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Caro P, Turner W, Caldwell DM, Macdonald G. Comparative effectiveness of psychological interventions for treating the psychological consequences of sexual abuse in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev 2023; 6:CD013361. [PMID: 37279309 PMCID: PMC10243720 DOI: 10.1002/14651858.cd013361.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Following sexual abuse, children and young people may develop a range of psychological problems, including anxiety, depression, post-traumatic stress disorder (PTSD), and a range of behaviour problems. Those working with children and young people experiencing these problems may use one or more of a range of psychological approaches. OBJECTIVES To assess the relative effectiveness of psychological interventions compared to other treatments or no treatment controls, to overcome psychological consequences of sexual abuse in children and young people up to 18 years of age. Secondary objectives To rank psychotherapies according to their effectiveness. To compare different 'doses' of the same intervention. SEARCH METHODS In November 2022 we searched CENTRAL, MEDLINE, Embase, PsycINFO, 12 other databases and two trials registers. We reviewed the reference lists of included studies, alongside other work in the field, and communicated with the authors of included studies. SELECTION CRITERIA We included randomised controlled trials comparing psychological interventions for sexually abused children and young people up to 18 years old with other treatments or no treatments. Interventions included: cognitive behavioural therapy (CBT), psychodynamic therapy, family therapy, child centred therapy (CCT), and eye movement desensitisation and reprocessing (EMDR). We included both individual and group formats. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias for our primary outcomes (psychological distress/mental health, behaviour, social functioning, relationships with family and others) and secondary outcomes (substance misuse, delinquency, resilience, carer distress and efficacy). We considered the effects of the interventions on all outcomes at post-treatment, six months follow-up and 12 months follow-up. For each outcome and time point with sufficient data, we performed random-effects network and pairwise meta-analyses to determine an overall effect estimate for each possible pair of therapies. Where meta-analysis was not possible, we report the summaries from single studies. Due to the low number of studies in each network, we did not attempt to determine the probabilities of each treatment being the most effective relative to the others for each outcome at each time point. We rated the certainty of evidence with GRADE for each outcome. MAIN RESULTS We included 22 studies (1478 participants) in this review. Most of the participants were female (range: 52% to 100%), and were mainly white. Limited information was provided on socioeconomic status of participants. Seventeen studies were conducted in North America, with the remaining studies conducted in the UK (N = 2), Iran (N = 1), Australia (N = 1) and Democratic Republic of Congo (N = 1). CBT was explored in 14 studies and CCT in eight studies; psychodynamic therapy, family therapy and EMDR were each explored in two studies. Management as usual (MAU) was the comparator in three studies and a waiting list was the comparator in five studies. For all outcomes, comparisons were informed by low numbers of studies (one to three per comparison), sample sizes were small (median = 52, range 11 to 229) and networks were poorly connected. Our estimates were all imprecise and uncertain. Primary outcomes At post-treatment, network meta-analysis (NMA) was possible for measures of psychological distress and behaviour, but not for social functioning. Relative to MAU, there was very low certainty evidence that CCT involving parent and child reduced PTSD (standardised mean difference (SMD) -0.87, 95% confidence intervals (CI) -1.64 to -0.10), and CBT with only the child reduced PTSD symptoms (SMD -0.96, 95% CI -1.72 to -0.20). There was no clear evidence of an effect of any therapy relative to MAU for other primary outcomes or at any other time point. Secondary outcomes Compared to MAU, there was very low certainty evidence that, at post-treatment, CBT delivered to the child and the carer might reduce parents' emotional reactions (SMD -6.95, 95% CI -10.11 to -3.80), and that CCT might reduce parents' stress. However, there is high uncertainty in these effect estimates and both comparisons were informed only by one study. There was no evidence that the other therapies improved any other secondary outcome. We attributed very low levels of confidence for all NMA and pairwise estimates for the following reasons. Reporting limitations resulted in judgements of 'unclear' to 'high' risk of bias in relation to selection, detection, performance, attrition and reporting bias; the effect estimates we derived were imprecise, and small or close to no change; our networks were underpowered due to the low number of studies informing them; and whilst studies were broadly comparable with regard to settings, the use of a manual, the training of the therapists, the duration of treatment and number of sessions offered, there was considerable variability in the age of participants and the format in which the interventions were delivered (individual or group). AUTHORS' CONCLUSIONS There was weak evidence that both CCT (delivered to child and carer) and CBT (delivered to the child) might reduce PTSD symptoms at post-treatment. However, the effect estimates are uncertain and imprecise. For the remaining outcomes examined, none of the estimates suggested that any of the interventions reduced symptoms compared to management as usual. Weaknesses in the evidence base include the dearth of evidence from low- and middle-income countries. Further, not all interventions have been evaluated to the same extent, and there is little evidence regarding the effectiveness of interventions for male participants or those from different ethnicities. In 18 studies, the age ranges of participants ranged from 4 to 16 years old or 5 to 17 years old. This may have influenced the way in which the interventions were delivered, received, and consequently influenced outcomes. Many of the included studies evaluated interventions that were developed by members of the research team. In others, developers were involved in monitoring the delivery of the treatment. It remains the case that evaluations conducted by independent research teams are needed to reduce the potential for investigator bias. Studies addressing these gaps would help to establish the relative effectiveness of interventions currently used with this vulnerable population.
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Affiliation(s)
- Paola Caro
- School for Policy Studies, University of Bristol, Bristol, UK
| | - William Turner
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Alavijeh M, Black D, Macdonald G. Innovative new pharma and biotech partnerships: How is the landscape transforming? Highlights from the Society for Medicines Research Conference. Stevenage - July 7, 2022. DRUG FUTURE 2023. [DOI: 10.1358/dof.2023.48.2.3542442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Duncan A, Macdonald G, Russell K, Bromiley A. A Comparison of Radical Radiotherapy Techniques in the Treatment of the Para-aortic Strip in Stage 2 Testicular Seminoma Patients. Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2021.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Taylor DJA, Shlonsky A, Albers B, Chakraborty S, Lewis J, Mendes P, Macdonald G, Williams K. Protocol for a systematic review of policies, programs or interventions designed to improve health and wellbeing of young people leaving the out-of-home care system. Syst Rev 2021; 10:240. [PMID: 34462001 PMCID: PMC8404288 DOI: 10.1186/s13643-021-01792-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 08/13/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Relative to their counterparts in the general population, young people who leave, or transition out of, out-of-home (OOHC) arrangements commonly experience poorer outcomes across a range of indicators, including higher rates of homelessness, unemployment, reliance on public assistance, physical and mental health problems and contact with the criminal justice system. The age at which young people transition from OOHC varies between and within some countries, but for most, formal support ceases between the ages of 18 and 21. Programs designed to support transitions are generally available to young people toward the end of their OOHC placement, although some can extend beyond. They often encourage the development of skills required for continued engagement in education, obtaining employment, maintaining housing and general life skills. Little is known about the effectiveness of these programs or of extended care policies that raise the age at which support remains available to young people after leaving OOHC. This systematic review will seek to identify programs and/or interventions that improve outcomes for youth transitioning from the OOHC system into adult living arrangements. METHODS This review will identify programs, interventions and policies that seek to improve health and wellbeing of this population that have been tested using robust controlled methods. Primary outcomes of interest are homelessness, health, education, employment, exposure to violence and risky behaviour. Secondary outcomes are relationships and life skills. We will search, from January 1990 onwards, MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, Cochrane CENTRAL, SocINDEX, Sociological Abstracts, Social Services Abstracts, NHS Economic Evaluation Database and Health Technology Assessment. Grey literature will be identified through searching websites and databases, e.g. clearing houses, government agencies and organisations known to be undertaking or consolidating research on this topic area. Two reviewers will independently screen all title and abstracts and full text articles with conflicts to be resolved by a third reviewer. Data extraction will be undertaken by pairs of review authors, with one reviewer checking the results of the other. If more than one study with suitable data can be identified, we plan to undertake both fixed-effects and random-effects meta-analyses and intend to present the random-effects result if there is no indication of funnel plot asymmetry. Risk of bias will be assessed using tools appropriate to the study methodology. Quality of evidence across studies will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. DISCUSSION Previous reviews were unable to identify any programs or interventions, backed by methodologically rigorous research, that improve outcomes for this population. This review seeks to update this previous work, taking into account changes in the provision of extended care, which is now available in some jurisdictions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020146999.
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Affiliation(s)
- David J A Taylor
- Department of Social Work, Monash University, 900 Dandenong Road, Caulfield East, VIC, 3145, Australia. .,Centre for Evidence and Implementation, 33 Lincoln Square South, Carlton, VIC, 3053, Australia.
| | - Aron Shlonsky
- Department of Social Work, Monash University, 900 Dandenong Road, Caulfield East, VIC, 3145, Australia
| | - Bianca Albers
- Centre for Evidence and Implementation, 33 Lincoln Square South, Carlton, VIC, 3053, Australia.,Institute for Implementation Science in Health Care, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Sangita Chakraborty
- Centre for Evidence and Implementation, 33 Lincoln Square South, Carlton, VIC, 3053, Australia
| | - Jane Lewis
- Centre for Evidence and Implementation, 33 Lincoln Square South, Carlton, VIC, 3053, Australia
| | - Phillip Mendes
- Department of Social Work, Monash University, 900 Dandenong Road, Caulfield East, VIC, 3145, Australia
| | - Geraldine Macdonald
- School for Policy Studies, University of Bristol, 8 Priory Rd, Bristol, BS8 1TZ, UK
| | - Kevin Williams
- The Fostering Network, 87 Blackfriars Road, London, SE1 8HA, UK
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Byford S, Petkova H, Barrett B, Ford T, Nicholls D, Simic M, Gowers S, Macdonald G, Stuart R, Livingstone N, Kelly G, Kelly J, Joshi K, Smith H, Eisler I. Cost-effectiveness of specialist eating disorders services for children and adolescents with anorexia nervosa: a national surveillance study. J Eat Disord 2021; 9:76. [PMID: 34174952 PMCID: PMC8235580 DOI: 10.1186/s40337-021-00433-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests specialist eating disorders services for children and adolescents with anorexia nervosa have the potential to improve outcomes and reduce costs through reduced hospital admissions. This study aimed to evaluate the cost-effectiveness of assessment and diagnosis in community-based specialist child and adolescent mental health services (CAMHS) compared to generic CAMHS for children and adolescents with anorexia nervosa. METHOD Observational, surveillance study of children and adolescents aged 8 to 17, in contact with community-based CAMHS in the UK or Republic of Ireland for a first episode of anorexia nervosa. Data were reported by clinicians at baseline, 6 and 12-months follow-up. Outcomes included the Children's Global Assessment Scale (CGAS) and percentage of median expected body mass for age and sex (%mBMI). Service use data included paediatric and psychiatric inpatient admissions, outpatient and day-patient attendances. A joint distribution of incremental mean costs and effects for each group was generated using bootstrapping to explore the probability that each service is the optimal choice, subject to a range of values a decision-maker might be willing to pay for outcome improvements. Uncertainty was explored using cost-effectiveness acceptability curves. RESULTS Two hundred ninety-eight children and adolescents met inclusion criteria. At 12-month follow-up, there were no significant differences in total costs or outcomes between specialist eating disorders services and generic CAMHS. However, adjustment for pre-specified baseline covariates resulted in observed differences favouring specialist services, due to significantly poorer clinical status of the specialist group at baseline. Cost-effectiveness analysis using CGAS suggests that the probability of assessment in a specialist service being cost-effective compared to generic CAMHS ranges from 90 to 50%, dependent on willingness to pay for improvements in outcome. CONCLUSIONS Assessment in a specialist eating disorders service for children and adolescents with anorexia nervosa may have a higher probability of being cost-effective than assessment in generic CAMHS. TRIAL REGISTRATION ISRCTN12676087 . Date of registration 07/01/2014.
