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The authors estimated the prevalence of heart malformation during the first year of life, using five data sets with varying degrees of completeness from two English regional health authorities. These areas covered a total population of 6, 872, 000. Analysis was carried out using capture-recapture methods, including log-linear modeling, on data collected between June 1993 and August 1994. A large number of cases in the community were unrecorded by any of the current sources of information. In South East Thames, where an antenatal training screening program for detecting heart malformations had been implemented in the late 1980s, the estimated prevalence rate varied from 5.5 per 1, 000 births (95% confidence interval (Cl): 3.5, 10.8) to 9.0 per 1, 000 births (95% Cl: 6.4, 14.2), depending on the assumptions in the model and the number of sources used in the analysis. In the Wessex region, which did not have a formal training program, prevalence was lower and varied little, from 4.3 per 1, 000 (95% Cl: 3.4, 6.0) to 5.1 per 1, 000 (95% Cl: 4.0, 7.2), according to assumptions. These two estimates were reasonable rates in comparison with reports in the literature. This analysis was helpful in demonstrating that the training program designed to identify servere heart malformations during the antenatal period in one of these regions had no lasting impact on prevalence. Am J Epidemiol 1999; 150: 778–85. [ABSTRACT FROM PUBLISHER]

This article focuses on he national evaluation of Sure Start local programmes in England. Sure Start local programmes are central to the Great Britain's government's policy for combating the adverse effects of poverty and disadvantage on young children and their families. Sure Start local programmes are designed to be comprehensive, community-based projects adapted to local needs, and making maximal use of local expertise and enthusiasms. The Sure Start programmes recognized the need for rigorous evaluation and after a competitive commissioning process the National evaluation of Sure Start was initiated. Sure Start local programmes involve changes to existing services. Improved services and community functioning are presumed to lead to enhanced family community functioning that enhance child development.

Reports global developments related to AIDS epidemiology and seroepidemiology as of March 2000. Effect of worldwide epidemic on HIV prevalence in Great Britain; Interrelation between AIDS and cancer in Zimbabwe; Analysis on the HIV-1 gene in Italy.

The overall incidence of multiple births in England and Wales, which had been declining since the early 1950s, started to increase in the early 1980s in all age groups except for women under 20. This followed a rise in the incidence of triplet and higher order multiple births which had started in the late 1970s. Analyses of data for births between 1978 and 1983 showed that while stillbirth, perinatal, neonatal, and post-neonatal mortalities among multiple births fell considerably, they remained consistently higher than those for singleton births. Differences in the distribution of birth weight do not wholly explain these differences. Analyses of certified causes of stillbirth and death are difficult to interpret because a considerable proportion were attributed to 'multiple pregnancy'. [ABSTRACT FROM AUTHOR]

We examined like and unlike sex twinning rates in Great Britain by social class over the period 1974-85. Although twinning rates are believed to have changed over that period, we found no evidence of differential change by social class, suggesting that any factors affecting twinning are widespread in the population. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of neonatal abstinence syndrome (NAS) across neonatal units, explore healthcare utilisation and estimate the direct cost to the NHS., Design: Population cohort study., Setting: NHS neonatal units, using data held in the National Neonatal Research Database., Participants: Infants born between 2012 and 2017, admitted to a neonatal unit in England, receiving a diagnosis of NAS (n=6411)., Main Outcome Measures: Incidence, direct annual cost of care (£, 2016-2017 prices), duration of neonatal unit stay (discharge HR), predicted additional cost of care, and odds of receiving pharmacotherapy., Results: Of 524 334 infants admitted during the study period, 6411 had NAS. The incidence (1.6/1000 live births) increased between 2012 and 2017 (β=0.07, 95% CI (0 to 0.14)) accounting for 12/1000 admissions and 23/1000 cot days nationally. The direct cost of care was £62 646 661 over the study period. Almost half of infants received pharmacotherapy (n=2631; 49%) and their time-to-discharge was significantly longer (median 18.2 vs 5.1 days; adjusted HR (aHR) 0.16, 95% CI (0.15 to 0.17)). Time-to-discharge was longer for formula-fed infants (aHR 0.73 (0.66 to 0.81)) and those discharged to foster care (aHR 0.77 (0.72 to 0.82)). The greatest predictor of additional care costs was receipt of pharmacotherapy (additional mean adjusted cost of £8420 per infant)., Conclusions: This population study highlights the substantial cot usage and economic costs of caring for infants with NAS on neonatal units. A shift in how healthcare systems provide routine care for NAS could benefit infants and families while alleviating the burden on services., Competing Interests: Competing interests: CG holds grants from the National Institute of Health Research, the Mason Medical Research Foundation, the Rosetrees Foundation and the Canadian Institute for Health Research. He receives personal fees from Chiesi Pharmaceuticals. Outside of the submitted work, CG is vice-chair of the NIHR Research for Patient Benefit London Regional Assessment Panel. CG is a non-remunerated member of the Neonatal Data Analysis Unit (NDAU) steering board, which oversees the National Neonatal Research Database (NNRD)., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To assess differences across educational outcomes in survivors of childhood cancer (CCS) compared with peers., Design: Systematic review and meta-analysis of observational studies., Data Sources and Study Selection: Medline, EMBASE, ERIC, CINAHL and PsycInfo from inception to 1st August 2018. Any peer reviewed, comparative study with a population of any survivor of childhood cancer, from high-economy countries, reporting outcomes on educational attainment, were selected., Results: 26 studies representing 28 434 CCS, 17 814 matched controls, 6582 siblings and six population studies from 11 high-income countries, which have similar access to education and years of mandatory schooling as reported by the Organisation for Economic Cooperation and Development, were included. CCS were more likely to remain at compulsory level (OR 1.36, 95% CI 1.26 to 1.43) and less likely to complete secondary (OR 0.93, 95% CI 0.87 to 1.0) and tertiary level education (OR 0.87, 95% CI 0.78 to 0.98). They were more likely to require special educational needs (OR 2.47, 95% CI 1.91 to 3.20). Subgroup analyses revealed that survivors, irrespective of central nervous system (CNS) involvement, were less likely to progress onto secondary level compared with cancer-free peers (OR 1.77. 95% CI 1.46 to 2.15; OR 1.19, 95% CI 1.00 to 1.42, respectively). This, however, changed at tertiary level where those with CNS involvement continued to perform worse (OR 0.61, 95% CI 0.55 to 0.68) but those without appeared to perform similarly to their peers (OR 1.12, 95% CI 1.0 to 1.25)., Conclusions: Compared with controls, we have elucidated significant differences in educational attainment in survivors. This is sustained across different countries, making it an international issue. CNS involvement plays a key role in educational achievement. Clinicians, teachers and policymakers should be made aware of differences and consider advocating for early educational support for survivors., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

