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Background As most obese adults were not overweight as children, the prediction of adult obesity from childhood body size alone is limited. We constructed a two-way, multifactor risk assessment framework for predicting adult obesity during childhood using the Foresight Obesity System Map and tested it against longitudinal data from the 1958 National Child Development Study. Methods The framework divided study participants according to two categories of risk: 'conditioning factors' (past/fixed events and conditions) and 'intervention factors' (present and modifiable). At the age of 11 years, conditioning factors were 'low/high birth weight' and 'absence of breastfeeding', and intervention factors were 'low childhood activity level' and 'having at least one obese parent'. From a composite score of all four variables, study participants were assigned to one of the four risk groups: low risk, past 'conditioning' risk only, present 'intervention' risk only and high combined risk. ORs and relative risks for the development of future overweight/obesity at ages 23, 33 and 42 years were calculated for each risk group. Results Those identified in the highest risk category at the age of 11 were around twice as likely to become overweight (body mass index (BMI)≥25 kg/m2) by the age of 23 years, and obese (BMI≥30 kg/m2) by ages 33 and 42 years, in comparison to their low-risk peers (total sample, N=11 752). Increased prevalence of future obesity was also observed for high-risk children who were not already overweight at the age of 11 (filtered sample, N=9549). Conclusions This framework identifies a greater proportion of the population that is at risk for future obesity than does childhood weight assessment alone. [ABSTRACT FROM AUTHOR]

Background Little is known about the links between the time that young children go to bed and their cognitive development. In this paper we seek to examine whether bedtimes in early childhood are related to cognitive test scores in 7-year-olds. Methods We examined data on bedtimes and cognitive test (z-scores) for reading, maths and spatial abilities for 11 178 7-year-old children from the UK Millennium Cohort Study. Results At age 7, not having a regular bedtime was related to lower cognitive test scores in girls: reading (β: −0.22), maths (β: −0.26) and spatial (β: −0.15), but not for boys. Non-regular bedtimes at age 3 were independently associated, in girls and boys, with lower reading (β: −0.10, −0.20), maths (β: −0.16, −0.11) and spatial (β: −0.13, −0.16) scores. Cumulative relationships were apparent. Girls who never had regular bedtimes at ages 3, 5 and 7 had significantly lower reading (β: −0.36), maths (β: −0.51) and spatial (β: −0.40) scores, while for boys this was the case for those having non-regular bedtimes at any two ages (3, 5 or 7 years): reading (β: −0.28), maths (β: −0.22) and spatial (β: −0.26) scores. In boys having non-regular bedtimes at all three ages (3, 5 and 7 years) were non-significantly related to lower reading, maths and spatial scores. Conclusions The consistent nature of bedtimes during early childhood is related to cognitive performance. Given the importance of early child development, there may be knock on effects for health throughout life. [ABSTRACT FROM AUTHOR]

Background Using a prospective birth cohort design, we estimate the relative contribution of long-term postnatal nicotine exposure from 17 to 86 months on children’s subsequent antisocial behaviour by the end of fourth grade. Method Parents reported the amount of household smoke exposure (at 17, 41, 65 and 86 months) for all 2055 children from the Quebec Longitudinal Study of Child Development. Main outcome measures include teacher- and child-reported antisocial and physically aggressive behaviour (at 121 months). Results In terms of prevalence, 58% of parents reported that their children were never exposed to secondhand smoke in the home, while 34% and 8% of parents reported transient and continuous levels of secondhand smoke, respectively. When compared with never exposed children, children exposed to continuous secondhand smoke scored higher on self-reported aggressive behaviour and teacher-rated antisocial behaviour in fourth grade, B=0.336 (95% CI 0.155 to 0.517) and B=0.319 (95% CI 0.107 to 0.531), respectively. Similarly, children exposed to transient levels of secondhand smoke scored higher on aggressive and antisocial behaviour, B=0.714 (95% CI 0.456 to 0.972) and B=0.566 (95% CI 0.260 to 0.872), respectively. Conclusions The observed prevalence is concordant with worldwide estimates of children’s exposure to secondhand smoke. In comparison with their never exposed peers, children continuously and intermittently exposed to secondhand smoke in childhood showed an increased propensity toward physical aggression and antisocial behaviour by the end of fourth grade. We found no evidence of dose-dependence. [ABSTRACT FROM AUTHOR]

