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1.
PLoS One ; 18(5): e0285375, 2023.
Article in English | MEDLINE | ID: covidwho-20233496

ABSTRACT

UK 'Lockdown' measures introduced in March 2020 aimed to mitigate the spread of COVID-19. Although seeking healthcare was still permitted within restrictions, paediatric emergency department attendances reduced dramatically and led to concern over risks caused by delayed presentation. Our aim was to gain insight into healthcare decisions faced by parents during the first wave of the COVID-19 pandemic and to understand if use of urgent healthcare, self-care, and information needs differed during lockdown as well as how parents perceived risks of COVID-19. We undertook qualitative telephone interviews with a purposive sample of parents living in the North East of England recruited through online advertising. We used a semi-structured interview schedule to explore past and current healthcare use, perceptions of risk and the impact of the pandemic on healthcare decisions. Interviews were transcribed and analysed using Thematic Analysis. Three major themes were identified which concerned (i) how parents made sense of risks posed to, and by their children, (ii) understanding information regarding health services and (iii) attempting to make the right decision. These themes contribute to the understanding of the initial impact of COVID-19 and associated restrictions on parental decisions about urgent healthcare for children. These findings are important to consider when planning for potential future public health emergencies but also in the wider context of encouraging appropriate use of urgent healthcare.


Subject(s)
COVID-19 , Emergency Medical Services , Child , Humans , COVID-19/epidemiology , Pandemics , Communicable Disease Control , United Kingdom/epidemiology , Parents
2.
Int J Environ Res Public Health ; 20(2)2023 Jan 12.
Article in English | MEDLINE | ID: covidwho-2215994

ABSTRACT

Refugees and asylum seekers residing in the UK face multiple barriers to accessing healthcare. A Health Access Card information resource was launched in Newcastle upon Tyne in 2019 by Newcastle City Council, intended to guide refugees and asylum seekers living in the city, and the professional organisations that support them, to appropriate healthcare services provided locally. The aim of this qualitative evaluation was to explore service user and professional experiences of healthcare access and utilisation in Newcastle and perspectives on the Health Access Card. Eleven semi-structured interviews took place between February 2020 and March 2021. Participants provided diverse and compelling accounts of healthcare experiences and described cultural, financial and institutional barriers to care. Opportunities to improve healthcare access for these population groups included offering more bespoke support, additional language support, delivering training and education to healthcare professionals and reviewing the local support landscape to maximise the impact of collaboration and cross-sector working. Opportunities to improve the Health Access Card were also described, and these included providing translated versions and exploring the possibility of developing an accompanying digital resource.


Subject(s)
Refugees , Humans , Qualitative Research , Health Services Accessibility , Health Services , England
3.
BMJ Open ; 12(12): e066963, 2022 12 12.
Article in English | MEDLINE | ID: covidwho-2161867

ABSTRACT

OBJECTIVES: To review the evidence on how pregnancy, birth experience, breast feeding, parental responsiveness and sensitivity, and bonding and attunement were impacted by COVID-19. METHODS: We searched eight literature databases and websites of relevant UK-based organisations. The review focused on evidence during pregnancy and the early years (0-5 years). Studies of any study design published in English from 1 March 2020 to 15 March 2021 and conducted in high-income countries were included. Screening and data extraction were undertaken in duplicate. Evidence was synthesised using a narrative approach. Study quality of included studies was assessed using the Mixed Methods Appraisal Tool. RESULTS: The search yielded 9776 publications, of which 26 met our inclusion criteria. Significant knowledge gaps on how COVID-19 affected pregnancy and breast feeding limited healthcare providers' ability to provide consistent evidence-based information and care at the start of the pandemic. There was an enduring sense of loss about loved ones being restricted from taking part in key moments. Parents were concerned about the limitations of virtual healthcare provision. Some parents reported more opportunities for responsive breast feeding and improved parent-infant bonding due to reduced social and work pressures. Women from minoritised ethnic groups were less likely to continue breast feeding and attributed this to a lack of face-to-face support. CONCLUSIONS: The evidence suggests that new and expectant families have been both negatively and positively impacted by the COVID-19 pandemic and the resulting restrictions. The impacts on parents' opportunities to bond with their young children and to be attuned to their needs were felt unequally. It is important that emergency response policies consider the mother and the partner as a family unit when making changes to the delivery of maternal and child health and care services, so as to mitigate the impact on the family and existing health inequalities. PROSPERO REGISTRATION NUMBER: CRD42021236769.


