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Background: When parents bring their child to appointments and then adhere to agreed speech and language therapy (SLT) recommendations, there is the potential to increase the intensity of the intervention, support generalization and improve outcomes. In SLT, however, little is known about factors that may promote attendance or adherence. Studies in other clinical areas such in medicine, psychology and physiotherapy have identified risk factors for non‐attendance or non‐adherence that are multifactorial and variable dependent on, for example, population and intervention. Aims: To identify rates of non‐attendance and non‐adherence, and to identify parent or child factors associated with parent involvement in intervention for children under 5 years of age receiving SLT. Methods: Parents completed questionnaires at two time points assessing the domains of parents' beliefs (problem perceptions, self‐efficacy), personal circumstances (socio‐demographics, family functioning), treatment experience and child factors. Predictors of parent attendance and adherence were identified through multiple regression analyses. Non‐attendance rates were identified via local health records and non‐adherence ascertained using a specific parent‐reported measure within the treatment experience domain. Results: Participants (N = 199) were predominantly mothers, and were ethnically and socio‐economically diverse, speaking a wide range of languages. Their children presented with a range of speech, language communication needs (SLCN). The rate of non‐attendance was 25% and the main predictors of non‐attendance were maternal age, education level and two factors within the parent beliefs domain. This model explained 40% of the variance in attendance. The rate of non‐adherence in this cohort was 26% with parental rating of the importance of a recommendation and self‐efficacy beliefs predicting adherence; this explained 56% of the variance in adherence to SLT recommendations at home. Conclusions & Implications: Our research has provided preliminary evidence of the influence of parents' beliefs, personal circumstances and treatment experiences on their involvement in their child's therapy. Speech and language therapists should consider factors impacting attendance and adherence to treatment and explore parental perceptions of their child's SLCN before embarking on an intervention, a foundation for collaborative practice. A possible limitation of this study is that the levels of attrition in our sample led to generally high measured rates of participation, which should be considered in future studies. Future research should explore adherence in treatments with varying doses, with different types of SLCN or interventions and in different settings. WHAT THIS PAPER ADDS: What is already known on the subject: It is acknowledged that parent involvement in their child's therapy, such as attending and adhering to recommendations, is important but little is known about the rates of involvement and what factors may be associated with attendance and adherence in SLT. Qualitative research has explored parental involvement suggesting that beliefs about an intervention may be pertinent. Extensive research in other clinical areas suggest multiple and varied factors are influential and further exploration of particular populations and interventions is necessary. What this paper adds to the existing knowledge: This study identified rates of parental non‐attendance and non‐adherence in a cohort of predominantly mothers of children under the age of 5 years. It is the first study to measure parent adherence in SLT and identify factors that are associated parental adherence to SLT recommendations. It adds to the small body of SLT specific research in understanding risk factors for non‐attendance. What are the potential or actual clinical implications of this work?: This study highlights the need for a speech and language therapist to consider and explore parents' perspectives of their child's SLCN as a part of achieving collaboration with a parent in order to achieve the best outcomes. It provides a foundation for further systematic research into parent involvement with the ultimate aim of enhancing outcomes for children with SLCN. [ABSTRACT FROM AUTHOR]

