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1. Born in Bradford Age of Wonder cohort: A protocol for qualitative longitudinal research [version 3; peer review: 2 approved]

Author: Helen Roberts, John Wright, Rosemary R.C. McEachan, Katy A. Shire, Sufyan Abid Dogra, Rosslyn Kerr, Kate Lightfoot, Olivia Joseph, Jennifer Hall, Hannah Nutting, Neil Small, and Nasiba Siddig
Subjects: Qualitative Longitudinal Research, Born in Bradford, Age of Wonder, Health and Wellbeing, Coproduction, Cohort Study, eng, Medicine, Science
Abstract: Bradford is multi-ethnic and one of the most deprived districts in the United Kingdom where around a quarter of children live in low-income families. Born in Bradford (BiB) has followed the lives of 13,776 children born in the district between 2007 and 2011. Children in the birth cohort are now entering adolescence, and the next phase of the research - Age of Wonder (AoW) - will be a whole city cohort capturing the experiences of 30,000 adolescents progressing into young adulthood. This protocol focuses on one component of the AoW programme: qualitative longitudinal research (QLR). The study will gather in depth and detailed accounts from a sub-sample of 100 young people across four major research priorities: personal life; social and community life; growing up with difference, and growing up in Bradford. As well as using traditional qualitative methods such as interviews, focus group discussions, and ethnography, we are adopting innovative creative methods including expressions through art, activism, online and digital content, portraits, and critical events. The process of engaging in and co-producing QLR potentially provides a route to empowering young people to shape the narrative of their own lives as well as informing intervention development.
Published: 2023
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2. Born in Bradford Age of Wonder cohort: A protocol for qualitative longitudinal research [version 2; peer review: 2 approved]

Author: Helen Roberts, John Wright, Rosemary R.C. McEachan, Katy A. Shire, Sufyan Abid Dogra, Rosslyn Kerr, Kate Lightfoot, Olivia Joseph, Jennifer Hall, Hannah Nutting, Neil Small, and Nasiba Siddig
Subjects: Qualitative Longitudinal Research, Born in Bradford, Age of Wonder, Health and Wellbeing, Coproduction, Cohort Study, eng, Medicine, Science
Abstract: Born in Bradford (BiB) has followed the lives of 13,776 children born in the district between 2007 and 2011. Children in the birth cohort are now entering adolescence, and the next phase of the research - Age of Wonder (AoW) - will be a whole city cohort capturing the experiences of 30,000 adolescents progressing into young adulthood. This protocol focuses on one component of the AoW programme: qualitative longitudinal research (QLR). The study will gather in depth and detailed accounts from a sub-sample of 100 young people across four major research priorities: personal life; social and community life; growing up with difference, and growing up in Bradford. As well as using traditional qualitative methods such as interviews, focus group discussions, and ethnography, we are adopting innovative creative methods including expressions through art, activism, online and digital content, portraits, and critical events. The process of engaging in and co-producing QLR potentially provides a route to empowering young people to shape the narrative of their own lives as well as informing intervention development.
Published: 2023
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3. Fine-scale population structure and demographic history of British Pakistanis

Author: Elena Arciero, Sufyan A. Dogra, Daniel S. Malawsky, Massimo Mezzavilla, Theofanis Tsismentzoglou, Qin Qin Huang, Karen A. Hunt, Dan Mason, Saghira Malik Sharif, David A. van Heel, Eamonn Sheridan, John Wright, Neil Small, Shai Carmi, Mark M. Iles, and Hilary C. Martin
Subjects: Science
Abstract: Little is known about the recent population history or the effects of endogamy on the Pakistani population. Here the authors examine the impact of the biraderi social stratification system on the population structure of individuals of British Pakistani ancestry in the Born in Bradford cohort.
Published: 2021
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4. Vulnerabilities in child well-being among primary school children: a cross-sectional study in Bradford, UK

Author: John Wright, Josie Dickerson, Brian Kelly, Mark Mon-Williams, Neil Small, Philippa K Bird, Kate E Pickett, Bo Hou, Deborah Lawlor, Rosemary McEachan, Katy Shire, Mildred Ajebon, and Claire McIvor
Subjects: Medicine
Published: 2022
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5. An annotated and critical glossary of the terminology of inclusion in healthcare and health research

Author: Shahid Islam and Neil Small
Subjects: Community engagement, Community involvement, Participation, Community development, Community empowerment, Community readiness, Medicine, Medicine (General), R5-920
Abstract: Abstract The importance of including members of the public has been accorded a significant position in health planning, service delivery and research. But this position masks a lack of clarity about terms that are used. This paper identifies terms that are in common use in the lexicon of community based involvement and engagement in health with the intention of clarifying meaning and thus reducing ambiguity. We define and distinguish between key terms related to inclusion, we consider the terminology attached to community processes and to the challenges of inclusion and we engage with the strengths and weaknesses of the commonly used metaphor of “a ladder of participation”. We wish to contribute to the clear communication of intentions, challenges and achievements in pursuing varied forms of inclusion in health.
Published: 2020
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6. On Folk Devils, Moral Panics and New Wave Public Health

Author: Russell Mannion and Neil Small
Subjects: moral panic, obesity, public health policy, medical sociology, Public aspects of medicine, RA1-1270
Abstract: New wave public health places an emphasis on exhorting individuals to engage in healthy behaviour with good health being a signifier of virtuous moral standing, whereas poor health is often associated with personal moral failings. In effect, the medical is increasingly being collapsed into the moral. This approach is consistent with other aspects of contemporary neoliberal governance, but it fuels moral panics and creates folk devils. We explore the implications and dysfunctional consequences of this new wave of public health policy in the context of the latest moral panic around obesity.
Published: 2019
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7. Associations of autozygosity with a broad range of human phenotypes

Author: David W Clark, Yukinori Okada, Kristjan H S Moore, Dan Mason, Nicola Pirastu, Ilaria Gandin, Hannele Mattsson, Catriona L K Barnes, Kuang Lin, Jing Hua Zhao, Patrick Deelen, Rebecca Rohde, Claudia Schurmann, Xiuqing Guo, Franco Giulianini, Weihua Zhang, Carolina Medina-Gomez, Robert Karlsson, Yanchun Bao, Traci M Bartz, Clemens Baumbach, Ginevra Biino, Matthew J Bixley, Marco Brumat, Jin-Fang Chai, Tanguy Corre, Diana L Cousminer, Annelot M Dekker, David A Eccles, Kristel R van Eijk, Christian Fuchsberger, He Gao, Marine Germain, Scott D Gordon, Hugoline G de Haan, Sarah E Harris, Edith Hofer, Alicia Huerta-Chagoya, Catherine Igartua, Iris E Jansen, Yucheng Jia, Tim Kacprowski, Torgny Karlsson, Marcus E Kleber, Shengchao Alfred Li, Ruifang Li-Gao, Anubha Mahajan, Koichi Matsuda, Karina Meidtner, Weihua Meng, May E Montasser, Peter J van der Most, Matthias Munz, Teresa Nutile, Teemu Palviainen, Gauri Prasad, Rashmi B Prasad, Tallapragada Divya Sri Priyanka, Federica Rizzi, Erika Salvi, Bishwa R Sapkota, Daniel Shriner, Line Skotte, Melissa C Smart, Albert Vernon Smith, Ashley van der Spek, Cassandra N Spracklen, Rona J Strawbridge, Salman M Tajuddin, Stella Trompet, Constance Turman, Niek Verweij, Clara Viberti, Lihua Wang, Helen R Warren, Robyn E Wootton, Lisa R Yanek, Jie Yao, Noha A Yousri, Wei Zhao, Adebowale A Adeyemo, Saima Afaq, Carlos Alberto Aguilar-Salinas, Masato Akiyama, Matthew L Albert, Matthew A Allison, Maris Alver, Tin Aung, Fereidoun Azizi, Amy R Bentley, Heiner Boeing, Eric Boerwinkle, Judith B Borja, Gert J de Borst, Erwin P Bottinger, Linda Broer, Harry Campbell, Stephen Chanock, Miao-Li Chee, Guanjie Chen, Yii-Der I Chen, Zhengming Chen, Yen-Feng Chiu, Massimiliano Cocca, Francis S Collins, Maria Pina Concas, Janie Corley, Giovanni Cugliari, Rob M van Dam, Anna Damulina, Maryam S Daneshpour, Felix R Day, Graciela E Delgado, Klodian Dhana, Alexander S F Doney, Marcus Dörr, Ayo P Doumatey, Nduna Dzimiri, S Sunna Ebenesersdóttir, Joshua Elliott, Paul Elliott, Ralf Ewert, Janine F Felix, Krista Fischer, Barry I Freedman, Giorgia Girotto, Anuj Goel, Martin Gögele, Mark O Goodarzi, Mariaelisa Graff, Einat Granot-Hershkovitz, Francine Grodstein, Simonetta Guarrera, Daniel F Gudbjartsson, Kamran Guity, Bjarni Gunnarsson, Yu Guo, Saskia P Hagenaars, Christopher A Haiman, Avner Halevy, Tamara B Harris, Mehdi Hedayati, David A van Heel, Makoto Hirata, Imo Höfer, Chao Agnes Hsiung, Jinyan Huang, Yi-Jen Hung, M Arfan Ikram, Anuradha Jagadeesan, Pekka Jousilahti, Yoichiro Kamatani, Masahiro Kanai, Nicola D Kerrison, Thorsten Kessler, Kay-Tee Khaw, Chiea Chuen Khor, Dominique P V de Kleijn, Woon-Puay Koh, Ivana Kolcic, Peter Kraft, Bernhard K Krämer, Zoltán Kutalik, Johanna Kuusisto, Claudia Langenberg, Lenore J Launer, Deborah A Lawlor, I-Te Lee, Wen-Jane Lee, Markus M Lerch, Liming Li, Jianjun Liu, Marie Loh, Stephanie J London, Stephanie Loomis, Yingchang Lu, Jian’an Luan, Reedik Mägi, Ani W Manichaikul, Paolo Manunta, Gísli Másson, Nana Matoba, Xue W Mei, Christa Meisinger, Thomas Meitinger, Massimo Mezzavilla, Lili Milani, Iona Y Millwood, Yukihide Momozawa, Amy Moore, Pierre-Emmanuel Morange, Hortensia Moreno-Macías, Trevor A Mori, Alanna C Morrison, Taulant Muka, Yoshinori Murakami, Alison D Murray, Renée de Mutsert, Josyf C Mychaleckyj, Mike A Nalls, Matthias Nauck, Matt J Neville, Ilja M Nolte, Ken K Ong, Lorena Orozco, Sandosh Padmanabhan, Gunnar Pálsson, James S Pankow, Cristian Pattaro, Alison Pattie, Ozren Polasek, Neil Poulter, Peter P Pramstaller, Lluis Quintana-Murci, Katri Räikkönen, Sarju Ralhan, Dabeeru C Rao, Wouter van Rheenen, Stephen S Rich, Paul M Ridker, Cornelius A Rietveld, Antonietta Robino, Frank J A van Rooij, Daniela Ruggiero, Yasaman Saba, Charumathi Sabanayagam, Maria Sabater-Lleal, Cinzia Felicita Sala, Veikko Salomaa, Kevin Sandow, Helena Schmidt, Laura J Scott, William R Scott, Bahareh Sedaghati-Khayat, Bengt Sennblad, Jessica van Setten, Peter J Sever, Wayne H-H Sheu, Yuan Shi, Smeeta Shrestha, Sharvari Rahul Shukla, Jon K Sigurdsson, Timo Tonis Sikka, Jai Rup Singh, Blair H Smith, Alena Stančáková, Alice Stanton, John M Starr, Lilja Stefansdottir, Leon Straker, Patrick Sulem, Gardar Sveinbjornsson, Morris A Swertz, Adele M Taylor, Kent D Taylor, Natalie Terzikhan, Yih-Chung Tham, Gudmar Thorleifsson, Unnur Thorsteinsdottir, Annika Tillander, Russell P Tracy, Teresa Tusié-Luna, Ioanna Tzoulaki, Simona Vaccargiu, Jagadish Vangipurapu, Jan H Veldink, Veronique Vitart, Uwe Völker, Eero Vuoksimaa, Salma M Wakil, Melanie Waldenberger, Gurpreet S Wander, Ya Xing Wang, Nicholas J Wareham, Sarah Wild, Chittaranjan S Yajnik, Jian-Min Yuan, Lingyao Zeng, Liang Zhang, Jie Zhou, Najaf Amin, Folkert W Asselbergs, Stephan J L Bakker, Diane M Becker, Benjamin Lehne, David A Bennett, Leonard H van den Berg, Sonja I Berndt, Dwaipayan Bharadwaj, Lawrence F Bielak, Murielle Bochud, Mike Boehnke, Claude Bouchard, Jonathan P Bradfield, Jennifer A Brody, Archie Campbell, Shai Carmi, Mark J Caulfield, David Cesarini, John C Chambers, Giriraj Ratan Chandak, Ching-Yu Cheng, Marina Ciullo, Marilyn Cornelis, Daniele Cusi, George Davey Smith, Ian J Deary, Rajkumar Dorajoo, Cornelia M van Duijn, David Ellinghaus, Jeanette Erdmann, Johan G Eriksson, Evangelos Evangelou, Michele K Evans, Jessica D Faul, Bjarke Feenstra, Mary Feitosa, Sylvain Foisy, Andre Franke, Yechiel Friedlander, Paolo Gasparini, Christian Gieger, Clicerio Gonzalez, Philippe Goyette, Struan F A Grant, Lyn R Griffiths, Leif Groop, Vilmundur Gudnason, Ulf Gyllensten, Hakon Hakonarson, Anders Hamsten, Pim van der Harst, Chew-Kiat Heng, Andrew A Hicks, Hagit Hochner, Heikki Huikuri, Steven C Hunt, Vincent W V Jaddoe, Philip L De Jager, Magnus Johannesson, Åsa Johansson, Jost B Jonas, J Wouter Jukema, Juhani Junttila, Jaakko Kaprio, Sharon L. R. Kardia, Fredrik Karpe, Meena Kumari, Markku Laakso, Sander W van der Laan, Jari Lahti, Matthias Laudes, Rodney A Lea, Wolfgang Lieb, Thomas Lumley, Nicholas G Martin, Winfried März, Giuseppe Matullo, Mark I McCarthy, Sarah E Medland, Tony R Merriman, Andres Metspalu, Brian F Meyer, Karen L Mohlke, Grant W Montgomery, Dennis Mook-Kanamori, Patricia B Munroe, Kari E North, Dale R Nyholt, Jeffery R O’connell, Carole Ober, Albertine J Oldehinkel, Walter Palmas, Colin Palmer, Gerard G Pasterkamp, Etienne Patin, Craig E Pennell, Louis Perusse, Patricia A Peyser, Mario Pirastu, Tinca J. C. Polderman, David J Porteous, Danielle Posthuma, Bruce M Psaty, John D Rioux, Fernando Rivadeneira, Charles Rotimi, Jerome I Rotter, Igor Rudan, Hester M Den Ruijter, Dharambir K Sanghera, Naveed Sattar, Reinhold Schmidt, Matthias B Schulze, Heribert Schunkert, Robert A Scott, Alan R Shuldiner, Xueling Sim, Neil Small, Jennifer A Smith, Nona Sotoodehnia, E-Shyong Tai, Alexander Teumer, Nicholas J Timpson, Daniela Toniolo, David-Alexandre Tregouet, Tiinamaija Tuomi, Peter Vollenweider, Carol A Wang, David R Weir, John B Whitfield, Cisca Wijmenga, Tien-Yin Wong, John Wright, Jingyun Yang, Lei Yu, Babette S Zemel, Alan B Zonderman, Markus Perola, Patrik K. E. Magnusson, André G Uitterlinden, Jaspal S Kooner, Daniel I Chasman, Ruth J. F. Loos, Nora Franceschini, Lude Franke, Chris S Haley, Caroline Hayward, Robin G Walters, John R. B. Perry, Tōnu Esko, Agnar Helgason, Kari Stefansson, Peter K Joshi, Michiaki Kubo, and James F Wilson
Subjects: Science
Abstract: Inbreeding depression has been observed in many different species, but in humans a systematic analysis has been difficult so far. Here, analysing more than 1.3 million individuals, the authors show that a genomic inbreeding coefficient (FROH) is associated with disadvantageous outcomes in 32 out of 100 traits tested.
Published: 2019
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8. Growing up in Bradford: protocol for the age 7–11 follow up of the Born in Bradford birth cohort

