Laura Elizabeth Cowley

Cardiff University | CU · School of Medicine

Objective To determine the prevalence of functional impairments in children with disabilities receiving care and support in Wales between 2016 and 2022, and to investigate risk factors associated with being placed in care amongst these children. Method This study used Children Receiving Care and Support (CRCS) Census records held in the Secure Anon...

IntroductionWhen a child has suffered, or is at risk of suffering, significant harm from parents or caregivers, the local authority may issue Section 31 (s.31) Care and Supervision proceedings under the Children Act (1989). Objectives We compared the healthcare use of infants less than one year old subject to s.31 proceedings in Wales (n = 1,332),t...

In this prepreint we report the estimated the number of clinical prediction models (CPM) development articles available for all medical fields from 1995 until 2020 on the basis of a systematic search of literature.

Objectives: We investigated SARS-CoV-2 infection trends, risk of SARS-CoV-2 infection and COVID-19 vaccination uptake among school staff, students and their household members in Wales, UK. Design: Seven-day average of SARS-CoV-2 infections and polymerase chain reaction tests per 1000 people daily, cumulative incidence of COVID-19 vaccination upt...

Objectives To determine whether clinically extremely vulnerable (CEV) children or children living with a CEV person in Wales were at greater risk of presenting with anxiety or depression in primary or secondary care during the COVID-19 pandemic compared with children in the general population and to compare patterns of anxiety and depression during...

Background: Domestic violence and abuse (DVA) has a detrimental impact on the health and well-being of children and families but is commonly underreported, with an estimated prevalence of 5.5% in England and Wales in 2020. DVA is more common in groups considered vulnerable, including those involved in public law family court proceedings; however,...

Introduction It is known that only a limited proportion of developed clinical prediction models (CPMs) are implemented and/or used in clinical practice. This may result in a large amount of research waste, even when considering that some CPMs may demonstrate poor performance. Cross-sectional estimates of the numbers of CPMs that have been developed...

Background. Studies show considerable variability in the definitions and operationalization of child maltreatment (CM), which limits research, policy formation, surveillance, and cross-country and cross-sector comparisons. Objective. To review the recent literature (2011–2021) to understand current issues and challenges in defining CM, to assist i...

This report provides an updated picture of the scale and pattern of mothers in recurrent care proceedings in England and Wales. It uses full-service population data produced routinely by Cafcass and Cafcass Cymru. Descriptive statistics are combined with statistical analysis of women's risk of return to court.

BACKGROUND Domestic violence and abuse (DVA) has a detrimental impact on the health and well-being of children and families but is commonly underreported, with an estimated prevalence of 5.5% in England and Wales in 2020. DVA is more common in groups considered vulnerable, including those involved in public law family court proceedings; however, th...

Objectives: To determine whether clinically extremely vulnerable (CEV) children or children living with a CEV person in Wales were at greater risk of presenting with anxiety or depression in primary or secondary care during the COVID-19 pandemic compared with children in the general population, and to compare patterns of anxiety and depression duri...

Objectives Examine if pre-COVID-19 pandemic (prior March 2020) health-related behaviours during primary school are associated with (1) being tested for SARS-CoV-2 and (2) testing positive between 1 March 2020 and 31 August 2021. Design Retrospective cohort study using an online cohort survey (January 2018 to February 2020) linked with routine PCR...

Objective When an infant is identified as having suffered or is at risk of suffering significant harm from parents or caregivers, section 31 care and supervision proceedings (s.31, Children Act 1989) may be issued. We examined the healthcare use of infants under one year old subject to these proceedings in Wales. ApproachA retrospective e-cohort st...

Objectives We aim to determine the proportion of infants entering care in Wales via the two primary legal routes (section 76 of the Social Services and Wellbeing (Wales) Act 2014, and section 31 of the Children Act 1989), and associations between mode of entry and infant characteristics and outcomes. ApproachThis is a longitudinal cohort study usin...

Background Pregnancy can be a stressful time and the COVID-19 pandemic has affected all aspects of life. This study aims to investigate the pandemic impact on pregnancy experience, rates of primary childhood immunisations and the differences in birth outcomes in during 2020 to those of previous years. Methods Self-reported pregnancy experience: 21...

