Attention control in preterm and term 5-month-old infants: Cross-task stability increases with gestational age.

Cross-task stability refers to performance consistency across different settings and measures of the same construct. Cross-task stability can help us understand developmental processes, including how risks such as preterm birth affect outcomes. We investigated cross-task stability of attention control in 32 preterm and 39 term infants. All infants had the same chronological age at time of testing (5 months) but varied in gestational age (GA) at birth (30-42 weeks). Infants completed an experimental attention following task with a researcher and a naturalistic play observation with their mothers. Both preterm and term infants demonstrated attention following in the experimental task. GA and flexibility of attention were related: the likelihood of no turn trials decreased with increasing GA. To evaluate cross-task stability, we compared attention performance in the experimental and naturalistic settings. Flexible attention shifts on the experimental task were positively related to attention to objects in the naturalistic observation. Furthermore, the association between flexible attention shifts on the experimental task and attention to objects in the naturalistic observation was moderated by GA. Our study provides initial evidence that the consolidation of attention control increases with GA. These findings highlight the value of comparing experimental and observational measures of attention.

Comparing the screening methods for gestational diabetes mellitus before and during the COVID-19 pandemic: A systematic review.

BACKGROUND: The oral glucose tolerance test (OGTT) is the gold standard for detecting gestational diabetes mellitus (GDM). However, during the COVID-19 pandemic, screening practices were reevaluated due to the risk of infection associated with the prolonged hospital visit required for the OGTT. Some countries have published novel screening protocols for GDM, suggesting the utilization of hemoglobin A1c (HbA1c), random plasma glucose (RPG), or fasting plasma glucose (FPG) in favor of OGTTs during the pandemic. Therefore, differences in screening methods before and after the epidemic need to be examined. METHODS: A systematic search was carried out across five electronic databases (Cinahl, Medline, Embase, Pubmed, and Web of Science) between 2016 and 2023. The Critical Appraisal Skills Programme (CASP) checklist for cohort studies was used to evaluate the quality of included papers. RESULTS: A total of 13 eligible studies were included. Prior to the COVID-19 pandemic, the OGTT was the recommended measure to screen GDM, internationally based on various official guidelines. During the pandemic, it was recommended that HbA1c or FPG, or RPG be used as a substitute for OGTTs. However, the new methods have low sensitivity, may not reflect accurately the prevalence of GDM, and may lead to many false-negative results in women and to adverse pregnancy and neonatal outcomes. CONCLUSION: The new screening methods for GDM have poor accuracy and a high risk of adverse pregnancy outcomes. Comparatively, targeted screening tests to detect GDM according to the risk level are more effective in an emergency. In the future, the alternatives to OGTTs still need to be further explored in more depth.

Prevalence, Clinical Features, Neuroimaging, and Genetic Findings in Children With Ataxic Cerebral Palsy in Europe.

BACKGROUND AND OBJECTIVES: To report on prevalence, associated impairments, severity, and neuroimaging findings in children with ataxic cerebral palsy (CP). METHODS: In children coded as having ataxic CP in the Central database of Joint Research Center-Surveillance of Cerebral Palsy in Europe (JRC-SCPE) and born during 1980-2010, birth characteristics, severity profiles including associated impairments, neuroimaging patterns, and the presence of syndromes were analyzed. Definitions were according to validated SCPE guidelines. Prevalence over time was estimated using Poisson regression. RESULTS: In total, 679 children with ataxic CP were identified in 20 European CP registers. The proportion with ataxic CP was 3.8% and varied from 0% to 12.9%. Prevalence over time showed no significant trend. Approximately 70% of children with ataxic CP were able to walk, and 40% had severe intellectual impairment and a high impairment index. Children with ataxic CP were mostly born at term (79%) and with normal birth weight (77%). Neuroimaging patterns revealed normal findings in 29%, brain maldevelopments in 28.5%, miscellaneous findings in 23.5%, and brain injuries in 19%, according to the SCPE classification. Genetic syndromes were described in 9%. DISCUSSION: This register-based multicenter study on children with ataxic CP provides a large sample size for the analysis of prevalence, severity, and origin of this rare CP subtype. Even with strict inclusion and classification criteria, there is variation between registers on how to deal with this subtype, and diagnosis of ataxic CP remains a challenge. Ataxic cerebral palsy differs from other CP subtypes: children with ataxic CP have a disability profile that is more pronounced in terms of cognitive than gross motor dysfunction. They are mostly term born and the origin rarely suggests acquired injuries. In addition to neuroimaging, a comprehensive genetic workup is particularly recommended for children with this CP type.

