Practice-informed guidance for undertaking remotely delivered mental health research.

BACKGROUND: The assessment and monitoring of health conditions using remote or online delivery is an emerging interest in healthcare systems globally but is not routinely used in mental health research. There is a growing need to offer remotely delivered appointments in mental health research. There is a lack of practical guidance about how nurse researchers can undertake remote research appointments ethically and safely, while maintaining the scientific integrity of the research. AIM: To provide mental health nurse researchers with information about important issues to consider when assessing the appropriateness of remotely delivered research and methods to support the development of a supportive research relationship. DISCUSSION: The practice guidance and checklist include issues a nurse researcher should consider when assessing suitability and eligibility for remotely delivered research visits, such as ethical considerations and arrangements, safety, communication, and identifying participants requiring further support. This article addresses processes to follow for assessing mental capacity, obtaining informed consent and collaboratively completing research measures. CONCLUSION: Remotely delivered research appointments could be acceptable and efficient ways to obtain informed consent and collect data. Additional checks need to be in place to identify and escalate concerns about safeguarding or risks. IMPLICATIONS FOR PRACTICE: Practical guidance for mental health nurse researchers when determining the appropriateness of remote research visits for participants, and an adaptable checklist for undertaking remote research appointments are outlined.

National hospital data for intussusception: Data linkage and retrospective analysis to assess quality and use in vaccine safety surveillance.

OBJECTIVES: To assess the quality of national Hospital Episode Statistics (HES) data for intussusception, and evaluate this routinely collected database for rotavirus vaccine safety surveillance by estimating pre-vaccination trends in intussusception hospitalisation. METHODS: Data linkage was performed between HES and prospective intussusception data from the British Paediatric Surveillance Unit (BPSU), followed by capture-recapture analysis to verify HES data quality. Inclusion criteria were infants aged less than 12 months and admitted for intussusception to National Health Service (NHS) hospitals in England from March 2008 to March 2009. To estimate pre-vaccination incidence rates of intussusception, we performed a retrospective analysis of HES data. Infants aged less than 12 months and admitted for intussusception to NHS hospitals in England between 1995 and 2009 were included. RESULTS: Data linkage between 254 cases of intussusception identified in HES data and 190 cases reported via the BPSU resulted in 163 cases common to both data sources. Of remaining 91 cases in HES, 37 had confirmed intussusception. HES data accuracy was 78.7% (200 confirmed/254 cases) and completeness for intussusception was 86% (163 matched/190 BPSU cases) compared to 81.5% (163 matched/200 HES cases) for BPSU. A total of 233 (95% CI: 227.4 to 238.8) intussusception cases were estimated for the infant population (2008 to 2009). For retrospective analysis, of 6462 intussusception admissions in HES data (1995 to 2009), 1594 (24.7%) were duplicate admissions. A declining trend in intussusception incidence was observed in the infant population, from 86/100,000 in 1997 to 34/100,000 in 2009 (60% reduction, P<0.001). Cosinor modelling showed an excess of cases among infants in winter and spring (P<0.001, n=4957, 1995 to 2009). CONCLUSION: National hospital data capture the majority of admissions for intussusception and should be considered for the post-implementation surveillance of rotavirus vaccine safety in England.

Child and adolescent psychopathology in a developing country: testing the validity of the strengths and difficulties questionnaire (Urdu version).

A study to test the validity of the Urdu version of the Strengths and Difficulties Questionnaire (SDQ) was carried out in Pakistan. The study population consisted of 212 children aged 4 to 16 years presenting to psychiatric (case group: n = 72) and paediatric outpatient clinics (comparison group: n = 140). Parents of these children were interviewed using the extended version of the SDQ. The case group was further subjected to diagnostic ICD-10 criteria by child psychiatrists, who were blind to SDQ scores. The Urdu version was able to discriminate between the study groups. The mean difficulties score was higher in the case group (mean = 21.7) than the comparison group (mean = 14.4), the difference (mean difference = 7.3) being statistically significant (p < 0.01, 95% CI = 5.3, 9.3) with an effect size of 1.1. Adequate sensitivity (> or = 61%) was obtained for each type of psychiatric disorder in the case group using the abnormal category of the SDQ symptom scores as a cutoff. A simple 'pencil-and-paper' algorithm combining symptom and impact scores further identified children in need of intervention. A ROC curve analysis showed an area under the curve > 0.70 for all scores. The choice of optimal cutoffs for the Urdu version is discussed.

