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Helen Bedford

Publications and source records attributed to Helen Bedford.

At least 19 recordsLinked to original sources
PubMed2007

Missed opportunities to vaccinate children admitted to a paediatric tertiary hospital.

BACKGROUND: Inequalities in vaccine uptake exist. Studies suggest paediatric inpatients have lower rates of immunisation uptake than the general population. Various UK policies advocate opportunistic immunisation. AIM: To evaluate practice within a paediatric tertiary hospital in identifying and facilitating vaccination of inpatients who were not fully immunised. METHODS: Case notes for 225 inpatients were examined. Thirty staff of various professions and grades were interviewed. Policies, forms and documents used in the hospital were reviewed. RESULTS: Immunisation status was recorded for 71% of children admitted, but for 69% of these immunisations were documented as "up-to-date" without any further information recorded. At least 20% of inpatients were incompletely immunised, but very little was done to facilitate vaccination. There was no training for staff either in giving advice or in administering vaccines and staff views differed regarding the hospital's role in immunisations. While there were guidelines for specific groups of patients, there were no general immunisation policies. Incorrect and out-of-date immunisation schedules were found on documents. CONCLUSIONS: Opportunities to immunise children continue to be missed by all levels of health care service provision. Tertiary centres have a role to play in supporting primary care services to ensure that these vulnerable children are appropriately immunised. Measures are being taken to address the problems identified in this study and we strongly suspect that other hospitals in the UK ought to be confronting these issues as well.

Adolescent↗
PubMed2006

DISCERN-Genetics: quality criteria for information on genetic testing.

Information currently available to the public is inadequate to support those deciding to consent to a genetic test. As genetic knowledge continues to evolve, more people will be forced to consider the complex issues raised by genetic testing. We developed and tested criteria to guide the production and appraisal of information resources produced for the public on genetic testing. Lay people with and without experience of a genetic condition, and providers and producers of health information appraised and listed the criteria they used to rate the quality of a sample of information on cystic fibrosis, Down's syndrome, familial breast cancer, familial colon cancer, haemochromatosis, Huntington's disease, sickle cell disease, and thalassaemia. These genetic conditions represent different populations, disease pathways, and treatment decisions. The information medium could be written, electronic, CD, audio or video. The quality criteria were tested iteratively (using the weighted kappa statistic) for the level of agreement between users applying successive drafts of the criteria to different samples of information. The final set of criteria consisted of 19 questions plus an overall quality rating. Chance corrected agreement (weighted kappa) among the appraisers for the overall quality rating was 0.61 (0.60-0.62). The criteria cover the scope of the information resources, information on the condition, the test procedure and results, decision making, and the reliability of the information. The DISCERN-Genetics criteria will guide the production and appraisal of information produced for the public, and will facilitate the involvement of the public in decisions around genetic screening and testing.

Female↗
PubMed2006

Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study.

BACKGROUND: Convulsive status epilepticus is the most common childhood medical neurological emergency, and is associated with significant morbidity and mortality. Most data for this disorder are from mainly adult populations and might not be relevant to childhood. Thus we undertook the North London Status Epilepticus in Childhood Surveillance Study (NLSTEPSS): a prospective, population-based study of convulsive status epilepticus in childhood, to obtain a uniquely paediatric perspective. METHODS: Clinical and demographic data for episodes of childhood convulsive status epilepticus that took place in north London were obtained through a clinical network that covered the target population. We obtained these data from anonymised copies of a standardised admission proforma; accident and emergency, nursing, ambulance, and intensive-care unit notes; and interviews with parents, medical, nursing, and paramedic staff. We investigated ascertainment using capture-recapture modelling. FINDINGS: Of 226 children enrolled, 176 had a first ever episode of convulsive status epilepticus. We estimated that ascertainment was between 62% and 84%. The ascertainment-adjusted incidence was between 17 and 23 episodes per 100,000 per year. 98 (56%, 95% CI 48-63) children were neurologically healthy before their first ever episode and 56 (57%, 47-66) of those children had a prolonged febrile seizure. 11 (12%, 6-18) of children with first ever febrile convulsive status epilepticus had acute bacterial meningitis. Conservative estimation of 1-year recurrence of convulsive status epilepticus was 16% (10-24%). Case fatality was 3% (2-7%). INTERPRETATION: Convulsive status epilepticus in childhood is more common, has a different range of causes, and a lower risk of death than that in adults. These paediatric data will help inform management of convulsive status epilepticus and appropriate allocation of resources to reduce the effects of this disorder in childhood.