Validation of the family focused mental health practice questionnaire in measuring health and social care professionals' family focused practice.

BACKGROUND: Parental mental illness is a major public health issue and there is growing evidence that family focused practice can improve outcomes for parents and their families. However, few reliable and valid instruments measure mental health and social care professionals' family focused practice. OBJECTIVES: To explore the psychometric properties of the Family Focused Mental Health Practice Questionnaire in a population of health and social care professionals. METHODS: Health and Social Care Professionals (n = 836) in Northern Ireland completed an adapted version of the Family Focused Mental Health Practice Questionnaire. Exploratory factor analysis was used to test the structure of the underlying dimensions in the questionnaire. The results, and theoretical considerations, guided construction of a model that could explain variation in respondents' items. This model was then validated using confirmatory factor analysis. RESULTS: Exploratory factor analysis revealed that solutions including 12 to 16 factors provided a good fit to the data and indicated underlying factors that could be meaningfully interpreted in line with existing literature. From these exploratory analyses, we derived a model that included 14 factors and tested this model with Confirmatory Factor Analysis. The results suggested 12 factors that summarized 46 items that were most optimal in reflecting family focused behaviours and professional and organizational factors. The 12 dimensions identified were meaningful and consistent with substantive theories: furthermore, their inter-correlations were consistent with known professional and organizational processes known to promote or hinder family focused practice. CONCLUSION: This psychometric evaluation reveals that the scale provides a meaningful measure of professionals' family focused practice within adult mental health and children's services, and the factors that hinder and enable practice in this area. The findings, therefore, support the use of this measure to benchmark and further develop family focused practice in both adult mental health and children's services.

Perceived treatment of respectful maternity care among pregnant women at healthcare facilities in the Kingdom of Saudi Arabia: A cross-sectional study.

BACKGROUND: Mistreatment of women during childbirth is a global issue and a violation of fundamental human rights. Respectful maternity care has been affirmed as a universal right of childbearing women. However, little is known about the level of respect experienced by women in the Kingdom of Saudi Arabia (KSA); which is undergoing key reforms in the scope of its healthcare provision. We explored the occurrence of respect perceived by women giving birth in the KSA and compared results between national healthcare sectors, as well as with previous international studies. METHOD: We conducted a cross-sectional study using an online survey. The online questionnaire included demographic questions, a translation of the internationally validated Mother on Respect index (MORi) scale, which we adapted to investigate KSA women's experiences, and questions to further investigate women's experiences (e.g. respect of privacy). Women who gave birth within five years at a Saudi healthcare facility were recruited through social media using a snowballing approach. RESULTS: Overall, 586 participants were recruited, 54% of whom had been cared for in government hospitals, 65% were aged between 25 and 34, and almost 79% had a BSc or higher qualification. Overall, women's perception about respectful maternity care was positive, however, opinions varied between governmental and private sectors. Women cared for in the government sector reported significantly lower levels of respect compared to those cared for in the private sector (ß = -.132, p = .001). The results also highlighted an issue of concern: one in five women (21.8%) reported having been physically abused. Our participants perceived their childbirth experiences to be less respectful compared to those in other high-income countries. CONCLUSION: Women birthing in the private sector reported a more respectful experience, which may be explained by the private sector being more consumer-focused. Women who gave birth in the KSA perceived their care to be less respectful than women giving birth in Canada and the USA. Beginning to understand what has provoked the occurrences of mistreatment in childbirth worldwide will inevitably contribute to the development of a solution. Respectful maternity care should be focused on providing women-centred care and quality of care which meets the WHO vision for women's and their families' needs being fulfilled and respected.