Intussusception incidence among infants in the UK and Republic of Ireland: a pre-rotavirus vaccine prospective surveillance study.

INTRODUCTION: Intussusception, an abdominal emergency in young children, has been linked to a previous vaccine used to prevent rotavirus gastroenteritis. Although this vaccine was withdrawn, recent studies have suggested a potential, very small increased risk of intussusception following the administration of newly developed rotavirus vaccines. We aimed to determine the baseline incidence of intussusception among infants in the UK and Republic of Ireland - prior to the imminent introduction of the rotavirus vaccine into the UK schedule this year. METHODS: Prospective, active surveillance via the established British Paediatric Surveillance Unit (BPSU) was carried out from March 2008 to March 2009. Clinicians across 101 National Health Service (and equivalent) hospitals, including 27 paediatric surgical centres, reported cases admitted for intussusception in the UK and Republic of Ireland. The standard Brighton Collaboration case definition was used with only definite cases included for incidence estimation. RESULTS: The study response rate was 94.5% (379 questionnaires received out of 401 case notifications). A total of 250 definite cases of intussusception were identified. The annual incidence among infants in the UK and Republic of Ireland was 24.8 (95% CI: 21.7-28.2) and 24.2 (95% CI: 15.0-37.0) per 100,000 live births. In the UK, the highest incidence occurred in Northern Ireland (40.6, 95% CI: 21.0-70.8), followed by Scotland (28.7, 95% CI: 17.5-44.3), England (24.2, 95% CI: 20.9-27.9), then Wales (16.9, 95% CI: 6.8-34.8). In England, regional incidence was highest in London and lowest in the West Midlands. By age, the highest incidence (50.3/100,000 live births, 95% CI: 33.4-72.7) occurred in the fifth month of life (for England). A seasonal trend in the presentation of intussusception was observed with the incidence significantly (p=0.001) increased during winter and spring. CONCLUSION: The baseline rates obtained in this study will inform rotavirus vaccine-safety policy by enabling comparison with post-introduction incidence.

Incomplete immunisation uptake in infancy: maternal reasons.

We examined uptake of primary immunisations in infancy and the reasons given by mothers for either incompletely or not immunising their infants. We used data from the Millennium Cohort Study, a cohort of 18,819 infants born between September 2000 and January 2002 in the UK. 95.6% infants were reported to be fully immunised, 3.3% partially immunised and 1.1% unimmunised. Mothers most frequently cited medical reasons (45%) for partial immunisation (n=697), but beliefs or attitudes (47%) for no immunisation (n=228). An understanding of maternal reasons for incomplete immunisation status may assist in identifying appropriate interventions to maximise uptake.

Differences in risk factors for partial and no immunisation in the first year of life: prospective cohort study.

OBJECTIVE: To compare demographic, social, maternal, and infant related factors associated with partial immunisation and no immunisation in the first year of life in the United Kingdom. DESIGN: Prospective cohort study. SETTING: Sample of electoral wards in England, Wales, Scotland, and Northern Ireland, stratified by measures of ethnic composition and social disadvantage. PARTICIPANTS: 18,488 infants born between September 2000 and January 2002, resident in the UK and eligible to receive child benefit (a universal benefit available to all families) at age 9 months. MAIN OUTCOME MEASURE: Immunisation status at 9 months of age, defined as fully immunised, partially immunised, or not immunised. RESULTS: Overall in the UK, 3.3% of infants were partially immunised and 1.1% were unimmunised; these rates were highest in England (3.6% and 1.3%, respectively; P < 0.01). Residence in ethnic or disadvantaged wards, larger family size, lone or teenaged parenthood, maternal smoking in pregnancy, and admission to hospital by 9 months of age were independently associated with partial immunisation status. In contrast, a higher proportion of mothers of unimmunised infants were educated to degree level or above (1.9%), were older (3.1%), or were of black Caribbean ethnicity (4.7%). CONCLUSIONS: Mothers of unimmunised infants differ in terms of age and education from those of partially immunised infants. Interventions to reduce incomplete immunisation in infancy need different approaches.