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Background Childhood vision impairment (VI) can adversely impact health and social outcomes and limit life chances. We investigated whether its adverse impacts into adult life changed during a period in which legislation, policy and services to address inequalities relating to disability were implemented. Methods Cross-cohort study comprising 14 247 participants from the 1946, 1958 and 1970 British birth cohorts (BC). Participants dichotomized as VI at age 15/16 (distance visual acuity was 6/12 or worse in the better-seeing eye) or normally sighted. Associations of childhood VI with health, well-being, socioeconomic and social participation outcomes in mid-adult life were investigated using regression models adjusted for participants' early life socioeconomic markers and sex. Change in adjusted odds ratios of >10% in the same direction in successive cohorts, or a > 20% difference between 1970BC and one older cohort were considered meaningful. Results Trends over time in impacts of childhood onset VI into mid-adult life were complex. This included worsening of odds of poorer physical health (odds ratio 1.47; 95% confidence interval 1.02–2.14), living in unsatisfactory (1.54; 1.03–2.29) or overcrowded (2.34; 1.26–4.06) households, being unemployed (2.19; 1.19–3.97) and not gaining additional educational qualifications during mid-adult life (1.61; 1.08–2.47). By contrast the odds of not participating in some social activities (e.g. seeing friends) improved over time. Associations with other outcomes were unchanged. Conclusions Many adverse impacts of childhood VI do not appear ameliorated over time by legislation, policies and provision that would have been expected to reduce inequalities. Moreover, some were increased. Childhood VI continues to cast a life-long shadow. [ABSTRACT FROM AUTHOR]

Objective Assess whether statins reduce mortality in the general population aged 60 years and above. Design Retrospective cohort study. Setting Primary care practices contributing to The Health Improvement Network database, England and Wales, 1990-2017. Participants Cohort who turned age 60 between 1990 and 2000 with no previous cardiovascular disease or statin prescription and followed up until 2017. Results Current statin prescription was associated with a significant reduction in all-cause mortality from age 65 years onward, with greater reductions seen at older ages. The adjusted HRs of mortality associated with statin prescription at ages 65, 70, 75, 80 and 85 years were 0.76 (95% CI 0.71 to 0.81), 0.71 (95% CI 0.68 to 0.75), 0.68 (95% CI 0.65 to 0.72), 0.63 (95% CI 0.53 to 0.73) and 0.54 (95% CI 0.33 to 0.92), respectively. The adjusted HRs did not vary by sex or cardiac risk. Conclusions Using regularly updated clinical information on sequential treatment decisions in older people, mortality predictions were updated every 6 months until age 85 years in a combined primary and secondary prevention population. The consistent mortality reduction of statins from age 65 years onward supports their use where clinically indicated at age 75 and older, where there has been particular uncertainty of the benefits. [ABSTRACT FROM AUTHOR]

Background: Over the last decade, a trend towards high utilisation of primary maternity care was observed in high-income countries. There is limited research with contradictory results regarding frequent attendance (FA) and perinatal outcomes in midwifery care. Therefore, this study examined possible associations between FA in midwifery care and obstetric interventions and perinatal outcomes.Methods: A retrospective cohort study was performed in a medium-sized midwifery-led care practice in an urban region in the Netherlands. Frequent attenders (FAs) were categorised using the Kotelchuck-Index Revised. Regression analyses were executed to examine the relationship between FAs and perinatal outcomes, stratified by antenatal referral to an obstetrician. Main outcomes of interest were Apgar score ≤ 7 and perinatal death, birth weight, mode of delivery, haemorrhage, place of birth, transfer during labour, and a requirement for pain relief.Results: The study included 1015 women, 239 (24%) FAs and 776 (76%) non-FAs, 538 (53%) were not referred and 447 (47%) were referred to an obstetrician. In the non-referred group, FA was significantly associated with a requirement for pain relief (OR 1.98, 95% CI 1.24-3.17) and duration of dilatation (OR 1.20, 95% CI 1.04-1.38). In the referred group, FA was significantly associated with induction of labour (OR 1.86, 95% CI 1.17-2.95), ruptured perineum (OR 0.50, 95% CI 0.27-0.95) and episiotomy (OR 0.48, 95% CI 0.24-0.95). In the non-referred and the referred group, FA was not associated with the other obstetric and neonatal outcomes. Due to small numbers, we could not measure possible associations of FA with an Apgar score ≤ 7 and perinatal death.Conclusion: In our study, perinatal outcomes differed by FA and antenatal referral to an obstetrician. In the non-referred group, FA was significantly associated with medical pain relief and duration of dilatation. In the referred group, FA was significantly associated with induction of labour, ruptured perineum, and episiotomy. Further research with a larger study population is needed to look for a possible association between FA and primary adverse birth outcomes such as perinatal mortality. [ABSTRACT FROM AUTHOR]

Local authorities in England are required to routinely collect administrative data on children in care and cross-sectional analyses of national data are published by central government. This paper explores the usefulness of undertaking a longitudinal analysis of these data at local authority level to determine the care pathways for children entering care, differentiating by age at entry. The sample consisted of 2208 children who entered care in one English local authority over a six-year period, and who were followed up for at least 2 years. A logistic regression model was fitted to explore factors associated with children staying long term in care. Age at entry was a key determinant of where children ended up (return to a parent, special guardianship or residence order, adoption or staying long term in care). Only a minority of entrants (mainly those entering care in their middle years) remained in longer term care. For the vast majority of children, the 'pre-care family context' remains important as children will either return to parents or relatives or stay in touch with them. The findings are used to urge service planners to make full use of data on care entrants, especially age at entry, when deciding on the balance between the different placement options needed, and the social work service delivery models. • After two years in care over one third of children (37%) had returned to their parents. • Just under one third of children (31%) stayed at least two years in care. • Age at entry was a very strong predictor of where children ended up. • Children age 0–2 were more likely to be adopted than any other outcome. • More than half (51%) of children entering care age 7–11 stayed long term in care. [ABSTRACT FROM AUTHOR]