Data linkage and pain medication in people with cerebral palsy: a cross-sectional study.

AIM: To explore data linkage and pain medication as a proxy for pain, to assess differences in pain medication between the cerebral palsy (CP) and the general populations, and to identify factors associated with pain medication in CP. METHOD: This cross-sectional study linked the Northern Ireland CP Register and two administrative health care databases for people resident in Northern Ireland born between 1981 and 2008. Pain medication as a proxy was validated by replicating analyses from the Study of Participation of Children with Cerebral Palsy Living in Europe (SPARCLE) studies. Logistic regression compared pain medication in the CP and general populations. Multi-level regression models assessed factors associated with pain medication in the CP cohort. RESULTS: The sample size was 701 075, of whom 1430 (0.2%) were people with CP. There were 358 969 males and 340 677 females in the general population, and 810 males and 620 females in the CP population, with an age range of 4 to 31 years in both groups. The validation exercise produced results similar to the SPARCLE studies. More people with CP received pain medication (61% vs 50.9%) and had twice the odds of being prescribed opioid analgesics (odds ratio [OR]=2.81, 95% confidence interval [CI] 2.32-3.40). Among those with CP, the odds of being prescribed pain medication were higher for: females (OR=1.34, 95% CI 1.06-1.70), younger age (OR=1.60, 95% CI 1.02-2.51), Gross Motor Function Classification System level V (OR=2.60, 95% CI 1.52-4.47), seizures (OR=2.55, 95% CI 1.68-3.87), and higher deprivation score (OR=2.06, 95% CI 1.41-3.24). INTERPRETATION: Pain medication is an effective proxy for pain. More people with CP were prescribed pain medication than the general population. Pain medication for people with CP is not only dependent on physiological and clinical characteristics, but also environmental factors. What this paper adds Data linkage using pain medication as a proxy for experiencing pain is a valid method. People with cerebral palsy (CP) are more likely to experience pain than the general population. People with CP have over twice the odds of receiving opioids compared to the general population. The odds of being prescribed pain medication were higher for females with CP. Prescription of pain medication among those with CP is not only dependent on clinical characteristics, but also environmental factors.

Adolescent condom use in Southern Africa: narrative systematic review and conceptual model of multilevel barriers and facilitators.

BACKGROUND: Adolescent HIV and pregnancy rates in Southern Africa are amongst the highest in the world. Despite decades of sexual and reproductive health (SRH) programming targeting adolescents, recent trends suggest there is a continued need for interventions targeting condom use for this age group. METHODS: This review synthesises evidence from qualitative studies that describe the determinants of condom use among adolescents in Southern Africa. We conducted systematic searches in four databases. Data were extracted, appraised for quality and analysed using a 'best-fit' framework synthesis approach. RESULTS: We coded deductively findings from 23 original studies using an a priori framework and subsequently conducted thematic analysis. Synthesised findings produced six key themes relating to: 1) pervasive unequal gender norms and restrictive masculinities favouring male sexual decision-making and stigmatising condom use in committed relationships; 2) other social norms reflecting negative constructions of adolescent sexuality and non-traditional family planning; 3) economic and political barriers including poverty and a lack of policy support for condom use; 4) service-level barriers including a lack of youth-friendly SRH services and comprehensive sex education in schools; 5) interpersonal barriers and facilitators including unequal power dynamics in sexual partnerships, peer influences and encouraging condoning condom use, and inadequate communication about SRH from parents/caregivers; and 6) negative attitudes and beliefs about condoms and condom use among adolescents. A conceptual model was generated to describe determinants of condom use, illustrating individual-, interpersonal- and structural-level barriers and facilitating factors. CONCLUSION: SRH programming targeting barriers and facilitators of condom use at multiple levels is recommended in Southern Africa. We present a multilevel integrated model of barriers and facilitators to guide adolescent SRH decision-making, programme planning and evaluation. Given the existence of multilevel barriers and facilitators, interventions should, likewise, take a multilevel approach that incorporates locally relevant understanding of the individual-, interpersonal- and structural-level barriers and facilitators to condom use among adolescents in the region.

The importance of social environment in preventing smoking: an analysis of the Dead Cool intervention.

