Associations of schooling type, qualification type and subsequent health in mid-adulthood: evidence from the 1970 British Cohort Study.

BACKGROUND: Education is thought to benefit health. However, existing studies have predominantly focused on educational attainment-the type of institution attended has been overlooked, despite being an important indicator of education resources, quality, and future socioeconomic outcomes. In this study, we investigated associations between type of high school or university attended and multiple adult health outcomes. METHODS: The 1970 British Cohort Study was used (n=8107). Associations between high school (comprehensive, grammar, private) and university (classified as normal or higher status (Russell Group)) attended with 10 health outcomes that capture cardiometabolic risks, physical capabilities and cognitive function at age 46 years were investigated. Multivariable regression models were used, adjusting for sex and childhood socioeconomic, health and cognitive factors. RESULTS: Both private school and higher-status university attendance were related to favourable health outcomes. After adjusting for potential confounders, associations between private school attendance and cardiometabolic risks remained; associations for higher-status university attendance and cognitive function remained, while associations with other outcomes were largely attenuated. For example, after full adjustment, private school attendance was associated with a 0.14 SD (95% CI: 0.04 to 0.23) lower body mass index and higher-status university attendance with a 0.16 SD (0.07 to 0.26) better memory recall. CONCLUSION: The type of educational institution attended was associated with multiple health outcomes, suggesting it might be a relevant factor to consider in future health inequality research-particularly in contemporary populations which have high overall attainment levels. Further research is warranted to test the causal nature of this relationship and its generalisability to other contexts.

Life-course social participation and physical activity in midlife: longitudinal associations in the 1970 British Cohort Study (BCS70).

A hypothesized benefit of social participation is that it encourages people to be more physically active. However, limited evidence exists on the association between social participation over the life-course and physical activity in midlife. We sought to apply a life-course framework to examine the association of social participation and device measured physical activity in midlife in the UK. We used the 1970 British Birth Cohort Study (BCS70), which includes all people born in Britain during a single week in 1970. Social participation was assessed at ages 16, 30, 34 and 42. Physical activity was measured by accelerometery at age 46, as mean daily step count and time spent in moderate to vigorous physical activity (MVPA). The associations of social participation and physical activity were tested using two different life-course models: the sensitive period model and the accumulation model. Individuals with medium and high participation compared to no social participation over their life-course had higher mean daily step count and MVPA in midlife, supporting the accumulation model. In the sensitive period model, only those that actively participated at age 42 had higher mean daily steps and MVPA compared to those who did not participate. Our study provides empirical evidence on the importance of sustaining social participation at all ages over the life-course rather than at a particular timepoint of someone's life. If our findings reflect causal effects, interventions to promote social participation throughout the life-course could be an avenue to promote physical activity in middle life.

Performance of non-binary athletes in mass-participation running events.

Objectives: To test the hypothesis that, controlling for age, natal-sex differences in running performance are lower among non-binary athletes than in the rest of the population. To test the hypothesis that natal-male non-binary athletes outperform natal-female non-binary athletes. Methods: A secondary analysis of 166 race times achieved by non-binary athletes within a data set of 85 173 race times derived from races with a non-binary category in the New York Road Runners database. The natal sex of non-binary athletes was modelled probabilistically using US Social Security Administration data when it could not be derived from previous races. Race times were used as the outcome variable in linear models with explanatory variables derived from natal sex, gender identity, age and the event being raced. Statistical significance was estimated using Monte Carlo methods as the model was not Gaussian. Results: There was no evidence that controlling for age, natal-sex differences in running performance are lower among non-binary athletes. Natal-male non-binary athletes outperform natal-female non-binary athletes at a confidence level of p=0.1%. Conclusions: Both natal sex and gender identity may be useful explanatory variables for the performance of athletes in mass-participation races. It is, therefore, valuable to include both variables in data collection.

The association between academic pressure and adolescent mental health problems: A systematic review.

