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Introduction Childhood poverty has life-long adverse impacts. We aimed to assess perceptions of parents of a cohort of children attending a paediatric emergency department regarding the impact of their housing on their child and family Methods From 01/11/2020 - 08/01/2021 a cross-sectional study was performed in a paediatric emergency department in Dublin Results Of 312 parents who completed a questionnaire, 4.5% (n = 14) reported themselves to be homeless. Homeless children were less likely to be registered with general practitioners (78.6% vs. 97.5%, p = .009) or be fully vaccinated (71.4% vs. 92.4%, p = .024). Homeless parents were more likely to feel unsafe at home (35.7% vs. 3.4%, plt;.001), and to report that their housing negatively impacted their child's education (58.3% vs 10.7%, plt;.001), physical health (45.5% vs 11.7, p = .007), and mental health (61.5% vs 12.6%, plt;.001). Ten percent of non-homeless parents were concerned about losing their home. A lack of landlord permission to install child safety measures in the home was reported by 28% of all parents. Conclusion Homeless parents were more likely to report that their living situation negatively impacted their child's play, development, education, safety, and health.

Introduction Corticosteroids are a mainstay in the treatment of moderately severe relapses of ulcerative colitis (UC), yet almost 50% of patients do not respond fully, with the risk of prolonged steroid use and side-effects. There is insufficient evidence to inform optimum treatment choice for steroid resistant disease. The aim of this study was to provide details of current practice in the management of steroid resistant UC. Methods A cross-sectional survey of Inflammatory Bowel Disease (IBD) healthcare professionals (HCPs) in the UK was conducted online using the Qualtrics platform. HCPs were invited to participate in the survey through professional networks: British Society of Gastroenterology IBD section, Royal College of Nursing IBD Nurses Network, and social media. Clinical scenarios representing patients with moderately severe UC with continuing symptoms (steroid resistant (SR)) and with relapse after steroid dose reduction (steroid dependent (SD)) were included – both thiopurine treated (TP+) and naive (TP-). Data were analysed descriptively with chi-squared tests on outcomes of interest using R software. Results 387 HCPs visited the survey; 47% (168 HCPs) consented (68% medical; 30% nurses; median 7.5 years since appointment) across all UK regions. Definitions of steroid resistance varied: 68% indicating an incomplete response to prednisolone 40 mg/day after 2 weeks and after 4 weeks in a further 58%. Only 13% felt that SR and SD disease should be treated identically. Anti-TNF drugs would be most frequently offered in each scenario (SR: TP+ 95%; TP- 87%; SD: TP+ 88%; TP- 74%) with infliximab most frequently suggested; apart from SD TP- patients flaring at prednisolone 5 mg/day. Admission for IV steroids was offered more often for SR disease (32%) than for SD (12%). In SD scenarios, thiopurine treatment would be instigated in TP- patients flaring at 25 mg prednisolone or 5 mg/day in 49% and in 70% respectively. Anti-TNF treatment would be offered more frequently if patients are TP+ in both SR (TP+ 81%; TP- 62% p=0.004) or SD patients and particularly for those relapsing at 5 mg/day (Relapse at 25 mg/day: TP+ 78% TP- 49%, p Conclusions There are important variations in practice in the UK in how to define, treat and use endoscopy in steroid resistant UC. Such variations need to be understood as part of initiatives to change practice - particularly to avoid excess steroid use - and in trial design.

Forms of parent-held records have been in existence for well over 100 years, but it is only relatively recently that they have been introduced on a systematic basis in the UK. As part of the review of Health for all children in 2003, the Personal Child Health Record was reviewed in England and a national standard core record introduced, reflecting the content of the child health programme with flexibility to allow for local details. It is intended as a record of growth and development and health events, but not as a repository of detailed health promotion material. This principle also applies in Scotland, Wales, and Northern Ireland with some variation. Parents value it, but apart from health visitors it is not well used by healthcare professionals. A digital version is in development.