Background Previous studies have shown markedly lower birth weight among infants of South Asian origin compared with those of White European origin. Whether such differences mask greater adiposity in South Asian infants and whether they persist across generations in contemporary UK populations is unclear. Our aim was to compare birth weight, skinfold thickness and cord leptin between Pakistani and White British infants and to investigate the explanatory factors, including parental and grandparental birthplace. Methods We examined the differences in birth weight and skinfold thickness between 4649 Pakistani and 4055 White British infants born at term in the same UK maternity unit and compared cord leptin in a subgroup of 775 Pakistani and 612 White British infants. Results Pakistani infants were lighter (adjusted mean difference −234 g 95% CI −258 to −210) and were smaller in both subscapular and triceps skinfold measurements. The differences for subscapular and triceps skinfold thickness (mean z-score difference −0.27 95% CI −0.34 to −0.20 and −0.23 95% CI −0.30 to −0.16, respectively) were smaller than the difference in birth weight (mean z-score difference −0.52 95% CI −0.58 to −0.47) and attenuated to the null with adjustment for birth weight (0.03 95% CI −0.03 to 0.09 and −0.01 95% CI −0.08 to 0.05, respectively). Cord leptin concentration (indicator of fat mass) was similar in Pakistani and White British infants without adjustment for birth weight, but with adjustment became 30% higher (95% CI 17% to 44%) among Pakistani infants compared with White British infants. The magnitudes of difference did not differ by generation. Conclusions Despite being markedly lighter, Pakistani infants had similar skinfold thicknesses and greater total fat mass, as indicated by cord leptin, for a given birth weight than White British infants. Any efforts to reduce ethnic inequalities in birth weight need to consider differences in adiposity and the possibility that increasing birth weight in South Asian infants might inadvertently worsen health by increasing relative adiposity. [ABSTRACT FROM AUTHOR]

Background Despite the rising childhood obesity rates,few studies have examined the association between access to recreational parks and facilities and obesity.Methods A cross-sectional study was performed among 42 278 US children who participated in the2007 National Survey of Children’s Health. Access to parks and recreational facilities was self-reported by parents, and body mass index was calculated from parents’ self-report of the child’s height and weight.Logistic regression was used to obtain ORs and 95%CIs. Since obesity was not a rare occurrence, an OR correction method was used to provide a more reliable estimate of the prevalence ratio (PR).Results Children with access to parks and facilities had decreased prevalence of obesity as compared to children without access (PR=0.79, 95% CI 0.69 to 0.91). After adjustment for covariates, the magnitude of the association remained unchanged; however, results were no longer statistically significant (PR=0.77, 95% CI 0.55to 1.07). Race/ethnicity was an effect modifier of the access–obesity relationship ( p<0.0001). Among Non-Hispanic White children, there was no strong association(PR=0.89, 95% CI 0.64 to 1.23). However, among Non-Hispanic Black children, those who had access to recreational parks and facilities had 0.40 times the prevalence of obesity as compared to those without access, and this result was statistically significant (95%CI 0.17 to 0.90).Conclusions This research highlights potential health disparities in childhood obesity due to limited access to recreational parks and facilities. Additional studies are needed to further investigate this association. If confirmed, providing safe, accessible parks and facilities may be one way to combat childhood obesity,particularly among minority children. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between bed-sharing with the mother at 3 months of age and incidence of hospitalisation due to pneumonia and diarrhoea between 3 and 12 months. Methods The 2004 Pelotas Birth Cohort included all live births to mothers living in Pelotas, Brazil, in 2004. Information on bed-sharing was obtained at the 3-month follow-up visit, and on hospitalisations at the 12-month visit, both based on mothers' reports. Only singleton infants with complete information on hospitalisation were analysed. Results 3906 infants were included. The bed-sharing prevalence at 3 months was 46.4% (95% CI 44.9 to 48.0%). The incidence of pneumonia admissions between 3 and 12 months was 3.6% (95% CI 3.3 to 4.2%) and diarrhoea, 0.9% (95% CI 0.6 to 1.2%). In crude analyses, bed-sharing with the mother was associated with higher incidence of hospitalisation due to both pneumonia and diarrhoea. There was interaction between bed-sharing and duration of breastfeeding regarding the chance of admission due to pneumonia. Among infants breastfed for 3 months or less, the chance of hospitalisation due to pneumonia among bedsharers was almost twice as high as among non-bedsharers (adjusted OR 1.96; 95% CI 1.08 to 3.55). There was no association between bed-sharing and hospitalisation due to pneumonia among infants breastfed for longer than 3 months in crude or adjusted analyses. The association between bed-sharing and admissions due to diarrhoea lost statistical significance after allowing for confounders. Conclusions The effect of bed-sharing in infancy on the risk of hospitalisation due to pneumonia depends on breastfeeding, such that weaned children present higher risk. [ABSTRACT FROM AUTHOR]

