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Inner City Area (inner + city_area)
Selected AbstractsDecision-making in community-based paediatric physiotherapy: a qualitative study of children, parents and practitionersHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2006Bridget Young BA PhD Abstract Approaches to practice based on partnership and shared decision-making with patients are now widely recommended in health and social care settings, but less attention has been given to these recommendations in children's services, and to the decision-making experiences of non-medical practitioners and their patients or clients. This study explored children's, parents' and practitioners' accounts of shared decision-making in the context of community-based physiotherapy services for children with cerebral palsy. Semi-structured interviews were conducted with 11 children with cerebral palsy living in an inner city area of northern England, and with 12 of their parents. Two focus groups were conducted with 10 physiotherapy practitioners. Data were analysed using the constant comparative method. When asked explicitly about decision-making, parents, children and practitioners reported little or no involvement, and each party saw the other as having responsibility for decisions. However, when talking in more concrete terms about their experiences, each party did report some involvement in decision-making. Practitioners' accounts focused on their responsibility for making decisions about resource allocation, and thereby, about the usefulness and intensity of interventions. Parents indicated that these practitioner-led decisions were sometimes in conflict with their aspirations for their child. Parents and children appeared to have most involvement in decisions about the acceptability and implementation of interventions. Children's involvement was more limited than parents'. While parents could legitimately curtail unacceptable interventions, children were mostly restricted to negotiating about how interventions were implemented. In these accounts the involvement of each party varied with the type of issue being decided and decision-making appeared more unilateral than shared. In advocating shared decision-making, greater understanding of its weaknesses as well as its strengths, and greater clarity about the domains that are suitable for a shared decision-making approach and the roles of different parties, would seem a helpful step. [source] Adverse perinatal conditions in hearing-impaired children in a developing countryPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2006Bolajoko O. Olusanya Summary Prevailing adverse perinatal conditions in developing countries have been associated with substantial mortality, but little evidence exists on their impact on permanent childhood disabilities and morbidity due to limitations in clinical investigations and medical records. This study aims to identify the possible association between parent-reported adverse perinatal conditions and permanent hearing loss, in order to establish service needs within current maternal and child health programmes. Structured questionnaires were administered to 363 parents of deaf children and 309 parents of normal-hearing children in an inner city area of Lagos, Nigeria. The parents were from all social classes. After a multivariable logistic regression analysis, birth asphyxia [OR 20.45; 95% CI 6.26, 66.85], difficult delivery [OR 8.09; 95% CI 2.76, 23.68], neonatal jaundice [OR 2.45; 95% CI 1.25, 4.79] and neonatal seizures [OR 2.30; 95% CI 1.09, 4.85] were associated with permanent hearing loss. Consanguineous marriages [OR 6.69; 95% CI 2.72, 16.46] and family history of deafness [OR 6.27; 95% CI 2.07, 18.97] also emerged as additional risk factors for permanent hearing loss. In addition, parents of children in state-owned schools for the deaf were significantly more likely to belong to higher social classes compared with normal-hearing children in mainstream state-owned schools. There is a need to incorporate services for the early detection of permanent hearing loss into current maternal and child healthcare programmes in developing countries. [source] Methadone-exposed newborn infants: outcome after alterations to a service for mothers and infantsCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2007J. Miles Abstract Objective, To evaluate the impact of a shared care approach in clinical management with a drug liaison midwife (DLM) service for mothers and infants established in 1995,1996 in an inner city area and to address the problem of congenital abnormality and microcephaly with fetal drug exposure. Methods, Descriptive analysis of data in live births of women enrolled in a methadone maintenance programme in 1991,1994 (n = 78) and 1997,2001 (n = 98), including time spent in hospital, treatment for neonatal abstinence syndrome (NAS), admission to the neonatal medical unit (NMU) and follow-up for child health checks. Results, In 1997,2001 compared with 1991,1994, the mothers used more methadone in the last week of pregnancy (median 40.0 mg/day vs. 21.5 mg/day, P = 0.0006) and there were more preterm deliveries (36% vs. 21%, P = 0.03). The infants spent less time in hospital (median 5 days vs. 28 days, P < 0.0001), a smaller proportion had treatment for NAS (14% vs. 79%, P < 0.0001), and NMU admission was reduced (median 14 days vs. 26 days, P < 0.0003). Neonatal convulsions (P = 0.0001) and jaundice (P < 0.001) occurred less frequently, and more infants were breastfed (P = 0.001). One infant in each study group had a cleft palate and none had microcephaly. Child health checks for 18,24 months showed a favourable outcome in 1997,2001. Conclusions, We altered antenatal care and modified neonatal management, subsequently infants spent less time in hospital and NMU admissions were reduced with less NAS treatment. Congenital abnormalities and microcephaly were not common and as regular child health checks were possible, the impact of the DLM service in shared management merits further investigation, for mother,infant bonding and developmental outcome. [source] Factors affecting participation in Sure Start programmes: a qualitative investigation of parents' viewsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2007Mark Avis BA(Hons) MSc RN RNT Cert Ed Abstract The objectives of the present study were to examine the factors that parents identify as promoting or hindering participation in Sure Start programmes, and to identify methods for enhancing parents' engagement with Sure Start. A qualitative, in-depth interview study was conducted with parents registered with two local Sure Start programmes based in the East Midlands, UK, and located in inner city areas with a range of health and social problems associated with social exclusion and disadvantage. Sixty parents, guardians or carers of children living in both Sure Start areas were recruited during autumn of 2004 on the basis of whether they were identified as a ,frequent user' or ,non-frequent user' of Sure Start services. The data were analysed using a thematic approach supported by NVivo computer software, and explanatory themes were subsequently tested for completeness and adequacy. The results of the study indicated that parents who used Sure Start services were positive about the benefits that they obtained for themselves and their children, in particular in overcoming a sense of isolation. Parents who were non-frequent users identified a number of practical reasons that prevented them using Sure Start services, although parents also recognised a loss of confidence and trust in the local communities summarised in the phrase ,keeping myself to myself'. Parents' awareness of the targeted nature of Sure Start can also lead to stigma and reluctance to use services. It is concluded that continued investment of time and effort in maintaining communication networks between Sure Start staff and local parents is vital if parents and children are to make the best use of Sure Start services. [source] | ||||||||||