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Affiliation(s)
- Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.
| | - Hristina Petkova
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Barbara Barrett
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Level 5 Clifford Allbutt Building, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0AH, UK
| | - Dasha Nicholls
- Imperial College London, Division of Psychiatry, Department of Brain Sciences, Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, Michael Rutter Centre for Children and Young People, De Crespigny Park, London, SE5 8AZ, UK
| | - Simon Gowers
- University of Liverpool, Mount Pleasant, Liverpool, L69 3BX, UK
| | - Geraldine Macdonald
- University of Bristol, School for Policy Studies, 8 Priory Road, Bristol, BS8 1TZ, UK
| | - Ruth Stuart
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Nuala Livingstone
- Queen's University Belfast, School of Social Sciences, Education & Social Work, 6 College Park Ave, Belfast, BT7 1PS, UK
| | - Grace Kelly
- Queen's University Belfast, University Road, Belfast, BT7 1NN, UK
| | - Jonathan Kelly
- Beat, Unit 1 Chalk Hill House, 19 Rosary Road, Norwich, Norfolk, NR1 1SZ, UK
| | - Kandarp Joshi
- NHS Grampian and University of Aberdeen, CAMHS, City Hospital, Park Road, Aberdeen, AB24 5AU, UK
| | - Helen Smith
- NHS Ayrshire and Arran, South CAMHS/NSAIU, CAMHS, Arrol Park Resource Centre, House 1, Doonfoot Road, Ayr, KA7 2DW, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, Maudsley Centre for Child and Adolescent Eating Disorders, Michael Rutter Centre for Children and Young People, De Crespigny Park, London, SE5 8AZ, UK
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Hanratty J, Macdonald G, Livingstone N. Child-focused psychosocial interventions for anger and aggression in children under 12 years of age. Hippokratia 2021. [DOI: 10.1002/14651858.cd011788.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jennifer Hanratty
- Centre for Evidence and Social Innovation; Queen's University Belfast; Belfast UK
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McNeilly P, Macdonald G, Kelly B. Rights Based, Participatory Interviews with Disabled Children and Young People: Practical and Methodological Considerations. Compr Child Adolesc Nurs 2021:1-10. [PMID: 33856235 DOI: 10.1080/24694193.2021.1874078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/06/2021] [Indexed: 10/21/2022]
Abstract
There has been an increased emphasis on the voice of the child since the ratification of the United Nations Convention on the Rights of the Child in 1991. Since that time, health and social care researchers have increasingly involved disabled children and young people in research, rather than relying on the views of adults as proxies, for example, parents and professionals. Drawing on doctoral research and the extensive experience of the authors, the aim of this article is to critically reflect on "what worked" along with the challenges of interviewing the children and young people who took part. Practical and methodological issues, such as the need for thorough preparation, the interview process, understanding the children and young people and managing the presence of others are discussed. Finally, recommendations are made for future researchers, including making participation fun, using a sensitive and individualized approach and conducting multiple visits. It is only by considering these factors that we can meaningfully involve disabled children and young people and facilitate their participation in research interviews. Emphasis here is on the practical issues rather than ethical issues that have been published elsewhere.
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Affiliation(s)
- Patricia McNeilly
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Berni Kelly
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
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Alavijeh M, Brown P, Butterworth S, Macdonald G. Advances in Genetic Medicine. Highlights from The Society for Medicines Research Online Meeting. Virtual -December 3, 2020. DRUG FUTURE 2021. [DOI: 10.1358/dof.2021.46.3.3277085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sneddon H, Gojkovic Grimshaw D, Livingstone N, Macdonald G. Cognitive-behavioural therapy (CBT) interventions for young people aged 10 to 18 with harmful sexual behaviour. Cochrane Database Syst Rev 2020; 6:CD009829. [PMID: 32572950 PMCID: PMC7387234 DOI: 10.1002/14651858.cd009829.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Around 1 in 1000 adolescents aged 12 to 17 years old display problematic or harmful sexual behaviour (HSB). Examples include behaviours occurring more frequently than would be considered developmentally appropriate; accompanied by coercion; involving children of different ages or stages of development; or associated with emotional distress. Some, but not all, young people engaging in HSB come to the attention of authorities for investigation, prosecution or treatment. Depending on policy context, young people with HSB are those whose behaviour has resulted in a formal reprimand or warning, conviction for a sexual offence, or civil measures. Cognitive-behavioural therapy (CBT) interventions are based on the idea that by changing the way a person thinks, and helping them to develop new coping skills, it is possible to change behaviour. OBJECTIVES To evaluate the effects of CBT for young people aged 10 to 18 years who have exhibited HSB. SEARCH METHODS In June 2019, we searched CENTRAL, MEDLINE, Embase, 12 other databases and three trials registers. We also examined relevant websites, checked reference lists and contacted authors of relevant articles. SELECTION CRITERIA We included all relevant randomised controlled trials (RCTs) using parallel groups. We evaluated CBT treatments compared with no treatment, waiting list or standard care, irrespective of mode of delivery or setting, given to young people aged 10 to 18 years, who had been convicted of a sexual offence or who exhibited HSB. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We found four eligible RCTs (115 participants). Participants in two studies were adolescent males aged 12 to 18 years old. In two studies participants were males simply described as "adolescents." Three studies took place in the USA and one in South Africa. The four studies were of short duration: one lasted two months; two lasted three months; and one lasted six months. No information was available on funding sources. Two studies compared group-based CBT respectively to no treatment (18 participants) or treatment as usual (21 participants). The third compared CBT with sexual education (16 participants). The fourth compared CBT (19 participants) with mode-deactivation therapy (21 participants) and social skills training (20 participants). Three interventions delivered treatment in a residential setting by someone working there, and one in a community setting by licensed therapist undertaking a PhD. CBT compared with no treatment or treatment as usual Primary outcomes No study in this comparison reported the impact of CBT on any measure of primary outcomes (recidivism, and adverse events such as self-harm or suicidal behaviour). Secondary outcomes There was little to no difference between CBT and treatment as usual on cognitive distortions in general (mean difference (MD) 1.56, 95% confidence interval (CI) -11.54 to 14.66, 1 study, 18 participants; very low-certainty evidence), assessed with Abel and Becker Cognition Scale (higher scores indicate more problematic distortions); and specific cognitive distortions about rape (MD 8.75, 95% CI 2.83 to 14.67, 1 study, 21 participants; very low-certainty evidence), measured with the Bumby Cardsort Rape Scale (higher scores indicate more justifications, minimisations, rationalisations and excuses for HSB). One study (18 participants) reported very low-certainty evidence that CBT may result in greater improvements in victim empathy (MD 5.56, 95% CI 0.94 to 10.18), measured with the Attitudes Towards Women Scale, compared with no treatment. One additional study also measured this, but provided no usable data. CBT compared with alternative interventions Primary outcomes One study (59 participants) found little to no difference between CBT and alternative treatments on post-treatment sexual aggression scores (MD 0.09, 95% CI -0.18 to 0.37, very low-certainty evidence), assessed using Daily Behaviour Reports and Behaviour Incidence Report Forms. No study in this comparison reported the impact of CBT on any measure of our remaining primary outcomes. Secondary outcomes One study (16 participants) provided very low-certainty evidence that, compared to sexual education, mean cognitive distortions pertaining to justification or taking responsibility for actions (MD 3.27, 95% CI -4.77 to -1.77) and apprehension confidence (MD 2.47 95% CI -3.85 to -1.09) may be lower in the CBT group. The same study indicated that mean cognitive distortions pertaining to social-sexual desirability may be lower in the CBT group, and there may be little to no difference between the groups for cognitive distortions pertaining to inappropriate sexual fantasies measured with the Multiphasic Sex Inventory. AUTHORS' CONCLUSIONS It is uncertain whether CBT reduces HSB in male adolescents compared to other treatments. All studies had insufficient detail in what they reported to allow for full assessment of risk of bias. 'Risk of bias' judgements were predominantly rated as unclear or high. Sample sizes were very small, and the imprecision of results was significant. There is very low-certainty evidence that group-based CBT may improve victim empathy when compared to no treatment, and may improve cognitive distortions when compared to sexual education, but not treatment as usual. Further research is likely to change the estimate. More robust evaluations of both individual and group-based CBT are required, particularly outside North America, and which look at the effects of CBT on diverse participants.
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Affiliation(s)
| | - Dina Gojkovic Grimshaw
- Department of Research and Evaluation, Associate Development Solutions Ltd, Sheffield, UK
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Hanafi H, Grant J, Macdonald G. Concurrent Chemoradiotherapy or Radiotherapy Alone in Muscle-invasive Bladder Cancer: Retrospective Review of Treatment and Outcome in Aberdeen Royal Infirmary. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cammaert L, Macdonald G. Clinical Impact of Radiotherapy to the Prostate in Patients with Low Burden of Metastatic Disease. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McNeilly P, Macdonald G, Kelly B. Ethical considerations when conducting research with children and young people with disabilities in health and social care. Nurse Res 2020; 28:e1645. [PMID: 31970946 DOI: 10.7748/nr.2020.e1645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Rights-based approaches for conducting research with children and young people are now widely accepted by those working in the field. Such approaches focus on the voice of the child and are underpinned by a firm recognition that children are experts on their own lives. However, children and young people with disabilities are less likely to take part in research. Aim To draw on doctoral research conducted with children and young people with disabilities to explore the ethical issues that arose concerning access, recruitment, consent, anonymity, confidentiality and sensitive issues, as well as what mitigated these issues. Discussion Research with children and young people with disabilities can pose additional ethical challenges. There is a growing body of literature about this area, but it needs further development. Conclusion Additional planning and preparation are vital in ensuring that children and young people with disabilities can participate in research in a meaningful way and that researchers conduct studies ethically. Implications for practice This paper has clear implications for research and nursing practice in terms of communicating with children and young people with disabilities, enabling them to express their views and participate in decisions about their lives.
