Potencijalna korist meteoroloških informacija u prometu

U uvodu se ukazuje na ulogu i značaj meteorološke službe u valorizaciji prometa Republike Hrvatske. U drugom poglavlju daju se ciljevi i nabrajaju korisnici meteoroloških informacija u prometu, objašnjava priroda korisničkih zahtjeva i njihova identifikacija, vrste i sadržaj meteoroloških informacija, odnos korisnika prema ovim informacijama, te načini ostvarenja potencijalnih koristi u prometu. U trećem poglavlju obrazlaže se potreba upoznavanja meteorologa s djelatnostima korisnika informacija te osposobljavanje korisnika, i svih onih koji po prirodi posla dolaze u dodir s meteorološkim informacijama na putu od meteorologa do korisnika, kako bi se one optimalno koristile. U četvrtom poglavlju prikazan je sastav simulacijskog modela za istraživanje i primjenu potencijalnih koristi meteoroloških informacija u prometu, te se ukratko opisuje metodologija za njihovo efikasno korištenje od strane korisnika primjenom cost/benefit analize na jednostavnom primjeru

Prediction of movement difficulties at age five from parent report at age two in children born extremely preterm

Aim:To assess the predictive validity of parent reported gross motor impairment (GMI) at age twoyears to detect significant movement difficulties (MD) at age five in children born extremely preterm.Method:  Data come from 556 children born <28 weeks’ gestation in 2011-12 in 10 Europeancountries. Parent report of moderate/severe GMI was defined as walking unsteadily or unable towalk unassisted at two years corrected age. Examiners assessed significant MD (score ≤5th percentileon the Movement Assessment Battery for Children, 2nd Edition) and diagnoses of cerebral palsy (CP)were collected via parent report at five years chronological age. Results:At two years, 66 (11.9%) children had moderate/severe GMI. At five years, 212 (38.1%) hadsignificant MD. Parent reports of GMI at age two accurately classified CP at age five in 91.0-93.2% ofchildren. Classification of moderate/severe GMI at age two had high specificity (96.2%; 95% CI 93.6%,98.0%) and positive predictive value (80.3%; 68.7%, 89.1%) for significant MD at age five. However,74.5% of children with significant MD at five years were not identified with moderate/severe GMI atage two, resulting in low sensitivity (25.1%; 19.4%, 31.5%). Interpretation: This questionnaire may be used to identify extremely preterm children at age twowho have a diagnosis of CP or MD that are likely to have a significant impact on their functionaloutcomes at age five. </p

Variability in the management and outcomes of extremely preterm births across five European countries: a population-based cohort study.

OBJECTIVE: To explore international variations in the management and survival of extremely low gestational age and birthweight births. DESIGN: Area-based prospective cohort of births SETTING: 12 regions across Belgium, France, Italy, Portugal and the UK PARTICIPANTS: 1449 live births and fetal deaths between 22(+0) and 25(+6) weeks gestation born in 2011-2012. MAIN OUTCOME MEASURES: Percentage of births; recorded live born; provided antenatal steroids or respiratory support; surviving to discharge (with/without severe morbidities). RESULTS: The percentage of births recorded as live born was consistently low at 22 weeks and consistently high at 25 weeks but varied internationally at 23 weeks for those weighing 500 g and over (range 33%-70%) and at 24 weeks for those under 500 g (range 5%-71%). Antenatal steroids and provision of respiratory support at 22-24 weeks gestation varied between countries, but were consistently high for babies born at 25 weeks. Survival to discharge was universally poor at 22 weeks gestation (0%) and at any gestation with birth weight <500 g, irrespective of treatment provision. In contrast, births at 23 and 24 weeks weighing 500 g and over showed significant international variation in survival (23 weeks: range: 0%-25%; 24 weeks range: 21%-50%), reflecting levels of treatment provision. CONCLUSIONS: Wide international variation exists in the management and survival of extremely preterm births at 22-24 weeks gestation. Universally poor outcomes for babies at 22 weeks and for those weighing under 500 g suggest little impact of intervention and support the inclusion of birth weight along with gestational age in ethical decision-making guidelines

Recommendations for data collection in cohort studies of preterm born individuals – the RECAP Preterm Core Dataset

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Risk factors for cerebral palsy and movement difficulties in 5-year-old children born extremely preterm

Background Motor impairment is common after extremely preterm (EPT, Methods Data come from a European population-based cohort of children born EPT in 2011–2012 in 11 countries. We used multinomial logistic regression to assess risk factors for CP and non-CP MD (Movement Assessment Battery for Children – 2nd edition ≤5th percentile) compared to no MD (>15th percentile) among 5-year-old children. Results Compared to children without MD (n = 366), young maternal age, male sex and bronchopulmonary dysplasia were similarly associated with CP (n = 100) and non-CP MD (n = 224) with relative risk ratios (RRR) ranging from 2.3 to 3.6. CP was strongly related to severe brain lesions (RRR >10), other neonatal morbidities, congenital anomalies and low Apgar score (RRR: 2.4–3.3), while non-CP MD was associated with primiparity, maternal education, small for GA (RRR: 1.6–2.6) and severe brain lesions, but at a much lower order of magnitude. Conclusion CP and non-CP MD have different risk factor profiles, with fewer clinical but more sociodemographic risk factors for non-CP MD. Impact Young maternal age, male sex and bronchopulmonary dysplasia similarly increased risks of both cerebral palsy and non-cerebral palsy movement difficulties. Cerebral palsy was strongly related to clinical risk factors including severe brain lesions and other neonatal morbidities, while non-cerebral palsy movement difficulties were more associated with sociodemographic risk factors. These results on the similarities and differences in risk profiles of children with cerebral palsy and non-cerebral palsy movement difficulties raise questions for etiological research and provide a basis for improving the identification of children who may benefit from follow-up and early intervention.</p