BACKGROUND: Academic pressure is a potential contributor to adolescent mental health problems, but international evidence on this association has never been synthesised. METHODS: We conducted the first systematic review of the association between academic pressure and adolescent depression, anxiety, self-harm, suicidality, suicide attempts and suicide. We searched MEDLINE, PsycINFO, ERIC and Web of Science (core collection) up to November 24, 2022, for studies of school-going children or adolescents, which measured academic pressure or timing within the school year as the exposure and depression, anxiety, self-harm, or suicidal ideation, attempts or suicide as outcomes. Risk of bias was assessed using the Mixed Methods Appraisal Tool. We used narrative synthesis to summarise the evidence. The review was prospectively registered with PROSPERO (CRD42021232702). RESULTS: We included 52 studies. Most studies assessed mixed anxiety and depressive symptoms (n = 20) or depressive symptoms (n = 19). Forty-eight studies found evidence of a positive association between academic pressure or timing within the school year and at least one mental health outcome. LIMITATIONS: Most studies were cross-sectional (n = 39), adjusted for a narrow range of confounders or had other limitations which limited the strength of causal inferences. CONCLUSIONS: We found evidence that academic pressure is a potential candidate for public health interventions which could prevent adolescent mental health problems. Large population-based cohort studies are needed to investigate whether academic pressure is a causal risk factor that should be targeted in school- and policy-based interventions. FUNDING: UCL Health of the Public; Wellcome Institutional Strategic Support Fund.

Risk factors for natural menopause before the age of 45: evidence from two British population-based birth cohort studies.

BACKGROUND: Menopause that occurs before the age of 45 and is not medically induced (referred to here as 'early natural menopause') affects around one in 10 women and has serious health consequences. These consequences include increased risk of all-cause mortality, cardiovascular disease, osteoporosis, and type 2 diabetes. METHODS: We investigate risk factors for the onset of natural menopause before the age of 45 in two population-based prospective cohort studies in Britain: the 1958 cohort following 8959 women and the 1970 cohort following 8655 women. These studies follow women from birth to adulthood, and we use harmonized data on birth and early life characteristics, reproductive health, health behaviour, and socioeconomic characteristics for 6805 women who were pre-menopausal, peri-menopausal or had undergone natural menopause. Of these 6805 women, 3614 participated in the 1958 cohort (of which 368 had early menopause) and 3191 participated in the 1970 cohort (of which 206 had early menopause). Taking a life course approach, we focus on three distinct life stages - birth/early life, childhood, and early adulthood - to understand when risk factors are most harmful. Respecting the temporal sequence of exposures, we use a series of multivariable logistic regression models to estimate associations between early menopause and each potential risk factor adjusted for confounders. RESULTS: We find that early menopause is influenced by circumstances at birth. Women born in lower social class families, whose mother smoked during the pregnancy or who were breastfed 1 month or less were more likely to undergo early menopause. Early menopause is also associated with poorer cognitive ability and smoking in childhood. Adult health behaviour also matters. Smoking is positively correlated with early menopause, while regular exercise and moderate frequency of alcohol drinking in women's early thirties are associated with reduced risk of early menopause. The occurrence of gynaecological problems by women's early thirties is also linked to early menopause. CONCLUSIONS: We demonstrate that characteristics at different periods of life are associated with early menopause. Some of these associations relate to modifiable behaviours and thus the risks of early menopause and the adverse health outcomes associated with it may be preventable.

Mycotoxin Illness: Recognition and Management from Functional Medicine Perspective.

Mold toxin exposure by inhalation and ingestion has significant health consequences for humans. In this article, we discuss the sources of these everyday toxins and their relevance to patient health. The effects of mycotoxins can present across all body systems, and the resulting symptoms can be acute, cumulative, and chronic. These effects can occur discretely, but they can also present alongside other clinical entities. It is important for the clinician to recognize the phenomenon of mycotoxin illness, because as a primary cause, it does not resolve with current standards of care for conditions secondary to it.

The consequences of early menopause and menopause symptoms for labour market participation.