Author: Philippa K Bird, Rosemary R. C. McEachan, Mark Mon-Williams, Neil Small, Jane West, Peter Whincup, John Wright, Elizabeth Andrews, Sally E Barber, Liam J B Hill, Laura Lennon, Dan Mason, Katy A Shire, Dagmar Waiblinger, Amanda H. Waterman, Deborah A. Lawlor, and Kate E. Pickett
Subjects: Born in Bradford, Birth cohort study, Ethnicity, Mental health, Cardiorespiratory health, Cognitive development, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Born in Bradford (BiB) is a prospective multi-ethnic pregnancy and birth cohort study that was established to examine determinants of health and development during childhood and, subsequently, adult life in a deprived multi-ethnic population in the north of England. Between 2007 and 2010, the BiB cohort recruited 12,453 women who experienced 13,776 pregnancies and 13,858 births, along with 3353 of their partners. Forty five percent of the cohort are of Pakistani origin. Now that children are at primary school, the first full follow-up of the cohort is taking place. The aims of the follow-up are to investigate the determinants of children’s pre-pubertal health and development, including through understanding parents’ health and wellbeing, and to obtain data on exposures in childhood that might influence future health. Methods We are employing a multi-method approach across three data collection arms (community-based family visits, school based physical assessment, and whole classroom cognitive, motor function and wellbeing measures) to follow-up over 9000 BiB children aged 7–11 years and their families between 2017 and 2021. We are collecting detailed parent and child questionnaires, cognitive and sensorimotor assessments, blood pressure, anthropometry and blood samples from parents and children. Dual x-ray absorptiometry body scans, accelerometry and urine samples are collected on subsamples. Informed consent is collected for continued routine data linkage to health, social care and education records. A range of engagement activities are being used to raise the profile of BiB and to disseminate findings. Discussion Our multi-method approach to recruitment and assessment provides an efficient method of collecting rich data on all family members. Data collected will enhance BiB as a resource for the international research community to study the interplay between ethnicity, socioeconomic circumstances and biology in relation to cardiometabolic health, mental health, education, cognitive and sensorimotor development and wellbeing.
Published: 2019
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9. Assessing community readiness for early intervention programmes to promote social and emotional health in children

Author: Shahid Islam, Neil Small, Maria Bryant, Sally Bridges, Nicola Hancock, and Josie Dickerson
Subjects: community readiness model, deprived neighbourhoods, early intervention, parenting interventions, pregnancy and maternity, social and emotional health, Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract: Abstract 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.
Published: 2019
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10. Integrating research and system-wide practice in public health: lessons learnt from Better Start Bradford

Author: Josie Dickerson, Philippa K. Bird, Maria Bryant, Nimarta Dharni, Sally Bridges, Kathryn Willan, Sara Ahern, Abigail Dunn, Dea Nielsen, Eleonora P. Uphoff, Tracey Bywater, Claudine Bowyer-Crane, Pinki Sahota, Neil Small, Michaela Howell, Gill Thornton, Kate E. Pickett, Rosemary R. C. McEachan, John Wright, on behalf of Better Start Bradford, and the Better Start Bradford Innovation Hub
Subjects: Early intervention, Public health, Integration, Systems change, Pragmatic evaluation, Service evaluation, Public aspects of medicine, RA1-1270
Abstract: Abstract Many interventions that are delivered within public health services have little evidence of effect. Evaluating interventions that are being delivered as a part of usual practice offers opportunities to improve the evidence base of public health. However, such evaluation is challenging and requires the integration of research into system-wide practice. The Born in Bradford’s Better Start experimental birth cohort offers an opportunity to efficiently evaluate multiple complex community interventions to improve the health, wellbeing and development of children aged 0–3 years. Based on the learning from this programme, this paper offers a pragmatic and practical guide to researchers, public health commissioners and service providers to enable them to integrate research into their everyday practice, thus enabling relevant and robust evaluations within a complex and changing system. Using the principles of co-production the key challenges of integrating research and practice were identified, and appropriate strategies to overcome these, developed across five key stages: 1) Community and stakeholder engagement; 2) Intervention design; 3) Optimising routinely collected data; 4) Monitoring implementation; and 5) Evaluation. As a result of our learning we have developed comprehensive toolkits (https://borninbradford.nhs.uk/what-we-do/pregnancy-early-years/toolkit/) including: an operational guide through the service design process; an implementation and monitoring guide; and an evaluation framework. The evaluation framework incorporates implementation evaluations to enable understanding of intervention performance in practice, and quasi experimental approaches to infer causal effects in a timely manner. We also offer strategies to harness routinely collected data to enhance the efficiency and affordability of evaluations that are directly relevant to policy and practice. These strategies and tools will help researchers, commissioners and service providers to work together to evaluate interventions delivered in real-life settings. More importantly, however, we hope that they will support the development of a connected system that empowers practitioners and commissioners to embed innovation and improvement into their own practice, thus enabling them to learn, evaluate and improve their own services.
Published: 2019
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11. ActEarly: a City Collaboratory approach to early promotion of good health and wellbeing [version 1; peer review: 2 approved]

Author: John Wright, Andrew Hayward, Jane West, Kate Pickett, Rosie M. McEachan, Mark Mon-Williams, Nicola Christie, Laura Vaughan, Jess Sheringham, Muki Haklay, Laura Sheard, Josie Dickerson, Sally Barber, Neil Small, Richard Cookson, Philip Garnett, Tracey Bywater, Nicholas Pleace, Eric J. Brunner, Claire Cameron, Marcella Ucci, Steve Cummins, Daisy Fancourt, Jens Kandt, Paul Longley, Steve Morris, George Ploubidis, Robert Savage, Robert Aldridge, Dan Hopewell, Tiffany Yang, Dan Mason, Gillian Santorelli, Richard Romano, Maria Bryant, Liam Crosby, and Trevor Sheldon
Subjects: Medicine, Science
Abstract: Economic, physical, built, cultural, learning, social and service environments have a profound effect on lifelong health. However, policy thinking about health research is dominated by the ‘biomedical model’ which promotes medicalisation and an emphasis on diagnosis and treatment at the expense of prevention. Prevention research has tended to focus on ‘downstream’ interventions that rely on individual behaviour change, frequently increasing inequalities. Preventive strategies often focus on isolated leverage points and are scattered across different settings. This paper describes a major new prevention research programme that aims to create City Collaboratory testbeds to support the identification, implementation and evaluation of upstream interventions within a whole system city setting. Prevention of physical and mental ill-health will come from the cumulative effect of multiple system-wide interventions. Rather than scatter these interventions across many settings and evaluate single outcomes, we will test their collective impact across multiple outcomes with the goal of achieving a tipping point for better health. Our focus is on early life (ActEarly) in recognition of childhood and adolescence being such critical periods for influencing lifelong health and wellbeing.
Published: 2019
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12. Born in Bradford’s Better Start: an experimental birth cohort study to evaluate the impact of early life interventions

Author: Josie Dickerson, Philippa K. Bird, Rosemary R. C. McEachan, Kate E. Pickett, Dagmar Waiblinger, Eleonora Uphoff, Dan Mason, Maria Bryant, Tracey Bywater, Claudine Bowyer-Crane, Pinki Sahota, Neil Small, Michaela Howell, Gill Thornton, Melanie Astin, Debbie A. Lawlor, and John Wright
Subjects: Birth cohort, Trials within cohort, Quasi-experimental, Inequalities, Early years interventions, Child health, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Early interventions are recognised as key to improving life chances for children and reducing inequalities in health and well-being, however there is a paucity of high quality research into the effectiveness of interventions to address childhood health and development outcomes. Planning and implementing standalone RCTs for multiple, individual interventions would be slow, cumbersome and expensive. This paper describes the protocol for an innovative experimental birth cohort: Born in Bradford’s Better Start (BiBBS) that will simultaneously evaluate the impact of multiple early life interventions using efficient study designs. Better Start Bradford (BSB) has been allocated £49 million from the Big Lottery Fund to implement 22 interventions to improve outcomes for children aged 0–3 in three key areas: social and emotional development; communication and language development; and nutrition and obesity. The interventions will be implemented in three deprived and ethnically diverse inner city areas of Bradford. Method The BiBBS study aims to recruit 5000 babies, their mothers and their mothers’ partners over 5 years from January 2016-December 2020. Demographic and socioeconomic information, physical and mental health, lifestyle factors and biological samples will be collected during pregnancy. Parents and children will be linked to their routine health and local authority (including education) data throughout the children’s lives. Their participation in BSB interventions will also be tracked. BiBBS will test interventions using the Trials within Cohorts (TwiCs) approach and other quasi-experimental designs where TwiCs are neither feasible nor ethical, to evaluate these early life interventions. The effects of single interventions, and the cumulative effects of stacked (multiple) interventions on health and social outcomes during the critical early years will be measured. Discussion The focus of the BiBBS cohort is on intervention impact rather than observation. As far as we are aware BiBBS is the world’s first such experimental birth cohort study. While some risk factors for adverse health and social outcomes are increasingly well described, the solutions to tackling them remain elusive. The novel design of BiBBS can contribute much needed evidence to inform policy makers and practitioners about effective approaches to improve health and well-being for future generations.
Published: 2016
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13. The HAPPY (Healthy and Active Parenting Programmme for early Years) feasibility randomised control trial: acceptability and feasibility of an intervention to reduce infant obesity

Author: Rosemary R. C. McEachan, Gillian Santorelli, Maria Bryant, Pinki Sahota, Diane Farrar, Neil Small, Shaheen Akhtar, Judith Sargent, Sally E. Barber, Natalie Taylor, Gerry Richardson, Amanda J. Farrin, Raj S. Bhopal, Daniel D. Bingham, Sara M. Ahern, John Wright, and on behalf of the BiB childhood obesity scientific group
Subjects: Infant obesity, Behaviour change, Feasibility randomised controlled trial, Nutrition, Pregnancy, Ethnicity, Public aspects of medicine, RA1-1270
Abstract: Abstract Background The prevalence of infant obesity is increasing, but there is a lack of evidence-based approaches to prevent obesity at this age. This study tested the acceptability and feasibility of evaluating a theory-based intervention aimed at reducing risk of obesity in infants of overweight/obese women during and after pregnancy: the Healthy and Active Parenting Programme for Early Years (HAPPY). Methods A feasibility randomised controlled trial was conducted in Bradford, England. One hundred twenty overweight/obese pregnant women (Body Mass Index [BMI] ≥25 kg/m2) were recruited between 10–26 weeks gestation. Consenting women were randomly allocated to HAPPY (6 antenatal, 6 postnatal sessions: N = 59) or usual care (N = 61). Appropriate outcome measures for a full trial were explored, including: infant’s length and weight, woman’s BMI, physical activity and dietary intake of the women and infants. Health economic data were collected. Measurement occurred before randomisation and when the infant was aged 6 months and 12 months. Feasibility outcomes were: recruitment/attrition rates, and acceptability of: randomisation, measurement, and intervention. Intra-class correlations for infant weight were calculated. Fidelity was assessed through observations and facilitator feedback. Focus groups and semi-structured interviews explored acceptability of methods, implementation, and intervention content. Results Recruitment targets were met (~20 women/month) with a recruitment rate of 30 % of eligible women (120/396). There was 30 % attrition at 12 months; 66 % of recruited women failed to attend intervention sessions, but those who attended the first session were likely to continue to attend (mean 9.4/12 sessions, range 1–12). Reaction to intervention content was positive, and fidelity was high. Group clustering was minimal; an adjusted effect size of −0.25 standard deviation scores for infant weight at 12 months (95 % CI: −0.16–0.65) favouring the intervention was observed using intention to treat analyses. No adverse events were reported. Conclusions The HAPPY intervention appeared feasible and acceptable to participants who attended and those delivering it, however attendance was low; adaptations to increase initial attendance are recommended. Whilst the study was not powered to detect a definitive effect, our results suggest a potential to reduce risk of infant obesity. The evidence reported provides valuable lessons to inform progression to a definitive trial. Trial Registration Current Controlled Trials ISRCTN56735429
Published: 2016
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14. Development and evaluation of an intervention for the prevention of childhood obesity in a multiethnic population: the Born in Bradford applied research programme

