The early educational environment at five years of age in a European cohort of children born very preterm: challenges and opportunities for research.

BACKGROUND: Early childhood education offers opportunities for stimulation in multiple developmental domains and its positive impact on long-term outcomes and wellbeing for children is well documented. Few studies have explored early education in children born very preterm (VPT; <32 weeks of gestation) who are at higher risk of neurodevelopmental disorders and poor educational outcomes than their term-born peers. The purpose of the study is to describe and compare the educational environment of children born VPT in European countries at 5 years of age according to the degree of perinatal risk. METHODS: Data originated from the population-based Screening to Improve Health In very Preterm infants (SHIPS) cohort of children born VPT in 2011/2012 in 19 regions from 11 European countries. Perinatal data were collected from medical records and the 5-year follow-up was conducted using parental questionnaires. Outcomes at 5 years were participation in early education (any, type, intensity of participation) and receipt of special educational support, which were harmonized across countries. RESULTS: Out of 6,759 eligible children, 3,687 (54.6%) were followed up at 5 years (mean gestational age 29.3 weeks). At 5 years, almost all children (98.6%) were in an educational program, but type (preschool/primary), attendance (full-time/part-time) and use and type of school support/services differed by country. In some countries, children with high perinatal risk were more likely to be in full-time education than those with low risk (e.g. Estonia: 97.9% vs. 87.1%), while the inverse pattern was observed elsewhere (e.g. Poland: 78.5% vs. 92.8%). Overall, 22.8% of children received special educational support (country range: 12.4-34.4%) with more support received by children with higher perinatal risk. Large variations between countries remained after adjustment for socio-demographic characteristics. CONCLUSIONS: There are marked variations in approaches to early education for children born VPT in Europe, raising opportunities to explore its impact on their neurodevelopment and well-being.

The aetiology of preterm birth and risks of cerebral palsy and cognitive impairment: A systematic review and meta-analysis.

AIM: The associations between the aetiology of preterm birth and later neurodevelopmental outcomes are unclear. A systematic review and meta-analysis examined the existing evidence. METHODS: The PubMed and Embase databases were searched for papers published in English from inception to 16 December 2020. We included original papers on the causes of preterm birth and the risks of cerebral palsy (CP) and suboptimal cognitive development. Two reviewers independently evaluated the studies and extracted the data. RESULTS: The literature search yielded 5472 papers and 13 were selected. The aetiology of preterm birth was classified under spontaneous or medically indicated delivery. A meta-analysis was performed, comprising 104 902 preterm infants from 11 papers on CP. Preterm infants born after a medically indicated delivery had a lower CP risk than infants born after spontaneous delivery, with a pooled odds ratio of 0.59 (95% confidence interval 0.40-0.86). This result was robust in the subgroup and sensitivity analyses. Cognitive development was reported in three papers, which suggested that worse outcomes were associated with medically indicated deliveries. CONCLUSION: The aetiology of preterm delivery may contribute to the risk of CP and cognitive delay. Further research is needed, using individual-level meta-analyses to adjust for possible confounders, notably gestational age.

Heterogeneity of design features in studies included in systematic reviews with meta-analysis of cognitive outcomes in children born very preterm.

BACKGROUND: Meta-analyses of the voluminous scientific literature on the impact of very preterm (VPT, <32 weeks' gestation) birth on cognition find a marked deficit in intelligence quotient (IQ) among children born VPT relative to term-born peers, but with unexplained between-study heterogeneity in effect size. OBJECTIVES: To conduct an umbrella review to describe the design and methodology of primary studies and to assess whether methodological heterogeneity affects the results of meta-analyses. DATA SOURCES: Primary studies from five systematic reviews with meta-analysis on VPT birth and childhood IQ. STUDY SELECTION AND DATA EXTRACTION: Information on study design, sample characteristics and results was extracted from studies. Study features covered study type, sample size, follow-up rates, adjustment for social context, management of severe impairments and test type. SYNTHESIS: We used random-effects subgroup meta-analyses and meta-regressions to investigate the contribution of study features to between-study variance in standardised mean differences (SMD) in IQ between groups. RESULTS: In 58 cohorts (56%), children with severe impairments were excluded, while 23 (22%) cohorts accounted for social factors. The least reported feature was the follow-up rate (missing in 38 cohorts). The largest difference in SMDs was between studies using full scale IQ tests (61 cohorts, SMD -0.89, 95% CI -0.96, -0.82) versus short-form tests (27 cohorts, SMD -0.68, 95% CI -0.79, -0.57). The proportion of between-study variance explained by the type of test was 14%; the other features explained less than 1% of the variance. CONCLUSIONS: Study design and methodology varied across studies, but most of them did not affect the variance in effect size, except the type of cognitive test. Key features, such as the follow-up rate, were not consistently reported limiting the evaluation of their potential contribution. Incomplete reporting limited the evaluation of the full impact of this methodological diversity.