Using a difference-in-difference estimator we identify the causal impact of early menopause and menopause symptoms on the time women spend in employment through to their mid-50s. We find the onset of early natural menopause (before age 45) reduces months spent in employment by 9 percentage points once women enter their 50s compared with women who do not experience early menopause. Early menopause is not associated with a difference in full-time employment rates. The number of menopause symptoms women face at age 50 is associated with lower employment rates: each additional symptom lowers employment rates and full-time employment rates by around half a percentage point. But not all symptoms have the same effects. Vasomotor symptoms tend not to be associated with lower employment rates, whereas the employment of women who suffer psychological problems due to menopause is adversely affected. Every additional psychological problem associated with menopause reduces employment and full-time employment rates by 1-2 percentage points, rising to 2-4 percentage points when those symptoms are reported as particularly bothersome.

Umbelliferyloxymethyl phosphonate compounds-weakly binding zinc ionophores with neuroprotective properties.

Umbelliferone is a member of the coumarin family of compounds which are known for diverse pharmacological activity including in targets relevant to Alzheimers disease, AD. The toxicity associated with some forms of the amyloid protein, Aß, and the role of Zn2+ (and other biometals) dyshomeostasis in this, are of great interest in AD and make metal ionophore capability desirable in so called multi target drug ligands MTDLs. A new series of umbelliferyloxymethyl phosphonic acid diethylester compounds (umbelliferyloxymethyl phosphonates) bearing a phosphonate at the 7-position (compounds 1, 3-6), hydrolysis products 2, 2a and 2b from 1 and analogues 7 and 8 of 1 with 7-O to 7-S and 1-O to 1-NH substitutions, are reported. Single crystal X-ray structures of compounds 1, 2 and 2a were determined. In terms of neuroprotective properties, the compounds 1, 2, 3, 4, 5 and 6 at 1 µM concentration, inhibited the toxicity of Aß1-42 (Aß42) in both toxic Amyloid Derived Diffusible Ligand (ADDL) and fibrillar (fibril) forms towards rat hippocampal cells. Compound 7 displayed cytotoxicity and 8 failed to inhibit Aß42 toxicity. Concerning compound-metal ionophore activity (assessed using chemical experiments), despite weak binding to Zn2+ determined from 31P NMR titration of 1 and 2 by ZnCl2, compounds 1, 3, 4, 5 and 6 demonstrated ionophore assisted partition of Zn2+ from water to octanol at micromolar concentrations with efficacy on a par with or better than the chelator MTDL clioquinol (5-chloro-7-iodo-8-hydroxyquinoline). Partition was assessed using furnace Atomic Absorption Spectroscopy (AAS). In further experiments interaction of compound 1 with Zn2+ or it's pathways was inferred by (i) delayed fluorescence response with added Zn2+ in cells treated with FluoZin-3 and (ii) by suppression of Zn2+ promoted aggregation of Aß42.

Patterns of Atopic Eczema Disease Activity From Birth Through Midlife in 2 British Birth Cohorts.

IMPORTANCE: Atopic eczema is characterized by a heterogenous waxing and waning course, with variable age of onset and persistence of symptoms. Distinct patterns of disease activity such as early-onset/resolving and persistent disease have been identified throughout childhood; little is known about patterns into adulthood. OBJECTIVE: This study aimed to identify subtypes of atopic eczema based on patterns of disease activity through mid-adulthood, to examine whether early life risk factors and participant characteristics are associated with these subtypes, and to determine whether subtypes are associated with other atopic diseases and general health in mid-adulthood. DESIGN, SETTING, AND PARTICIPANTS: This study evaluated members of 2 population-based birth cohorts, the 1958 National Childhood Development Study (NCDS) and the 1970 British Cohort Study (BCS70). Participant data were collected over the period between 1958 and 2016. Data were analyzed over the period between 2018 and 2020. MAIN OUTCOMES AND MEASURES: Subtypes of atopic eczema were identified based on self-reported atopic eczema period prevalence at multiple occasions. These subtypes were the outcome in models of early life characteristics and an exposure variable in models of midlife health. RESULTS: Latent class analysis identified 4 subtypes of atopic eczema with distinct patterns of disease activity among 15 939 individuals from the NCDS (51.4% male, 75.4% White) and 14 966 individuals from the BCS70 (51.6% male, 78.8% White): rare/no (88% to 91%), decreasing (4%), increasing (2% to 6%), and persistently high (2% to 3%) probability of reporting prevalent atopic eczema with age. Sex at birth and early life factors, including social class, region of residence, tobacco smoke exposure, and breastfeeding, predicted differences between the 3 atopic eczema subtypes and the infrequent/no atopic eczema group, but only female sex differentiated the high and decreasing probability subtypes (odds ratio [OR], 1.99; 95% CI, 1.66-2.38). Individuals in the high subtype were most likely to experience asthma and rhinitis, and those in the increasing subtype were at higher risk of poor self-reported general (OR, 1.29; 95% CI, 1.09-1.53) and mental (OR 1.45; 95% CI, 1.23-1.72) health in midlife. CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that extending the window of observation beyond childhood may reveal clear subtypes of atopic eczema based on patterns of disease activity. A newly identified subtype with increasing probability of activity in adulthood warrants additional attention given observed associations with poor self-reported health in midlife.

