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Background: Post-natal depression is common and has been associated with adverse effects on children's later emotional and behavioural development. The evidence for effects on children's cognitive development is unclear but this could potentially be a major public health issue. The aim was to examine whether maternal depression and maternal caregiving during the first year of life are associated with children's subsequent language development., Methods: One thousand two hundred and one women were recruited from antenatal and post-natal baby clinics in two areas in England, and followed up until their babies were 3 years. Mothers and children were assessed by questionnaire, interview and home observation; 999 children's language was assessed at 36 months, although 55 were excluded principally because they had been exposed to insufficient English., Results: In bivariate analyses maternal depressive symptomatology in the post-natal year but not at 36 months was associated with poorer child language at 36 months; maternal caregiving, was positively associated with language. Structural Equation Modelling revealed that depression was associated with poorer caregiving but was not independently associated with language. Higher quality caregiving at 10 months was associated with better language. When the sample was split by socioeconomic factors the effects of depression on caregiving were stronger in the less advantaged group. In both groups poorer quality early caregiving predicted lower language outcome., Conclusions: Post-natal depression had a negative effect on caregiving, which in turn affected language; post-natal depression did not have an additional direct effect on language. Socioeconomic factors moderated the effects of depression on caregiving. When targeting interventions at mothers with post-natal depression, it may be strategic to focus on lower socioeconomic groups at higher risk.

Background: There is some evidence that early sexual abuse is an aetiological factor for eating disorder. However, there is sparse information from large-scale, non-clinical studies., Aims: This study was designed to explore which early experiences, recalled during pregnancy, were associated with both lifetime and antenatal eating disorder symptoms in a community sample., Method: Univariate and multivariate analyses were conducted of data from questionnaires administered during pregnancy to a community sample of pregnant women., Results: Recall of parental mental health problems and of early unwanted sexual experiences were independently associated with both lifetime eating problems, laxative use and vomiting during pregnancy, and marked concern during pregnancy over shape and weight., Conclusions: There are public health implications for these results. Eating disorders in mothers represent a risk for child development. It may be important to enquire during pregnancy about a history of eating problems and to provide the opportunity for early experiences to be discussed.

Background: There is evidence that exposure to social and family disadvantages in childhood are a risk factor for adult depression., Aims: To explore the effects of multiple adversity in early childhood on adult depression, and the relative effects of the different adversities., Method: This study utilises data from the Newcastle Thousand Family Study. Information on childhood disadvantages was collected when the participants were 5 years old, and information on mental health was gathered when they were 33 years old. Mental health data were scrutinised blind to the evidence of early disadvantage, and best-estimate diagnoses of major depressive disorder were made according to DSM-III-R criteria., Results: Multiple family disadvantages in childhood substantially increase the risk of suffering a major depressive disorder in adulthood. Such disadvantages include family or marital relationship instability, a combination of poor mothering and poor physical care, and a combination of dependence on social welfare and overcrowding. For females major depression was linked in particular to the quality of parenting in early life., Conclusions: Social and family (especially multiple family) disadvantages during childhood predispose individuals to an increased risk of major depression in adulthood.

Objectives: To study the components of two risk assessment scales for decubitus ulcer risk, Waterlow and Braden, and of the Chailey score for the same purpose., Design: Experimental study of patients at risk of developing decubitus ulcers., Setting: The West Midlands and Yorkshire., Subjects: One hundred and fifty wheelchair users from the West Midlands and 9022 patients from a District General Hospital in York, the latter consisting of all admissions to the hospital in a four-month period., Interventions: Braden, Chailey scores (wheelchair users) and Waterlow scores (all subjects) measured., Main Outcome Measures: Development of a pressure sore, receiver operating characteristic (ROC) curves., Results: Waterlow outperformed Braden for classification of wheelchair patients with respect to decubitus ulcer. The Chailey score performed randomly in this group. The sensitivity and specificity as seen in ROC curves was different for Waterlow scores for wheelchair users and general patients, the latter being much better classified. Only three items out of 11 in the Waterlow score appeared to have any classification ability in the wheelchair group., Conclusions: Risk indicators used for general patients are probably poorly suited for wheelchair users. There is a need for large-scale predictive studies of wheelchair users and other groups to allow regression analysis of the subscales of risk indicators. From the provisional data of this study it appears that splitting patients by gender and into full- and part-time wheelchair users classifies almost as well the much more complicated risk assessment tools currently available.

Over the recent past, a number of different approaches to quality improvement have been introduced to the field of health-care delivery. Presents an overview of the approach developed at Brighton Health Care Trust. Outlines the strategic approach incorporating: the recognition of the need for staff education to enable them to participate fully in improving the quality of patient care; the identification of seven core components; the development of an educational package; and the development of a structure to support the implementation.