Author: John Wright, Lesley Fairley, Rosemary McEachan, Maria Bryant, Emily Petherick, Pinki Sahota, Gillian Santorelli, Sally Barber, Debbie A Lawlor, Natalie Taylor, Raj Bhopal, Noel Cameron, Jane West, Andrew Hill, Carolyn Summerbell, Amanda Farrin, Helen Ball, Tamara Brown, Diane Farrar, and Neil Small
Subjects: childhood obesity, early life risk factors, south asian, birth cohort, growth trajectories, born in bradford, pilot trial, obesity prevention intervention, pregnancy, Public aspects of medicine, RA1-1270
Abstract: Background: There is an absence of evidence about interventions to prevent or treat obesity in early childhood and in South Asian populations, in whom risk is higher. Objectives: To study patterns and the aetiology of childhood obesity in a multiethnic population and develop a prevention intervention. Design: A cohort of pregnant women and their infants was recruited. Measures to compare growth and identify targets for obesity prevention, sensitive to ethnic differences, were collected. A feasibility randomised controlled trial (RCT) was undertaken. Setting: Bradford, UK. Participants: A total of 1735 mothers, 933 of whom were of South Asian origin. Intervention: A feasibility trial of a group-based intervention aimed at overweight women, delivered ante- and postnatally, targeting key modifiable lifestyle behaviours to reduce infant obesity. Main outcome measures: The feasibility and acceptability of the pilot intervention. Data sources: Routine NHS data and additional bespoke research data. Review methods: A systematic review of diet and physical activity interventions to prevent or treat obesity in South Asian children and adults. Results: Routine measures of growth were accurate. The prevalence of risk factors differed between mothers of white British ethnicity and mothers of Pakistani ethnicity and weight and length growth trajectories differed between Pakistani infants and white British infants. Prediction equations for risk of childhood obesity were developed. An evidence-based intervention was evaluated in a pilot RCT and was found to be feasible and acceptable. Limitations: This was a single-centre observational study and a pilot evaluation. Conclusions: The programme has been successful in recruiting a unique multiethnic childhood obesity cohort, which has provided new evidence about modifiable risk factors and biethnic growth trajectories. A novel group-based behavioural change intervention has been developed and successfully piloted. A multisite cluster RCT is required to evaluate effectiveness. Trial registration: Current Controlled Trials ISRCTN56735429. Funding: The National Institute for Health Research Programme Grants for Applied Research programme.
Published: 2016
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15. The Effects of Caring for Young Children with Developmental Disabilities on Mothers' Health and Healthcare Use: Analysis of Primary Care Data in the Born in Bradford Cohort

Author: Sarah C. Masefield, Stephanie L. Prady, Trevor A. Sheldon, Neil Small, Stuart Jarvis, and Kate E. Pickett
Abstract: We explored the association between caregiving for preschool children with developmental disabilities and maternal health and healthcare use using linked primary care and Born in Bradford birth cohort data. Adjusting for prenatal health, healthcare use and socioeconomic status, mothers who were caregivers were more likely than other mothers to have symptoms of psychological distress (odds ratio 1.24; 95% CI 1.01, 1.53), exhaustion (1.42; 1.12, 1.80) and possibly head and musculoskeletal pain (1.18; 0.97, 1.43). Despite the higher prevalence of symptoms, they did not access healthcare services more and may seek healthcare for psychological distress less often (0.64; 0.40, 1.02). In general, socioeconomic disadvantage was associated with worse health. Pakistani ethnicity (versus white British) and prenatal consultation were strongly associated with higher postnatal consultation rates. Prenatal ill health, healthcare use and socioeconomic status are important factors in the detection of postnatal ill health via primary care services. If caregiver burden and the risk of under-detecting (and thus under treating) caregiver ill health is not addressed during the preschool period health inequalities between caregivers and other mothers and their families may persist and grow. The health of mothers of young disabled children, in particular their unmet health needs, warrants attention in research and clinical practice.
Published: 2022
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16. A Study Proposing a Data Model for a Dementia Care Mapping (DCM) Data Warehouse for Potential Secondary Uses of Dementia Care Data.

Author: Shehla Khalid, Neil Small, Daniel Neagu, and Claire Surr
Published: 2019
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17. How the NHS and social care change and why they often don't

Author: Neil Small
Published: 2023

18. Failures in Health and Social Care

Author: Neil Small
Published: 2023

19. Afterword

Author: Neil Small
Published: 2023

20. Conclusions

Author: Neil Small
Published: 2023

21. Are problems new and are they widespread?

Author: Neil Small
Published: 2023

22. Mid-Staffordshire, the Francis Report and its aftermath

Author: Neil Small
Published: 2023

23. The fall of the Liverpool Care Pathway and the challenges in end-of-life care

Author: Neil Small
Published: 2023

24. How ideological shifts are manifest in society

Author: Neil Small
Published: 2023

25. Change in action

Author: Neil Small
Published: 2023

26. Introduction

Author: Neil Small
Published: 2023

27. Health and Care in Neoliberal Times

Author: Neil Small
Published: 2023

28. Changing organisations and the impact of neoliberalism on health professions

Author: Neil Small
Published: 2023

29. Applying the community readiness model to identify and address inequity in end-of-life care in South Asian communities

Author: Rachael H Moss, Jamilla Hussain, Shahid Islam, Neil Small, and Josie Dickerson
Subjects: Anesthesiology and Pain Medicine, General Medicine
Abstract: Background: Individuals from minoritised ethnic backgrounds are less likely than individuals from the dominant ethnic group to access palliative care services and to have documented Advance Care Plans. They are more likely to be admitted to hospital in the last months of life. Aim: To use the Community Readiness Model to identify the barriers that influence how South Asian communities access and use two new palliative care services. Design: The Community Readiness Model is a validated tool that measures the readiness of a community. Key stakeholders were asked to: (i) complete a questionnaire to assess South Asian communities’ readiness to engage in advance care planning and, (ii) attend a focus group to explore their views on the communities’ understandings of palliative and end-of-life care. Setting/participants: Ten key stakeholders who held a variety of occupations within palliative and end-of-life care services were recruited from the community. Findings: The South Asian communities were found to be at the ‘pre-planning’ stage of readiness, despite initiatives to improve awareness. The readiness of the health system was found to be limited, with a narrow medical focus during advance care planning, poor integration of voluntary and community services and limited understanding of what people consider a ‘good’ death. Conclusions: The Community Readiness Model allowed insight into the South Asian communities’ awareness of and readiness (to use) palliative care services. Using the Community Readiness Model before service implementation allowed steps to be taken to avoid widening inequities in access and use of new services.
Published: 2022

30. The Effects of Caring for Young Children with Developmental Disabilities on Mothers’ Health and Healthcare Use: Analysis of Primary Care Data in the Born in Bradford Cohort

Author: Kate E. Pickett, Sarah Masefield, Trevor A Sheldon, Stuart William Jarvis, Stephanie L. Prady, and Neil Small
Subjects: medicine.medical_specialty, business.industry, Public health, Ethnic group, Physical Therapy, Sports Therapy and Rehabilitation, Caregiver burden, Odds ratio, Primary care, 03 medical and health sciences, 0302 clinical medicine, Family medicine, Health care, Cohort, Developmental and Educational Psychology, medicine, 030212 general & internal medicine, business, Psychology, Socioeconomic status, 030217 neurology & neurosurgery
Abstract: We explored the association between caregiving for preschool children with developmental disabilities and maternal health and healthcare use using linked primary care and Born in Bradford birth cohort data. Adjusting for prenatal health, healthcare use and socioeconomic status, mothers who were caregivers were more likely than other mothers to have symptoms of psychological distress (odds ratio 1.24; 95% CI 1.01, 1.53), exhaustion (1.42; 1.12, 1.80) and possibly head and musculoskeletal pain (1.18; 0.97, 1.43). Despite the higher prevalence of symptoms, they did not access healthcare services more and may seek healthcare for psychological distress less often (0.64; 0.40, 1.02). In general, socioeconomic disadvantage was associated with worse health. Pakistani ethnicity (versus white British) and prenatal consultation were strongly associated with higher postnatal consultation rates. Prenatal ill health, healthcare use and socioeconomic status are important factors in the detection of postnatal ill health via primary care services. If caregiver burden and the risk of under-detecting (and thus under treating) caregiver ill health is not addressed during the preschool period health inequalities between caregivers and other mothers and their families may persist and grow. The health of mothers of young disabled children, in particular their unmet health needs, warrants attention in research and clinical practice.
Published: 2021

31. Disciplinary and pastoral power, food and poverty in late-modernity

Author: Neil Small and Maddy Power
Subjects: Late modernity, Poverty, 05 social sciences, Perspective (graphical), 0507 social and economic geography, Food bank, 0506 political science, Power (social and political), Food poverty, Political Science and International Relations, Development economics, 050602 political science & public administration, Sociology, 050703 geography, Discipline
Abstract: Using a Foucauldian perspective, we explicate the systems of power which shape the lives of women in or at risk of ‘food poverty’. We develop a theoretical framework of power for analyses of contemporary food poverty, which we apply to data from focus groups with women on low incomes in two cities in the north of England. Our data underlines the repressive power of the state as well as the broader chronicity of state surveillance. We argue that, while disciplinary and pastoral power may characterise the majority of food banks, alternative logics of mutual aid are evident within some food aid providers. We underline the power of governmental discourse in constituting gendered subjectivities and find that the most potent form of coercion is derived from self-regulation. The article closes by exploring possibilities for praxis via discursive resistance.
Published: 2021

32. Accounting for the effect of heterogeneous plastic deformation on the formability of aluminium and steel sheets

Author: D. K. Williams, S. K. Hazra, Neil Small, and Rajat Roy
Subjects: 0209 industrial biotechnology, Digital image correlation, Materials science, TL, chemistry.chemical_element, 02 engineering and technology, TS, Measure (mathematics), Industrial and Manufacturing Engineering, 020901 industrial engineering & automation, Aluminium, Formability, Limit (mathematics), Composite material, QA, Microscale chemistry, Strain (chemistry), Mechanical Engineering, 021001 nanoscience & nanotechnology, Computer Science Applications, TA, chemistry, Control and Systems Engineering, TJ, 0210 nano-technology, Software, Necking
Abstract: Forming limit curves characterise “mean” failure strains of sheet metals. Safety levels from the curves define the deterministic upper limit of the processing and part design window, which can be small for high strength, low formability materials. Effects of heterogeneity of plastic deformation, widely accepted to occur on the microscale, are neglected. Marciniak tests were carried out on aluminium alloys (AA6111-T4, NG5754-O), dual-phase steel (DP600) and mild steel (MS3). Digital image correlation was used to measure the effect of heterogeneity on failure. Heterogeneity, based on strain variance, was modelled with the 2-component Gaussian mixture model, and a framework was proposed to (1) identify the onset of necking and to (2) re-define formability as a probability to failure. The results were “forming maps” in major-minor strain space of contours of constant probability (from probability,P= 0 toP= 1), which showed how failure risk increased with major strain. The contour bands indicated the unique degree of heterogeneity in each material. NG5754-O had the greatest width (0.07 strain) in plane strain and MS3 the lowest (0.03 strain). This novel characterisation will allow engineers to balance a desired forming window for a component design with the risk to failure of the material.
Published: 2020

33. Born in Bradford Age of Wonder cohort: A protocol for qualitative longitudinal research

Author: Sufyan Abid Dogra, Kate Lightfoot, Rosslyn Kerr, Jennifer Hall, Olivia Joseph, Nasiba Siddig, Hannah Nutting, Katy A. Shire, Helen Roberts, Neil Small, Rosemary R.C. McEachan, and John Wright
Subjects: Medicine (miscellaneous), General Biochemistry, Genetics and Molecular Biology
Abstract: Born in Bradford (BiB) has followed the lives of 13,776 children born in the district between 2007 and 2011. Children in the birth cohort are now entering adolescence, and the next phase of the research - Age of Wonder (AoW) - will be a whole city cohort capturing the experiences of 30,000 adolescents progressing into young adulthood. This protocol focuses on one component of the AoW programme: qualitative longitudinal research (QLR). The study will gather in depth and detailed accounts from a sub-sample of 100 young people across four major research priorities: personal life; social and community life; growing up with difference, and growing up in Bradford. As well as using traditional qualitative methods such as interviews, focus group discussions, and ethnography, we are adopting innovative creative methods including expressions through art, activism, online and digital content, portraits, and critical events. The process of engaging in and co-producing QLR potentially provides a route to empowering young people to shape the narrative of their own lives as well as informing intervention development.
Published: 2022

34. Assessing community readiness for early intervention programmes to promote social and emotional health in children

Author: Neil Small, Nicola Hancock, Shahid Islam, Maria Bryant, Sally Bridges, and Josie Dickerson
Subjects: Adult, Quality Assurance, Health Care, Emotions, Psychological intervention, Poison control, Qualitative property, Health Promotion, Community Networks, Suicide prevention, community readiness model, Occupational safety and health, 03 medical and health sciences, 0302 clinical medicine, Nursing, Pregnancy, Early Medical Intervention, Injury prevention, Humans, 030212 general & internal medicine, Early childhood, Qualitative Research, parenting interventions, lcsh:R5-920, 030503 health policy & services, social and emotional health, lcsh:Public aspects of medicine, Infant, Newborn, Public Health, Environmental and Occupational Health, Infant, deprived neighbourhoods, lcsh:RA1-1270, pregnancy and maternity, Original Research Paper, early intervention, England, Child, Preschool, Female, Catchment area, 0305 other medical science, Psychology, lcsh:Medicine (General), Original Research Papers, Social Adjustment
Abstract: 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.
Published: 2019

35. Addressing obesity in Roma communities: a community readiness approach

Author: Anna Cronin de Chavez, Neil Small, Maria Bryant, Shahid Islam, Josie Dickerson, Fiona Saville, and Tiffany Yang
Subjects: Medical education, Health (social science), Public Administration, Sociology and Political Science, Social Psychology, 030503 health policy & services, Health Policy, media_common.quotation_subject, Qualitative property, medicine.disease, Obesity, Eastern european, 03 medical and health sciences, 0302 clinical medicine, Originality, medicine, Contextual information, 030212 general & internal medicine, 0305 other medical science, Psychology, media_common
Abstract: Purpose Participation in community programmes by the Roma community is low, whilst this community presents with high risk of poor health and low levels of wellbeing. To improve rates of participation in programmes, compatibility must be achieved between implementation efforts and levels of readiness in the community. The Community Readiness Model (CRM) is a widely used toolkit which provides an indication of how prepared and willing a community is to take action on specific issues. The purpose of this paper is to present findings from a CRM assessment for the Eastern European Roma community in Bradford, UK, on issues related to nutrition and obesity. Design/methodology/approach The authors interviewed key respondents identified as knowledgeable about the Roma community using the CRM. This approach applies a mixed methodology incorporating readiness scores and qualitative data. A mean community readiness score was calculated enabling researchers to place the community in one of nine possible stages of readiness. Interview transcripts were analysed using a qualitative framework analysis to generate the contextual information. Findings An overall score consistent with vague awareness was achieved, which indicates a low level of community readiness. This score suggests that there will be a low likelihood of participation in currently available nutrition and obesity programmes. Originality/value To our knowledge, this is the first study to apply the CRM in the Roma community for any issue. The authors present the findings for each of the six dimensions that make up the CRM together with salient qualitative findings.
Published: 2019

36. A Study Proposing a Data Model for a Dementia Care Mapping (DCM) Data Warehouse for Potential Secondary Uses of Dementia Care Data

