The role of inflammation in the association between poverty and working memory in childhood

Background: Family financial difficulties have been directly linked to poorer executive functioning in childhood. However, recent studies suggest that difficulties in affording basic items and other necessities may also indirectly affect children’s executive functions through several psychological but also physiological paths. One of the latter may be inflammation, which has been related to both financial difficulties and executive functioning. In this study, we explored for the first time if the relationship between early family financial difficulties and working memory in middle childhood can be explained by inflammation. / Methods: Using data from 4,525 children of the Avon Longitudinal Study of Parents and Children, a general population birth cohort, we tested associations between parents’ perceptions at ages 0-3 years of having difficulties in affording basic items for their children including food and clothing, and children’s inflammation [measured by interleukin 6 (IL-6) and C-reactive protein (CRP)] at age 9 years and working memory performance at age 10 years. Confounders included socioeconomic status at ages 0-3 years, economic hardship between ages 3-9 years, BMI and gender. / Results: Using Structural Equation Modelling, we found that financial difficulties were associated with worse working memory (β=-0.076, 95% CI=-0.105, -0.043) even after adjusting for confounders. This association was partially explained by inflammation (β=-0.002, 95% CI=-0.005, -0.001) as measured by IL-6. / Conclusions: Children in families struggling to afford necessities early in life have higher levels of inflammation, in turn related to poorer executive functioning in middle childhood. These findings suggest that living under financial strain has a unique effect on children’s cognitive development through inflammation in the general population

Do upsetting life events explain the relationship between low socioeconomic status and systemic inflammation in childhood? Results from a longitudinal study

BACKGROUND Children from families of low socioeconomic status (SES) are more likely to be exposed to upsetting situations and stressors. Such exposures have, in turn, been linked to inflammation in some studies. In this study we explore if low SES is related to inflammation in children via such stressful life events. METHODS Data on 4,525 children of the Avon Longitudinal Study of Parents and Children, a general population birth cohort, were used to explore associations between SES at ages 0-3 years, upsetting life events at ages 3-9 years and inflammatory markers [interleukin 6 (IL-6) and C-reactive protein (CRP)] at age 9 years. Confounders included body mass index, gender, financial problems, and upsetting life events at ages 0-3 years. RESULTS Using Structural Equation Modelling, we found that early socioeconomic disadvantage predicted higher levels of IL-6 (β=0.034, 95% CI=0.063, 0.005) even after adjusting for confounders. This association was partially mediated by upsetting life events (β=0.003, 95% CI=0.011, 0.001). CONCLUSIONS In the general child population, low SES is associated with increased exposure to stressful life events, in turn associated with later inflammation. These findings highlight the role of stressors associated with poverty and disadvantage in the development of inflammation among children in the general population

To what extent does punishment insensitivity explain the relationship between callous-unemotional traits and academic performance in secondary school students?

BACKGROUND: Callous‐unemotional (CU) traits are related to low achievement but not to deficits in verbal ability, commonly regarded as a major risk factor for poor academic outcomes in antisocial youth. This suggests that CU traits may have utility in explaining heterogeneous risk pathways for poor school performance in antisocial children. Reduced sensitivity to teacher discipline has been suggested as a potential explanation for the association between CU traits and low achievement, given its importance in facilitating engagement in learning. This study is the first to examine punishment insensitivity as a potential mechanism explaining the relationship between CU traits and poor achievement. AIM: The current study investigated the indirect pathway from CU traits via the predictor of punishment insensitivity to English, Maths, and Science grades. SAMPLE: A total of 437 English secondary school students aged 11 to 14 years (49% girls). METHODS: We conducted a mediation analysis within a structural equation modelling framework. CU traits and punishment insensitivity were assessed using child report questionnaires and academic grades were obtained from school records. RESULTS: CU traits were indirectly associated with low academic grades in Maths and Science, but not English, via punishment insensitivity, controlling for child age, gender, single parent household status, free school meals eligibility, externalizing problems, and classroom effects. CONCLUSIONS: Findings indicated that reduced sensitivity to discipline forms a pathway linking CU traits to poor performance in Maths and Science. Teachers may therefore need additional support to implement discipline effectively with children high in CU traits in order to prevent poor academic outcomes

Outdoor and indoor air quality and cognitive ability in young children

BACKGROUND: This study examined outdoor and indoor air quality at ages 9 months and 3 years and their association with cognitive ability at age 3 in England and Wales. METHOD: Data from 8198 Millennium Cohort Study children were analysed using multilevel regression. Outdoor air quality was assessed with mean annual estimates of nitrogen dioxide (NO2) levels within a standard small area (ward). Indoor air quality was measured with parent-reports of damp or condensation in the home and exposure to secondhand smoke in the home. Cognitive ability was assessed with the British Ability Scales Naming Vocabulary subscale and the Bracken School Readiness Assessment. RESULTS: In adjusted models, consistent exposure to high levels of NO2 at age 9 months and age 3 years was associated with lower verbal ability at age 3 years. Damp/condensation and secondhand smoke in the home at either age or at both ages were correlated with lower school readiness at age 3 years. Exposures to damp/condensation at age 3 years or at both ages and secondhand smoke at either age or at both ages were associated with lower verbal ability at age 3 years. CONCLUSION: Young children's exposures to indoor damp or condensation and secondhand smoke are likely to be detrimental for their cognitive outcomes. However, there do not appear to be any short-term effects of NO2

Does general intelligence moderate the association between inflammation and psychological distress?