Subject(s)
COVID-19 , Pandemics , Child , Pregnancy , Female , Humans , Child, Preschool , Breast Feeding , Developed Countries , COVID-19/epidemiology , Parents , Mothers
4.
Archives of Disease in Childhood ; 107(Suppl 2):A4, 2022.
Article in English | ProQuest Central | ID: covidwho-2019810

ABSTRACT

AimsIn March 2020 the World Health Organisation declared COVID-19 as a global pandemic. At this time the UK’s healthcare services were becoming overwhelmed. To relieve the pressures the government initiated the first ever ‘lockdown’, the key message being ‘Stay home, Protect the NHS, Save Lives’.Although seeking healthcare was still permitted, there was an alarming reduction in the number of attendances to paediatric accident and emergency units. The Royal College of Paediatrics and Child Health expressed concern in relation to delayed presentation, identifying nine deaths across the UK where delay was a potential factor.We aimed to describe parents’ decision-making regarding use of children’s urgent healthcare services during the first wave of COVID-19 and the experience of those who had accessed services.MethodsThe study was in two phases: 1) Parents were invited, via online platforms, to complete an online survey which collected demographic data and responses about use of, and attitudes towards, accessing urgent paediatric healthcare during the pandemic. 2) A purposive sample of survey respondents were invited to take part in a telephone interview, where a semi-structured topic guide was used to further explore experiences and views. Interviews were recorded, transcribed, and analysed according to principles of Thematic Analysis.ResultsIn total 121 parents responded to the online survey, in order to obtain maximum variation we purposely sampled, 21 were then interviewed. The largest represented age group was 35-39 years, with most families having 2 children.When asked if COVID-19 impacted their decision around the use of emergency departments, 8 (38.1%) replied yes, 11 (52.5%) replied no and 2 (9.5%) responses were missing.The interviews identified three main themes: i) Making sense of risks: Parents differentiated between the risk to the child of contracting COVID-19 in the emergency department (ED) and the potential risk of viral transmission from the child to the wider community;it was the latter that commonly took precedence. Most regarded the risk to their child from COVID-19 as small.(ii) Understanding information regarding health service availability: Many parents understood that emergency services were accessible throughout, however some inferred ‘protect the NHS’ meant they should not be used. Parents cited that the overwhelming amount of information and resources available often lead to dissemination of misinformation and made identifying correct guidance difficult.(iii) Attempting to make the right decision: Parents stated it was a perpetual struggle between managing risks and acting within the ‘rules’. They were acutely aware of not applying unnecessary pressure on an already stretched NHS but most stated that ultimately their primary concern would be their childrens’ health.ConclusionThe data provides a real time snapshot of parental views on seeking emergency healthcare for children during the early stages of the pandemic. Our insights into parental decision-making help to explain part of the reduction in ED attendance. This work could be used to formulate future messages and improve communication from governmental and local bodies to the public during public health emergencies. Post-pandemic this may contribute to initiatives encouraging the appropriate use of urgent healthcare.

5.
BMJ Open ; 12(7), 2022.
Article in English | ProQuest Central | ID: covidwho-1950196

ABSTRACT

ObjectiveTo survey parents and carers of children with a congenital anomaly across Europe about their experiences of healthcare services and support during the COVID-19 pandemic.DesignCross-sectional study.SettingOnline survey in 10 European countries, open from 8 March 2021 to 14 July 2021.Population1070 parents and carers of children aged 0–10 years with a cleft lip, spina bifida, congenital heart defect (CHD) requiring surgery and/or Down syndrome.Main outcome measuresParental views about: the provision of care for their child (cancellation/postponement of appointments, virtual appointments, access to medication), the impact of disruptions to healthcare on their child’s health and well-being, and satisfaction with support from medical sources, organisations and close relationships.ResultsDisruptions to healthcare appointments were significantly higher (p<0.001) in the UK and Poland, with approximately two-thirds of participants reporting ‘cancelled or postponed’ tests (67/101;256/389) and procedures compared with approximately 20% in Germany (13/74) and Belgium/Netherlands (11/55). A third of participants in the UK and Poland reported ‘cancelled or postponed’ surgeries (22/72;98/266) compared with only 8% in Germany (5/64). In Poland, 43% (136/314) of parents reported that changes to their child’s ongoing treatment had moderately to severely affected their child’s health, significantly higher than all other countries (p<0.001). Satisfaction ratings for support from general practitioners were lowest in the UK and Poland, and lowest in Poland and Italy for specialist doctors and nurses.ConclusionA large proportion of participants reported disruptions to healthcare during the pandemic, which for some had a significant impact on their child’s health. Regional differences in disruptions raise questions about the competence of certain healthcare systems to meet the needs of this vulnerable group of patients and indicate improvements should be strived for in some regions.

