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ObjectiveTo examine the association between gestational age at birth and hospital admission costs from birth to 8 years of age.DesignPopulation-based, record linkage, cohort study in England.SettingNational Health Service (NHS) hospitals in England, UK.Participants1 018 136 live, singleton births in NHS hospitals in England between 1 January 2005 and 31 December 2006.Main outcome measuresHospital admission costs from birth to age 8 years, estimated by gestational age at birth (<28, 28–29, 30–31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks).ResultsBoth birth admission and subsequent admission hospital costs decreased with increasing gestational age at birth. Differences in hospital admission costs between gestational age groups diminished with increasing age, particularly after the first 2 years following birth. Children born extremely preterm (<28 weeks) and very preterm (28–31 weeks) still had higher average hospital admission costs (£699 (95% CI £419 to £919) for <28 weeks; £434 (95% CI £305 to £563) for 28–31 weeks) during the eighth year of life compared with children born at 40 weeks (£109, 95% CI £104 to £114). Children born extremely preterm had the highest 8-year cumulative hospital admission costs per child (£80 559 (95% CI £79 238 to £82 019)), a large proportion of which was incurred during the first year after birth (£71 997 (95% CI £70 866 to £73 097)).ConclusionsThe association between gestational age at birth and hospital admission costs persists into mid-childhood. The study results provide a useful costing resource for future economic evaluations focusing on preventive and treatment strategies for babies born preterm.

ObjectiveTo examine the association between gestational age at birth across the entire gestational age spectrum and special educational needs (SENs) in UK children at 11 years of age.MethodsThe Millennium Cohort Study is a nationally representative longitudinal sample of children born in the UK during 2000–2002. Information about the child’s birth, health and sociodemographic factors was collected when children were 9 months old. Information about presence and reasons for SEN was collected from parents at age 11. Adjusted relative risks (aRRs) were estimated using modified Poisson regression, accounting for confounders.ResultsThe sample included 12 081 children with data at both time points. The overall prevalence of SEN was 11.2%, and it was inversely associated with gestational age. Among children born <32 weeks of gestation, the prevalence of SEN was 27.4%, three times higher than among those born at 40 weeks (aRR=2.89; 95% CI 2.02 to 4.13). Children born early term (37–38 weeks) were also at increased risk for SEN (aRR=1.33; 95% CI 1.11 to 1.59); this was the same when the analysis was restricted to births after labour with spontaneous onset. Birth before full term was more strongly associated with having a formal statement of SEN or SEN for multiple reasons.ConclusionChildren born at earlier gestational ages are more likely to experience SEN, have more complex SEN and require support in multiple facets of learning. This association was observed even among children born early-term and when labour began spontaneously.

ObjectiveTo describe ethnic and socioeconomic variation in cause-specific infant mortality of preterm babies by gestational age at birth.DesignNational birth cohort study.SettingEngland and Wales 2006–2012.SubjectsSingleton live births at 24–36 completed weeks’ gestation (n=256 142).Outcome measuresAdjusted rate ratios for death in infancy by cause (three groups), within categories of gestational age at birth (24–27, 28–31, 32–36 weeks), by baby’s ethnicity (nine groups) or area deprivation score (Index of Multiple Deprivation quintiles).ResultsAmong 24–27 week births (5% of subjects; 47% of those who died in infancy), all minority ethnic groups had lower risk of immaturity-related death than White British, the lowest rate ratios being 0.63 (95% CI 0.49 to 0.80) for Black Caribbean, 0.74 (0.64 to 0.85) for Black African and 0.75 (0.60 to 0.94) for Indian. Among 32–36 week births, all minority groups had higher risk of death from congenital anomalies than White British, the highest rate ratios being 4.50 (3.78 to 5.37) for Pakistani, 2.89 (2.10 to 3.97) for Bangladeshi and 2.06 (1.59 to 2.68) for Black African; risks of death from congenital anomalies and combined rarer causes (infection, intrapartum conditions, SIDS and unclassified) increased with deprivation, the rate ratios comparing the most with the least deprived quintile being, respectively, 1.54 (1.22 to 1.93) and 2.05 (1.55 to 2.72). There was no evidence of socioeconomic variation in deaths from immaturity-related conditions.ConclusionsGestation-specific preterm infant mortality shows contrasting ethnic patterns of death from immaturity-related conditions in extremely-preterm babies, and congenital anomalies in moderate/late-preterm babies. Socioeconomic variation derives from congenital anomalies and rarer causes in moderate/late-preterm babies. Future research should examine biological origins of extremely preterm birth.