Research has shown that inflammation is implicated in the pathogenesis of mental health disorders, but not all individuals with such disorders have raised inflammatory markers. This study examined whether general intelligence may be a protective factor for 9666 adults aged 18–97 with elevated inflammation, measured with C-reactive protein (CRP), using data from the UK's Understanding Society. In multigroup analyses for males and females, multiple linear regression was used to model psychological distress dependent upon CRP, adjusting for a host of possible confounders including alcohol consumption, smoking status, history of cardiovascular disease or diabetes, physical exercise and obesity. Moderation by intelligence was tested with a multiplicative interaction term. Results showed that, in adjusted models, CRP was related to an increase in psychological distress in males (β = .049) but not females. Furthermore, intelligence moderated the effect of CRP on psychological distress in males (β = −.037), such that males with higher CRP levels were at lower risk with increased intelligence. In conclusion, general intelligence may protect male adults from the negative effects of inflammation on psychological distress

An overview of synthetic administrative data for research

Use of administrative data for research and for planning services has increased over recent decades due to the value of the large, rich information available. However, concerns about the release of sensitive or personal data and the associated disclosure risk can lead to lengthy approval processes and restricted data access. This can delay or prevent the production of timely evidence. A promising solution to facilitate more efficient data access is to create synthetic versions of the original datasets which are less likely to hold confidential information and can minimise disclosure risk. Such data may be used as an interim solution, allowing researchers to develop their analysis plans on non-disclosive data, whilst waiting for access to the real data. We aim to provide an overview of the background and uses of synthetic data and describe common methods used to generate synthetic data in the context of UK administrative research. We propose a simplified terminology for categories of synthetic data (univariate, multivariate, and complex modality synthetic data) as well as a more comprehensive description of the terminology used in the existing literature and illustrate challenges and future directions for research

Serial CT analysis in idiopathic pulmonary fibrosis: comparison of visual features that determine patient outcome

Aims: Patients with idiopathic pulmonary fibrosis (IPF) receiving antifibrotic medication and patients with non-IPF fibrosing lung disease often demonstrate rates of annualised forced vital capacity (FVC) decline within the range of measurement variation (5.0%–9.9%). We examined whether change in visual CT variables could help confirm whether marginal FVC declines represented genuine clinical deterioration rather than measurement noise. Methods: In two IPF cohorts (cohort 1: n=103, cohort 2: n=108), separate pairs of radiologists scored paired volumetric CTs (acquired between 6 and 24 months from baseline). Change in interstitial lung disease, honeycombing, reticulation, ground-glass opacity extents and traction bronchiectasis severity was evaluated using a 5-point scale, with mortality prediction analysed using univariable and multivariable Cox regression analyses. Both IPF populations were then combined to determine whether change in CT variables could predict mortality in patients with marginal FVC declines. Results: On univariate analysis, change in all CT variables except ground-glass opacity predicted mortality in both cohorts. On multivariate analysis adjusted for patient age, gender, antifibrotic use and baseline disease severity (diffusing capacity for carbon monoxide), change in traction bronchiectasis severity predicted mortality independent of FVC decline. Change in traction bronchiectasis severity demonstrated good interobserver agreement among both scorer pairs. Across all study patients with marginal FVC declines, change in traction bronchiectasis severity independently predicted mortality and identified more patients with deterioration than change in honeycombing extent. Conclusions: Change in traction bronchiectasis severity is a measure of disease progression that could be used to help resolve the clinical importance of marginal FVC declines

Predicting outcomes in rheumatoid arthritis related interstitial lung disease

Aims: To compare radiology-based prediction models in rheumatoid arthritis-related interstitial lung disease (RA-ILD) to identify patients with a progressive fibrosis phenotype.Methods: RAILD patients had CTs scored visually and by CALIPER and forced vital capacity (FVC) measurements. Outcomes were evaluated using three techniques: 1.Scleroderma system evaluating visual ILD extent and FVC values; 2.Fleischer Society IPF diagnostic guidelines applied to RAILD; 3.CALIPER scores of vessel-related structures (VRS). Outcomes were compared to IPF patients.Results: On univariable Cox analysis, all three staging systems strongly predicted outcome: Scleroderma System:HR=3.78, p=9×10-5; Fleischner System:HR=1.98, p=2×10-3; 4.4% VRS threshold:HR=3.10, p=4×10-4 When the Scleroderma and Fleischner Systems were combined, termed the Progressive Fibrotic System (C-statistic=0.71), they identified a patient subset (n=36) with a progressive fibrotic phenotype and similar 4-year survival to IPF.On multivariable analysis, with adjustment for patient age, gender and smoking status, when analysed alongside the Progressive Fibrotic System, the VRS threshold of 4.4% independently predicted outcome (Model C-statistic=0.77).Conclusions: The combination of two visual CT-based staging systems identified 23% of an RAILD cohort with an IPF-like progressive fibrotic phenotype. The addition of a computer-derived VRS threshold further improved outcome prediction and model fit, beyond that encompassed by RAILD measures of disease severity and extent