Background: Despite rises in reconstituted and lone-parent families, relatively little is known about how the health of children in different family types varies, and the extent to which any differences might be explained by poverty. The authors examined this using cross-sectional data on 13 681 seven-year-olds from the Millennium Cohort Study. Methods: The authors estimated RRs and 95% CIs for having poor physical (general health, long-standing illness, injury, overweight, asthma, fits) and mental health (using strengths and difficulties scores) according to family structure using Poisson regression. The authors adjusted for confounders (aRR) and then investigated the role of poverty as a mediator by entering a poverty score (based on income, receipt of benefits, subjective poverty and material deprivation) into the main model. Results: Children living in reconstituted and lone-parent families were at a slight increased risk of poor health compared with those living with two natural parents. Adjusting for poverty tended to remove the elevated risk of poor physical health in children living in lone-parent and reconstituted families. However, for the mental health outcomes, poverty tended to remove the elevated risk for lone parents but not for reconstituted families. For example, the aRR for borderline--abnormal total difficulties fell from 1.45 (1.22 to 1.72) to 1.34 (1.13 to 1.59) in children living in reconstituted families and from 1.29 (1.14 to 1.45) to 1.05 (0.92 to 1.19) in those living with lone parents. Conclusions: Poor physical and mental health was slightly more prevalent in children living in lone-parent or reconstituted families. Poverty reduction may help to reduce these differences, especially for children living with lone parents; however, alternative mechanisms should be also explored, particularly for children living in reconstituted families. [ABSTRACT FROM AUTHOR]

Background Obesity in childhood and adolescence has important health consequences, but its relation to risk of adult depression remains uncertain. Objective To examine the effect of perceived and actual obesity during childhood and adolescence on prevalence and incidence of adult depression risk. Methods Cohort study of 91 798 female registered nurses followed longitudinally for 12 years. Results As compared with lean women of the same age, women in the two highest categories of body shape at age 10 had both higher prevalence (OR=2.59, 95% CI 1.46 to 4.61) and incidence (OR=2.01, 95% CI 1.08 to 3.71) of depression. Similar results were obtained for body shape at age 20 (OR=3.43 for prevalence and OR=2.03 for incidence) and for body mass index (BMI) at age 18 (OR=2.92 for BMI ≥40 kg/m2). These associations remained significant after adjustment for multiple confounders. Conclusion These results indicate that childhoodeadolescence obesity is a strong and independent risk factor for adult depression. [ABSTRACT FROM AUTHOR]