Prevalence and early-life determinants of mid-life multimorbidity: evidence from the 1970 British birth cohort.

BACKGROUND: We sought to: [1] estimate the prevalence of multimorbidity at age 46-48 in the 1970 British Cohort Study-a nationally representative sample in mid-life; and [2] examine the association between early-life characteristics and mid-life multimorbidity. METHOD: A prospective longitudinal birth cohort of a community-based sample from the 1970 British Cohort Study (BCS70). Participants included all surviving children born in mainland Britain in a single week in April 1970; the analytical sample included those with valid data at age 46-48 (n = 7951; 2016-2018). The main outcome was multimorbidity, which was operationalised as a binary indicator of two or more long-term health conditions where at least one of these conditions was of physical health. It also included symptom complexes (e.g., chronic pain), sensory impairments, and alcohol problems. RESULTS: Prevalence of mid-life multimorbidity was 33.8% at age 46-48. Those with fathers from unskilled social occupational class (vs professional) at birth had 43% higher risk of mid-life multimorbidity (risk ratio = 1.43, 95% confidence interval 1.15 to 1.77). After accounting for potential child and family confounding, an additional kilogram of birthweight was associated with 10% reduced risk of multimorbidity (risk ratio = 0.90, 95% confidence interval 0.84 to 0.96); a decrease of one body mass index point at age 10 was associated with 3% lower risk (risk ratio = 1.03, 95% confidence interval 1.01 to 1.05); one standard deviation higher cognitive ability score at age 10 corresponded to 4% lower risk (risk ratio = 0.96, 95% confidence interval 0.91 to 1.00); an increase of one internalising problem at age 16 was equated with 4% higher risk (risk ratio = 1.04, 95% confidence interval 1.00 to 1.08) and of one externalising problem at age 16 with 6% higher risk (risk ratio = 1.06, 1.03 to 1.09). CONCLUSION: Prevalence of multimorbidity was high in mid-life (33.8% at age 46-48) in Britain. Potentially modifiable early-life exposures, including early-life social circumstances, cognitive, physical and emotional development, were associated with elevated risk of mid-life multimorbidity.

The intergenerational transmission of language skill.

This paper examines the relationship between parents' and children's language skills for a nationally representative birth cohort born in the United Kingdom-the Millennium Cohort Study (MCS). We investigate both socioeconomic and ethnic differentials in children's vocabulary scores and the role of differences in parents' vocabulary scores in accounting for these. We find large vocabulary gaps between highly educated and less educated parents, and between ethnic groups. Nevertheless, socioeconomic and ethnic gaps in vocabulary scores are far wider among the parents than among their children. Parental vocabulary is a powerful mediator of inequalities in offspring's vocabulary scores at age 14, and also a powerful driver of change in language skills between the ages of five and 14. Once we account for parental vocabulary, no ethnic minority group of young people has a negative "vocabulary gap" compared to whites.

Influence of childhood socioeconomic position and ability on mid-life cognitive function: evidence from three British birth cohorts.