Developmental motor problems and health-related quality of life in 5-year-old children born extremely preterm: A European cohort study.

AIM: To measure the association between cerebral palsy (CP) and non-CP-related movement difficulties and health-related quality of life (HRQoL) among 5-year-old children born extremely preterm (<28 weeks gestational age). METHOD: We included 5-year-old children from a multi-country, population-based cohort of children born extremely preterm in 2011 to 2012 in 11 European countries (n = 1021). Children without CP were classified using the Movement Assessment Battery for Children, Second Edition as having significant movement difficulties (≤5th centile of standardized norms) or being at risk of movement difficulties (6th-15th centile). Parents reported on a clinical CP diagnosis and HRQoL using the Pediatric Quality of Life Inventory. Associations were assessed using linear and quantile regressions. RESULTS: Compared to children without movement difficulties, children at risk of movement difficulties, with significant movement difficulties, and CP had lower adjusted HRQoL total scores (ß [95% confidence interval] = -5.0 [-7.7 to -2.3], -9.1 [-12.0 to -6.1], and - 26.1 [-31.0 to -21.2]). Quantile regression analyses showed similar decreases in HRQoL for all children with CP, whereas for children with non-CP-related movement difficulties, reductions in HRQoL were more pronounced at lower centiles. INTERPRETATION: CP and non-CP-related movement difficulties were associated with lower HRQoL, even for children with less severe difficulties. Heterogeneous associations for non-CP-related movement difficulties raise questions for research about mitigating and protective factors.

Health-related quality of life of children born very preterm: a multinational European cohort study.

PURPOSE: This study aims to (1) describe the health-related quality of life (HRQoL) outcomes experienced by children born very preterm (28-31 weeks' gestation) and extremely preterm (< 28 weeks' gestation) at five years of age and (2) explore the mediation effects of bronchopulmonary dysplasia (BPD) and severe non-respiratory neonatal morbidity on those outcomes. METHODS: This investigation was based on data for 3687 children born at < 32 weeks' gestation that contributed to the EPICE and SHIPS studies conducted in 19 regions across 11 European countries. Descriptive statistics and multi-level ordinary linear squares (OLS) regression were used to explore the association between perinatal and sociodemographic characteristics and PedsQL™ GCS scores. A mediation analysis that applied generalised structural equation modelling explored the association between potential mediators and PedsQL™ GCS scores. RESULTS: The multi-level OLS regression (fully adjusted model) revealed that birth at < 26 weeks' gestation, BPD status and experience of severe non-respiratory morbidity were associated with mean decrements in the total PedsQL™ GCS score of 0.35, 3.71 and 5.87, respectively. The mediation analysis revealed that the indirect effects of BPD and severe non-respiratory morbidity on the total PedsQL™ GCS score translated into decrements of 1.73 and 17.56, respectively, at < 26 weeks' gestation; 0.99 and 10.95, respectively, at 26-27 weeks' gestation; and 0.34 and 4.80, respectively, at 28-29 weeks' gestation (referent: birth at 30-31 weeks' gestation). CONCLUSION: The findings suggest that HRQoL is particularly impaired by extremely preterm birth and the concomitant complications of preterm birth such as BPD and severe non-respiratory morbidity.

Chronic health conditions and school experience in school-aged children in 19 European countries.