Author: Neil Small, Daniel Neagu, Claire Surr, and Shehla Khalid
Subjects: Information Systems and Management, Knowledge management, 020205 medical informatics, business.industry, Computer science, Data management, media_common.quotation_subject, Medicine (miscellaneous), 02 engineering and technology, Reuse, medicine.disease, Data warehouse, Data model, 020204 information systems, 0202 electrical engineering, electronic engineering, information engineering, medicine, Dementia, Observational study, Quality (business), Quality of care, business, Information Systems, media_common
Abstract: There is growing emphasis on sharing and reusing dementia care-related datasets to improve the quality of dementia care. Consequently, there is a need to develop data management solutions for collecting, integrating and storing these data in formats that enhance opportunities for reuse. Dementia Care Mapping (DCM) is an observational tool that is in widespread use internationally. It produces rich, evidence-based data on dementia care quality. Currently, that data is primarily used locally, within dementia care services, to assess and improve quality of care. Information-rich DCM data provides opportunities for secondary use including research into improving the quality of dementia care. But an effective data management solution is required to facilitate this. A rationale for the warehousing of DCM data as a technical data management solution is suggested. The authors also propose a data model for a DCM data warehouse and present user-identified challenges for reusing DCM data within a warehouse.
Published: 2019

37. Vulnerabilities in child wellbeing among primary school children: a cross-sectional study in Bradford, UK

Author: Neil Small, John Wright, Philippa K Bird, Mildred Oiza Ajebon, Rosemary R. C. McEachan, Katy A. Shire, Brian Kelly, Josie Dickerson, Bo Hou, Debbie A Lawlor, Mark Mon-Williams, and Kate E. Pickett
Subjects: Male, Coronavirus disease 2019 (COVID-19), Cross-sectional study, media_common.quotation_subject, common, Ethnic group, Vulnerability, Humans, Medicine, Child, Pandemics, media_common, Schools, business.industry, common.demographic_type, Child Health, COVID-19, General Medicine, United Kingdom, Cross-Sectional Studies, Mental Health, Feeling, Communicable Disease Control, Material resources, Female, Worry, business, Demography, White British
Abstract: ObjectiveTo describe the prevalence of factors related to well-being among primary school children in a deprived multiethnic community in the UK.Design and participantsCross-sectional survey of 15 641 children aged 7–10 years in Born in Bradford’s Primary School Years study: whole-classroom samples in 89 Bradford primary schools between 2016 and 2019.Main outcome measuresPrevalence estimates by ethnicity (%, 95% CI) of single and multiple vulnerabilities in child well-being within and across four domains (Home, Family, Relationships; Material Resources; Friends and School; Subjective Well-being).ResultsOnly 10% of children had no vulnerabilities in any domain of well-being; 10% had one or more vulnerabilities in all four domains. The highest prevalence estimates were for being bullied some or all of the time (52.7%, 95% CI: 51.9% to 53.4%), keeping worries to oneself (31.2%, 95% CI: 30.5% to 31.9%), having no park near home (30.8%, 95% CI: 30.1% to 31.5%) and worrying all the time about how much money their family has (26.3%, 95% CI: 25.6% to 27%). Boys were consistently significantly more likely than girls to report all of the vulnerabilities in the Home, Family and Family Relationships domain, and the majority of indicators in the other domains, and in all domains except Friends and School, boys were significantly more likely to have at least one vulnerability. Girls were significantly more likely to report not having many friends (16.7%, 95% CI: 15.9% to 17.6% vs 12.5%, 95% CI: 11.8% to 13.2%), being bullied some or all of the time (55.8%, 95% CI: 54.7% to 56.9% vs 49.7%, 95% CI: 48.6% to 50.8%) and feeling left out all the time (12.1%, 95% CI: 11.4% to 12.8%) versus (10.3%, 95% CI: 9.7% to 11.0%). Variations in vulnerabilities by ethnicity were complex, with children in black, Asian and minority ethnic groups sometimes reporting more vulnerabilities and sometimes fewer than white British children. For example, compared with children of Pakistani heritage, white British children were more likely to say that their family never gets along well (6.3%, 95% CI: 5.6% to 7.1% vs 4.1%, 95% CI: 3.6% to 4.6%) and to have no access to the internet at home (22.3%, 95% CI: 21% to 23.6% vs 18%, 95% CI: 17% to 18.9%). Children with Pakistani heritage were more likely than white British children to say they had no park near their home where they can play with friends (32.7%, 95% CI: 31.6% to 33.9% vs 29.9%, 95% CI: 28.6% to 31.3%), to report not having three meals a day (17.9%, 95% CI: 16.9% to 18.8% vs 11.9%, 95% CI: 10.9% to 12.9%) and to worry all the time about how much money their families have (29.3%, 95% CI: 28.2% to 30.3%) vs (21.6%, 95% CI: 20.4% to 22.9%). Gypsy/Irish Traveller children were less likely than white British children to say they were bullied some or all of the time (42.2%, 95% CI: 35.4% to 49.4% vs 53.8%, 95% CI: 52.3% to 55.3%), but more likely to say they were mean to others all the time (9.9%, 95% CI: 6.3% to 15.2% vs 4%, 95% CI: 3.5% to 4.7%) and can never work out what to do when things are hard (15.2%, 95% CI: 10.6% to 21.2% vs 9%, 95% CI: 8.2% to 9.9%). We considered six vulnerabilities to be of particular concern during the COVID-19 pandemic and associated national and local lockdowns: family never gets along well together; no garden where child can play; no nearby park where they can play; not having three meals a day; no internet at home; worried about money all the time. Pre-pandemic, 37.4% (95% CI: 36.6% to 38.3%) of Bradford children had one of these vulnerabilities and a further 29.6% (95% CI: 28.9% to 30.4%) had more than one.ConclusionsAlthough most primary school children aged 7–10 in our study had good levels of well-being on most indicators across multiple domains, fewer than 10% had no vulnerabilities at all, a worrying 10% had at least one vulnerability in all the four domains we studied and two-thirds had vulnerabilities of particular concern during the COVID-19 lockdowns.
Published: 2021

38. Health and Care in Neoliberal Times

Author: NEIL SMALL and NEIL SMALL
Subjects: Social change, Politics, Practical, Medical care--Political aspects--Great Britain, Medical policy--Great Britain
Abstract: This book argues that neoliberal changes in health and social care go beyond resource allocations, priority setting and privatisation, and manifest in an invidious erosion of the quality of our social relationships, including relationships between care provider and care recipient.Critically examining the concept of culture and why shifts in what is considered'acceptable practice'happen, the book explores the conduct of conduct. It draws together what we know about neoliberalism's impact on the economy and public services with research around governmentality and social change. Looking at breakdowns in the quality of care in the NHS and social care across a range of settings it holds that macro influences, such as austerity and marketisation, cannot explain everything and many of the damaging things that go on in care breakdowns occur in micro-interactions between care provider and care recipient. Analysing the interactions between the calculations of political centres, the strength of professional identities, the effectiveness of oversight and supervision and the biographies of protagonists, Neil Small problematises the focus on culture, and culture change, in our response to care failures and examines what a different approach to care might involve.Exploring the interaction of politics, economics and social change and their impact on health care and the wider welfare state, this is an important contribution for students and researchers in health and social care, sociology, political science and management studies.
Published: 2023

39. Failures in Health and Social Care : Governance and Culture Change

Author: Neil Small and Neil Small
Subjects: National health services--Great Britain, Medical care--Great Britain, Medical policy--Great Britain
Abstract: This thought-provoking book examines breakdowns in the quality of health and social care over the past decade, exploring governance failures and the challenges of achieving lasting change.Failures in care have been manifest across many different settings. Drawing on examples from care of older people and end-of-life care, as well as from learning disabilities, mental health, maternity care and services for vulnerable children, Neil Small shows that the same sorts of problems are evident across these settings and that they are occurring up to the present day. Discussing culture change alongside levels of funding and the impact of prevailing political and economic orthodoxies, and through the lens of shifts of trust in society, this book argues that the concept of culture must be cast much wider than organisational and professional cultures if change is to be secured. This book engages with how to improve quality of care in the NHS and welfare systems more generally. Its case examples are from the UK but the issues of governance, culture change and shifts in the social contract that failures illuminate have an international relevance. It is important reading for those with an interest in health, social care, political science, and sociology.
Published: 2023

40. Fine-scale population structure and demographic history of British Pakistanis

Author: Elena Arciero, Karen A. Hunt, John Wright, Sufyan Abid Dogra, Dan Mason, Eamonn Sheridan, Shai Carmi, Neil Small, David A. van Heel, Hilary C. Martin, Mark M. Iles, Massimo Mezzavilla, Theofanis Tsismentzoglou, and Qin Qin Huang
Subjects: medicine.medical_specialty, education.field_of_study, Demographic history, Public health, media_common.quotation_subject, Population, Consanguinity, Social stratification, Geography, Effective population size, Endogamy, medicine, education, Demography, Diversity (politics), media_common
Abstract: Previous genetic and public health research in the Pakistani population has focused on the role of consanguinity in increasing recessive disease risk, but little is known about its recent population history or the effects of endogamy. Here, we investigate fine-scale population structure, history and consanguinity patterns using genetic and questionnaire data from >4,000 British Pakistani individuals, mostly with roots in Azad Kashmir and Punjab. We reveal strong recent population structure driven by thebiraderisocial stratification system. We find that all subgroups have had low effective population sizes (Ne) over the last 50 generations, with some showing a decrease in Ne15-20 generations ago that has resulted in extensive identity-by-descent sharing and increased homozygosity. Using new theory, we show that the footprint of regions of homozygosity in the two largest subgroups is about twice that expected naively based on the self-reported consanguinity rates and the inferred historical Netrajectory. These results demonstrate the impact of the cultural practices of endogamy and consanguinity on population structure and genomic diversity in British Pakistanis, and have important implications for medical genetic studies.
Published: 2020