Longitudinal health behaviour patterns among adults aged ≥50 years in China and their associations with trajectories of depressive symptoms.

OBJECTIVES: Against the background of the growing recognition of the need for a holistic perspective on health behaviour, we aim to identify longitudinal patterns of multiple health behaviours, and to assess associations of such patterns with depressive symptoms among older people in China. METHODS: Using three waves of China Health and Retirement Longitudinal Study data (n = 8439), we performed latent class growth analyses (LCGAs) to identify longitudinal patterns of multiple health behaviours. Random-effects models were estimated to assess associations between health behaviour patterns and depressive symptoms. RESULTS: The best fitting LCGA model had seven classes: (1) connected active non-smokers (average posterior probability: 21.8%), (2) isolated active non-smokers (24.7%), (3) isolated inactive non-smokers (17.0%), (4) isolated active smokers (14.5%), (5) connected active smokers (12.2%), (6) increasingly connected and active non-smokers (5.4%), and (7) moderately connected inactive smokers (4.4%). Depressive symptoms were highest in the four classes with lower probabilities of social participation across waves. No evidence was found of change over time in depressive symptomatology gaps between people with different health behaviour trajectories. CONCLUSION: Health behaviour patterns characterized by consistently low social participation were associated with raised depressive symptomatology, suggesting that focusing on social participation may benefit later-life mental health promotion strategies.

Attention and social communication skills of very preterm infants after training attention control: Bayesian analyses of a feasibility study.

BACKGROUND: Very preterm (VP) infants (born 28 to <32 weeks of gestation) are at risk of cognitive delays and lower educational attainments. These risks are linked to anomalies in attention and information processing that emerge in the first years of life. Early interventions targeting attention functioning may equip VP infants with key building blocks for later attainments. METHODS: We tested the feasibility of a randomised trial where VP infants took part in a computerised cognitive procedure to train attention control. Ten healthy VP infants aged approximately 12 months (corrected age) and randomly allocated with 1:1 ratio to the training (interactive computerised presentations) or an active control procedure completed the study. Before and after the training programme, participating infants completed a battery of screen-based attention tests, naturalistic attention and communication tasks, and temperament assessments. In a previous study we analysed the data concerning feasibility (e.g. recruitment and retention). In the paper presented here we considered the infants' performance and used Bayesian regression in order to provide credible treatment estimates considering the data collected. RESULTS: Estimates indicate moderate treatment effects in visual memory: compared to controls, trained infants displayed improvements equivalent to 0.59 SD units. Trained infants also improved in their abilities to attend to less salient stimuli presentations by 0.82 SD units, compared to controls. However, results did not indicate relevant gains in attention habituation or disengagement. We also reported moderate improvements in focused attention during naturalistic tasks, and in directing other people's attention to shared objects. DISCUSSION: The results warrant further investigation concerning the effectiveness of training attention control in VP infants, extending this line of research beyond our small and homogeneous sample of healthy VP infants. This study also emphasises the utility of Bayesian approaches in estimating potentially relevant effects in small samples or exploratory studies. The scope for further research on early attention control training is discussed in light of studies indicating VP children's susceptibility to positive environmental inputs. TRIAL REGISTRATION: Registration ID: NCT03896490. Retrospectively registered at Clinical Trials Protocol Registration and Results System (clinicaltrials.gov).

Pandemic-related pregnancy stress among pregnant women during the COVID-19 pandemic in Spain.