Background: Geographical and cultural differences have been shown to affect public attitudes towards stuttering. However, increasingly for many individuals in the world one's birthplace culture (or home culture) and culture in their local geographical environment (or host culture) are not the same. Aims: The effects of home culture and host culture in shaping the attitudes towards stuttering among students with British, Arab and Chinese home cultures attending one British university were explored. The effects of host culture were investigated by considering the time lived in the UK for Arab and Chinese students. Methods & Procedures: The study used a descriptive survey design that included a standardized self‐delivered questionnaire: the Public Opinion Survey of Human Attributes—Stuttering (POSHA‐S). Purposive sampling was carried out thorough volunteer mailing lists, student societies and personal contact. The final sample of 156 university students included 51 British, 52 Arab and 53 Chinese students. Outcomes & Results: Overall stuttering score (OSS), which is indicative of attitudes towards stuttering, was highest for British participants (mean = 30) and lowest for Chinese participants (mean = 13), with Arab participants falling in the middle (mean = 21). The differences in attitudes between the three groups were statistically significant, suggesting that home culture is a contributor to attitudes towards stuttering. A post‐hoc item analysis of the POSHA‐S revealed numerous specific differences in attitudes towards stuttering between the three groups, including differences in the attribution of the aetiology of stuttering, their role in helping people who stutter (PWS) and sympathy toward PWS. Time lived in the UK—a proxy measure for the role of host culture—did not significantly influence the attitudes of Arab and Chinese respondents. Conclusions & Implications: To varying degrees, all three groups had evidence of stereotypical stuttering attitudes. Nevertheless, given similar ages and student status in the same university, observed respondent differences confirm previous research documenting geographical influences on stuttering attitudes in Western versus East Asian and Middle Eastern samples. The study also provides evidence that home culture was influential in shaping attitudes towards stuttering, but host culture was not a significant contributor. What this paper addsWhat is already known on the subjectPublic stereotypical beliefs towards stuttering are found across the world and hinder the quality of life among PWS. Different cultures have unique stereotypical beliefs towards PWS.What this study adds to existing knowledgeTo the best of our knowledge, no other study has investigated specifically if individuals who live in the same geographical location but have different home cultures, have similar or differing attitudes towards PWS. Results provide preliminary evidence that the home culture of an individual was influential in shaping attitudes towards PWS, but host culture, measured as the length of time living in the current geographical location, did not have a significant relationship with attitudes towards stuttering.What are the potential or actual clinical implications of this workThis study highlights that culturally sensitive clinical practice should not be based on just the culture of the region but should take home culture into consideration as well, and clinicians should discuss cultural perceptions of stuttering with clients in clinical practice. [ABSTRACT FROM AUTHOR]

Stark, widening health and income inequalities in the United Kingdom underpin the need for increased support for low‐income families to access affordable and nutritious foods. Using anonymised supermarket loyalty card transaction records, this study aimed to assess how an additional Healthy Start voucher (HSV) top‐up of £2, redeemable only against fruit and vegetables (FVs), was associated with FV purchases among at‐risk households. Transaction and redemption records from 150 loyalty card‐holding households, living in northern England, who had engaged with the top‐up scheme, were analysed to assess the potential overall population impact. Using a pre‐post study design, 133 of these households' records from 2021 were compared with equivalent time periods in 2019 and 2020. Records were linked to product, customer and store data, permitting comparisons using Wilcoxon matched‐pairs sign‐ranked tests and relationships assessed with Spearman's Rho. These analyses demonstrated that 0.9 more portions of FV per day per household were purchased during the scheme compared to the 2019 baseline (p = 0.0017). The percentage of FV weight within total baskets also increased by 1.6 percentage points (p = 0.0242), although the proportional spend on FV did not change. During the scheme period, FV purchased was higher by 0.4 percentage points (p = 0.0012) and 1.6 percentage points (p = 0.0062) according to spend and weight, respectively, in top‐up redeeming baskets compared to non‐top‐up redeeming baskets with at least one FV item and was associated with 5.5 more HSV 'Suggested' FV portions (p < 0.0001). The median weight of FV purchased increased from 41.83 kg in 2019 to 54.14 kg in 2021 (p = 0.0017). However, top‐up vouchers were only redeemed on 9.1% of occasions where FV were purchased. In summary, this study provides novel data showing that safeguarding funds exclusively for FV can help to increase access to FV in low‐income households. These results yield important insights to inform public policy aimed at levelling up health inequalities. [ABSTRACT FROM AUTHOR]

