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Background: The Netherlands are lacking reliable empirical data in relation to the development of birth and population prevalence of Down syndrome. For the UK and Ireland there are more historical empirical data available. A theory-based model is developed for predicting Down syndrome prevalence in the Netherlands from the 1950s onwards. It is likewise applied to Ireland and the UK for the purpose of validation. Furthermore, a prediction to 2050 is constructed. Materials and Methods: Maternal age births data in the general population, maternal age related risk of Down syndrome, data on selective terminations of Down syndrome pregnancies and mortality rates (from 35 studies from the 1930s until today) were obtained to create this model. Results: For the Netherlands, nowadays birth prevalence is estimated at 14 per 10 000 with around 275 total annual births. The impact of selective abortion is lower than in the UK. Present Dutch Down syndrome population prevalence is estimated, according to this theory-based model, at 7.7 per 10 000 and the grand total at 12 600 individuals. The prevalence of "older" persons with Down syndrome (over 40 years of age) in the Netherlands will reach a peak in 2010, a doubling compared to 1990, implying an increased demand on medical care and counselling. Validity of this theory-based model was examined by comparison with relevant available empirical data from the three countries. The model shows a good fit with historical empirical research, notably four UK and two Irish population prevalence studies and eight birth prevalence studies. Conclusions: A theory-based model for Down syndrome prevalence provides supplementary data in situations with a lack of empirical material and can be used for understanding and predicting long-term developments.

This study aims to disentangle the contribution of genetic liability, educational attainment (EA), and their overlap and interaction in lifetime smoking. We conducted genome-wide association studies (GWASs) in UK Biobank (N = 394,718) to (i) capture variants for lifetime smoking, (ii) variants for EA, and (iii) variants that contribute to lifetime smoking independently from EA ('smoking-without-EA'). Based on the GWASs, three polygenic scores (PGSs) were created for individuals from the Netherlands Twin Register (NTR, N = 17,805) and the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2, N = 3090). We tested gene–environment (G × E) interactions between each PGS, neighborhood socioeconomic status (SES) and EA on lifetime smoking. To assess if the PGS effects were specific to smoking or had broader implications, we repeated the analyses with measures of mental health. After subtracting EA effects from the smoking GWAS, the SNP-based heritability decreased from 9.2 to 7.2%. The genetic correlation between smoking and SES characteristics was reduced, whereas overlap with smoking traits was less affected by subtracting EA. The PGSs for smoking, EA, and smoking-without-EA all predicted smoking. For mental health, only the PGS for EA was a reliable predictor. There were suggestions for G × E for some relationships, but there were no clear patterns per PGS type. This study showed that the genetic architecture of smoking has an EA component in addition to other, possibly more direct components. PGSs based on EA and smoking-without-EA had distinct predictive profiles. This study shows how disentangling different models of genetic liability and interplay can contribute to our understanding of the etiology of smoking. [ABSTRACT FROM AUTHOR]

Gender and sexually diverse adolescents have been reported to be at an elevated risk for suicidal thoughts and behaviors. For transgender adolescents, there has been variation in source of ascertainment and how suicidality was measured, including the time-frame (e.g., past 6 months, lifetime). In studies of clinic-referred samples of transgender adolescents, none utilized any type of comparison or control group. The present study examined suicidality in transgender adolescents (M age, 15.99 years) seen at specialty clinics in Toronto, Canada, Amsterdam, the Netherlands, and London, UK (total N = 2771). Suicidality was measured using two items from the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). The CBCL/YSR referred and non-referred standardization samples from both the U.S. and the Netherlands were used for comparative purposes. Multiple linear regression analyses showed that there was significant between-clinic variation in suicidality on both the CBCL and the YSR; in addition, suicidality was consistently higher among birth-assigned females and strongly associated with degree of general behavioral and emotional problems. Compared to the U.S. and Dutch CBCL/YSR standardization samples, the relative risk of suicidality was somewhat higher than referred adolescents but substantially higher than non-referred adolescents. The results were discussed in relation to both gender identity specific and more general risk factors for suicidality. [ABSTRACT FROM AUTHOR]

Purpose: In developed countries, diet-related health inequalities between people with different levels of socioeconomic advantage persist. However, there is limited qualitative evidence to inform the design of effective healthy eating (HE) strategies in socioeconomically disadvantaged populations (SDPs). The purpose of this review was to explore the characteristics influencing HE strategies for SDPs and develop a new understanding of how and why they influence their success. Methods: A qualitative evidence synthesis using a systematic meta-ethnographic approach. The twelve studies included were conducted in the USA, Canada, Australia, and UK. Results: The studies described a range of HE strategies, including nutrition education programs, food vouchers, and community gardens. Personal values and sense of pride and autonomy were found to have an influence on participants' attitudes towards HE strategies. Similarly, social characteristics such as level of social support and opportunities for shared benefits influenced participants' engagement. Structural characteristics such as the affordability and accessibility of healthy foods determined strategy acceptability and success. Finally, organizational characteristics such as flexibility influenced how well strategies supported the circumstances of participants. Conclusions: These overlapping characteristics may be used to inform the development, implementation, and evaluation of strategies to improve healthy eating in SDPs. [ABSTRACT FROM AUTHOR]