OBJECTIVE: The aim was to develop and establish the psychometric properties of the Pandemic-Related Pregnancy Stress Scale (PREPS) in European Spanish speaking pregnant women in Spain. DESIGN: A cross section design using a non-random sample of 206 women completed the questionnaire during the first COVID-19 pandemic lockdown from April to June 2020 in Spain. Psychological, sociodemographic and obstetric factors and the new PREPS were collected. RESULTS: Bartlett's test of sphericity (χ2(105) = 580.36, p < .001), and KMO = .79 confirmed appropriateness for factor analysis of the PREPS. Confirmatory factor analyses based on the factor structure of the original USA English version of this instrument confirmed three factors - Preparedness Stress (7 items), Perinatal Infection Stress (5 items), and Positive Appraisal (3 items). The 15-item version of the PREPS demonstrates internal consistency and reliability are adequate (α > .77), and for F1 - Preparedness (α > .65), for F2 - Infection (α > 0.60) and for F3 - Positive appraisal (α > .55). The three factors exhibited good inter-item correlations, (F1 - Preparedness: .21; F2 - Infection: .23, and F3 - Positive Appraisal: .29). Convergent validity was examined through the Pearson's correlation coefficients of the PREPS with the Perceived Stress Scale (PSS) and the Prenatal Distress Questionnaire (PDQ). Correlation between PREPS total and PSS was high, and moderate with PDQ (p < .05). CONCLUSION: The psychometric properties of the Spanish version of the PREPS make it a valuable psychological measure to assess pandemic-related stress among pregnant women.

Trends in Prevalence and Severity of Pre/Perinatal Cerebral Palsy Among Children Born Preterm From 2004 to 2010: A SCPE Collaboration Study.

Aim: To report on prevalence of cerebral palsy (CP), severity rates, and types of brain lesions in children born preterm 2004 to 2010 by gestational age groups. Methods: Data from 12 population-based registries of the Surveillance of Cerebral Palsy in Europe network were used. Children with CP were eligible if they were born preterm (<37 weeks of gestational age) between 2004 and 2010, and were at least 4 years at time of registration. Severity was assessed using the impairment index. The findings of postnatal brain imaging were classified according to the predominant pathogenic pattern. Prevalences were estimated per 1,000 live births with exact 95% confidence intervals within each stratum of gestational age: ≤27, 28-31, 32-36 weeks. Time trends of both overall prevalence and prevalence of severe CP were investigated using multilevel negative binomial regression models. Results: The sample comprised 2,273 children. 25.8% were born from multiple pregnancies. About 2-thirds had a bilateral spastic CP. 43.5% of children born ≤27 weeks had a high impairment index compared to 37.0 and 38.5% in the two other groups. Overall prevalence significantly decreased (incidence rate ratio per year: 0.96 [0.92-1.00[) in children born 32-36 weeks. We showed a decrease until 2009 for children born 28-31 weeks but an increase in 2010 again, and a steady prevalence (incidence rate ratio per year = 0.97 [0.92-1.02] for those born ≤27 weeks. The prevalence of the most severely affected children with CP revealed a similar but not significant trend to the overall prevalence in the corresponding GA groups. Predominant white matter injuries were more frequent in children born <32 weeks: 81.5% (≤27 weeks) and 86.4% (28-31 weeks), compared to 63.6% for children born 32-36 weeks. Conclusion: Prevalence of CP in preterm born children continues to decrease in Europe excepting the extremely immature children, with the most severely affected children showing a similar trend.

Complex childhood trauma, gender and depression: Patterns and correlates of help-seeking and maladaptive coping.

BACKGROUND: Little is known about access to treatment or maladaptive coping amongst those with a history of childhood trauma and subsequent depressive disorder, which is often complicated by post traumatic stress disorder (PTSD). AIMS: To (1) identify profiles of complex childhood trauma amongst men and women with major depression, (2) examine patterns of service access and treatment or maladaptive coping (drug misuse, alcohol abuse or suicidality), and (3) associations with socio-economic/demographic characteristics, comorbid PTSD, anxiety/mood disorders and perceived social support. METHOD: Analysis of Wave 3 of the national epidemiologic survey on alcohol and related conditions (NESARC) (2012-2013). We use the Latent Class Analysis 3-step approach in Mplus to examine individual differences in childhood experiences and coping behaviour. We examined both (a) the inter-relationship of this patterning, and (b) the extent to which proactive and maladaptive coping are associated with socio-economic/demographic characteristics, comorbid PTSD, anxiety disorders and perceived social support. RESULTS: a diagnosis of Major Depression was recorded for 7432 people, two thirds of whom reported a history of complex childhood trauma. Maladaptive coping is associated with the most severe trauma groups, comorbid PTSD, dysthymia, and anxiety disorders. CONCLUSION: Given the evidence of the current study, suggesting a poorer treatment course for depression in adults with complex childhood trauma, early screening for a trauma history will facilitate preventive efforts before onset of depression, possibly mitigating a poorer treatment course.

