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

Feasibility of collecting oral fluid samples in the home setting to determine seroprevalence of infections in a large-scale cohort of preschool-aged children

Oral fluid is a non-invasive biological sample, which can be returned by post, making it suitable for large-scale epidemiological studies in children. We report our experience of oral fluid collection from 14 373 preschool-aged children in the UK Millennium Cohort Study. Samples were collected by mothers in the home setting following the guidance of trained interviewers, and posted to the laboratory. Samples were received from 11698 children (81.4 %). Children whose mothers were of Black Caribbean ethnicity and who lived in non-English-speaking households were less likely to provide a sample, and those with a maternal history of asthma more likely to provide a sample [adjusted risk ratio (95 % CI) 0.85 (0.73-0.98), 0.87 (0.77-0.98) and 1.03 (1.00-1.05) respectively]. Collection of oral fluid samples is feasible and acceptable in large-scale child cohort studies. Formal interpreter support may be required to increase participation rates in surveys that collect biological samples from ethnic minorities

Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.

Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice

An ecological systems approach to examining risk factors for early childhood overweight: findings from the UK Millennium Cohort Study

Objective: To use an ecological systems approach to examine individual-, family-, community- and area-level risk factors for overweight (including obesity) in 3-year-old children. Methods: A prospective nationally representative cohort study conducted in England, Wales, Scotland, Northern Ireland. Participants included 13 188 singleton children aged 3 years in the Millennium Cohort Study, born between 2000 and 2002, who had complete height/weight data. The main outcome measure was childhood overweight (including obesity) defined by the International Obesity TaskForce cut-offs for body mass index. Results: 23.0% of 3-year-old children were overweight or obese. In the fully adjusted model, primarily individual- and family-level factors were associated with early childhood overweight: birthweight z-score (adjusted odds ratio, 1.36, 95% CI 1.30 to 1.42), black ethnicity (1.41, 1.11 to 1.80) (compared with white), introduction to solid foods or =21 hours/week (1.23, 1.10 to 1.37) (compared with never worked). Breastfeeding > or =4 months (0.86, 0.76 to 0.97) (compared with none) and Indian ethnicity (0.63, 0.42 to 0.94) were associated with a decreased risk of early childhood overweight. Children from Wales were also more likely to be overweight than children from England. Conclusions: Most risk factors for early childhood overweight are modifiable or would allow at-risk groups to be identified. Policies and interventions should focus on parents and providing them with an environment to support healthy behaviours for themselves and their children

Regional differences in overweight: an effect of people or place?

Objective: To examine UK country and English regional differences in childhood overweight (including obesity) at 3 years and determine whether any differences persist after adjustment for individual risk factors. Design: Nationally representative prospective study. Setting: England, Wales, Scotland and Northern Ireland. Participants: 13 194 singleton children from the UK Millennium Cohort Study with height and weight data at age 3 years. Main outcome measure: Overweight (including obesity) was defined according to the International Obesity TaskForce cut-offs for body mass index, which are age and sex specific. Results: At 3 years of age, 23% (3102) of children were overweight or obese. In univariable analyses, children from Northern Ireland (odds ratio 1.30, 95% confidence interval 1.14 to 1.48) and Wales (1.26, 1.11 to 1.44) were more likely to be overweight than children from England. There were no differences in overweight between children from Scotland and England. Within England, children from the East (0.71, 0.57 to 0.88) and South East regions (0.82, 0.68 to 0.99) were less likely to be overweight than children from London. There were no differences in overweight between children from other English regions and children from London. These differences were maintained after adjustment for individual socio-demographic characteristics and other risk factors for overweight. Conclusions: UK country and English regional differences in early childhood overweight are independent of individual risk factors. This suggests a role for policies to support environmental changes that remove barriers to physical activity or healthy eating in young children

Maternal employment and early childhood overweight: findings from the UK Millennium Cohort Study

