Paediatric Epidemiology and Community Health: Research Interests
The range of research pursued by the Unit encompasses topics that are epidemiologically important throughout the early years of the human life cycle, i.e. from conception to adolescence. Some of the major studies currently being pursued are summarised below. A major new initiative has been to link the PEACH unit and paediatric research in the University of Glasgow more closely with the research needs and aspirations of NHS Greater Glasgow and its partners in Education and Social Work. This started as the PEACH Liaison Group which has become more generalised as the Children’s Services Research Group. From this group a full time post in the PEACH unit has been funded by the health board to research strategically important issues in their early stages prior to more substantive competitive grant funding. The idea of using local academics to evaluate new strategies is promising, but comes with a cost and timeline which may be challenging to health, social work and education.
(italics denote PEACH Unit staff)
Evaluation of health promotion initiatives to improve breastfeeding rates in Scotland using routinely collected data (Britten, Broadfoot, Tappin)
A paper has been published by Archives of Disease in Childhood describing the effect of the Baby Friendly Hospital Initiative on breastfeeding rates in Scottish Maternity Units. This work was funded by SPorts Aiding Research for Kids (SPARKS). A further paper describing the effect of Health Visitors on breastfeeding rates in Glasgow has been published by the International Breastfeeding Journal. More recently Unit members co-wrote a review of breastfeeding and also a paper describing the effectiveness of breastfeeding support groups in Scotland, both published in the BMJ in collaboration with Dr Pat Hoddinott and colleagues at Aberdeen University.
Epidemiological studies of injury and violence (Stone, Jeffrey, Pearson)
Trauma is the leading cause of death in childhood and adolescence in Europe. We contribute to its prevention through a series of studies on injury epidemiology in Glasgow (e.g. using CHIRPP – the Children’s Hospitals Injury Reporting and Prevention Programme), Scotland (in collaboration with ISD and others) and Europe (via the EU Injury Prevention Programme Network). We have recently focused particularly on gender and other factors that influence injury risk, and on time trends. Other components of our injury research and prevention work are described elsewhere in this report.
The public health challenge of road safety (Stone, Blamey, Sherriff, Fischbacher, Jeffrey, Hutchings)
An earlier evaluation of the impact of speed cameras on road casualties, funded by the Strathclyde Safety Camera Partnership, has led to a new and more ambitious study. Its aim is to evaluate the public health impact of a range of road safety measures in the Strathclyde Police Region. It includes both retrospective and prospective analyses of road casualties and employs various sources of traffic related injury data using epidemiological, geographical and sociological techniques. Sub-group analyses are being performed to compare the data across different age ranges, geographical locations and socio-economic categories. The results will be used to inform the forward planning of the road safety measures in Strathclyde and beyond. This is a collaborative study between a multidisciplinary group based at the University of Glasgow, Strathclyde Police and the Information Services Division of the Scottish NHS.
Epidemiology, natural history and prevention of congenital anomalies (Stone)
The Glasgow Register of Congenital Anomalies (operated by NHS Greater Glasgow and Clyde) is a rich source of data on the epidemiology of neural tube defects, trisomies and many other relatively common and disabling birth defects. Our ongoing studies in this field focus on epidemiology and natural history. These involve close collaboration with colleagues at NHSGGC (notably Mrs Hilary Jordan and Dr Patricia Sandham), the Information Services Division (ISD) of NHS Scotland, and colleagues in other registries around the British Isles (via the BINOCAR Network) and Europe (via the EUROCAT Network). Research in this area has recently been hampered by concerns relating to the Register’s compliance with the Data Protection Act. Efforts are currently underway to resolve these.