Background: Rapid population ageing is driving demand for qualified gerontological nurses. Yet, early career nurse attrition and limited focus on retention in the speciality limits supply. Objectives: To test the feasibility and acceptability of an Education‐Career pathway in Healthcare for Older People (ECHO) intervention for early career nurses to improve retention and capability in gerontological nursing. ECHO is a multicomponent intervention with integrated education, career planning and coaching components, tested over two 6‐month cycles. Methods: A feasibility study with a pre‐post design using a multi‐methods evaluation. Twenty‐nine early career nurse participants were recruited from eight NHS acute and community care Trusts in England. ECHO participants completed online questionnaires at baseline (Time 1), 6‐month (T2, end of intervention) and follow‐up at 18 months from baseline (T3). Outcome measures were career intention, self‐reported knowledge, career planning confidence, and burnout using the Maslach Burnout Inventory. Qualitative interviews were undertaken with participants (n = 23) and organizational stakeholders (n = 16) who facilitated ECHO. Data analysis used descriptive statistics and non‐parametric tests for paired data and thematic analysis for qualitative data. Results: Overall, 19 of 29 participants (65%) completed all aspects of the intervention. The evaluation was completed by 23 participants. ECHO was well received by participants and stakeholders. At T3, the 23 participants were working in the speciality, though two had changed organizations. There was a significant improvement in self‐reported gerontological knowledge, pre 87 (IQR 81–102), post 107 (IQR 98–112) p = 0.006, but no significant changes in other outcomes. In qualitative data, participants and organizational stakeholders held similar views, presented under four main themes: intended outcomes (personal and professional development, raise gerontological profile, expand horizons); nurse retention‐a double‐edged sword, ECHO logistics, and sustainability. Conclusion: Education‐Career pathway in Healthcare for Older People was feasible and may positively impact early career nurse retention, capability and socialization into gerontological nursing. ECHO requires further refinement and piloting, but learning can contribute to retention strategies. Implications for practice: Attracting and retaining early‐career nurses to the gerontological speciality requires greater innovation, organizational and senior nurse leadership. [ABSTRACT FROM AUTHOR]

Aims: To develop a questionnaire to identify Intensive Care survivor needs at key transitions during the recovery process, and assess its validity and reliability in a group of ICU survivors. Methods: Development of the Support Needs After ICU (SNAC) questionnaire was based on a systematic scoping review, and analysis of patient interviews (n = 22). Face and content validity were assessed by service users (n = 12) and an expert panel of healthcare professionals (n = 6). A pilot survey among 200 ICU survivors assessed recruitment at one of five different stages after ICU discharge [(1) in hospital, (2) < 6 weeks, (3) 7 weeks to 6 months, (4) 7 to 12 months, or (5) 12 to 24 months post‐hospital discharge]; to assess reliability of the SNAC questionnaire; and to conduct exploratory data analysis. Reliability was determined using Cronbach's alpha for internal consistency; intraclass correlation coefficients for test–retest reliability. We explored correlations with sociodemographic variables using Pearson's correlation coefficient; differences between questionnaire scores and patient demographics using one‐way ANOVA. Results: The SNAC questionnaire consisted of 32 items that assessed five categories of support needs (informational, emotional, instrumental [e.g. practical physical help, provision of equipment or training], appraisal [e.g. clinician feedback on recovery] and spiritual needs). ICU survivors were recruited from Northern Ireland, England and Scotland. From a total of 375 questionnaires distributed, 202 (54%) were returned. The questionnaire had high internal consistency (0.97) and high test–retest reliability (r = 0.8) with subcategories ranging from 0.3 to 0.9. Conclusions: The SNAC questionnaire appears to be a comprehensive, valid, and reliable questionnaire. Further research will enable more robust examination of its properties e.g. factor analysis, and establish its utility in identifying whether patients' support needs evolve over time. Relevance to clinical practice: The SNAC questionnaire has the potential to be used to identify ICU survivors' needs and inform post‐hospital support services. [ABSTRACT FROM AUTHOR]