This study investigates chronic conditions (CC) prevalence among children in mainstream schools, their school experience and life satisfaction in Europe. Data were collected from the 2017/2018 HBSC survey, a cross-national study using self-reported questionnaires administered in classrooms. Nationally representative samples of children aged 11, 13, and 15 years in mainstream schools from 19 European countries (n = 104,812) were used. School experience was assessed using four variables: low school satisfaction, schoolwork pressure, low teacher support, and peer-victimization, which were related to life satisfaction. Latent class analysis (LCA) was conducted to identify patterns of school experience among students with CC. The prevalence of CC varied from 8.4 (Armenia) to 28.2% (Finland). Children with CC (n = 17,514) rated their school experience and life satisfaction lower than children without CC. LCA identified three school experience patterns: "negative on all items" (37%), "negative on all items, except school pressure" (40%) and "overall positive" (23%). The distribution of subgroups varied across countries-in countries with a higher proportion of children with CC in mainstream schools, children reported more negative school experiences. Compared to the "overall positive" group, low life satisfaction was highest for students classified as "negative on all items" (relative risk (RR) = 2.9; 95% CI 2.2-3.8) with a lesser effect for "negative on all items, except school pressure" (RR) = 1.8; 95% CI 1.4-2.4). These findings provide cross-national data documenting the diversity in inclusive educational practices regarding school placement and school experiences, and suggest that efforts are still needed to allow a fully inclusive environment.

The challenges of heterogeneity in gestational age and birthweight inclusion criteria for research synthesis on very preterm birth and childhood cognition: An umbrella review and meta-regression analysis.

BACKGROUND: Meta-analyses of studies on very preterm (VPT) birth and childhood cognition select primary studies using gestational age inclusion criteria only, while others also include birthweight criteria. The consequences of this choice are unknown. OBJECTIVE: The objective of this study was to describe the gestational age (GA) and birthweight (BW) criteria used in studies of VPT birth and cognition and to investigate whether meta-analysis results differ based on these criteria. DATA SOURCES: Five systematic reviews on VPT birth and childhood IQ. STUDY SELECTION AND DATA EXTRACTION: Country, birth years, GA-BW selection criteria and participant IQ were extracted from 156 studies representing 103 birth cohorts. SYNTHESIS: Pooled standardised mean differences (SMD) in IQ between children born VPT and term-born controls were estimated by sub-group based on GA-BW criteria (GA, BW and GA-BW combined) and degree of preterm birth-low birthweight combinations: extremely preterm (EPT, <28 weeks) and extremely low BW (ELBW, <1000 g); VPT (<32 weeks) and very low BW (VLBW, <1500 g); and moderately MPT (<34 weeks) and moderately low BW (MLBW, <1800 g). RESULTS: Cohorts used 27 distinct GA-BW inclusion criteria. Most common criteria were BW <1500 g (24 cohorts), BW <1000 g (12), GA <32 weeks (12) and GA <33 weeks (12); 23 studies used GA-BW combinations. BW-only criteria were more frequent in North America than Europe (63% versus 24%) and for cohorts before than after 1990 (67% vs 26%). Pooled SMD in IQ varied: SMDEPT/ELBW -0.94, 95% confidence interval [CI] -1.07, -0.82; SMDVPT/VLBW -0.78, 95% CI -0.85, -0.71; SMDMPT/MLBW -0.68, 95% CI -0.79, -0.57; however, there was no difference in SMD across cohorts using BW compared to GA criteria after adjustment on risk group. CONCLUSIONS: These findings support the inclusion of studies using GA and/or BW criteria in meta-analyses on VPT birth and cognition to increase the geographical and temporal generalisability of the results and to allow investigation of the impact of the heterogeneous inclusion criteria in this literature on outcomes.

Disparity of child/parent-reported quality of life in cerebral palsy persists into adolescence.

