The genetic and life course epidemiology of familial adiposity

The developmental overnutrition hypothesis proposes that prenatal exposure to maternal obesity causes increased risk of obesity and cardiometabolic disease in the offspring in subsequent adult life. Maternal body mass index (BMI) before or during pregnancy is positively associated with offspring adiposity from birth to adulthood, and with adult cardiometabolic disease incidence and mortality, but whether these associations are causal remains uncertain. This thesis aimed to investigate whether greater maternal BMI before or during pregnancy causes greater offspring adiposity in childhood and adolescence, and whether maternal BMI is associated with an adverse offspring cardiometabolic risk factor profile in adulthood. I analysed data from five European prospective birth cohorts: the Northern Finland Birth Cohorts (NFBCs) 1966 and 1986, the Avon Longitudinal Study of Parents and Children (ALSPAC), Born in Bradford (BiB) and Generation R, as well as the UK Biobank. I applied polygenic risk scoring (PRS), intergenerational Mendelian randomization (MR), bivariate Genomic Restricted Maximum Likelihood implemented in the GCTA software package (bivariate GCTA-GREML) and maternal GCTA-GREML. In NFBC1966, greater maternal BMI was associated with greater offspring adiposity and insulin resistance in adulthood, but these associations were somewhat attenuated on adjustment for a PRS partially capturing the offspring’s genetic predisposition to increased BMI. In ALSPAC and BiB, MR analyses suggested that maternal BMI does not have a large causal effect on offspring adiposity in late childhood and adolescence. Bivariate GCTA-GREML analyses in five cohorts showed that imputed offspring single nucleotide polymorphisms (SNPs) explained up to half of the phenotypic covariance between maternal BMI and offspring child and adolescent adiposity. Maternal GCTA-GREML analyses in ALSPAC and BiB showed that genetic confounding (the direct effects of maternal alleles inherited by the offspring) is an important explanation for this. My findings suggest that interventions aimed at reducing pre-conceptional adiposity in women are of uncertain effectiveness as a means to reduce offspring obesity risk.Open Acces

Globalization, culture and mental health [Editorial]

The idea for this special edition of the International Review of Psychiatry edited by Rachel Tribe and Steve Melhuish arose out of a conference with a similar title, ‘Globalisation, culture and psychology’, held at the University of Leicester in 2012, where a number of the journal contributors presented their ideas. Globalization, culture and mental health is a complex, multidimensional theme, potentially covering large and diverse areas of literature and practice as well as a range of contemporary debates and politically charged narratives. It is not possible to do justice to all of the potential avenues that could be explored; as such, this special edition is inevitably partial and selective in what it covers. It comprises articles written by authors from a number of countries: Cuba, Ethiopia, India, Sri Lanka and the UK. Many of the contributors are applied psychologists and as such there is a strong focus on the intersection between psychology and the broader themes of globalization and culture. However, there are also articles about the global mental health movement and cultural formulation written by psychiatrists and a service user/expert by experience

Cuban internationalism – An alternative form of globalization

This paper looks at how the principles of internationalism have been integral to the Cuban healthcare system and to Cuba's cooperation and medical support in other countries around the world. The paper details the range and scope of Cuban health internationalism and the principles that underpin the Cuban approach of long-term collaboration, humane care, contextualization, trans-disciplinarity, respect for collective/historical memory and an ethical stance. The paper details the role of Cuban psychologists who have contributed to disaster relief work and gives an example of the Cuban approach in relation to Haiti following the earthquake in 2010

Criteria of efficiency for conformal prediction

We study optimal conformity measures for various criteria of efficiency of classification in an idealised setting. This leads to an important class of criteria of efficiency that we call probabilistic; it turns out that the most standard criteria of efficiency used in literature on conformal prediction are not probabilistic unless the problem of classification is binary. We consider both unconditional and label-conditional conformal prediction.Comment: 31 page

Confidence Evaluation for Risk Prediction

This paper describe an application of a transductive method for risk mapping which allows to compute the confidence interval of an estimation, without any assumption on data distribution, except identity and independancy of inputs. The methos reliability is compared to conditionnal Sequential Gaussian Simulation. The robustness of this reliability to poor underlying regression models is also studied. The data set used is a digital elevation model of the South-West part of Switzerland ('Valais'). Experiments to evaluate the robustness of RRCM against the iid assumption are conducted using the data set of cadmium concentration in Leman Lake sediments in 1983 ('Cd83'

Improving continence in children and young people with neurodisability: a systematic review and survey.