41. Associations of autozygosity with a broad range of human phenotypes

Author: Dennis O. Mook-Kanamori, Salma M. Wakil, Lisa R. Yanek, Dominique P.V. de Kleijn, Gert J. de Borst, Alison D. Murray, Kamran Guity, Vincent W. V. Jaddoe, Mario Pirastu, Carole Ober, Giuseppe Matullo, Charles N. Rotimi, Daniela Ruggiero, Teresa Tusié-Luna, Wolfgang Lieb, Chew-Kiat Heng, John R. B. Perry, Hortensia Moreno-Macías, Jie Zhou, John M. Starr, Juhani Junttila, Lei Yu, Danielle Posthuma, Marcus Dörr, Yingchang Lu, Jonathan P. Bradfield, Einat Granot-Hershkovitz, Karina Meidtner, Wouter van Rheenen, T Esko, Maris Alver, Wen-Jane Lee, Zhengming Chen, Jennifer A. Brody, Paolo Gasparini, Yii-Der Ida Chen, Cinzia Sala, Peter P. Pramstaller, Gauri Prasad, Nana Matoba, Natalie Terzikhan, Simonetta Guarrera, Bjarke Feenstra, Peter Vollenweider, Smeeta Shrestha, Yi-Jen Hung, Lilja Stefansdottir, David R. Weir, Felix R. Day, Antonietta Robino, Liang Zhang, Lluis Quintana-Murci, Nicholas J. Timpson, Robyn E Wootton, Xue W. Mei, Dharambir K. Sanghera, Gisli Masson, Debbie A Lawlor, Thomas Meitinger, Sharon L.R. Kardia, Peter K. Joshi, Frank J. A. van Rooij, Claude Bouchard, Cassandra N. Spracklen, Ken K. Ong, Taulant Muka, Guanjie Chen, Laura J. Scott, Walter Palmas, Daniel I. Chasman, Sarah E. Medland, Krista Fischer, Blair H. Smith, Jon K. Sigurdsson, Leon Straker, Clara Viberti, Yuan Shi, Louis Pérusse, Peter J. van der Most, Timo Tõnis Sikka, Chris Haley, Kuang Lin, Leif Groop, Hester M. den Ruijter, Hakon Hakonarson, Masato Akiyama, Stephan J. L. Bakker, Sonja I. Berndt, Jeffery R. O'Connell, Cisca Wijmenga, Daniele Cusi, Lorena Orozco, Kristjan H. S. Moore, Kevin Sandow, Stephen S. Rich, Stephanie J. Loomis, George Davey Smith, Cornelia M. van Duijn, Sharvari Rahul Shukla, Agnar Helgason, Thorsten Kessler, Anuj Goel, Dan Mason, David W. Clark, James S. Pankow, Simona Vaccargiu, Uwe Völker, Tamara B. Harris, Matthew A. Allison, Clicerio Gonzalez, Sarju Ralhan, I-Te Lee, Matthias Laudes, Yen-Feng Chiu, Neil Poulter, Benjamin Lehne, John Wright, Lawrence F. Bielak, Philip L. De Jager, Reinhold Schmidt, Ya Xing Wang, Matthias Nauck, Diana L. Cousminer, Patrick Deelen, Ani Manichaikul, Stephen J. Chanock, Anders Hamsten, Barry I. Freedman, Gudmar Thorleifsson, Peter Kraft, Ozren Polasek, Jie Yao, Yoshinori Murakami, Paul M. Ridker, Anubha Mahajan, Struan F.A. Grant, Claudia Schurmann, Bjarni Gunnarsson, Catriona L. K. Barnes, Jessica van Setten, Sandosh Padmanabhan, Alena Stančáková, Markus M. Lerch, Anuradha Jagadeesan, Franco Giulianini, Daniel F. Gudbjartsson, Dwaipayan Bharadwaj, Shengchao Alfred Li, Peter S. Sever, Trevor A. Mori, Albertine J. Oldehinkel, Koichi Matsuda, Xueling Sim, Evangelos Evangelou, André G. Uitterlinden, Pekka Jousilahti, Yukihide Momozawa, Ioanna Tzoulaki, Chao A. Hsiung, Ginevra Biino, Murielle Bochud, Hannele Mattsson, Ilja M. Nolte, Sarah H. Wild, Patricia B. Munroe, Jianjun Liu, Bruce M. Psaty, Giriraj R. Chandak, Masahiro Kanai, Tony R. Merriman, Teemu Palviainen, Rodney A. Lea, Janie Corley, Nicholas J. Wareham, Alan B. Zonderman, Makoto Hirata, Matthew J. Bixley, Caroline Hayward, Nora Franceschini, Kristel R van Eijk, Etienne Patin, Daniel Shriner, Niek Verweij, Xiuqing Guo, Fredrik Karpe, Ruth J. F. Loos, Tiinamaija Tuomi, Ashley van der Spek, Patricia A. Peyser, Jessica D. Faul, Christian Fuchsberger, David Cesarini, Alex S. F. Doney, Janine F. Felix, Cornelius A. Rietveld, Jagadish Vangipurapu, Tanguy Corre, Line Skotte, Rajkumar Dorajoo, Catherine Igartua, Meena Kumari, Nona Sotoodehnia, Leonard H. van den Berg, Najaf Amin, Dale R. Nyholt, Harry Campbell, Massimiliano Cocca, Scott D. Gordon, Patrik K. E. Magnusson, John C. Chambers, Traci M. Bartz, Mike A. Nalls, Tin Aung, Nduna Dzimiri, Colin N. A. Palmer, Rob M. van Dam, Johanna Kuusisto, Russell P. Tracy, Anna Damulina, Pierre-Emmanuel Morange, Sylvain Foisy, Jing Hua Zhao, Nicholas G. Martin, Ching-Yu Cheng, Mariaelisa Graff, Rashmi B. Prasad, Alice Stanton, David-Alexandre Trégouët, Yu Guo, Helen R. Warren, Lyn R. Griffiths, Weihua Meng, Annika Tillander, Christa Meisinger, Albert V. Smith, Mark I. McCarthy, Jingyun Yang, Marine Germain, Neil Small, Linda Broer, Vilmundur Gudnason, Gunnar K. Pálsson, Michele K. Evans, Alexander Teumer, Mark J. Caulfield, Giorgia Girotto, Thomas Lumley, Tinca J. C. Polderman, Wei Zhao, Carlos A. Aguilar-Salinas, Jari Lahti, Matthew L. Albert, Yechiel Friedlander, Veikko Salomaa, Iona Y Millwood, Jan H. Veldink, Archie Campbell, Andres Metspalu, Ulf Gyllensten, Grant W. Montgomery, Veronique Vitart, Jai Rup Singh, Saima Afaq, Alan R. Shuldiner, Miao-Li Chee, Adebowale Adeyemo, Jennifer A. Smith, David A. van Heel, Jaspal S. Kooner, Daniela Toniolo, Cristian Pattaro, Jerome I. Rotter, John Whitfield, Melissa C. Smart, Kari E. North, Salman M. Tajuddin, Tallapragada Divya Sri Priyanka, Christopher A. Haiman, Diane M. Becker, Bernhard K. Krämer, Paul Elliott, Lihua Wang, He Gao, Patrick Sulem, Jinyan Huang, Chiea Chuen Khor, Ruifang Li-Gao, Åsa Johansson, Winfried März, Shai Carmi, Ilaria Gandin, Eric Boerwinkle, Gardar Sveinbjornsson, Saskia P. Hagenaars, Sander W. van der Laan, Gerard Pasterkamp, E-Shyong Tai, Hagit Hochner, Yih Chung Tham, Kent D. Taylor, Kari Stefansson, Matt J. Neville, Craig E. Pennell, Yanchun Bao, Annelot M. Dekker, Helena Schmidt, Mehdi Hedayati, Joshua Elliott, Ian J. Deary, Iris E. Jansen, Judith B. Borja, Edith Hofer, Martin Gögele, Igor Rudan, Lude Franke, Matthias Munz, Folkert W. Asselbergs, Bengt Sennblad, Imo Hofer, John D. Rioux, Pim van der Harst, Bahareh Sedaghati-khayat, Giovanni Cugliari, Morris A. Swertz, Francine Grodstein, Erwin P. Bottinger, Carol A. Wang, Andre Franke, Brian F. Meyer, Adele M. Taylor, Klodian Dhana, Jian'an Luan, Constance Turman, Robert A. Scott, May E. Montasser, Alison Pattie, Marco Brumat, Liming Li, Heiner Boeing, Karen L. Mohlke, Clemens Baumbach, Bishwa Raj Sapkota, Unnur Thorsteinsdottir, Naveed Sattar, Amy R. Bentley, Matthias B. Schulze, Ivana Kolcic, Stella Trompet, Sarah E. Harris, Ayo P. Doumatey, Charumathi Sabanayagam, David Eccles, Mary F. Feitosa, Jost B. Jonas, Massimo Mezzavilla, Mark O. Goodarzi, David Ellinghaus, Heribert Schunkert, Christian Gieger, Heikki V. Huikuri, Lingyao Zeng, Johan G. Eriksson, Woon-Puay Koh, Yucheng Jia, Gurpreet Singh Wander, James F. Wilson, Torgny Karlsson, Steven C. Hunt, Weihua Zhang, Maria Pina Concas, Zoltán Kutalik, Rebecca Rohde, Chittaranjan S. Yajnik, Yasaman Saba, Dabeeru C. Rao, Robin G. Walters, Reedik Mägi, Marie Loh, Eero Vuoksimaa, Josyf C. Mychaleckyj, Katri Räikkönen, Philippe Goyette, M. Arfan Ikram, Alicia Huerta-Chagoya, David J. Porteous, Teresa Nutile, J. Wouter Jukema, Noha A. Yousri, Yoichiro Kamatani, Maryam S. Daneshpour, Babette S. Zemel, Rona J. Strawbridge, Tien Yin Wong, Claudia Langenberg, Amy Moore, Marcus E. Kleber, Fereidoun Azizi, Avner Halevy, Erika Salvi, Francis S. Collins, Markku Laakso, Tim Kacprowski, S. Sunna Ebenesersdóttir, William R. Scott, Michael Boehnke, Jin-Fang Chai, Markus Perola, Nicola Pirastu, Wayne Huey-Herng Sheu, Robert Karlsson, Lenore J. Launer, Lili Milani, Renée de Mutsert, Fernando Rivadeneira, David A. Bennett, Nicola D. Kerrison, Paolo Manunta, Graciela E. Delgado, Magnus Johannesson, Carolina Medina-Gomez, Alanna C. Morrison, Kay-Tee Khaw, Jian-Min Yuan, Jaakko Kaprio, Melanie Waldenberger, Ralf Ewert, Hugoline G. de Haan, Andrew A. Hicks, Yukinori Okada, Maria Sabater-Lleal, Marilyn C. Cornelis, Stephanie J. London, Federica Rizzi, Jeanette Erdmann, Marina Ciullo, Michiaki Kubo, University of Edinburgh, Broad Institute of MIT and Harvard (BROAD INSTITUTE), Harvard Medical School [Boston] (HMS)-Massachusetts Institute of Technology (MIT)-Massachusetts General Hospital [Boston], Osaka University Graduate School of Medicine, Laboratory for Cardiovascular Genomics and Informatics [Yokohama] (RIKEN IMS), RIKEN Center for Integrative Medical Sciences [Yokohama] (RIKEN IMS), RIKEN - Institute of Physical and Chemical Research [Japon] (RIKEN)-RIKEN - Institute of Physical and Chemical Research [Japon] (RIKEN), deCODE genetics [Reykjavik], Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK (BIHR), Area Science Park, Università degli studi di Trieste = University of Trieste, MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Interfaculty Institute for Genetics and Functional Genomics, Universität Greifswald - University of Greifswald, Harbor UCLA Medical Center [Torrance, Ca.], Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, Department of Electrical and Computer Engineering [Waterloo] (ECE), University of Waterloo [Waterloo], Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet [Stockholm], Institute of Pop. Genetics, CNR, Sassari, Shardna life science Pula Cagliari, Swiss Institute of Bioinformatics [Lausanne] (SIB), Université de Lausanne = University of Lausanne (UNIL), Medstar Research Institute, Florida State University [Tallahassee] (FSU), University Medical Center [Utrecht], Centre for Population Health Sciences, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), California State University [Sacramento], Department of Thrombosis and Haemostasis, Leiden University Medical Center (LUMC), Universiteit Leiden-Universiteit Leiden, Medical University Graz, Department of Neurology, Alzheimer Centre, VU Medical Centre, Amsterdam, Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Heidelberg, Frederick National Laboratory for Cancer Research (FNLCR), Wellcome Trust Centre of Human Genetics, University of Oxford, Department of Epidemiology, German Institute of Human Nutrition, University Medical Center Groningen [Groningen] (UMCG), Institute of Genetics and Biophysics, National Research Council of Italy | Consiglio Nazionale delle Ricerche (CNR), Department of Medicine, Surgery, and Dentistry, University of Milano, Icelandic Heart Association, Kopavogur, Iceland., Department of Epidemiology [Rotterdam], Erasmus University Medical Center [Rotterdam] (Erasmus MC), University of Glasgow, Department of Cardiology, Leiden University Medical Center, Leiden, Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, Queen Mary University of London (QMUL), General Internal Medicine, Johns Hopkins School of Medicine, Johns Hopkins University School of Medicine [Baltimore], Institut de biologie moléculaire des plantes (IBMP), Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Immunobiologie des Cellules dendritiques, Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche Translationnelle - Center for Translational Science (CRT), Institut Pasteur [Paris] (IP), Genentech, Inc., Genentech, Inc. [San Francisco], University of Tartu, Duke-NUS Medical School [Singapore], Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke (DifE), Leibniz Association, Human Genome Sequencing Center, Baylor College of Medicine, Baylor College of Medicine (BCM), Baylor University-Baylor University, University of San Carlos, Office of Population Studies Foundation, Icahn School of Medicine at Mount Sinai [New York] (MSSM), King‘s College London, Division of Cancer Epidemiology and Genetics, National Cancer Institute [Bethesda] (NCI-NIH), National Institutes of Health [Bethesda] (NIH)-National Institutes of Health [Bethesda] (NIH), University of Oxford, Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Department of Internal Medicine B, University Medicine Greifswald, Greifswald, University of Chicago, University of Huddersfield, Infectious diseases division, Department of internal medicine, Washington University in Saint Louis (WUSTL), Section on Nephrology [Winston-Salem, NC, USA] (Department of Internal Medicine), Wake Forest School of Medicine [Winston-Salem], Wake Forest Baptist Medical Center-Wake Forest Baptist Medical Center, Radcliffe Department of Medicine [Oxford], Harvard School of Public Health, Kunming University of Science and Technology (KMUST), Sans affiliation, University of Southern California (USC), National Institute on Aging [Bethesda, USA] (NIA), National Institutes of Health [Bethesda] (NIH), Centre National de Génotypage (CNG), Commissariat à l'énergie atomique et aux énergies alternatives (CEA), MRC Centrer for Nutritional Epidemiology and Cancer Prevention and Survival, University of Cambridge [UK] (CAM), National University of Singapore (NUS), Experimental Cardiology Laboratory (ECL), Unirversity Medical Center, Department of Medical Statistics, Epidemiology and Medical Informatics, University of Zagreb, Department of Medical Genetics, Department of Medicine, University of Eastern Finland-Kuopio University Hospital, MRC Epidemiology Unit, University of Cambridge [UK] (CAM)-Institute of Metabolic Science, Capital Normal University [Beijing], Saw Swee Hock School of Public Health, National Institute for Environmental Health Sciences Research Triangle Park, Brown University, MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, Toyota Research Institute, Helmholtz Zentrum München = German Research Center for Environmental Health, Department of Chemistry and Biochemistry [Boulder], University of Colorado [Boulder], Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital de la Timone [CHU - APHM] (TIMONE), Metacohorts Consortium, Universiteit Leiden, Institute of Clinical Chemistry and Laboratory Medicine, University of Groningen [Groningen], Medical Research Concil Epidemiology Unit, Institute of Medical Science, Faculty of Medicine, Genetics and Pathology, Imperial College London, Génétique Evolutive Humaine - Human Evolutionary Genetics, Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Centre de Bioinformatique, Biostatistique et Biologie Intégrative (C3BI), Brigham and Women's Hospital [Boston], Erasmus University Rotterdam, Department of Chronic Disease Prevention, National Institute for Health and Welfare [Helsinki], Department of Biostatistics and Center for Statistical Genetics, University of Michigan [Ann Arbor], University of Michigan System-University of Michigan System-School of public health, The University of Hong Kong (HKU)-The University of Hong Kong (HKU), Stockholm Bioinformatics Center (SBC), Stockholm University, Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, INRH, Department of Genetics, Los Angeles Biomedical Research Institute (LA BioMed), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán - National Institute of Medical Science and Nutrition Salvador Zubiran [Mexico], Western General Hospital, German Research Center for Environmental Health - Helmholtz Center München (GmbH), Medical Research Council, Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute-University of Pittsburgh Graduate School of Public Health, Zhengzhou University of Light Industry, Department of Electrical and Electronic Engineering [Niigata Univ.], Niigata University, Genetic Epidemiology Unit, University College of London [London] (UCL), Aston Business School, Aston University [Birmingham], Division of Cancer Epidemiology and Genetics [Bethesda, MD, États-Unis], Centre Hospitalier Universitaire Vaudois (CHUV), Pennington Biomedical Research Center, University of Washington [Seattle], Guy's and St Thomas' Hospitals, Northwestern Polytechnical University [Xi'an] (NPU), Department of Social Medicine, University of Bristol [Bristol], Department of Genomics of Common Disease [London, UK], Imperial College London-Hammersmith Hospital NHS Imperial College Healthcare, Department of Internal Medicine, Institute of Clinical Molecular Biology, Kiel University, Medizinische Klinik II, Universität zu Lübeck = University of Lübeck [Lübeck], Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina, Institute for Social Research, University of Michigan System-University of Michigan System, Division of Statistical Genomics, Washington University School of Medicine, Institute for Clinical Molecular Biology, Christian-Albrechts-Universität zu Kiel (CAU), Department of Physics, RISSC-Lab-University of Naples Federico II = Università degli studi di Napoli Federico II, Lund University [Lund], Icelandic Heart Association, Heart Preventive Clinic and Research Institute, The Center for Applied Genomics, Children’s Hospital of Philadelphia (CHOP ), Génétique moléculaire de la neurotransmission et des processus neurodégénératifs (LGMNPN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), Medical Research Center Oulu, University of Oulu, University of Utah School of Medicine [Salt Lake City], The Generation R Study, Pediatrics, Epidemiology, Center for Translational and Computational Neuroimmunology [New York, NY, États-Unis] (CTCN), Department of Neurology [New York, NY, États-Unis], Columbia University Medical Center (CUMC), Columbia University [New York]-Columbia University [New York]-Columbia University Medical Center (CUMC), Columbia University [New York]-Columbia University [New York], Universität Heidelberg [Heidelberg] = Heidelberg University, Interuniversity Cardiology Institute Netherlands, School of Public Health, University of Michigan [Dearborn], Department of Epidemiology and Public Health, University of Kuopio, Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Institute of Epidemiology and Biobank PopGen, Department of Biostatistics, University of Washington, Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), Clinical Institute of Medical and Chemical Laboratory Diagnostics, Karl-Franzens-Universität Graz, Department of Genetics, Biology and Biochemistry, Università degli studi di Torino = University of Turin (UNITO), Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), QIMR Berghofer Medical Research Institute, University of North Carolina [Chapel Hill] (UNC), University of North Carolina System (UNC)-University of North Carolina System (UNC), University of North Carolina System (UNC)-University of North Carolina System (UNC)-UNC Gillings School of Global Public Health-Carolina Center for Genome Sciences, University of Illinois [Chicago] (UIC), University of Illinois System, Experimental Cardiology Laboratory, Genetic Epidemiology and Clinical Research Group, Umea University Hospital, Functional Genomics, Erasmus Medical Centre, National Human Genome Research Institute (NHGRI), School of Medicine [Los Angeles], University of California [Los Angeles] (UCLA), University of California (UC)-University of California (UC), Department of Pathological Biochemistry, Royal Infirmary, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Institute of Metabolic Science, MRC, University of Maryland School of Medicine [Baltimore, MD, USA], Centre for Molecular Epidemiology, Centre for Causal Analyses in Translational Epidemiology, University of Bristol [Bristol]-Medical Research Council, IRCCS San Raffaele Scientific Institute [Milan, Italie], U937, Génomique cardiovasculaire, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), University of Michigan System, HMNC Brain Health, Singapore Eye Research Institute, Partenaires INRAE, Institut d'Électronique et des Technologies du numéRique (IETR), Université de Nantes (UN)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS), Institute for Molecular Medicine Finland [Helsinki] (FIMM), Helsinki