should be alert to the possible problems it might raise, especially when directed towards younger children. • Assessing a child's general health can be vital for accurate diagnosis and treatment. • We studied questions about general health in real consultations for the first time. • "Are you otherwise fit and well?" involves navigating complex interactional matters. • Participants treat the question as a shift to discussing general well-being. • Clinical training should incorporate interactional consequences of questions. [ABSTRACT FROM AUTHOR]

This qualitative study explored public attitudes to COVID-19 vaccines in children, including reasons for support or opposition to them. This was a qualitative study using online focus groups and interviews. Group and individual online interviews were conducted with a diverse sample of 24 adults in the United Kingdom to explore their views on the issue of COVID-19 vaccination in children. Data were analysed using a framework approach. COVID-19 vaccination in children was framed as a complex problem (a 'minefield'). Six themes emerged to explain participants views: (1) uncertainty over whether children can catch, transmit or be severely harmed by COVID-19; (2) lower risk tolerance for unknown longer term effects of the vaccine in children; (3) association of the vaccine programme with government's handling of the pandemic; (4) local social norms as a driver of hesitancy; (5) vaccinating children as a way to protect vulnerable adults; and (6) children's vaccination as parental choice. COVID-19 vaccination in children is perceived by members of the public as a complex issue, and many are torn or hesitant about the idea. Public health communications will need to combat this hesitancy if vaccine uptake for children is to be pursued as a public health policy. [ABSTRACT FROM AUTHOR]

Gender role attitudes have been found to be associated with the mental health of adults and adolescents, but little is known about whether parents' gender attitudes are associated with their children's mental health. Using data from Understanding Society, the UK Household Longitudinal Study (UKHLS), a large-population representative sample, we examine the links between parental gender role attitudes and child mental health outcomes as measured by the total and five components of the strengths and difficulties questionnaire (SDQ). We construct structural equation models, separately for mothers and for fathers and for children aged 5 and 8, and adjust for key sociodemographic variables. We find that children aged 5 years exhibit fewer emotional and peer relationship problems and are more prosocial when their mothers have more egalitarian (compared to traditionalist) gender role attitudes. We also find that children are more prosocial at age 8 when their mothers have more egalitarian gender role attitudes. No statistically significant mediation effect is observed via maternal parenting behaviour. Fathers' more egalitarian gender role attitudes were associated with higher hyperactivity at age 5 and more prosocial behaviour at age 8. Further, engaging in less negative parenting behaviour completely mediates the association of fathers' more egalitarian gender attitudes with children's mental health across the majority of the SDQ scales. This suggests that parental gender attitudes may be a possible target for the prevention of mental health difficulties among children; however, future research will be required to examine the extent to which the associations we identified reflect causality. • Little is known about parents' gender attitudes and their children's mental health. • Parental gender attitudes are linked to specific domains of child's mental health. • Potential mechanisms may depend on the gender of the parent. • Parenting behaviour attenuates the association for fathers but not mothers. [ABSTRACT FROM AUTHOR]

Developing methodology for measuring and valuing child health-related quality of life (HRQoL) is a priority for health technology agencies. One aspect of this is normative decisions that are made in child HRQoL valuation. This qualitative study aimed to better understand adult public opinion on the normative questions of whose preferences to elicit (adults, children, or both) and from which perspective (who should be imagined living in impaired health), when valuing child HRQoL. Opinions of the adult UK public (N = 32) were solicited using online semi-structured focus groups, featuring a breadth of age, sex, ethnicities, and responsibility for children under 18 years. Participants were provided with bespoke informational material on health state valuation and were probed for their views. Arguments for and against different positions were discussed. Data was analysed using framework analysis. Participants demonstrated near-to-universal agreement that children should be involved in valuation in some form, yet this should differ depending on age or maturity. There was strong support for approaches combining involvement from children and adults (e.g., their parents), especially for younger children. There was little intuitive support for the 'taxpayer argument' for asking taxpaying adults. In the context of greater involvement of children in valuation, most participants supported using an 'own' perspective. Most participants thought that valuation study participants should know the exercise is about valuing child health states for ethical reasons. Informed views from the UK public on who should be asked and with what perspective when valuing child HRQoL appear to differ from normative positions previously advocated by some health economists, such as prioritising the preferences of taxpaying adults. In contrast, the results suggest including adults and children in valuation, with the proviso that the children are of an appropriate age and level of maturity, and that an own perspective is used wherever possible. • Little evidence on public views of how to value child health states. • Opinions of an informed UK public elicited using semi-structured focus groups. • Strong public support for some involvement of children in valuation tasks. • Little intuitive support for the 'taxpayer argument' for involving taxpaying adults. • Public views differ from normative positions advocated by some health economists. [ABSTRACT FROM AUTHOR]

• This study reviewed the prevalence of mental health disorders among Looked After Children in the UK. • Prevalence rates varied across studies. • The Strengths and Difficulties Questionnaire (SDQ) was the most frequently used tool to assess mental health. • There is still uncertainty about the scale and nature of mental health difficulties in this group. Care-experienced children and young people are more likely to experience poorer mental health relative to the general population. Some of the most highly cited literature in this area is becoming increasingly outdated, however, and as the gap between mental health service availability and provision is steadily growing, it is imperative that we understand the scale and nature of the mental health needs of this group. A systematic review of all literature published from the UK was conducted in March 2022 using APA PsycINFO, ASSIA, Cochrane Library, Medline, PubMed, Scopus, Social Policy and Practice, Social Services Abstracts, and Web of Science. Papers were included if they 1) sampled young people (aged 0 to 18 years) with care experience and, 2) used either a standard or non-standardised measurement tool, or health records to assess mental health prevalence rates (reported as a percentage). Risk of bias assessed used the QuADS tool (Harrison et al., 2021) and data was extracted. Thirty-nine studies were included and summarised. The estimated prevalence of mental health disorders of young people in care ranged from 1 to 82 %. The most frequently used tool to assess mental health was the Strengths and Difficulties Questionnaire (Goodman, 1997) and, while over half of studies utilised prevalence information from a comparator group, this was most commonly young people in the general population. The results of the systematic review demonstrate that estimates of mental health disorders among care-experienced young people in the UK vary considerably. Further consideration should be given toward what measures are used to assess mental health in this population and how we can optimally assess and characterise their support needs. [ABSTRACT FROM AUTHOR]

Objective: Enduring mental health (EMH) is a relatively new concept, which refers to a long-term state of not experiencing a mental illness (ie, enduring mental wellness). No analysis using this concept has been undertaken on United Kingdom data nor specifically in the childhood years. The present study seeks to consider the extent and predictors of EMH in children aged 9 months to 14 years who were part of the UK-wide Millennium Cohort Study.Method: Data derived from 13,310 children (49.4% girls) at ages 9 months and 3, 5, 7, 11, and 14 years were pooled into 3 categories: EMH, some instances of mental health problems (SIMHP), and many instances of mental health problems (MIMHP).Results: Fewer than half of the children (41%) fell into the category of EMH; the rest had at least some periods of mental health problems. Factors associated with EMH relative to those with SIMHP or MIMHP included cognitive ability, lack of special educational needs, good emotion regulation, cooperation, and enjoyment of school. Parenting and maternal mental health were also associated with EMH but only compared with those with MIMHP.Conclusion: Findings suggests that EMH is not the norm during childhood. Identification of the high association between both educational well-being and emotional regulation with EMH offer the opportunity for a potentially powerful combination of community and individual initiatives. These might include supporting positive mental health of the primary care giver, systems to support early recognition, supporting positive parenting in the early years, enhancing school engagement, and strengthening the child's social and emotional skills (including cooperation) and self-regulation to prevent later mental health problems. [ABSTRACT FROM AUTHOR]

