Parent-child conversations associated with alcohol-related risk behaviours in young people (13-17 years) in the UK: a cross-sectional study.

OBJECTIVE: To investigate different types of parent-child conversations associated with young people's (13-17 years) alcohol-related risk behaviours. DESIGN: Secondary analysis of the 2016 Drinkaware Monitor Survey. This survey employed a cross-sectional design and collected data using self-completion questionnaires. SETTING: UK-wide. PARTICIPANTS: 561 parent-child pairs were included in the analysis. The nationally representative quota sample was weighted by reference to the UK population. METHODOLOGY: Data were analysed using purposeful selection modelling (adjusted OR (AOR), 95% CIs). RISK BEHAVIOURS: 'Whether have ever drank' and 'whether vomited as a result of alcohol'. RESULTS: 50% (277/553) of young people reported drinking a whole alcoholic drink, and 22% (60/277) of these experienced vomiting as a result. After adjusting for age and gender, the likelihood of ever having drank alcohol was significantly increased among the following young people: those whose parents believed they knew a little about how much they drink (AOR 1.80, 95% CI 1.04 to 3.13) or that some/most/all friends drink (AOR 3.82, 95% CI 2.40 to 6.08); those given gentle reminders about taking care when drinking alcohol (AOR 1.82, 95% CI 1.15 to 2.88), practical advice (AOR 2.09, 95% CI 1.20 to 3.64) or designated time, led by the parent, to instil care around alcohol through a formal sit-down (AOR 1.79, 95% CI 1.07 to 2.99). The likelihood was reduced for parents aged 40-49 years (AOR 0.52, 95% CI 0.31 to 0.89) and conversations providing information (AOR 0.53, 95% CI 0.29 to 0.98). Vomiting was significantly associated with some/most/all friends drinking alcohol (AOR 3.65, 95% CI 1.08 to 12.30), parent's beliefs about child's frequency of drinking alcohol (AOR 1.26, 95% CI 1.02 to 1.54), parental harmful/dependency drinking (AOR 3.75, 95% CI 1.13 to 12.50) and having a formal sit-down conversation (AOR 2.15, 95% CI 0.99 to 4.66). CONCLUSIONS: We found evidence of mostly negative associations between young people's risk behaviours and different types of parent-child conversations. Conversations providing information were linked to a reduced tendency to have ever drunk alcohol. All other types of conversations were negatively associated with risk behaviours. Psychological reactance and conversation quality possibly explain these findings.

Development and validation of the Children's Competence in Decision-Making Scale.

BACKGROUND: Measuring competence in children's ability to make decisions about their care is laden with conceptual problems. Although there are a variety of tools to measure competence, no scales have been identified that measured competence in children. AIM: To develop, test and validate a scale that measured competence in the decision-making process of children aged 8-12 years with long-term conditions, called the Children's Competence in Decision-Making (CCD-M) Scale. METHOD: A convergent, sequential, mixed-methods validation design was used. Four stages of scale development were used following recommended procedures. The qualitative arm explored the experiences of being involved in decision-making and these insights were used to develop the scale which was then subject to psychometric testing. RESULTS: Cronbach's α of the overall scale was 0.86, which shows good internal validity. Additionally, the α analysis when items were deleted showed no considerable variation and had no value below 0.7, showing excellent internal validity throughout. No substantial increase in α could be achieved. CONCLUSION: The CCD-M Scale offers practitioners the ability to test the competence levels of children to decide the extent to which they may want to be involved in the decision-making process. This, in turn, may help to plan care in a more effective way and may have an effect on adherence levels in self-management of illness.

A meta-analysis of sodium profiling techniques and the impact on intradialytic hypotension.

Introduction Hemodialysis has improved in recent years, however, despite such improvements, intra-dialytic hypotensive episodes still persist which can lead to a reduction in the overall effectiveness of the treatment. Profiling sodium levels during dialysis can improve vascular refilling and therefore may prevent hypotensive events. A number of profiling methods exist and this meta-analysis set out to examine the effectiveness of these methods. Methods To assess the effectiveness of hemodialysis sodium profiling techniques. A review and meta-analysis analytical framework was used. A search was conducted using Medline, Embase and CINAHL, Scopus and Web of Knowledge between 1946 and 2014 of published English-language peer reviewed randomized control studies. In total 10 articles were retrieved and included in the review. All data was abstracted with a standardized data collection form. Stata 11.2 (Stata Corp) was used to analyse the data. Actual numbers of hypotensive events were pooled between studies. Analysis of subgroups was performed on sodium profile type. The data were further investigated using meta-regression. Publication bias was also tested. Findings Stepwise profiling was shown to be statistically significantly effective in reducing intradialytic episodes. Results demonstrated that linear sodium profiling was not effective in reducing hypotensive events during dialysis. Discussion This review has shown that using stepwise profiling is more effective at reducing intra-dialytic symptoms than other profiling methods. There was no evidence that linear profiling method was any more effective than conventional dialysis and in fact the results showed the reverse.

Comparison of Kt/V and urea reduction ratio in measuring dialysis adequacy in paediatric haemodialysis in England.

BACKGROUND: The National Kidney Foundation-Dialysis Outcomes Quality Initiative (KDOQI) guidelines and the Renal Association recommend the use of either Kt/V or urea reduction ratio (URR) to measure haemodialysis adequacy. OBJECTIVES: To determine the methods used to measure paediatric haemodialysis adequacy and to assess consistency between calculations of single pool Kt/V (spKt/V) and URR. DESIGN: A service evaluation was conducted to establish current practices in measuring dialysis adequacy. A prospective longitudinal study was conducted to compare spKt/V and URR. PARTICIPANTS: Thirty-two children were recruited consisting of 13 males and 19 females in five paediatric dialysis centres. RESULTS: Inconsistencies were reported of the method of post-urea sampling with 4 of the 10 centres using the KDOQI recommended sampling method. Five dialysis centres reported using URR and five reported using spKt/V. There were substantial differences between the two measures. Using URR suggested that up to 44% of children did not receive adequate dialysis, whereas measurement by spKt/V suggested no more than 6% of the same dialysis sessions were not adequate. CONCLUSION: One standard measure should be used to assess dialysis adequacy in paediatric centres in England. KDOQI guidelines were not consistently followed in obtaining a post-urea blood sample and this procedure should be standardised.