Institute of Life Science (HiLIFE), Helsingin yliopisto = Helsingfors universitet = University of Helsinki-Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Department of Psychiatry and Psychotherapy, Rheinische Friedrich-Wilhelms-Universität Bonn, University of Groningen, Department of Genomics of Common Disease, Department of Microbiology, The Freeman Hospital, Department Biostatistics University of North Carolina, Complex Trait Genetics, Amsterdam Neuroscience - 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M., Trompet, S., Turman, C., Verweij, N., Viberti, C., Wang, L., Warren, H. R., Wootton, R. E., Yanek, L. R., Yao, J., Yousri, N. A., Zhao, W., Adeyemo, A. A., Afaq, S., Aguilar-Salinas, C. A., Akiyama, M., Albert, M. L., Allison, M. A., Alver, M., Aung, T., Azizi, F., Bentley, A. R., Boeing, H., Boerwinkle, E., Borja, J. B., de Borst, G. J., Bottinger, E. P., Broer, L., Campbell, H., Chanock, S., Chee, M. -L., Chen, G., Chen, Y. -D. I., Chen, Z., Chiu, Y. -F., Cocca, M., Collins, F. S., Concas, M. P., Corley, J., Cugliari, G., van Dam, R. M., Damulina, A., Daneshpour, M. S., Day, F. R., Delgado, G. E., Dhana, K., Doney, A. S. F., Dorr, M., Doumatey, A. P., Dzimiri, N., Ebenesersdottir, S. S., Elliott, J., Elliott, P., Ewert, R., Felix, J. F., Fischer, K., Freedman, B. I., Girotto, G., Goel, A., Gogele, M., Goodarzi, M. O., Graff, M., Granot-Hershkovitz, E., Grodstein, F., Guarrera, S., Gudbjartsson, D. F., Guity, K., Gunnarsson, B., Guo, Y., Hagenaars, S. P., Haiman, C. A., Halevy, A., Harris, T. B., Hedayati, M., van Heel, D. A., Hirata, M., Hofer, I., Hsiung, C. A., Huang, J., Hung, Y. -J., Ikram, M. A., Jagadeesan, A., Jousilahti, P., Kamatani, Y., Kanai, M., Kerrison, N. D., Kessler, T., Khaw, K. -T., Khor, C. C., de Kleijn, D. P. V., Koh, W. -P., Kolcic, I., Kraft, P., Kramer, B. K., Kutalik, Z., Kuusisto, J., Langenberg, C., Launer, L. J., Lawlor, D. A., Lee, I. -T., Lee, W. -J., Lerch, M. M., Li, L., Liu, J., Loh, M., London, S. J., Loomis, S., Lu, Y., Luan, J., Magi, R., Manichaikul, A. W., Manunta, P., Masson, G., Matoba, N., Mei, X. W., Meisinger, C., Meitinger, T., Mezzavilla, M., Milani, L., Millwood, I. Y., Momozawa, Y., Moore, A., Morange, P. -E., Moreno-Macias, H., Mori, T. A., Morrison, A. C., Muka, T., Murakami, Y., Murray, A. D., de Mutsert, R., Mychaleckyj, J. C., Nalls, M. A., Nauck, M., Neville, M. J., Nolte, I. M., Ong, K. K., Orozco, L., Padmanabhan, S., Palsson, G., Pankow, J. S., Pattaro, C., Pattie, A., Polasek, O., Poulter, N., Pramstaller, P. P., Quintana-Murci, L., Raikkonen, K., Ralhan, S., Rao, D. C., van Rheenen, W., Rich, S. S., Ridker, P. M., Rietveld, C. A., Robino, A., van Rooij, F. J. A., Ruggiero, D., Saba, Y., Sabanayagam, C., Sabater-Lleal, M., Sala, C. F., Salomaa, V., Sandow, K., Schmidt, H., Scott, L. J., Scott, W. R., Sedaghati-Khayat, B., Sennblad, B., van Setten, J., Sever, P. J., Sheu, W. H. -H., Shi, Y., Shrestha, S., Shukla, S. R., Sigurdsson, J. K., Sikka, T. T., Singh, J. R., Smith, B. H., Stancakova, A., Stanton, A., Starr, J. M., Stefansdottir, L., Straker, L., Sulem, P., Sveinbjornsson, G., Swertz, M. A., Taylor, A. M., Taylor, K. D., Terzikhan, N., Tham, Y. -C., Thorleifsson, G., Thorsteinsdottir, U., Tillander, A., Tracy, R. P., Tusie-Luna, T., Tzoulaki, I., Vaccargiu, S., Vangipurapu, J., Veldink, J. H., Vitart, V., Volker, U., Vuoksimaa, E., Wakil, S. M., Waldenberger, M., Wander, G. S., Wang, Y. X., Wareham, N. J., Wild, S., Yajnik, C. S., Yuan, J. -M., Zeng, L., Zhang, L., Zhou, J., Amin, N., Asselbergs, F. W., Bakker, S. J. L., Becker, D. M., Lehne, B., Bennett, D. A., van den Berg, L. H., Berndt, S. I., Bharadwaj, D., Bielak, L. F., Bochud, M., Boehnke, M., Bouchard, C., Bradfield, J. P., Brody, J. A., Campbell, A., Carmi, S., Caulfield, M. J., Cesarini, D., Chambers, J. C., Chandak, G. R., Cheng, C. -Y., Ciullo, M., Cornelis, M., Cusi, D., Smith, G. D., Deary, I. J., Dorajoo, R., van Duijn, C. M., Ellinghaus, D., Erdmann, J., Eriksson, J. G., Evangelou, E., Evans, M. K., Faul, J. D., Feenstra, B., Feitosa, M., Foisy, S., Franke, A., Friedlander, Y., Gasparini, P., Gieger, C., Gonzalez, C., Goyette, P., Grant, S. F. A., Griffiths, L. R., Groop, L., Gudnason, V., Gyllensten, U., Hakonarson, H., Hamsten, A., van der Harst, P., Heng, C. -K., Hicks, A. A., Hochner, H., Huikuri, H., Hunt, S. C., Jaddoe, V. W. V., De Jager, P. L., Johannesson, M., Johansson, A., Jonas, J. B., Jukema, J. W., Junttila, J., Kaprio, J., Kardia, S. L. R., Karpe, F., Kumari, M., Laakso, M., van der Laan, S. W., Lahti, J., Laudes, M., Lea, R. A., Lieb, W., Lumley, T., Martin, N. G., Marz, W., Matullo, G., Mccarthy, M. I., Medland, S. E., Merriman, T. R., Metspalu, A., Meyer, B. F., Mohlke, K. L., Montgomery, G. W., Mook-Kanamori, D., Munroe, P. B., North, K. E., Nyholt, D. R., O'Connell, J. R., Ober, C., Oldehinkel, A. J., Palmas, W., Palmer, C., Pasterkamp, G. G., Patin, E., Pennell, C. E., Perusse, L., Peyser, P. A., Pirastu, M., Polderman, T. J. C., Porteous, D. J., Posthuma, D., Psaty, B. M., Rioux, J. D., Rivadeneira, F., Rotimi, C., Rotter, J. I., Rudan, I., Den Ruijter, H. M., Sanghera, D. K., Sattar, N., Schmidt, R., Schulze, M. B., Schunkert, H., Scott, R. A., Shuldiner, A. R., Sim, X., Small, N., Smith, J. A., Sotoodehnia, N., Tai, E. -S., Teumer, A., Timpson, N. J., Toniolo, D., Tregouet, D. -A., Tuomi, T., Vollenweider, P., Wang, C. A., Weir, D. R., Whitfield, J. B., Wijmenga, C., Wong, T. -Y., Wright, J., Yang, J., Yu, L., Zemel, B. S., Zonderman, A. B., Perola, M., Magnusson, P. K. E., Uitterlinden, A. G., Kooner, J. S., Chasman, D. I., Loos, R. J. F., Franceschini, N., Franke, L., Haley, C. S., Hayward, C., Walters, R. G., Perry, J. R. B., Esko, T., Helgason, A., Stefansson, K., Joshi, P. K., Kubo, M., Wilson, J. F., Læknadeild (HÍ), Faculty of Medicine (UI), Félagsfræði-, mannfræði- og þjóðfræðideild (HÍ), Faculty of Sociology, Anthropology and Folkloristics (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), School of Engineering and Natural Sciences (UI), Verkfræði- og náttúruvísindasvið (HÍ), Félagsvísindasvið (HÍ), School of Social Sciences (UI), Háskóli Íslands, University of Iceland, Clark, David W [0000-0002-1025-9185], Okada, Yukinori [0000-0002-0311-8472], Moore, Kristjan H S [0000-0002-9579-4362], Mason, Dan [0000-0002-0026-9216], Pirastu, Nicola [0000-0002-5363-3886], Gandin, Ilaria [0000-0003-3196-2491], Deelen, Patrick [0000-0002-5654-3966], Schurmann, Claudia [0000-0003-4158-9192], Medina-Gomez, Carolina [0000-0001-7999-5538], Karlsson, Robert [0000-0002-8949-2587], Bao, Yanchun [0000-0002-6102-5098], Biino, Ginevra [0000-0002-9936-946X], Brumat, Marco [0000-0003-3268-039X], Chai, Jin-Fang [0000-0003-3770-1137], Eccles, David A [0000-0003-4634-4995], Gordon, Scott D [0000-0001-7623-328X], Harris, Sarah E [0000-0002-4941-5106], Kacprowski, Tim [0000-0002-5393-2413], Karlsson, Torgny [0000-0001-8095-6149], Kleber, Marcus E [0000-0003-0663-7275], Mahajan, Anubha [0000-0001-5585-3420], Matsuda, Koichi [0000-0001-7292-2686], Meng, Weihua [0000-0001-5388-8494], van der Most, Peter J [0000-0001-8450-3518], Munz, Matthias [0000-0002-4728-3357], Palviainen, Teemu [0000-0002-7847-8384], Prasad, Rashmi B [0000-0002-4400-6741], Salvi, Erika [0000-0002-2724-2291], Skotte, Line [0000-0002-7398-1271], van der Spek, Ashley [0000-0001-7136-0159], Spracklen, Cassandra N [0000-0003-3590-7182], Strawbridge, Rona J [0000-0001-8506-3585], Tajuddin, Salman M [0000-0002-7919-8528], Verweij, Niek [0000-0002-4303-7685], Yanek, Lisa R [0000-0001-7117-1075], Zhao, Wei [0000-0001-7388-0692], Albert, Matthew L [0000-0001-7285-6973], Bentley, Amy R [0000-0002-0827-9101], Chanock, Stephen [0000-0002-2324-3393], Chen, Zhengming [0000-0001-6423-105X], Chiu, Yen-Feng [0000-0002-3352-4500], Cocca, Massimiliano [0000-0002-1127-7596], Collins, Francis S [0000-0002-1023-7410], Cugliari, Giovanni [0000-0002-6080-0718], Damulina, Anna [0000-0001-8241-2727], Day, Felix R [0000-0003-3789-7651], Dhana, Klodian [0000-0002-6397-7009], Dzimiri, Nduna [0000-0003-3395-5754], Elliott, Paul [0000-0002-7511-5684], Felix, Janine F [0000-0002-9801-5774], Freedman, Barry I [0000-0003-0275-5530], Girotto, Giorgia [0000-0003-4507-6589], Goel, Anuj [0000-0003-2307-4021], Goodarzi, Mark O [0000-0001-6364-5103], Gudbjartsson, Daniel F [0000-0002-5222-9857], Guity, Kamran [0000-0002-8379-9668], van Heel, David A [0000-0002-0637-2265], Hirata, Makoto [0000-0002-9994-9958], Ikram, M Arfan [0000-0003-0372-8585], Kamatani, Yoichiro [0000-0001-8748-5597], Kanai, Masahiro [0000-0001-5165-4408], Khor, Chiea Chuen [0000-0002-1128-4729], Kolcic, Ivana [0000-0001-7918-6052], Langenberg, Claudia [0000-0002-5017-7344], Lawlor, Deborah A [0000-0002-6793-2262], Liu, Jianjun [0000-0002-3255-3019], London, Stephanie J [0000-0003-4911-5290], Luan, Jian’an [0000-0003-3137-6337], Matoba, Nana [0000-0001-5329-0134], Mei, Xue W [0000-0002-6279-4884], Mezzavilla, Massimo [0000-0002-9000-4595], Milani, Lili [0000-0002-5323-3102], Mori, Trevor A [0000-0002-5264-9229], Murakami, Yoshinori [0000-0002-2826-4396], Murray, Alison D [0000-0003-4915-4847], Mychaleckyj, Josyf C [0000-0003-2595-0005], Neville, Matt J [0000-0002-6004-5433], Nolte, Ilja M [0000-0001-5047-4077], Ong, Ken K [0000-0003-4689-7530], Pálsson, Gunnar [0000-0002-8231-3961], Pankow, James S [0000-0001-7076-483X], Pattaro, Cristian [0000-0002-4119-0109], Quintana-Murci, Lluis [0000-0003-2429-6320], van Rheenen, Wouter [0000-0002-5860-1533], Rich, Stephen S [0000-0003-3872-7793], Rietveld, Cornelius A [0000-0003-4053-1861], Ruggiero, Daniela [0000-0003-3898-7827], Sabanayagam, Charumathi [0000-0002-4042-4719], Sabater-Lleal, Maria [0000-0002-0128-379X], Sala, Cinzia Felicita [0000-0003-2514-2075], Salomaa, Veikko [0000-0001-7563-5324], Scott, Laura J [0000-0002-4886-5084], Sedaghati-Khayat, Bahareh [0000-0002-7665-8648], Sennblad, Bengt [0000-0002-4360-8003], van Setten, Jessica [0000-0002-4934-7510], Smith, Blair H [0000-0002-5362-9430], Stančáková, Alena [0000-0002-1375-0252], Stanton, Alice [0000-0002-4961-165X], Straker, Leon [0000-0002-7786-4128], Sulem, Patrick [0000-0001-7123-6123], Swertz, Morris A [0000-0002-0979-3401], Taylor, Kent D [0000-0002-2756-4370], Tzoulaki, Ioanna [0000-0002-4275-9328], Veldink, Jan H [0000-0001-5572-9657], Vitart, Veronique [0000-0002-4991-3797], Völker, Uwe [0000-0002-5689-3448], Wander, Gurpreet S [0000-0002-4596-4247], Wang, Ya Xing [0000-0003-2749-7793], Wild, Sarah [0000-0001-7824-2569], Yuan, Jian-Min [0000-0002-4620-3108], Asselbergs, Folkert W [0000-0002-1692-8669], Boehnke, Mike [0000-0002-6442-7754], Bouchard, Claude [0000-0002-0048-491X], Brody, Jennifer A [0000-0001-8509-148X], Campbell, Archie [0000-0003-0198-5078], Caulfield, Mark J [0000-0001-9295-3594], Smith, George Davey [0000-0002-1407-8314], Dorajoo, Rajkumar [0000-0001-6608-2051], Ellinghaus, David [0000-0002-4332-6110], Erdmann, Jeanette [0000-0002-4486-6231], Evangelou, Evangelos [0000-0002-5488-2999], Feenstra, Bjarke [0000-0003-1478-649X], Feitosa, Mary [0000-0002-0933-2410], Franke, Andre [0000-0003-1530-5811], Grant, Struan F A [0000-0003-2025-5302], Griffiths, Lyn R [0000-0002-6774-5475], Groop, Leif [0000-0002-0187-3263], Gudnason, Vilmundur [0000-0001-5696-0084], van der Harst, Pim [0000-0002-2713-686X], Heng, Chew-Kiat [0000-0002-7309-9473], Hicks, Andrew A [0000-0001-6320-0411], Jaddoe, Vincent W V [0000-0003-2939-0041], De Jager, Philip L [0000-0002-8057-2505], Johannesson, Magnus [0000-0001-8759-6393], Johansson, Åsa [0000-0002-2915-4498], Jonas, Jost B [0000-0003-2972-5227], Jukema, J Wouter [0000-0002-3246-8359], Kaprio, Jaakko [0000-0002-3716-2455], Laakso, Markku [0000-0002-3394-7749], van der Laan, Sander W [0000-0001-6888-1404], Lahti, Jari [0000-0002-4310-5297], Martin, Nicholas G [0000-0003-4069-8020], Medland, Sarah E [0000-0003-1382-380X], Merriman, Tony R [0000-0003-0844-8726], Metspalu, Andres [0000-0002-3718-796X], Mohlke, Karen L [0000-0001-6721-153X], Montgomery, Grant W [0000-0002-4140-8139], Munroe, Patricia B [0000-0002-4176-2947], Nyholt, Dale R [0000-0001-7159-3040], Ober, Carole [0000-0003-4626-9809], Oldehinkel, Albertine J [0000-0003-3925-3913], Palmer, Colin [0000-0002-6415-6560], Perusse, Louis [0000-0001-6440-9698], Polderman, Tinca J. C. [0000-0001-5564-301X], Porteous, David J [0000-0003-1249-6106], Rioux, John D [0000-0001-7560-8326], Rivadeneira, Fernando [0000-0001-9435-9441], Rotimi, Charles [0000-0001-5759-053X], Rotter, Jerome I [0000-0001-7191-1723], Rudan, Igor [0000-0001-6993-6884], Sattar, Naveed [0000-0002-1604-2593], Sim, Xueling [0000-0002-1233-7642], Smith, Jennifer A [0000-0002-3575-5468], Teumer, Alexander [0000-0002-8309-094X], Timpson, Nicholas J [0000-0002-7141-9189], Tuomi, Tiinamaija [0000-0002-8306-6202], Wang, Carol A [0000-0002-4301-3974], Weir, David R [0000-0002-1661-2402], Whitfield, John B [0000-0002-1103-0876], Magnusson, Patrik K. E. [0000-0002-7315-7899], Uitterlinden, André G [0000-0002-7276-3387], Loos, Ruth J. F. [0000-0002-8532-5087], Franke, Lude [0000-0002-5159-8802], Haley, Chris S [0000-0002-9811-0210], Hayward, Caroline [0000-0002-9405-9550], Walters, Robin G [0000-0002-9179-0321], Joshi, Peter K [0000-0002-6361-5059], Wilson, James F [0000-0001-5751-9178], Apollo - University of Cambridge Repository, Moore, Kristjan HS [0000-0002-9579-4362], Luan, Jian'an [0000-0003-3137-6337], Grant, Struan FA [0000-0003-2025-5302], Jaddoe, Vincent WV [0000-0003-2939-0041], Polderman, Tinca JC [0000-0001-5564-301X], Magnusson, Patrik KE [0000-0002-7315-7899], Loos, Ruth JF [0000-0002-8532-5087], Neurology, Human genetics, Amsterdam Reproduction & Development (AR&D), Life Course Epidemiology (LCE), Groningen Institute for Gastro Intestinal Genetics and Immunology (3GI), Groningen Institute for Organ Transplantation (GIOT), Lifestyle Medicine (LM), Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Interdisciplinary Centre Psychopathology and Emotion regulation (ICPE), Stem Cell Aging Leukemia and Lymphoma (SALL), Institute for Molecular Medicine Finland, Department of Psychology and Logopedics, University Management, Developmental Psychology Research Group, Staff Services, Cognitive and Brain Aging, Research Programs Unit, Diabetes and Obesity Research Program, Johan Eriksson / Principal Investigator, Department of General Practice and Primary Health Care, Clinicum, University of Helsinki, Centre of Excellence in Complex Disease Genetics, Department of Public Health, Genetic Epidemiology, Helsinki Collegium for Advanced Studies, HUS Abdominal Center, Endokrinologian yksikkö, Bradford Teaching Hospitals NHS Foundation Trust [Bradford, UK] (BTHFT), University of Trieste, Université de Lausanne (UNIL), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Consiglio Nazionale delle Ricerche (CNR), Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur [Paris], Institut Pasteur [Paris], University of Oxford [Oxford], Medical Genetics, Dept. RSD and Public Health, IRCCS-Burlo Garofolo/University of Trieste, sans affiliation, Helmholtz-Zentrum München (HZM), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Institute of Cardiovascular Science, University College London, Hammersmith Hospital NHS Imperial College Healthcare-Imperial College London, Universität zu Lübeck [Lübeck], University of Ioannina Medical School, Università degli studi di Napoli Federico II-RISSC-Lab, Universität Heidelberg [Heidelberg], University of Turin, University of California-University of California, Nantes Université (NU)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS), University of Helsinki-University of Helsinki, Université de Nantes (UN)-Université de Rennes 1 (UR1), Erasmus MC other, Internal Medicine, and Applied Economics
Subjects: 0301 basic medicine, 631/208/1397, Chemistry(all), Health Status, [SDV]Life Sciences [q-bio], LOCI, General Physics and Astronomy, MESH: Haplotype, MESH: Cognition, 030105 genetics & heredity, Runs of Homozygosity, Biochemistry, Consanguinity, Cognition, Inbreeding depression, 2.1 Biological and endogenous factors, Body Size, Inbreeding, Skyldleikarækt, Aetiology, Human phenotypes, lcsh:Science, MESH: Health Status, Genetics, Multidisciplinary, Inbreeding Depression, Confounding, Homozygote, RUNS, 631/208/205, 631/208/721, 3. Good health, genomic inbreeding coefficients, MESH: Risk-Taking, 631/208/730, Autozygosit, homozygosity, Erfðarannsóknir, Medical Genetics, genomic inbreeding coefficient, MESH: Homozygote, Offspring, Science, Autozygosity, Blóðsifjar, 610 Medicine & health, Biology, INBREEDING DEPRESSION, HOMOZYGOSITY, FERTILITY, QUANTIFICATION, Physics and Astronomy(all), General Biochemistry, Genetics and Molecular Biology, Article, Association, 03 medical and health sciences, Risk-Taking, 360 Social problems & social services, Journal Article, Humans, ddc:610, Allele, Alleles, Medicinsk genetik, Genetic association study, MESH: Consanguinity, MESH: Body Size, MESH: Humans, Biochemistry, Genetics and Molecular Biology(all), MESH: Alleles, Haplotype, MESH: Fertility, General Chemistry, Brain Disorders, MESH: Inbreeding Depression, 030104 developmental biology, Fertility, Haplotypes, Genetic markers, lcsh:Q, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 3111 Biomedicine, Genetics and Molecular Biology(all)
Abstract: Publisher's version (útgefin grein)., In many species, the offspring of related parents suffer reduced reproductive success, a phenomenon known as inbreeding depression. In humans, the importance of this effect has remained unclear, partly because reproduction between close relatives is both rare and frequently associated with confounding social factors. Here, using genomic inbreeding coefficients (FROH) for >1.4 million individuals, we show that FROH is significantly associated (p < 0.0005) with apparently deleterious changes in 32 out of 100 traits analysed. These changes are associated with runs of homozygosity (ROH), but not with common variant homozygosity, suggesting that genetic variants associated with inbreeding depression are predominantly rare. The effect on fertility is striking: FROH equivalent to the offspring of first cousins is associated with a 55% decrease [95% CI 44–66%] in the odds of having children. Finally, the effects of FROH are confirmed within full-sibling pairs, where the variation in FROH is independent of all environmental confounding., This paper is the work of the ROHgen consortium. We thank the Sigma T2D Consortium, whose members are detailed in Supplementary Note 3. We thank the UK Biobank Resource, approved under application 19655; we acknowledge funding from the UK Medical Research Council Human Genetics Unit and MRC Doctoral Training Programme in Precision Medicine. We also thank Neil Robertson, Wellcome Trust Centre for Human Genetics, Oxford, for use of his author details management software, Authorial. Finally, we thank all the participants, researchers and funders of ROHgen cohorts. Cohort-specific acknowledgements are in Supplementary Data 2; personal acknowledgements and disclosures are in Supplementary Note 2. We thank Rachel Edwards for administrative assistance.
Published: 2019