Objective: Evidence for early intervention and prevention‐based approaches for improving social and emotional health in young children is robust. However, rates of participation in programmes are low. We explored the dynamics which affect levels of community readiness to address the issues of social and emotional health for pregnant women, young children (0‐4 years) and their mothers. Setting: A deprived inner‐city housing estate in the north of England. The estate falls within the catchment area of a project that has been awarded long‐term funding to address social and emotional health during pregnancy and early childhood. Methods: We interviewed key respondents using the Community Readiness Model. This approach applies a mixed methodology, incorporating readiness scores and qualitative data. A mean community readiness score was calculated enabling the placement of the community in one of nine possible stages of readiness. Interview transcripts were analysed using a qualitative framework approach to generate contextual information to augment the numerical scores. Results: An overall score consistent with vague awareness was achieved, indicating a low level of community readiness for social and emotional health interventions. This score suggests that there will be a low likelihood of participation in programmes that address these issues. Conclusion: Gauging community readiness offers a way of predicting how willing and prepared a community is to address an issue. Modifying implementation plans so that they first address community readiness may improve participation rates. [ABSTRACT FROM AUTHOR]

Aim: To explore how older people with complex health problems experience frailty in their daily lives. Background: A better understanding of the personal experience of frailty in the context of fluctuating ill‐health has the potential to contribute to the development of personalised approaches to care planning and delivery. Design: An ethnographic study of older people, living at home, receiving support from a community matron service in a large city in the North of England. Methods: Up to six care encounters with each of ten older people, and their community matron, were observed at monthly intervals, over a period of time ranging from 4 to 11 months. Semi‐structured interviews were conducted with the older participants in their own homes. Fieldwork took place over a 4‐year period. Data analysis was undertaken using the constant comparative method. Findings: The experience of frailty was understood through the construction of four themes: Fluctuating ill‐health and the disruption of daily living; Changes to the management of daily living; Frailty as fear, anxiety and uncertainty; Making sense of changes to health and daily living. Conclusions: Older people work hard to shape and maintain daily routines in the context of complicated and enduring transitions in health and illness. However, they experience episodic moments of frailty, often articulated as uncertainty, where daily living becomes precarious and their resilience is threatened. Developing an understanding of the personal experiences of frail older people in the context of transition has the potential to inform nursing practice in person‐centred care . Implications for practice: Nurses need to support frail older people to maintain independence and continuity of personhood in the context of daily routines. [ABSTRACT FROM AUTHOR]

Objectives Willingness-to-pay ( WTP) provides a broad assessment of well-being, capturing benefits beyond health. However, the validity of the approach has been questioned and the evidence relating to the sensitivity of WTP to changes in health status is mixed. Using menorrhagia (heavy menstrual bleeding) as a case study, this exploratory study assesses the sensitivity to scale of WTP to change in health status as measured by a condition-specific measure, MMAS, which includes both health and non-health benefits. The relationship between EQ-5D and change in health status is also assessed. Methods Baseline EQ-5D and MMAS values were collected from women taking part in a randomized controlled trial for pharmaceutical treatment of menorrhagia. Following treatment, these measures were administered along with a WTP exercise. The relationship between the measures was assessed using Spearman's correlation analysis, and the sensitivity to scale of WTP was measured by identifying differences in WTP alongside differences in MMAS and EQ5D values. Results Our exploratory findings indicated that WTP, and not EQ-5D, was significantly positively correlated with change in MMAS, providing some evidence for convergent validity. These findings suggest that WTP is capturing the non-health benefits within the MMAS measure. Mean WTP also increased with percentage improvements in MMAS, suggesting sensitivity to scale. Conclusion When compared to quality of life measured using the condition-specific MMAS measure, the convergent validity and sensitivity to scale of WTP is indicated. The findings suggest that WTP is more sensitive to change in MMAS, than with EQ-5D. [ABSTRACT FROM AUTHOR]