Motor-related health care among five-year-old extremely preterm children with movement difficulties: results from a European cohort

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Variation in term birthweight across European countries affects the prevalence of small for gestational age among very preterm infants.

AIM: This study assessed the prevalence of small for gestational age (SGA) among very preterm (VPT) infants using national and European intrauterine references. METHODS: We generated country-specific and common European intrauterine growth references for 11 European countries, according to Gardosi's approach and Hadlock's foetal growth model, using national data on birthweights by sex. These references were applied to the Effective Perinatal Intensive Care in Europe (EPICE) cohort, which comprised 7766 live VPT births without severe congenital anomalies under 32 weeks of gestation in 2011-2012, to estimate the prevalence of infants with SGA birthweights, namely those below the 10th percentile. RESULTS: The SGA prevalence was 31.8% with country-specific references and 34.0% with common European references. The European references yielded a 10-point difference in the SGA prevalence between countries with lower term birthweights (39.9%) - Portugal, Italy and France - and higher term birthweights, namely Denmark, the Netherlands, Sweden (28.9%; p < 0.001). This was not observed with country-specific references, where the respective figures were 32.4% and 33.9% (p = 0.34), respectively. CONCLUSION: One-third of VPT infants were SGA according to intrauterine references. Common European references showed significant differences in SGA prevalence between countries with high and low-term birthweights

Postnatal growth restriction and neurodevelopment at 5 years of age: a European extremely preterm birth cohort study

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Motor-related health care for 5-year-old children born extremely preterm with movement impairments.

Aim To (1) determine the proportion of 5-year-old children born extremely preterm (EPT) with movement difficulties including cerebral palsy (CP) and the proportion of these children receiving motor-related health care (MRHC), and (2) describe factors associated with receiving MRHC. Method Children born before 28 weeks’ gestation in 2011 to 2012 in 11 European countries were assessed with the Movement Assessment Battery for Children, Second Edition (MABC-2) at 5 years of age. Information on family characteristics, child health including CP diagnosis, and health care use were collected using parent-report questionnaires. MRHC was defined as visits in the previous year with health care providers (physical and occupational therapists) specialized in assessing/treating motor problems. We analysed receipt of MRHC and associated factors among children at risk of movement difficulties (MABC-2 score 6th–15th centiles), with significant movement difficulties (SMD; ≤5th centile) or with CP. Results Of 807 children assessed at 5 years 7 months (SD 4 months; 4 years 7 months–7 years 1 month), 412 were males (51.1%), 170 (21.1%) were at risk of movement difficulties, 201 (24.9%) had SMD, and 92 (11.4%) had CP. Those who received MRHC comprised 89.1% of children with CP, 42.8% with SMD, and 25.9% at risk of movement difficulties. MRHC for children with SMD varied from 23.3% to 66.7% between countries. Children were more likely to receive MRHC if they had other developmental problems or socioemotional, conduct, or attention difficulties. Interpretation Efforts are needed to increase MRHC for 5-year-old children born EPT with movement difficulties.</p

Specialist health care services use in a European cohort of infants born very preterm.

AIM: Children born very preterm require additional specialist care because of the health and developmental risks associated with preterm birth, but information on their health service use is sparse. We sought to describe the use of specialist services by children born very preterm in Europe. METHOD: We analysed data from the multi-regional, population-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of births before 32 weeks' gestation in 11 European countries. Perinatal data were abstracted from medical records and parents completed a questionnaire at 2 years corrected age (4322 children; 2026 females, 2296 males; median gestational age 29wks, interquartile range [IQR] 27-31wks; median birthweight 1230g, IQR 970-1511g). We compared parent-reported use of specialist services by country, perinatal risk (based on gestational age, small for gestational age, and neonatal morbidities), maternal education, and birthplace. RESULTS: Seventy-six per cent of the children had consulted at least one specialist, ranging across countries from 53.7% to 100%. Ophthalmologists (53.4%) and physiotherapists (48.0%) were most frequently consulted, but individual specialists varied greatly by country. Perinatal risk was associated with specialist use, but the gradient differed across countries. Children with more educated mothers had higher proportions of specialist use in three countries. INTERPRETATION: Large variations in the use of specialist services across Europe were not explained by perinatal risk and raise questions about the strengths and limits of existing models of care. WHAT THIS PAPER ADDS: Use of specialist services by children born very preterm varied across Europe. This variation was observed for types and number of specialists consulted. Perinatal risk was associated with specialist care, but did not explain country-level differences. In some countries, mothers' educational level affected use of specialist services