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Affiliation(s)
- Patricia McNeilly
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Berni Kelly
- Queen's University Belfast, Belfast, Northern Ireland
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Wieland LS, Brassington R, Macdonald G. Barriers to the registration and conduct of Cochrane systematic reviews of traditional East Asian medicine therapies. Eur J Integr Med 2019; 32:101008. [PMID: 31933695 PMCID: PMC6957081 DOI: 10.1016/j.eujim.2019.101008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Traditional East Asian medicine (TEAM) is widely used in Asia and increasingly in the West. Systematic reviews (SRs) are the best summaries of the potential benefits or harms of interventions, and Cochrane is a leading international SR organization. Cochrane perspectives on the barriers to the initiation and completion of Cochrane SRs of TEAM therapies were solicited. METHODS Cochrane Review Groups (CRGs) were identified from the online listing of CRGs at cochrane.org and a link to an online survey was e-mailed to the primary contact for each CRG. RESULTS Forty-eight responses were received on behalf of 49/53 (92%) CRGs. Most CRGs had experience producing TEAM reviews, primarily in acupuncture or herbal medicine. The main barriers to taking on a new TEAM review were difficulty in understanding and assessing the intervention, and the low priority of TEAM topics. Problems with the quality and accessibility of randomized trials in TEAM were cited as a major concern. CRGs suggested that the quality and accessibility of randomized trials should be improved, that the methodological and language expertise of authors should be enhanced, and that further peer review expertise should be made available to CRGs. CONCLUSIONS TEAM topics are covered in Cochrane reviews but are often considered low-priority. This survey highlights Cochrane concerns about the quality of the underlying evidence base and the training of the author teams as barriers to successful SR completion. Specific approaches are proposed to increase the number of TEAM reviews and address the limitations of TEAM research processes within Cochrane.
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Affiliation(s)
- L Susan Wieland
- Cochrane Complementary Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore MD, USA
| | - Ruth Brassington
- Cochrane Neuromuscular, Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Geraldine Macdonald
- Cochrane Developmental, Psychosocial and Learning Problems, School of Policy Studies, University of Bristol, Bristol, UK
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O'Hara L, Smith ER, Barlow J, Livingstone N, Herath NINS, Wei Y, Spreckelsen TF, Macdonald G. Video feedback for parental sensitivity and attachment security in children under five years. Cochrane Database Syst Rev 2019; 11:CD012348. [PMID: 31782528 PMCID: PMC6883766 DOI: 10.1002/14651858.cd012348.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Children who are securely attached to at least one parent are able to be comforted by that parent when they are distressed and explore the world confidently by using that parent as a 'secure base'. Research suggests that a secure attachment enables children to function better across all aspects of their development. Promoting secure attachment, therefore, is a goal of many early interventions. Attachment is mediated through parental sensitivity to signals of distress from the child. One means of improving parental sensitivity is through video feedback, which involves showing a parent brief moments of their interaction with their child, to strengthen their sensitivity and responsiveness to their child's signals. OBJECTIVES To assess the effects of video feedback on parental sensitivity and attachment security in children aged under five years who are at risk for poor attachment outcomes. SEARCH METHODS In November 2018 we searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, nine other databases and two trials registers. We also handsearched the reference lists of included studies, relevant systematic reviews, and several relevant websites SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs that assessed the effects of video feedback versus no treatment, inactive alternative intervention, or treatment as usual for parental sensitivity, parental reflective functioning, attachment security and adverse effects in children aged from birth to four years 11 months. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes 22 studies from seven countries in Europe and two countries in North America, with a total of 1889 randomised parent-child dyads or family units. Interventions targeted parents of children aged under five years, experiencing a wide range of difficulties (such as deafness or prematurity), or facing challenges that put them at risk of attachment issues (for example, parental depression). Nearly all studies reported some form of external funding, from a charitable organisation (n = 7) or public body, or both (n = 18). We considered most studies as being at low or unclear risk of bias across the majority of domains, with the exception of blinding of participants and personnel, where we assessed all studies as being at high risk of performance bias. For outcomes where self-report measures were used, such as parental stress and anxiety, we rated all studies at high risk of bias for blinding of outcome assessors. Parental sensitivity. A meta-analysis of 20 studies (1757 parent-child dyads) reported evidence of that video feedback improved parental sensitivity compared with a control or no intervention from postintervention to six months' follow-up (standardised mean difference (SMD) 0.34, 95% confidence interval (CI) 0.20 to 0.49, moderate-certainty evidence). The size of the observed impact compares favourably to other, similar interventions. Parental reflective functioning. No studies reported this outcome. Attachment security. A meta-analysis of two studies (166 parent-child dyads) indicated that video feedback increased the odds of being securely attached, measured using the Strange Situation Procedure, at postintervention (odds ratio 3.04, 95% CI 1.39 to 6.67, very low-certainty evidence). A second meta-analysis of two studies (131 parent-child dyads) that assessed attachment security using a different measure (Attachment Q-sort) found no effect of video feedback compared with the comparator groups (SMD 0.02, 95% CI -0.33 to 0.38, very low-certainty evidence). Adverse events. Eight studies (537 parent-child dyads) contributed data at postintervention or short-term follow-up to a meta-analysis of parental stress, and two studies (311 parent-child dyads) contributed short-term follow-up data to a meta-analysis of parental anxiety. There was no difference between intervention and comparator groups for either outcome. For parental stress the SMD between video feedback and control was -0.09 (95% CI -0.26 to 0.09, low-certainty evidence), while for parental anxiety the SMD was -0.28 (95% CI -0.87 to 0.31, very low-certainty evidence). Child behaviour. A meta-analysis of two studies (119 parent-child dyads) at long-term follow-up found no evidence of the effectiveness of video feedback on child behaviour (SMD 0.04, 95% CI -0.33 to 0.42, very low-certainty evidence). A moderator analysis found no evidence of an effect for the three prespecified variables (intervention type, number of feedback sessions and participating carer) when jointly tested. However, parent gender (both parents versus only mothers or only fathers) potentially has a statistically significant negative moderation effect, though only at α (alpha) = 0.1 AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that video feedback may improve sensitivity in parents of children who are at risk for poor attachment outcomes due to a range of difficulties. There is currently only little, very low-certainty evidence regarding the impact of video feedback on attachment security, compared with control: results differed based on the type of measure used, and follow-up was limited in duration. There is no evidence that video feedback has an impact on parental stress or anxiety (low- and very low-certainty evidence, respectively). Further evidence is needed regarding the longer-term impact of video feedback on attachment and more distal outcomes such as children's behaviour (very low-certainty evidence). Further research is needed on the impact of video-feedback on paternal sensitivity and parental reflective functioning, as no study measured these outcomes. This review is limited by the fact that the majority of included parents were mothers.
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Affiliation(s)
- Leeanne O'Hara
- Queen's University BelfastSchool of Social Sciences, Education and Social Work6 College ParkBelfastNorthern IrelandUKBT7 1LP
| | - Emily R Smith
- University of WarwickWarwick Medical SchoolCoventryUKUKCV4 7AL
| | - Jane Barlow
- University of OxfordDepartment of Social Policy and InterventionBarnett House32 Wellington SquareOxfordUKOX1 2ER
| | - Nuala Livingstone
- CochraneEditorial & Methods DepartmentSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | | | - Yinghui Wei
- University of PlymouthCentre for Mathematical Sciences, School of Engineering, Computing and MathematicsPlymouthUK
| | - Thees Frerich Spreckelsen
- University of GlasgowSchool of Social and Political Sciences, Department of SociologyAdam Smith Building, Room 513Bute GardenGlasgowUKG12 8RT
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Petkova H, Simic M, Nicholls D, Ford T, Prina AM, Stuart R, Livingstone N, Kelly G, Macdonald G, Eisler I, Gowers S, Barrett BM, Byford S. Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study. BMJ Open 2019; 9:e027339. [PMID: 31640991 PMCID: PMC6954494 DOI: 10.1136/bmjopen-2018-027339] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to estimate the incidence of DSM5 anorexia nervosa in young people in contact with child and adolescent mental health services in the UK and Ireland. DESIGN Observational, surveillance study, using the Child and Adolescent Psychiatry Surveillance System, involving monthly reporting by child and adolescent psychiatrists between 1st February 2015 and 30th September 2015. SETTING The study was based in the UK and Ireland. PARTICIPANTS Clinician-reported data on young people aged 8-17 in contact with child and adolescent mental health services for a first episode of anorexia nervosa. MAIN OUTCOME MEASURES Annual incidence rates (IRs) estimated as confirmed new cases per 100 000 population at risk. RESULTS 305 incident cases of anorexia nervosa were reported over the 8-month surveillance period and assessed as eligible for inclusion. The majority were young women (91%), from England (70%) and of white ethnicity (92%). Mean age was 14.6 years (±1.66) and mean percentage of median expected body mass index for age and sex was 83.23% (±10.99%). The overall IR, adjusted for missing data, was estimated to be 13.68 per 100 000 population (95% CI 12.88 to 14.52), with rates of 25.66 (95% CI 24.09 to 27.30) for young women and 2.28 (95% CI 1.84 to 2.79) for young men. Incidence increased steadily with age, peaking at 15 (57.77, 95% CI 50.41 to 65.90) for young women and 16 (5.14, 95% CI 3.20 to 7.83) for young men. Comparison with earlier estimates suggests IRs for children aged 12 and under have increased over the last 10 years. CONCLUSION These results provide new estimates of the incidence of anorexia nervosa in young people. Service providers and commissioners should consider evidence to suggest an increase in incidence in younger children. TRIAL REGISTRATION NUMBER ISRCTN12676087.