International comparisons of stillbirth allow assessment of variations in clinical practice to reduce mortality. Currently, such comparisons include only stillbirths from 28 or more completed weeks of gestational age, which underestimates the true burden of stillbirth. With increased registration of early stillbirths in high-income countries, we assessed the reliability of including stillbirths before 28 completed weeks in such comparisons.

Introduction: Maternity Hospital Episode Statistics (HES) data were linked to birth registration and NHS Numbers for Babies (NN4B) data to bring together some key demographic and clinical data items not otherwise available at a national level. This project added to earlier work involving linkage of birth registration records to NN4B records.Methods: Birth registration and NN4B records were linked to Maternity HES delivery records and also Maternity HES baby records using the NHS Number or other indirect identifiers if NHS Number was missing.Data quality and completeness of Maternity HES were assessed in relation to birth registration data wherever possible. For information not collected at registration, NN4B data were used to validate quality of Maternity HES.Results: Overall, 91 per cent of Maternity HES delivery records could be linked to the birth registration/NHS Numbers for Babies records and 84 per cent of Maternity HES baby records were linked.In 2005 only 3 per cent of Maternity HES records had mother's NHS number missing, compared with 30 per cent in the NN4B dataset. This did not reflect the extent to which Maternity HES data items were missing or discordant. Over a quarter of all linked Maternity HES records for singleton babies had one or more of the following data items missing: birthweight, gestational age, birth status, sex, and date of birth of the baby. On the other hand, for data items where information was stated such as birthweight, birth status, and sex for singleton babies, there was good agreement between Maternity HES and linked birth registration and NN4B data.Although NN4B records the ethnic category of the baby as defined by the mother, and Maternity HES records mother's ethnic category, 87 per cent of the linked records had the same ethnic group.Conclusion: Even though a good linkage rate was obtained, the method used will be simplified before data for 2007 are linked. To gain the maximum benefit from this linkage in future years, improvements are urgently needed in the quality and completeness of the data contained in Maternity HES.List of Tables, 55. [ABSTRACT FROM AUTHOR]

Introduction Maternity Hospital Episode Statistics (HES) data were linked to birth registration and NHS Numbers for Babies (NN4B) data to bring together some key demographic and clinical data items not otherwise available at a national level. This project added to earlier work involving linkage of birth registration records to NN4B records. Methods Birth registration and NN4B records were linked to Maternity HES delivery records and also Maternity HES baby records using the NHS Number or other indirect identifiers if NHS Number was missing. Data quality and completeness of Maternity HES were assessed in relation to birth registration data wherever possible. For information not collected at registration, NN4B data were used to validate quality of Maternity HES. Results Overall, 91 per cent of Maternity HES delivery records could be linked to the birth registration/NHS Numbers for Babies records and 84 per cent of Maternity HES baby records were linked. In 2005 only 3 per cent of Maternity HES records had mother's NHS number missing, compared with 30 per cent in the NN4B dataset. This did not reflect the extent to which Maternity HES data items were missing or discordant. Over a quarter of all linked Maternity HES records for singleton babies had one or more of the following data items missing: birthweight, gestational age, birth status, sex, and date of birth of the baby. On the other hand, for data items where information was stated such as birthweight, birth status, and sex for singleton babies, there was good agreement between Maternity HES and linked birth registration and NN4B data. Although NN4B records the ethnic category of the baby as defined by the mother, and Maternity HES records mother's ethnic category, 87 per cent of the linked records had the same ethnic group. Conclusion Even though a good linkage rate was obtained, the method used will be simplified before data for 2007 are linked. To gain the maximum benefit from this linkage in future years, improvements are urgently needed in the quality and completeness of the data contained in Maternity HES. [ABSTRACT FROM AUTHOR]