BACKGROUND: An adolescent's perceptions of their family's and friends' smoking attitudes and behaviour can influence their own uptake of smoking. There are two broad sources of such social influence: observing the behaviour directly, and assimilating attitudes. METHODS: We analysed data collected for the evaluation of Dead Cool, a school based smoking prevention intervention in Northern Ireland (n=480 in 20 clusters). The main analysis fits three nested logistic regression models predicting pre-intervention susceptibility to taking up smoking, as reflected in responses to three attitudinal questions. Model 1 includes only personal characteristics as explanatory factors. Model 2 adds the behaviour of friends and family that would provide an opportunity for social influence through observational learning. Model 3 adds the susceptibility of friends. RESULTS: Each additional group of variables improved the model fit (with reduced AIC and BIC). However, in the final model, only three variables were found to be statistically significant (p<0.05) in predicting susceptibility to smoking initiation: rebelliousness (OR [1.1,1.3]) from the personal characteristics group; and, in the observational learning group, being friends with a smoker (OR [1.0,2.9]) and frequency of being in the same room or car with someone smoking (OR [2.0,9.0] for most frequent). Adding the two measures of diffusion of susceptibility through the friendship network improved the model fit, but neither was found to be statistically significant. CONCLUSIONS: The analysis provides additional evidence to support policies that could reduce children's exposure to smoking behaviour, and potential subsequent smoking initiation. No conclusions could be drawn about the diffusion of smoking attitudes through the school friendship networks of children.

Scoping systematic review on the extent, nature and quality of evidence underlying ophthalmic and paraophthalmic education.

BACKGROUND: Effective education of relevant professionals underpins provision of quality eye healthcare. OBJECTIVES: This scoping systematic review had 2 aims: first to investigate the extent and nature of scholarly output published on ophthalmic and paraophthalmic education, and second to focus on the quality of reporting of randomised controlled trials (RCTs) identified. STUDY SELECTION: A search strategy was created and applied to PubMed. Any scholarly publications on any aspect of education of those involved in the care of patients with visual problems as the main theme or context was selected. Predefined data were extracted. FINDINGS: Of 255 studies included, the most common type of scholarly publications were descriptions of an educational innovation, opinion pieces and descriptive studies. RCTs made up 5.5% of the sample. Most of the 14 RCTs failed to report most of the items recommended in the CONSORT guidelines. CONCLUSIONS: This review highlights the need for investigators, ethical committees and journals to insist on a better quality of RCT conduct than is presently apparent, but also that clinicians should not be blind to the strengths of non-RCT-based studies in the field of education.

Video-based interventions promoting social behavioural skills for autistic children and young people: An evidence and gap map.

Background: Video-based interventions (VBIs) are an approach that can be used to promote social behavioural skills for autistic children and young people. Despite an abundance of literature in this area, previous evidence syntheses are limited by their exclusive search strategies and eligibility criteria. Therefore, there is a lack of comprehensive evidence syntheses to provide insight on whether these interventions work, for whom, and in what circumstances. Evidence and Gap Maps (EGMs) are used to collate vast literature on a broad topic area such as this, highlighting areas for synthesis, and identifying gaps for future research. Objectives: To identify, map and synthesise existing primary research on VBIs promoting social behavioural skills for autistic children and young people, creating a live, searchable and publicly available EGM. Search Methods: Searches were conducted in electronic databases (n = 8), web search engines, and other repositories including published papers and grey literature. The search strategy was developed around two concepts including (1) terms related to autism, and (2) terms related to VBIs. Searches were conducted in May 2021. Selection Criteria: All primary studies evaluating the effectiveness of VBIs in promoting social behaviours for autistic children and young people aged 3-18 were included in the EGM. Data Collection and Analysis: Search results were imported into Eppi-Reviewer where duplicates of identical studies were removed. Titles and abstracts were then screened by two independent reviewers. Potentially eligible full texts were located and also screened by two reviewers. Data were then extracted on study design, participant characteristics, type of intervention, type of outcome, and country of study, by one of three reviewers. EPPI-Mapper was used to create the interactive EGM. Main Results: The current EGM contains 438 studies reporting on 394 single subject research designs, 25 randomised controlled trials, 15 non-randomised group designs, and 8 pretest-posttest designs. Included studies evaluated VBIs in all male (n = 238), mixed gender (n = 172) or all female (n = 17) samples. VBIs employed included video modelling (n = 273), video self-modelling (n = 82), point-of-view modelling (n = 61), video prompting (n = 57), video feedback (n = 12) and computer-based video instruction (n = 4). The most frequently used models were adults (n = 191) and peers (n = 135). In relation to social outcomes, almost half evaluated social engagement (n = 199) with limited studies looking at safety (n = 9) and community (n = 7) skills. Authors' Conclusions: This EGM provides a valuable resource for policy-makers, practitioners, researchers, funders and members of the public to access evidence on VBIs promoting social behavioural skills in autistic children and young people. The map has identified areas of sufficient research where evidence can undergo synthesis. In addition, important gaps in the evidence were highlighted and suggest further research is warranted in all female samples and less frequently evaluated types of VBIs and social outcomes. Evidence included in this EGM will be further explored via systematic review and meta-analysis on control group designs.