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Affiliation(s)
- Hristina Petkova
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Mima Simic
- Michael Rutter Centre for Children and Young People, South London and Maudsley NHS Foundation Trust, London, UK
| | - Dasha Nicholls
- The Centre for Psychiatry, Imperial College London, London, UK
| | - Tamsin Ford
- Institute of Health Research, University of Exeter, Exeter, UK
| | - A Matthew Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ruth Stuart
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Nuala Livingstone
- School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
| | - Grace Kelly
- School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
| | | | - Ivan Eisler
- Michael Rutter Centre for Children and Young People, South London and Maudsley NHS Foundation Trust, London, UK
| | - Simon Gowers
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Barbara M Barrett
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Sarah Byford
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Byford S, Petkova H, Stuart R, Nicholls D, Simic M, Ford T, Macdonald G, Gowers S, Roberts S, Barrett B, Kelly J, Kelly G, Livingstone N, Joshi K, Smith H, Eisler I. Alternative community-based models of care for young people with anorexia nervosa: the CostED national surveillance study. Health Serv Deliv Res 2019. [DOI: 10.3310/hsdr07370] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Evidence suggests that investing in specialist eating disorders services for young people with anorexia nervosa could have important implications for the NHS, with the potential to improve health outcomes and reduce costs through reductions in the number and length of hospital admissions.
Objectives
The primary objectives were to evaluate the costs and cost-effectiveness of alternative community-based models of service provision for young people with anorexia nervosa and to model the impact of potential changes to the provision of specialist services.
Design
Observational surveillance study using the Child and Adolescent Psychiatry Surveillance System.
Setting
Community-based secondary or tertiary child and adolescent mental health services (CAMHS) in the UK and the Republic of Ireland.
Participants
A total of 298 young people aged 8–17 years in contact with CAMHS for a first episode of anorexia nervosa in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria.
Interventions
Community-based specialist eating disorders services and generic CAMHS.
Main outcome measures
Children’s Global Assessment Scale (CGAS) score (primary outcome) and percentage of median expected body mass index (BMI) for age and sex (%mBMI) (secondary outcome) were assessed at baseline and at 6 and 12 months.
Data sources
Data were collected by clinicians from clinical records.
Results
Total costs incurred by young people initially assessed in specialist eating disorders services were not significantly different from those incurred by young people initially assessed in generic CAMHS. However, adjustment for baseline covariates resulted in observed differences favouring specialist services (costs were lower, on average) because of the significantly poorer clinical status of the specialist group at baseline. At the 6-month follow-up, mean %mBMI was significantly higher in the specialist group, but no other significant differences in outcomes were evident. Cost-effectiveness analyses suggest that initial assessment in a specialist service has a higher probability of being cost-effective than initial assessment in generic CAMHS, as determined by CGAS score and %mBMI. However, no firm conclusion can be drawn without knowledge of society’s willingness to pay for improvements in these outcomes. Decision modelling did not support the hypothesis that changes to the provision of specialist services would generate savings for the NHS, with results suggesting that cost per 10-point improvement in CGAS score (improvement from one CGAS category to the next) varies little as the percentage of participants taking the specialist or generic pathway is varied.
Limitations
Follow-up rates were lower than expected, but the sample was still larger than has been achieved to date in RCTs carried out in this population in the UK, and an exploration of the impact of missing cost and outcome data produced very similar results to those of the main analyses.
Conclusions
The results of this study suggest that initial assessment in a specialist eating disorders service for young people with anorexia nervosa may have a higher probability of being cost-effective than initial assessment in generic CAMHS, although the associated uncertainty makes it hard to draw firm conclusions. Although costs and outcomes were similar, young people in specialist services were more severely ill at baseline, suggesting that specialist services were achieving larger clinical effectiveness gains without the need for additional expenditure. The results did not suggest that providing more specialist services would save money for the NHS, given similar costs and outcomes, so decisions about which service type to fund could be made with reference to other factors, such as the preferences of patients and carers.
Future work
Data on measures of quality of life capable of generating quality-adjusted life-years are needed to confirm the cost-effectiveness of specialist services.
Trial registration
Current Controlled Trials ISRCTN12676087.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Byford
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Hristina Petkova
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ruth Stuart
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Dasha Nicholls
- Department of Medicine, Imperial College London, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Institute of Health Research, Department of Psychological Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | - Sarah Roberts
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Barbara Barrett
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Grace Kelly
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Nuala Livingstone
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Kandarp Joshi
- Child and Adolescent Mental Health Service, Royal Cornhill Hospital, NHS Grampian, Aberdeen, UK
- Mental Health Division, University of Aberdeen, Aberdeen, UK
| | | | - Ivan Eisler
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Valentine JC, Leach SM, Fowler AP, Stojda DK, Macdonald G. Families and Schools Together (FAST) for improving outcomes for children and their families. Cochrane Database Syst Rev 2019; 7:CD012760. [PMID: 31425610 PMCID: PMC6699677 DOI: 10.1002/14651858.cd012760.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Parents and carers have a major influence on children's learning and development from birth, through the school years, and into adulthood. Parental contributions to education include providing a secure environment in which to learn, providing intellectual stimulation, transmitting social norms and values, shaping the child's resilience through fostering literacy and problem-solving, and encouraging personal and social aspiration. Increasingly, providers of formalised education are recognising the primary role of parents, carers, and the wider family, as well as peers and the environment, in shaping children's education, health, and life experiences. OBJECTIVES To assess the effectiveness of the Families and Schools Together (FAST) programme in improving outcomes among children and their families. SEARCH METHODS Between October 2018 and December 2018, we searched CENTRAL, MEDLINE, Embase, PsycINFO, 11 additional databases, and three trial registers. We handsearched the reference lists of included studies and relevant reports and reviews, contacted the programme developer and independent researchers, and searched relevant websites to identify other eligible studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs examining the effects of FAST, relative to waiting list, usual or alternative services, or no intervention, on outcomes for children (aged from birth to completion of compulsory education) and their families. DATA COLLECTION AND ANALYSIS At least two review authors independently evaluated the records retrieved from the search for relevance. One review author (JV) extracted data from eligible studies with a second independent review author (AF, DK, or SL). Review authors consulted with one another to resolve disagreements. We used a fixed-effect model for meta-analysis. We presented results as standardised mean differences (SMDs) because all outcomes were continuously scaled, and we accompanied these with 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence for each outcome. MAIN RESULTS We identified 10 completed RCTs, most of which were relatively recent (2007 or later) and were conducted with at least some involvement from the intervention developer or the FAST organisation. Nine of the 10 trials were from the USA; the other was from the UK. Children were young (five to nine years old; mean age approximately six years), and therefore, whilst not so named in the reports, evaluations consisted of what is sometimes referred to as 'Kids FAST' and sometimes 'Elementary Level FAST'). Among the USA-based studies, at least 62% of participants were members of a racial/ethnic minority group (most commonly, African American or Latino). FAST was usually delivered in schools after the school day. Trials lasted about eight weeks and usually examined the effects of FAST relative to no additional intervention. Most studies were funded by agencies in the US federal government. We judged the certainty of evidence in the included studies to be moderate or low for the main review outcomes. Failure to include all families in outcome analyses (attrition) and possible bias in recruitment of families into the trials were the main limitations in the evidence.We included over 9000 children and their families in at least one meta-analysis. The follow results relate to meta-analyses of data at long-term follow-up.Primary outcomesFour studies (approximately 6276 children) assessed child school performance at long-term follow-up. The effect size was very small, and the CI did not include effects that, if real, suggest possibly important positive or negative effects if viewed from an individual perspective (SMD -0.02, 95% CI -0.11 to 0.08). We assessed the certainty of evidence for this outcome as moderate. No studies assessed child adverse events, parental substance use, or parental stress.Secondary outcomesParent reports of child internalising behaviour (SMD -0.03, 95% CI -0.11 to 0.17; 4 RCTs, approximately 908 children; low-certainty evidence) and family relationships (SMD 0.08, 95% CI -0.03 to 0.19; 4 RCTs, approximately 2569 children; moderate-certainty evidence) also yielded CIs that did not include effects that, if real, suggest possibly important positive or negative effects.The CI for parent reports of child externalising behaviour, however, did include effects that, if real, were possibly large enough to be important (SMD -0.19, 95% CI -0.32 to -0.05; 4 RCTs, approximately 754 children; low-certainty evidence). AUTHORS' CONCLUSIONS Given these results, it is hard to support the assertion that assignment to FAST is associated with important positive outcomes for children and their parents.
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Affiliation(s)
- Jeffrey C Valentine
- University of LouisvilleDepartment of Counseling and Human DevelopmentLouisvilleKYUSA40292
| | - Stephen M Leach
- University of LouisvilleDepartment of Counseling and Human DevelopmentLouisvilleKYUSA40292
| | - Allison P Fowler
- University of LouisvilleDepartment of Counseling and Human DevelopmentLouisvilleKYUSA40292
| | - Diana K Stojda
- University of LouisvilleEpidemiology and Population Health5439 Pine Top CircleLouisvilleKYUSA27612
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18
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Caro P, Turner W, Macdonald G. Comparative effectiveness of interventions for treating the psychological consequences of sexual abuse in children and adolescents. Hippokratia 2019. [DOI: 10.1002/14651858.cd013361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Paola Caro
- University of Bristol; School for Policy Studies; 8 Priory Road Bristol UK BS8 1TZ
| | - William Turner
- University of Bristol; School for Policy Studies; 8 Priory Road Bristol UK BS8 1TZ
| | - Geraldine Macdonald
- University of Bristol; School for Policy Studies; 8 Priory Road Bristol UK BS8 1TZ
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19
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McConachie H, Livingstone N, Morris C, Beresford B, Le Couteur A, Gringras P, Garland D, Jones G, Macdonald G, Williams K, Parr JR. Parents Suggest Which Indicators of Progress and Outcomes Should be Measured in Young Children with Autism Spectrum Disorder. J Autism Dev Disord 2019; 48:1041-1051. [PMID: 28861649 PMCID: PMC5861173 DOI: 10.1007/s10803-017-3282-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evaluation of interventions for children with autism spectrum disorder (ASD) is hampered by the multitude of outcomes measured and tools used. Measurement in research with young children tends to focus on core impairments in ASD. We conducted a systematic review of qualitative studies of what matters to parents. Parent advisory groups completed structured activities to explore their perceptions of the relative importance of a wide range of outcome constructs. Their highest ranked outcomes impacted directly on everyday life and functioning (anxiety, distress, hypersensitivity, sleep problems, happiness, relationships with brothers and sisters, and parent stress). Collaboration between professionals, researchers and parents/carers is required to determine an agreed core set of outcomes to use across evaluation research.