Gestational age is highly correlated with birth outcomes including birthweight and infant mortality. Since gestational age is not recorded at the registration of live births in England and Wales, it has not been possible to produce routine statistics on gestation-specific infant mortality rates. A new system, introduced in 2002, for allocating NHS numbers at birth (NN4B) provided the opportunity to obtain gestational age information. NN4B records have been linked with birth registration data for all births occurring in 2005, and further linked with registration records for deaths in the first year of life. Thus, for the first time, we produce gestation-specific infant mortality rates for England and Wales as a whole, including in relation to birthweight, multiplicity, age of mother, marital status/registration type, and the National Statistics Socio-Economic Classification. [ABSTRACT FROM AUTHOR]

Information about gestational age is important but is not available for live births from registration data. It is, however, collected in NHS Numbers for Babies (NN4B) records. This project investigates the feasibility of linking NN4B data for births in the first quarter of 2005 with birth registration records. Overall 99.8 per cent of NN4B records linked with a registration record. Accuracy of linkage was questioned in 0.9 per cent. Live/stillbirth and multiple birth status were each differently classified in approximately 1 per 1,000 records. Discordance rates for other individual data items ranged from 0.3 per cent for date of birth to 12.9 per cent for postcode. Although needing further investigation, these results justify extending the linkage to the remainder of births in 2005. Linkage would be improved by retaining NHS numbers on stillbirth registration records and avoiding manual transfer of NHS numbers. [ABSTRACT FROM AUTHOR]

In Tower Hamlets, the Bangladeshi women have a very low rate of breastfeeding and the difference between their intentions to breastfeed and actually breastfeeding is far wider than for women from other ethnic groups. In Bangladesh, breastfeeding is well rooted in its own traditional culture. A Sure Start local programme funded a Bangladeshi support worker to work with childbearing Bangladeshi women in the area; many of whom are not fluent in English. A short evaluation of this work was conducted to assess the impact of bilingual breastfeeding support to women's uptake and duration of breastfeeding. The majority of women found the support worker to be the most helpful breastfeeding advisor and felt she influenced them to breastfeed. Despite this, a minority of women exclusively breastfed and most reported having problems feeding during hospital stay. This evaluation highlighted the need for further work in this area.

The government, in its plan for reforms in the NHS, recognizes the importance of nurses and midwives undertaking new roles and breaking down old demarcations (Department of Health, 2000). In response to feedback from women and in order to provide safe and effective care for women who experience birth by caesarean section at a central London teaching hospital it was decided registered general nurses (RGNs) and nursery nurses (NNs) were recruited to provide support for midwives in caring for women postnatally. The nurses would support the women with their specific nursing needs while they recovered from surgery and nursery nurses would help women care for their babies. The aim was to free up more time for midwives to spend giving specific midwifery care. A postal questionnaire was sent to women who gave birth by caesarean before and after the nurses and nursery nurses were recruited. The introduction of these new roles appears to have improved care for women who experienced birth by caesarean section.

This article describes trends in live births between 1976 and 2000 and by birthweight from 1983 to 2000 in England and Wales. It investigates variation by mother's age, social class of father and marital status and describes trends in the percentage of births which were multiple. Changes in patterns of childbearing and cohabitation throughout the period are described. [ABSTRACT FROM AUTHOR]

ABSTRACTMacrophages play a crucial role in the defense against pathogens. Distinct macrophage populations can be defined by the expression of restricted cell surface proteins. Resident tissue macrophages, encompassing Kupffer cells of the liver and red pulp macrophages of the spleen, characteristically express the F4/80 molecule, a cell surface glycoprotein related to the seven transmembrane-spanning family of hormone receptors. In this study, gene targeting was used to simultaneously inactivate the F4/80 molecule in the germ line of the mouse and to produce a mouse line that expresses the Cre recombinase under the direct control of the F4/80 promoter (F4/80-Cre knock-in). F4/80-deficient mice are healthy and fertile. Macrophage populations in tissues can develop in the absence of F4/80 expression. Functional analysis revealed that the generation of T-cell-independent B-cell responses and macrophage antimicrobial defense after infection with Listeria monocytogenesare not impaired in the absence of F4/80. Interestingly, tissues of F4/80-deficient mice could not be labeled with anti-BM8, another macrophage subset-specific marker with hitherto undefined molecular antigenic structure. Recombinant expression of a F4/80 cDNA in heterologous cells confirmed this observation, indicating that the targets recognized by the F4/80 and BM8 monoclonal antibodies are identical.

