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BACKGROUND The Structured E-Parenting Support (STEPS) app provides support for parents of children with elevated levels of hyperactivity/impulsivity, inattention, and conduct problems, awaiting clinical assessment by child health services. STEPS will be evaluated in a randomised controlled trial (RCT), as part of the OPTIMA research programme in the United Kingdom. Phase 1 of the OPTIMA programme focused on testing the feasibility of participants’ recruitment and the app's usability. OBJECTIVE To (1) adapt a digital routine clinical monitoring system, myHealthE, for research purposes to facilitate waitlist recruitment; (2) test whether we could use remote methods to screen and identify participants for the RCT quickly and systematically; (3) pilot the acceptability of the proposed recruitment and assessment protocol; and (4) explore STEPS usability to optimise its value for parents. METHODS myHealthE was adapted to handle and screen patients’ data. Feedback on myHealthE was collected from parents and clinicians and information governance reviews were conducted in clinical services planning to host the RCT. Potential participants for the observational feasibility study were identified from new referrals enrolled on myHealthE and via non-myHealthE methods. Descriptive statistics were used to summarise demographic and outcome variables. We estimated whether the recruitment rate would meet the planned RCT sample size requirements (n = 352). In addition to the feasibility study participants, another group of parents were recruited to assess STEPS usability. They completed the adapted System Usability Scale [1] and responded to open-ended questions about the app, which were coded using the Enlight quality constructs template [2]. RESULTS Overall, 124 potential participants were identified as eligible (121 via myHealthE and 3 via non- myHealthE methods). Of those,107 parents were contacted and 48 consented and were asked if, hypothetically, they would be willing to take part in the OPTIMA RCT. Most of the feasibility study participants identified as White (75%). Their children were predominantly male (65%) and had an average age of 8.4 years. During the primary recruitment period (June-July 2021), 19 participants per month (84% of all consented) agreed hypothetically to take part in the RCT (95% CI: 13.5 – 26.1), meeting the stop/go criterion of 18 participants per month to proceed with the RCT. All parents were satisfied or very satisfied with the study procedures. Parents (n=12) recruited to assess STEPS’ usability described the app as easy to navigate and use, with an attractive combination of colours and visual design. They described the content as useful, pitched at the right level and presented sensitively. Suggested improvements included adding captions to videos or making the recorded reflections editable. CONCLUSIONS Remote recruitment and study procedures for testing a parenting intervention app are feasible and acceptable for parents. Parents felt STEPS was a useful and easy-to-use digital parenting support tool. CLINICALTRIAL The RCT that will be conducted in Phase 2 of the OPTIMA programme has been prospectively registered on 18 November 2021; ISRCTN16523503 INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1186/s40814-021-00959-0

Summary Background Exposure and Response Prevention (ERP) is a form of behavioural therapy for tics; however, its effectiveness remains uncertain. We aimed to evaluate the effectiveness of internet-delivered, therapist-supported, and parent-assisted ERP for treatment of tics in children and young people with Tourette syndrome or chronic tic disorder. Methods This multicentre, parallel group, single-blind, randomised controlled trial was conducted across two study sites in England. Participants were recruited via 16 patient identification centres, two study sites in England (Nottingham and London), or online self-referral. Eligible participants were aged 9–17 years, had Tourette syndrome or chronic tic disorder, had not received behavioural therapy for tics in the past 12 months or were about to start, and had a Yale Global Tic Severity Scale (YGTSS) Total Tic Severity Score (TTSS) of more than 15 or more than 10 if they had only motor or vocal tics. Patients were excluded if they had started or stopped medication for tics within the past 2 months; had current alcohol or substance dependence, psychosis, suicidality, anorexia nervosa, or suspected moderate to severe intellectual disability; or presented an immediate risk to self or others; or the parent or carer was unable to speak, read, or write in English. Eligible patients were randomly assigned (1:1) by masked outcome assessors to receive 10 weeks of online, remotely delivered, therapist-supported ERP or psychoeducation (active control). Outcome assessors, statisticians, health economists, the trial manager, and the chief investigator were masked to group allocation. Patients were not directly informed of their allocation, but this could be established from the content once treatment commenced and the patients were not, therefore, considered masked to treatment. The primary outcome was YGTSS-TTSS 3 months after randomisation, and analysis was done in all randomised patients for whom data were available for each timepoint and outcome. Safety analysis was by intention to treat. Longer term follow-up is ongoing. This trial is registered with ISRCTN (ISRCTN70758207) and ClinicalTrials.gov ( NCT03483493 ). Findings Between May 8, 2018, and Sept 30, 2019, we assessed 445 candidates for inclusion in the study. 221 potential participants were excluded (90 did not meet inclusion criteria, 84 declined to participate, and 47 unable to contact family). 224 participants were enrolled and randomly assigned to ERP (n=112) or psychoeducation (n=112). The enrolled patients were mostly male (n=177; 79%) and of White ethnicity (n=195; 87%). 11 patients were lost to follow-up 3 months after randomisation in the ERP group, compared with 12 patients in the psychoeducation group. Mean YGTSS-TTSS at 3 months after randomisation was 23·9 (SD 8·2) in the ERP group and 26·8 (7·3) in the psychoeducation group. The mean total decrease in YGTSS-TTSS at 3 months was 4·5 (16%, SD 1·1) in the ERP group versus 1·6 (6%, 1·0) in the psychoeducation group. The estimated mean difference in YGTSS-TTSS change between the groups adjusted for baseline and site was –2·29 points (95% CI –3·86 to –0·71) in favour of ERP, with an effect size of –0·31 (95% CI –0·52 to –0·10). Two serious adverse events occurred (one collapse and one tic attack), both in the psychoeducation group, neither of which were related to study treatment. Interpretation ERP is an effective behavioural therapy for tics. Remotely delivered, online ERP with minimal therapist contact time represents an efficient public mental health approach to improve access to behavioural therapy for tics in children and adolescents. Funding National Institute for Health Research and Health and Technology Assessment.