AIM: To examine the evolution of child-parent discrepancy in reporting quality of life (QoL) between childhood and adolescence in children with cerebral palsy (CP) and to investigate potential factors associated with such a discrepancy. METHOD: We used data from the SPARCLE (Study of PARticipation of Children with CP Living in Europe) study, a population-based cohort study of children with CP, aged 8 to 12 years at baseline (in 2004-2005), in nine European centres, who were followed up at the age of 13 to 17 years. The KIDSCREEN-52 Quality of Life measure was used at baseline and follow-up; 354 child-parent dyads out of 500 eligible dyads were followed up (201 males, 153 females). We used intraclass correlation coefficients (ICCs) to examine agreement between parent proxy-reports and self-reported QoL. We used linear regression to examine factors associated with child-parent discrepancy in QoL reporting. RESULTS: Agreement was low to moderate (ICC=0.16-0.48) in childhood and in adolescence across all QoL domains. In four domains (moods and emotions, self-perception, relationship with parents and home life, and social support and peers), the extent of the discrepancy increased significantly between childhood and adolescence. Parenting stress, child pain, and child behaviour problems influenced parent proxy-reports during both childhood and adolescence. INTERPRETATION: The points of view of the child and their parents should be treated as complementary to obtain better knowledge regarding the QoL of children and adolescents with CP.

Education disparities in young people with and without neurodisabilities.

AIM: To examine key outcomes in the education of young people with and without neurodisabilities, and to investigate additional disparities in educational achievement in relation to socio-economic background. METHOD: Data were collected on 2488 Canadian children (age range 10-11y) in 1994 and 1995 from the National Longitudinal Survey of Children and Youth whom were followed for 14 years. We performed separate, discrete-time survival analysis to investigate the effects of having a neurodisability on high school completion, enrolment in post-secondary education (PSE), and PSE completion. RESULTS: The baseline prevalence of neurodisabilities was 12%. Fewer children with neurodisabilities completed high school or enrolled in PSE, compared to children without neurodisabilities, irrespective of parental education. The likelihood that students with neurodisabilities completed PSE differed according to their parents' education: students with neurodisabilities living in less-educated families were about half as likely to complete PSE themselves. INTERPRETATION: Children with neurodisabilities receive less education than children without neurodisabilities. Children from families with low educational attainment appear to be particularly vulnerable. WHAT THIS PAPER ADDS: Twelve per cent of children in Canada aged 10 years to 11 years have a neurodisability. High school completion rate was 70% for children with neurodisabilities versus 94% for children without neurodisabilities. Children with neurodisabilities from less-educated families are particularly vulnerable to lower educational achievement.

School start time and sleep in Canadian adolescents.

Insufficient sleep is a serious problem in adolescents and school start time is thought to be a key contributor. This study provided the first comprehensive assessment of school start times across Canada and examined whether school start times were associated with sleep duration and tiredness among adolescents. We collected information on school start times from 362 schools that participated in the 2013/2014 Health Behaviour in School-aged Children study. We calculated sleep duration from weekday bedtime and wake time reported by 29 635 students (aged 10-18 years). We classified weekday sleep as sufficient if it met national recommendations, and used data on self-reported tiredness at school in the morning. Random-effects regression models estimated the association of school start time with sleep duration, sleep sufficiency and tiredness. On average, schools started at 08:43 hours. Students slept an average of 8:36 h on weekdays and 69% met sleep duration recommendations, but 60% reported feeling tired in the morning. Every 10-min delay in school start time corresponded with 3.2 [95% confidence interval (CI): 2.0, 4.5] additional minutes of sleep, a 1.6% (95% CI: 0.5, 2.8) greater probability of sufficient sleep and a 2.1% (95% CI: 1.0, 3.2) smaller probability of feeling tired at school in the morning. Students from schools that started later slept longer, were more likely to meet sleep recommendations and were less likely to report feeling tired in the morning. The study adds weight to the mounting evidence that delaying school start time benefits adolescent sleep.

Physical Activity Among Adolescents With Long-Term Illnesses or Disabilities in 15 European Countries.

Physical activity (PA) is an important health-promoting behavior from which adolescents with long-term illnesses or disabilities (LTID) can benefit. It is important to monitor differences across countries in adherence with PA recommendations for health. The aim of this study was to compare PA levels among 15 European countries after disaggregating data by disability. Data from pupils (mean age = 13.6 years, SD = 1.64) participating in the 2013/2014 Health Behavior in School-aged Children study were analyzed to compare adolescents without LTID, with LTID, and with LTID that affects their participation (affected LTID). Logistic regression models adjusted for age and family affluence, stratified by gender and country group with PA recommendations for health as the outcome variable. With the data pooled, 15% (n = 9,372) of adolescents reported having LTID and 4% (n = 2,566) having affected LTID. Overall, fewer boys with LTID met PA recommendations for health than boys without LTID, although it was not statistically significant either at the national levels or for girls.