42. 'Bringing heaven down to earth': the purpose and place of religion in UK food aid

Author: Neil Small, Madeleine Sarah Power, Kate E. Pickett, Bob Doherty, and Barbara J. Stewart-Knox
Subjects: 060303 religions & theology, education.field_of_study, Food security, Sociology and Political Science, Big Society, media_common.quotation_subject, 05 social sciences, Economics, Econometrics and Finance (miscellaneous), Population, Doctrine, 06 humanities and the arts, Management, Monitoring, Policy and Law, Development, Public administration, 0603 philosophy, ethics and religion, 0506 political science, Faith, Originality, 050602 political science & public administration, Business, Management and Accounting (miscellaneous), Heaven, Sociology, education, media_common, Primary research
Abstract: Purpose This paper uses data from a city with a multi-ethnic, multi-faith population to better understand faith-based food aid. The paper aims to understand what constitutes faith-based responses to food insecurity, compare the prevalence and nature of faith-based food aid across different religions and explore how community food aid meets the needs of a multi-ethnic, multi-faith population. Design/methodology/approach The study involved two phases of primary research. In Phase 1, desk-based research and dialogue with stakeholders in local food security programmes were used to identify faith-based responses to food insecurity. Phase 2 consisted of 18 semi-structured interviews involving faith-based and secular charitable food aid organizations. Findings The paper illustrates the internal heterogeneity of faith-based food aid. Faith-based food aid is highly prevalent and the vast majority is Christian. Doctrine is a key motivation among Christian organizations for their provision of food. The fact that the clients at faith-based, particularly Christian, food aid did not reflect the local religious demographic is a cause for concern in light of the entry-barriers identified. This concern is heightened by the co-option of faith-based organizations by the state as part of the “Big Society” agenda. Originality/value This is the first academic study in the UK to look at the faith-based arrangements of Christian and Muslim food aid providers, to set out what it means to provide faith-based food aid in the UK and to explore how faith-based food aid interacts with people of other religions and no religion.
Published: 2017

43. Exploring the Potential for Secondary uses of Dementia Care Mapping (DCM) Data for Improving the Quality of Dementia Care

Author: Claire Surr, Neil Small, Shehla Khalid, and Daniel Neagu
Subjects: Sociology and Political Science, media_common.quotation_subject, Datasets as Topic, Grounded theory, Interviews as Topic, 03 medical and health sciences, 0302 clinical medicine, Contextual design, Nursing, Patient-Centered Care, Health care, Humans, Medicine, Dementia, Quality (business), Computer Security, Quality of Health Care, media_common, 030214 geriatrics, business.industry, General Social Sciences, General Medicine, medicine.disease, Quality Improvement, Data mapping, Data quality, Grounded Theory, Female, Observational study, business, 030217 neurology & neurosurgery
Abstract: The reuse of existing datasets to identify mechanisms for improving healthcare quality has been widely encouraged. There has been limited application within dementia care. Dementia Care Mapping is an observational tool in widespread use, predominantly to assess and improve quality of care in single organisations. Dementia Care Mapping data have the potential to be used for secondary purposes to improve quality of care. However, its suitability for such use requires careful evaluation. This study conducted in-depth interviews with 29 Dementia Care Mapping users to identify issues, concerns and challenges regarding the secondary use of Dementia Care Mapping data. Data were analysed using modified Grounded Theory. Major themes identified included the need to collect complimentary contextual data in addition to Dementia Care Mapping data, to reassure users regarding ethical issues associated with storage and reuse of care related data and the need to assess and specify data quality for any data that might be available for secondary analysis.
Published: 2017

44. Food insecurity and socio-demographic characteristics in two UK ethnic groups: an analysis of women in the Born in Bradford cohort

Author: Neil Small, Madeleine Sarah Power, Bob Doherty, Kate E. Pickett, Barbara J. Stewart-Knox, and Eleonora Uphoff
Subjects: Gerontology, medicine.medical_specialty, common, Population, Ethnic group, Logistic regression, White People, Food Supply, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Environmental health, Epidemiology, Ethnicity, Humans, Medicine, Pakistan, 030212 general & internal medicine, education, Family Characteristics, education.field_of_study, 030505 public health, business.industry, Public health, common.demographic_type, Public Health, Environmental and Occupational Health, General Medicine, Odds ratio, United Kingdom, Socioeconomic Factors, Cohort, 0305 other medical science, business, White British
Abstract: Background The use of foodbanks has risen sharply in the UK; however, the epidemiology of UK food insecurity is undeveloped. This study contributes to the field by analysing socio-demographic risk factors for food insecurity in a female, ethnically diverse population. Methods Data from the Born in Bradford (BiB) cohort were matched with data on food insecurity from the nested BiB1000 study (N = 1280). Logistic regression was used to model food insecurity in relation to ethnicity and socio-demographic factors. Results Food insecurity, reported by 13.98% of the sample, was more likely among White British than Pakistani women (crude Odds Ratio (OR) 1.94, 95% CI: 1.37; 2.74, adjusted OR 2.37, 95% CI: 1.57; 3.59). In fully adjusted analyses, food insecurity was associated with a range of socio-economic measures, particularly the receipt of mean-tested benefits (adjusted OR 2.11, 95% CI: 1.41; 3.15) and perception of financial insecurity (adjusted OR 8.91, 95% CI: 4.14; 19.16 for finding it difficult/very difficult compared to living comfortably). Conclusions The finding that food insecurity prevalence may be higher than previously thought and that food insecurity is highly associated with socio-economic status, notably benefit receipt, is a cause for concern necessitating an urgent policy response.
Published: 2017