Background Process evaluations are an important component in the interpretation and understanding of outcomes in trials. The Online Remote Behavioural Intervention for Tics (ORBIT) study is a randomized controlled trial evaluating the effectiveness of an Internet-delivered behavioural intervention (called BIP TIC) compared to an Internet-delivered education programme aimed at children and young people with tics. A process evaluation will be undertaken alongside the main trial to determine precisely how the behavioural intervention works and ascertain whether, and if so, how, the intervention could be successfully implemented in standard clinical practice. This protocol paper describes the rationale, aims, and methodology of the ORBIT trial process evaluation. Methods The process evaluation will have a mixed-methods design following the UK Medical Research Council 2015 guidelines, comprising both quantitative and qualitative data collection. This will include analysing data usage of participants in the intervention arm; purposively sampled, semi-structured interviews of parents and children, therapists and supervisors, and referring clinicians of the ORBIT trial, as well as analysis of qualitative comments put into the online therapy platform by participants at the end of treatment. Qualitative data will be analysed thematically. Quantitative and qualitative data will be integrated in a triangulation approach, to provide an understanding of how the intervention works, and what resources are needed for effective implementation, uptake and use in routine clinical care. Discussion This process evaluation will explore the experiences of participants, therapists and supervisors and referring clinicians of a complex online intervention. By contextualising trial efficacy results, this will help understand how and if the intervention worked and what may be required to sustain the implementation of the treatment long term. The findings will also aid in our understanding of factors that can affect the success of complex interventions. This will enable future researchers developing online behavioural interventions for children and young people with mental health and neurological disorders to gain invaluable information from this process evaluation. Trial registration International Standard Randomised Controlled Trials Number, ISRCTN70758207. Registered on 20 March 2018. ClinicalTrials.gov, NCT03483493. Registered on 30 March 2018.

Background Online CBT-based interventions have shown potential to improve mental health in university students. However, their impacts in West Asian cultures and on educational achievement have yet to be fully investigated. This study aims to explore the feasibility, acceptability and potential effectiveness of a self-directed, internet-delivered, cognitive-behavioural skills training program (MoodGYM) in reducing depression and improving academic performance in university students in the United Arab Emirates (UAE). Methods This exploratory pre-post intervention study with an historic control group recruited 50 students from one UAE university, with GPA p = 0.008, d = 0.6). Compared to historic control, the intervention group had higher GPA at follow-up (p d = 0.6) fewer attendance warnings (p = 0.036 d = 0.7). Most students (79.6%) evaluated MoodGYM as useful and all students completed at least 2 MoodGYM modules. More modules completed (p = 0.005) and greater reduction in attendance warnings (p = 0.007) were independently associated with greater improvement in GPA scores at follow-up. Conclusions This study provides support for a web based mental health promotion intervention (MoodGYM) to improve academic achievement in university students with depressive symptoms. Further research is needed to explore how MoodGYM can be best implemented within University settings.

Background Many university students experience depression and anxiety, both of which have been shown to affect cognitive function. However, the impact of these emotional difficulties on academic performance is unclear. This study aims to determine the prevalence of depression and anxiety in university students in United Arab Emirates (UAE). It further seeks to explore the relationship between emotional difficulties and students’ academic performance. Methods This longitudinal study recruited 404 students (aged 17–25 years) attending one UAE university (80.4% response rate). At baseline, participants completed a paper-based survey to assess socio-economic factors and academic performance, including most recent grade point average (GPA) and attendance warnings. PHQ-9 and GAD-7 scales were used to assess depressive and anxiety symptoms. At six-month follow-up, 134 participants (33.3%) provided details of their current GPA. Results Over a third of students (34.2%; CIs 29.7–38.9%) screened for possible major depressive disorder (MDD; PHQ-9 ≥ 10) but less than a quarter (22.3%; CIs 18.2–26.3%) screened for possible generalized anxiety disorder (GAD; GAD-7 ≥ 10). The Possible MDD group had lower GPAs (p = 0.003) at baseline and were less satisfied with their studies (p = 0.015). The MDD group also had lower GPAs at follow-up (p = 0.035). The Possible GAD group had lower GPAs at baseline (p = 0.003) but did not differ at follow-up. The relationship between GAD group and GPA was moderated by gender with female students in the Possible GAD group having lower GPAs (p p = 0.006). This relationship was no longer statistically significant after controlling for baseline GPA (p Conclusion This study confirms previous findings that around a third of university students are likely to be experiencing a depressive disorder at any one time. Furthermore, it provides important evidence regarding the negative impacts of emotional difficulties on students’ academic performance. The results support the need to consider the mental health of students who are struggling academically and highlight the importance of signposting those students to appropriate support, including evidence-based therapies.

Background There is some evidence that university students are at higher risk of depression; but rates have been found to vary widely across different countries, and there have been few surveys in representative samples. This study was carried out to assess the reliability of the Arabic-language Zagazig Depression Scale (ZDS) in a sample of Egyptian university students and to use the ZDS to assess the prevalence of depression. Methods The study was a cross-sectional survey of a representative sample of 988 undergraduate students from Assiut University, Egypt (response rate, 82.3%). Prevalence of depressive symptoms was assessed using the ZDS, a self-report Arabic-language version of the Hamilton Rating Scale, modeled on the Carroll Rating Scale for Depression. Results Participants had a mean ZDS score of 17.8 (±9.0) out of a possible maximum score of 46. Using the recommended cutoffs for the ZDS, 37.6% of the students were found to have at least moderate depression, with 71% exceeding the cutoff for mild depression. The internal consistency of the ZDS was excellent (Cronbach α = 0.904), as was the split-half correlation coefficient. Conclusion This survey revealed a worryingly high rate of depressive symptoms in a representative sample of Egyptian university students. The ZDS is a reliable and acceptable tool for assessing mental health in a university population.

IntroductionTourette syndrome and chronic tic disorder are common, disabling childhood-onset conditions. Guidelines recommend that behavioural therapy should be offered as first-line treatment for children with tics. However, there are very few trained behaviour therapists for tics and many patients cannot access appropriate care. This trial investigates whether an internet-delivered intervention for tics can reduce severity of symptoms.Methods and analysisThis parallel-group, single-blind, randomised controlled superiority trial with an internal pilot will recruit children and young people (aged 9–17 years) with tic disorders. Participants will be randomised to receive 10 weeks of either online, remotely delivered, therapist-supported exposure response prevention behavioural therapy for tics, or online, remotely delivered, therapist-supported education about tics and co-occurring conditions. Participants will be followed up mid-treatment, and 3, 6, 12 and 18 months post randomisation.The primary outcome is reduction in tic severity as measured on the Yale Global Tic Severity Scale total tic severity score. Secondary outcomes include a cost-effectiveness analysis and estimate of the longer-term impact on patient outcomes and healthcare services. An integrated process evaluation will analyse quantitative and qualitative data in order to fully explore the implementation of the intervention and identify barriers and facilitators to implementation. The trial is funded by the National Institute of Health Research (NIHR), Health Technology Assessment (16/19/02).Ethics and disseminationThe findings from the study will inform clinicians, healthcare providers and policy makers about the clinical and cost-effectiveness of an internet delivered treatment for children and young people with tics. The results will be submitted for publication in peer-reviewed journals. The study has received ethical approval from North West Greater Manchester Research Ethics Committee (ref.: 18/NW/0079).Trial registration numbersISRCTN70758207andNCT03483493; Pre-results.