6.
BMJ Open ; 11(8): e048180, 2021 08 26.
Article in English | MEDLINE | ID: covidwho-1376499

ABSTRACT

INTRODUCTION: Since the global financial crises of 2008, there has been a rise in the number of people experiencing food insecurity. The COVID-19 pandemic has exacerbated this. Many more are unable to afford or access food of sufficient quality and quantity to enable good health and well-being. Particularly vulnerable are mothers with young children, pregnant women and lone parents (the majority of whom are women). This review aims to understand experiences of food insecurity and how it affects women and children's nutritional health and well-being, focusing on experiences explicitly related to nutrition. Findings will help guide health policy and practice to support food-insecure women and children from high-income countries. METHODS AND ANALYSIS: A systematic review and meta-ethnography exploring (1) food-insecure women's own accounts of their nutritional health and (2) food-insecure household's accounts of their children's nutritional health. Six major databases (MEDLINE, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), grey literature databases and relevant stakeholder websites will be searched from 1 January 2008 to 30 March 2021. Reference list and citation searches will supplement electronic database searches. Outcomes of interest are accounts of nutrition and nutritional health, including diet, food practices, infant feeding practices and physical and mental health. The review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol guidelines, but as this is a meta-ethnography it will adhere to eMERGe Reporting Guidance for synthesis and writing findings of the final report. Critical Appraisal Skills Programme qualitative checklist will assess the quality of studies. A meta-ethnographic analysis will be conducted for all included studies. ETHICS AND DISSEMINATION: As a qualitative systematic review, without primary data collection, ethical approval will not be required. Findings will be submitted for peer-reviewed publication. PROSPERO REGISTRATION NUMBER: CRD42020214159.


Subject(s)
COVID-19 , Food Insecurity , Child , Child, Preschool , Developed Countries , Female , Humans , Infant , Male , Meta-Analysis as Topic , Pandemics , Pregnancy , SARS-CoV-2 , Systematic Reviews as Topic
7.
BMJ Open ; 11(3): e042753, 2021 03 15.
Article in English | MEDLINE | ID: covidwho-1136082

ABSTRACT

OBJECTIVE: There has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant impacts on the life chances of children. The objective of this review was to understand the association between individual-level and household-level measures of socioeconomic status and adverse pregnancy outcomes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Nine databases were searched (Medline, Embase, Scopus, ASSIA, CINAHL, PsycINFO, BNI, MIDRIS and Google Scholar) for articles published between 1999 and August 2019. Grey literature searches were also assessed. STUDY SELECTION CRITERIA: Studies reporting associations between individual-level or household socioeconomic factors on pregnancy outcomes in the UK or Ireland. RESULTS: Among the 82 353 search results, 53 821 titles were identified and 35 unique studies met the eligibility criteria. Outcomes reported were neonatal, perinatal and maternal mortality, preterm birth, birth weight and mode of delivery. Pooled effect sizes were calculated using random-effects meta-analysis. There were significantly increased odds of women from lower levels of occupation/social classes compared with the highest level having stillbirth (OR 1.40, 95% CI 1.23 to 1.59, I298.62%), neonatal mortality (OR 1.39, 95% CI 1.22 to 1.57, I297.09%), perinatal mortality (OR 1.39, 95% CI 1.23 to 1.57, I298.69%), preterm birth (OR 1.41, 95% CI 1.33 to 1.50, I270.97%) and low birth weight (OR 1.40, 95% CI 1.19 to 1.61, I299.85%). Limitations relate to available data, unmeasured confounders and the small number of studies for some outcomes. CONCLUSIONS: This review identified consistent evidence that lower occupational status, especially manual occupations and unemployment, were significantly associated with increased risk of multiple adverse pregnancy outcomes. Strategies to improve pregnancy outcomes should incorporate approaches that address wider determinants of health to provide women and families with the best chances of having a healthy pregnancy and baby and to decrease pregnancy-related health inequalities in the general population. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019140893.


Subject(s)
Pregnancy Outcome , Premature Birth , Child , Female , Humans , Infant , Infant, Newborn , Ireland/epidemiology , Pregnancy , Pregnancy Outcome/epidemiology , Premature Birth/epidemiology , Socioeconomic Factors , United Kingdom/epidemiology
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