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Objective: Poor descriptions of standard care may compromise interpretation of results in randomised controlled trials (RCTs) of health interventions. We investigated quality of standard care in RCTs of behaviour change interventions for young people with type 1 diabetes and consider implications for evaluating trial outcomes.\ud \ud Design: We conducted systematic searches for articles published between 1999 and 2012. We extracted standard care descriptions and contacted trial authors to complete a checklist of standard care activities. The relationship between standard care quality and outcomes was examined via subgroup meta-analyses and meta-regression.\ud \ud Main outcome measures: Standard care descriptions, standard care quality, and relationships between standard care quality with medical and psychological outcomes.\ud \ud Results: We identified 20 RCTs described across 26 articles. Published descriptions of standard care were limited to service-level features. Author responses indicated standard care provision extended beyond published accounts. Subgroup analyses suggested control groups receiving higher standard care quality showed larger improvements in both medical and psychological outcomes, although standard care quality did not predict outcomes significantly.\ud \ud Conclusion: The quality of care delivered to control group participants can influence outcomes of RCTs. Inadequate reporting exacerbates this issue by masking variations between trials. We argue for increased clarity in reporting standard care in future trials.

Acute Lymphoblastic Leukaemia (ALL) is the most common form of childhood cancer. Despite good survival rates, quality of life (QOL) may be compromised, and children show mood and behaviour problems (MBP). We report a 2-year longitudinal study where mothers assessed their child's QOL and MBP ∼3 months after diagnosis with ALL (T1), 1 year (T2) and 2 years (T3) later. Mothers of 46 children (M age 7 years at T1) with ALL completed ratings of child's QOL (PedsQL™) and Mood and Behaviour Problems (MBP) at each time point; they also recalled change in MBP over the past year and anticipation of future change over the next year. QOL and MBP improved, especially from T1 to T2. Retrospective and serial measures of change were uncorrelated. Mothers’ optimism at T1 was a significant predictor of subsequent ratings, not only of current MBP but also QOL, up to 2 years later. Retrospective measures of change are not a substitute for serial measurements.

Survivors of childhood cancer are at risk of compromised physical and psychological functioning as a result of disease and treatment. However, survivors experiencing similar physical problems vary considerably in their self-reported Quality of Life (QOL) raising questions about the processes underlying adjustment and maintenance of QOL. Seventy seven survivors of either Acute Lymphoblastic Leukaemia (ALL) or tumours of the Central Nervous System (CNS) completed a standardised measure of QOL and semi-structured interview. Based on theoretical assumptions that QOL reflects a difference between what survivors can, and would like to be able to do, interviews were coded for reports of discrepancies and any coping strategy employed. Survivors of tumours of the CNS reported worse QOL and more discrepancies than survivors of ALL. A significant relationship was found between QOL measured by questionnaire and number of reported discrepancies. Five kinds of strategies to reduce discrepancies were identified: changin...

A questionnaire concerning the use of additives in foods was completed by 572 high school students aged 12-15 years. Participants recorded how often they ate each of 16 common foods, and rated the relative levels of colourings, flavourings, preservatives and traces of pesticides that each of these foods contained. They also rated the relative importance of eight reasons (e.g. taste, health) in their own food choices, and provided comparative evaluations of the concepts 'food with additives' and 'food without additives' in terms of these same eight attributes. Participants discriminated between the 16 foods in terms of the chemicals they believed they contained, but these estimates were unaffected by age or sex. When these estimates were weighted by participants' own reports of consumption, girls scored lower than boys on a measure of the assumed additive content of their own diet. Own additive consumption was significantly associated with ratings of reasons for food choice and comparisons of food with/wit...

Fifty people with diabetes attending a 'high risk' renal clinic were interviewed about their perceptions of diabetic nephropathy and other diabetes related complications. Despite the high risks involved many patients appeared relatively unconcerned with, or even unaware of, the severity of their condition. It is argued that lack of obvious symptoms associated with nephropathy can lead to ambiguity during consultations and greater opportunity for the use of a variety of risk attenuation strategies by the patient. It is recommended that medical staff become aware of these strategies in order to understand failures in self-management in the face of complications such as nephropathy.

