Starting school:Educational development as a function of age of entry and prematurity

To estimate the impact on early development of prematurity and summer birth and the potential a € double disadvantage' created by starting school a year earlier than anticipated during pregnancy, due to being born preterm. Design, setting and patients We investigated the impact of gestational and school-entry age on the likelihood of failing to achieve a a € Good Level of Development' (GLD) on the Early Years Foundation Stage Profile in 5-year-old children born moderate-to-late preterm using data from the Born in Bradford longitudinal birth cohort. We used hierarchical logistic regression to control for chronological maturity, and perinatal and socioeconomic factors. Results Gestational age and school-entry age were significant predictors of attaining a GLD in the 10 337 children who entered school in the correct academic year given their estimated date of delivery. The odds of not attaining a GLD increased by 1.09 (95% CI 1.06 to 1.11) for each successive week born early and by 1.17 for each month younger within the year group (95% CI 1.16 to 1.18). There was no interaction between these two effects. Children starting school a year earlier than anticipated during pregnancy were less likely to achieve a GLD compared with (1) other children born preterm (fully adjusted OR 5.51 (2.85-14.25)); (2) term summer births (3.02 (1.49-6.79)); and (3) preterm summer births who remained within their anticipated school-entry year (3.64 (1.27-11.48)). Conclusions These results confirm the developmental risks faced by children born moderate-to-late preterm, and - for the first time - illustrate the increased risk associated with a 'double disadvantage'.</p

Risk of Developmental Disorders in Children Born at 32 to 38 Weeks' Gestation : A Meta-Analysis

CONTEXT: Very preterm birth (<32 weeks) is associated with increased risk of developmental disorders. Emerging evidence suggests children born 32 to 38 weeks might also be at risk. OBJECTIVES: To determine the relative risk and prevalence of being diagnosed with, or screening positive for, developmental disorders in children born moderately preterm, late preterm, and early term compared with term (≥37 weeks) or full term (39-40/41 weeks). DATA SOURCES: Medline, Embase, Psychinfo, Cumulative Index of Nursing, and Allied Health Literature. STUDY SELECTION: Reported ≥1 developmental disorder, provided estimates for children born 32 to 38 weeks. DATA EXTRACTION: A single reviewer extracted data; a 20% sample was second checked. Data were pooled using random-effects meta-analyses. RESULTS: Seventy six studies were included. Compared with term born children, there was increased risk of most developmental disorders, particularly in the moderately preterm group, but also in late preterm and early term groups: the relative risk of cerebral palsy was, for 32 to 33 weeks: 14.1 (95% confidence intervals [CI]: 12.3-16.0), 34 to 36 weeks: 3.52 (95% CI: 3.16-3.92) and 37 to 38 weeks: 1.44 (95% CI: 1.32-1.58). LIMITATIONS: Studies assessed children at different ages using varied criteria. The majority were from economically developed countries. All were published in English. Data were variably sparse; subgroup comparisons were sometimes based on single studies. CONCLUSIONS: Children born moderately preterm are at increased risk of being diagnosed with or screening positive for developmental disorders compared with term born children. This association is also demonstrated in late preterm and early term groups but effect sizes are smaller

Starting school: educational development as a function of age of entry and prematurity

Objective: To estimate the impact on early development of prematurity and summer birth and the potential ‘double disadvantage’ created by starting school a year earlier than anticipated during pregnancy, due to being born preterm. Design, setting and patients: We investigated the impact of gestational and school-entry age on the likelihood of failing to achieve a ‘Good Level of Development’ (GLD) on the Early Years Foundation Stage Profile in 5-year-old children born moderate-to-late preterm using data from the Born in Bradford longitudinal birth cohort. We used hierarchical logistic regression to control for chronological maturity, and perinatal and socioeconomic factors. Results: Gestational age and school-entry age were significant predictors of attaining a GLD in the 10 337 children who entered school in the correct academic year given their estimated date of delivery. The odds of not attaining a GLD increased by 1.09 (95% CI 1.06 to 1.11) for each successive week born early and by 1.17 for each month younger within the year group (95% CI 1.16 to 1.18). There was no interaction between these two effects. Children starting school a year earlier than anticipated during pregnancy were less likely to achieve a GLD compared with (1) other children born preterm (fully adjusted OR 5.51 (2.85–14.25)); (2) term summer births (3.02 (1.49–6.79)); and (3) preterm summer births who remained within their anticipated school-entry year (3.64 (1.27–11.48)). Conclusions: These results confirm the developmental risks faced by children born moderate-to-late preterm, and—for the first time—illustrate the increased risk associated with ‘double disadvantage’

Scoping potential routes to UK civil unrest via the food system: Results of a structured expert elicitation

We report the results of a structured expert elicitation to identify the most likely typesof potential food system disruption scenarios for the UK, focusing on routes to civil unrest. Wetake a backcasting approach by defining as an end-point a societal event in which 1 in 2000 peoplehave been injured in the UK, which 40% of experts rated as “Possible (20–50%)”, “More likely thannot (50–80%)” or “Very likely (>80%)” over the coming decade. Over a timeframe of 50 years, thisincreased to 80% of experts. The experts considered two food system scenarios and ranked theirplausibility of contributing to the given societal scenario. For a timescale of 10 years, the majorityidentified a food distribution problem as the most likely. Over a timescale of 50 years, the expertswere more evenly split between the two scenarios, but over half thought the most likely route tocivil unrest would be a lack of total food in the UK. However, the experts stressed that the variouscauses of food system disruption are interconnected and can create cascading risks, highlighting theimportance of a systems approach. We encourage food system stakeholders to use these results intheir risk planning and recommend future work to support prevention, preparedness, response andrecovery planning