Adolescent↗
PubMed2006

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.

Attitude↗
PubMed2006

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.

Age Factors↗
PubMed2006

Use of personal child health records in the UK: findings from the millennium cohort study.

OBJECTIVES: The personal child health record (PCHR) is a record of a child's growth, development, and uptake of preventive health services, designed to enhance communication between parents and health professionals. We examined its use throughout the United Kingdom with respect to recording children's weight and measures of social disadvantage and infant health. DESIGN: Cross sectional survey within a cohort study. SETTING: UK. PARTICIPANTS: Mothers of 18,503 children born between 2000 and 2002, living in the UK at 9 months of age. MAIN OUTCOME MEASURES: Proportion of mothers able to produce their child's PCHR; proportion of PCHRs consulted containing record of child's last weight; effective use of the PCHR (defined as production, consultation, and child's last weight recorded). RESULTS: In all, 16,917 (93%) mothers produced their child's PCHR and 15,138 (85%) mothers showed effective use of their child's PCHR. Last weight was recorded in 97% of PCHRs consulted. Effective use was less in children previously admitted to hospital, and, in association with factors reflecting social disadvantage, including residence in disadvantaged communities, young maternal age, large family size (four or more children; incidence rate ratio 0.87; 95% confidence interval 0.83 to 0.91), and lone parent status (0.88; 0.86 to 0.91). CONCLUSIONS: Use of the PCHR is lower by women living in disadvantaged circumstances, but overall the record is retained and used by a high proportion of all mothers throughout the UK in their child's first year of life. PCHR use is endorsed in the National Service Framework for Children and has potential benefits which extend beyond the direct care of individual children.

Body Weight↗
PubMed2006

Information on childhood immunisation: parents' views.

In a survey of parents' views about information on immunisation conducted in three English PCTs it was found that, while a variety of sources of information were used, health visitors and NHS leaflets were the two most frequently mentioned. Although the majority of parents expressed satisfaction with the information they had received, 20% were not satisfied and the main reason for this was that the information was insufficient or they had to search for information themselves. The findings of this study suggest that there is room for improvement in the provision of information about immunisation to parents. Not only is it necessary for healthcare professionals to be well informed about immunisation but the nature of the way they communicate with parents is important. Community practitioners will be at the forefront of advising parents about the pneumococcal conjugate vaccine, to be introduced together with other changes to the routine childhood immunisation programme in 2006, and should build on their existing prominent role in this important field of public health.

Adult↗
PubMed2005

Feeling bad about immunising our children.

Uptake of MMR vaccinations is as low as 60% in some parts of the UK. This poses a serious public health issue. This longitudinal study investigates parental decisions about MMR and single vaccinations. Parents (n=114) rated their perceptions of the benefits and risks of immunisation, and emotion-related variables; and were followed up to ask their final immunisation decision. Analyses demonstrated that parental decisions were explained by emotion-related variables, specifically anticipated responsibility and regret. It was concluded that parents' decisions about MMR are strongly influenced by the idea than harm that occurs as a result of deciding to immunise (commission) is less acceptable than harm that occurs as a result of deciding not to immunise (omission) (known as 'omission bias').

Adult↗
PubMedDate not supplied

Measles: the disease and its prevention.

The MMR vaccine is currently the subject of controversy. Helen Bedford describes the measles disease and its complications, and advises nurses on what to tell parents about vaccination.

Child, Preschool↗