Background: There is lack of recent information on the prescribing trends of antidepressants and coprescription with other psychotropic medications in the United Kingdom (UK) pediatric population.Methods: Using the Clinical Practice Research Datalink, we estimated the annual rates of patients newly prescribed an antidepressant (selective serotonin reuptake inhibitors (SSRIs), other newer generation antidepressants, and tricyclic antidepressants (TCAs)) and the percentage of new users of antidepressants with a same-day coprescription for other psychotropic medications. We also estimated the prevalence of patients with antidepressant prescriptions and percentage of coprescription for other psychotropic medications.Results: After a 42% decline from 2000 to 2005, the rate of patients newly prescribed an antidepressant increased from 2006 onwards. From 2008 to 2018, the rate increased from 254.3 to 471.2 per 100,000 person-years (rate ratio 1.97, 95% confidence interval 1.96-1.99). The rate was higher in females and adolescents aged 15 to 17. SSRIs were most commonly prescribed (70% of all antidepressant prescriptions). Overall, 4.7% of patients newly prescribed an antidepressant had at least one same-day coprescription for another psychotropic medication. During the study period, coprescription rose from 2.6% to 6.4% and was more frequent in males. In 2018, most coprescriptions were anxiolytics and hypnotics (63%) and antipsychotics (26%). Trends in prevalent prescriptions corresponded to trends in new prescriptions.Limitations: By using a primary care database, we did not have information on prescriptions from specialists or during hospitalizations.Conclusions: During the last decade, antidepressant prescriptions and psychotropic coprescription in primary care increased in UK children and adolescents. [ABSTRACT FROM AUTHOR]

Background: We examined associations between family status (living with a spouse or partner and number of children) and lifetime depression.Methods: We used data from the UK Biobank, a large prospective study of middle-aged and older adults. Lifetime depression was assessed as part of a follow-up mental health questionnaire. Logistic regression was used to estimate associations between family status and depression. We included extensive adjustment for social, demographic and other potential confounders, including depression polygenic risk scores.Results: 52,078 participants (mean age = 63.6, SD = 7.6; 52% female) were included in our analyses. Living with a spouse or partner was associated with substantially lower odds of lifetime depression (OR = 0.67, 95% CI 0.62-0.74). Compared to individuals without children, we found higher odds of lifetime depression for parents of one child (OR = 1.17, 95% CI 1.07-1.27) and parents of three (OR = 1.11, 95% CI 1.03-1.20) or four or more children (OR = 1.27, 95% CI 1.14-1.42). Amongst those not cohabiting, having any number of children was associated with higher odds of lifetime depression. Our results were consistent across age groups, the sexes, neighbourhood deprivation and genetic risk for depression. Exploratory Mendelian randomisation analyses suggested a causal effect of number of children on lifetime depression.Limitations: Our data did not allow distinguishing between non-marital and marital cohabitation. Results may not generalise to all ages or populations.Conclusions: Living with a spouse or partner was strongly associated with reduced odds of depression. Having one or three or more children was associated with increased odds of depression, especially in individuals not living with a spouse or partner. [ABSTRACT FROM AUTHOR]

Violence against children can have extensive, long-term, and far-reaching adverse impacts on survivors and society. There is currently little consensus in the United Kingdom around the prevalence of violence against children: maltreatment, intimate partner violence, sexual violence, bullying, and community violence, and most existing studies focus on only a single or a few forms of violence. This study aims to produce data to highlight the current magnitude of the problem in the UK, to inform policy, drive action and allow for monitoring of progress over time. To produce weighted prevalence estimates by violence type, as well as gender and age sub-categories, to give as full a picture as possible of the current prevalence of violence against children in the UK. The prevalence of violence against children from 23 self-report studies conducted in the United Kingdom was gathered through a systematic review. Databases were searched from inception to 24th June 2022. Studies were reviewed systematically for appropriate data and meta-analyses were conducted to give pooled prevalence data based on a quality effects model. The most prevalent self-reported experience of childhood violence was community violence at 27.33 % (95 % CI [9.84, 48.97]). Prevalence of bullying was also high at 22.75 % (95 % CI [13.25, 33.86]). The most prevalent forms of child maltreatment were domestic violence exposure at 11.9 % (95 % CI [6.34, 18.84]) and emotional maltreatment at 11.84 % (95 % CI [5.58, 19.89]). National child maltreatment surveys are needed in the UK, using a comprehensive and conceptually robust approach, and valid and reliable instruments, to provide data for researchers and policymakers on the prevalence of all types of violence against children including exposure to multiple types. This allows monitoring of trends over time, can inform strategies for prevention, and can enable monitoring of future progress in reducing violence against children and its associated health and economic burden. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) have a negative impact on childhood health, but their impact on education outcomes is less well known. We investigated whether or not ACEs were associated with reduced educational attainment at age 7 and 11 years. The study design used in the study is a population-based electronic cohort study. We analysed data from a total population electronic child cohort in Wales, UK. ACEs (exposures) were living with an adult household member with any of (i) serious mental illness, (ii) common mental disorder (CMD), (iii) an alcohol problem; (iv) child victimisation, (v) death of a household member and (vi) low family income. We used multilevel logistic regression to model exposure to these ACEs and not attaining the expected level at statutory education assessments, Key Stage (KS) 1 and KS2 separately, adjusted for known confounders including perinatal, socio-economic and school factors. There were 107,479 and 43,648 children included in the analysis, with follow-up to 6–7 years (KS1) and 10–11 years (KS2), respectively. An increased risk of not attaining the expected level at KS1 was associated with living with adult household members with CMD (adjusted odds ratio [aOR]: 1.13 [95% confidence interval [CI]: 1.09–1.17]) or an alcohol problem (adjusted odds ratio [aOR]: 1.16 [95% confidence interval [CI]: 1.10–1.22]), childhood victimisation (adjusted odds ratio [aOR]: 1.58 [95% confidence interval [CI]: 1.37–1.82]), death of a household member (adjusted odds ratio [aOR]: 1.14 [95% confidence interval [CI]: 1.04–1.25]) and low family income (adjusted odds ratio [aOR]: 1.92 [95% confidence interval [CI]: 1.84–2.01]). Similar results were observed for KS2. Children with multiple adversities had substantially increased odds of not attaining the expected level at each educational assessment. The educational potential of many children may not be achieved due to exposure to adversity in childhood. Affected children who come in to contact with services should have relevant information shared between health and care services, and schools to initiate and facilitate a coordinated approach towards providing additional support and help for them to fulfil their educational potential, and subsequent economic and social participation. • This is the first UK study to use routinely available healthcare data record-linked to education outcome data in a total population electronic child cohort to examine the cumulative impact of multiple forms of childhood and household adversity on early educational attainment. • Children exposed to adverse experiences during childhood were less likely, compared with non-exposed peers, to attain the expected level of education at age 6–7 years (Key Stage 1) and age 10–11 years (Key Stage 2). • Exposure to adverse childhood experiences increases the chances that children develop into adults with poor economic prospects, contributing to a cycle of hardship that fuels inequalities and potentially locks families into deprivation and ill health across generations. [ABSTRACT FROM AUTHOR]