Background This study aimed to examine prospective associations of young infants' home environments with expressive vocabulary delay and internalising and externalising problem scores independently of family socioeconomic status (SES) and national origin. Methods Prospective data from fetal life to age 3 were collected in a total of 2711 families participating in the Generation R Study, a longitudinal population-based cohort. Infants' home environments (ie, the learning environment and the physical environment) were assessed exclusively by observation in their first few months of life (mean age=3.38 months, SD=1.17). Internalising and externalising problems were measured at age 1.5 and 3; expressive vocabulary delay was assessed at age 2.5. Family socio-demographic characteristics, including SES variables and national origin, were measured during pregnancy. Results Lower quality learning environments of young infants, but not physical environments, were associated with expressive vocabulary delay and more internalising problems in toddlerhood independently of SES and national origin. Associations of SES and national origin with children's outcomes were reduced when the home environmental variables were added to the regression model. Conclusions The current findings suggest that SES and national origin are reflected, to some degree, in the quality of infants' home environments. Some of the possible interpretations of these results are discussed together with their implications for the early identification of children at risk of impaired development. [ABSTRACT FROM AUTHOR]

Background: The authors assessed whether socioeconomic inequalities in asthma symptoms were already present in preschool children and to what extent prenatal, perinatal and postnatal risk factors for asthma symptoms mediate the effect of socioeconomic status (SES). Methods: The study included 3136 Dutch children participating in the Generation R Study, a prospective cohort study. Adjusted ORs of asthma symptoms for low and middle SES (household income and maternal education) compared to high SES were calculated after adjustment for potential confounders and also adjusted for prenatal, perinatal and postnatal mediators at preschool age. Results: At age 1 year, low-SES children had a 40% lower risk of asthma symptoms compared to high-SES children (p<0.01). However, the risk of asthma symptoms in 3- and 4-year-old low-SES children was 1.5 times higher compared to their high-SES age mates (p<0.05). The positive associations at age 1 year were particularly modified by postnatal factors (up to 38%). In toddlers, prenatal factors explained up to 58% of the negative associations between SES and asthma symptoms. Conclusions: SES indirectly affects asthma symptoms at preschool age. The inverse association between SES and asthma symptoms emerges at age 3 years. This is particularly due to a high level of adverse prenatal circumstances in low-SES toddlers. Future research should evaluate public health programs (during pregnancy) to reduce socioeconomic inequalities in childhood asthma. [ABSTRACT FROM AUTHOR]

Background: In 1974, Sweden became the first country to permit fathers to take paid parental leave. Other countries are currently following suit issuing similar laws. While this reform supports the principles of the United Nations convention of the right for children to be with both parents and enshrines the ethos of gender equality, there has been little systematic examination of its potential impact on child health. Instead, there is uninformed debate that fathers may expose their children to greater risks of injury than mothers. In this Swedish national study, the authors therefore assess whether fathers' parental leave can be regarded as a more serious risk factor for child injuries than that of mothers. Methods: Nationwide register-based ecological and longitudinal studies of hospitalisation due to injury (and intoxication) in early childhood, involving the Swedish population in 1973--2009 (ecological design), and children born in 1988 and 1989 (n=118 278) (longitudinal design). Results: An increase in fathers' share of parental leave over time was parallelled by a downward trend in child injury rates (age 0--4 years). At the individual level, the crude incidence of child injury (age 0--2 years) was lower during paternity as compared with maternity leave. This association was, however, explained by parental socio-demographic characteristics (multivariate HR 0.96, 95% CI 0.74 to 1.2). Conclusion: There is no support for the notion that paternity leave increases the risk of child injury. [ABSTRACT FROM AUTHOR]