Macrophages play a crucial role in the defense against pathogens. Distinct macrophage populations can be defined by the expression of restricted cell surface proteins. Resident tissue macrophages, encompassing Kupffer cells of the liver and red pulp macrophages of the spleen, characteristically express the F4/80 molecule, a cell surface glycoprotein related to the seven transmembrane-spanning family of hormone receptors. In this study, gene targeting was used to simultaneously inactivate the F4/80 molecule in the germ line of the mouse and to produce a mouse line that expresses the Cre recombinase under the direct control of the F4/80 promoter (F4/80-Cre knock-in). F4/80-deficient mice are healthy and fertile. Macrophage populations in tissues can develop in the absence of F4/80 expression. Functional analysis revealed that the generation of T-cell-independent B-cell responses and macrophage antimicrobial defense after infection with Listeria monocytogenesare not impaired in the absence of F4/80. Interestingly, tissues of F4/80-deficient mice could not be labeled with anti-BM8, another macrophage subset-specific marker with hitherto undefined molecular antigenic structure. Recombinant expression of a F4/80 cDNA in heterologous cells confirmed this observation, indicating that the targets recognized by the F4/80 and BM8 monoclonal antibodies are identical.

Previous studies have suggested that a population's entire birth weight distribution may be shifted towards higher or lower birth weights, and that optimal birth weight may be lower in populations with a lower average birth weight. We evaluated this hypothesis for seven western European countries.

Data about consultations recorded for babies born in 1994 and their mothers during the first year of the babies' lives were used to assess whether the General Practice Research Database can be used to fill the gap in our knowledge about the health of mothers and babies. Almost all babies and most of their mothers had consultations recorded during the first year of their babies' lives for illness as well as for immunisation of babies, postnatal checks and contraception for mothers. Although the General Practice Research Database has proved useful for investigating adverse outcomes of prescribed drugs, it has considerable limitations for monitoring illness in new babies and their mothers and cannot be used for investigating inequalities. [ABSTRACT FROM AUTHOR]

Objective To quantify the impact of publication criteria on differences in published national perinatal mortality rates among Western European countries.

This article describes analyses of live births, stillbirths and early neonatal, late neonatal and postneonatal deaths by day of birth from the early 1980s to the mid 1990s. Using statistical models to analyse daily, seasonal and longer term trends simultaneously, it found a pronounced weekly cycle in live births, with more births on weekdays and fewer births at weekends and also on bank holidays. Stillbirth and early neonatal mortality rates tended to be higher on Saturdays and Sundays respectively, compared with other days. All the mortality rates varied according to the time of statisstatistical anayear. [ABSTRACT FROM AUTHOR]

Background:Previous studies used indirect methods to identify basophils in the bronchi in asthma, and the numbers were not compared with eosinophils and mast cells. Furthermore, differences in basophil numbers between atopic and nonatopic asthma at baseline and between late-phase skin and asthmatic reactions have not been previously documented. Objective:The basophil granule–specific mAb BB1 was used to identify basophils in (1) bronchial biopsy specimens from atopic asthmatic subjects and nonatopic asthmatic subjects and control subjects, (2) biopsy specimens from atopic asthmatic subjects before and after inhalational allergen challenge, and (3) late-phase skin reactions. Basophil numbers were compared with EG2+eosinophils and tryptase+mast cells. Methods:Cells were enumerated in bronchial and skin biopsy specimens by means of immunohistochemistry with the alkaline phosphatase-antialkaline phosphatase method. Results:There were elevated numbers of basophils in baseline biopsy specimens in atopic asthmatic subjects compared with atopic control subjects or normal control subjects, although eosinophils and mast cells were 10-fold higher. There was an intermediate number of basophils in nonatopic asthmatic subjects. Basophils increased after allergen inhalation, but again basophils were less than 10% of eosinophils. In contrast, basophils in cutaneous late-phase reactions were approximately 40% of infiltrating eosinophils. The peak of basophil accumulation was at 24 hours, whereas maximal eosinophil infiltration occurred at 6 hours. One third of cutaneous basophils had morphologic appearances suggestive of degranulation. Conclusion:Numerous basophils infiltrated cutaneous late-phase reactions in atopic subjects. However, this cell was not prominent in bronchial biopsy specimens of asthmatic subjects, either at baseline or after allergen challenge. (J Allergy Clin Immunol 2000;105:99-107.)