BACKGROUND: Childhood socioeconomic position (SEP) is robustly associated with cognitive function later in life. However, it is unclear whether this reflects a direct relationship, or an indirect association via modifiable factors such as educational attainment and occupation. We sought to clarify these associations using retrospectively harmonised data from three ongoing British birth cohorts. METHODS: We analysed data from the 1946 National Survey of Health and Development (n=2283), the 1958 National Child Development Study (n=9385) and the 1970 British Cohort Study (n=7631). Retrospective harmonisation was used to derive equivalent indicators of cognition, SEP, education and occupation across the three cohorts. Structural equation modelling was used to examine the association between childhood SEP and mid-life cognitive function, via childhood cognitive ability, educational attainment and mid-life occupation. RESULTS: Across all three cohorts, no direct pathways were observed between childhood SEP and mid-life cognitive function. Rather, this association was indirect via the three temporally ordered mediators. In addition, the direct pathway between childhood cognition and adult cognitive function was weaker in the two younger studies. CONCLUSIONS: Across three British birth cohorts, we found that the association between early life SEP and mid-life cognitive function was fully mediated by childhood cognitive ability, educational attainment and occupational status. Furthermore, the association between early cognitive ability and mid-life cognitive function has decreased in younger generations. Therefore, cognitive function in adulthood may be influenced by modifiable factors and societal change.

Pathways from origins to destinations: Stability and change in the roles of cognition, private schools and educational attainment.

While much attention has been devoted to measuring levels of social mobility over time, less attention has been given to the possibility of changing pathways to social mobility. This paper examines pathways from social origins to socio-economic destinations in midlife for two British cohorts, born in 1958 and 1970 respectively, using Structural Equation Modelling (SEM). We address the roles of cognitive attainment, private schooling and educational attainment in mediating the link between social origins and destinations. Have these mechanisms become more or less important over time, in a context of structural change in the state schooling system and educational expansion? We find that private schools displayed greater academic selectivity and an increased link to high levels of educational attainment for the younger cohort. Essentially, private schools adapted to changing circumstances, becoming more academically selective and less socially selective, and more focused on educational credentials. Childhood social origins were less strongly linked to childhood cognitive scores in the younger cohort, but cognitive scores were also more weakly linked to educational attainment for this cohort. We also find a decreased association between social origins and educational attainment for the younger cohort. While the finding that educational inequalities weakened over this time period is positive, the lack of a corresponding reduction in the overall link between social origins and destinations suggests that reducing educational inequalities was not sufficient to increase social mobility when accompanied by countervailing changes in the role of private schools.

Feasibility of Measuring Sedentary Time Using Data From a Thigh-Worn Accelerometer.

In large-scale cohort studies, sedentary behavior has been routinely measured using self-reports or devices that apply a count-based threshold. We employed a gold standard postural allocation technique using thigh inclination and acceleration to capture free-living sedentary behavior. Participants aged 46.8 (standard deviation (SD), 0.7) years (n = 5,346) from the 1970 British Cohort Study (United Kingdom) were fitted with a waterproofed thigh-mounted accelerometer device (activPAL3 micro; PAL Technologies Ltd., Glasgow, United Kingdom) worn continuously over 7 days; data were collected in 2016-2018. Usable data were retrieved from 83.0% of the devices fitted, with 79.6% of the sample recording at least 6 full days of wear (at least 10 waking hours). Total daily sitting time (average times were 9.5 (SD, 2.0) hours/day for men and 9.0 (SD, 2.0) hours/day for women) accounted for 59.4% and 57.3% of waking hours in men and women, respectively; 73.8% of sample participants recorded ≥8 hours/day of sitting. Sitting in prolonged bouts of 60 continuous minutes or more accounted for 25.3% and 24.4% of total daily sitting in men and women, respectively. In mutually adjusted models, male sex, underweight, obesity, education, poor self-rated health, television-viewing time, and having a sedentary occupation were associated with higher device-measured sitting times. Thigh-worn accelerometry was feasibly deployed and should be considered for larger-scale national surveys.

Clinical onset of atopic eczema: Results from 2 nationally representative British birth cohorts followed through midlife.

