‘Do I don’t I call the doctor’: a qualitative study of parental perceptions of calling the GP out‐of‐hours

The purpose of this study was to investigate how parents use the GP out‐of‐hours service. There was a lack of information about how parents managed childhood illness and what strategies they put in place to help them to cope before calling the GP. The investigation of parental perceptions was based on a qualitative design using in‐depth interviews of 29 families from a semi‐rural location in the south‐east of England. All parents said they found dealing with a sick child out‐of‐hours stressful and were concerned to make the right decision for their child. Furthermore, parents usually employed a reasonable strategy in attempting to manage the child’s illness. This study demonstrated that the decision to call the doctor was not taken lightly. Many parents had implemented useful strategies prior to calling the doctor. However, most parents were also aware of their limitations and feared doing the wrong thing. It would seem that on occasion this fear combined with factors such as a lack of social support and loss of parental confidence resulted in calling the doctor out of hours to seek ‘peace of mind’. A rethink is needed among health professionals about the ‘problem’ of out‐of‐hours calls. GPs could actively seek to empower parents by educating them about minor illness during visits and consultations. It is not enough to offer reassurance to parents that their children are fine. Health visitors and other health professionals who come into contact with young families may help to educate and empower.     

Descriptive study of carers' support,encouragement and modelling of healthy lifestyle behaviours in residential out‐of‐home care

Objective: Given the high prevalence of overweight/obesity among young people in residential out‐of‐home care (OOHC), and as their carers are in loco parentis, this research aimed: 1) to examine the healthy lifestyle cognitions and behaviours of residential carers; and 2) to describe resources needed to improve diet and/or physical activity outcomes for residents. Methods: Cross‐sectional data were collected from 243 residential carers. Measures included: demographics; knowledge of dietary/physical activity recommendations; self‐reported encouragement/importance of health behaviours; physical activity/screen time (at work); unit ‘healthiness’; and necessary resources for creating a healthy environment. Results: Staff placed importance on the residents eating well and being physically active. However, examination of carer knowledge found significant gaps in staff education. Three key priority areas were identified to help build a healthy food and activity environment in residential OOHC: funding, professional development and policy. Conclusion: Carer knowledge of healthy lifestyles can be improved and they need to be well resourced to ensure children in public care settings live in a healthy environment. Implications: These findings may inform the development of ongoing professional development to improve carers' health literacy, as well as policy to support dietary/activity guidelines for the OOHC sector.     

Good food in family day care: Improving nutrition and food safety in family day care

Aim:  To determine the effectiveness of a nutrition and food safety intervention in family day care schemes.
Methods:  Staff and carers from seven Sydney family day care schemes completed a nutrition and food safety knowledge questionnaire and diet history about food and drinks offered to children in care before and after attending workshops and receiving advice and resources. Participating schemes' nutrition and food safety policies were assessed before and after intervention. At baseline, 18 staff members and 104 carers were interviewed. Diet histories were collected for 20 infants and 103 one-to-five-year olds. Post intervention, 21 staff and 102 carers were interviewed and diet histories collected for 22 infants and 102 one-to-five-year olds. Baseline and post-intervention data were compared using the χ²-test for categorical data (or the Fisher's exact test when expected values were below five), and t -tests for independent samples for normally distributed means.
Results:  Nutrition and food safety knowledge and the number (from one to seven) and quality of appropriate policies improved post intervention. Changes in mean per cent nutrition scores for infants (78.2% to 83.4%) and for one-to-five-year olds (68.8% to 75.2%; P  < 0.01) indicated improvements in nutritional quality of food and drinks offered during care.
Conclusion:  Health promotion strategies can improve food and drinks offered in family day care and make a sustainable contribution to children's access to safe and nutritious food.     