Background The optimum treatment for steroid resistant ulcerative colitis (SRUC) is not clear and a range of options can be considered. The aim of this study was to quantify the relative importance of different treatment characteristics to clinicians and understand their preferences for benefit-risk trade-offs. Methods A discrete choice experiment (DCE) was conducted in the UK via online survey of clinicians with expertise in inflammatory bowel disease. This involved 12 tasks where respondents selected a preferred treatment option when presented with two competing, hypothetical treatment profiles for a SRUC scenario. Profiles described five treatment characteristics focusing on clinical outcomes and safety, identified from qualitative interviews with clinicians and evidence from systematic reviews. DCE responses were analysed using conditional logistic regressions. Regression coefficients were used to calculate benefit-risk trade-offs, to find the rate at which clinicians are willing to trade levels of risks in exchange for the preferred levels of clinical outcomes. Regression coefficients were also used to predict uptake rates for selected drugs currently prescribed to patients with SRUC. Results 116 clinicians completed the survey (age 46y; female 42%; consultant 60%; nurse 26%; mean experience 11y). Figure 1 shows the treatment characteristics that make respondents more likely (positive coefficient) or less likely (negative coefficient) to choose a treatment. One unit increase in both lymphoma risk and serious infection risk were strongly considered when clinicians were choosing a treatment compared to one unit increase in the symptom improvement characteristics. Clinicians would accept a higher lymphoma risk of 5 per 10,000 patient years for a 10% improvement in remission rate compared to 4 and 2 cases per 10,000 patient years for 10% better rates of clinical response and mucosal healing respectively. Clinicians at secondary hospitals accepted a lymphoma risk of 4 cases per 10,000 patient years for a 10% improvement in remission vs 7 per 10,000 patient years at tertiary centres. Similar trade-off results were found for serious infection risks. Predicted uptake comparing preferred characteristics to existing treatments was infliximab (62%), tofacitinib (18%), vedolizumab (15%) and adalimumab (5%). Conclusion Clinicians are willing to make difficult trade-offs and tolerate elevated safety risks in exchange for therapeutic benefits. Risk tolerance was highest if the treatment improved long term remission rate, lowest for mucosal healing and higher in clinicians at tertiary centres. The results help to better understand treatment decisions and identify outcomes that might be considered in choosing agents to evaluate in clinical trials.

Numbers of looked-after children and young people (LACYP) in the UK have risen over the last seven years. Looked-after children and young people should receive regular health assessments, including establishing immunization status and, if needed, developing a health plan to achieve full immunization. The Department for Education publish data on immunizations among LACYP to monitor both how well they are immunized and service performance.A literature review was conducted using four databases (PubMed, Embase, Scopus and Web of Science) on immunization status of LACYP, factors affecting uptake and challenges to immunization, and interventions to improve immunization rates.Thirty-two papers were identified, 16 of which were UK based. Looked-after children and young people are less likely to be 'up-to-date' with their immunizations than children in the general population. Looked-after children and young people are less likely to receive timely immunizations, and older LACYP are less likely to be 'up-to-date' than younger LACYP. Barriers to immunization include failure to attend health checks, absence from school and frequent placement moves. Unknown and discrepant immunization histories, name changes, sharing of information between organizations and obtaining consent for immunizations are also challenges.In recent years, immunization of LACYP has been given a higher priority. However, the immunization figures produced by the Department for Education are problematic because of challenges in determining whether the child is 'up-to-date', and data are not comparable with the general population; ideally, this should be changed to correspond to routine immunization data. In the interim, for reporting purposes, the use of a tool to assist with determining a child's immunization status would be beneficial. When a child's immunization status is incomplete or unknown, Public Health England's algorithm for vaccination of individuals with uncertain or incomplete status should be used. Practice to improve immunization uptake amongst LACYP needs to be evaluated to develop evidence-based recommendations.

There is much debate surrounding the topic of immunisation. Helen McCarthy discusses the immunisation process with an emphasis on risk assessment.

Objective: To investigate the relationship between primary immunisation status and MMR uptake. Design: Nationally representative Millennium Cohort Study. Setting: Children born in the UK, 2000–2002. Participants: 14 578 children with immunisation data. Main outcome measures: MMR status at 3 years, defined as immunised with MMR, immunised with at least one single antigen vaccine or unimmunised. Results: 88.6% of children had been immunised with MMR, 5.2% had received at least one of the single antigen vaccines and 6.1% were unimmunised against measles, mumps and rubella at age 3 years. Children who were unimmunised with the primary vaccines at ages 9 months (1.2%, n = 168) and 3 years (0.4%, n = 67) were 13 (95% CI 10.8 to 14.7) and 17 (95% CI 14.6 to 19.7) times more likely to be unimmunised against measles, mumps and rubella compared with children who were fully immunised. They were also more likely to be immunised with at least one of the single antigen vaccines with risk ratios of 2.8 (95% 1.2 to 6.1) and 4.3 (95% CI 1.8 to 10.1). Similar but smaller associations were observed if children were partially immunised with the primary vaccines at 9 months (3.4%, n = 502) and 3 years (3.6%, n = 522) with risk ratios of 4.0 (95% 3.2 to 4.9) and 5.2 (95% 4.2 to 6.1) for no MMR immunisation, and 2.0 (95% C 1.1 to 3.6) and 1.6 (95% CI 1.1 to 2.5) for single antigen vaccine use. Conclusion: Children who remain unimmunised with primary vaccines are also more likely not to receive MMR. More work is needed to determine how best to target this group.

