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Objective. This study investigated cardiorespiratory fitness (CRF) levels and the relationship with field-based measures of anthropometry in children aged 10 to 11 years. Methods . A total of 288 boys and 257 girls participated in the study. CRF (20 m shuttle run) and several field-based measures of anthropometry were assessed. Multiple regression was utilized for all data analysis. Results. Boys performed significantly better than girls on the CRF test ( P

Objectives To better understand the complexity and healthcare needs of children and young people in Wales with life-limiting or life threatening conditions to better plan and target healthcare services. Previous attempts to quantify complexity have required primary data collection; this is not feasible at scale, use of existing data is preferred. Methods Routinely collected healthcare and administrative data were linked: primary care data, hospital care data sets, cancer and congenital anomaly registries, paediatric intensive care audit data and death records. Children and young people with life-limiting conditions were identified using a previously developed diagnostic framework. Previous work on conceptualising medical complexity across eight domains was operationalised for the first time using the wide range of available data, with scores across five domains and a total complexity score. The relationship between the complexity score, healthcare use, stage of condition and category of condition was explored. Results Children and young people with life-limiting conditions showed the full range of medical complexity scores, from zero to five, with distributions varying across age groups with increasing complexity at greater ages. Distributions also varied across categories of condition, with congenital and oncology conditions, although among the most prevalent, exhibiting lower medical complexity. Nonetheless, all conditions showed a range of complexities – there were no conditions for which all individuals were either high or low complexity. Complexity scores were correlated with stage of condition and healthcare use and may be used to identify groups likely to have higher healthcare demand or greater risk of clinical instability. While life-limiting conditions were more prevalent in areas of higher deprivation, there was no association between deprivation and medical complexity. Conclusion Assessment of medical complexity from routinely-collected data can be useful in better understanding a population and in targeting and planning care, without requiring additional data collection. This can help to design resilient services that prepare for changing needs and aid targeting of limited resources.

Objectives To estimate point of transition from paediatric to adult healthcare from routinely collected healthcare records and to use this to compare emergency care use pre- and post transition for young people with life-limiting conditions. Approach Routinely collected healthcare records were obtained from the Clinical Practice Research Datalink. These included linked primary care and hospital (inpatient, outpatient and A&E) records and death and deprivation data. The data were used to identify young people (12-23 years)with life-limiting conditions, diabetes and no long term conditions. Methods were developed to estimate point of transition from paediatric to adult care by classifying treatment specialties recorded in inpatient and outpatient care as paediatric or adult. These were compared and a favoured method selected. Emergency hospital care use was then compared, pre- and post-transition to adult care for the three groups. Results The last inpatient or outpatient record classified as paediatric care was chosen as the transition point. Simulation showed that this had the potential for far greater sensitivity to changes at transition (~20% difference in detected effect size) than using a simple age cut-off. Application of the method to the data showed significant increases in emergency inpatient admissions (by 29%, 95% confidence interval 14-46%) and A&E visits (by 24%, 95% confidence interval 12-38%) post- compared to pre-transition in the life-limiting conditions group, but no increases for the diabetes or no long term conditions groups, suggesting that transition has little effect for these groups. Conclusion Linked, routinely collected healthcare records, combined with estimating transition point from the data, provide a more sensitive method for detecting changes at transition with reduced risk of misclassification bias. There is an increase in emergency care after transition, with negative effects on young people, families and cost implications for providers.

Background: The number of children with life-limiting conditions in England is known to be increasing, which has been attributed in part to increased survival times. Consequently, more of these young people will reach ages at which they start transitioning to adult healthcare (14-19 years). However, no research exists that quantifies the number of young people with life-limiting conditions in England reaching transition ages or their medical complexity, both essential data for good service planning. Methods: National hospital data in England (Hospital Episode Statistics) from NHS Digital were used to identify the number of young people aged 14-19 years from 2012/13 to 2018/19 with life-limiting conditions diagnosed in childhood. The data were assessed for indicators of medical complexity: number of conditions, number of main specialties of consultants involved, number of hospital admissions and Accident & Emergency Department visits, length of stay, bed days and technology dependence (gastrostomies, tracheostomies). Overlap between measures of complexity was assessed. Results: The number of young people with life-limiting conditions has increased rapidly over the study period, from 20363 in 2012/13 to 34307 in 2018/19. There was evidence for increased complexity regarding the number of conditions and number of distinct main specialties of consultants involved in care, but limited evidence of increases in average healthcare use per person or increased technology dependence. The increasing size of the group meant that healthcare use increased overall. There was limited overlap between measures of medical complexity. Conclusions: The number of young people with life-limiting conditions reaching ages at which transition to adult healthcare should take place is increasing rapidly. Healthcare providers will need to allocate resources to deal with increasing healthcare demands and greater complexity. The transition to adult healthcare must be managed well to limit impacts on healthcare resource use and improve experiences for young people and their families.

We explored the association between caregiving for preschool children with developmental disabilities and maternal health and healthcare use using linked primary care and Born in Bradford birth cohort data. Adjusting for prenatal health, healthcare use and socioeconomic status, mothers who were caregivers were more likely than other mothers to have symptoms of psychological distress (odds ratio 1.24; 95% CI 1.01, 1.53), exhaustion (1.42; 1.12, 1.80) and possibly head and musculoskeletal pain (1.18; 0.97, 1.43). Despite the higher prevalence of symptoms, they did not access healthcare services more and may seek healthcare for psychological distress less often (0.64; 0.40, 1.02). In general, socioeconomic disadvantage was associated with worse health. Pakistani ethnicity (versus white British) and prenatal consultation were strongly associated with higher postnatal consultation rates. Prenatal ill health, healthcare use and socioeconomic status are important factors in the detection of postnatal ill health via primary care services. If caregiver burden and the risk of under-detecting (and thus under treating) caregiver ill health is not addressed during the preschool period health inequalities between caregivers and other mothers and their families may persist and grow. The health of mothers of young disabled children, in particular their unmet health needs, warrants attention in research and clinical practice.