The impact of transitional programmes on post‐transition outcomes for youth leaving out‐of‐home care: a meta‐analysis

Youth residing in out‐of‐home care settings have often been exposed to childhood trauma, and commonly report experiencing adverse outcomes after transitioning from care. This meta‐analysis appraised internationally published literature investigating the impact of transitional programme participation (among youth with a baseline age of 15–24 years) on post‐transition outcomes of housing, education, employment, mental health and substance use. A comprehensive search of sociology (e.g. ProQuest Sociology), psychology (e.g. PsycInfo) and health (e.g. ProQuest Family Health) electronic abstraction databases was conducted for the period 1990–2014. Search terms included ‘out‐of‐home care’, ‘transition’, ‘housing’, ‘education’, ‘employment’, ‘mental health’ and ‘substance use’. Nineteen studies, all from the United States, met the inclusion criteria and were included in the meta‐analysis. Living independently and homelessness were the most commonly described housing outcomes. Rates of post‐transition employment varied, while rates of post‐secondary education were low. Depression and alcohol use were commonly reported among transitioning youth. Findings of the meta‐analysis showed that attention should be given to the potential benefit of transitional programme participation on outcomes such as housing, employment and education. Moderator analyses showed that these benefits may differ based on study design, sample size and sampling unit, but not for mean age or gender. Detailed and rigorous research is needed internationally to examine the characteristics of transitional programmes resulting in more successful outcomes for youth, and whether these outcomes are sustained longitudinally.     

Experts’ views regarding Australian school‐leavers’ knowledge of nutrition and food systems

Objective: To explore Australian experts’ views regarding strengths and gaps in school‐leavers’ knowledge of nutrition and food systems ( N&FS) and factors that influence that knowledge. Method: Semi‐structured interviews were conducted with 21 highly experienced food‐related experts in Australia. Qualitative data were analysed thematically using Attride‐Stirling's thematic network framework. Results: Two global themes and several organising themes were identified. The first global theme, ‘structural curriculum‐based problems’, emerged from three organising themes of: inconsistencies in provided food education programs at schools in Australia; insufficient coverage of food‐related skills and food systems topics in school curricula; and the lack of trained school teachers. The second global theme, ‘insufficient levels of school‐leavers knowledge of N&FS ’, was generated from four organising themes, which together described Australian school‐leavers’ poor knowledge of N&FS more broadly and knowledge translation problem for everyday practices. Conclusion: Study findings identified key problems relating to current school‐based N&FS education programs in Australia and reported knowledge gaps in relation to N&FS among Australian school‐leavers. Implications: These findings provide important guidance for N&FS curriculum development, to clearly articulate broadly‐based N&FS knowledge acquisition in curriculum policy and education documents for Australian schools.     

Changes in physical activity in pre-schoolers and first-grade children: longitudinal study in the Czech Republic

Background The transition from kindergarten to first year at school is associated with a variety of psychosocial changes in children. The aim of this longitudinal study was to identify the changes in children's physical activity (PA) upon entry to first year at school; and to identify the days of the school week that exhibit low PA. Methods We monitored the PA levels of 176 children twice: initially in kindergarten and again in first‐year classes at school. The age (mean ± standard deviation) of children at kindergarten was 5.7 ± 0.5 years and 6.7 ± 0.5 years at the first year of elementary school. We evaluated PA employing the activity energy expenditure (AEE – kcal/kg/day) from Caltrac accelerometer and daily amount of steps (STEPS) from Yamax pedometer. Participants were monitored over 7 days to include a weekend. Results The mean AEE was 11.5 in pre‐school girls and 12.9 kcal/kg/day in boys; and STEPS were 9923 steps/day in girls and 11 864 in boys on weekdays. At weekends, it was 11.5 kcal/kg/day in girls and 12.7 kcal/kg/day in boys and 10 606 steps/day in girls and 11 182 steps/day in boys. The mean AEE and STEPS in first‐grade girls and boys was 9.9 and 9.8 kcal/kg/day respectively, and 7911 and 8252 steps/day respectively on weekdays, and 8.8 and 9.0 kcal/kg/day and 6872 and 7194 steps/day respectively at weekends. First‐grade school children had significantly lower PA than pre‐school children on weekdays (P < 0.0001) and at weekends (P < 0.0001). Decline in PA on weekdays was during time spent at school (P < 0.0001) and not during after‐school children's leisure time. Conclusion The parts of the week when first‐grade school children show low PA are the times spent in lessons and in after‐school nursery and at weekends. PA needs to be promoted using intervention programmes mainly during the after‐school nursery programmes and at weekends.     