PROTOCOL: Video-based interventions for promoting positive social behaviour in children with autism spectrum disorders: a systematic review and meta-analysis.

This is the protocol for a Campbell review. The primary objective for this review is summarising the effectiveness of video-based interventions (VBI) in promoting prosocial behaviours in a population of young people with autism spectrum disorders (ASD). The research questions employed to fulfil this objective include: (1) Do VBI improve prosocial behaviours in children with ASD? (2) Which social skills and interactive behaviours are most successful? (3) Do VBI generally have successful rates of skill generalisation and response maintenance? (4) Do demographic characteristics (age, gender) of participants influence the effectiveness of VBI's?

Adaptation of a gender-transformative sexual and reproductive health intervention for adolescent boys in South Africa and Lesotho using intervention mapping.

Background: Rates of adolescent HIV and unintended pregnancy in southern Africa are amongst the highest in the world. Gender-transformative interventions that address underlying gender inequalities and engage both males and females have been emphasised by the World Health Organisation, amongst others, to target prevention. However, few such gender-transformative interventions have been rigorously developed or evaluated.Objective: To expedite potential impact and reduce development costs, we conducted a needs assessment to inform the co-design, in consultation with local stakeholders, of adapted versions of an existing gender-transformative Relationships and Sexuality Education intervention for use in South Africa and Lesotho.Methods: Adaptation of the intervention was guided by a modified version of Intervention Mapping (IM). This process involved consultation with separate adolescent, community and expert advisory groups and a collaboratively conducted needs assessment, which drew on focus groups with adolescents (8 groups, n = 55) and adults (4 groups, n = 22) in South Africa and Lesotho, and was informed by our systematic review of the literature on the determinants of condom use among adolescents in the region.Results: The findings clarified how the intervention should be adapted, which individual- and environmental-level determinants of condom use to target, and actions for facilitating successful adoption, evaluation and implementation in the new settings.Conclusions: The IM approach allows for a systematic appraisal of whether components and processes of an existing intervention are appropriate for a new target population before costly evaluation studies are conducted. The findings will be of interest to those wishing to rigourously develop and evaluate gender-transformative interventions engaging men to improve health for all.

Peer tutoring in reading: the effects of role and organization on two dimensions of self-esteem.

BACKGROUND: Paired reading (PR) is an application of peer tutoring. It has been extensively researched, and its efficacy across a range of outcomes has been established. Benefits include improvements in key reading skills, and also in affective aspects of learning. Several studies have shown gains in self-esteem, although measurement methods have varied, and the model of self-esteem has rarely been clearly articulated. AIMS: To investigate the changes in self-esteem of children participating in a randomized trial of PR over a 15-week treatment period. To investigate the relative contribution of self-worth and self-competence to any gains in self-esteem. To investigate whether the pattern of change differs in children who take on different roles in the PR process. PARTICIPANTS: The participants comprised a subset of a large-scale randomized trial of peer learning (The Fife Peer Learning Project). Four schools were randomly selected from schools allocated to the same-age PR condition, and four schools from those allocated to the cross-age PR condition. The same-age group consisted of 87 primary 6 children (10-11 years old). The cross-age group consisted of 81 primary 6 children. The controls, from schools randomly selected from a neighbouring authority, consisted of 92 primary 6 children. METHOD: A pre-post design employing self-report measures of self-esteem. Rosenberg's Self-Esteem Scale was used, with scores analysed for worth and competence. The treatment period was 15 weeks, with the participants following a prescribed PR process. RESULTS: Significant pre-post gains were noted in self-esteem, driven predominantly by improved beliefs about competence, in both same-age and cross-age conditions, but not for controls. Gains were also seen in self-worth in the cross-age condition. Further analyses of the influence of organizational condition (same-age or cross-age) and role played (tutor vs. tutee) showed significant differences between same-age tutors and cross-age tutors in relation to self-worth. Effect sizes were generally small or moderate. CONCLUSIONS: The findings provide further support for the belief that PR can enhance self-esteem. Importantly, the use of a two-dimensional model provides extra information about self-perceptions in PR contexts: first, the central role of self-competence; and second, the gains in self-worth which are associated with tutoring younger children (but not same-age peers). This new information has educational significance for schools considering the potential of peer tutoring and the benefits of different organizational conditions.