Background: Good sleep is a growing public health focus. Given the multidimensional nature of sleep, it is of interest to examine population sleep profiles and determine sociodemographic and lifestyle correlates.Methods: This study uses actigraphy-measured sleep data collected between February 2015 and March 2016 in the Child Health CheckPoint study. Participants wore actigraphy monitors (GENEActiv Original, Cambs, UK) on their non-dominant wrist for seven days and sleep characteristics (duration, efficiency, timing, and variability) were derived from raw actigraphy data. Sleep profiles of 1043 Australian children aged 11-12 years and their parents were determined using K-means cluster analysis. The association between cluster membership and potential sociodemographic and lifestyle correlates were assessed using Generalised Estimating Equations, adjusting for geographic clustering.Results: Four sleep profiles were identified: Short sleepers, Late to bed, Long sleepers, and Overall good sleepers. Compared to Overall good sleepers, Late to bed cluster were of lower socioeconomic position and had the least favourable diet and activity patterns. Compared to Overall good sleepers, those in the Late to bed cluster had higher sedentary time, lower levels of moderate-vigorous physical activity and a higher consumption of savoury snacks. In contrast, sugary drink consumption was higher in Late to bed children and Long sleeper adults.Conclusion: Examining sleep profiles may provide a more holistic way of monitoring sleep at the population level. Future health promotion strategies may be best to consider sleep in terms of profiles, with emphasis on sleep timing and duration. [ABSTRACT FROM AUTHOR]

• In 2013, the UK extended its National Vaccination Programme for influenza. • Children were vaccinated with intranasally administered LAIV. • The programme was phased in over several years to broader childhood age groups. • Uptake of the childhood vaccination programme has been good to excellent. • The programme has had a positive impact on influenza-related outcomes. In 2012, the Joint Committee on Vaccination and Immunisation recommended that the United Kingdom's (UK) National Vaccination Programme (NVP) for influenza was extended to include healthy children and adolescents aged 2 to <17 years. Previously, the UK's NVP focused on seasonal vaccination of the elderly and people (including children) with underlying health conditions that put them at high risk of hospitalisation if they contracted influenza. The extension of the UK's programme began in the 2013/14 influenza season through the vaccination of children aged 2–3 years in primary care across England and the devolved administrations of Scotland, Wales, and Northern Ireland. School-aged children were generally vaccinated in a school setting, with several implementation pilots in England and Scotland. Due to the scale of the programme, it has been phased in over several years and expanded to include broader childhood age groups. This article reviews the experiences from the implementation of the UK's childhood influenza NVP over the first six influenza seasons (between 2013/14 and 2018/19) from the perspectives of England, Scotland, Wales, and Northern Ireland. The processes used to deliver the vaccination programme in general practice and the school-based setting are described in terms of governance, contracting, workforce management, communication, administrative tasks, vaccination sessions, vaccine supply and distribution, and surveillance. In addition, the available evidence regarding the clinical impact of the UK's childhood influenza NVP over the first six influenza seasons is reviewed. We also share lessons learned from the programme and recommendations to provide guidance to other countries looking to implement childhood influenza vaccination programmes. [ABSTRACT FROM AUTHOR]

• DTaP5-HB-IPV-Hib is a vaccine against diseases caused by 6 infectious agents. • DTaP5-HB-IPV-Hib was given with 1 of 2 meningococcus group C conjugate vaccines. • Satisfactory seroprotection rates were achieved against all vaccine antigens. • High rates of seroprotection against meningococcus group C were observed. Concomitant administration of vaccines simplifies delivery. DTaP5-HB-IPV-Hib is a fully liquid, combination vaccine against 6 diseases. This study evaluated the compatibility of DTaP5-HB-IPV-Hib with 2 different meningococcus group C conjugate (MCC) vaccines in infants. In a phase 3, open-label study, 284 healthy infants from 11 UK centres received DTaP5-HB-IPV-Hib at age 2, 3, and 4 months; 13-valent pneumococcal conjugate vaccine (PCV13) at 2 and 4 months; a Haemophilus influenzae type b (Hib)-MCC vaccine and a measles/mumps/rubella vaccine at 12 months. Participants were randomised 1:1 to receive either an MCC-detoxified tetanus toxin vaccine (MCC-TT; n = 141) or an MCC- Corynebacterium diphtheriae CRM 197 protein vaccine (MCC-CRM; n = 143) at 3 and 4 months. The primary outcome was seroprotection rate (SPR) to MCC (percent with rabbit complement serum bactericidal antibody titer ≥8). Per protocol analysis, MCC SPRs were 100 and 96.4 one month after the first dose, 100 and 99.1 after the second dose, and 100 and 97.3 after the third (booster) dose of MCC in the MCC-TT and MCC-CRM groups, respectively. One month after all 3 doses of DTaP5-HB-IPV-Hib, immunoglobulin G anti-polyribosylribitol phosphate SPRs (% ≥0.15 µg/mL) were 97.8 in the MCC-TT group and 100 in the MCC-CRM group; anti-hepatitis B antigen SPRs (% ≥10 mIU/mL) were 96.8 and 96.3 in the MCC-TT and MCC-CRM groups, respectively. All participants were seroprotected against diphtheria and tetanus (≥0.01 IU/mL) and poliovirus types 1, 2, and 3 (≥8 dilution), and seroresponse rates to all pertussis antigens were ≥90.4%. Two vaccine-related serious adverse events (transient severe abdominal pain and crying) occurred concomitantly in 1 participant in the MCC-CRM group. Adverse event rates were similar to other studies of DTaP5-HB-IPV-Hib, with pyrexia ≥38 ° C in 10.9% of participants following any dose. DTaP5-HB-IPV-Hib can be effectively used in a 2-, 3-, and 4-month infant priming schedule when given with 2 doses of MCC. [ABSTRACT FROM AUTHOR]

The use of dexamethasone in acute lymphoblastic leukaemia therapy contributes to short- and long-term toxicities. The UKALL 2011 randomised trial investigated whether a more intense dexamethasone dose (10 mg/m2/d x 14d, short vs 6 mg/m2/d x 28d, standard) would lead to a more rapid cytoreduction and reduced adverse effects associated with longer durations of steroids in induction. The impact of dose and duration on dexamethasone pharmacokinetics was investigated. Blood samples were obtained on one of the first three and last three days of induction dexamethasone dosing at time points up to 8 h after oral administration. Plasma dexamethasone levels were quantified in 1084 plasma samples obtained from 174 children and a population pharmacokinetic model developed. Drug exposure varied significantly between patients, with a >12-fold variation in AUC 0–12h values and a marked overlap in dexamethasone exposures between dose levels. Intuitively, AUC 0–12h was significantly higher with short dosing (10 mg/m2/d), but cumulative exposure was significantly higher with standard dosing over 28 days, after a higher cumulative dose. Concomitant rasburicase administration was associated with a 60% higher dexamethasone clearance. Day 8 bone marrow response was comparable between dosing arms, but those with <5% blast count exhibited a greater mean dexamethasone exposure than those with >5%. No statistical differences were observed between arms in terms of steroid-related toxicity or minimal residual disease at the end of induction. The potential significance of dexamethasone AUC 0–12h on early response and higher cumulative exposure on the standard arm suggest that duration of therapy and exposure may be more important factors than absolute dose from a clinical pharmacology perspective. • The impact of dose and duration on dexamethasone pharmacokinetics has been investigated in ALL patients. • Dexamethasone levels were quantified in 1084 plasma samples obtained from 174 children. • Marked interpatient pharmacokinetic variability was observed between patients on different dose levels. • Patients with a day 8 blast count <5% had significantly higher dexamethasone exposures than those with a blast count >5%. • Duration of dexamethasone therapy may be more important than absolute dose from a clinical pharmacology perspective. [ABSTRACT FROM AUTHOR]