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Affiliation(s)
- Helen McConachie
- Institute of Health and Society, Newcastle University, Sir James Spence Institute 3rd floor, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
| | - Nuala Livingstone
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK.,Cochrane Editorial Unit, London, UK
| | - Christopher Morris
- PenCRU, Child Health Group, University of Exeter Medical School, Exeter, UK
| | | | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Sir James Spence Institute 3rd floor, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - Paul Gringras
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Deborah Garland
- National Autistic Society, North East Resource Centre, Newcastle upon Tyne, UK
| | - Glenys Jones
- School of Education, University of Birmingham, Birmingham, UK
| | - Geraldine Macdonald
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK.,University of Bristol, Bristol, UK
| | - Katrina Williams
- Developmental Medicine, Royal Children's Hospital, University of Melbourne and Murdoch Childrens Research Institute, Parkville, Australia
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Montgomery P, Movsisyan A, Grant SP, Macdonald G, Rehfuess EA. Considerations of complexity in rating certainty of evidence in systematic reviews: a primer on using the GRADE approach in global health. BMJ Glob Health 2019; 4:e000848. [PMID: 30775013 PMCID: PMC6350753 DOI: 10.1136/bmjgh-2018-000848] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 12/31/2022] Open
Abstract
Public health interventions and health technologies are commonly described as 'complex', as they involve multiple interacting components and outcomes, and their effects are largely influenced by contextual interactions and system-level processes. Systematic reviewers and guideline developers evaluating the effects of these complex interventions and technologies report difficulties in using existing methods and frameworks, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE). As part of a special series of papers on implications of complexity in the WHO guideline development, this paper serves as a primer on how to consider sources of complexity when using the GRADE approach to rate certainty of evidence. Relevant sources of complexity in systematic reviews, health technology assessments and guidelines of public health are outlined and mapped onto the reported difficulties in rating the estimates of the effect of these interventions. Recommendations on how to address these difficulties are further outlined, and the need for an integrated use of GRADE from the beginning of the review or guideline development is emphasised. The content of this paper is informed by the existing GRADE guidance, an ongoing research project on considering sources of complexity when applying the GRADE approach to rate certainty of evidence in systematic reviews and the review authors' own experiences with using GRADE.
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Affiliation(s)
- Paul Montgomery
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Ani Movsisyan
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Sean P Grant
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, USA
| | | | - Eva Annette Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig Maximilian University, Munich, Germany
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Montgomery P, Grant S, Mayo-Wilson E, Macdonald G, Michie S, Hopewell S, Moher D. Reporting randomised trials of social and psychological interventions: the CONSORT-SPI 2018 Extension. Trials 2018; 19:407. [PMID: 30060754 PMCID: PMC6066921 DOI: 10.1186/s13063-018-2733-1] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/08/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) are used to evaluate social and psychological interventions and inform policy decisions about them. Accurate, complete, and transparent reports of social and psychological intervention RCTs are essential for understanding their design, conduct, results, and the implications of the findings. However, the reporting of RCTs of social and psychological interventions remains suboptimal. The CONSORT Statement has improved the reporting of RCTs in biomedicine. A similar high-quality guideline is needed for the behavioural and social sciences. Our objective was to develop an official extension of the Consolidated Standards of Reporting Trials 2010 Statement (CONSORT 2010) for reporting RCTs of social and psychological interventions: CONSORT-SPI 2018. METHODS We followed best practices in developing the reporting guideline extension. First, we conducted a systematic review of existing reporting guidelines. We then conducted an online Delphi process including 384 international participants. In March 2014, we held a 3-day consensus meeting of 31 experts to determine the content of a checklist specifically targeting social and psychological intervention RCTs. Experts discussed previous research and methodological issues of particular relevance to social and psychological intervention RCTs. They then voted on proposed modifications or extensions of items from CONSORT 2010. RESULTS The CONSORT-SPI 2018 checklist extends 9 of the 25 items from CONSORT 2010: background and objectives, trial design, participants, interventions, statistical methods, participant flow, baseline data, outcomes and estimation, and funding. In addition, participants added a new item related to stakeholder involvement, and they modified aspects of the flow diagram related to participant recruitment and retention. CONCLUSIONS Authors should use CONSORT-SPI 2018 to improve reporting of their social and psychological intervention RCTs. Journals should revise editorial policies and procedures to require use of reporting guidelines by authors and peer reviewers to produce manuscripts that allow readers to appraise study quality, evaluate the applicability of findings to their contexts, and replicate effective interventions.
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Affiliation(s)
- Paul Montgomery
- School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Sean Grant
- Behavioral & Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, 90407-2138 CA USA
| | - Evan Mayo-Wilson
- Department of Epidemiology, 615 North Wolfe Street, E6036, Baltimore, 21205 MD USA
| | | | - Susan Michie
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, London, WC1E 7HB UK
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD UK
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa, K1H 8L6 ON Canada
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Grant S, Mayo-Wilson E, Montgomery P, Macdonald G, Michie S, Hopewell S, Moher D. CONSORT-SPI 2018 Explanation and Elaboration: guidance for reporting social and psychological intervention trials. Trials 2018; 19:406. [PMID: 30060763 PMCID: PMC6066913 DOI: 10.1186/s13063-018-2735-z] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/08/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The CONSORT (Consolidated Standards of Reporting Trials) Statement was developed to help biomedical researchers report randomised controlled trials (RCTs) transparently. We have developed an extension to the CONSORT 2010 Statement for social and psychological interventions (CONSORT-SPI 2018) to help behavioural and social scientists report these studies transparently. METHODS Following a systematic review of existing reporting guidelines, we conducted an online Delphi process to prioritise the list of potential items for the CONSORT-SPI 2018 checklist identified from the systematic review. Of 384 international participants, 321 (84%) participated in both rating rounds. We then held a consensus meeting of 31 scientists, journal editors, and research funders (March 2014) to finalise the content of the CONSORT-SPI 2018 checklist and flow diagram. RESULTS CONSORT-SPI 2018 extends 9 items (14 including sub-items) from the CONSORT 2010 checklist, adds a new item (with 3 sub-items) related to stakeholder involvement in trials, and modifies the CONSORT 2010 flow diagram. This Explanation and Elaboration (E&E) document is a user manual to enhance understanding of CONSORT-SPI 2018. It discusses the meaning and rationale for each checklist item and provides examples of complete and transparent reporting. CONCLUSIONS The CONSORT-SPI 2018 Extension, this E&E document, and the CONSORT website ( www.consort-statement.org ) are helpful resources for improving the reporting of social and psychological intervention RCTs.
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Affiliation(s)
- Sean Grant
- Behavioral & Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138 USA
| | - Evan Mayo-Wilson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, E6036, Baltimore, MD 21205 USA
| | - Paul Montgomery
- School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | | | - Susan Michie
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, WC1E 7HB UK
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD UK
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6 Canada
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Macdonald G, Livingstone N, Hanratty J, McCartan C, Cotmore R, Cary M, Glaser D, Byford S, Welton NJ, Bosqui T, Bowes L, Audrey S, Mezey G, Fisher HL, Riches W, Churchill R. The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis. Health Technol Assess 2018; 20:1-508. [PMID: 27678342 DOI: 10.3310/hta20690] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003889. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Geraldine Macdonald
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK.,School for Policy Studies, University of Bristol, Bristol, UK
| | - Nuala Livingstone
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Jennifer Hanratty
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Claire McCartan
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Richard Cotmore
- Evaluation Department, National Society for the Prevention of Cruelty to Children (NSPCC), London, UK
| | - Maria Cary
- King's Health Economics, King's College London, London, UK
| | - Danya Glaser
- University College London and Great Ormond Street Hospital for Sick Children, London, UK
| | - Sarah Byford
- King's Health Economics, King's College London, London, UK
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tania Bosqui
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Lucy Bowes
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Suzanne Audrey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Gill Mezey
- Population Health Sciences and Education, St George's, University of London, London, UK
| | - Helen L Fisher
- King's Health Economics, King's College London, London, UK
| | - Wendy Riches
- Riches and Ullman Limited Liability Partnership, London, UK
| | - Rachel Churchill
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Macdonald G, Alderdice F, Clarke M, Perra O, Lynn F, McShane T, Millen S. Right from the start: protocol for a pilot study for a randomised trial of the New Baby Programme for improving outcomes for children born to socially vulnerable mothers. Pilot Feasibility Stud 2018; 4:44. [PMID: 29435357 PMCID: PMC5797371 DOI: 10.1186/s40814-018-0235-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 01/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Children born to mothers who experience social complexity (e.g. substance misuse, intimate partner violence, mental ill health, a history of maltreatment) are at increased risk for a range of adverse outcomes at birth and during development. Home visiting programmes have been advocated as a strategy for improving outcomes for disadvantaged mothers and children, such as the Nurse-Family Partnership for young, socially disadvantaged first-time mothers. However, no evidence-based programme is available for multiparous women or older first-time mothers. The New Baby Programme was developed in Northern Ireland. It augments the universal health visiting service available in the UK with a content designed to promote maternal health and well-being in pregnancy, maximise secure attachments of children and parents and enhance sensitive parenting and infant cognitive development. METHODS/DESIGN This pilot study is designed to investigate whether it is possible to recruit and retain socially vulnerable mothers in a randomised trial that compares the effects of the New Baby Programme with standard antenatal and postnatal care. Feasibility issues include the referral/recruitment pathway (including inclusion and exclusion criteria), the consent and randomisation, the ability to maintain researcher blinding, the acceptability of the intervention to participants, and the feasibility and acceptability of the outcome measures. The results of the study will inform a definitive phase-3 RCT. DISCUSSION Trials of complex social interventions often encounter challenges that lead to the trial being abandoned (e.g. because of problems in recruitment) or present considerable analytic challenges relating to dropout, attrition and bias. This pilot study aims to maximise the chances of successful implementation. TRIAL REGISTRATION ISRCTN35456296 retrospectively registered.