Background: Improvements in health are an important expected outcome of many housing infrastructureprograms. The authors aimed to determine if improvement in the notoriously poor housinginfrastructure in Australian Indigenous communities results in reduction in common childhood illness and to identify important mediating factors in this relationship.Methods: The authors conducted a prospective cohort study of 418 children aged 7 years or younger in 10Australian Indigenous communities, which benefited most substantially from government-funded housing programs over 2004e2005. Data on functional and hygienic state of houses, reports of common childhood illness and on socio-economic conditions were collected through inspection of household infrastructure and interviews with children's carers and householders.Results: After adjustment for a range of potential confounding variables, the analysis showed no consistent reduction in carers' reporting of common childhood illnesses in association with improvements in household infrastructure, either for specific illnesses or for these illnesses in general. While there was strong association between improvement in householdinfrastructure and improvement of hygienic condition of the house, there were only marginal improvements in crowding.Conclusions: High levels of household crowding and poor social, economic and environmental conditions in many Australian Indigenous communities appear to place major constraints on the potential for building programs to impact on the occurrence of common childhood illness. These findings reinforce the need for building programs to be supported by a range of social,behavioural and community-wide environmentalinterventions in order for the potential health gains of improved housing to be more fully realised. [ABSTRACT FROM AUTHOR]

Background Potential health effects of cell phone use in children have not been adequately examined. As children are using cell phones at earlier ages, research among this group has been identified as the highest priority by both national and international organisations. The authors previously reported results from the Danish National Birth Cohort (DNBC), which looked at prenatal and postnatal exposure to cell phone use and behavioural problems at age 7 years. Exposure to cell phones prenatally, and to a lesser degree postnatally, was associated with more behavioural difficulties. The original analysis included nearly 13 000 children who reached age 7 years by November 2006. Methods To see if a larger, separate group of DNBC children would produce similar results after considering additional confounders, children of mothers who might better represent current users of cell phones were analysed. This 'new' dataset consisted of 28 745 children with completed Age-7 Questionnaires to December 2008. Results The highest OR for behavioural problems were for children who had both prenatal and postnatal exposure to cell phones compared with children not exposed during either time period. The adjusted effect estimate was 1.5 (95% CI 1.4 to 1.7). Conclusions The findings of the previous publication were replicated in this separate group of participants demonstrating that cell phone use was associated with behavioural problems at age 7 years in children, and this association was not limited to early users of the technology. Although weaker in the new dataset, even with further control for an extended set of potential confounders, the associations remained. [ABSTRACT FROM AUTHOR]

Background In the 1990s pneumonia hospitalisation rates in Western Australia (WA) were 13 times higher in Indigenous children than in non-Indigenous children. Rates of invasive pneumococcal disease in Indigenous children declined following the introduction in 2001 of 7-valent pneumococcal conjugate vaccine (7vPCV) in a 2e4e6 month schedule with an 18-month pneumococcal polysaccharide booster (PPV). We investigated population trends for pneumonia hospitalisations between 1996 and 2005. Methods Population-based retrospective data linkage cohort study of singleton live births from 1996e2005. Hospitalisations for acute lower respiratory infections in Indigenous and non-Indigenous children less than 5 years of age were extracted and trends in age-specific incidence rates were examined using log-linear modelling. Results From 245 249 births (7.1% Indigenous), there were 7727 pneumonia episodes. Between 1996 and 2000 and 2001 and 2005 all-cause pneumonia hospitalisations fell by 28e44% in Indigenous children aged 6e35 months with no equivalent decline in non-Indigenous children or for other acute lower respiratory infections. Incidence rate ratios for pneumonia comparing Indigenous with non-Indigenous children aged 6e11 months fell from 14.6 (95% CI 12.3 to 17.2) in 1996e2000 to 9.9 (8.4 to 11.6) in 2001e2005. Log-linear modelling showed a steady decline in Indigenous children of 9%/annum (5e12%) at age 12e23 months for all-cause pneumonia and 37%/ annum (20e50%) at age 6e11 months for pneumococcal pneumonia from 1996 to 2005, including the years prior to introduction of pneumococcal vaccines. Conclusions Pneumonia hospitalisations and the disparity between Indigenous and non-Indigenous children has declined by a third. The unique Australian pneumococcal vaccine programme is likely to have had a significant effect but changes in socioeconomic factors have also contributed to the declines. [ABSTRACT FROM AUTHOR]