Obesity in the United Kingdom and the Republic of Ireland is rising, as is the frequency of eating out in restaurants. The aim of this study was to investigate the nutritional quality of children's menus in restaurants. Cross-sectional review of menus aimed at children from 20 popular chain restaurants in the United Kingdom and Ireland. Total energy, fat, saturated fat, and salt were collected from every food item on the menu in each restaurant. All potential meal combinations were created. A total of 39,266 meals were analysed. Meals were compared with UK nutritional guidelines. Meals from fast food and full-service restaurants and main meals and meal deals were compared. The average meal for younger children (aged 2–5 years) contained 609 ±117 kcal, and for older children (6–12 years) 653 ± 136 kcal compared with guidelines of 364 and 550 kcal, respectively. A total of 68% of younger children's and 55% of older children's meals contained more total fat than recommended and more than 4 times the amount of saturated fat. Fast food restaurant meals contained less energy, fat, and salt than did full-service restaurants, and meal deals were less likely to meet dietary guidelines than were main meals alone. Eating in chain restaurants, in particular meal deals, does not contribute positively to the diet of children in the United Kingdom and Ireland. [ABSTRACT FROM AUTHOR]

This article discusses the influence of a chromosome condition affecting women's reproductive capacity, Turner Syndrome (TS), on affected women's social timing, examining the strategic decisions that are made within families in relation to reproduction, to navigate these disruptions. Based on photo elicitation interviews with 19 women with TS and 11 mothers of girls with TS in the UK, it presents findings from an under-researched topic, TS and reproductive choices. In a social context where motherhood is not only desirable, but expected (Suppes, 2020), the social imaginary of infertility anticipates a future of unhappiness and rejection, an undesirable condition that should be avoided. Accordingly, mothers of girls with TS often expect that their daughter will want to have children. Infertility diagnosed in childhood has a distinctive impact on reproductive timing, as future options may be anticipated for years. This article uses the concept of 'crip time' (Kafer, 2013) to explore how women with TS and mothers of girls with TS experience temporal misfitting based on a childhood diagnosis of infertility, and manage, resist and re-frame this to minimise stigma. The 'curative imaginary' (Kafer, 2013), a social norm where disabled people are expected to desire a cure for their condition, is used as an analogy for infertility, describing how mothers of girls with TS respond to social pressure to plan for their daughter's reproductive future. These findings may be useful both for families navigating childhood infertility and practitioners who support them. This article demonstrates the cross-disciplinary potential of applying disability studies concepts to the context of infertility and chronic illness, where concepts shed new light on the dimensions of timing and anticipation in this context, improving our understanding of the lived experience of women with TS, and how they view and use reproductive technologies. • A childhood diagnosis of TS means affected girls and parents frequently face 'misfitting' with social timing. • Multiple strategies are employed to manage, re-frame and resist infertility, TS and timing stigma. • The support of TS social groups is an important counterbalance. • Mothers of girls with TS feel pressure to facilitate their daughter's future reproductive choices. • Concepts from disability studies enrich a sociological discussion of fertility and chronic illness. [ABSTRACT FROM AUTHOR]

To obtain an overview of the management and outcomes of children aged 18 years or younger diagnosed with differentiated thyroid carcinoma of follicular cell origin across the UK, by collecting and analysing data from the limited number of centres treating these patients. This multicentre data might provide a more realistic perspective than single-institution series. Six centres submitted data extracted from historical records on patients aged 18 years or younger, diagnosed between 1964 and 2017. The univariate and multivariable Cox proportional hazard model was used to identify potential predictors of progression-free survival, using national data as a control. Data on 166 patients were available for analysis. Females (74%) were predominant, and the age ranged from 3 to 19 years at diagnosis, mean 14.1 years. Nodal metastases were present in 51%; 12% had distant metastases. After surgery, 95% received radioactive iodine (39% on more than one occasion) and 4% received external beam radiotherapy. With a median follow-up duration of 5 years, 69% are alive with no evidence of disease; 20% are alive with a raised thyroglobulin level as the only evidence of residual disease; 6% have residual structural disease detectable on imaging; 2% have died, from cerebral metastases. Despite most patients having advanced disease at presentation, outcomes are very good. A national prospective registry should allow systematic collection of good-quality data and may facilitate research to further improve outcomes. • Paediatric thyroid cancer patients are treated in a small number of UK centres. • Despite presentation with advanced disease, good long-term outcomes are expected. • National prospective data collection is recommended. [ABSTRACT FROM AUTHOR]

Children who grow up in neighborhoods with more green vegetation show enhanced cognitive development in specific domains over short timespans. However, it is unknown if neighborhood greenery per se is uniquely predictive of children's overall cognitive development measured across many years. The E-Risk Longitudinal Study, a nationally representative 1994-5 birth-cohort of children in Britain (n = 1658 urban and suburban-dwelling participants), was used to test whether residential neighborhood greenery uniquely predicts children's cognitive development across childhood and adolescence. Greenery exposure was assessed from ages 5 to 18 using the satellite imagery-based normalized difference vegetation index (NDVI) in 1-mile buffers around the home. Fluid and crystalized intellectual performance was assessed in the home at ages 5, 12, and 18 using the Wechsler Intelligence Scale, and executive function, working memory, and attention ability were assessed in the home at age 18 using the Cambridge Neuropsychological Test Automated Battery. Children living in residences surrounded by more neighborhood greenery scored significantly higher, on average, on IQ measures at all ages. However, the association between greenery and cognitive measures did not hold after accounting for family or neighborhood socioeconomic status. After adjustment for study covariates, child greenery exposure was not a significant predictor of longitudinal increases in IQ across childhood and adolescence or of executive function, working memory, or attention ability at age 18. Children raised in greener neighborhoods exhibit better overall cognitive ability, but the association is likely accounted for by family and neighborhood socioeconomic factors. • We tested whether neighborhood greenery predicts child cognitive development. • Satellite-imagery measures of greenery were related to cognitive ability assessed at ages 5, 12, and 18. • Children raised in greener neighborhoods showed greater ability at all ages. • Children raised in greener neighborhoods also showed greater growth in crystalized cognitive ability from age 5 to 12. • However, the positive associations were best accounted for by family/neighborhood socioeconomic factors. [ABSTRACT FROM AUTHOR]

Although primarily conceptualized as a disorder of phonological awareness, developmental dyslexia is often associated with broader problems perceiving and attending to transient or rapidly-moving visual stimuli. However, the extent to which such visual deficits represent the cause or the consequence of dyslexia remains contentious, and very little research has examined the relative contributions of phonological, visual, and other variables to reading performance more broadly. We measured visual sensitivity to global motion (GM) and global form (GF), performance on various language and other cognitive tasks believed to be compromised in dyslexia (phonological awareness, processing speed, and working memory), together with a range of social and demographic variables often omitted in previous research, such as age, gender, non-verbal intelligence, and socio-economic status in an unselected sample (n = 132) of children aged 6-11.5 yrs from two different primary schools in Edinburgh, UK. We found that: (i) Mean GM sensitivity (but not GF) was significantly lower in poor readers (medium effect size); (ii) GM sensitivity accounted for only 3% of the variance in reading scores; (iii) GM sensitivity deficits were observed in only 16% of poor readers; (iv) the best predictors of reading performance were phonological awareness, non-verbal intelligence, and socio-economic status, suggesting the importance of controlling for these in future studies of vision and reading. These findings suggest that developmental dyslexia is unlikely to represent a single category of neurodevelopmental disorder underpinned by lower-level deficits in visual motion processing. [ABSTRACT FROM AUTHOR]