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Affiliation(s)
- Geraldine Macdonald
- School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 4BQ UK
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
- School of Nursing and Midwifery, Queen’s University Belfast, Health Sciences Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Health Sciences Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
| | - Oliver Perra
- School of Nursing and Midwifery, Queen’s University Belfast, Health Sciences Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Queen’s University Belfast, Health Sciences Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
| | - Theresa McShane
- School of Nursing and Midwifery, Queen’s University Belfast, Health Sciences Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
| | - Sharon Millen
- School of Nursing and Midwifery, Queen’s University Belfast, Health Sciences Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
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Durrant M, Konneh M, Macdonald G, Sykes A. The best of both worlds: innovation, collaboration and synergy between CROs and their client partners. Highlights from the Society for Medicines Research symposium. Stevenage, UK - September 26, 2018. DRUG FUTURE 2018. [DOI: 10.1358/dof.2018.043.12.2918959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Barnes J, Stuart J, Allen E, Petrou S, Sturgess J, Barlow J, Macdonald G, Spiby H, Aistrop D, Melhuish E, Kim S, Pink J, Datta J, Elbourne D. Results of the First Steps study: a randomised controlled trial and economic evaluation of the Group Family Nurse Partnership (gFNP) programme compared with usual care in improving outcomes for high-risk mothers and their children and preventing abuse. Public Health Res 2017. [DOI: 10.3310/phr05090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundFamily Nurse Partnership (FNP) is a home-based nurse home-visiting programme to support vulnerable parents. Group Family Nurse Partnership (gFNP) has similar aims and materials and was demonstrated to be feasible in implementation evaluations.ObjectivesTo determine whether or not gFNP, compared with usual care, could reduce risk factors for maltreatment in a vulnerable group and be cost-effective.DesignA multisite randomised controlled parallel-group trial and prospective economic evaluation, with eligible women allocated (minimised by site and maternal age group) to gFNP or usual care.SettingCommunity locations in the UK.ParticipantsExpectant mothers aged < 20 years with one or more previous live births, or expectant mothers aged 20–24 years with no previous live births and with low educational qualifications (defined as General Certificate of Education at grade C or higher in neither mathematics nor English language or, if they had both, no more than four General Certificates of Education at grade C or higher).InterventionForty-four sessions of gFNP (14 during pregnancy and 30 in the first 12 months after birth) were offered to groups of between 8 and 12 women with similar expected delivery dates (the difference between the earliest and latest expected delivery date ranged from 8 to 10 weeks depending on the group) by two family nurses (FNs), one of whom had notified her intention to practise as a midwife.Main outcome measuresParenting was assessed by a self-report measure of parenting opinions, the Adult Adolescent Parenting Inventory Version 2 (AAPI-2), and an objective measure of maternal sensitivity, the CARE-Index. Cost-effectiveness was primarily expressed in terms of incremental cost per quality-adjusted life-year (QALY) gained.Data sourcesInterviews with participants at baseline and when infants were aged 2, 6 and 12 months. Cost information from nurse weekly logs and other service delivery data.ResultsIn total, 166 women were enrolled (99 to the intervention group and 67 to the control group). Adjusting for site and maternal age group, the intention-to-treat analysis found no effect of gFNP on either of the primary outcomes. AAPI-2 total was 7.5/10 [standard error (SE) 0.1] in both arms [difference also adjusted for baseline 0.08, 95% confidence interval (CI) –0.15 to 0.28;p = 0.50]. CARE-Index maternal sensitivity mean: intervention 4.0 (SE 0.3); control 4.7 (SE 0.4) (difference –0.76, 95% CI –1.67 to 0.13;p = 0.21). The sensitivity analyses supported the primary analyses. The probability that the gFNP intervention was cost-effective based on the QALY measure did not exceed 3%. However, in terms ofchangein AAPI-2 score (baseline to 12 months), the probability that gFNP was cost-effective reached 25.1%. A separate discrete choice experiment highlighted the value placed by both pregnant women and members of the general population on non-health outcomes that were not included in the QALY metric.LimitationsSlow recruitment resulted in smaller than ideal group sizes. In some cases, few or no sessions took place owing to low initial group size, and small groups may have contributed to attrition from the intervention. Exposure to gFNP sessions was below maximum for most group members, with only 58 of the 97 intervention participants receiving any sessions; FNs were experienced with FNP but were mainly new to delivering gFNP.ConclusionsThe trial does not support the delivery of gFNP as a means of reducing the risk of child abuse or neglect in this population.Future workA randomised controlled trial with modified eligibility to enable first-time mothers aged < 20 years to be included, and a modified recruitment strategy to enable faster identification of potential participants from antenatal medical records.Trial registrationCurrent Controlled Trials ISRCTN78814904.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Jane Stuart
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Joanna Sturgess
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Barlow
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Helen Spiby
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Dipti Aistrop
- Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Edward Melhuish
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Sungwook Kim
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Joshua Pink
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jessica Datta
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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Barnes J, Stuart J, Allen E, Petrou S, Sturgess J, Barlow J, Macdonald G, Spiby H, Aistrop D, Melhuish E, Kim SW, Elbourne D. Randomized controlled trial and economic evaluation of nurse-led group support for young mothers during pregnancy and the first year postpartum versus usual care. Trials 2017; 18:508. [PMID: 29092713 PMCID: PMC5667036 DOI: 10.1186/s13063-017-2259-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 10/13/2017] [Indexed: 11/12/2022] Open
Abstract
Background Child maltreatment is a significant public health problem. Group Family Nurse Partnership (gFNP) is a new intervention for young, expectant mothers implemented successfully in pilot studies. This study was designed to determine the effectiveness and cost-effectiveness of gFNP in reducing risk factors for maltreatment with a potentially vulnerable population. Methods A multi-site, randomized controlled, parallel-arm trial and prospective economic evaluation was conducted, with allocation via remote randomization (minimization by site, maternal age group) to gFNP or usual care. Participants were expectant mothers aged below 20 years with at least one live birth, or aged 20–24 years with no live births and with low educational qualifications. Data from maternal interviews at baseline and when infants were 2, 6 and 12 months, and video-recording at 12 months, were collected by researchers blind to allocation. Cost information came from weekly logs completed by gFNP family nurses and other service delivery data reported by participants. Primary outcomes measured at 12 months were parenting attitudes (Adult-Adolescent Parenting Index, AAPI-2) and maternal sensitivity (CARE Index). The economic evaluation was conducted from a UK NHS and personal social services perspective with cost-effectiveness expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. The main analyses were intention-to-treat with additional complier average causal effects (CACE) analyses. Results Between August 2013 and September 2014, 492 names of potential participants were received of whom 319 were eligible and 166 agreed to take part, 99 randomly assigned to receive gFNP and 67 to usual care. There were no between-arm differences in AAPI-2 total (7 · 5/10 in both, SE 0.1), difference adjusted for baseline, site and maternal age group 0 · 06 (95% CI − 0 · 15 to 0 · 28, p = 0 · 59) or CARE Index (intervention 4 · 0 (SE 0 · 3); control 4 · 7 (SE 0 · 4); difference adjusted for site and maternal age group − 0 · 68 (95% CI − 1 · 62 to 0 · 16, p = 0 · 25) scores. The probability that gFNP is cost-effective based on the QALY measure did not exceed 3%. Conclusions The trial did not support gFNP as a means of reducing the risk of child maltreatment in this population but slow recruitment adversely affected group size and consequently delivery of the intervention. Trial registration ISRCTN78814904. Registered on 17 May 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2259-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck University of London, Malet Street, London, WC1E 7HX, UK.
| | - Jane Stuart
- Department of Psychological Sciences, Birkbeck University of London, Malet Street, London, WC1E 7HX, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Joanna Sturgess
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Barlow
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Helen Spiby
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Dipti Aistrop
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Edward Melhuish
- Department of Psychological Sciences, Birkbeck University of London, Malet Street, London, WC1E 7HX, UK.,Department of Education, University of Oxford, Oxford, UK
| | - Sung Wook Kim
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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McNeilly P, Macdonald G, Kelly B. The participation of parents of disabled children and young people in health and social care decisions. Child Care Health Dev 2017; 43:839-846. [PMID: 28795422 DOI: 10.1111/cch.12487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 06/08/2017] [Accepted: 06/21/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is widespread acceptance that parents should be fully involved in decisions about their son or daughter's health and social care. This is reflected in partnership models of practice as well as local and national policy across the United Kingdom. Previous research indicates that parents' experiences of decision making with professionals are mixed. AIM The research reported here aimed to explore parents' experiences of participating in decisions made with professionals about their disabled son or daughter's care. DESIGN This research used mixed methods including survey methodology and qualitative in depth interviews. SETTING AND PARTICIPANTS The research was conducted in one Trust in Northern Ireland. Participants were 77 parents of children and young people with a range of impairments aged between 3 and 28 years. RESULTS Three themes emerged from the data: taking the lead, not knowing, and getting the balance right. Parents wanted to be involved in all aspects of decision making. Although parents reported many examples of good practice, there were also times when they did not feel listened to or did not have enough information to inform decisions. DISCUSSION AND CONCLUSION Parents in this research recounted positive as well as negative experiences. Parents took on a protective role when decisions were made about their son or daughter and at times, reported the need to "fight" for their child. The provision of information remains problematic for these families, and at times, this created a barrier to parents' participation in decision making. Partnership approaches to care that recognize parents' expertise are particularly important to parents when decisions are made with professionals.
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Affiliation(s)
- P McNeilly
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - G Macdonald
- School for Policy Studies, University of Bristol, Bristol, UK
| | - B Kelly
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
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Affiliation(s)
- Geraldine Macdonald
- University of Bristol; School for Policy Studies; Priory Road Bristol UK BS8 1TZ
| | - Nuala Livingstone
- Cochrane; Cochrane Editorial Unit; St Albans House 57-59 Haymarket London UK SW1Y 4QX
| | - Jeffrey C Valentine
- University of Louisville; Department of Educational and Counseling Psychology; Louisville Kentucky USA 40292
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Lassemillante A, Nitis S, McCoy S, Fawcett J, Jarrett M, Woodward A, Macdonald G, Campbell K, Hickman I. Food and dietary behaviours as cardiometabolic risk factors in liver transplant recipients. Journal of Nutrition & Intermediary Metabolism 2017. [DOI: 10.1016/j.jnim.2017.04.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fitzpatrick E, Macdonald G, Martiniuk A, D’Antoine H, Oscar J, Carter M, Lawford T, Elliott E. The Picture Talk Project: Starting a Conversation with Community Leaders on Research with Remote Aboriginal Communities of Australia. BMC Med Ethics 2017; 18:34. [PMID: 28494760 PMCID: PMC5426070 DOI: 10.1186/s12910-017-0191-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 04/22/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Researchers are required to seek consent from Indigenous communities prior to conducting research but there is inadequate information about how Indigenous people understand and become fully engaged with this consent process. Few studies evaluate the preference or understanding of the consent process for research with Indigenous populations. Lack of informed consent can impact on research findings. METHODS The Picture Talk Project was initiated with senior Aboriginal leaders of the Fitzroy Valley community situated in the far north of Western Australia. Aboriginal people were interviewed about their understanding and experiences of research and consent processes. Transcripts were analysed using NVivo10 software with an integrated method of inductive and deductive coding and based in grounded theory. Local Aboriginal interpreters validated coding. Major themes were defined and supporting quotes sourced. RESULTS Interviews with Aboriginal leaders (n = 20) were facilitated by a local Aboriginal Community Navigator who could interpret if necessary and provide cultural guidance. Participants were from all four major local language groups of the Fitzroy Valley; aged 31 years and above; and half were male. Themes emerging from these discussions included Research-finding knowledge; Being respectful of Aboriginal people, Working on country, and Being flexible with time; Working together with good communication; Reciprocity-two-way learning; and Reaching consent. CONCLUSION The project revealed how much more there is to be learned about how research with remote Aboriginal communities should be conducted such that it is both culturally respectful and, importantly, meaningful for participants. We identify important elements in community consultation about research and seeking consent.
