Birth Cohort Research Articles

Associations of childhood physical activity and screen time with cardiometabolic health in preteens who were born to mothers with previous macrosomic delivery: Findings from the ROLO longitudinal birth cohort study.

Macrosomia (birthweight ≥4 kg) may alter the associations of physical activity (PA) and screen time (ST) throughout childhood with later cardiometabolic risk. To investigate associations of PA and ST over a 4-6-year follow-up period with cardiometabolic outcomes in preteens (9-11-year-olds) who were born to mothers with previous macrosomic delivery. This is an analysis of 402 preteens from the ROLO study, who were born to mothers that previously delivered an infant with macrosomia. Parental-reported measures of PA and ST were obtained in early childhood at 5-years of age. Preteen self-reported PA, parental-reported ST, anthropometry, dual-energy x-ray absorptiometry, blood pressure, heart rate, cardiorespiratory endurance, and blood biomarkers were obtained at 9-11-years. Crude and adjusted linear regression models explored associations and the interaction of birthweight was investigated in all models. Early childhood PA and ST at the 5-year follow-up were not related to preteen cardiometabolic outcomes. In adjusted models, higher preteen PA was associated with lower sum of skinfolds (B = -3.00, 95% CI -5.98, -0.02, p = 0.048) and higher cardiorespiratory endurance (B = 0.50, 95% CI 0.20, 0.80, p = 0.001) at the same time point. No strong evidence for modification by birthweight was found. Higher preteen PA may have potential benefits for cardiometabolic health, irrespective of birthweight.

Associations of gestational and childhood exposure to lead, cadmium, and fluoride with cognitive abilities, behavior, and social communication at 4 years of age: NICE Birth Cohort Study

BackgroundEarly-life lead exposure affects cognitive development and emerging evidence suggests similar effects of cadmium and fluoride. ObjectiveTo assess the impact of gestational and childhood exposure to lead, cadmium, and fluoride on cognitive abilities and behavioral and social communication problems. MethodsWe studied 470 pregnant women (gestational week 29) and their 4-year-old children from the NICE cohort in northern Sweden. Concentrations of erythrocyte lead and cadmium and urinary cadmium were measured using inductively coupled plasma mass spectrometry and urinary fluoride with an ion-selective electrode. Urinary concentrations were specific-gravity adjusted. Associations of log2-transformed exposure concentrations with cognitive abilities (full-scale IQ and verbal comprehension by Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition), behavioral problems (Child Behavior Checklist), and social communication (Social Responsiveness Scale-Second Edition) were evaluated with multivariable-adjusted linear regression analysis. ResultsBoth gestational and cord erythrocyte lead concentrations were non-significantly inversely associated with child cognitive abilities (full-scale IQ: B [95%CI]: -1.2 [-2.9, 0.5] and -1.6 [-3.7, 0.4], respectively; per doubling of exposure). Similarly, both gestational and child urinary cadmium were inversely associated with cognitive abilities (full-scale IQ: -1.1 [-2.5, 0.3] and -1.1 [-2.5, 0.4], verbal comprehension: -1.2 [-3.1, 0.6] and -1.4 [-3.4, 0.6], respectively). Urinary fluoride concentrations showed no association with cognitive abilities. However, gestational fluoride was associated with increasing externalizing problems (0.9 [-0.3, 2.0]) and ADHD raw scores (0.3 [0.0, 0.6]). Childhood erythrocyte lead and urinary cadmium were non-significantly associated with increased behavioral problems (lead with total problems: 1.2 [-0.4, 2.9] and internalizing problems: 1.5 [-0.4, 3.4]; cadmium with externalizing problems: 1.1 [-0.2, 2.4]). ConclusionDespite non-significant associations, both lead and cadmium exposure showed consistent inverse associations with cognitive abilities at 4 years, whereas associations with behavioral problems were less conclusive, especially for cadmium. Results on fluoride indicated association with externalizing problems, including ADHD, but prevalence of behavioral problems was low, increasing uncertainty.

Associations between maternal depression trajectories and infant neurodevelopment at eight months.

Maternal depression is an increasingly recognized risk factor of child neurodevelopment difficulties. Few studies have investigated the association between the severity and duration of maternal depression and child development. We aimed to identify whether trajectories of maternal depressive symptoms from pregnancy to six months postpartum are associated with child development at eight months. We included 988 mother-child pairs who participated in Shenzhen Birth Cohort Study, which was conducted in Shenzhen Nanshan Maternity & Child Healthcare Hospital of China. Maternal depressive symptoms were evaluated by the Edinburgh Postnatal Depression Scale (EPDS) at late pregnancy, 1, 3 and 6months postpartum. Child emotional and behavioral development were assessed by Ages and Stages Questionnaires: Social-Emotional (ASQ-se) and Ages and Stages Questionnaires-Third Edition (ASQ-3) at aged 8months. Latent profile analysis (LPA) was used to identify the trajectories of maternal depressive symptoms. Univariate and multivariate linear regression were conducted to explore the association between the depressive symptoms trajectories and child development. Four trajectories of maternal depressive symptoms were identified by LPA: low (n=597), subclinical (n=91), moderately low and increasing (n=246) and persistently high (54). Multivariable regression model showed that children of mothers with persistently high depressive symptoms were more likely to have lower scores in three ASQ-3 domains: fine motor (beta [95%C]): -2.30 [-4.32, -0.29], problem-solving (-3.72 [-5.81, -1.62]) and personal-social motor (-2.56 [-4.98, -0.15]), but higher ASQ-se scores (9.49 [5.09, 13.9]). Compared to children of mothers with low depressive symptoms, subclinical depressive symptoms were prediposed to having lower scores in two ASQ-3 domains: communication motor (-2.48 [-4.32, -0.64]) and gross motor (-2.35 [-4.2,-0.51]) and lower ASQ-se scores(4.86 [2.54, 7.18]). Higher levels of maternal depression symptoms were associated with increased risk of child developmental delay, highlighting the importance of early intervention and addressing maternal depression from pregnancy through early childhood.