Adolescent suicidal behaviours in 32 low- and middle-income countries.

OBJECTIVE: To estimate prevalence of suicidal ideation and suicidal ideation with a plan in each surveyed country and to examine cross-national differences in associated risk factors. METHODS: We analysed data of students aged 13-17 years who participated in the 2003-2012 Global School-based Health Surveys in 32 countries, of which 29 are low- and middle-income. We used random effects meta-analysis to generate regional and overall pooled estimates. Multivariable logistic regression was used to estimate risk ratios for the associated risk factors. Population attributable fractions were estimated based on adjusted risk ratios and the prevalence of the determinants within each exposure level. FINDINGS: Across all countries, the pooled 12-month prevalence of suicide ideation were 16.2% (95% confidence interval, CI: 15.6 to 16.7) among females and 12.2% (95% CI: 11.7 to 12.7) among males and ideation with a plan were 8.3% (95% CI: 7.9 to 8.7) among females and 5.8% (95% CI: 5.5 to 6.1) among males. Suicide ideation in the WHO Region of the Americas was higher in females than males, with an estimated prevalence ratio of 1.70 (95% CI: 1.60 to 1.81), while this ratio was 1.04 (95% CI: 0.98 to 1.10) in the WHO African Region. Factors associated with suicidal ideation in most countries included experiences of bullying and physical violence, loneliness, limited parental support and alcohol and tobacco use. CONCLUSION: The prevalence of adolescent suicidal behaviours varies across countries, yet a consistent set of risk factors of suicidal behaviours emerged across all regions and most countries.

Weight concerns among adolescent boys.

OBJECTIVE: To investigate weight concerns among adolescent boys and relationships with health indicators and family factors. DESIGN: Analysis of the 2010 Health Behaviour in School-aged Children survey of 10-17-year-olds. SETTING: Schools in the Republic of Ireland. RESULTS: Among 6187 boys, 25.1% reported a desire to lose weight (weight 'loss' concern) and 7.7% reported a desire to gain weight (weight 'gain' concern). Both types of weight concerns were associated with poor self-rated health, life satisfaction and happiness, and with more frequent emotional and physical symptoms. Family factors were associated with boys' weight concerns. In adjusted analyses, the risk of weight 'loss' concerns decreased with daily family breakfasts (OR=0.80; 95% CI 0.66, 0.97). The risk of weight 'gain' concerns decreased with frequent family evening meals (OR=0.77; 95% CI 0.60, 0.99). Ease of communication with mother was associated with a decreased risk of weight 'loss' and weight 'gain' concerns among boys (OR=0.74; 95% CI 0.60, 0.90 and OR=0.61; 95% CI 0.44, 0.82, respectively). An open father-son relationship and having a father present in the home decreased the risk of weight 'loss' concerns (OR=0.69; 95% CI 0.57, 0.82 and OR=0.81; 95% CI 0.67, 0.98, respectively). CONCLUSIONS: Body weight concerns were reported by a sizeable minority of boys and were associated with negative health outcomes. The findings support the need to promote frequent family meals and facilitate open communication in families.

Peer victimization and subjective health among students reporting disability or chronic illness in 11 Western countries.

BACKGROUND: To compare the strength of the association between peer victimization at school and subjective health according to the disability or chronic illness (D/CI) status of students across countries. METHODS: This study used data from 55 030 students aged 11, 13 and 15 years from 11 countries participating in the 2005-06 Health Behaviour in School-aged Children survey. Self-completed questionnaires were administered in classrooms. Multivariate models of logistic regression (controlled for confounding factors and countries) were used to investigate differences in the association between peer victimization and poor subjective health according to the D/CI status. RESULTS: Overall, 13.5% of the students reported having been bullied at least two or three times a month. The percentage of victims was significantly higher among those reporting D/CI than among others in all countries studied. Victims of bullying were more likely to report poor self-rated health, low life satisfaction and multiple health complaints. However, there were no differences in the associations between peer victimization and subjective health indicators according to the D/CI status. CONCLUSIONS: In all countries studied, students reporting D/CI were more likely to report being victims of bullying. Victims of bullying reported more negative subjective health outcomes regardless of their D/CI status. Although inclusive education is currently a major topic of educational policies in most countries, additional efforts should be made to improve the quality of the integration of students with D/CI.