The aim of this study was to examine the prevalence of all substance use disorders (SUD) and cannabis-specific SUDs reported in two first-episode epidemiological studies, conducted in the same catchment area, 5 years apart.The prevalence of schizophrenia in Nottingham and Aetiology and Ethnicity of Schizophrenia and Other Psychoses studies included all people with a first-episode of psychosis between 1992 and 1994 and 1997 and 1999, respectively. Those individuals with a comorbid diagnosis of a SUD (ICD-10 harmful use or dependence) were identified.An upward (but not statistically significant) trend in all SUDs was found for the first-episode study population as a whole, between the two cohorts (11.9-18.2%). When analysed by age, a significant increase in cannabis-specific SUDs was observed for all first-episode cases aged 16-29 between cohorts (3.2-10.6%). When analysed by age and gender, a significant increase in all SUDs was apparent for female first-episode patients aged 16-29 between cohorts (6.1-24.2%), this same increase was not seen in male patients.Illegal drug misuse is common in patients with a first-episode of psychosis. However, most concerning is that when both age and gender are considered, females with a first-episode of psychosis aged 16-29 show a highly significant rise in the prevalence of all SUDs over the 1990s. More recent drug use data from England and Wales shows that the prevalence of drug use in the 21st century is declining; further epidemiological studies are required to determine whether this is also the case in young female first-episode psychosis populations.

Background: Children with medically unexplained symptoms (MUS) represent a challenge for paediatricians and typically undergo extensive in-patient investigations for symptoms such as abdominal pain. This can delay access to psychological services. This study aims to develop and evaluate a scale to assess the attitudes of paediatric staff to caring for children with MUS and to explore factors influencing those attitudes. Method: In this cross-sectional survey, 118 health professionals at one UK hospital with experience of caring for children with MUS completed an attitude questionnaire developed for the study. Results: Factor analysis identified four factors that explained significant variance in staff perceptions of care: rewarding nature of care; demanding nature of care; parental influence; children’s need for skilled support. The combined subscales formed the MUS-Q. Conclusion: Paediatric staff found caring for children with MUS difficult and would welcome more support from CAMHS. The MUS-Q proved a reliable tool to evaluate staff attitudes.

Background: Patient-centred medicine improves psychological and physiological functioning in chronic illnesses. Aims: To determine to what extent the patient-centred ethos (as exemplified by research addressing subjective experiences) was incorporated into work presented at major international schizophrenia research forums between 1988 and 2004. Method: Whole population-based, retrospective cohort study using abstracts from the International Congress on Schizophrenia Research and the Biennial Winter Workshop on Schizophrenia ( n = 9,284). Comparative analysis using abstracts from the International Society for the Psychological Treatment of Schizophrenia ( n = 992). Patient-centredness was assessed by determining the number of abstracts that primarily addressed participants' subjective experiences. Results: Research was presented from 50 countries globally. European and North American countries produced 8,573 (92%) of the total. Biological research was the main theme of 6,960 (75%) of the abstracts, with psychosocial research constituting less than 5%. One hundred and eighty three (2%) abstracts from the two main conferences addressed subjective experiences, as did 333 (34%) from the comparative analysis. Conclusions: Between 1988 and 2004 research emanating from North American and European countries, together with biologically orientated research, were the most prevalent perspectives on schizophrenia. It appears that research into the subjective experiences of participants has not been as prevalent as more objective accounts of the disorder, suggesting that this research effort has not been patient-centred.

Aims and MethodTo explore the feasibility of a randomised controlled trial of the effects of two anti-stigma films on medical students' attitudes to serious mental illness and psychiatry. Attitudes to serious mental illness, perceived dangerousness, social distance and psychiatry, were measured before and after watching the films and at 8 weeks.ResultsIntervention films significantly improved general attitudes to serious mental illness and social distance, with a trend towards reducing perceived dangerousness. These effects appeared to attenuate during the students' clinical placements, suggesting a possible interaction with their clinical experiences.Clinical ImplicationsOur results suggest both that it may be possible to conduct a substantive trial of the effects of the intervention films on a larger cohort of medical students and that the films may be effective in reducing stigmatising attitudes in medical students.

Parents of sick neonates experience high levels of stress, anxiety and depression. Most interventions with families of sick infants have focused on fostering the mother–infant relationship through the provision of information about infant developmental needs or through increased mother–infant contact. Many of these studies have reported improved maternal well-being, though there are some concerns about the scope and practicality of large-scale interventions. The few studies to have prioritized emotional support for parents of sick neonates have produced encouraging results. Even interventions requiring relatively few resources, such as telephone support, parent-to-parent support and group support, have been associated with reduced psychological morbidity for parents. The needs of parents can change throughout their infant's hospitalization and not all want or benefit from the provision of additional support. Thus, neonatal intensive care units should aim to provide a varied, flexible and sustainable programme of support options. Further research should focus on the needs of fathers.

Background: Tourette syndrome (TS) and chronic tic disorder (CTD) affect 1–2% of children and young people, but the most effective treatment is unclear. To establish the current evidence base, we conducted a systematic review of interventions for children and young people. Methods: Databases were searched from inception to 1 October 2014 for placebo-controlled trials of pharmacological, behavioural, physical or alternative interventions for tics in children and young people with TS or CTD. Certainty in the evidence was assessed with the GRADE approach. Results: Forty trials were included [pharmacological (32), behavioural (5), physical (2), dietary (1)]. For tics/global score there was evidence favouring the intervention from four trials of a2-adrenergic receptor agonists [clonidine and guanfacine, standardised mean difference (SMD) = -0.71; 95% CI -1.03, -0.40; N = 164] and two trials of habit reversal training (HRT)/comprehensive behavioural intervention (CBIT) (SMD = -0.64; 95% CI -0.99, -0.29; N = 133). Certainty in the effect estimates was moderate. A post hoc analysis combining oral clonidine/guanfacine trials with a clonidine patch trial continued to demonstrate benefit (SMD = -0.54; 95% CI -0.92, -0.16), but statistical heterogeneity was high. Evidence from four trials suggested that antipsychotic drugs improved tic scores (SMD = -0.74; 95% CI -1.08, -0.40; N = 76), but certainty in the effect estimate was low. The evidence for other interventions was categorised as low or very low quality, or showed no conclusive benefit. Conclusions: When medication is considered appropriate for the treatment of tics, the balance of clinical benefits to harm favours a2-adrenergic receptor agonists (clonidine and guanfacine) as first-line agents. Antipsychotics are likely to be useful but carry the risk of harm and so should be reserved for when a2-adrenergic receptor agonists are either ineffective or poorly tolerated. There is evidence that HRT/CBIT is effective, but there is no evidence for HRT/CBIT alone relative to combining medication and HRT/CBIT. There is currently no evidence to suggest that the physical and dietary interventions reviewed are sufficiently effective and safe to be considered as treatments.