45. Is food insecurity associated with maternal health among UK ethnic groups? An exploration of women in the BiB cohort

Author: Madeleine Sarah Power, Barbara J. Stewart-Knox, Bob Doherty, Neil Small, and Kate E. Pickett
Subjects: Adult, 0301 basic medicine, common, Health impact, Ethnic group, White People, Food Supply, Odds, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Asian People, Environmental health, Ethnicity, Humans, Medicine, Financial security, Maternal health, 030212 general & internal medicine, 030109 nutrition & dietetics, business.industry, digestive, oral, and skin physiology, common.demographic_type, Public Health, Environmental and Occupational Health, United Kingdom, Food insecurity, Socioeconomic Factors, Cohort, Female, business, White British
Abstract: Food insecurity is a determinant of maternal health; however, research on the health impact of food insecurity among mothers of varying ethnicities is under-developed. We assessed the association of food insecurity and health among white British and Pakistani mothers. Data from the Born in Bradford cohort were matched with data on food insecurity and self-reported health from the nested BiB1000 study (N = 1280). Food insecurity was associated with elevated odds of fair/poor health among white British mothers but not Pakistani mothers. Adjusting for financial security, the association between food insecurity and poor health was not significant among either white British or Pakistani mothers.
Published: 2018

46. An ecological framework for improving child and adolescent health

Author: Chris Bem and Neil Small
Subjects: Health Knowledge, Attitudes, Practice, Inequality, Adolescent, Social Determinants of Health, media_common.quotation_subject, Ecology (disciplines), Health Status, Adolescent Health, Disease, 030204 cardiovascular system & hematology, Social Environment, Child and adolescent, 03 medical and health sciences, 0302 clinical medicine, Health Transition, Ecological psychology, Medicine, Humans, 030212 general & internal medicine, Healthcare Disparities, Child, media_common, Health economics, Ecology, business.industry, Principal (computer security), Child Health, Mental Health, Action (philosophy), Socioeconomic Factors, Pediatrics, Perinatology and Child Health, business, Environmental Health
Abstract: The rise in non-communicable disease as a principal cause of premature mortality and a continuing failure to address health inequalities requires a critical examination of prevailing paradigms in health. In this paper, we offer ecology as an alternative way to view health need and as a guide to action to enhance human health and model a healthy economy. After describing the shortcomings of the prevailing biophysical approach to health, we describe an ecological approach to health that brings to the forefront social and environmental determinants and empowers health workers together with their communities to achieve a health-affirming society and economy.
Published: 2019

47. Growing up in Bradford:protocol for the age 7-11 follow up of the Born in Bradford birth cohort

Author: Liam J. B. Hill, John Wright, Neil Small, Philippa K Bird, Laura Lennon, Rosemary R. C. McEachan, Elizabeth Andrews, Mark Mon-Williams, Dagmar Waiblinger, Amanda H. Waterman, Kate E. Pickett, Jane West, Peter H. Whincup, Sally E. Barber, Dan Mason, Debbie A Lawlor, and Katy A. Shire
Subjects: Male, Gerontology, medicine.medical_specialty, Social Determinants of Health, Population, Socio-economic status, 030209 endocrinology & metabolism, Study Protocol, 03 medical and health sciences, 0302 clinical medicine, Cardiorespiratory health, Pregnancy, Surveys and Questionnaires, Epidemiology, medicine, Ethnicity, Humans, Prospective Studies, 030212 general & internal medicine, Social determinants of health, Child, education, Poverty, Socioeconomic status, Sensorimotor development, education.field_of_study, business.industry, lcsh:Public aspects of medicine, 4. Education, Public health, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Mental health, 3. Good health, England, Birth cohort study, Born in Bradford, Cohort, Cognitive development, Female, Biostatistics, business, Follow-Up Studies
Abstract: Background Born in Bradford (BiB) is a prospective multi-ethnic pregnancy and birth cohort study that was established to examine determinants of health and development during childhood and, subsequently, adult life in a deprived multi-ethnic population in the north of England. Between 2007 and 2010, the BiB cohort recruited 12,453 women who experienced 13,776 pregnancies and 13,858 births, along with 3353 of their partners. Forty five percent of the cohort are of Pakistani origin. Now that children are at primary school, the first full follow-up of the cohort is taking place. The aims of the follow-up are to investigate the determinants of children’s pre-pubertal health and development, including through understanding parents’ health and wellbeing, and to obtain data on exposures in childhood that might influence future health. Methods We are employing a multi-method approach across three data collection arms (community-based family visits, school based physical assessment, and whole classroom cognitive, motor function and wellbeing measures) to follow-up over 9000 BiB children aged 7–11 years and their families between 2017 and 2021. We are collecting detailed parent and child questionnaires, cognitive and sensorimotor assessments, blood pressure, anthropometry and blood samples from parents and children. Dual x-ray absorptiometry body scans, accelerometry and urine samples are collected on subsamples. Informed consent is collected for continued routine data linkage to health, social care and education records. A range of engagement activities are being used to raise the profile of BiB and to disseminate findings. Discussion Our multi-method approach to recruitment and assessment provides an efficient method of collecting rich data on all family members. Data collected will enhance BiB as a resource for the international research community to study the interplay between ethnicity, socioeconomic circumstances and biology in relation to cardiometabolic health, mental health, education, cognitive and sensorimotor development and wellbeing. Electronic supplementary material The online version of this article (10.1186/s12889-019-7222-2) contains supplementary material, which is available to authorized users.
Published: 2019

48. ActEarly: a City Collaboratory approach to early promotion of good health and wellbeing

Author: George B. Ploubidis, Nicholas Pleace, Paul A. Longley, Muki Haklay, Robert Savage, Mark Mon-Williams, Liam Crosby, John Wright, Tracey Bywater, Tiffany Yang, Laura Sheard, Josie Dickerson, Claire Cameron, Daisy Fancourt, Rosie McEachan, Trevor A Sheldon, Dan Mason, Andrew Hayward, Steven Cummins, Richard Romano, Neil Small, Kate E. Pickett, Jess Sheringham, Laura Vaughan, Nicola Christie, Jens Kandt, Richard Cookson, Maria Bryant, Steve Morris, Sally E. Barber, Jane West, Marcella Ucci, Robert W Aldridge, Eric J. Brunner, Gillian Santorelli, Philip Garnett, Dan Hopewell, Wright, John [0000-0001-9572-7293], West, Jane [0000-0002-5770-8363], Pickett, Kate [0000-0002-8066-8507], McEachan, Rosie M [0000-0003-1302-6675], Mon-Williams, Mark [0000-0001-7595-8545], Vaughan, Laura [0000-0003-0315-2977], Sheringham, Jess [0000-0003-3468-129X], Haklay, Muki [0000-0001-6117-3026], Small, Neil [0000-0002-4426-3596], Cookson, Richard [0000-0003-0052-996X], Garnett, Philip [0000-0001-6651-0220], Bywater, Tracey [0000-0001-7207-8753], Cameron, Claire [0000-0001-5477-0500], Ucci, Marcella [0000-0001-5618-7247], Cummins, Steve [0000-0002-3957-4357], Fancourt, Daisy [0000-0002-6952-334X], Aldridge, Robert [0000-0003-0542-0816], Yang, Tiffany [0000-0003-4549-7850], Santorelli, Gillian [0000-0003-0427-1783], Romano, Richard [0000-0002-2132-4077], Bryant, Maria [0000-0001-7690-4098], Crosby, Liam [0000-0003-4643-3701], Sheldon, Trevor [0000-0002-7479-5913], and Apollo - University of Cambridge Repository
Subjects: Service (systems architecture), media_common.quotation_subject, Psychological intervention, Medicine (miscellaneous), 030209 endocrinology & metabolism, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, 0302 clinical medicine, Promotion (rank), Noncommunicable diseases, Ethnicity, 030212 general & internal medicine, media_common, Upstream (petroleum industry), business.industry, Child Health, Articles, Collaboratory, Public relations, Tipping point (climatology), Mental health, Collective impact, 3. Good health, Mental Health, Environment and Public Health, Open Letter, Psychology, business
Abstract: Economic, physical, built, cultural, learning, social and service environments have a profound effect on lifelong health. However, policy thinking about health research is dominated by the ‘biomedical model’ which promotes medicalisation and an emphasis on diagnosis and treatment at the expense of prevention. Prevention research has tended to focus on ‘downstream’ interventions that rely on individual behaviour change, frequently increasing inequalities. Preventive strategies often focus on isolated leverage points and are scattered across different settings. This paper describes a major new prevention research programme that aims to create City Collaboratory testbeds to support the identification, implementation and evaluation of upstream interventions within a whole system city setting. Prevention of physical and mental ill-health will come from the cumulative effect of multiple system-wide interventions. Rather than scatter these interventions across many settings and evaluate single outcomes, we will test their collective impact across multiple outcomes with the goal of achieving a tipping point for better health. Our focus is on early life (ActEarly) in recognition of childhood and adolescence being such critical periods for influencing lifelong health and wellbeing.
Published: 2019

49. ENDOGAMY, CONSANGUINITY AND THE HEALTH IMPLICATIONS OF CHANGING MARITAL CHOICES IN THE UK PAKISTANI COMMUNITY

Author: John Wright, Neil Small, Emily S. Petherick, and Alan H. Bittles
Subjects: Adult, Male, 0301 basic medicine, Adolescent, Cross-sectional study, media_common.quotation_subject, Developing country, Genes, Recessive, Consanguinity, 030105 genetics & heredity, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Residence Characteristics, Humans, Medicine, Family, Pakistan, 030212 general & internal medicine, Marriage, Young adult, Child, Developing Countries, Aged, media_common, Aged, 80 and over, business.industry, Homozygote, Genetic Diseases, Inborn, Infant, Newborn, Public Health, Environmental and Occupational Health, Infant, General Social Sciences, Middle Aged, Social stratification, Cross-Sectional Studies, Endogamy, Child, Preschool, Female, Psychological resilience, business, Demography, Cohort study
Abstract: SummaryThe biraderi (brotherhood) is a long-established, widely prevalent dimension of social stratification in Pakistani communities worldwide. Alongside consanguinity, it offers a route for cementing social solidarities and so has strong socio-biological significance. A detailed breakdown of biraderi affiliation among participants in an ongoing birth cohort study in the northern English city of Bradford is presented. There is historical resilience of intra-biraderi marriage, but with a secular decline in prevalence across all biraderi and considerable reductions in some. While a majority of marriages in all biraderi are consanguineous the prevalence varies, ranging from over 80% to under 60%. In consanguineous unions, first cousin marriages account for more than 50% in five of the fifteen biraderi and >40% in six others. Within-biraderi marriage and consanguinity enhance genetic stratification, thereby increasing rates of genomic homozygosity and the increased expression of recessive genetic disorders. The trends reported constitute putative signals of generational change in the marital choices in this community.
Published: 2016

50. Born in Bradford’s Better Start: an experimental birth cohort study to evaluate the impact of early life interventions

Author: Dagmar Waiblinger, Dan Mason, Philippa K Bird, Maria Bryant, Tracey Bywater, Eleonora Uphoff, Melanie Astin, Pinki Sahota, Rosemary R. C. McEachan, Claudine Bowyer‐Crane, Debbie A Lawlor, Kate E. Pickett, Neil Small, John Wright, Josie Dickerson, Gill Thornton, and Michaela Howell
Subjects: Gerontology, Male, Soicial, Psychological intervention, Cohort Studies, Study Protocol, 0302 clinical medicine, Child Development, Pregnancy, Risk Factors, Ethnicity, 030212 general & internal medicine, Child development, Language, Trials within cohort, Child health, Communication, lcsh:Public aspects of medicine, England, Research Design, Child, Preschool, Quasi-experimental, Cohort, Female, Emotional, Birth cohort, Cohort study, Adult, medicine.medical_specialty, Early years interventions, Mothers, Nutritional Status, Life chances, Health Promotion, Language Development, 03 medical and health sciences, quasi-experimental, Social, 030225 pediatrics, medicine, Humans, Obesity, Socioeconomic status, Poverty, Nutrition, business.industry, Public health, Infant, Newborn, Public Health, Environmental and Occupational Health, Infant, lcsh:RA1-1270, Mental health, Health promotion, Inequalities, business
Abstract: Background Early interventions are recognised as key to improving life chances for children and reducing inequalities in health and well-being, however there is a paucity of high quality research into the effectiveness of interventions to address childhood health and development outcomes. Planning and implementing standalone RCTs for multiple, individual interventions would be slow, cumbersome and expensive. This paper describes the protocol for an innovative experimental birth cohort: Born in Bradford’s Better Start (BiBBS) that will simultaneously evaluate the impact of multiple early life interventions using efficient study designs. Better Start Bradford (BSB) has been allocated £49 million from the Big Lottery Fund to implement 22 interventions to improve outcomes for children aged 0–3 in three key areas: social and emotional development; communication and language development; and nutrition and obesity. The interventions will be implemented in three deprived and ethnically diverse inner city areas of Bradford. Method The BiBBS study aims to recruit 5000 babies, their mothers and their mothers’ partners over 5 years from January 2016-December 2020. Demographic and socioeconomic information, physical and mental health, lifestyle factors and biological samples will be collected during pregnancy. Parents and children will be linked to their routine health and local authority (including education) data throughout the children’s lives. Their participation in BSB interventions will also be tracked. BiBBS will test interventions using the Trials within Cohorts (TwiCs) approach and other quasi-experimental designs where TwiCs are neither feasible nor ethical, to evaluate these early life interventions. The effects of single interventions, and the cumulative effects of stacked (multiple) interventions on health and social outcomes during the critical early years will be measured. Discussion The focus of the BiBBS cohort is on intervention impact rather than observation. As far as we are aware BiBBS is the world’s first such experimental birth cohort study. While some risk factors for adverse health and social outcomes are increasingly well described, the solutions to tackling them remain elusive. The novel design of BiBBS can contribute much needed evidence to inform policy makers and practitioners about effective approaches to improve health and well-being for future generations. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3318-0) contains supplementary material, which is available to authorized users.
Published: 2016

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