Prosocial and Aggressive Behavior: A Longitudinal Study.

Developmental theorists have made strong claims about the fundamental prosocial or aggressive nature of the human infant. However, only rarely have prosocial behavior and aggression been studied together in the same sample. We charted the parallel development of both behaviors from infancy to childhood in a British community sample, using a two-construct, multimethod longitudinal design. Data were drawn from the Cardiff Child Development Study (CCDS), a prospective longitudinal study of a volunteer sample of parents and their firstborn children. A sample of 332 mothers was recruited from National Health Service (NHS) prenatal clinics and general practice clinics in Wales, UK, between Fall of 2005 and Summer of 2007. Potential participants represented the full range of sociodemographic classifications of neighborhoods. Participating families were divided about equally between middle- and working-class families, were somewhat more likely to have sons than daughters, and the majority (90%) were in a stable partnership. In response to standard categories recommended for use in Wales at the time, the majority (93%) of mothers reported themselves as Welsh, Scottish, English, or Irish; most others named a European or South Asian nationality. Of the 332 families agreeing to participate, 321 mothers (Mage = 28 years) and 285 partners (Mage = 31 years) were interviewed during the pregnancy and 321 of the families contributed data at least once after the child's birth. After an initial home visit at 6 months, data collection occurred in four additional waves of testing when children's mean ages were approximately 1, 1.5, 2.5, and 7 years. Data collection alternated between family homes and Cardiff University. Of those families seen after the child's birth, 89% were assessed at the final wave of testing. Data collection ended in 2015. Methods included direct observation, experimental tasks, and collection of reports from mothers, fathers, other relatives or family friends, and classroom teachers. Interactions with a familiar peer were observed at 1.5 years. Interactions with unfamiliar peers took place during experimental birthday parties at 1 and 2.5 years. At 7 years, parents were interviewed, parents and teachers completed questionnaires, and the children engaged in cognitive and social decision-making tasks. Based on reports from parents and other informants who knew the children well, individual differences in both prosocial behavior and aggression were evident in children. Both types of behavior showed stability across the second and third years. The association between prosocial behavior and aggression changed over time: at 1.5 years, they were not significantly related (the association approached zero), but they became negatively correlated by 3 years. Different patterns were seen when children played with familiar versus unfamiliar peers. At 1.5 years, when children were observed at home with a familiar peer, prosocial behavior and aggression were unrelated, thus showing a pattern of results like that seen in the analysis of informants' reports. However, a different pattern emerged during the experimental birthday parties with unfamiliar peers: prosocial behavior and aggression were positively correlated at both 1 and 2.5 years, contributing to a general sociability factor at both ages. Gender differences in prosocial behavior were evident in informants' reports and were also evident at the 1-year (though not the 2.5-year) birthday parties. In contrast, gender differences in both prosocial behavior and aggression were evident by 7 years, both in children's aggressive decision-making and in their parents' and teachers' reports of children's aggressive behavior at home and school. By age 7, children's aggressive decision-making and behavior were inversely associated with their verbal skills, working memory, and emotional understanding. Some children had developed aggressive behavioral problems and callous-unemotional traits. A few (12%) met diagnostic criteria for conduct disorder or oppositional-defiant disorders, which had been predicted by early angry aggressiveness and lack of empathy for other people. Taken together, the findings revealed a gradual disaggregation of two ways in which children interact with other people. Individual differences in both prosocial behavior and aggression revealed continuity over time, with gender differences emerging first in prosocial behavior, then in aggression. Restrictions in the participant sample and the catchment area (e.g., all were first-time parents; all were drawn from a single region in the United Kingdom) mean that it is not possible to generalize findings broadly. It will be important to expand the study of prosocial behavior and aggression in other family and environmental contexts in future work. Learning more about early appearing individual differences in children's approaches to the social world may be useful for both educational and clinical practice.