Introduction School-based COVID-19 mitigation strategies have greatly impacted the primary school day (children aged 3–11) including: wearing face coverings, two metre distancing, no mixing of children, and no breakfast clubs or extra-curricular activities. This study examines these mitigation measures and association with COVID-19 infection, respi...

Objectives Examine if prior health-related behaviours during primary school are associated with being tested for SARS-CoV-2 and testing positive during adolescence. Design Retrospective cohort study using an online cohort survey (1 April 2014 to 28 February 2020) linked to routine PCR SARS-CoV-2 test results (1 March 2020 to 31 August 2021) Setti...

Background Pregnancy can be a stressful time and the COVID-19 pandemic is thought to have heightened maternal stress. This study aimed to investigate the effect of the COVID-19 pandemic on population birth outcomes, uptake of primary immunisations, and expectant mothers' experiences of pregnancy in Wales. Methods In this mixed methods study we ana...

Background The COVID-19 pandemic has had a detrimental effect on children's mental health. Shielded children or those living with a shielded person might be particularly susceptible to mental health difficulties arising as a result of strict public health restrictions. However, studies examining mental health outcomes in these children are scarce....

Introduction School-based COVID-19 mitigation strategies have greatly impacted the primary school day (children aged 3-11) including: wearing face coverings, 2-metre distancing, no mixing of children, and no breakfast clubs or extra-curricular activities. This study examines these mitigation methods and association with COVID-19 infection, respirat...

Background: Pregnancy can be a stressful time and the COVID 19 pandemic has affected all aspects of life. This study aims to investigate the impact of the pandemic on population birth outcomes in Wales, rates of primary immunisations and examine expectant mothers experiences of pregnancy including self reported levels of stress and anxiety. Methods...

Background Burns from hot drinks are common and preventable amongst children under 5 years. Methods The 3-month SafeTea campaign aimed to prevent hot drink scalds and improve burns first aid using social media, and a website hosting downloadable resources and videos. Key messages were disseminated on Twitter, Facebook and MumsNet to parents/caregi...

Abstract Background National guidance recommends CT-head for all children <1 year old with suspected physical abuse, and to be considered for those <2 years old to exclude abusive head trauma. Objectives To investigate whether this guidance is followed, and the associations between clinical presentation and CT findings, to determine whether guidan...

Objectives SafeTea is a multifaceted intervention delivered by community practitioners to prevent hot drink scalds to young children and improve parents’ knowledge of appropriate burn first aid. We adapted SafeTea for a national multimedia campaign, and present a mixed-methods process evaluation of the campaign. Methods We used social media, a web...

Objective The validated Predicting Abusive Head Trauma (PredAHT) clinical prediction tool calculates the probability of abusive head trauma (AHT) in children <3 years of age who have sustained intracranial injuries (ICIs) identified on neuroimaging, based on combinations of six clinical features: head/neck bruising, seizures, apnoea, rib fracture,...

Clinical prediction rules (CPRs) that predict the absolute risk of a clinical condition or future outcome for individual patients are abundant in the medical literature; however, systematic reviews have demonstrated shortcomings in the methodological quality and reporting of prediction studies. To maximise the potential and clinical usefulness of C...

Background: The validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) in children <3 years old with intracranial injury. Objective: To explore the impact of PredAHT on clinicians' AHT probability estimates and child protection (CP) actions, and assess inter-rater agreement between their es...

To the Editor, We read with great interest the critical analysis of our work (Cuellar, 2017). We appreciate the opportunity to respond, and to provide clarification regarding the purpose of our validated Predicting Abusive Head Trauma (PredAHT) clinical prediction tool (Maguire et al., 2011; Cowley et al., 2015). In the abstract and throughout the...

Clinicians face unique challenges when assessing suspected child abuse cases. The majority of the literature exploring diagnostic decision-making in this field is anecdotal or survey-based and there is a lack of studies exploring decision-making around suspected abusive head trauma (AHT). We aimed to determine factors influencing decision-making an...

The validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) based on combinations of six clinical features: head/neck bruising; apnea; seizures; rib/long-bone fractures; retinal hemorrhages. We aimed to determine the acceptability of PredAHT to child protection professionals. We conducted quali...

Rationale aims and objectives: Motivational Interviewing (MI) is an individual-level approach to behaviour change that has been evaluated in over 600 randomised clinical trials across multiple settings. Increasingly, research efforts focus on how MI works and how it can best be integrated into public health and clinical programmes. As the applicat...

Background and objectives: A 4-variable abusive head trauma (AHT) clinical prediction rule (CPR) for use in the PICU was derived and validated for children <3 years of age by the Pediatric Brain Injury Research Network (PediBIRN). We aimed to externally validate PediBIRN as designed (PICU only) as well as using broader inclusion criteria (admitted...

Objective Misdiagnosis of abusive head trauma (AHT) has serious consequences for children and families. This systematic review identifies and compares clinical prediction rules (CPredRs) assisting clinicians in assessing suspected AHT. Design We searched MEDLINE, Embase, PubMed and Cochrane databases (January 1996 to August 2016). Externally valid...

Aims: The aim of this study was to explore from the perspectives of key stakeholders involved in the pathway to diagnosis, the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood. Methods: Qualitative interviews and free-text analyses were undertaken in 21 parents with a child diagnosed with type 1 diabetes, 60 parents w...

Aims The predicting abusive head trauma (PredAHT) clinical prediction tool has been derived and validated. Based on the presence or absence of six clinical features (long-bone fractures/ rib fractures/retinal haemorrhage/head or neck bruising/apnoea/ seizures) this electronic calculator estimates the probability of abusive head trauma (AHT) in youn...

Aims Misdiagnosis of abusive head trauma (AHT) in the clinical setting can have serious consequences for the affected children and families. Clinical prediction rules (CPRs) can assist clinicians in deciding which children might have sustained injury as a result of AHT and should receive further investigation. The objective of this study was to com...

Background: Neglect is often overlooked in adolescence, due in part to assumptions about autonomy and misinterpretation of behaviors being part of normal adolescent development. Emotional maltreatment (abuse or neglect) has a damaging effect throughout the lifespan, but is rarely recognized amongst adolescents. Our review aims to identify features...

Aims: To design, develop, and evaluate the feasibility of delivering a multi-component community based intervention to parents and primary health care professionals to raise awareness of the symptoms of Type 1 diabetes (T1D) in childhood in 3 adjoining borough counties of South Wales. Materials and methods: Parent and primary health care advisor...

Abusive head trauma (AHT) may be missed in the clinical setting. Clinical prediction tools are used to reduce variability in practice and inform decision-making. From a systematic review and individual patient data analysis we derived the Predicting Abusive Head Trauma (PredAHT) tool, using multilevel logistic regression to predict likelihood of AH...

Interventions to minimize the long-term consequences of neglect or emotional abuse rely on prompt identification of these children. This systematic review of world literature (1947-2012) identifies features that children aged 5-14 years experiencing neglect or emotional abuse, as opposed to physical or sexual abuse, may exhibit. Searching 18 databa...

A growing body of scientific evidence suggests that there is an association between occult spinal injury and abusive head trauma (previously known as shaken baby syndrome). Consideration needs to be given to the nature of these injuries, the possible causal mechanisms and what investigations should be undertaken to delineate the full extent of spin...

Aim Neglect has far reaching consequences on a child?s emotional, psychological and social development. Our systematic review aims to identify the evidence base for observable features of the parent child interaction amongst neglected or emotionally abused children. Methods Using 80 key words & phrases we searched 18 databases and seven websites f...

Fractures are a manifestation of physical abuse and common accidental injuries. Distinguishing which fractures are indicative of abuse and optimizing the identification of occult fractures are the challenges. To identify additional studies published since our original systematic reviews to address these two issues. An all-language literature search...

In contrast to other areas of medical practice, there was a lack of a clear, concise and accessible synthesis of scientific literature to aid the recognition and investigation of suspected child abuse, and no national training program or evidence based guidelines for clinicians. The project's aim was to identify the current scientific evidence for...