Background Children from disadvantaged backgrounds are more likely to experience unintentional injuries and poor home environments. The aim of this study was to explore the home environment as a potential mediator between socioeconomic circumstances and unintentional injuries, in the UK Millennium Cohort Study (n=14 378). Methods RRs and 95% CIs for being injured in the home between age 9 months and 3 years were estimated according to four measures of socioeconomic circumstances: social class, maternal education, lone parenthood status and tenure. Proxy indicators of housing quality (build type, storey, garden access, rooms per capita, central heating and presence of damp) and safety equipment use (use of fireguards, safety gates, electric socket covers and smoke alarms) were then controlled for in order to observe potential mediation. Results Children from routine and manual backgrounds were more likely to be injured than those from managerial and professional backgrounds (RR=1.33, 95% CI 1.21 to 1.47), as were children of lone parents (compared with couple families) (RR=1.23, 95% CI 1.12 to 1.36), those whose mothers had no educational qualifications (compared with a degree) (RR=1.42, 95% CI 1.24 to 1.63) and those living in socially rented accommodation (compared with owned/mortgaged homes) (RR=1.35, 95% CI 1.24 to 1.46). However, controlling for the indicators of housing quality and safety equipment use did not alter the elevated risk of injury experienced by children from less advantaged backgrounds. Conclusions In this contemporary UK cohort, proxy indicators of the home environment did not appear to explain socioeconomic inequalities in injuries. Research exploring alternative explanations for inequalities in injuries could help contribute to the design or adaptation of policies to reduce them. [ABSTRACT FROM AUTHOR]

Objective To examine whether the season of birth or season of the early phase of gestation is associated with sensitisation to food allergens in children, with special reference to mothers' pollen exposure in spring. Design A population-based cohort study linking information from a questionnaire survey to allergy tests performed on the target population and regional pollen counts. Population Children born in 2001-6 who were resident in the province of South Karelia, Finland, at the time of the survey (N-5920). Main Outcome Measures A positive result in any food allergy test or food-specific immunoglobulin E test (sIgE). Results The cumulative incidence of a positive food allergy test up to the age of 4 years was highest among children born in October-November (10%) and lowest among those born in June-July (5%), and correspondingly highest among children who were in their 11th gestational week in April-May (11%), the season of high concentrations of birch and alder pollen, and lowest among those reaching that stage in December-January (6%). The amplitude of seasonal variation in any test, estimated as the relative ratio between the peak and trough of the smoothed incidence curve over the year, was 2.03 (95% CI 1.52 to 2.76). The amplitudes of positive sIgE were especially pronounced for milk (3.07; 95% CI 1.81 to 5.50) and egg (3.03; 95% CI 1.86 to 5.18). Conclusions Children having their early gestational period in the pollen season for broad-leafed trees are more prone to sensitisation to food allergens than other children. [ABSTRACT FROM AUTHOR]