Motor development in school‐age children is associated with the home environment including socioeconomic status

The aim of the present study was to examine how the home environment, including socioeconomic status (SES), affects motor development in school‐age children. Seven hundred seven children (332 boys and 375 girls) aged between 6 and 10 years participated in the study. Motor Development was determined using the Bruininks–Oseretsky Test of Motor Proficiency‐Second Edition. Parents answered the Middle Childhood Home Observation Measurement of the Environment (HOME) Inventory, and Brazilian Association of Market Research Institutes Questionnaire (for SES). Children from “Adequate” homes (HOME score), compared with “Less Adequate,” displayed better motor behavior. Mediation and moderation analysis revealed that motor development increased as SES increased. The proportion of variance in motor development explained by SES increased from 9% to 13% when the home was added as a mediation variable. We also found that the effect of SES on motor development was moderated by age. For older children, the effect was lower than for younger children. The best model used SES as the predictor, HOME as the mediator, and AGE as the moderator variable and explained 17% of the variance in motor development. In summary, these findings suggest that, like previous reports with young children, the HOME environment and SES may play an important role in motor development of school‐age children. Our findings encourage the assessment of the home and interventions that take into account the home environment to improve motor development in school‐age children.     

Systematic review of organisation‐wide,trauma‐informed care models in out‐of‐home care (OoHC) settings

Trauma in early childhood has been shown to adversely affect children's social, emotional, and physical development. Children living in out‐of‐home care (OoHC) have better outcomes when care providers are present for children, physically, psychologically, and emotionally. Unfortunately, the high turnover of out‐of‐home carers, due to vicarious trauma (frequently resulting in burnout and exhaustion) can result in a child's trauma being re‐enacted during their placement in OoHC. Organisation‐wide therapeutic care models (encompassing the whole organisation, from the CEO to all workers including administration staff) that are trauma‐informed have been developed to respond to the complex issues of abuse and neglect experienced by children who have been placed in OoHC. These models incorporate a range of therapeutic techniques, and provide an overarching approach and common language that is employed across all levels of the organisation. The aim of this study was to investigate the current empirical evidence for organisation‐wide, trauma‐informed therapeutic care models in OoHC. A systematic review searching leading databases was conducted for evidence of organisation‐wide, trauma‐informed, out‐of‐home care studies, between 2002 and 2017. Seven articles were identified covering three organisational models. Three of the articles assessed the Attachment Regulation and Competency framework (ARC), one study assessed the Children and Residential Experiences programme (CARE), and three studies assessed The Sanctuary Model. Risk of bias was high in six of the seven studies. Only limited information was provided on the effectiveness of the models identified through this systematic review, although the evidence did suggest that trauma‐informed care models may have significantly positive outcomes for children in OoHC. Future research should focus on evaluating components of trauma‐informed care models and assessing the efficacy of the various organisational care models currently available.     

The EIT Food School Network: Integrating solutions to improve eating habits and reduce food wastage in secondary schoolchildren

Most European children and adolescents do not meet dietary guidelines. Therefore, there is a need to develop and implement effective strategies to help young people adopt healthier dietary habits and maintain these into adulthood. The amount of time that children and adolescents spend in the school setting makes this an ideal environment in which to develop interventions that target healthy eating. Schools, however, are complex systems and a whole‐school approach that promotes consistent messages within the school environment and across the curriculum is needed to support positive food choices. Given current concerns about climate change and the environment, it is also important to ensure that any nutrition interventions implemented in the school setting are environmentally friendly and do not increase food wastage. This paper presents the results of stakeholder discussions on the topic of secondary school food in Northern Ireland, conducted as part of the recently developed European Institute for Innovation and Technology (EIT) Food School Network. The Network was established to facilitate the exchange of information within existing national schools programmes and to identify and develop strategies that positively impact on food choice and food wastage in schools across Europe. Improving schools’ adherence to the Food in Schools Policy and engaging pupils and parents to encourage a sense of ‘ownership’ of the school food system were identified as potential ways to positively impact on the dietary habits of children and adolescents.