Translational research in child public health (Stone, Campbell, McClintock)
Funding has been secured from NHSGGC to establish a full time post of Research Fellow in Evidence Based Child Public Health. This pioneering experiment in translational child public health research arose in response to the growing recognition of the need to promote close collaboration between health board based child public health practitioners and planners, on the one hand, and academically oriented researchers on the other. The rationale for such a combined academic-service effort was to optimise the prospects of successfully addressing the major public health challenges confronting children and young people in Glasgow in the 21st century. The purpose of the new post is to stimulate translational research (TR) in child public health by providing a mechanism for ongoing, mutually beneficial collaborative working between the Paediatric Epidemiology and Community Health (PEACH) Unit of the University of Glasgow and NHSGGC. Its remit is to help generate relatively rapid responses to board requests for evidence based advice on child public health. The topics covered have been fairly wide-ranging. Two main themes have been addressed: child mental health and parenting/early years. There has been a substantial degree of overlap between the two.
The epidemiology and prevention of cot death (Tappin)
Cot death (Sudden Infant Death Syndrome) remains the leading cause of post-neonatal infant mortality despite the recent decline in the wake of the “Back to Sleep” campaign. A case-control study run by the Scottish Cot Death Trust, with which the Unit collaborates closely, continues to yield valuable new insights into some of the potentially avoidable factors (including smoking - see below) contributing to the causes of this deeply disturbing condition. The data have been published as a research article in the Journal of Pediatrics. The Department of Health, and the Scottish Office used these data to help update its leaflet ‘Reducing the Risks of Cot Death’. Presentation of this work continues.
Strategies for the avoidance of cigarette smoking in pregnancy and childhood (Tappin)
Dr Tappin spent a period of Academic Leave in 2005 working in the department of Professor Judith Lumley in Melbourne, Australia. After examining recorded interviews with pregnant smokers from the SmokeChange study supervised by Dr Jeanne Daly, this led to a project: ‘Smoking and Pregnancy: The experiences of women trying to quit’ with Dr Bauld from Urban Studies, University of Glasgow. This has been funded by a grant from the Public Health Resource Unit of NHSGGC. Papers have been published in Midwifery on behalf of the CATCH study in Paisley and the BREATHE service in Glasgow. Dr Tappin has provided the routine data analysis with Dr Deborah Shipton for a ‘Mapping of Smoking Cessation Services for Pregnant Women’ funded by NHS Health Scotland. Dr Shipton led a group with Dr Chalmers, ISD, and Drs Aitken and Crossley to establish how accurately women reported their smoking habit when asked at maternity booking, funded by Glasgow Centre for Population Health and published in the BMJ. Dr Tappin is leading a group which includes members of the UK Centre for Tobacco Control Studies (Bauld, MacAskill), the Robertson Centre for Biostatistics (McConnachie, Norrie), the Director of Glasgow Centre for Population Health (Professor Tannahill), the Director of Public Health, NHSGGC (Dr de Caestecker) and Tayside Health Board (Dr Radley) to use clinical trial methodology to determine whether incentives paid to pregnant smokers for quitting will increase engagement with specialist services and lead to increased cessation during pregnancy.
Smoking cessation for parents of children who attend respiratory clinics (Tappin)
Dr Steven Turner, Senior Lecturer in Respiratory Paediatrics at the University of Aberdeen, is developing a specialist nurse intervention to help parents of children with respiratory disease to stop smoking. A paper has been published in the Archives of Disease in Childhood describing this pilot work. Collaboration with Dr J Paton, University of Glasgow, and Brenda Friel, NHSGGC aims to reduce second hand smoke exposure among parents of children referred to respiratory clinics in Glasgow using early phase clinical trial methodology.
Services to families of children with encopresis and enuresis (Tappin)
Although encopresis (soiling), nocturnal enuresis (bedwetting) and diurnal enuresis (daywetting) are three of the most distressing and common disorders of childhood, research into their aetiology and clinical management has been minimal. Utilising the Unit’s links with community child health services, we have undertaken a series of action research projects designed to provide and evaluate support for affected children and their families. So far, services for night wetting are established for Glasgow children run by school nurses in conjunction with outreach general paediatric clinics. Nurse-led day wetting services are also run by specialist nurses linked to urology, renal medicine and outreach general paediatric clinics. Grants from the Psychology Department East CHSP and the Yorkhill Children’s Foundation fund Dr Tappin to lead a group who employ a research psychologist, Dr Shazia Nawaz, supported by Dr Peter Griffiths to produce a package of care for a nurse-led service for children with constipation and soiling. A full-time nurse is being trained to provide a psychological model of care. Further grant applications and service development will follow.