In recent years, there has been an imperative to improve productivity in the NHS. This requires the use of appropriate tools and appropriate leadership at all levels of organisations. This article outlines to concept of transformational change, discusses productivity as a national driver for improving healthcare services, looks at the most appropriate tools to use at various levels of organisations to achieve this, and considers why leadership is a vital component in transformational change.

The study evaluated the sex distribution of major isolated malformations and common trisomies among a large and geographically varied sample. Eighteen registries from 24 countries contributed cases, which were centrally reviewed and classified in three clinical types as isolated, associated, or syndromic. We selected cases of 26 major defects (n = 108,534); trisomy 21, 18, and 13 (n = 30,114); other syndromes (n = 2,898); and multiple congenital anomalies (n = 24,197), for a total of 165,743 cases. We observed a significant deviation of sex distribution (compared to a sex ratio of 1.06 or male proportion of 51.4%) for 24 of the 29 groups (a male excess in 16, a female excess in 8), and in 8 of such groups these estimates varied significantly across registries. A male excess was noted for two left obstructive cardiac defects (hypoplastic left heart and coarctation of the aorta) and a female excess for all the main types of neural tube defects. A male excess was seen for omphalocele but not gastroschisis. For neural tube defects the female excess tended to be stronger in areas with historically high prevalence for these defects. For 15 of the 26 birth defects the sex distribution differed among isolated, associated, and syndromic cases. Some of these epidemiologic commonalities are consistent with known or putative developmental processes. Further, the geographic variation for some defects may reflect local prevalence rates and risk factors. Finally, the findings underscore the need for clinical classification (e.g., into isolated, multiple, syndromes) in studies of birth defects.

Objectives: To evaluate the effectiveness of policies and recommendations on folic acid aimed at reducing the occurrence of neural tube defects., Design: Retrospective cohort study of births monitored by birth defect registries., Setting: 13 birth defects registries monitoring rates of neural tube defects from 1988 to 1998 in Norway, Finland, Northern Netherlands, England and Wales, Ireland, France (Paris, Strasbourg, and Central East), Hungary, Italy (Emilia Romagna and Campania), Portugal, and Israel. Cases of neural tube defects were ascertained among liveborn infants, stillbirths, and pregnancy terminations (where legal). Policies and recommendations were ascertained by interview and literature review., Main Outcome Measures: Incidences and trends in rates of neural tube defects before and after 1992 (the year of the first recommendations) and before and after the year of local recommendations (when applicable)., Results: The issuing of recommendations on folic acid was followed by no detectable improvement in the trends of incidence of neural tube defects., Conclusions: Recommendations alone did not seem to influence trends in neural tube defects up to six years after the confirmation of the effectiveness of folic acid in clinical trials. New cases of neural tube defects preventable by folic acid continue to accumulate. A reasonable strategy would be to quickly integrate food fortification with fuller implementation of recommendations on supplements.

Concern about apparent increases in the prevalence of hypospadias--a congenital male reproductive-tract abnormality--in the 1960s to 1980s and the possible connection to increasing exposures to endocrine-disrupting chemicals have underlined the importance of effective surveillance of hypospadias prevalence in the population. We report here the prevalence of hypospadias from 1980 to 1999 in 20 regions of Europe with EUROCAT (European Surveillance of Congenital Anomalies) population-based congenital anomaly registers, 14 of which implemented a guideline to exclude glanular hypospadias. We also report data from the England and Wales National Congenital Anomaly System (NCAS). Our results do not suggest a continuation of rising trends of hypospadias prevalence in Europe. However, a survey of the registers and a special validation study conducted for the years 1994-1996 in nine EUROCAT registers as well as NCAS identified a clear need for a change in the guidelines for registration of hypospadias. We recommend that all hypospadias be included in surveillance, but that information from surgeons be obtained to verify location of the meatus, and whether surgery was performed, in order to interpret trends. Investing resources in repeated special surveys may be more cost-effective than continuous population surveillance. We conclude that it is doubtful whether we have had the systems in place worldwide for the effective surveillance of hypospadias in relation to exposure to potential endocrine-disrupting chemicals.