Gender diverse individuals who do not conform to society's binary gender expectations are more likely to experience difficulties in acceptance and in recognition of gender, compared to binary-identifying transgender people. This may accentuate the feeling that their gender identity is not socially recognized or validated. This study aimed to investigate psychological functioning among gender diverse adolescents and adults who identify beyond the binary gender spectrum. In both study populations, 589 clinically-referred gender diverse adolescents from the UK (n = 438 birth-assigned females and n = 151 birth-assigned males), and 632 clinically-referred gender diverse adults from the Netherlands (n = 278 birth-assigned females and n = 354birth-assigned males), we found that a higher degree of psychological problems was predicted by identifying more strongly with a non-binary identity. For adolescents, more psychological problems were related to having a non-binary gender identity and being assigned female at birth. In the adult population, experiencing psychological difficulties was also significantly related to having a stronger non-binary identity and having a younger age. Clinicians working with gender diverse people should be aware that applicants for physical interventions might have a broader range of gender identities than a binary transgender one, and that people with a non-binary gender identity may, for various reasons, be particularly vulnerable to psychological difficulties. [ABSTRACT FROM AUTHOR]

The representations of clouds, aerosols, and cloud–aerosol–radiation impacts remain some of the largest uncertainties in climate change, limiting our ability to accurately reconstruct past climate and predict future climate. The south-east Atlantic is a region where high atmospheric aerosol loadings and semi-permanent stratocumulus clouds are co-located, providing an optimum region for studying the full range of aerosol–radiation and aerosol–cloud interactions and their perturbations of the Earth's radiation budget. While satellite measurements have provided some useful insights into aerosol–radiation and aerosol–cloud interactions over the region, these observations do not have the spatial and temporal resolution, nor the required level of precision to allow for a process-level assessment. Detailed measurements from high spatial and temporal resolution airborne atmospheric measurements in the region are very sparse, limiting their use in assessing the performance of aerosol modelling in numerical weather prediction and climate models. CLARIFY-2017 was a major consortium programme consisting of five principal UK universities with project partners from the UK Met Office and European- and USA-based universities and research centres involved in the complementary ORACLES, LASIC, and AEROCLO-sA projects. The aims of CLARIFY-2017 were fourfold: (1) to improve the representation and reduce uncertainty in model estimates of the direct, semi-direct, and indirect radiative effect of absorbing biomass burning aerosols; (2) to improve our knowledge and representation of the processes determining stratocumulus cloud microphysical and radiative properties and their transition to cumulus regimes; (3) to challenge, validate, and improve satellite retrievals of cloud and aerosol properties and their radiative impacts; (4) to improve the impacts of aerosols in weather and climate numerical models. This paper describes the modelling and measurement strategies central to the CLARIFY-2017 deployment of the FAAM BAe146 instrumented aircraft campaign, summarizes the flight objectives and flight patterns, and highlights some key results from our initial analyses. [ABSTRACT FROM AUTHOR]

Purpose: To explore whether the increase observed in referrals to child and adolescent gender identity services (GIDSs) has been similar in four Nordic countries and in the UK. Materials and methods: Numbers of referrals per year in 2011–2017 were obtained from all GIDS in Denmark, Finland, Norway, Sweden and the UK and related to population aged <18. Results: A similar pattern of increase in referral rates was observed across countries, resulting in comparable population adjusted rates in 2017. In children, male:female birth sex ratio was even; in adolescents, a preponderance of females (birth sex) was observed, particularly in Finland. Conclusions: The demand for GIDSs has evolved similarly across Nordic countries and the UK. The reasons for the increase are not known but increased awareness of gender identity issues, service availability, destigmatization as well as social and media influences may play a role. [ABSTRACT FROM AUTHOR]