A strong association between deprivation and severe COVID-19 outcomes has been reported among adults. We estimated population-based rates of SARS-CoV-2 testing, laboratory-confirmed infections, and hospital admissions with COVID-19 in children and young people (aged 0–23 years) in Scotland according to sociodemographic risk factors.

In the previous article, we discussed the need for midwives to record accurately and and completely information about the women for whom they care, and described the uses which can be made of this at local level (Kenney et al, 1999). in this article we examine the use made of maternity data by health authorities and the Department of Health and show how data can also be used to monitor international trends in maternity care.

Debate about how to obtain the statistics needed to monitor the health of the population has been stimulated by a resurgence of interest, both nationally and locally, in public health. At the moment, it is clear that data systems are not up to the task. Existing national data collection systems are largely concentrated on measuring mortality and monitoring the activities of health services. Thus, work done so far has had to rely on proxy indicators of health, rather than those which would be recommended ideally. In the face of this, central government has started to discuss how to monitor and promote the health of the population. Also, over the past 10 years, health and local authorities have started to search for data to guide them in targeting the activities that they undertake to improve the health of their populations. This has highlighted the need to extend the limited range of morbidity data currently collected. Before constructing new data collection systems, which might themselves be equally inappropriate, it is essential to clarify the questions to be asked, however. There is a need to decide how concepts such as ‘health’ and ‘deprivation’ should be defined, to determine how appropriate data can be collected and to select the analytical methods to be used.

F4/80 is a monoclonal antibody that recognizes a murine macrophage-restricted cell surface glycoprotein and has been extensively used to characterize macrophage populations in a wide range of immunological studies. Apart from the tightly regulated pattern of expression of the F4/80 antigen, little is known about its possible role in macrophage differentiation and function. We have sought to characterize the molecule at the molecular level, through the isolation of cDNA clones, and now describe the sequence of the F4/80 protein. The primary amino acid sequence demonstrates homology to two protein superfamilies. The NH2-terminal region consists of seven epidermal growth factor-like domains, separated by approximately 300 amino acids from a COOH-terminal region that shows homology to members of the seven transmembrane-spanning family of hormone receptors. The potential role of these distinct domains is discussed with respect to the possible function of the F4/80 molecule.

The biosynthesis of conglutin d has been studied in developing cotyledons of Lupinus angustifolius L. Precursors of conglutin d formed the major sink for [35S]-cysteine incorporated by developing lupin cotyledons, and these precursors were rapidly sequestered into the endoplasmic reticulum. The sequence of a cDNA clone coding for one such precursor of conglutin d was determined. The structure of the precursor polypeptide for conglutin d predicted from the cDNA sequence contained an N-terminal leader peptide of 22 amino acids directly preceding a subunit polypeptide of Mr 4520, together with a linking region of 13 amino acids and a subunit polypeptide of Mr 9558 at the C-terminus. The amino acid sequence predicted from the cDNA sequence showed minor variations from that established by sequencing of the protein purified from mature dried seeds (Lilley and Inglis, 1986). These were consistent with the existence of a multi-gene family coding for conglutin d. Comparison of the sequences of conglutin d with those of other 2S storage proteins showed that the cysteines involved in internal disulphide bridges between the mature subunits of conglutin d, were maintained throughout this family of proteins but that little else was conserved either at the protein or DNA level.

This is a report of a meeting organised jointly by the Medical Section of the Royal Statistical Society and the Society for Social Medicine to discuss the quality of official health statistics. It brought together government and National Health Service (NHS) statisticians with people who use official health statistics, both inside and outside the NHS and government.