Children are shaped in part by their environment and one rich in communication is therefore beneficial. Activities such as play and reading have long lasting positive effects on development. This study examined the social and demographic characteristics of mothers who play with, read to and tell stories to their child, using data from the UK-wide Millennium Cohort Study (MCS).The study included 14 034 mothers of singleton 5-year-old children. Using data from the first and third sweeps of the MCS, we examined how often mothers engaged with their child in playing, reading and telling stories, according to their social and demographic characteristics: ethnicity, socio-economic status, highest academic qualification, lone mother status, age at birth of cohort child, number of children and employment status. Adjusted logistic regression analyses were conducted using Stata.When their children were 5 years old, 22% of mothers reported playing, 51% reading and 13% telling stories everyday. Indian, Pakistani, Bangladeshi and Black mothers were significantly less likely to play with their child at least weekly compared with White mothers. The same applied to lone mothers compared with those living with a partner. Mothers with academic qualifications lower than degree level were less likely to read at least once weekly. Compared with mothers who worked full-time, those who worked part-time, were 'on-leave' or unemployed, were more likely to play with, and read to, their child at least weekly. Mothers with more than one child were significantly less likely to engage at least weekly in any of the three activities studied.We found significant inequalities in the frequency of playing, reading and telling stories according to sociodemographic characteristics. This information is important to be able to target more effectively vulnerable children using established public health initiatives, like 'Bookstart' and 'Surestart', aimed at promoting play, reading and story telling.

Background Seasonal pasture myopathy (SPM) is a highly fatal form of nonexertional rhabdomyolysis that occurs in pastured horses in the United States during autumn or spring. In Europe, a similar condition, atypical myopathy (AM), is common. Recently, a defect of lipid metabolism, multiple acyl-CoA dehydrogenase deficiency (MADD), has been identified in horses with AM. Objective To determine if SPM in the United States is caused by MADD. Animals Six horses diagnosed with SPM based on history, clinical signs, and serum creatine kinase activity, or postmortem findings. Methods Retrospective descriptive study. Submissions to the Neuromuscular Diagnostic Laboratory at the University of Minnesota were reviewed between April 2009 and January 2010 to identify cases of SPM. Inclusion criteria were pastured, presenting with acute nonexertional rhabdomyolysis, and serum, urine, or muscle samples available for analysis. Horses were evaluated for MADD by urine organic acids, serum acylcarnitines, muscle carnitine, or histopathology. Results Six horses had clinical signs and, where performed (4/6 horses), postmortem findings consistent with SPM. Affected muscle (4/4) showed degeneration with intramyofiber lipid accumulation, decreased free carnitine concentration, and increased carnitine esters. Serum acylcarnitine profiles (3/3) showed increases in short- and medium-chain acylcarnitines and urinary organic acid profiles (3/3) revealed increased ethylmalonic and methylsuccinic acid levels, and glycine conjugates, consistent with equine MADD. Conclusions and Clinical Importance Similar to AM, the biochemical defect causing SPM is MADD, which causes defective muscular lipid metabolism and excessive myofiber lipid content. Diagnosis can be made by assessing serum acylcarnitine and urine organic acid profiles.

Regular assessment of growth is an important part of child health surveillance in the UK and most parents are very interested in their child's growth. UK parents are given a personal child health record (PCHR), including growth charts, which are plotted during baby clinic visits. Parents were consulted as part of the process of designing new UK charts to incorporate the World Health Organization growth standard. This paper describes the main themes that emerged and how they influenced the final design.Three sets of consultations with 47 parents were conducted to collect preliminary information, and to evaluate proposed chart designs, instructions and written information for parents. At every consultation, the impact of the depiction of the 50th centile line in bold was mentioned spontaneously by parents. They also found aspects of the charts unclear, including the implications of a recorded weight on any particular centile, the difficulty of understanding existing text about charts in the PCHR, their preference for using pounds and ounces rather than metric weights and confusion about how frequently babies should be weighed. This led to the production of parental information including explanation of these issues which were then tested in two further sets of focus groups.Involving parents in the process of designing growth charts and information influenced the finished design and the text in the PCHR. Ensuring information meets parents' needs is important to ensure successful growth monitoring.