Data linkage and pain medication in people with cerebral palsy: a cross-sectional study.

AIM: To explore data linkage and pain medication as a proxy for pain, to assess differences in pain medication between the cerebral palsy (CP) and the general populations, and to identify factors associated with pain medication in CP. METHOD: This cross-sectional study linked the Northern Ireland CP Register and two administrative health care databases for people resident in Northern Ireland born between 1981 and 2008. Pain medication as a proxy was validated by replicating analyses from the Study of Participation of Children with Cerebral Palsy Living in Europe (SPARCLE) studies. Logistic regression compared pain medication in the CP and general populations. Multi-level regression models assessed factors associated with pain medication in the CP cohort. RESULTS: The sample size was 701 075, of whom 1430 (0.2%) were people with CP. There were 358 969 males and 340 677 females in the general population, and 810 males and 620 females in the CP population, with an age range of 4 to 31 years in both groups. The validation exercise produced results similar to the SPARCLE studies. More people with CP received pain medication (61% vs 50.9%) and had twice the odds of being prescribed opioid analgesics (odds ratio [OR]=2.81, 95% confidence interval [CI] 2.32-3.40). Among those with CP, the odds of being prescribed pain medication were higher for: females (OR=1.34, 95% CI 1.06-1.70), younger age (OR=1.60, 95% CI 1.02-2.51), Gross Motor Function Classification System level V (OR=2.60, 95% CI 1.52-4.47), seizures (OR=2.55, 95% CI 1.68-3.87), and higher deprivation score (OR=2.06, 95% CI 1.41-3.24). INTERPRETATION: Pain medication is an effective proxy for pain. More people with CP were prescribed pain medication than the general population. Pain medication for people with CP is not only dependent on physiological and clinical characteristics, but also environmental factors. What this paper adds Data linkage using pain medication as a proxy for experiencing pain is a valid method. People with cerebral palsy (CP) are more likely to experience pain than the general population. People with CP have over twice the odds of receiving opioids compared to the general population. The odds of being prescribed pain medication were higher for females with CP. Prescription of pain medication among those with CP is not only dependent on clinical characteristics, but also environmental factors.

Very preterm infants engage in an intervention to train their control of attention: results from the feasibility study of the Attention Control Training (ACT) randomised trial.

BACKGROUND: Very premature birth (gestational age between 28 and 31 + 6 weeks) is associated with increased risk of cognitive delay and attention deficit disorder, which have been linked to anomalies in the development of executive functions (EFs) and their precursors. In particular, very preterm (VP) infants display anomalies in controlling attention and gathering task-relevant information. Early interventions that support attention control may be pivotal in providing a secure base for VP children's later attainments. The Attention Control Training (ACT) is a cognitive training intervention that targets infants' abilities to select visual information according to varying task demands but had not been tested in VP infants. We conducted a feasibility study to test the processes we intend to use in a trial delivering the ACT to VP infants. METHODS AND DESIGN: We tested recruitment and retention of VP infants and their families in a randomised trial, as well as acceptability and completion of baseline and outcome measures. To evaluate these aims, we used descriptive quantitative statistics and qualitative methods to analyse feedback from infants' caregivers. We also investigated the quality of eye-tracking data collected and indicators of infants' engagement in the training, using descriptive statistics. RESULTS: Twelve VP infants were recruited, and 10 (83%) completed the study. Participants' parents had high education attainment. The rate of completion of baseline and outcome measures was optimal. VP infants demonstrated engagement in the training, completing on average 84 min of training over three visits, and displaying improved performance during this training. Eye-tracking data quality was moderate, but this did not interfere with infants' engagement in the training. DISCUSSION: The results suggest the ACT can be delivered to VP infants. However, challenges remain in recruitment of numerous and diverse samples. We discuss strategies to overcome these challenges informed by results of this study. TRIAL REGISTRATION: Registered Registration ID: NCT03896490 . Retrospectively registered at Clinical Trials Protocol Registration and Results System ( clinicaltrials.gov ).