Psychological well-being and individuals representations of their illness were assessed for 96 patients with Type 1 diabetes and 139 patients with Type 2 diabetes who attended a hospital diabetic clinic for an annual check-up. Metabolic control (HbAlc) and the presence of diabetic complications (retinopathy, neuropathy, hypertension and nephropathy) were also recorded. Type 2 patients, as expected, tended to be older and be experiencing more complications than Type 1 patients. Consistent with previous findings, women reported lower well-being than men. Type 1 and Type 2 patients did not differ in terms of well-being, but the predictors of well-being were somewhat different in the two groups. In both groups, well-being was related to control beliefs (confidence in self-management and ability to delay complications) and to lower ratings of the extent to which diabetes interfered with everyday activities. For Type 1 patients only, well-being also related to a tendency to perceive their diabetes as h...

Sixty-three survivors of childhood cancer (mean age 17 years), currently well and off-treatment, and their mothers were interviewed individually about their experiences and the impact of their illness on their lives. Survivors also completed four questionnaire measures of different aspects of quality of life (perceptions of illness experience, future worries, health problems and body image satisfaction), whereas mothers recorded their perceptions of their child's quality of life on the same four scales. These scales showed good internal consistency and convergent validity for both survivors and mothers. Mothers also completed a measure of their own quality of life (the SF-36). The interviews with both survivors and mothers were content-analysed for statements expressing social comparisons. These statements were coded according to whether the comparison implied a favourable, neutral or unfavourable evaluation of the individual survivor. Mothers who made a higher proportion of unfavourable comparis...

(1995). The Place of Bereavement and Loss in the Curriculum: Teachers' Attitudes. Pastoral Care in Education: Vol. 13, No. 4, pp. 32-36.

Measures of attitude concerning exposure to the sun, and judgements of risk and other beliefs concerning skin cancer and four other problems (stomach cancer, deafness, AIDS and sunstroke) were obtained from a questionnaire completed by 176 university students. Subjects also estimated the incidence of each problem using one of three response formats. The highest incidence estimates were obtained when subjects were asked to guess at an absolute number, and the lowest when they used a scale which differentiated between lower frequencies, while grouping higher frequencies into a single response category. The effect of the response scale format, however, did not generalize to other ratings of personal risk. Subjects' ratings of their personal risk, compared with their peers, showed an optimistic bias over the five problems as a whole, particularly for AIDS, but not reliably so in the case of skin cancer. Optimism was inversely related to the amount of thought given to each problem. Men and women did n...

Sixty-two mothers and 45 fathers of children with diabetes completed questionnaires to assess their confidence to manage the disease and treatment. Implications of parental confidence for attitudes to (1) child-rearing, (2) coping and (3) perceived restrictions of the disease were considered. Mothers and fathers differed in reported child-rearing behaviours and strategies for coping. More confident fathers reported that information was helpful in coping with the disease, while more confident mothers reported that support from the family was more helpful. Predictors of children's locus of control scores differed between mothers and fathers. However, children expressed more external locus of control beliefs where parents believed their children to be more restricted.

Mothers and fathers with a child with diabetes, asthma, cardiac conditions, epilepsy or leukaemia completed questionnaires to investigate their appraisal of disease-related difficulties and patterns of coping. There were differences both in appraised difficulties and coping patterns as a function of diagnostic group. In general, mothers who perceived more difficulties reported that it was helpful to cope by gaining disease-related knowledge. Fathers who perceived more difficulties reported it was more helpful to adopt strategies to enhance their own personal autonomy. Fathers who perceived more difficulties also reported that contact with medical staff was less helpful. Implications are discussed in terms of the differential implications of coping with chronic childhood diseases for mothers and fathers. Theoretical models need to take into account the differential demands of specific diseases in accounting for parents' stress appraisal and coping patterns.

Eight-five healthy children (mean age = 11.5 years) and 61 with diabetes completed measures of health locus of control and health-related self-efficacy. Those with diabetes also completed a diabetes specific self-efficacy scale. Low but significant correlations were found between locus of control and both efficacy measures. Factor analysis of the health efficacy scale yielded three factors (personal responsibility, safety and communication). Three factors were also derived for the diabetes efficacy scale (personal responsibility, social communication and minimization of threat). In terms of locus of control, children with diabetes expressed weaker beliefs in powerful others and personal control than healthy children, and weaker beliefs in the personal responsibility sub-scale of general health efficacy. Results are discussed in terms of the theoretical and practical implications of locus of control and efficacy in diabetes management.