Objective: To evaluate the influence of parenting intervention on maternal responsiveness and infant neurobehavioural development following a very premature birth. Design: Cluster-randomised controlled trial, with a crossover design and three-month washout period. Setting: Six neonatal intensive care units. Patients: Infants born Intervention: The Parent Baby Interaction Programme (PBIP) is a supportive, educational intervention delivered by research nurses in the neonatal intensive care unit, with optional home follow-up for up to six weeks after discharge. Main outcome measures: Parenting stress at 3 months adjusted age, as measured by the Parenting Stress Index (PSI). Other outcomes included the Neurobehavioural Assessment of the Preterm Infant (NAPI) and maternal interaction as assessed by the Nursing Child Assessment Teaching Scale (NCATS) and the responsivity subscale for Home Observation for Measurement of the Environment (HOME). Results: 112 infants were recruited in the intervention phases and 121 in the control phases. Mean standardised NAPI scores at 35 weeks did not differ between the PBIP and control groups. Both groups had low but similar NCATS caregiver scores before discharge (36.6 in the PBIP group and 37.4 in control, adjusted mean difference −0.7, 95% CI −2.7 to 1.4). At three months, adjusted age mean PSI scores for the PBIP group were 71.9 compared with 67.1 for controls (adjusted mean difference 3.8, 95% CI −4.7 to 12.4). NCATS scores and HOME responsivity scores were similarly distributed between the groups. Conclusion: This early, nurse-delivered, parent-focused interaction programme intervention had no measurable effects on short-term infant neurobehavioural function, mother–child interaction or parenting stresses.

The objectives were to examine emotional and behavioural difficulties in HIV positive Zambian adolescents and to determine the relationship between disclosure of HIV status and mental health. The design used in the study was a cross-sectional survey. Participants were 127 HIV positive adolescents aged 11 to 15 years recruited through clinics in the Lusaka region. Mental health was assessed using the youth report version of the Strengths and Difficulties Questionnaire (SDQ). Caregivers completed the parent SDQ. Sixty-two participants were invited for a semi-structured interview which probed views on attending a peer support group. Compared to a British community sample participants had increased mental health problems (OR 2.1) particularly emotional symptoms (OR = 3.6) and peer problems (OR = 7.1). The majority of children (n = 94) were receiving antiretroviral (ARV) treatment but only 48 children (37.8%) had their HIV status disclosed. Those who had not had their HIV status disclosed were younger (P < 0.001) and less likely to be receiving ARV treatment (P < 0.001). Controlling for these factors they were also more likely to score in the abnormal range of the emotional difficulties subscale (OR = 2.63 95% CI: 1.11 to 6.26). Of 38 interviews transcribed content analysis showed that only 3 children were opposed to participation in a peer-group program with the majority (23/38) expressing reasoned and positive responses regardless of disclosure status. High rates of emotional and peer problems were found in this sample but disclosure of HIV status did not have a negative effect on mental health. Interventions to promote disclosure could facilitate access to emotional and peer support. (authors)

This prospective controlled study aimed to evaluate the effectiveness and acceptability of a computer program (CAL) designed to educate patients about skin protection including signs of melanoma. Two hundred and twenty-seven patients were recruited either from the Pigmented Lesion Clinic (PLC) or the Orthopaedic Fracture Clinic (OFC). A baseline measure of anxiety was obtained and subjects were allocated to either non-interactive, interactive or control conditions. Measures of anxiety and knowledge about malignant melanoma and skin protection were obtained prior to discharge from the clinic and knowledge was assessed again at 1-week follow-up. Results indicate that, although anxiety in the PLC subjects decreased significantly more than in the OFC patients, there was no significant effect of intervention. There was a significant effect of intervention on knowledge (F = 81.06, d.f. 2, 218, P < 0.0001) with participants having better knowledge on leaving the clinic in the interactive CAL condition than in both the Non-interactive condition and control. Non-interactive CAL was associated with higher knowledge than control. Knowledge gains were maintained at 1-week follow-up.

BackgroundSeveral studies have reported a decline of up to 50% in the incidence of schizophrenia over recent decades. We aimed to measure changes in the incidence and diagnostic patterns of first-episode psychosis by comparing two Nottingham cohorts, identified in two equal periods separated by 14 years.MethodTwo prospectively ascertained cohorts of first-episode psychotic disorder were identified over the time periods 1978–80 and 1992–94. The earlier cohort was of the World Health Organization Determinants of Outcome of Severe Mental Disorder (DOSMD) ten-country study. The later cohort was obtained using similar methodology. Both groups were diagnosed using ICD-10 diagnostic criteria and age-standardised incidence rates were compared.ResultsThe standardised incidence rate for all psychotic disorders rose slightly from 2.49 to 2.87 per 10 000 population per year, but the F20 classification fell significantly by over a third (1.41 to 0.87 per 10 000 per year). The second study group (1992–1994) included a greater diversity of psychotic diagnoses compared with the first, in particular an increased proportion of acute and drug-related psychoses.ConclusionsMethodological considerations call for caution in interpreting such data, but we conclude that the significant fall in the narrowly defined diagnostic category of schizophrenia reflects a real change in the syndromal presentation of psychotic disorders.