Risk factors for intellectual disability in children with spastic cerebral palsy.

BACKGROUND: Cerebral palsy (CP) is a non-progressive disorder of posture and movement caused by prenatal or perinatal lesions of the brain. Children with CP are also at increased risk of other disabilities, for example, intellectual disability. Previous studies suggest the risk of intellectual disability varies in complex ways according to the type of motor impairment and perinatal factors such as gestational age. OBJECTIVE: To determine the patterns of risk of intellectual disability in children with spastic CP. DESIGN: Cross-sectional, population-based study using the Northern Ireland Cerebral Palsy Register. PARTICIPANTS: Persons born in 1981-2008 with congenital bilateral or unilateral spastic CP (N=1452). OUTCOME MEASURE: The outcome measure was severe intellectual disability (IQ <50), as reported by clinicians known to the child. Data pertaining to CP subtype, sex, gestational age, birth weight and functional level were included in analyses. RESULTS: Severe intellectual disability was significantly more prevalent in children with bilateral spastic CP (BSCP) compared with children with unilateral spastic CP (χ² (2)=162.60, p<0.001). Compared with very preterm infants with BSCP, the risk of intellectual disability increased in moderately preterm (OR=3.97, 95% CI 1.04 to 15.23) and at-term (OR=2.51, 95% CI 1.16 to 5.44) children with BSCP. CONCLUSIONS: Children with BSCP are at increased risk of intellectual disability, with those born at term at the highest risk. The findings highlight the importance of early screening, particularly for children with BSCP born at term.

Cerebral palsy in twins and higher multiple births: a Europe-Australia population-based study.

AIM: To describe the birth prevalence, temporal trends, and clinical outcomes of twins, triplets, or quadruplets with cerebral palsy (CP). METHOD: This was a cross-sectional study using data for twins, triplets, and quadruplets with prenatally or perinatally acquired CP and pooled from the Surveillance of Cerebral Palsy in Europe network (born 1992-2009) and Australian Cerebral Palsy Register (born 1993-2009). Children were at least 4 years old at time of registration. Children born in regions with population ascertainment and available denominator data were included in prevalence calculations (n=1033 twins, 81 triplets, and 11 quadruplets). Clinical data from children registered in all participating registers were described, including 2163 twins (56% male), 187 triplets (59% male), and 20 quadruplets (45% male). RESULTS: The birth prevalence of CP was higher with increasing plurality (twins 6.5 per 1000 live births [95% confidence interval {CI} 6.1-6.9], triplets 17.1 [95% CI 13.6-21.2], quadruplets 50.7 [95% CI 25.6-88.9]); however, prevalence by gestational age was similar across all pluralities. Between 1992-1994 and 2007-2009, prevalence of CP among twins declined (p=0.001) but prevalence of CP among triplets did not change significantly over time (p=0.55). The distributions of Gross Motor Function Classification System, epilepsy, and impairments of intellect, vision, and hearing were similar regardless of plurality. INTERPRETATION: The data combined from two CP register networks indicated that triplets and quadruplets had increased risk of CP compared to twins. The higher prevalence of CP in triplets and quadruplets is due to their higher risk of preterm birth. Prevalence of CP among twins significantly declined in Europe and Australia. Clinical outcomes were similar for all multiple births.

Population-based study on the prevalence and clinical profile of adults with cerebral palsy in Northern Ireland.

OBJECTIVES: This study aimed to report the prevalence and clinical characteristics of adults with cerebral palsy (CP) in a geographically defined region of the UK. DESIGN AND SETTING: Cross-sectional study using the Northern Ireland Cerebral Palsy Register (NICPR). PARTICIPANTS: All validated cases known to the NICPR, born 1981-2001 and alive and resident in Northern Ireland at age 19 years were included. RESULTS: The study included 1218 persons with CP aged 19-39 years, 46 of whom died in adulthood. The prevalence of CP was 2.38 per 1000. The majority of cases had spastic CP (n=1132/1218, 93%) and could walk (n=949/1218, 78%). Those that died in adulthood typically had bilateral spastic CP (n=39/46) and used a wheelchair (n=40/46). CONCLUSION: The prevalence of CP in adults is similar to other common neurological conditions such as multiple sclerosis and Parkinson's disease. The needs of adults with CP vary widely with almost half having two or more associated impairments that may require multiprofessional and multiagency coordination. Results from this study can be used to inform transformation of health and care services for adults with CP.