Background: Little is known about how social and cultural variants interact with gender identity development. This article aims to identify the ethnicities of children and young people referred to the United Kingdom's national Gender Identity Development Service (GIDS), and compare the ethnicity data with the UK child population and referrals to Child and Adolescent Mental Health Services (CAMHS). Methods: GIDS referrals made between April 2012 and April 2015 for children and young people were retrieved. Ethnicity data were obtained by the '16 + 1' ethnicity list. Chi-square and t -tests were performed on the demographics. Results: Less than 10% of the 995 referrals at GIDS were from Black and minority ethnic (BME) groups – an underrepresentation as compared with both the national population and CAMHS figures. No significant differences in ethnic representation were found between the demographic birth-assigned sexes, across age groups, or year of referral. Conclusions: Hypotheses proposed for this underrepresentation take into account both the potential barriers to accessing services and the possibility of cross-cultural variations in the conceptualisations of gender, gender roles and gender diversity. Ethnicity, culture and religion, and their overlapping relationship with gender need further exploration. [ABSTRACT FROM AUTHOR]

International literature suggests that gender-diverse people are at increased risk of thoughts and acts of self-injury compared to their cisgender peers. The current review aimed to investigate the prevalence of self-injurious thoughts and behaviours (SITBs) among children and young people (CYP) in the United Kingdom identifying as a gender not typically associated with the sex they were assigned at birth and, further, to examine relevant prevalence rates of SITBs reported both in academic and grey literature. In total, seven studies were included in the review and indicated an increased prevalence of SITBs among gender-diverse CYP compared to the general population. However, methodological limitations and significant heterogeneity in the rates of SITBs reported require that the available literature be interpreted with some caution. Important factors to consider when interpreting SITB rates, as well as recommendations for future research, are discussed. [ABSTRACT FROM AUTHOR]

There has been a recent rise in the number of people who hold a non-binary gender identity. However, the proportion of young people attending gender services who identify as non-binary has not yet been investigated. This article presents the findings from a pilot study of newly designed questionnaire, the Gender Diversity Questionnaire, which included questions about gender identity and gender expression. Responses from 251 adolescents attending the United Kingdom's National Gender Identity Development Service between June 2016 and February 2017 are reported here. The majority, 56.9%, of young people identified as trans, 29.3% identified as a binary gender (male or female), 11% identified as non-binary and 1.2% as agender. There were no significant differences in self-defined identities based on assigned gender or age. However, once young people were separated into these groups, some of them were very small; thus, a larger sample is required. In terms of aspects of gender expression that were important to the young people, the data formed five themes – name and pronouns, external appearance, the body, intrinsic factors and 'other'. Strengths and weaknesses of the research are discussed as well as future work that will be conducted. [ABSTRACT FROM AUTHOR]

Abstract Introduction The prevalence of gender dysphoria in children is not known; however, there are some data on the sex ratio of children referred to specialized gender identity clinics. Aim We sought to examine the sex ratio of children, and some associated factors (age at referral and year of referral), referred to the Gender Identity Development Service in the United Kingdom, the largest such clinic in the world. Methods The sex ratio of children (N = 1,215) referred to the Gender Identity Development Service between 2000–2017 was examined, along with year of referral, age-related patterns, and age at referral. Main Outcome Measure Sex ratio of birth-assigned boys vs birth-assigned girls. Results The sex ratio significantly favored birth-assigned boys over birth-assigned girls (1.27:1), but there were also age and year of referral effects. The sex ratio favored birth-assigned boys at younger ages (3–9 years), but favored birth-assigned girls at older ages (10–12 years). The percentage of referred birth-assigned boys significantly decreased when 2 cohorts were compared (2000–2006 vs 2007–2017). On average, birth-assigned boys were referred at a younger age than birth-assigned girls. Clinical Implications The evidence for a change in the sex ratio of children referred for gender dysphoria, particularly in recent years, matches a similar change in the sex ratio of adolescents referred for gender dysphoria. The reasons for this remain understudied. Strength & Limitations The United Kingdom data showed both similarities and differences when compared to data from 2 other gender identity clinics for children (Toronto, Ontario, Canada, and Amsterdam, The Netherlands). Such data need to be studied in more gender identity clinics for children, perhaps with the establishment of an international registry. Conclusion Further study of the correlates of the sex ratio for children referred for gender dysphoria will be useful in clinical care and management. de Graaf NM, Carmichael P, Steensma TD, et al. Evidence for a Change in the Sex Ratio of Children Referred for Gender Dysphoria: Data From the Gender Identity Development Service in London (2000–2017). J Sex Med 2018;15:1381–1383. [ABSTRACT FROM AUTHOR]

A 'burden reducing' agenda has spurred an increased interest in how EU environmental legislation is transposed into national legislation--most prominently reflected in the principle of 'no gold-plating'. Yet, an important question is to what extent transposition principles and practices may ensure a coherent and accessible body of environmental legislation, while at the same time ensuring adequate transposition of EU environmental legislation. This article analyses the existence, or emergence, of transposition principles and practices in three Member States--the United Kingdom, the Netherlands and Denmark. It also examines how EU initiatives may influence these principles and practices. The article concludes that the steering of transposition processes by general transposition principles and objectives alone, and in particular those dominated by a 'burden reducing' agenda, has a limited focus on coherence and accessibility with respect to environmental legislation and that such issues deserve more attention in the transposition process. [ABSTRACT FROM AUTHOR]