Motor skill screening tools are essential for the early detection of developmental coordination disorder (DCD). The present study aimed to examine any cultural and rater effects on these tools. This then enabled us to judge the validity of the original cut-off values for identifying diagnosable children. A community sample survey was performed in Japan; 3852 children aged 6–9 years were recruited. Both parents and teachers evaluated the motor skills of their children using the Movement Assessment Battery for Children – Second Edition Checklist. The psychometric properties were evaluated and the scoring characteristics examined based on the type of rater and country of origin, as compared to data originally sampled in the UK. High reliability and validity of the Japanese samples were confirmed. The Japanese adults evaluated their children's motor skills more rigorously than the Europeans. Additionally, there was a large disagreement between parent and teacher rating scores; the degree of agreement varied depending on the severity of motor deficits in the child. The first findings from a Japanese sample suggest that the assessment of motor skills in children is significantly affected by culture and rater. These cultural characteristics and rater biases strongly suggest that new cut-off values, reflecting country and rater type, be introduced for identifying children at risk of DCD. [ABSTRACT FROM AUTHOR]

Abstract Background Research about online child sexual exploitation material (CSEM) users focuses on psychological assessments, demographics, motivations, and offending rates. Little is known about their understandings of children in CSEM. Objective From an anthropological perspective, examine CSEM users' constructions of children and childhood online and offline, and explore how these factor into their crimes. Participants and setting CSEM users in UK group programs. Methods In-depth ethnography, including 17 months of participant observation in group programs with 81 CSEM users, 31 semi-structured interviews with group participants, and inductive analysis of themes illuminated by childhood theory from anthropology. Results When referring to children offline, many participants claimed to align with Euro-American norms and constructions surrounding children's learning, protection, irrationality, inexperience, asexuality, and innocence. However online, many constructed children differently: as less or not "real," and as sexualized. This rendered children in CSEM fundamentally different , which facilitated offending, assisted in overcoming barriers, and allowed participants to hold conventional beliefs about children and childhood while engaging in incongruent online activity. Vital in this process was Internet use and associated distancing, detachment, anonymity, and cultural othering. The program used victim empathy to restore dominant norms to online children, for which participants invoked feelings, recognized their role in abuse, extrapolated consequences for victims, and reinforced norms. Conclusions Constructions of children and childhood were central in offending. The complexities of negotiating "real" versus "not real" in both offending and victim empathy are discussed, as are conceptual distinctions between "constructions" and "cognitive distortions," and implications for treatment and prevention. [ABSTRACT FROM AUTHOR]

Objective To explore whether paternal psychological distress is related to the longitudinal course of child problem behavior after accounting for maternal psychological distress. Method We used data from the Millennium Cohort Study (MCS), a large general-population birth cohort in the United Kingdom. Maternal and paternal psychological distress was measured with the Kessler 6-item Psychological Distress Scale (K-6) at child ages 3, 5, 7, 11, and 14 years. Problem behavior was measured with the Strengths and Difficulties Questionnaire at these ages. Data were analyzed using growth curve modeling, before and after adjustment for confounders (N = 13,442). Results The effect of paternal psychological distress was weaker than that of maternal psychological distress. However, even after adjustment for maternal psychological distress and confounding, paternal psychological distress predicted all four domains of child problem behavior that we examined (hyperactivity, conduct, emotional, and peer problems). Child problem scores were generally lower in biological father families, but the effect of paternal psychological distress was the same for children in biological and nonbiological father families and did not depend on the level of maternal psychological distress. High levels of paternal psychological distress predicted some problems (emotional symptoms and hyperactivity) more strongly in boys than in girls. Conclusion There was evidence for a robust association between psychological distress in fathers and problem behavior in their offspring. Our findings suggest that the mental health of both fathers and mothers is important for the behavior of their children. [ABSTRACT FROM AUTHOR]

Introduction: Appropriate first aid can reduce the morbidity of burns, however, there are considerable variations between international first aid recommendations. We aim to identify, and compare first aid practices in children who present to Emergency Departments (ED) with a burn.Methods: A prospective cross-sectional study of 500 children (0-16 completed years) presenting with a burn to a paediatric ED in the UK (Cardiff) and the USA (Denver, Colorado), during 2015-2017. The proportion of children who had received some form of first aid and the quality of first aid were compared between cities.Results: Children attending hospital with a burn in Cardiff were 1.47 times more likely (RR 1.47; CI 1.36, 1.58), to have had some form of first aid than those in Denver. Denver patients were 4.7 time more likely to use a dressing and twice as likely to apply ointment/gel/aloe vera than the Cardiff cohort. First aid consistent with local recommendations was only administered to 26% (128/500) of children in Cardiff and 6% (31/500) in Denver. Potentially harmful first aid e.g. application of food, oil, toothpaste, shampoo or ice was applied to 5% of children in Cardiff and 10% in Denver.Conclusion: A low number of children received optimal burns first aid, with potentially harmful methods applied in a considerable proportion of cases. There is an urgent need for internationally agreed, evidence-based burn first aid recommendations. [ABSTRACT FROM AUTHOR]

Abstract The main objectives of this study were to investigate the effects of mediation with a puppet on teachers' mediated learning experience (MLE) strategies. The sample was composed of 18 teachers and 145 kindergarten children, selected from special education (n = 68) and regular (n = 77) kindergartens. About half of each group was assigned to a puppet and half to a no-puppet group. Each teacher was assigned to a small group of 3–5 children and asked to teach them a story for 15 min in a puppet and 15 min in no-puppet conditions in a counterbalanced order. The teaching lessons were videotaped and analyzed by the Observation of Mediation Interaction scale. The findings revealed that teachers in the puppet condition used significantly and uniquely higher levels of mediation in all MLE strategies than in the no-puppet condition. A significant Mediation Modality X MLE Strategy interaction indicates that the differences between the two conditions were highest in strategies of Intentionality and Reciprocity and Meaning and lower in strategies of Transcendence, Feelings of Competence and Self-Regulation. Use of a puppet was effective similarly for children in special education as for children in regular group. When mediators accessed the puppet (i.e., in puppet condition) their level of mediation for Meaning was significantly higher than when the puppet was not accessed. When mediators did not access the puppet their level of mediation for Intentionality and Reciprocity, Feelings of Competence, and Self-Regulation was higher than when the puppet was accessed. The findings were discussed in relation to MLE theory and educational implications are provided. Highlights • Teaching with a puppet elicits higher level of mediation strategies than teaching without a puppet. • Highest differences between puppet and no puppet conditions were in Intentionality and Reciprocity and Meaning. • Use of a puppet was effective similarly for children in special education as for children in regular group. • When the puppet was accessed, in puppet condition, mediation for Meaning was significantly higher than when the puppet was not accessed. [ABSTRACT FROM AUTHOR]