Children and young people with neurodisability often need help to achieve socially acceptable bladder and bowel control. Approaches vary depending on whether or not the impairment results from spinal cord pathology that impairs motor control and sensation of the bladder and bowel. Currently, there is uncertainty about which interventions are effective. The objective was to summarise the available evidence on and current practice for improving continence in children and young people with neurodisability. A systematic review of the effectiveness, cost-effectiveness and factors that modify intervention implementation, alongside a cross-sectional, online survey of current practice with health professionals, parent carers, school and care staff and young people with neurodisability. Twelve databases were searched in the review, resulting in 5756 references; 71 studies (72 papers) were included in the analyses. Most of the evidence was for children with spinal cord pathology, which involved evaluations of pharmacological approaches and surgical techniques, whereas the evidence pertaining to those with non-spinal-cord-related pathology tended to be for behavioural interventions. The methodological quality of studies was rated as being moderate to poor. There were three robust qualitative studies about the experience of continence among children with spinal cord pathology. We found substantial heterogeneity across the interventions that we evaluated in terms of quality, study design and outcomes measured. No economic studies were found. The results were synthesised narratively and reported in text and tables. We did not find any eligible studies evaluating interventions using toilet and clothing adaptations in the review, although the survey highlighted that these types of interventions are frequently used and considered. In total, 949 people responded to the survey: 202 health professionals, 605 parent carers, 122 school and social care staff, and 20 young people. The survey results illustrated the different roles that professionals have in improving continence, highlighting the importance of a multidisciplinary approach to supporting children and young people and their families. Clinicians employ a range of assessments and interventions to improve continence or independent toileting, depending on the needs of the child. Quantitative studies in the review were not methodologically robust. The survey had a risk of response bias. Our research found a dearth of good-quality evidence for many of the interventions currently in use, and no evidence of experiences of implementing interventions for children with non-spinal-cord-related pathology. There was also no evidence of cost-effectiveness of any of the interventions. There is a need to involve young people and families in the design of high-quality evaluative research for interventions that aim to improve continence. This is especially the case for children with autism and learning disability, who have been neglected in previous evaluative and qualitative research. We recommend better training for health, education and care professionals about toileting, informed by evidence and the lived experiences of children and their families. We recommend a joined-up multidisciplinary and holistic approach to improving continence to maximise independence, dignity and comfort. It is vital that children and young people with neurodisability have early access to regular, integrated assessment of their bladder and bowel health, and are fully supported with appropriate personalised treatment. This study is registered as PROSPERO CRD42018100572. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 25, No. 73. See the NIHR Journals Library website for further project information

Interventions to improve continence for children and young people with neurodisability: a national survey of practitioner and family perspectives and experiences.

Objective Describe families’ experiences of interventions to improve continence in children and young people with neurodisability, and health professionals’ and school and social care staff’s perspectives regarding factors affecting intervention use. Design Four online surveys were developed and advertised to parent carers, young people with neurodisability, health professionals and school and social care staff, via societies, charities, professional contacts, schools, local authorities, and national parent carer and family forums, who shared invitations with their networks. Survey questions explored: difficulties helping children and young people use interventions; acceptability of interventions and waiting times; ease of use and availability of interventions, and facilitators and barriers to improving continence. Results 1028 parent carers, 26 young people, 352 health professionals and 202 school and social care staff registered to participate. Completed surveys were received from 579 (56.3%) parent carers, 20 (77%) young people, 193 (54.8%) health professionals, and 119 (58.9%) school and social care staff. Common parent carer-reported difficulties in using interventions to help their children and young people to learn to use the toilet included their child’s lack of understanding about what was required (reported by 337 of 556 (60.6%) parent carers who completed question) and their child’s lack of willingness (343 of 556, 61.7%). Almost all (142 of 156, 91%) health professionals reported lack of funding and resources as barriers to provision of continence services. Many young people (14 of 19, 74%) were unhappy using toilet facilities while out and about. Conclusions Perceptions that children lack understanding and willingness, and inadequate facilities impact the implementation of toileting interventions for children and young people with neurodisability. Greater understanding is needed for children to learn developmentally appropriate toileting skills. Further research is recommended around availability and acceptability of interventions to ensure quality of life is unaffected

Suicidality in family caregivers of people with long-term illnesses and disabilities: A scoping review

This is the author accepted manuscript; the final version is available from Elsevier via the DOI in this record.An emerging body of international research suggests family caregivers may be a high-risk group for suicide, but the evidence has not been synthesised. Forty-eight peer-reviewed journal articles were included in this review, spanning low-, middle-, and high-income countries and a variety of illnesses and disabilities. The proportion of caregivers experiencing suicidal ideation ranged from 2.7% to 71%, with evidence of suicide attempts, deaths by suicide, and deaths by homicide-suicide also reported. Risk and protective factors varied across studies and there was little consideration of differences by caregiving relationship, type of illness/disability, or country. There is sufficient evidence to warrant concern for caregivers around the world and prompt action in policy and practice, but more rigorous research is required to draw clear, nuanced conclusions about risk and inform evidence-based prevention and intervention.National Institute for Health Research (NIHR)University of BristolWeston NHS Foundation Trus