BACKGROUND: Atopic eczema onset is described primarily in early childhood, and the frequency and characteristics of adult-onset disease remain controversial. OBJECTIVE: We sought to determine the proportion of subjects who report atopic eczema symptoms between birth and midadulthood and to examine demographic, immunologic, and genetic factors associated with period of symptom onset. METHODS: We conducted a longitudinal study using data from 2 nationally representative community-based birth cohorts from the United Kingdom: the British Cohort Studies 1958 and 1970. Subjects were followed from birth through age 42 to 50 years. The primary outcome was the age period of self-reported atopic eczema symptom onset based on repeated measures of self-reported atopic eczema at each survey wave. RESULTS: The annual period prevalence of atopic eczema ranged from 5% to 15% in 2 cohorts of more than 17,000 participants each followed from birth through middle age. There was no clear trend in prevalence by age, and among adults reporting active atopic eczema during a given year, only 38% had symptom onset reported in childhood. When compared with subjects whose eczema started in childhood, those with adult-onset disease were more likely to be women, from Scotland or Northern England, of lower childhood socioeconomic group, smokers in adulthood, and less likely to have a history of asthma. In a subanalysis using data from the 1958 cohort only, genetic mutations previously associated with atopic eczema, including filaggrin-null mutations, and allergen-specific IgE were more common among those with childhood-onset disease. CONCLUSION: Rates of self-reported atopic eczema remain high after childhood, and adult-onset atopic eczema has different risk factor associations than childhood-onset eczema.

The path from social origins to top jobs: social reproduction via education.

This paper provides a comprehensive account of the way in which cognitive and educational attainment mediate the link between social origins and elite social class destinations in mid-life. Using the 1970 British Cohort Study (BCS70), we assess the roles of a range of pathways through which educational advantage may lead to occupational attainment: cognitive development; private and selective secondary schools; school level qualifications; and higher education, including institution and field of study. Whereas past research has shown a residual direct effect of social origins on class destinations, we find that, once a sufficiently detailed picture of educational attainment is taken into account, education fully explains the link between social origins and top social class destinations. In contrast, the gap between men and women in achieving top social class positions is in no part accounted for by education.

Use of a fluorescent probe to monitor the enhanced affinity of rh-BMP-2 to silicated-calcium phosphate synthetic bone graft substitutes under competitive conditions.

A comparative investigation was undertaken on 1-2mm sized granules of two forms of synthetic bone graft substitute (SBG) with identical pore structure but varied bulk chemistry, stoichiometric hydroxyapatite (HA) and silicate substituted (0.8wt% Si) hydroxyapatite (SA), to assess the influence of SBG chemistry on the relative affinity of an osteogenic growth factor (GF), recombinant human bone morphogenetic protein-2 (rhBMP-2). A previously described novel fluorescent probe, fluoresceinthioureidoaminocaproic acid (FTCA), was covalently attached to rhBMP-2 to give FTCA-rhBMP-2 and facilitate the quantitative monitoring of GF uptake and release from the two chemistries of SBG. The relative affinity of rhBMP-2 for the HA and SA granules was assessed at a physiologically relevant concentration of 300ngmL-1 from three (increasingly complex) environments; phosphate buffered saline (PBS), minimum Eagles' medium (MEM) and serum supplemented MEM (SCEM) in order to closely mimic clinical bone repair procedures. The results demonstrated that rhBMP-2 affinity to SBGs was highly sensitive to both SBG chemistry and the composition of the local environment. Under the most physiologically relevant competitive conditions of SCEM, rhBMP-2 showed greater affinity to SA (P<0.05) such that 50% of the rhBMP-2 in solution was adsorbed to the SA granules after only 15min, as compared to 30% adsorbed to the HA granules. Subsequent investigation of the desorption of adsorbed GF from the SBGs demonstrated that a significantly higher percentage of the adsorbed rhBMP-2 was desorbed from HA as compared to SA granules. Together, these observations suggested that at physiologically relevant concentrations and conditions, rhBMP-2 has a greater affinity to silicate-substituted hydroxyapatite as compared to stoichiometric hydroxyapatite, which may in part explain the enhanced osteoconductivity and reported osteoinductivity for silicate-substituted hydroxyapatite based SBGs.