Abstract For many local authority children and family services in the UK faced with the task of responding to children and families facing difficulties and with declining budgets, there is an increasing imperative on how services can respond more effectively to the diverse needs of families on the edge of care. At the same time policy and paradigm shifts have affected the way in which social workers engage with families. This paper is rooted in research commissioned by one local authority that used an innovative visual 'river of experience' co- production approach to understand better the experiences of children and families on their journeys to the edge of care and to inform how statutory services might respond 'better', and possibly earlier, to prevent children being taken into care. The research highlights the gap between assumptions and practices of child and family services and the realities and needs of children and families. The paper discusses these disjunctions and draws out questions to challenge statutory services. In particular, the paper asks why, in spite of serial involvement of professionals, do children still end up in the care system. The paper contributes to current discourses about rethinking child protection, arguing for a different approach to responding to families facing difficulties involving human centred, holistic family support and a more reflexive and relational approach to professional practice. Highlights • The continuing gap between services and the needs of children and families • Children's voices frequently go unheard in statutory professional interventions. • Insufficient attention to emotional/psychological legacy of early neglect • Reiterates the need for re-imagining child protection as family-centred practice • Need for Children and Family services to be flexible and adaptive learning systems [ABSTRACT FROM AUTHOR]

This paper presents a community based participatory research project, which adopted a photovoice approach with seven unaccompanied asylum-seeking children (UASC) living in foster care in the United Kingdom. The project also included a focus group with six foster carers to explore their perceptions of caring for UASCs. At the end of the focus group we then shared the young people's images from the photovoice project. The purpose of this was to better inform the carers understanding of this group's needs and the reality of their lived experiences, to see if this would have any impact on their perceptions or willingness to offer these children a placement in the future. The young people then developed the photographs into posters, which were shown at community events and exhibited in community spaces during refugee week. Findings from the focus group show that some of these carers had anxieties and held misconceptions around caring for UASCs. This highlights the need for practitioners to engage in open conversations with foster carers, to discuss their perceptions and challenge any misconceptions. Furthermore, the project identified that some of these carers were concerned about being able to meet the cultural needs of the young people. Foster carers also seemed unaware of the available support in place to help with this. Therefore, it would be beneficial for foster care services and practitioners to ensure that carers are fully informed of the support and training available to them to assist in meeting UASCs cultural, religious and linguistic needs. The project also presents important lessons for researchers committed to finding ways to engage UASCs meaningfully in the research process. The action orientated approach of photovoice led to a wide range of public engagement activities, that allowed us to show important aspects of the young people's lived realities growing up in foster care. [ABSTRACT FROM AUTHOR]

Objectives: Using data from an international collaborative research project on youth resilience in the context of migration, this study aims to investigate how different acculturation patterns (i.e. integration, assimilation, separation and marginalization) influence the mental health of migrant youth, and whether resilience might function as a mediator in the association between acculturation and mental health. Study design: A cross-sectional pilot study conducted in six countries employing a common survey questionnaire. Methods: The study sample was 194 youths aged 10-17 years (median = 13.6) from six countries (Australia, Canada, China, New Zealand, South Africa, and United Kingdom) and included cross-border and internal migrants. Mental health and well-being was measured by the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). Resilience was measured by the Child and Youth Resilience Measure-28 (CYRM-28). Acculturation was assessed using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA). Multivariate regression and path analysis were performed to examine the hypothesized mediation model. Results: Resilience scores correlated strongly with mental health and well-being. Acculturation exerted no significant direct effects on the mental health of migrant youths. Nevertheless, compared to youths who were integration-oriented, assimilation-oriented youths tended to exhibit lower levels of resilience, resulting in poorer mental health. Compared to youths from other countries, migrant youths from China also reported lower levels of resilience, which led to poorer mental health outcome. Conclusion: Acculturation plays a significant role in the mental health of migrant youth, with different acculturative orientations exhibiting different influences through the mediation effect of resilience. Fostering resilience and facilitating integration-oriented acculturation are recommended public health strategies for migrant youth. [ABSTRACT FROM AUTHOR]

The validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) based on combinations of six clinical features: head/neck bruising; apnea; seizures; rib/long-bone fractures; retinal hemorrhages. We aimed to determine the acceptability of PredAHT to child protection professionals. We conducted qualitative semi-structured interviews with 56 participants: clinicians (25), child protection social workers (10), legal practitioners (9, including 4 judges), police officers (8), and pathologists (4), purposively sampled across southwest United Kingdom. Interviews were recorded, transcribed and imported into NVivo for thematic analysis (38% double-coded). We explored participants’ evaluations of PredAHT, their opinions about the optimal way to present the calculated probabilities, and their interpretation of probabilities in the context of suspected AHT. Clinicians, child protection social workers and police thought PredAHT would be beneficial as an objective adjunct to their professional judgment, to give them greater confidence in their decisions. Lawyers and pathologists appreciated its value for prompting multidisciplinary investigations, but were uncertain of its usefulness in court. Perceived disadvantages included: possible over-reliance and false reassurance from a low score. Interpretations regarding which percentages equate to ‘low’, ‘medium’ or ‘high’ likelihood of AHT varied; participants preferred a precise % probability over these general terms. Participants would use PredAHT with provisos: if they received multi-agency training to define accepted risk thresholds for consistent interpretation; with knowledge of its development; if it was accepted by colleagues. PredAHT may therefore increase professionals’ confidence in their decision-making when investigating suspected AHT, but may be of less value in court. [ABSTRACT FROM AUTHOR]

To survey attitudes towards, and knowledge about, epilepsy among school staff in a defined geographical region in the United Kingdom. School staff (n = 160) from 18 schools (56% of eligible schools) where children with epilepsy were currently attending were surveyed. Surveys were developed in collaboration with educational professionals. Questions focussed on attitudes towards, and knowledge about, epilepsy. Factors associated with attitudes and knowledge were analyzed using multivariable logistic regression. The majority of staff expressed positive attitudes towards the inclusion of children with epilepsy in school, although for most questions there was a significant minority who expressed less positive views. Only 30% of staff agreed that they would feel confident managing a child having a seizure whilst 42% of all staff would be concerned if they had to administer emergency medication. Regarding knowledge, half (50%) of respondents correctly indicated that a child who has a seizure should not always leave the classroom, whilst 54% knew that an ambulance should not always be called every time a child has a seizure. Regarding seizure semiology, almost all respondents (96%) answered 'yes' when asked if seizures could involve convulsions/limb jerking or whole-body convulsions. The vast majority (94%) also identified that seizures could involve 'staring blankly into space'. From a list of eight medical/neurodevelopmental conditions, epilepsy was the condition staff ranked of most concern. Factors independently associated with more positive attitudes and better knowledge included working in a special school as opposed to a mainstream school, having previously witnessed a seizure, and having been in receipt of training on epilepsy (all p < 0.05). Most respondents expressed a desire for more training on seizure management and on the learning and behavioral aspects of epilepsy. Whilst attitudes toward children with epilepsy are largely positive, epilepsy was the condition staff were most concerned about. Additionally, attitudes towards seizure management and administration of emergency medication in school are less positive, and knowledge of correct actions in the event of seizures in the classroom is deficient in nearly half of respondents. More positive attitudes and better knowledge were associated with previous experience of witnessing seizures, working in special schools, and having received epilepsy training. School staff in UK schools are likely to benefit from access to training on epilepsy in order to improve attitudes and increase knowledge and confidence towards supporting a child with epilepsy in their classroom. • Most staff expressed positive attitudes towards the inclusion of children with epilepsy in school. • Only 30% of staff agreed that they would feel confident managing a child having a seizure. • 42% of all staff would be concerned if they had to administer emergency medication • From a list of eight conditions, epilepsy was the condition staff ranked of most concern. • Most respondents expressed a desire for more training on all aspects of epilepsy. [ABSTRACT FROM AUTHOR]