It has often been proposed that children under the age of six years do not readily understand the nature of contagion. They may believe that even ailments such as toothaches are transmitted through...

Twenty five‐year‐olds and twenty eight‐year‐olds were asked to tell six stories on health and illness‐related themes. Analysis of the stories did not support a stage‐theory of developmental changes in understanding of illness. It is argued that young children share many ideas about illness with older children, but these may be limited by the very restricted nature of experience.

(2004). CommentNeurocognitive sequelae of childhood cancers and their treatment: a comment on Mulhern and Butler. Pediatric Rehabilitation: Vol. 7, No. 1, pp. 15-16.

Four hundred and ten school children, aged between 13 and 16 years, were administered a questionnaire to investigate (a) their perceptions of AIDS and implications of the disease for the victim; (b) beliefs about how best to prevent the spread of disease; (c) sources of information and (d) AIDS relevant topics they would like to learn in school. The results suggested that there were few differences in knowledge or attitude as a function of age, but some significant differences due to sex. Boys were more likely to derogate the AIDS victim compared with girls. In terms of different strategies for prevention, boys were more in favour of “scare” approaches, and girls of information-giving. The success of any AIDS education package may be at least partly determined by individual beliefs about the disease, and preferences for different educational strategies.

Previous approaches to drugs education are reviewed and evaluated. A new programme, called ‘Double Take’ is described. This consists of two videos, each with teacher notes and pupil exercises, which were distributed freely to secondary schools by the DHSS. One video is based on the television series Minder, and the other takes a more didactic approach. Five studies are reported. The first is concerned with teachers’ evaluations of the package, and the remainder with the effects of the videos on pupils’ attitudes and knowledge. The results suggest that teachers could select to focus on either video, depending on the goals of their course.

Saile et al. (1988) reported the results of a meta-analysis involving 75 studies concerned with preparing children for hospitalization and concluded that “the mean effect sue was modest”. In th paper, some of the methodological problems associated with this meta-analysis are considered. In particular, it is argued that the inclusion of studies, regardless of experimental rigour. may lessen the apparent size of the effects of preparation and acceptability of the findings.

Fourteen triads of 4‐5 year olds and 8 triads of 7‐8 year olds were video‐taped playing “doctors and nurses” in a pretend hospital at school. The tapes were analysed in terms of the “scripts” or sequences of activities displayed by the children. These analyses suggest that children were aware of the serial order of activities that occur in medical examinations, though this was clearer among the older children. The data are discussed in terms of the relevance of “script theory” for understanding developmental changes in children's beliefs about hospitals and medical procedures.

Forty‐nine children with asthma and their mothers were interviewed regarding their knowledge of asthma, factors that precipitated attacks, and how they attempted to reduce the probability of an attack. Many mothers and children were well aware of factors that precipitated attacks, but took little positive action to reduce attacks. The data suggest that much ill‐health in asthmatic children could be reduced by improving education available to mothers and children.

Research concerned with the development of children's beliefs about health and illness has practical implications for educating children about their illness, treatment and hospital admission. Previous research has suggested that beliefs about health and illness develop through a series of systematic stages, and that children are unable to understand explanations in advance of their own cognitive level. Alternative theories which give greater emphasis to the role of experience are considered, and some implications for clinical practice drawn.

58 children #opaged 7-8 years#cp and 52 children #opaged 10-11 years#cp were each read a short description of a child with a chronic disease #opeither cancer or diabetes#cp. Information about the disease was either in a simple medical form, or explained the illness in terms of a metaphor. Older children understood the information better than younger children regardless of the form of the information. Younger children were only marginally helped by presenting information in a metaphorical form.

Summary A total of 562 teachers responded to a postal questionnaire, concerned with the organization and content of drugs education courses in school, and their evaluation of a drugs education package, ‘Double Take’. This is a broadly based ‘life‐skills’ approach, distributed free by the Department of Health and Social Security. We found that most secondary schools taught drugs in social or health education, as opposed to biology courses, and used a range of material. Many schools are still developing their courses. Teachers’ ratings of ‘Double Take’ were determined by their own attitudes to drug‐taking, suggesting they need some convincing of the potential value of the ‘life‐skills’ approach.