We investigate the class identity of married women as it relates to their own and their husband's class position. Whereas previous workers have attempted to test whether identity depends solely on the husband's position, not at all on the husband's position or equally on the husband's and wife's position, leaving out all intermediate cases, we estimate new diagonal reference models that quantify the relative weight of each partner's class position on their own class identity. In previous literature, it was also argued that women who work full time should be more likely to adopt a sharing model than other women and in some cases these different types of women were compared. We move beyond this simple dichotomy and more systematically formulate hypotheses about the conditions under which women attach more or less weight to their own class position and less or more weight respectively to that of their husbands. To test these hypotheses, we consider models where the weights are allowed to depend on characteristics of each partner and the couple. Using the British Social Attitudes Survey data for 1985–1991, we find that, when the husband's commitment to the labour force exceeds that of the wife, the husband's weight exceeds the wife's weight but, when the wife's commitment exceeds that of the husband's, the weights are approximately equal. We also find (unexpectedly) that women who hold higher positions than their husbands attach more weight to their husband's position than to their own position. [ABSTRACT FROM AUTHOR]

The public reporting of comparative information about health care quality is becoming an accepted way of improving accountability and quality. Quality report cards have been prominent in the United States for more than a decade and are a central feature of British health system reform. In this paper we examine the common challenges and differences in implementation of the policy in the two countries. We use this information to explore some key questions relating to the content, target audience, and use of published information. We end by making specific recommendations for maximizing the effectiveness of public reporting. [ABSTRACT FROM AUTHOR]

Worldwide initiatives currently aim to reduce free sugar intakes, but success will depend on consumer attitudes towards sugar and the alternatives. This work aimed to explore attitudes towards sugar, sweeteners and sweet-tasting foods, towards consumption and related policies, in a sample of the general public of the UK. Focus groups and interviews were conducted with 34 adults (7 males, ages: 18–65 years). Thematic analysis identified six themes: 'Value' (e.g., pleasure, emotions), 'Angle' (e.g., disinterest), 'Personal Relevance' (to be concerned and/or change one's own behavior), 'Personal Responsibility' (one has an active relationship with these food items), 'Understanding' (the acquisition, comprehension and application of information) and 'It's Not Up to Me' (a passive approach, because intake is subjected to other factors). Both positive and negative attitudes towards sugar, sweeteners and sweet-tasting foods were expressed in all themes. Participants also reported varied engagement with and motivations towards all food items, with implications for intakes. Suggested challenges and potential strategies for reducing free sugar intakes highlighted the need for differing approaches. Future work should assess associations between attitudes and intakes. For greatest population benefit, evidence of the dominant attitudes in those in greatest need of reduced free sugar intakes would be of value. [ABSTRACT FROM AUTHOR]

The article contrasts the conventional from the revised treatment of British women in class analysis. There has been growing controversy in recent years about the treatment of women in class analysis. In the past, the conventional practice was to treat the family as the unit of analysis and to classify its members according to the head of household's position. In addition to women's increased participation in the labor market, there are two further possibilities which might tend to increase the importance of women's own occupations. First, the growth of the women's movement or the greater risk of divorce might lead some women to place greater emphasis on their own career interests rather than on their husband's. Thus, there may be ideological and social changes in contemporary society which modify women's subjective interpretations of their long-run class interests. If, for any of these reasons, women's occupations are becoming more important (relative to spouse's occupation) in explaining their own behavior, then the conventional approach to class analysis will increasingly be called into question. Indeed, to stick with this approach, classifying women according to their husband's occupations, could reduce the explanatory force of class analysis and might lead to an apparent weakening of the relationship between class and the dependent variables of interest. For these reasons, a number of revisions have been suggested to the conventional approach to class analysis. One persuasive suggestion is that, while the family should be retained as the unit of analysis, its class position should be based on that of the higher-level partner, irrespective of whether that person is the husband or wife.

The article cites a study concerning the prevalence of equine neonatal isoerythrolysis (NI) caused by non-specific hemolytic alloantibody in Great Britain. This condition could be life-threatening and may require intensive management. Research shows that the proper way to prevent the disease is by identifying the mares that are at risk of producing antibodies that causes NI.

The article discusses a project which explores what the main health challenges for the Great Britain population will be in 2040 and the opportunities to address them. Respondents included doctors, medical students and professors whose ideas ranged from the expected to pure science fiction. They were united in their certainty about the changes that were predictable such as the rise in obesity and non-communicable disease and the emergence of antibiotic resistance.