Decreasing cerebral palsy prevalence in multiple births in the modern era: a population cohort study of European data.

Multiple births (twins or higher order multiples) are increasing in developed countries and may present higher risk for cerebral palsy (CP). However, few studies can reliably investigate trends over time because these outcomes are relatively rare. OBJECTIVE: We pooled data from European CP registers to investigate CP birth prevalence and its trends among single and multiple births born between 1990 and 2008. DESIGN: Population cohort study. SETTING: 12 population-based registers from the Surveillance of Cerebral Palsy in Europe collaboration. PARTICIPANTS: 4 446 125 single and multiple live births, of whom 8416 (0.19%) had CP of prenatal or perinatal origin. MAIN OUTCOMES: CP diagnosis ascertained in childhood using harmonised methods; CP subtype; Motor impairment severity among CP cases. RESULTS: The rate of multiple births increased from 1990. Multiples displayed higher risk for CP (RR=4.27, 95% CI 4.00 to 4.57). For singletons and multiples alike, risk for CP was higher among births of lower gestational age (GA) or birth weight (BW). However, CP birth prevalence declined significantly among very preterm (<32 weeks) and very low BW (<1500 g) multiples. Singletons and multiples with CP displayed similar severity of motor impairment. CONCLUSIONS: Between 1990 and 2008, CP birth prevalence decreased steadily among multiples with low GA or BW. Furthermore, multiples with CP display similar profiles of severe motor impairment compared with CP singletons. Improvements in management of preterm birth since the 1990s may also have been responsible for providing better prospects for multiples.

Continuity and change in anger and aggressiveness from infancy to childhood: The protective effects of positive parenting.

Early signs of anger and aggression can be identified in infancy. Our aim was to use person-centered methods to identify which infants were most at risk for clinically significant behavioral problems by age 3 and diagnoses of ODD/CD by 7 years, while considering the role of family risk factors and positive parenting. A representative British community sample of 304 infants was assessed by multiple informants at mean ages of 6, 21, and 36 months of age. Latent Transition Analysis (LTA) identified three ordered subgroups at each age, with one subgroup (18%) displaying high levels of physical force as well as anger. These angry aggressive infants were at elevated risk for behavioral problems in early childhood and diagnoses of conduct disorder (CD) and/or oppositional defiant disorder (ODD) at 7 years of age. After other risk factors were taken into account, parents' beliefs in warm parenting and their observed positive affect while interacting with their infants were protective factors. These findings indicate the significance of very early manifestations of angry aggressiveness and have relevance for developmental theories of aggression and prevention strategies.

Healthcare use by children and young adults with cerebral palsy.

AIM: To link routinely collected health data to a cerebral palsy (CP) register in order to enable analysis of healthcare use by severity of CP. METHOD: The Northern Ireland Cerebral Palsy Register was linked to hospital data. Data for those on the CP register born between 1st January 1981 and 31st December 2009 and alive in 2004 were extracted, forming a CP cohort (n=1684; 57% males, 43% females; aged 0-24y). Frequencies of healthcare events, and the reasons for them, were reported according to CP severity and compared with those without CP who had had at least one hospital attendance in Northern Ireland within the study period. RESULTS: Cases of CP represented 0.3% of the Northern Ireland population aged 0 to 24 years but accounted for 1.6% of hospital admissions and 1.6% of outpatient appointments. They had higher rates of elective admissions and multi-day hospital stays than the general population. Respiratory conditions were the most common reason for emergency admissions. Those with most severe CP were 10 times more likely to be admitted, and four times more likely to attend outpatients, than those with mild CP. INTERPRETATION: Linkage between a register and routinely collected healthcare data provided a confirmed cohort of cases of CP that was sufficiently detailed to analyse healthcare use by disease severity.