BackgroundThis paper describes the 13 year course of illness in an epidemiologically defined and representative cohort of patients selected when they were experiencing their first episode of schizophrenia.MethodIn a 13-year follow-up study of 67 patients with ICD–9 schizophrenia, identified in Nottingham in 1978–80, the course of illness (symptoms, disability and hospitalisation) was assessed using standardised instruments, applied at onset 1, 2, and 13 years. Time to first relapse and first readmission were calculated and plotted as survival curves and patients were assigned to the course types described by Ciompi.ResultsThe survival curves show that first relapses and first readmissions occur during the first five years. The amount of time spent in psychotic episodes and in hospital is greatest in the first year of follow-up, but stable thereafter. Social adjustment improves from entry to the study to the first follow-up year, but there is a small deterioration in social adjustment between 2 and 13 years.ConclusionsThe findings reported suggest that after the initial episode the course of schizophrenia is relatively stable. The data support neither concepts of progressive deterioration nor progressive amelioration. There was no evidence of a ‘late recovery’.

BackgroundThis paper describes the 13-year outcome of an epidemiologically defined and representative cohort of patients selected when they were experiencing their first episode of schizophrenia.MethodIn a 13-year follow-up study of a cohort identified in Nottingham in 1978–80, the outcome (symptoms, disability, residence and treatment) was assessed using standardised instruments.ResultsFour of the original 67 patients with ICD–9 schizophrenia were lost to follow-up and five were dead: 52% were without psychotic symptoms in the last two years of follow-up, 52% were without negative symptoms and 55% showed good/fair social functioning. However, only 17% were alive at follow-up, without symptoms and disability, and receiving no treatment.ConclusionsThe findings reported are similar to those of other long-term follow-up studies of schizophrenia and also to 5-year follow-up studies. Kraepelin's emphasis on the longitudinal implications of a diagnosis of schizophrenia are supported, but may be over-pessimistic.

Background Many university students experience some symptoms of depression during the course of their studies but there is evidence that students from less advantaged backgrounds may be more vulnerable. Methods The study was a cross-sectional online survey of 923 undergraduate students attending 6 UK Universities in the academic year 2009–2010 who completed a modified version of the Zagazig Depression Scale (ZDS). Results Overall, 58.1 % of female and 59.9 % of male study participants screened positive for depression (ZDS score [10). In the fully adjusted model, final year students (OR = 1.8) who lived in a more deprived area (OR = 2.3) were more likely to report higher rates of depressive symptoms. Additionally, students with high perceived control (OR = 1.6) whose mothers were highly educated (OR = 0.5) and from a family of a high affluence (OR = 0.3) were less likely to suffer from higher rates of depressive symptoms. The relationship between lower social economic status and depression was partly mediated by low sense of control. Conclusion Students from less advantaged backgrounds are more at risk of depression but a strong sense of control over one’s life may be protective. Application Since depression has strong impact on students’ learning and quality of life universities should consider confidential screening for mental health problems and provide additional support for students.

ObjectiveTo determine risk factors for childhood overweight that can be identified during the first year of life to facilitate early identification and targeted intervention.DesignSystematic review and meta-analysis.Search strategyElectronic database search of MEDLINE, EMBASE, PubMed and CAB Abstracts.Eligibility criteriaProspective observational studies following up children from birth for at least 2 years.ResultsThirty prospective studies were identified. Significant and strong independent associations with childhood overweight were identified for maternal pre-pregnancy overweight, high infant birth weight and rapid weight gain during the first year of life. Meta-analysis comparing breastfed with non-breastfed infants found a 15% decrease (95% CI 0.74 to 0.99; I2=73.3%; n=10) in the odds of childhood overweight. For children of mothers smoking during pregnancy there was a 47% increase (95% CI 1.26 to 1.73; I2=47.5%; n=7) in the odds of childhood overweight. There was some evidence associating early introduction of solid foods and childhood overweight. There was conflicting evidence for duration of breastfeeding, socioeconomic status at birth, parity and maternal marital status at birth. No association with childhood overweight was found for maternal age or education at birth, maternal depression or infant ethnicity. There was inconclusive evidence for delivery type, gestational weight gain, maternal postpartum weight loss and ‘fussy’ infant temperament due to the limited number of studies.ConclusionsSeveral risk factors for both overweight and obesity in childhood are identifiable during infancy. Future research needs to focus on whether it is clinically feasible for healthcare professionals to identify infants at greatest risk.

The behaviour of 63 children aged between 2 and 11 years, admitted for minor surgery, was observed in the anaesthetic room using the Observational Scale of Behavioural Distress. Assessment by the mother of her child's temperament using a short questionnaire administered on the day prior to surgery predicted the child's level of distress in the anaesthetic room. More distress was shown by younger children and those scoring highly on temperament traits of intensity of response and withdrawal from new situations. There was also evidence that maternal presence in the anaesthetic room was associated with less distress. Child distress was not related to maternal anxiety once age and temperament were controlled and children accompanied by mothers had significantly better behavioural adjustment at one week post-operation. The results support maternal presence during medical procedures and suggest that temperament theory may provide a useful framework for conceptualising children's responses.

Background: Worldwide population surveys show that prevalence of mental disorders in developing countries was as common as in industrialized countries. College life is an important stage in every person’s life; unfortunately, it may be the time to experience depression for the first time. Latterly, there has been a steady increase in the number of university students diagnosed and treated as depressed patients. This paper presents the results of a study carried out on a representative sample of undergraduate students of an Egyptian University, which aimed to study the relationship between social factors and the occurrence of depression. It was assumed that the poorer the socio-economic background the higher the rates of depression. Method: Data were collected in 2004 from students at Assiut University using the Zagazig Depression scale (ZDS) and an Egyptian socio-economic status measure. This analysis, based on a refined version of the ZDS used STATA (v. 10.1.). Descriptive statistics, univariate and multivariate regression models were used to test for associations with the dimensions of SES and depression. Result: Thirty-seven percent of the students had symptoms scored above the threshold for moderate depression. In the fully adjusted model: faculty of study, father’s occupation, family income and number of persons per room were associated with depression in this sample. Conclusion: The high prevalence of depressive symptoms among Egyptian students found in this study call attention to the need for a student counseling service offering mental health support. This service should particularly discover an approach for low affluence students. Refereed/Peer-reviewed

Background There is uncertainty as to whether there is a safe threshold for drinking alcohol during pregnancy. We explored pregnant women's attitudes towards drinking alcohol in pregnancy and their attitudes towards sources of information about drinking in pregnancy following recent changes in UK government guidance. Methods A qualitative study involving individual, semi-structured interviews with 20 pregnant women recruited from community organisations in the UK. Interview transcripts were analysed qualitatively using thematic analysis. Results Most women found information and advice about safe levels of drinking in pregnancy confusing and lacking in evidence and detail. Although most women considered that there were risks involved with drinking in pregnancy and these perceptions influenced their behaviour, only six women reported abstinence. Women reported being influenced by advice from family and friends and their experiences of previous pregnancies. Many had received no individual advice from general practitioners or midwives relating to drinking during pregnancy. Conclusion Pregnant women wished to take responsibility for their own health and make choices based on informed advice. In order to do so, they require clear and consistent advice about safe levels of drinking from policy makers and health professionals. This is an important issue as women might drink socially during their pregnancy.