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Affiliation(s)
- E.F.M. Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, NSW Australia
- The Sydney Children’s Hospital Network, 4 Governor Phillip Place, West Pennant Hills, Sydney, 2125 NSW Australia
| | - G. Macdonald
- Department of Anthropology, University of Sydney, Sydney, NSW Australia
| | - A.L.C. Martiniuk
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
- The George Institute for Global Health, Sydney, NSW Australia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - H. D’Antoine
- Menzies School of Health Research, Darwin, NT Australia
| | - J. Oscar
- Marninwarntikura Women’s Resource Centre, Fitzroy Crossing, WA Australia
- Nulungu Research Institute, The University of Notre Dame, Broome, Australia
| | - M. Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, WA Australia
| | - T. Lawford
- Kimberley Aboriginal Law and Culture Centre, Fitzroy Crossing, Australia
| | - E.J. Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, NSW Australia
- The Sydney Children’s Hospital Network, 4 Governor Phillip Place, West Pennant Hills, Sydney, 2125 NSW Australia
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
- The George Institute for Global Health, Sydney, NSW Australia
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Fitzpatrick E, Martiniuk A, D'Antoine H, Oscar J, Carter M, Lawford T, Macdonald G, Hunter C, Elliott E. Yarning with remote Aboriginal communities about seeking consent for research, culturally respectful community engagement and genuine research partnerships. Intern Med J 2017. [DOI: 10.1111/imj.2_13463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- E Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Children's Hospital Westmead; Sydney Children's Hospital Network; Sydney New South Wales Australia
| | - A Martiniuk
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- The George Institute for Global Health; Sydney New South Wales Australia
- Dalla Lana School of Public Health; University of Toronto; Toronto Canada
| | - H D'Antoine
- Menzies School of Health Research; Charles Darwin University; Darwin Northern Territory Australia
| | - J Oscar
- Marninwarntikura Women's Resource Centre; Fitzroy Crossing Western Australia Australia
- Nulungu Research Institute; The University of Notre Dame; Broome Western Australia Australia
| | - M Carter
- Nindilingarri Cultural Health Services; Fitzroy Crossing Western Australia Australia
| | - T Lawford
- Kimberley Aboriginal Law and Culture Centre; Fitzroy Crossing Australia
| | - G Macdonald
- Department of Anthropology; University of Sydney; Sydney New South Wales Australia
| | - C Hunter
- Department of Anthropology; University of Sydney; Sydney New South Wales Australia
- International Public Health, School of Public Health; University of Sydney; Sydney New South Wales Australia
| | - E Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Children's Hospital Westmead; Sydney Children's Hospital Network; Sydney New South Wales Australia
- The George Institute for Global Health; Sydney New South Wales Australia
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Barbui C, Purgato M, Churchill R, Adams CE, Amato L, Macdonald G, McCleery J, Minozzi S, Sheriff RS. Evidence-based interventions for global mental health: role and mission of a new Cochrane initiative. Cochrane Database Syst Rev 2017; 4:ED000120. [PMID: 28453184 PMCID: PMC10414526 DOI: 10.1002/14651858.ed000120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Corrado Barbui
- University of VeronaWHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of PsychiatryItaly
| | - Marianna Purgato
- University of VeronaWHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of PsychiatryItaly
| | - Rachel Churchill
- University of YorkCentre for Reviews and DisseminationUK
- Cochrane Common Mental Disorders
| | - Clive E Adams
- University of NottinghamInstitute of Mental HealthUK
- Cochrane Schizophrenia
| | - Laura Amato
- Lazio Regional Health ServiceDepartment of EpidemiologyRomeItaly
- Cochrane Drugs & Alcohol
| | - Geraldine Macdonald
- Queen's University BelfastInstitute of Child Care Research, School of Sociology, Social Policy and Social WorkUK
- University of BristolSchool for Policy StudiesUK
- Cochrane Developmental, Learning and Psychosocial Disorders
| | - Jenny McCleery
- Oxford Health NHS Foundation TrustOxfordUK
- Cochrane Dementia and Cognitive Improvement
| | - Silvia Minozzi
- Lazio Regional Health ServiceDepartment of EpidemiologyRomeItaly
- Cochrane Drugs & Alcohol
| | - Rebecca Syed Sheriff
- Chulalongkorn UniversityChild and Adolescent Psychiatric Unit, Department of Psychiatry, Faculty of MedicineBangkokThailand
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Duncan A, Macdonald G, Grant J. Survival Data for Patients with High Risk Prostate Cancer Treated with Intensity Modulated Radiotherapy/Volumetric Modulated Arc Therapy at Aberdeen Royal Infirmary. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2016.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Durrant M, Macdonald G, Ritchie J, Sykes A. Innovative partnerships for medicines research: How is the landscape evolving? Highlights from the Society for Medicines Research Symposium. Babraham Research Campus, Cambridge, UK - June 15, 2017. DRUG FUTURE 2017. [DOI: 10.1358/dof.2017.042.07.2682629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lawrence M, Naude C, Armstrong R, Bero L, Covic N, Durao S, Ghersi D, Macdonald G, MacLehose H, Margetts B, Tovey D, Volmink J, Young T. A call to action to reshape evidence synthesis and use for nutrition policy. Cochrane Database Syst Rev 2016; 11:ED000118. [PMID: 27883192 PMCID: PMC10287194 DOI: 10.1002/14651858.ed000118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mark Lawrence
- Deakin UniversityPublic Health Nutrition, Institute for Physical Activity and NutritionMelbourneAustralia
| | - Celeste Naude
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesWestern CapeSouth Africa
- Cochrane Nutrition
| | - Rebecca Armstrong
- University of MelbourneJack Brockhoff Child Health & Wellbeing Program, Melbourne School of Population and Global HealthAustralia
- Cochrane Public Health
| | - Lisa Bero
- University of SydneyMedicines Use and Health Outcomes, Charles Perkins Centre and Faculty of PharmacyAustralia
- Cochrane Steering Group
| | - Namukolo Covic
- International Food Policy Research InstitutePoverty, Health and Nutrition DivisionAddis AbabaEthiopia
| | - Solange Durao
- Cochrane Nutrition
- Cochrane South AfricaSouth Africa
- South African Medical Research CouncilCape TownSouth Africa
| | - Davina Ghersi
- National Health and Medical Research CouncilResearch Policy and TranslationCanberraAustralia
| | - Geraldine Macdonald
- University of BristolUK
- Cochrane Developmental, Psychosocial and Learning Problems
| | | | - Barrie Margetts
- University of Southampton, Southampton General HospitalSchool of MedicineUK
| | | | - Jimmy Volmink
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesWestern CapeSouth Africa
- Cochrane South AfricaSouth Africa
- South African Medical Research CouncilCape TownSouth Africa
| | - Taryn Young
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesWestern CapeSouth Africa
- South African Medical Research CouncilCape TownSouth Africa
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Affiliation(s)
- Leeanne O'Hara
- Queen's University Belfast; School of Social Sciences, Education and Social Work; 6 College Park Belfast Northern Ireland UK BT7 1LP
| | - Jane Barlow
- University of Warwick; Division of Mental Health and Wellbeing, Warwick Medical School; Gibbett Hill Road Coventry UK CV4 7LF
| | - Nuala Livingstone
- Cochrane; Cochrane Editorial Unit; St Albans House 57-59 Haymarket London UK SW1Y 4QX
| | - Geraldine Macdonald
- University of Bristol; School for Policy Studies; Priory Road Bristol UK BS8 1TZ
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Hyde A, Fullerton D, Lohan M, McKeown C, Dunne L, Macdonald G, Howlin F, Healy M. The perceived impact of interprofessional information sharing on young people about their sexual healthcare. J Interprof Care 2016; 30:512-9. [PMID: 27196959 DOI: 10.3109/13561820.2016.1154022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article presents the results from an analysis of data from service providers and young adults who were formerly in state care about how information about the sexual health of young people in state care is managed. In particular, the analysis focuses on the perceived impact of information sharing between professionals on young people. Twenty-two service providers from a range of professions including social work, nursing and psychology, and 19 young people aged 18-22 years who were formerly in state care participated in the study. A qualitative approach was employed in which participants were interviewed in depth and data were analysed using modified analytical induction (Bogdan & Biklen, 2007). Findings suggest that within the care system in which service provider participants worked it was standard practice that sensitive information about a young person's sexual health would be shared across team members, even where there appeared to be no child protection issues. However, the accounts of the young people indicated that they experienced the sharing of information in this way as an invasion of their privacy. An unintended outcome of a high level of information sharing within teams is that the privacy of the young person in care is compromised in a way that is not likely to arise in the case of young people who are not in care. This may deter young people from availing themselves of the sexual health services.
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Affiliation(s)
- Abbey Hyde
- a School of Nursing, Midwifery and Health Systems, UCD Health Sciences Centre, University College Dublin , Dublin , Ireland
| | - Deirdre Fullerton
- b Insights Health and Social Research , Derry , Northern Ireland , UK
| | - Maria Lohan
- c Nursing and Midwifery, Queens University Belfast , Belfast , Northern Ireland , UK
| | - Caroline McKeown
- d School of Nursing, Midwifery and Health Systems, University College Dublin , Dublin , Ireland
| | - Laura Dunne
- e School of Education, Queens University Belfast , Belfast , Northern Ireland , UK
| | | | - Frances Howlin
- a School of Nursing, Midwifery and Health Systems, UCD Health Sciences Centre, University College Dublin , Dublin , Ireland
| | - Maria Healy
- a School of Nursing, Midwifery and Health Systems, UCD Health Sciences Centre, University College Dublin , Dublin , Ireland
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Hyde A, Fullerton D, Lohan M, Dunne L, Macdonald G. The role of knowledge in the contraceptive behaviour of sexually active young people in state care. Sex Reprod Healthc 2016; 8:37-41. [PMID: 27179376 DOI: 10.1016/j.srhc.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 02/04/2016] [Accepted: 02/07/2016] [Indexed: 11/28/2022]
Abstract
AIM To analyse the role of sex-focused knowledge in the contraceptive behaviour of sexually active young people in state care. METHODS The sample consisted of 19 care leavers (young people previously in state care) aged 18-22 years, 16 females and 3 males. In-depth interviewing was the method of data collection, and a qualitative strategy resembling modified analytical induction was used to analyse data. FINDINGS Findings indicated that a lack of information was not the sole or even the primary reason for engaging in unsafe sexual practices. Other factors such as ambivalence to becoming pregnant also featured in participants' accounts. Several participants conveyed a relatively weak sense of agency about consistently using contraception. A small number of participants expressed a strong determination to avoid pregnancy, and these appeared to have a level of anxiety about becoming pregnant that motivated them to engage with knowledge about contraception and its use. CONCLUSION Lack of sex-focused information is just one aspect of a myriad of complex factors, including socioeconomic disadvantage and/or emotional deprivation, that influence contraceptive behaviour.