Background: In most developed countries, maternal employment has increased rapidly. Changing patterns of family life have been suggested to be contributing to the rising prevalence of childhood obesity. Objectives: Our primary objective was to examine the relationship between maternal and partner employment and overweight in children aged 3 years. Our secondary objective was to investigate factors related to early childhood overweight only among mothers in employment. Design: Cohort study. Subjects: A total of 13 113 singleton children aged 3 years in the Millennium Cohort Study, born between 2000 and 2002 in the United Kingdom, who had complete height/weight data and parental employment histories. Measurements: Parents were interviewed when the child was aged 9 months and 3 years, and the child's height and weight were measured at 3 years. Overweight (including obesity) was defined by the International Obesity Task Force cut-offs. Results: A total of 23% (3085) of children were overweight at 3 years. Any maternal employment after the child's birth was associated with early childhood overweight (odds ratio (OR) [95% confidence interval (CI)]; 1.14 [1.00, 1.29]), after adjustment for potential confounding and mediating factors. Children were more likely to be overweight for every 10 h a mother worked per week (OR [95% CI]; 1.10 [1.04, 1.17]), after adjustment. An interaction with household income revealed that this relationship was only significant for children from households with an annual income of pound33 000 ($57 750) or higher. There was no evidence for an association between early childhood overweight and whether or for how many hours the partner worked, or with mothers' or partners' duration of employment. These relationships were also evident among mothers in employment. Independent risk factors for early childhood overweight were consistent with the published literature. Conclusions: Long hours of maternal employment, rather than lack of money may impede young children's access to healthy foods and physical activity. Policies supporting work-life balance may help parents reduce potential barriers

Progress in prevention of mother-to-child transmission of HIV infection in Ukraine: results from a birth cohort study

Background: Ukraine was the epicentre of the HIV epidemic in Eastern Europe, which has the most rapidly accelerating HIV epidemic world-wide today; national HIV prevalence is currently estimated at 1.6%. Our objective was to evaluate the uptake and effectiveness of interventions for prevention of mother-to-child transmission (PMTCT) over an eight year period within operational settings in Ukraine, within the context of an ongoing birth cohort study.Methods: The European Collaborative Study (ECS) is an ongoing birth cohort study in which HIV-infected pregnant women identified before or during pregnancy or at delivery were enrolled and their infants prospectively followed. Three centres in Ukraine started enrolling in 2000, with a further three joining in September 2006.Results: Of the 3356 women enrolled, 21% (689) reported current or past injecting drug use (IDU). Most women were diagnosed antenatally and of those, the proportion diagnosed in the first/second trimester increased from 47% in 2000/01 (83/178) to 73% (776/1060) in 2006/07 (p < 0.001); intrapartum diagnosis was associated with IDU (Adjusted odds ratio 4.38; 95% CI 3.19-6.02). The percentage of women not receiving any antiretroviral prophylaxis declined from 18% (36/205) in 2001 to 7% in 2007 (61/843) p < 0.001). Use of sdNVP alone substantially declined after 2003, with a concomitant increase in zidovudine prophylaxis. Median antenatal zidovudine prophylaxis duration increased from 24 to 72 days between 2000 and 2007. Elective caesarean section (CS) rates were relatively stable over time and 34% overall. Mother-to-child transmission (MTCT) rates decreased from 15.2% in 2001 (95% CI 10.2-21.4) to 7.0% in 2006 (95% CI 2.6-14.6). In adjusted analysis, MTCT risk was reduced by 43% with elective CS versus vaginal delivery and by 75% with zidovudine versus no prophylaxis.Conclusion: There have been substantial improvements in use of PMTCT interventions in Ukraine, including earlier diagnosis of HIV-infected pregnant women and increasing coverage with antiretroviral prophylaxis and the initial MTCT rate has more than halved. Future research should focus on hard-to-reach populations such as IDU and on missed opportunities for further reducing the MTCT rate

Pregnancy is associated with elevation of liver enzymes in HIV-positive women on antiretroviral therapy.

The objective of this study is to assess whether pregnancy is associated with an increased risk of liver enzyme elevation (LEE) and severe LEE in HIV-positive women on antiretroviral therapy (ART)

WFMOS - Sounding the Dark Cosmos

Vast sound waves traveling through the relativistic plasma during the first million years of the universe imprint a preferred scale in the density of matter. We now have the ability to detect this characteristic fingerprint in the clustering of galaxies at various redshifts and use it to measure the acceleration of the expansion of the Universe. The Wide-Field Multi-Object Spectrograph (WFMOS) would use this test to shed significant light on the true nature of dark energy, the mysterious source of this cosmic acceleration. WFMOS would also revolutionise studies of the kinematics of the Milky Way and provide deep insights into the clustering of galaxies at redshifts up to z~4. In this article we discuss the recent progress in large galaxy redshift surveys and detail how WFMOS will help unravel the mystery of dark energy.Comment: 6 pages, pure pdf. An introduction to WFMOS and Baryon Acoustic Oscillations for a general audienc

Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes : randomised controlled trial

© 2013 Royal College of Obstetricians and Gynaecologists. Funded by Royal College of Obstetricians and Gynaecologists, London, UK; Health Research Council of New Zealand. Grant Number: RG 819/06 New Zealand Lottery Grant Board Health Services Research Unit, University of Aberdeen Chief Scientist Office of the Scottish Government Health DirectoratesPeer reviewedPostprin