Background It is unclear whether the incidence of first episode psychoses is in decline. We had the opportunity to determine whether incidence had changed over a 20-year period in a single setting, and test whether this could be explained by demographic or clinical changes. Methods The entire population at-risk aged 16–54 in Nottingham over three time periods (1978–80, 1993–95 and 1997–99) were followed up. All participants presenting with an ICD-9/10 first episode psychosis were included. The remainder of the population at-risk formed the denominator. Standardized incidence rates were calculated at each time period with possible change over time assessed via Poisson regression. We studied six outcomes: substance-induced psychoses, schizophrenia, other non-affective psychoses, manic psychoses, depressive psychoses and all psychotic disorders combined. Results Three hundred and forty-seven participants with a first episode psychosis during 1.2 million person-years of follow-up over three time periods were identified. The incidence of non-affective or affective psychoses had not changed over time following standardization for age, sex and ethnicity. We observed a linear increase in the incidence of substance-induced psychosis, per annum, over time (incidence rate ratios: 1.15; 95% CI 1.05–1.25). This could not be explained by longitudinal changes in the age, sex and ethnic structure of the population at-risk. Conclusions Our findings suggest psychotic disorders are not in decline, though there has been a change in the syndromal presentation of non-affective disorders, away from schizophrenia towards other non-affective psychoses. The incidence of substance-induced psychosis has increased, consistent with increases in substance toxicity over time, rather than changes in the prevalence or vulnerability to substance misuse. Increased clinical and popular awareness of substance misuse could also not be excluded.

OBJECTIVES. The purpose of this work was to identify barriers to physical activity in children with asthma and to compare their customary activity levels, BMI and emotional well-being with that of children with other medical conditions. It was hypothesized that children with asthma would have higher BMI and lower levels of customary activity. PATIENTS AND METHODS. We studied children aged 7 to 14 years attending hospital outpatient clinics for either asthma (asthma group: n = 56) or for otorhinolaryngology or dermatological conditions (nonasthma group: n = 61). In this cross-sectional survey, children's weight and height were recorded and their BMI classified according to International Obesity Task Force classification of obesity. Child mental health was assessed by the parent-rated Strengths and Difficulties Questionnaire. The child-rated Physical Activity Questionnaire assessed total sedentary and physical activities during the previous 24 hours. RESULTS. The asthma group had a higher mean BMI (20.78 vs 18.82) and higher rates of obesity (21.4% vs 6.6%). Children with asthma reported fewer physical activities than the nonasthma group (median 4 per day vs 6 per day) but comparable levels of sedentary activities. Asthma was the strongest predictor of lower activity scores, followed by younger age. The asthma group had higher levels of emotional difficulties and, within this group, more active children had better mental health. More parents in the asthma group identified the child's health as a barrier to exercise (60.7% vs 11%). The same was true of children (66.1% vs 11.5%). CONCLUSIONS. We found that children attending a hospital clinic for asthma were more likely to be obese and were significantly less active than a comparison group with other medical conditions. Asthma was identified as a barrier to exercise by parents and children. Strategies to promote exercise within pediatric asthma care are needed to protect both mental and physical health.

OBJECTIVE. The purpose of this study was to evaluate the impact and acceptability of an educational multimedia program designed to promote self-management skills in children with asthma.METHODS. We conducted a randomized, controlled trial with measures at baseline and 1- and 6-month follow-up. The trial was conducted in pediatric outpatient respiratory clinics in 3 United Kingdom hospitals. Participants included 101 children aged 7 to 14 years under the care of hospital-based asthma services. The children were randomly assigned to receive an asthma information booklet alone or the booklet plus The Asthma Files, an interactive CD-ROM for children with asthma. Asthma knowledge was the primary outcome measure. Other measures included asthma locus of control, lung function, use of oral steroids, and school absence.RESULTS. At the 1-month follow-up (n = 99), children in the computer group had improved knowledge compared with the control group and a more internal locus of control. There were no differences in objective lung-function measures, hospitalizations, or oral steroid use. The study participants were positive in their evaluation of the intervention. At the 6-month follow-up (n = 90), significantly fewer children in the intervention group had required oral steroids and had had time off school for asthma in the previous 6 months. The difference did not reach statistical significance in the intention-to-treat analysis for both steroid use and school absence.CONCLUSION. The Asthma Files was found to be an effective and popular health education tool for promoting asthma self-management skills within pediatric care.

Obesity represents a serious threat to health through its association with conditions such as type 2 diabetes mellitus, coronary heart disease and certain types of cancer. Knowledge regarding risk to health is an important determinant of behaviour and is the focus of many health education strategies. To the authors’ knowledge, there is no valid and reliable measure of knowledge regarding the health risks associated with obesity. To validate a short, reliable psychometric scale measuring knowledge regarding the effects of obesity on health, the Obesity Risk Knowledge (ORK-10) scale. The ORK-10 scale was administered to a sample of individuals with no specific obesity-related expertise (n=230) and a sample of experts (n=200). Univariate and multivariate statistical analyses were used to investigate the scale's criterion validity. The ORK-10 scale has good internal consistency (Cronbach's alpha coefficient>0.7) and is acceptable for use in a UK adult population with an estimated reading age of 12–13 years. The scale demonstrated strong criterion validity, as those with educational or vocational expertise in the field of obesity achieved significantly higher scores than nonexperts (median 9.0 vs 4.0, Z=−17.364; P

Summary Educational interventions for children with asthma can result in both clinical and psychological improvements. However, traditional education programs have been hampered by lack of resources and doubts concerning long-term benefits. Researchers have looked to computer technology to overcome some of these obstacles and respiratory conditions have been the focus for a number of educational computer programs. Computer education packages should have a robust theoretical basis. Many programs aim to improve children's confidence, self-esteem and feelings of control, all of which are linked to compliance and positive health behaviours. The specific skills and knowledge needed for effective self- management also need to be taught in order to equip the child for future independent self- care. Programs tend to be either a stand- alone game, promoting self- regulation and practicing of skills, or an internet- enabled package, which may provide a link to their healthcare provider and/or other people with a similar condition. Computer technology is flexible, can be tailored to individuals' information needs, provides ongoing educational support and promotes active learning. However, there can be problems around accessibility, both in terms of computer ownership and technological literacy. Furthermore, internet sites are largely unregulated and of variable quality. It is essential that educational computer interventions are evidence- based and rigorously evaluated to identify who will benefit most from these packages.