Risk of Developmental Disorders in Children Born at 32 to 38 Weeks’ Gestation: A Meta-Analysis

CONTEXT Very preterm birth (<32 weeks) is associated with increased risk of developmental disorders. Emerging evidence suggests children born 32 to 38 weeks might also be at risk. OBJECTIVES To determine the relative risk and prevalence of being diagnosed with, or screening positive for, developmental disorders in children born moderately preterm, late preterm, and early term compared with term (≥37 weeks) or full term (39–40/41 weeks). DATA SOURCES Medline, Embase, Psychinfo, Cumulative Index of Nursing, and Allied Health Literature. STUDY SELECTION Reported ≥1 developmental disorder, provided estimates for children born 32 to 38 weeks. DATA EXTRACTION A single reviewer extracted data; a 20% sample was second checked. Data were pooled using random-effects meta-analyses. RESULTS Seventy six studies were included. Compared with term born children, there was increased risk of most developmental disorders, particularly in the moderately preterm group, but also in late preterm and early term groups: the relative risk of cerebral palsy was, for 32 to 33 weeks: 14.1 (95% confidence intervals [CI]: 12.3–16.0), 34 to 36 weeks: 3.52 (95% CI: 3.16–3.92) and 37 to 38 weeks: 1.44 (95% CI: 1.32–1.58). LIMITATIONS Studies assessed children at different ages using varied criteria. The majority were from economically developed countries. All were published in English. Data were variably sparse; subgroup comparisons were sometimes based on single studies. CONCLUSIONS Children born moderately preterm are at increased risk of being diagnosed with or screening positive for developmental disorders compared with term born children. This association is also demonstrated in late preterm and early term groups but effect sizes are smaller

Signatures of tumour immunity distinguish Asian and non-Asian gastric adenocarcinomas

OBJECTIVE: Differences in gastric cancer (GC) clinical outcomes between patients in Asian and non-Asian countries has been historically attributed to variability in clinical management. However, recent international Phase III trials suggest that even with standardised treatments, GC outcomes differ by geography. Here, we investigated gene expression differences between Asian and non-Asian GCs, and if these molecular differences might influence clinical outcome. DESIGN: We compared gene expression profiles of 1016 GCs from six Asian and three non-Asian GC cohorts, using a two-stage meta-analysis design and a novel biostatistical method (RUV-4) to adjust for technical variation between cohorts. We further validated our findings by computerised immunohistochemical analysis on two independent tissue microarray (TMA) cohorts from Asian and non-Asian localities (n=665). RESULTS: Gene signatures differentially expressed between Asians and non-Asian GCs were related to immune function and inflammation. Non-Asian GCs were significantly enriched in signatures related to T-cell biology, including CTLA-4 signalling. Similarly, in the TMA cohorts, non-Asian GCs showed significantly higher expression of T-cell markers (CD3, CD45R0, CD8) and lower expression of the immunosuppressive T-regulatory cell marker FOXP3 compared to Asian GCs (p<0.05). Inflammatory cell markers CD66b and CD68 also exhibited significant cohort differences (p<0.05). Exploratory analyses revealed a significant relationship between tumour immunity factors, geographic locality-specific prognosis, and postchemotherapy outcomes. CONCLUSIONS: Analyses of >1600 GCs suggest that Asian and non-Asian GCs exhibit distinct tumour immunity signatures related to T-cell function. These differences may influence geographical differences in clinical outcome, and the design of future trials particularly in immuno-oncology

Scoping Potential Routes to UK Civil Unrest via the Food System: Results of a Structured Expert Elicitation

Peer reviewed: TrueAcknowledgements: We are very grateful to the other participants not included as authors who took the survey, including Dan Crossley, Sue Davies, Katie Palmer, Anna Taylor, Alex Read and those who did not opt in to being named. Thank you to Adam Amara for helpful discussions about the framing of the study. We are grateful to Ben Dare for assistance in formatting and proofreading. The contents of this paper should not be taken to represent the views of the UK Government or the organisations to which the authors are affiliated.Publication status: PublishedFunder: Met Office Food, Farming and Natural Environment Climate ServiceFunder: Met Office Hadley Centre Climate ProgrammeFunder: DSITWe report the results of a structured expert elicitation to identify the most likely types of potential food system disruption scenarios for the UK, focusing on routes to civil unrest. We take a backcasting approach by defining as an end-point a societal event in which 1 in 2000 people have been injured in the UK, which 40% of experts rated as “Possible (20–50%)”, “More likely than not (50–80%)” or “Very likely (&gt;80%)” over the coming decade. Over a timeframe of 50 years, this increased to 80% of experts. The experts considered two food system scenarios and ranked their plausibility of contributing to the given societal scenario. For a timescale of 10 years, the majority identified a food distribution problem as the most likely. Over a timescale of 50 years, the experts were more evenly split between the two scenarios, but over half thought the most likely route to civil unrest would be a lack of total food in the UK. However, the experts stressed that the various causes of food system disruption are interconnected and can create cascading risks, highlighting the importance of a systems approach. We encourage food system stakeholders to use these results in their risk planning and recommend future work to support prevention, preparedness, response and recovery planning.</jats:p