Fetal Alcohol Syndrome (Tappin, Stone)
Fetal Alcohol Syndrome is the commonest cause of birth defects and mental retardation. Dr Saeed Dastgiri, a visiting postdoctoral researcher from Iran, performed a systematic review of the epidemiology of this difficult problem during 2009. A group of academics has met and will put forward a proposal to measure the prevalence of significant alcohol intake during the second trimester of pregnancy using anonymised routinely collected residual serum samples.
Gateshead Millennium Study (Wright, Reilly, Adamson, Le-Couteur, Minnis, Young, Sherriff, McColl, Cox, Villoria)
This is a prospective population based study of feeding and growth. The study recruited 1029 babies in 1999-2000 shortly after birth, between and then studied them via parental and staff questionnaires to the age of 30 months. The main purpose was to study feeding behaviour from birth and relate this to growth, as well as exploring the influence of social deprivation, maternal well-being and child temperament. In 2006, after the subjects had all entered school funding was obtained from a consortium headed by the MRC to undertake an extensive follow-up of the whole cohort in 2006/2007 looking at body composition, activity and diet, and the data collection was completed in December 2007. As well as supporting staff in Newcastle, there was also funding to support statistical work in Glasgow, and Maria Villoria was recruited in 2007 to work on the data as an MRes student in the Department of Statistics. With CSO funding, Marie Cox joined the unit in 2007 to use data from the infancy phase to develop a new infancy feeding and eating assessment scale. The first papers from this wave are now beginning to appear.
(Wright, Puckering, Gumley) Joanne Robertson, a Clinical Psychology student, analysed feeding videos from the cohort, using the Mellow Parenting assessment method as part of her doctoral thesis and found important differences were found between weight faltering and normal infants. In 2007 further work has been done on the videos by medical student Patrick Hughes to develop an observational measure of infant feeding and this will be tested on the cohort by a further Clinical Psychology doctoral student in 2009-10.
MRC West of Scotland 11/16 Study (Sweeting, Wright)
This is a joint MRC PhD studentship using subjects from this long-standing cohort to explore factors that lead teenagers to become fat or slim down. Emily Smith, a PhD student, undertook a qualitative study of factors related to weight loss and gain in obese or formerly obese members of the cohort, now aged 22 years. She has completed data collection and is now writing up.
Weaning children from enteral feeding (Wright, Smith, Morrison)
This is a detailed audit of a rare case series of children referred for weaning from long term enteral feeding to the tertiary multidisciplinary feeding clinic at Yorkhill. These findings from this were presented as a poster at the European Society of Clinical Nutrition meeting in Florence in September 2008 and a paper has been submitted to Archives of Disease in Childhood.
UK-WHO growth charts (Wright, Haines)
The Royal College of Paediatrics and Child Health appointed Professor Wright as academic lead for a DH funded project to design and implement new growth charts for children aged 0-4 years based on WHO data, working on the project one day per week for a year from April 2008. Working with a team of experts from across the UK, the charts were designed and evaluated using mixed quantitative and qualitative methods. These revealed that growth charts are complex clinical tools which are, at present, poorly understood and inconsistently used. The new charts were launched in May 2009 in England and January 1st 2010 in Scotland. Hundreds of thousands of the charts have already been issued and they are also to be adopted in New Zealand. Through the process of designing the charts and writing evidence-based instructions, the importance of clear rules and formal training has been recognised and translated into a wide range of supporting educational materials (free to download at www.growthcharts.rcpch.ac.uk). Further work to design more charts for older children is planned for 2010.
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