Background This study examines the relationship between light drinking during pregnancy and the risk of socioemotional problems and cognitive deficits at age 5 years. Methods Data from the nationally representative prospective UK Millennium Cohort Study (N=11 513) were used. Participants were grouped according to mothers' reported alcohol consumption during pregnancy: never drinker; not in pregnancy; light; moderate; heavy/binge. At age 5 years the strengths and difficulties questionnaire (SDQ) and British ability scales (BAS) tests were administered during home interviews. Defined clinically relevant cut-offs on the SDQ and standardised scores for the BAS subscales were used. Results Boys and girls born to light drinkers were less likely to have high total difficulties (for boys 6.6% vs 9.6%, OR=0.67, for girls 4.3% vs 6.2%, OR=0.69) and hyperactivity (for boys 10.1% vs 13.4%, OR=0.73, for girls 5.5% vs 7.6%, OR=0.71) scores compared with those born to mothers in the not-in-pregnancy group. These differences were attenuated on adjustment for confounding and mediating factors. Boys and girls born to light drinkers had higher mean cognitive test scores compared with those born to mothers in the not-in-pregnancy group: for boys, naming vocabulary (58 vs 55), picture similarities (56 vs 55) and pattern construction (52 vs 50), for girls naming vocabulary (58 vs 56) and pattern construction (53 vs 52). Differences remained statistically significant for boys in naming vocabulary and picture similarities. Conclusions At age 5 years cohort members born to mothers who drank up to 1e2 drinks per week or per occasion during pregnancy were not at increased risk of clinically relevant behavioural difficulties or cognitive deficits compared with children of mothers in the not-in-pregnancy group. [ABSTRACT FROM AUTHOR]

Background/Aims The impact of the SAFE strategy (surgery, antibiotics, face washing, environmental hygiene), recommended to eliminate blinding trachoma, is not well explored. We determined the operational effectiveness of the whole SAFE intervention package. Methods Analytical cross-sectional trachoma surveys were conducted in four program areas across Ethiopia before and after 3 years of intervention with the SAFE strategy. A total of 8358 children 1-9 years, 4684 people above 14 and 3572 households were assessed in the follow-up evaluations using methodologies recommended by the WHO. Effects were measured by comparing follow-up proportions with baseline estimates of four key indicators. Results Coverage was 36% for trichiasis surgery, 59% for antibiotic and 57% for health-promotion services. Prevalence of trachoma trichiasis (TT) decreased from 4.6% (95% CI: 3.6% to 5.8%) down to 2.9% (CI: 2.1% to 3.9%). Prevalence of trachoma inflammation-follicular (TF) dropped from 36.7% (33.9% to 39.6%) to 18.4% (CI: 15.4% to 21.8%). The proportion of unclean faces and households not using latrines fell from 72.8% (68.9% to 76.4%) and 74.5% (69.9% to 78.7%) down to 47.0% (CI: 43% to 51%) and 51.7% (47.2% to 56.2%), respectively. All the reductions related with antibiotic (TF), face washing (clean face) and environmental (latrine) components were statistically significant except for Surgery (TT). Conclusions Considerable decline in the magnitude of trachoma and its risk factors was observed in areas where the SAFE strategy was implemented. The coverage of services should be maintained or improved in order to eliminate blinding trachoma by the year 2020. [ABSTRACT FROM AUTHOR]

Background Standards for school meals were recently introduced in the UK; however, no such standards exist for packed lunches. This study measures the provision and consumption of a range of food types and nutrients in British children's packed lunches and compares the results with the prevailing school meal standards in England. Methods Cross-sectional survey data was collected from 1294 children, age 8-9 years, attending 89 British primary schools. Eighty-seven primary schools declined to take part. The outcomes were the weight of food types and nutrients, provided and consumed in packed lunches and the proportion meeting the government food and nutrient school meal standards for England. Results Fourteen out of 1294 (1.1%) of packed lunches met all the food-based standards for school meals in England. Eighty-five per cent of children were provided with a sandwich, 19% with vegetables, 54% with fruit, 17% with cheese, 44% with a milk-based dessert, 82% with restricted snacks (crisps or confectionery) and 61% with a sweetened drink. The nutrient standards most likely to be met were protein and vitamin C. The nutrient standards least likely to be met were non-milk extrinsic sugars (NMES) and sodium. Girls were provided with, and consumed, more fruit, vegetables and milk-based desserts. Children at schools with lower percentage free school meals eligibility (% FSME) were provided with, and consumed, more vegetables. Conclusion Few packed lunches meet the school meal standards. Future research should address policy, interventions, and programmes to educate parents about the nutritional content of packed lunches. [ABSTRACT FROM AUTHOR]