The aim of this study was to ascertain the prevalence of erectile dysfunction (ED), how it is perceived and the percentage seeking treatment for the condition in a population of men with cardiovascular disease (CVD) attending a cardiac rehabilitation programme in East London, UK. One hundred male subjects aged between 30 and 88 years attending a cardiac rehabilitation centre in East London participated in the study. An audit of men attending a cardiac rehabilitation programme was conducted. Participants completed the International Index of Erectile Function (IIEF‐5) to ascertain the severity of ED, an adapted ‘bother score’ item from the International Prostate Symptom Score (IPSS) to investigate the extent to which participants were bothered by the symptoms of their ED and questions related to both ED treatment‐seeking and beliefs about the impact of cardiac medication on ED. Demographic and clinical data were also collected. The audit was carried out between January and September 2014. Out of 117 male participants, 100 were audited (85·5% uptake). Prevalence of ED in this cohort was 80%, and 38% were suffering with moderate or severe ED. Older men had significantly higher levels of ED, and participants with severe ED were significantly more bothered by their condition. Those of Asian or British Asian descent reported significantly higher levels of ED severity than men from white ethnic backgrounds. Sixty‐five percent of men with ED had never spoken to a health care professional (HCP) about the condition, and 35% believed that their medication had a deleterious effect on erectile function. High incidences of ED remain undetected in this patient population. The study stresses the importance for HCPs to discuss ED with patients within primary care and cardiac rehabilitation programmes, which in turn could reduce mortality in those at risk of a future cardiac event as well as facilitate access to ED treatment. [ABSTRACT FROM AUTHOR]

Evidence links high levels of Autism Spectrum Disorder Traits in women with chronicity of anorexia nervosa. This study reports through clinical audit the impact of ASD traits on treatment outcomes of girls who were referred for treatment in a specialist eating disorder service. Presence of current, but not early childhood, ASD traits was elevated in comparison with previously reported community samples. Current ASD traits were correlated with emotional disorders and with need for treatment augmentation (psychiatric inpatient or day patient admission), but this relationship was not significant after the contribution of depression had been controlled for. There was no difference in Morgan Russell Outcomes at discharge for those with high and low current ASD traits. Parent-reported ASD-related developmental difficulties were associated with attenuated change in self-reported cognitive symptoms of AN. This study highlights the need for further understanding of the aetiology, diagnostic significance and predictive utility for future relapse of elevated ASD traits in childhood eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background Well-documented associations exist between socio-economic background and language ability in early childhood, and between educational attainment and language ability in children with clinically referred language impairment. However, very little research has looked at the associations between language ability, educational attainment and socio-economic background during adolescence, particularly in populations without language impairment. Aims To investigate: (1) whether adolescents with higher educational outcomes overall had higher language abilities; and (2) associations between adolescent language ability, socio-economic background and educational outcomes, specifically in relation to Mathematics, English Language and English Literature GCSE grade. Method & Procedures A total of 151 participants completed five standardized language assessments measuring vocabulary, comprehension of sentences and spoken paragraphs, and narrative skills and one nonverbal assessment when between 13 and 14 years old. These data were compared with the participants' educational achievement obtained upon leaving secondary education (16 years old). Univariate logistic regressions were employed to identify those language assessments and demographic factors that were associated with achieving a targeted A*-C grade in English Language, English Literature and Mathematics General Certificate of Secondary Education (GCSE) at 16 years. Further logistic regressions were then conducted to examine further the contribution of socio-economic background and spoken language skills in the multivariate models. Results & Outcomes Vocabulary, comprehension of sentences and spoken paragraphs, and mean length utterance in a narrative task along with socio-economic background contributed to whether participants achieved an A*-C grade in GCSE Mathematics and English Language and English Literature. Nonverbal ability contributed to English Language and Mathematics. The results of multivariate logistic regressions then found that vocabulary skills were particularly relevant to all three GCSE outcomes. Socio-economic background only remained important for English Language, once language assessment scores and demographic information were considered. Conclusions & Implications Language ability, and in particular vocabulary, plays an important role for educational achievement. Results confirm a need for ongoing support for spoken language ability throughout secondary education and a potential role for speech and language therapy provision in the continuing drive to reduce the gap in educational attainment between groups from differing socio-economic backgrounds. [ABSTRACT FROM AUTHOR]