Life satisfaction in the context of the COVID-19 pandemic among middle school adolescents in France: findings from a repeated cross-sectional survey (EnCLASS, 2012-2021).

Background and aims: Since the COVID-19 pandemic, several studies have reported a decrease in adolescents' well-being. We aim to describe life satisfaction over the last decade and examine the factors associated with its variations between 2020 and 2021 among French students in their last year of middle school (around 14-15 years old). Methods: Data were drawn from a repeated biennial cross-sectional national survey conducted in French schools over the last decade (EnCLASS study), using a self-administered questionnaire. After describing life satisfaction trends between 2012 and 2021 using the Cantril ladder, we examined individual changes in life satisfaction between 2020 and 2021 and their associations with housing and studying conditions during the COVID-19 lockdown, using multinomial logistic regression analysis (decrease, increase, no change as reference). Results: Among the 17,686 survey respondents, an overall slight decrease in the prevalence of adolescents reporting high life satisfaction (i.e., Cantril score ≥6) was observed since 2012 with the lowest proportion reported in 2021 (77.4%). Between 2020 and 2021, 16.3% of French adolescents experienced an improvement in life satisfaction, while 17.7% experienced the opposite. Decrease in life satisfaction between 2020 and 2021 was more likely experienced by adolescents living in reconstructed families [aOR 2.09 (95%CI, 1.58-2.77)], those who did not have their own room [aOR 1.58 (1.16-2.15)], nor access to the Internet to interact with their friends during the lockdown [aOR 1.47 (1.09-1.98)]. Interestingly, more girls than boys were represented in both those reporting increase and decrease in life satisfaction [aOR 1.82 (1.40-2.37) and 1.43 (1.14-1.79), respectively]. Conclusions: This study shows that the way adolescents experienced the first 2020 lockdown in France was not uniform, and that one must consider sex as well as housing and studying conditions when interpreting adolescents' life satisfaction decrease during the COVID-19 pandemic.

Peer victimization among school-aged children with chronic conditions.

Peer victimization is a common problem among school-aged children, and those with chronic conditions are at an increased risk. A systematic review of the literature was carried out to explore the increased risk of peer victimization among children with chronic conditions compared with others, considering a variety of chronic conditions; and to assess intervention programs designed to reduce negative attitudes or peer victimization at school toward children with chronic conditions. Various data sources were used (PubMed, ERIC, PsycINFO, Web of Science), and 59 studies published between 1991 and 2011 and mainly carried out in North American and European countries were included in the review. A higher level of peer victimization among children with chronic conditions was shown for each type of condition explored in this review (psychiatric diagnoses, learning difficulties, physical and motor impairments, chronic illnesses, and overweight). Despite a substantial number of studies having shown a significant association between chronic conditions and peer victimization, intervention studies aiming to reduce bullying among these children were rarely evaluated. The findings of this review suggest a growing need to develop and implement specific interventions targeted at reducing peer victimization among children with chronic conditions.

Prevalence and characteristics of children with cerebral palsy according to socioeconomic status of areas of residence in a French department.

AIM: To study the association between the socioeconomic environment of area of residence and prevalence and characteristics of children with cerebral palsy (CP). METHOD: Data on 8-year-old children with CP born in 2000-2011 (n = 252) were extracted from a regional population-based register in France. The European Deprivation Index (EDI), available at census block level, characterised socioeconomic deprivation in the child's area of residence at age of registration. The prevalence of CP was estimated in each group of census units defined by EDI distribution tertiles in the general population. The association between deprivation level and CP severity was assessed according to term/preterm status. RESULTS: CP prevalence differed between deprivation risk groups showing a J-shaped form with the prevalence in the most deprived tertile (T3) being the highest but not significantly different of the prevalence in the least deprived one (T1). However, the prevalence in the medium deprivation tertile (T2) was significantly lower than that in the most deprived one with a prevalence risk ratio (PRR) of: PRRT2/T3 = 0.63 95% CI [0.44-0.89]). Prevalences of CP with associated intellectual disability (ID) and CP with inability to walk were significantly higher in the most deprived tertile compared to the least deprived one (respectively PRRT3/T1 = 1.86 95% CI [1.19-2.92] and PRRT3/T1 = 1.90 95% CI [1.07-3.37]). Compared to children living in the least deprived areas, children with CP born preterm living in the most deprived areas had more severe forms of motor impairment, such as an inability to walk or a combination of an inability to walk and moderate to severe impairment of bimanual function. They also had more associated intellectual disability. No associations were observed among term-born children. INTERPRETATION: A significant association between area deprivation group and CP severity was observed among preterm children but not among term-born children.

