Transforming child and adolescent mental health services – NHS England blog

As the NHS prepares to mark its 70th anniversary, the Clinical Director at the South London Partnership, Child and Adolescent Mental Health (CAMHS) programme outlines how the New Care Models are leading an ambitious transformation of mental health, aspiring to help an extra million people with high-quality care supported by £1 billion additional investment:

‘You’re the commissioner, what would you do for south London’s children and young people?’

This was one of the questions we posed to clinicians and operational managers at a recent South London Mental Health and Community Partnership workshop.

Five years ago, it would have been hard to imagine such conversations or challenges, covering a population of more than three million people. Or that our three mental health trusts would plan system-wide services together. And even less that the innovations and ideas would become reality.

Thanks to NHS England Children and Adolescent Mental Health (CAMHS) tier 4 New Care Models programme, and the collaboration between Oxleas NHS Foundation Trust, South London and Maudsley NHS Foundation Trust, and South West London and St George’s Mental Health Trust, our clinicians and managers are working together for genuine transformation.

Three trusts that once competed are now collaborating and sharing approaches, pathways, resources and clinical expertise – all for the benefit of some of the most vulnerable of our children and young people.

Link to blog page here

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A new dawn for children’s health and wellbeing

 

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NHS England’s National Clinical Director for Children and Young People highlights how the journey to integrated care presents a real opportunity to join up pathways around the needs of children and families:

Often our narrative about the challenges facing health and care is dominated by a very adult view of the world.

Writ large are the issues of an ageing population and people living longer with multiple conditions.

At the other end of the spectrum we have babies, children, young people and their families who are starting a lifelong association with our health services, and where early intervention and prevention can have the greatest and most lasting impact.

Successful programmes, such as immunisation, help to get infants off to the best start in life. Many children, unfortunately, have long-term conditions – diabetes, epilepsy and asthma – and complex health issues, like neurodisability, which continue into adulthood.

We know that half of all lifetime mental health illness can be diagnosed at the age of 14 so early intervention will alter the life chances of these young people.

We also face the increasing and serious prevalence of childhood obesity. Overweight children are more likely to require more medical care, be absent from school, experience health-related limitations and have mental health problems. The risks of going on to develop Type 2 Diabetes are also higher.

Managing these systemic problems is complex and the reality is that no hospital or GP surgery can tackle them alone.  The way we are working now must change as demands on our GPs, hospitals, community services and social care continue to rise.

Link to full article here

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Safety and Tolerability of Moxifloxacin in Children – JPIDS article

 

Image: Pixabay.com

 

Abstract

Objectives

Moxifloxacin is not approved by the US Food and Drug Administration for pediatric use. Although its use might be indicated under certain conditions, data regarding its safety and tolerability in pediatric patients are limited. The primary objective of this study was to evaluate the safety of systemic moxifloxacin therapy in children.

Methods

We conducted a retrospective observational study of patients aged <18 years who received oral or intravenous moxifloxacin at our institution between January 2011 and July 2016. Patient demographics, clinical characteristics, indication for moxifloxacin use, and adverse events (AEs) were extracted via chart review. The attribution of AEs to moxifloxacin use was adjudicated in consultation with a pediatric infectious disease (ID) pharmacist.

Results

We identified 221 patients who received 300 courses of moxifloxacin. The average age at moxifloxacin initiation was 10.4 years. One or more AEs occurred during 195 (65%) of the courses. Of the 463 distinct AEs, 46 (9.9%) were attributed to moxifloxacin. AEs attributed to moxifloxacin included corrected QT interval (QTc) prolongation (18 [6%] courses), transaminase level elevation (7 [2.3%] courses), and increased bilirubin level (3 [1%] courses). AEs led to moxifloxacin discontinuation in 18 (6%) courses. ID consultation was associated with QTc (P < .001) and transaminase (P= .002) monitoring.

Conclusions

AEs that occur during pediatric moxifloxacin therapy are relatively common but rarely serious enough to require premature discontinuation. The drug might be used safely in most children with monitoring, including evaluation for QTc prolongation, and guidance from ID specialists.

Link to article page here

Association of Exposure to Formula in the Hospital and Subsequent Infant Feeding Practices With Gut Microbiota and Risk of Overweight in the First Year of Life – JAMA Pediatrics

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Key Points

Question  How do infant feeding practices influence gut microbiota and risk of overweight?

Findings  Among 1087 infants from the Canadian Healthy Infant Longitudinal Development (CHILD) cohort, earlier cessation of breastfeeding and supplementation with formula (more so than complementary foods) were associated with a dose-dependent increase in risk of overweight by age 12 months; this association was partially explained by specific gut microbiota features at 3 to 4 months. Subtle but significant microbiota differences were observed after brief exposure to formula limited to the birth hospital stay, but these differences were not associated with overweight.

Meaning  Breastfeeding may contribute to protection against overweight by modifying the gut microbiota, particularly during early infancy.

Link to article page here

Association of Maternal Diabetes With Neonatal Outcomes of Very Preterm and Very Low-Birth-Weight Infants – JAMA Pediatrics

Key Points

Question  Does maternal diabetes, a strong risk factor for very preterm birth, have an association with risks of in-hospital mortality or severe neonatal morbidity in very preterm infants?

Findings  In this international cohort study of singleton infants born very preterm, the risk of in-hospital mortality or severe neonatal morbidity for infants who were born to mothers with diabetes was not significantly different from the risk of infants who were born to mothers without diabetes.

Meaning  Maternal diabetes is not associated with an excess risk of in-hospital mortality or severe morbidity in infants born very preterm in high-income countries.

Link to article page here

Towards an individual screening strategy for first-degree relatives of celiac patients – European journal of Pediatrics

Abstract

Celiac disease (CD) is known to be more prevalent in first-degree relatives of patients. In this retrospective cohort study of 609 relatives between 1994 and 2016, we investigated the effect of sex, HLA type, and age at time of index celiac diagnosis. Pearson’s chi-square test and Kaplan-Meier survival analysis were used as statistical analyses. CD screening was carried out for 427 relatives (70%), resulting in a prevalence of 15%. HLA typing in 335 relatives showed HLA-DQ2/DQ8 positivity in 87.5%. In 63% of children and all parents, celiac disease was diagnosed at first screening. It was diagnosed significantly more often in females, HLA-DQ2 homozygosity, and children (all p < 0.05). In children aged 0–1 year at time of index diagnosis, celiac disease was diagnosed after consecutive screening in 58%, after 3.9 ± 2.5 (max 10) years (p < 0.001).

Conclusion:

Future screening policies for relatives of celiac patients should include retesting, especially in HLA-positive relatives younger than 10 years of age. In addition, one-time celiac-specific antibody testing alone could be sufficient to rule out the disease in adolescent siblings and parents of newly diagnosed celiac patients.

Link to article page here