The Archaeological Journal, 62, 20-36

Objective There is conflicting evidence on the association between television viewing in childhood and cognition. No recent UK and few worldwide studies have looked at the longer-term effects of television viewing in childhood. This study investigates the association between verbal and non-verbal cognitive outcomes at 7 years and television habits at 3, 5 and 7 years. Method The study comprises longitudinal and cross-sectional analysis of the United Kingdom Millennium Cohort Study based on 8,148 children with complete data on variables of interest, maternal reports of television viewing and scores from objective tests of cognitive ability (British Ability Scales Second Edition) collected when cohort members were 3, 5 and 7 years. Mean ability scores were converted into the equivalent progress expected in a child at each age group using existing age equivalents derived for the cohort study population. Linear regression was used to estimate the relationship between each subscale and categories of television viewing (in relation to a reference group who watched between 1–3 hours of television a weekday) after adjustment for co-variates. Results Children who did not watch television at 3 years had verbal ability scores at 7 years approximately 7 months behind the reference group (p There was no significant association between television viewing at 5 and verbal or non-verbal ability at 7 years. Children who did not watch television at 7 years had verbal ability scores approximately 3 months ahead of the reference group (p Conclusion There was a positive association between television viewing at 3 years and verbal and non-verbal cognition at 7 years in this cohort but a negative association between television viewing at 7 years and verbal skills at 7 years. This may influence potential guidance on television viewing. Possible explanations are the type of programmes watched or accumulation of viewing hours.

To explore the knowledge, attitudes and concerns with respect to immunization and vaccine-preventable infections in parents whose children have not completed the recommended course of immunization.Parents of children resident in the London Borough of Hackney.Children born between 1 January 1999 and 15 February 1999 were identified from the child health database, and cases were defined as those who had defaulted for one or more primary immunization by 18 months of age. After validation of immunization status from health records, questionnaires were sent to parents. Ten respondents from this sample were interviewed.Questionnaires were sent to 129 parents of children identified as not completing the recommended immunization course. Nine questionnaires were returned 'address unknown', and 76 parents returned the completed questionnaire. The response rate from known residents was 76/110 (69%). Eight parents stated that their child had been immunized, leaving 68 questionnaires available for further analysis. Measles, mumps, rubella (MMR) and meningococcal C were most frequently omitted, usually because of concerns about vaccine safety. Twenty-three out of 68 respondents perceived that having their child immunized with a particular vaccine was more risky than non-immunization, particularly for MMR and meningococcal C vaccines. Those who agreed to be interviewed were notably concerned about the MMR vaccine, but not immunization in general. They perceived the information provided by health professionals to be poor.The decision-making process around childhood immunization is complex. Parents require information that is up to date, tailored to their individual needs and provided by health professionals who are well informed.

Meningitis is more likely to occur in childhood that at any other age. Preventive measures, in the form of vaccination programmes targeted at certain at-risk age groups, have drastically reduced the incidence in recent years. Early identification of symptoms remains vital in order to prevent mortality and reduce the likelihood of long-term effects.

Children are a priority in “Vision 2020”, the World Health Organization's recently launched global initiative for the prevention of avoidable visual impairment by the year 2020.1Successful implementation in the United Kingdom will depend to a greater extent on improvements in secondary and tertiary preventive strategies, to treat and rehabilitate affected children, than on the currently limited primary preventive approaches to the major paediatric eye diseases. Early detection is important to the successful management of children with ophthalmic disorders. In recognition of this, over the past few decades in the UK diverse activities have been implemented to promote early detection of specific ophthalmic conditions in children as well as to monitor their visual development. These comprise physical examinations by various health professionals and effectively form a continuum of screening and surveillance whose purpose and value is best considered in terms of sequential gain. Although now well established, these practices have arisen haphazardly and few have been subject to rigorous evaluation of their benefits. Indeed the scientific basis of some has been seriously questioned.2 In the UK they are undertaken within the broader context of a national programme of child health surveillance.3 Changes in this, such as the increased emphasis on health promotion,3 increasing responsibilities of general practitioners,4 and reconsideration of the roles of health visitors and school nurses,5 consequently have implications for ophthalmological screening and surveillance. The Children's Sub-Group of the National Screening Committee (NSC) of the UK has recently reviewed screening for ophthalmic disorders and visual deficits in children for the first time. The NSC categorised existing activities into five separate screening programmes for retinopathy of prematurity (ROP) in preterm/low birthweight infants; congenital cataract and other ocular anomalies in newborn and young infants; amblyopia and impaired vision in preschool age children; impaired vision, …

Immunisation is widely acknowledged to be one of the most effective public health interventions of this century. Very few parents positively refuse immunisation for their child, but their objections are fuelled by national media and professional journal coverage of the counter arguments. Helen Bedford reviews the case for immunisation. Health professionals need to be able to discuss the issues from an informed, balanced base if they are to advise those parents who believe it is of no benefit and may even harm their child, she writes.