Adventurous play, where children take age-appropriate risks involving uncertainty, fear, and thrill, is positively associated with children's physical health, mental health, and development. There is growing concern that children's access to and engagement with adventurous play opportunities are declining in Westernised countries, which may have negative implications for children's health. The current study aimed to ascertain the facilitators of and barriers to children's adventurous play most identified by parents in Britain and to determine whether these differ across socio-demographic and geographic groups. This study analysed the responses of a nationally representative sample of 1919 parents who took part in the British Children's Play Survey. Two open-ended questions asked parents to identify what they perceive to be the facilitators of and barriers to their child's adventurous play. A quantitative coding scheme, developed using the qualitative framework identified by Oliver et al. (2022), was applied to parents' responses. A diversity in the most identified facilitators and barriers was found, including concerns about the risk of injury from adventurous play and the safety of society, positive attitudes about the benefits of adventurous play, as well as factors related to child attributes. In general, these were consistently identified across different socio-demographic and geographic groups, although some differences were found in barriers. The findings of this research support the identification of key targets for those working with parents to improve children's adventurous play opportunities and ultimately their physical and mental health. Future research should seek to design and tailor interventions by asking parents about the support they would value. • Limited adventurous play may negatively impact a child's physical and mental health. • Examines the most common facilitators and barriers to adventurous play for parents in Britain. • Facilitators were positive attitudes about play, the presence of supervision, and perceptions of child attributes. • Barriers were perceptions of child attributes, safety of society, and the risk of injury. • Health promotion campaigns that aim to increase children's play should target such factors. [ABSTRACT FROM AUTHOR]

Objectives Genocide remains one of the most widespread forms of preventable mortality and morbidity for children today. Despite the creation of multiple human rights treaties, genocide has not been eliminated and its effects disproportionally impact children. The Kindertransport was a series of rescue efforts that brought thousands of refugee children to the United Kingdom from Nazi Germany between 1938 and 1940. This qualitative study asks what public health professionals can learn from the prevention efforts of the Kindertransport by examining the experiences and reflections of individuals rescued as children. The specific aims of the study were (1) to analyze qualitatively the impact of the rescue on rescued children; (2) to evaluate the strengths and limitations of the Kindertransport as a prevention effort; and (3) to draw implications for contemporary public health responses to global genocide. Study design Qualitative research study. Methods In-depth interviews, using a semi-structured interview guide, were conducted with 27 survivors of the rescue. The data were thematically coded, and excerpts exported and interpreted in reflection of patterns and themes using Dedoose. Results Five inductive themes emerged from the data related to the broad spectrum of antisemitic persecution: the breakup of families; integration in the UK via the Kindertransport; the challenges of adapting to a new environment; and the implications for global rescue efforts. Conclusions The results suggest that the public health community should act to prevent genocide through rapid intervention and rescue; at the same time, the effects of persecution must be addressed and sustained social, emotional, and psychological support must be provided to those rescued. [ABSTRACT FROM AUTHOR]

Background: Much of the research on parenting and its influence on child development has emphasised the mother's role. However, increasing evidence highlights the important role of fathers in the development, health and well-being of their children. We sought to explore the association between paternal involvement in early child-rearing and depressive symptoms in 9 and 11 year-old children.Methods: We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort recruited in the southwest of England. The outcome was depressive symptoms measured using the short Moods and Feelings Questionnaire (sMFQ) score. The main exposure was father involvement measured through factor analysis of fathers' responses on their participation in, understanding of, and feelings about their child's early upbringing. Scores on factor 1 measured fathers' emotional response to the child; scores on factor 2 measured the frequency of father involvement in domestic and childcare activities; scores on factor 3 measured fathers' feelings of security in their role as parent and partner.Results: Children of fathers with high scores on factors 1 and 3 had 13% (OR 0.87, 95%CI 0.77-0.98, p = 0.024) and 9% (OR 0.91, 95%CI 0.80-1.03, p = 0.129) respectively lower adjusted odds of depressive symptoms at 9 and 11 years. For factor 2, there was weak evidence of a 17% increase in odds of depressive symptoms associated with 1 unit higher factor scores at both ages (OR 1.17, 95%CI 1.00-1.37, p = 0.050).Limitations: In these observational data, the possibility of residual confounding in the association between the exposure and the outcome cannot be ruled out.Conclusion: Positive psychological and emotional aspects of father involvement in children's early upbringing, but not the quantity of direct involvement in childcare, may protect children against developing symptoms of depression in their pre-teen years. [ABSTRACT FROM AUTHOR]

Superior learning for fear-relevant stimuli is typically indicated in the laboratory by faster acquisition of fear responses, greater learned fear, and enhanced resistance to extinction. Three experiments investigated the speed, magnitude, and robustness of UK children's (6–10 years; N = 290; 122 boys, 168 girls) vicariously learned fear responses for three types of stimuli. In two experiments, children were presented with pictures of novel animals (Australian marsupials) and flowers (fear-irrelevant stimuli) alone (control) or together with faces expressing fear or happiness. To determine learning speed the number of stimulus-face pairings seen by children was varied (1, 10, or 30 trials). Robustness of learning was examined via repeated extinction procedures over 3 weeks. A third experiment compared the magnitude and robustness of vicarious fear learning for snakes and marsupials. Significant increases in fear responses were found for snakes, marsupials and flowers. There was no indication that vicarious learning for marsupials was faster than for flowers. Moreover, vicariously learned fear was neither greater nor more robust for snakes compared to marsupials, or for marsupials compared to flowers. These findings suggest that for this age group stimulus fear relevance may have little influence on vicarious fear learning. [ABSTRACT FROM AUTHOR]

Research has suggested that children who move home report poorer mental health than those who remain residentially stable. However, many previous studies have been based on cross sectional data and have failed to consider major life events as confounders. This study uses longitudinal data from ALSPAC, a UK population based birth cohort study, and employs within-between random effect models to decompose the association between moving in childhood and poor mental health. Results suggest that while unobserved between-individual differences between mobile and non-mobile children account for a large portion of this association, within-individual differences remain and indicate that moving may have a detrimental impact upon subsequent mental health. There is heterogeneity in children's response to moving, suggesting that a dichotomy of movers vs stayers is overly simplistic. [ABSTRACT FROM AUTHOR]