Background. Rates of malignant melanoma are rising, with those people with sun-sensitive skin most at risk. Health education interventions are needed to help people protect themselves by detecting early signs of melanoma and by protecting their skin from sunburn. This study aimed to evaluate the impact of an interactive multimedia intervention “Skinsafe” on patients' knowledge about melanoma and on their skin protective behaviors. Methods. In this cluster-randomized, controlled trial conducted in Nottinghamshire, UK, doctors and nurses in 5 family practices prescribed Skinsafe to patients with higher risk skin characteristics. Measures of melanoma knowledge, perceived risk of melanoma and reported skin protective behaviors were obtained at baseline and at 6-month follow-up from 259 patients receiving the intervention and 330 patients with higher risk skin characteristics in 5 matched control practices. Results and discussion. Participants had low levels of melanoma knowledge at baseline. At follow-up, the intervention group had higher knowledge scores than control (3.71 vs. 3.03, P ≤ 0.001), reported more protective skin behaviors (5.36 vs. 5.06, P = 0.007) and were more likely to report mole checking (odds ratio 1.67, 95% CI 1.04 to 2.70, P = 0.035). The Skinsafe intervention was evaluated positively by patients and could be used to support melanoma health education within clinical settings.

Background and aims Being physically active can help to reduce the risk of obesity in later life. This study aimed to evaluate the effectiveness of a targeted, school-based intervention (Steps to Active Kids - STAK) in improving exercise self-efficacy and reducing BMI in children. Method STAK is a 12 week, activity programme including activity diary, street dance DVD, circuit training and, for children at or above the 91 st centile weight for height, motivational interviewing and goal setting. STAK was evaluated in a cluster-randomised trial in 24 schools. Children aged 9 to 11 were screened for overweight, low exercise self-efficacy or asthma. Twelve schools were randomised to receive the STAK intervention and 12 to control. BMI, waist circumference and exercise self-efficacy were assessed at baseline and post intervention (4 months). Results Of the 2479 children screened, 1065 children (43%) met the study inclusion criteria. Parents of 424 (40%) children consented to their child’s participation with 4 months follow-up data available for 392 (92%). The groups were well matched at baseline. After controlling for baseline values and time between testing, children in the intervention group had higher total self-efficacy at 4 month follow-up. In the group of children who were overweight at baseline (=>91 st centile), those in the STAK intervention group had smaller waist circumference and lower BMI at 4 month follow-up. Conclusion Preliminary analysis suggests that a targeted activity intervention has benefits for children at risk of obesity. Future analyses will explore if benefits are sustained at 12 months follow-up.

Introduction: Evidence about effective interventions that reduce obesity risk during infancy is needed. This project aimed to systematically review published Randomised Controlled Trials (RCTs) of behavioural and non-behavioural interventions which address potential risk factors for obesity to inform a guideline for UK health visitors. Methods: A multiprofessional Guideline Development Group (GDG) was convened to undertake a systematic review, based on the National Institute for Health and Clinical Excellence (NICE) guidelines. Findings from the review were used to develop a guideline which was subsequently externally reviewed by national experts and practitioners. Results: We identified 28 RCTs reporting behavioural and non-behavioural interventions delivered during infancy with breastfeeding and/or weight outcomes measured during the first two years of life. A number of on-going studies were also identified. Inclusion criteria for intervention studies included parental breastfeeding intentions and first time parents. Good evidence exists for breastfeeding promotion and support interventions. Evidence exists for parental education around responsive feeding, aspects of infant diet and soothing/sleep expectations. These behavioural components informed the guideline. Despite good evidence that infants fed lower protein formula milk gained less weight compared to milk with higher protein levels, it was not possible to incorporate the evidence from the non-behavioural studies into the guideline. Conclusion: Further research is needed to establish clinically effective interventions for obesity prevention during infancy. Continuous dialogue between commissioners, policy makers, health visitors and parents is essential to ensure existing UK policies are not a barrier to implementing obesity prevention strategies in the first year of life.

Asthma is now the most common chronic childhood illness in Britain and the prevalence is increasing.1 Currently 1.5 million children (aged 2–15 years) in the UK are estimated to have asthma, giving the country one of the highest prevalences in the world,2 with estimated costs of £100–150m.3Asthma also has a significant social impact, including school absence4 and poorer psychological health.5 Educational programmes for children with asthma have been around since the 1940s, albeit in varying guises, utilising leaflets, group work, individualised training, home visits, and specialised camps.6-9 The goal behind them has always been to improve the child's physical and/or psychological management of their asthma.10 More recently, attention has focused on the potential contribution of multimedia computer programs to paediatric health education.11 Multimedia software delivers information to a laptop or desktop computer screen using a range of visual and auditory forms, including animation, video, voice over, and sound effect. The interactive capabilities of such programs and their potential to store users' responses can be harnessed to provided personalised information in engaging forms such as games or quizzes. Computer technology has altered the way children spend their free time, and has become increasingly integrated into education, possibly because of expectations that all learning must be “fun”.12Educational software developers have been quick to catch up with this demand for “edutainment”, and packages have been developed for a variety of illnesses, including asthma.13 14 Arguably, they are suited to paediatric education because they combine familiar technology with interesting graphics that hold children's attention.11 15 16 Voice-overs and graphical demonstrations can enhance comprehension of complicated concepts that might otherwise be hampered by the child's level of literacy. Such technologies can also reduce demands on parents and medical staff in terms of …

BackgroundReports suggest a high prevalence of substance misuse in psychotic disorders but few studies examine comorbidity at onset of psychosis.AimsTo identify the prevalence and pattern of substance use and misuse in first-episode psychosis, and relationships with diagnosis, mode of presentation and demographic variables.MethodConsensus diagnoses for 168 subjects presenting with first-episode psychosis were made using ICD–10 diagnostic criteria. Information on substance use and misuse was obtained from multiple sources. We examined associations between substance misuse, diagnosis and demographic factors.ResultsCriteria for drug use, drug misuse or alcohol misuse were met by 37% of the sample. One-year prevalence rates were 19.5% (drug misuse) and 11.7% (alcohol misuse). Thirteen subjects (8.4%) received a primary diagnosis of substance-related psychotic disorder; a significant increase compared with an earlier cohort from the same catchment area. Drug misuse was associated with younger age of onset of psychosis, male gender and non–African–Caribbean ethnicity.ConclusionsThis study confirms high rates of substance misuse at onset of psychosis. There is evidence for an increase in diagnosis of substance-related psychotic disorders over time. Those most at risk of substance misuse are young males.