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Ahmad S, Zakikhani P, Gietzman W, Macdonald G, Royle JS. Radiation therapy for urological cancers. Journal of Clinical Urology 2016. [DOI: 10.1177/2051415816634564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S Ahmad
- Department of Urology, Aberdeen Royal Infirmary Hospital, UK
| | - P Zakikhani
- Department of Urology, Aberdeen Royal Infirmary Hospital, UK
| | - W Gietzman
- Department of Urology, Aberdeen Royal Infirmary Hospital, UK
| | - G Macdonald
- Department of Oncology, Aberdeen Royal Infirmary Hospital, UK
| | - JS Royle
- Department of Urology, Aberdeen Royal Infirmary Hospital, UK
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Hanratty J, Livingstone N, Robalino S, Terwee CB, Glod M, Oono IP, Rodgers J, Macdonald G, McConachie H. Systematic Review of the Measurement Properties of Tools Used to Measure Behaviour Problems in Young Children with Autism. PLoS One 2015; 10:e0144649. [PMID: 26659821 PMCID: PMC4689504 DOI: 10.1371/journal.pone.0144649] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background Behaviour problems are common in young children with autism spectrum disorder (ASD). There are many different tools used to measure behavior problems but little is known about their validity for the population. Objectives To evaluate the measurement properties of behaviour problems tools used in evaluation of intervention or observational research studies with children with ASD up to the age of six years. Methods Behaviour measurement tools were identified as part of a larger, two stage, systematic review. First, sixteen major electronic databases, as well as grey literature and research registers were searched, and tools used listed and categorized. Second, using methodological filters, we searched for articles examining the measurement properties of the tools in use with young children with ASD in ERIC, MEDLINE, EMBASE, CINAHL, and PsycINFO. The quality of these papers was then evaluated using the COSMIN checklist. Results We identified twelve tools which had been used to measure behaviour problems in young children with ASD, and fifteen studies which investigated the measurement properties of six of these tools. There was no evidence available for the remaining six tools. Two questionnaires were found to be the most robust in their measurement properties, the Child Behavior Checklist and the Home Situations Questionnaire—Pervasive Developmental Disorders version. Conclusions We found patchy evidence on reliability and validity, for only a few of the tools used to measure behaviour problems in young children with ASD. More systematic research is required on measurement properties of tools for use in this population, in particular to establish responsiveness to change which is essential in measurement of outcomes of intervention. PROSPERO Registration Number CRD42012002223
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Affiliation(s)
- Jennifer Hanratty
- School of Sociology, Social Policy and Social Work, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Nuala Livingstone
- School of Sociology, Social Policy and Social Work, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Caroline B. Terwee
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Magdalena Glod
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Inalegwu P. Oono
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jacqui Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Geraldine Macdonald
- School of Sociology, Social Policy and Social Work, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Abstract
BACKGROUND People with Down syndrome are vulnerable to developing dementia at an earlier age than the general population. Alzheimer's disease and cognitive decline in people with Down syndrome can place a significant burden on both the person with Down syndrome and their family and carers. Various pharmacological interventions, including donepezil, galantamine, memantine and rivastigmine, appear to have some effect in treating cognitive decline in people without Down syndrome, but their effectiveness for those with Down syndrome remains unclear. OBJECTIVES To assess the effectiveness of anti-dementia pharmacological interventions and nutritional supplements for treating cognitive decline in people with Down syndrome. SEARCH METHODS In January 2015, we searched CENTRAL, ALOIS (the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group), Ovid MEDLINE, Embase, PsycINFO, seven other databases, and two trials registers. In addition, we checked the references of relevant reviews and studies and contacted study authors, other researchers and relevant drug manufacturers to identify additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of anti-dementia pharmacological interventions or nutritional supplements for adults (aged 18 years and older) with Down syndrome, in which treatment was administered and compared with either placebo or no treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias of included trials and extracted the relevant data. Review authors contacted study authors to obtain missing information where necessary. MAIN RESULTS Only nine studies (427 participants) met the inclusion criteria for this review. Four of these (192 participants) assessed the effectiveness of donepezil, two (139 participants) assessed memantine, one (21 participants) assessed simvastatin, one study (35 participants) assessed antioxidants, and one study (40 participants) assessed acetyl-L-carnitine.Five studies focused on adults aged 45 to 55 years, while the remaining four studies focused on adults aged 20 to 29 years. Seven studies were conducted in either the USA or UK, one between Norway and the UK, and one in Japan. Follow-up periods in studies ranged from four weeks to two years. The reviewers judged all included studies to be at low or unclear risk of bias.Analyses indicate that for participants who received donepezil, scores in measures of cognitive functioning (standardised mean difference (SMD) 0.52, 95% confidence interval (CI) -0.27 to 1.13) and measures of behaviour (SMD 0.42, 95% CI -0.06 to 0.89) were similar to those who received placebo. However, participants who received donepezil were significantly more likely to experience an adverse event (odds ratio (OR) 0.32, 95% CI 0.16 to 0.62). The quality of this body of evidence was low. None of the included donepezil studies reported data for carer stress, institutional/home care, or death.For participants who received memantine, scores in measures of cognitive functioning (SMD 0.05, 95% CI -0.43 to 0.52), behaviour (SMD -0.17, 95% CI -0.46 to 0.11), and occurrence of adverse events (OR 0.45, 95% CI 0.18 to 1.17) were similar to those who received placebo. The quality of this body of evidence was low. None of the included memantine studies reported data for carer stress, institutional/home care, or death.Due to insufficient data, it was possible to provide a narrative account only of the outcomes for simvastatin, antioxidants, and acetyl-L-carnitine. Results from one pilot study suggest that participants who received simvastatin may have shown a slight improvement in cognitive measures. AUTHORS' CONCLUSIONS Due to the low quality of the body of evidence in this review, it is difficult to draw conclusions about the effectiveness of any pharmacological intervention for cognitive decline in people with Down syndrome.
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Affiliation(s)
- Nuala Livingstone
- Queen's University BelfastSchool of Sociology, Social Policy and Social Work6 College ParkBelfastUKBT7 1LP
| | - Jennifer Hanratty
- Queen's University BelfastSchool of Sociology, Social Policy and Social Work6 College ParkBelfastUKBT7 1LP
| | - Rupert McShane
- University of OxfordRadcliffe Department of MedicineJohn Radcliffe HospitalLevel 4, Main Hospital, Room 4401COxfordOxfordshireUKOX3 9DU
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Hanratty J, Macdonald G, Livingstone N. Child-focused psychosocial interventions for anger and aggression in children under 12 years of age. Hippokratia 2015. [DOI: 10.1002/14651858.cd011788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jennifer Hanratty
- Queen's University Belfast; School of Sociology, Social Policy and Social Work; 6 College Park Belfast UK BT7 1LP
| | - Geraldine Macdonald
- Queen's University Belfast; School of Sociology, Social Policy and Social Work; 6 College Park Belfast UK BT7 1LP
| | - Nuala Livingstone
- Queen's University Belfast; School of Sociology, Social Policy and Social Work; 6 College Park Belfast UK BT7 1LP
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Livingstone N, Macdonald G, Williams K, Caldwell DM, Baker LB, Hazell P. Pharmacological intervention for irritability, aggression, and self-injury in Autism Spectrum Disorders (ASD). Hippokratia 2015. [DOI: 10.1002/14651858.cd011769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Nuala Livingstone
- Queen's University Belfast; School of Sociology, Social Policy and Social Work; 6 College Park Belfast UK BT7 1LP
| | - Geraldine Macdonald
- Queen's University Belfast; School of Sociology, Social Policy and Social Work; 6 College Park Belfast UK BT7 1LP
| | - Katrina Williams
- University of Melbourne; Department of Paediatrics; Flemington Rd Melbourne Victoria Australia
- Royal Children's Hospital; Department of Developmental Medicine; Flemington Rd Melbourne Victoria Australia
- Murdoch Children's Research Institute; Flemington Rd Melbourne Victoria Australia 3052
| | - Deborah M Caldwell
- University of Bristol; School of Social and Community Medicine; Canynge Hall, 39 Whatley Road Bristol Avon UK BS8 2PS
| | - Louise Brigid Baker
- Royal Children's Hospital; Paediatric Developmental Medicine and Paediatric Rehabilitation; Flemington Road, Parkville Melbourne Victoria Australia 3052
| | - Philip Hazell
- Sydney Medical School; Discipline of Psychiatry; G03 - Thomas Walker Hospital Hospital Rd Concord West New South Wales Australia 2138
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Affiliation(s)
| | | | - Clive E Adams
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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McConachie H, Parr JR, Glod M, Hanratty J, Livingstone N, Oono IP, Robalino S, Baird G, Beresford B, Charman T, Garland D, Green J, Gringras P, Jones G, Law J, Le Couteur AS, Macdonald G, McColl EM, Morris C, Rodgers J, Simonoff E, Terwee CB, Williams K. Systematic review of tools to measure outcomes for young children with autism spectrum disorder. Health Technol Assess 2015; 19:1-506. [PMID: 26065374 PMCID: PMC4781156 DOI: 10.3310/hta19410] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children's progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness; skills such as social functioning and play; participation outcomes such as social inclusion; and parent and family impact. OBJECTIVES To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents. METHODS The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013; systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD; and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers. RESULTS The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains 'Impairments', 'Activity Level Indicators', 'Participation', and 'Family Measures'. In review 1, 10,154 papers were sifted - 3091 by full text - and data extracted from 184; in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a 'recommended battery' for use. In particular, there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents). CONCLUSIONS This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research. FUTURE WORK Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002223. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Helen McConachie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Magdalena Glod
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jennifer Hanratty
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nuala Livingstone
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Inalegwu P Oono
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian Baird
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Deborah Garland
- National Autistic Society North East Autism Resource Centre, Newcastle upon Tyne, UK
| | - Jonathan Green
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Paul Gringras
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Glenys Jones
- School of Education, University of Birmingham, Birmingham, UK
| | - James Law
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ann S Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Geraldine Macdonald
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Elaine M McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Morris
- PenCRU, Child Health Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jacqueline Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Katrina Williams
- University of Melbourne, Royal Children's Hospital and Murdoch Childrens Research Institute, Melbourne, Australia
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