Background: Postnatal maternal depressive symptoms are consistently associated with reduced quality of mother- infant interaction. However, there is little research examining the role of maternal cognitive factors (e.g. rumination) in the relationship between depressive symptoms and mother-infant interaction quality. This study investigated the hypotheses that: dysphoric mothers would demonstrate less sensitive behaviour towards their infants compared with nondysphoric mothers; mothers induced to ruminate would be less sensitive towards infants; rumination would moderate the relationship between maternal depressive symptoms and maternal sensitivity and the impact of the rumination induction would increase following a stressor (still face) task. Method: Mothers (N = 79; 39 dysphoric and 40 nondysphoric) and their infants were randomised to either a rumination induction or a control condition. Maternal sensitivity in mother-infant interactions was assessed before and after the induction using the CARE Index. In the second interaction task, mothers also completed the still-face procedure as a stressor. Results: Extending previous research, mixed measures ANOVAs demonstrated that dysphoric mothers had reduced quality of interaction with their infant compared with nondysphoric mothers and that mothers in the rumination condition exhibited reduced sensitivity towards their infants relative to mothers in the control condition. Further, maternal sensitivity worsened further after the still-face procedure in the rumination condition, but not in the control condition. Conclusions: This study suggests that the repetitive, internal focus of a ruminative state is causally implicated in mother-infant interaction quality, regardless of the level of depressive symptoms. This research extends understanding of specific mechanisms involved in the quality of the mother-infant relationship. [ABSTRACT FROM AUTHOR]

Incontinence is associated with mental illness and neuroleptic medications but diagnosis and treatment is often poor or non-existent. Problems of incontinence are compounded in secure psychiatric services for women by poor health, obesity, and a sedentary lifestyle. Addressing the physical health of this group necessitates a more accurate picture of the nature, incidence, and management of incontinence. A point-in-time survey of 108 women who agreed to be interviewed (93%) covered presence, frequency, and nature of incontinence, and information on management case note data was used to gather demographic and previous medical history, comparisons were made between patients with and without problems of incontinence. Findings indicate a problem of incontinence in 48% of women with a dominance of problems of stress and urge enuresis. Of modifiable factors that contribute to enuresis, the current study highlighted the contribution of obesity, smoking and clozapine medication. A further finding was the preference for managing rather than treating problems of incontinence. Actions to improve the detection and treatment of this problem are described. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives There is evidence that health and well-being of the National Health Service ( NHS) workforce affects organizational and patient outcomes. A Cochrane review of the effectiveness of clinical audit to improve quality of care has shown great variation between studies, depending on the design and intensity of support offered. This study evaluates the effectiveness of an organizational audit methodology with (1) action-planning workshops and follow-up and (2) audit feedback alone, to support the implementation of the National Institute for Health and Care Excellence ( NICE) workplace guidance. Methods Two rounds of audit using a self-administered online questionnaire were conducted. An overall implementation score was devised for each trust. Following round 1, interviews were conducted with a cohort of trusts with high scores. The interviews used a theory-based framework to identify predictors of and barriers to successful implementation. From this, the content for action-planning workshops was devised and workshops held with lower scoring trusts. The remaining trusts received only written feedback on their audit results. Changes in the implementation score between rounds 1 and 2 were compared within and between cohorts. Results The median improvement in scores between rounds 1 and 2 was statistically significant except where baseline score was high. The improvement for trusts who received workshops was very much better than those who did not ( P < 0.001). This difference remained after adjustment using stratification by baseline score ( P = 0.001). Conclusions Audit, combined with action-planning workshops and follow-up, appears to be more effective in improving implementation of NICE workplace health and well-being guidance than audit with feedback alone. [ABSTRACT FROM AUTHOR]

Background Adults with intellectual disabilities ( ID) experience a wide range of eating, drinking and/or swallowing ( EDS) problems, for which they receive diverse mealtime support interventions. Previous research has estimated that dysphagia (difficulty swallowing) affects 8% of all adults with ID and that 15% require some form of mealtime support. People with ID (whether they require mealtime support or not) also experience a greater burden of ill health and die younger than their peers in the general population with no ID. Methods Using an exploratory, population-based cohort study design, we set out to examine health-related outcomes in adults with ID who receive mealtime support for any eating, drinking or swallowing problem, by establishing the annual incidence of healthcare use, EDS-related ill health, and all-cause mortality. This study was conducted in two counties in the East of England. Results In 2009, 142 adults with mild to profound ID and a need for any type of mealtime support were recruited for a baseline survey. At follow-up 1 year later, 127 individuals were alive, eight had died and seven could not be contacted. Almost all participants had one or more consultations with a general practitioner ( GP) each year (85-95%) and, in the first year, 20% reportedly had one or more emergency hospitalizations. Although their annual number of GP visits was broadly comparable with that of the general population, one-fifth of this population's primary healthcare use was directly attributable to EDS-related ill health. Respiratory infections were the most common cause of morbidity, and the immediate cause of all eight deaths, while concerns about nutrition and dehydration were surprisingly minor. Our participants had a high annual incidence of death (5%) and, with a standardized mortality ratio of 267, their observed mortality was more than twice that expected in the general population of adults with ID (not selected because of mealtime support for EDS problems). Conclusions All Annual Health Checks now offered to adults with ID should include questions about respiratory infections and EDS functioning, in order to focus attention on EDS problems in this population. This has the potential to reduce life-threatening illness. [ABSTRACT FROM AUTHOR]