Maternal education and cognitive development in 15 European very-preterm birth cohorts from the RECAP Preterm platform.

BACKGROUND: Studies are sparse and inconclusive about the association between maternal education and cognitive development among children born very preterm (VPT). Although this association is well established in the general population, questions remain about its magnitude among children born VPT whose risks of medical and developmental complications are high. We investigated the association of maternal education with cognitive outcomes in European VPT birth cohorts. METHODS: We used harmonized aggregated data from 15 population-based cohorts of children born at <32 weeks of gestational age (GA) or <1500 g from 1985 to 2013 in 13 countries with information on maternal education and assessments of general development at 2-3 years and/or intelligence quotients between 4 and 15 years. Term-born controls (≥37 weeks of GA) were available in eight cohorts. Maternal education was classified as: low (primary/lower secondary); medium (upper secondary/short tertiary); high (bachelor's/higher). Pooled standardized mean differences (SMDs) in cognitive scores were estimated (reference: high educational level) for children assessed at ages 2-3, 4-7 and 8-15 years. RESULTS: The study included 10 145 VPT children from 12 cohorts at 2-3 years, 8829 from 12 cohorts at 4-7 years and 1865 children from 6 cohorts at 8-15 years. Children whose mothers had low, compared with high, educational attainment scored lower on cognitive measures [pooled unadjusted SMDs: 2-3 years = -0.32 (95% confidence intervals: -0.43 to -0.21); 4-7 years = -0.57 (-0.67; -0.47); 8-15 years = -0.54 (-0.72; -0.37)]. Analyses by GA subgroups (<27 vs ≥27 weeks) in children without severe neonatal morbidity and term controls yielded similar results. CONCLUSIONS: Across diverse settings and regardless of the degree of prematurity, low maternal education was associated with lower cognition.

Improving attitudes towards children with disabilities in a school context: a cluster randomized intervention study.

AIM: although inclusive education of disabled children is now an accepted practice, it is often challenged by negative peer attitudes. We undertook an interventional study aimed at improving students' attitudes towards their disabled peers. METHOD: the participants were students from the 7th grade of twelve paired schools (1509 students from 62 classes; age 12-13y), randomly allocated to an intervention group (205 males, 285 females) or a control group (132 males, 165 females). The intervention consisted of a mandatory comprehensive educational project on disability. The Chedoke-McMaster Attitudes Towards Children with Handicaps Scale (CATCH) was used to assess children's attitudes before (T0) and after (T1) intervention. The hierarchical structure of the data was taken into account by adjusting standard deviations and using linear multilevel models. RESULTS: seven hundred and eighty-four students had at least one score on the three domains (cognitive, affective, behavioural) of the CATCH at T0 and T1. The final scores were higher than baseline scores (total scores, intervention group: baseline score 25.6 (SD=5.4), final score 26.8 (5.9), p<0.001; CONTROL GROUP: baseline 25.2 (5.4), final 26.0 (5.7), p<0.009) with no significant difference between the intervention and control groups. Individual score changes over time were associated with baseline score (p<0.001 for total and all sub-scores). Lower improvement in attitudes was found in students from schools with special units for their peers with cognitive impairment for total (p=0.013), affective (p<0.001), and behavioural (p=0.001) scores, while higher improvement existed for the cognitive domain (p=0.029). INTERPRETATION: although we found no effect of our intervention, we found an improvement in attitudes in the intervention and control groups that could be a result of the nature of the scales and questionnaires the students had to complete before the intervention.