Objectives The present study tested whether self-reported school and leisure-time physical activity have a reciprocal relationship with Physical Education (PE)-based motivational regulations described by self-determination theory. Participants were 635 11- and 12-year-old school children from the United Kingdom. Design & Method A cross-lagged longitudinal design over two time points was employed. Study hypotheses were analyzed using latent factor reciprocal effects models. Results Following temporal invariance tests, data revealed positive relationships between both types of physical activity and subsequent changes in autonomous motivation, but not the oft-stated reverse relationship. No relationships were observed involving introjected regulation. Theoretically aligned relationships between external regulation and changes in physical activity were observed, but no reverse relationships. Both types of physical activity behavior were negatively associated with changes in amotivation in PE, but surprisingly, amotivation in PE positively predicted changes in leisure-time physical activity. Conclusions In general, physical activity participation may help children internalize reasons for partaking in PE and foster self-determination. However, the widespread theory that self-determined PE motives can develop school and leisure-time physical activity participation was not compellingly demonstrated. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in childhood Body Mass Index (BMI) are becoming increasingly more pronounced across the world. Although countries differ in the direction and strength of these inequalities, cross-national comparative research on this topic is rare. This paper draws on harmonized longitudinal cohort data from four wealthy countries—Germany, the Netherlands, the United Kingdom (UK), and the United States (US)—to 1) map cross-country differences in the magnitude of socioeconomic inequalities in childhood BMI, and 2) to examine cross-country differences in the role of three energy-balance-related behaviors—physical activity, screen time, and breakfast consumption—in explaining these inequalities. Children were aged 5–7 at our first timepoint and were followed up at age 8–11. We used data from the German National Educational Panel Study, the Dutch Generation R study, the UK Millennium Cohort Study and the US Early Childhood Longitudinal-Kindergarten Study. All countries revealed significant inequalities in childhood BMI. The US stood out in having the largest inequalities. Overall, inequalities between children with low versus medium educated parents were smaller than those between children with high versus medium educated parents. The role of energy-balance-related behaviors in explaining inequalities in BMI was surprisingly consistent. Across countries, physical activity did not, while screen time and breakfast consumption did play a role. The only exception was that breakfast consumption did not play a role in the US. Cross-country differences emerged in the relative contribution of each behavior in explaining inequalities in BMI: Breakfast consumption was most important in the UK, screen time explained most in Germany and the US, and breakfast consumption and screen time were equally important in the Netherlands. Our findings suggest that what constitutes the most effective policy intervention differs across countries and that these should target both children from medium as well as low educated families. • All countries showed substantial socioeconomic inequalities in childhood BMI. • In all countries, inequalities in BMI steepen over course of primary school. • Protective factors among the most advantaged seem to mainly drive inequalities. • Across most countries, underlying mechanisms for inequalities in BMI are similar. • The relative contribution of each mechanism to BMI inequalities differs per country. [ABSTRACT FROM AUTHOR]

Objectives: Waterpipe tobacco smoking has received little epidemiological and policy attention in the UK despite reports of increasing prevalence alongside an anecdotally noncompliant industry. This study aimed to determine how waterpipe tobacco smoking is changing among young people in the UK, both in terms of prevalence and sociodemographic correlates of use, and to quantify the extent of illegal underage use in waterpipeserving premises in the UK. Study design: Repeat cross-sectional. Methods: A secondary analysis of two cross-sectional surveys (total N = 3376), conducted in 2013 and 2015 among secondary school students aged 11-16 years in Stoke-on-Trent, measured lifetime (both surveys) and regular (at least monthly; 2015 survey only) waterpipe tobacco prevalence and location of usual use. Logistic regression models measured the association between independent variables (age, sex, ethnicity, presence of free school meals, cigarette smoking status) with lifetime and regular waterpipe tobacco use, and with illegal underage use; the latter defined as usually smoking waterpipe tobacco in a waterpipe-serving premise. Results: Lifetime waterpipe tobacco prevalence remained similar in 2013 (13.7%, 95% con- fidence interval [CI] 12.0-15.4%) and 2015 (14.6%, 95% CI 12.8-16.4%), whereas regular use was measured at 2.9% (95% CI 2.1-3.8%) in 2015. Older, non-white, males who concurrently used cigarettes had higher odds of lifetime waterpipe tobacco use. Illegal underage use was reported among 27.1% of all regular users, correlates of which included increasing age and South Asian ethnicity. The presence of free school meals was not associated with lifetime or regular waterpipe tobacco prevalence, nor illegal underage use. Conclusions: Increased monitoring of waterpipe tobacco prevalence and patterns, including the underage policy compliance of waterpipe-serving premises, is needed to help inform policy decisions to control waterpipe tobacco use. [ABSTRACT FROM AUTHOR]

Background: The prevalence of antidepressant prescribing in children and adolescents increased steadily in the United States and parts of Europe between 2005 and 2012 despite regulatory safety warnings. Little is known about the characteristics of those being prescribed antidepressants for the first time.Methods: A longitudinal study of antidepressant prescribing in 3-17 year olds was carried out using data from the UK Clinical Practice Research Datalink (CPRD) between 2000 and 2015. Changes in the incidence of first ever antidepressant prescriptions and the characteristics of those being prescribed them was examined.Results: Incidence of first ever prescriptions nearly doubled between 2006 and 2015 rising from 1.60 (95%CI: 1.51, 1.69) to 3.12 (3.00, 3.25) per 1000 person years. Only 21% of the 1721 patients with incident prescriptions in 2015 could be linked to a depression diagnosis, with an additional 22% of prescriptions linked to alternative indications. The incidence of prescriptions linked to a depression diagnosis increased between 2012 and 2015, with an adjusted incidence rate ratio of 1.46 (1.26, 1.70). Antidepressant prescribing for depression and other indications has been increasing most rapidly in 15 to 17 year old females.Limitations: Diagnoses are not directly linked to prescriptions in CPRD, so linkage must be inferred by temporal proximity.Conclusions: Antidepressant prescribing in children increased between 2006 and 2015. This is, at least in part, due to a rise in alternative uses of antidepressants, including the treatment of anxiety, chronic pain and migraines. [ABSTRACT FROM AUTHOR]

Cyberbullying is a worldwide problem affecting mental health, education, safety and general well-being for individuals across the globe. Despite the widespread availability of the Internet, research into prevalence rates of cyberbullying in Qatar is lacking and legislating for the crime has been slow to develop. Recently there have been some positive initiatives in the country such as a Cybercrime Prevention Law, the development of a National ICT Strategy, and a website detailing safe practice guidelines for Internet usage. However, the implementation and usage of these initiatives are still limited and there is a lack of awareness of cyberbullying in Qatar. As a result, the risk factors and consequences among school-aged children are unknown. The current paper presents an evaluation of the legislative and public policy solutions to cyberbullying available in Qatar, and outlines the critical challenges that could potentially face educators in shaping best practice guidelines for the future. [ABSTRACT FROM AUTHOR]

Exiting and re-entering out-of-home care (OHC) is considered a disruption to permanence which may have long-lasting, negative consequences for children due to a lack of stability and continuity. Each year approximately one-third of children in OHC in England exit, but information is lacking on rates of re-entries and associated factors. Using national administrative data, we calculated rates of re-entry among children exiting OHC from 2007 to 2012, identified key child and care factors associated with re-entry using Cox proportional hazards modelling, and developed a simple probability calculator to estimate which groups of children are most likely to re-enter OHC within three months. Between 2007 and 2012 re-entries to OHC in England decreased (from 23.3% to 14.4% within one year of exit, p < 0.001), possibly due to concurrent changes in the way children exited OHC. Overall, more than one-third of children exiting OHC in 2008 re-entered within five years (35.3%, N = 4076), but rates of re-entry varied by child and care characteristics including age, ethnicity, mode of exit, and placement stability. Based on these associated factors, we developed a calculator that can estimate the likelihood of rapid re-entry to OHC for a group of children and could be used by social care practitioners or service planners. Our findings provide insight into which groups of children are most likely to re-enter OHC, who may benefit from additional support or ongoing monitoring. [ABSTRACT FROM AUTHOR]