ObjectiveTo examine the association between gestational age at birth and hospital admissions to age 10 years and how admission rates change throughout childhood.DesignPopulation based, record linkage, cohort study in England.SettingNHS hospitals in England, United Kingdom.Participants1 018 136 live, singleton births in NHS hospitals in England between January 2005 and December 2006.Main outcome measuresPrimary outcome was all inpatient hospital admissions from birth to age 10, death, or study end (March 2015); secondary outcome was the main cause of admission, which was defined as the World Health Organization’s first international classification of diseases, version 10 (ICD-10) code within each hospital admission record.Results1 315 338 admissions occurred between 1 January 2005 and 31 March 2015, and 831 729 (63%) were emergency admissions. 525 039 (52%) of 1 018 136 children were admitted to hospital at least once during the study period. Hospital admissions during childhood were strongly associated with gestational age at birth (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, and 42 weeks). In comparison with children born at full term (40 weeks’ gestation), those born extremely preterm (<28 weeks) had the highest rate of hospital admission throughout childhood (adjusted rate ratio 4.92, 95% confidence interval 4.58 to 5.30). Even children born at 38 weeks had a higher rate of hospital admission throughout childhood (1.19, 1.16 to 1.22). The association between gestational age and hospital admission decreased with increasing age (interaction P<0.001). Children born earlier than 28 weeks had an adjusted rate ratio of 6.34 (95% confidence interval 5.80 to 6.85) at age less than 1 year, declining to 3.28 (2.82 to 3.82) at ages 7-10, in comparison with those born full term; whereas in children born at 38 weeks, the adjusted rate ratios were 1.29 (1.27 to 1.31) and 1.16 (1.13 to 1.19), during infancy and ages 7-10, respectively. Infection was the main cause of excess hospital admissions at all ages, but particularly during infancy. Respiratory and gastrointestinal conditions also accounted for a large proportion of admissions during the first two years of life.ConclusionsThe association between gestational age and hospital admission rates decreased with age, but an excess risk remained throughout childhood, even among children born at 38 and 39 weeks of gestation. Strategies aimed at the prevention and management of childhood infections should target children born preterm and those born a few weeks early.

Midwives go to considerable efforts to record information about the women and babies for whom they care. Many may be unclear about the extent to which this information and the statistics derived from them can be used. In the first of two articles we describe the need for accurate and complete maternity information and the use which can be made of this information at a local level.

COMPARISON of the weekly death registrations in Greater London1with temperatures at the London Weather Centre during the summer of 1975 shows a temporary increase in mortality that coincides with the heatwave of late July to mid-August (Fig. 1). There was also an increase in death registrations in the first week of June, when there was a change from cold weather with a little snow to very warm weather (but these figures may have been slightly inflated by increased delays in registration following a public holiday in the previous week). Increases in mortality associated with heatwaves have been widely reported in North America, although there is some evidence that the pattern there may have been modified by air conditioning2–5. Little attention has been drawn to such episodes in England and Wales, although an association between deaths from cerebral infarction and temperature in summer has been reported6.

The place of childbirth seems to be changing as reflected by the slow but steady increase in the number of home births. This article examines the reasons behind this trend and discusses an updated review of the scientific evidence on place of birth, Where to be born? the debate and the evidence,which supports the proposals on place of birth made in Changing Childbirth.

Recent work suggests that severe maternal morbidity may indicate the quality and efficacy of obstetric care more accurately than mortality alone. The investigators used data from the MOthers Mortality and Severe morbidity (MOMS) study, a population-based questionnaire survey of pregnant women in 9 European countries, to determine the frequency of 3 acute, severe forms of maternal morbidity: preeclampsia, postpartum hemorrhage, and sepsis. The study group included women having 1 or more of these conditions. Among the 1734 women in the study were 847 with severe bleeding, 793 having preeclampsia, and 142 with severe sepsis.

BackgroundClaims that perinatal and infant mortality rates in the UK are higher than those of all comparable countries are often made in a spirit of moral panic, to argue for policies or interventions that may or may not be effective at reducing the rates. Crude perinatal and infant mortality rates tend to be included routinely in successive national and international indicator sets, sometimes being interpreted as measures of population health and sometimes as measures of quality of health care. Such claims inevitably ignore the effect of differences in childbearing populations, data collection methods, and inclusion criteria. The Euro-Peristat project was established to move beyond presentation of unidimensional indicators in isolation and to present data about the outcome of pregnancy for mothers and babies stratified by birthweight and gestational age while presenting comparative data about maternity care and the characteristics of the childbearing population to set them in context.