We welcome the interest shown by Weiner and McDonough in our article on asthma as a barrier to physical activity. In our study, we used the International Obesity TaskForce definition of overweight and obesity,1 whereas Weiner and McDonough used the 85th and 95th percentile for BMI for overweight and obesity, respectively. However, we were interested to read that they found the …

Background and aims The quality of father-infant interaction impacts on infant developmental outcomes and is increasingly targeted for intervention. Review of the literature reveals few measures to assess the quality of parent-infant interaction during a structured task. Studies exploring the quality of fathers’ interactions have to date, only used the costly and time-consuming Nursing Child Teaching Assessment Scale (NCATS) to rate father-infant interaction. This study aims to explore the reliability and validity of the ORSPI as a measure of the quality of father-infant interaction. Method Videotapes of 152 five-month old and 74 eight-month old father-infant dyads interacting during a structured task were rated using the 8 item ORSPI scale (scores range from 1–15). Total ORSPI scores were correlated with previously rated NCATS scores. Internal consistency and intra-rater reliability of the ORSPI were also assessed. Results ORSPI scores were significantly positively correlated with NCATS total caregiver scores for five-month dyads (r=0.513, p Conclusions The ORSPI has good concurrent validity, correlating with the highly regarded NCATS, and was both easy to use and reliable. These findings support its use as a simple measure of the quality of father-infant interaction.

This study found a high rate of post-operative overnight stay in a group of 93 children aged between 5 and 12 years admitted to a paediatric ward for day-case procedures. Those children detained were older, had had later operations, were more worried pre-operatively and had been less happy about going to school than were children discharged on the day of surgery. Social factors, maternal worries and pre-medication also predicted delayed discharge. At a follow-up there were no differences between the day-case and in-patient groups in terms of children's psychological outcome but difficulties associated with ward-based day-case surgery were highlighted.

Objective :To establish the residential history of an incident cohort of psychotic patients 13 years after their first contact with the psychiatric services. Design :Tracing of all patients admitted to the WHO study on determinants of outcome of severe mental disorders in Nottingham between 1978 and 1980. Patients were assessed using standardised and comparable instruments, and extra information was obtained from key informants and medical records. Setting :Catchment area of Nottingham psychiatric services. Main outcome measures :Main place of residence over the previous two years and residential history over 13 years in terms of homelessness, imprisonment, and use of high dependency psychiatric facilities. Results :95 patients were traced. At the point of follow up no patients were in long stay psychiatric wards, two were in supervised residence, none was homeless, and none was in prison or a high security hospital. 85 patients were living either independently alone or with their family or friends in the community. Of these, 44 had had no contact with the psychiatric services at the point of follow up. Conclusions :Although many patients experienced a difficult early course of illness, the longer term outcome of the disorder was associated with remarkably low periods of homelessness and imprisonment and low use of intensive care facilities. These findings offer some reassurance, given the concerns about the effectiveness of community oriented care for this potentially most vulnerable group of psychiatric patients.

Background and aims: Surprisingly, previous research has suggested an association between overweight and symptoms of inattention/hyperactivity (ADHD) in children. This study aims to explore whether children with risk factors for obesity recruited to an activity intervention have higher rates of inattention/hyperactivity compared to a normative population. Method: Children in 12 primary schools aged 9 to 11 years were screened for teacher rated overweight, low exercise self-efficacy, self reported inactivity and other barriers to activity such as asthma. Children meeting inclusion criteria were recruited to a school-based physical activity intervention. Baseline measures included body mass index (BMI) and the teacher and parent reported Strengths and Difficulties Questionnaire (SDQ). Results: Of 1087 children screened, 447 met inclusion criteria. Of those, 180 (40%) children were recruited to the study (42% boys) with 62 (35%) of the children above the 91st centile for BMI. The teacher-rated SDQ hyperactivity/inattention subscale mean score was 3.65 compared to the norm value of 2.9 (p=0.001) and 36.7% scored above the cut-off for possible disorder compared to 17.5% in the normative sample (OR =2.09, CI=1.47-2.97). The parent-rated SDQ hyperactivity/inattention subscale mean score was 4.0 compared to normative value of 3.5 (p=0.05). Twenty-seven (26%) of children scored above the cut-off for possible disorder: a non-significant difference compared to 22.1% in the normative sample. There was no relationship between BMI and symptoms of hyperactivity/inattention in this selected sample. Conclusion: The findings indicate that inactive children with barriers to exercise have higher levels of reported hyperactivity/inattention problems compared to a normative sample.

Background and aims: Identifying primary school children who are not sufficiently active will permit timely intervention by parents, schools and healthcare professionals. This study aims to investigate the accuracy of teachers' ratings of children's body size and barriers to participation in physical activities. Methods: Teachers rated body shape in 1021 children aged 9-11 using the Child Body Image Scale (consisting of representations of boys and girls at different weight centiles). They also indicated if the child lacked confidence during P.E. lessons or, in contrast, could be considered ‘sporty’. Children rated their willingness to engage in physical activity using the Predilection sub-scale of the Children's Self-Perceptions of Adequacy in and Predilection toward Physical Activity scale (CSAPPA). Results: Teachers identified 161 children (16%) in whom they felt low confidence was a barrier to exercise and these children had significantly lower scores on the predilection subscale of the CSAPPA (p< 0.001). Children rated as sporty by teachers, in contrast, had significantly higher scores on the CSAPPA (p< 0.001). Seventy-two children were rated above the 75th centile, 29 boys and 43 girls. Consent was obtained to measure actual weight and height in 176 children (74 boys; 102 girls). A strong agreement was found between teacher ratings of centiles and child BMI in both boys (ICC=0.85; p< 0.001) and girls (ICC=0.89; p< 0.001). Conclusions: Teacher identification of children who are overweight and have low confidence is both feasible and valid enabling targeted interventions to be tailored to the school setting.

Background and Aims: The quality of early mother-infant interaction predicts infant developmental outcomes and is an important target for intervention. This study aims to further establish the reliability and validity of the Observational Rating Scale of Parental Interactions (ORSPI) as a measure of mother-infant interaction.