Background Historically, many women with intellectual disability ( ID) did not have children. However, a few decades ago it became more common for women with ID to give birth. Our aim was to compare the completed pregnancies of mothers with ID with other completed pregnancies in a large, defined population. Methods We used the archived dataset of the Oxford record linkage study from 1970 to 1989, which included a specialized dataset of all maternities in a population of 850 000 people. Results There were 245 007 births, of which 217 were to mothers with a record of ID. Mothers with a record of ID were more likely than others to give birth at a young age, were much more likely to be unmarried (42% compared with 9%) and to have smoked in the pregnancy (54% compared with 23%). Comparing babies born of mothers with ID and others, percentages with very low birth weight (<2000 g) were similar at 1.9 and 1.8%. There was no excess of babies who were low birth weight for gestational age. Babies born of mothers with ID were much less likely than others to be breastfed (respectively, 33 and 70%). There were no significant associations with presentation at delivery, Caesarean section or forceps delivery. The distribution of Apgar scores at 1 min after birth was similar in babies of mothers with ID and other babies. The sex ratio of the babies was normal. Combining stillbirths and infant deaths, rates per 1000 were 27.9 for babies of mothers with ID and 13.4 in other babies (borderline significant at P = 0.07). Conclusions Comparing pregnancies and outcomes of mothers with and without ID, there are some important differences, and some important similarities. It is possible, however, that there may be differences over time and between different places in the care and outcomes of pregnancies in mothers with ID. In the modern era, with electronic health records, it should be possible for maternity services, both locally and on a whole population basis, routinely to monitor the pregnancies, and their outcomes, of mothers with ID. [ABSTRACT FROM AUTHOR]

Background In general, children with specific language impairment (SLI) tend to fall behind their typically developing (TD) peers in educational attainment. Less is known about how children with SLI fare in particular areas of the curriculum and what predicts their levels of performance. Aims To compare the distributions of performance of children with SLI in three core school subjects (English, Mathematics and Science); to test the possibility that performance would vary across the core subjects; and to examine the extent to which language impairment predicts performance. Methods & Procedures This study was conducted in England and reports historical data on educational attainments. Teacher assessment and test scores of 176 eleven-year-old children with SLI were examined in the three core subjects and compared with known national norms. Possible predictors of performance were measured, including language ability at ages 7 and 11, educational placement type, and performance IQ. Outcomes & Results Children with SLI, compared with national norms, were found to be at a disadvantage in core school subjects. Nevertheless, some children attained the levels expected of TD peers. Performance was poorest in English; relative strengths were indicated in Science and, to a lesser extent, in Mathematics. Language skills were significant predictors of performance in all three core subjects. PIQ was the strongest predictor for Mathematics. For Science, both early language skills at 7 years and PIQ made significant contributions. Conclusions & Implications Language impacts on the school performance of children with SLI, but differentially across subjects. English for these children is the most challenging of the core subjects, reflecting the high levels of language demand it incurs. Science is an area of relative strength and mathematics appears to be intermediate, arguably because some tasks in these subjects can be performed with less reliance on verbal processing. Many children with SLI do have the potential to reach or exceed educational targets that are set at national levels for TD children. [ABSTRACT FROM AUTHOR]