Objective To examine incidence rates and trends of childhood Type 1 diabetes in Yorkshire from 1978 to 2007. Methods Data from the population-based Yorkshire Register of Diabetes in Children and Young People was used to analyse the incidence of Type 1 diabetes in children aged <15 years diagnosed in the former Yorkshire Regional Health Authority. Incidence rates (per 100 000 per year) were estimated using mid-year population estimates stratified by sex, age and ethnicity: south Asian (Indian, Pakistani, Bangladeshi) or non-south Asian (all other ethnicities). Ethnicity was assigned using two name recognition programs (Nam Pehchan and SANGRA) and a local expert. Age-sex standardised rates were calculated between 1978 and 2007 and by ethnic-group between 1990 and 2007. Poisson regression was used to assess incidence trends and estimate predicted rates up to 2020. Goodness-of-fit, AIC and likelihood-ratio tests were used to assess model fit. Results 3896 children were diagnosed in Yorkshire between 1978 and 2007. Overall incidence was 18.1 (95% CI 17.5 to to 18.6), increasing from 13.3 (1978 to 1987) to 16.9 (1988 to 1997) to 24.1 (1998 to 2007). Incidence increased significantly over time: average annual percentage change (AAPC) was 2.8% (1.8 to 3.8). The inclusion of an age-sex interaction term provided evidence for differences in trends between sexes depending on age, with females having higher incidence and AAPC than males for those aged 5–9. Overall incidence for non-south Asians (21.4; 20.6 to 22.3) was significantly higher than that of south Asians (14.6; 12.3 to 17.0) over the entire study period. A significant increasing trend in incidence was observed for non-south Asians of 3.3% (1.3 to 5.2) compared to a non-significant trend seen in south Asians (1.9%; –0.4 to 4.3). Overall forecasted incidence for 2020 is 38.3 per 100 000. Conclusions Type 1 diabetes incidence rates have risen almost uniformly for non-south Asians of all ages but not for south Asians, contrary to findings in the Bradford area of Yorkshire between 1978 and 1998. Overall incidence increased most quickly in the 5–9 age-group. Incidence doubled from 12.5 to 25.2 between 1978 and 2007. If current trends continue, rates will rise by 52% to 38.3 between 2007 and 2020. [ABSTRACT FROM PUBLISHER]

Objective Environmental factors are involved in the aetiology of type 1 diabetes. A particular role for infectious exposures has been postulated. Temporal and spatial variation in incidence would be consistent with this hypothesis. We aimed to test predictions of increasing incidence and spatial variation occurring among cases of type 1 diabetes in children (aged 0–14 years) that might arise as a result of environmental mechanisms. Design Population-based descriptive analysis of type 1 diabetes data. Setting Northeast England. Participants The study analysed 545 cases of type 1 diabetes diagnosed in children who were resident in a geographically defined region of northeast England during the period 1990–2007. Main Outcome Measures Age-specific and age-standardised incidence rates were calculated. Temporal trends were analysed using Poisson regression. Relationships between incidence rates and small area (census ward) population density and Townsend deprivation index (and its components) were analysed using negative binomial regression. Results Age-standardised incidence rates increased from 15.7 per 100 000 population in 1990–1995 to 27.9 per 100 000 population in 2002–2007. Furthermore, there was a regular 6-year cyclical pattern of plus or minus 25% in incidence rates (RR 1.25; 95% CI 1.11 to 1.41) and an overall increase of 4.8% per annum (95% CI 3.1 to 6.6). Lower incidence was associated with residence in wards that had higher levels of unemployment (RR per one percent increase in unemployment 0.97; 96% CI 0.95 to 0.99). Conclusions The results are consistent with the involvement of one or more environmental exposures in aetiology. A possible role for a specific infectious agent should be considered. [ABSTRACT FROM PUBLISHER]