Association between fine particulate matter (PM2.5) and infant mortality in a North Carolina birth cohort (2003-2015).

While the association between fine particulate matter (PM2.5) and adult mortality is well established, few studies have examined the association between long-term PM2.5 exposure and infant mortality. We conducted an unmatched case-control study of 5992 infant mortality cases and 60,000 randomly selected controls from a North Carolina birth cohort (2003-2015). PM2.5 during critical exposure periods (trimesters, pregnancy, first month alive) was estimated using residential address and a national spatiotemporal model at census block centroid. We fit adjusted logistic regression models and calculated odds ratios (ORs) and 95% confidence intervals (CIs). Due to differences in PM2 .5 over time, we stratified analyses into two periods: 2003-2009 (mean = 12.1 µg/m3, interquartile range [IQR]: 10.8-13.5) and 2011-2015 (mean = 8.4 µg/m3, IQR: 7.7-9.0). We assessed effect measure modification by birthing parent race/ethnicity, full-term birth, and PM2.5 concentrations. For births 2003-2015, the odds of infant mortality increased by 12% (95% CI: 1.06, 1.17) per 4.0 µg/m3 increase in PM2.5 exposure averaged over the pregnancy. After stratifying, we observed an increase of 4% (95% CI: 0.95, 1.14) for births in 2003-2009 and a decrease of 15% (95% CI: 0.72, 1.01) for births in 2011-2015. Among infants with higher PM2.5 exposure (≥12 µg/m3) during pregnancy, the odds of infant mortality increased (OR: 2.69; 95% CI: 2.17, 3.34) whereas the lower exposure (<8 µg/m3) group reported decreased odds (OR: 0.50; 95% CI: 0.28, 0.89). We observed differing associations of PM2.5 exposure with infant mortality across higher versus lower PM2.5 concentrations. Research findings suggest the importance of accounting for long-term trends of decreasing PM2.5 concentrations in future research.

Association between prenatal mercury exposure and pediatric neurodevelopment: The Japan environment and children's study

Mercury pollution, including from its use during gold mining and refining, remains an important problem worldwide. In particular, methylmercury, a microbial alteration of mercury released into the environment, is a major environmental neurotoxicant. Although there has been growing concern about the health hazards of exposure to low levels of mercury, the effects of prenatal mercury exposure on neurodevelopmental outcomes in children have remained controversial. In the Japan Environment and Children's Study, a large-scale nationwide birth cohort study, we measured methylmercury and inorganic mercury concentrations in cord blood and conducted developmental scoring tests at ages 2 and 4 years. We then analyzed the associations between mercury levels in cord blood and neurodevelopmental outcomes. Measurements of cord blood obtained from 3822 participants revealed median values of 7.39 ng/ml (5th percentile: 2.95, 95th percentile: 18.1) and 0.25 ng/ml (5th percentile: 0.10, 95th percentile: 0.58) for methylmercury and inorganic mercury, respectively. Analyzing the association with fish consumption, bonito-tuna was most strongly correlated with both methylmercury and inorganic mercury in cord blood. Although the association between cord blood mercury and neurodevelopmental scores was subsequently examined in 3083 individuals, we found no significant association with either methylmercury or inorganic mercury. Further quartile group analysis based on methylmercury concentrations in cord blood revealed no concentration-dependent association between a prenatal mercury exposure and neurodevelopment in children. However, various factors influence neurodevelopment, and long-term observational studies that consider those covariates are necessary for a more definitive conclusion. Although the findings of our study provide important insights into the association between prenatal mercury exposure and neurodevelopment, further research is needed to make recommendations for safe mercury intake thresholds during pregnancy.

Associations of per- and polyfluoroalkyl substances with human milk metabolomic profiles in a rural North American cohort.

Per- and polyfluoroalkyl substances (PFAS) are a class of persistent synthetic chemicals that are found in human milk and are associated with negative health effects. Research suggests that PFAS affect both lactation and the human metabolome. We measured perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) in the milk of 425 participants from the New Hampshire Birth Cohort Study using liquid chromatography-tandem mass spectrometry (LC-MS/MS). A nontargeted metabolomics assay was performed using LC with high-resolution MS, and metabolites were identified based on in-house database matching. We observed six metabolic profiles among our milk samples using self-organizing maps, and multinomial logistic regression was used to identify sociodemographic and perinatal predictors of these profiles, including infant sex, parity, participant body mass index, participant age, education, race, smoking status, gestational weight gain, and infant age at time of milk collection. Elevated PFOA was associated with profiles containing higher amounts of triglyceride fatty acids, glycerophospholipids and sphingolipids, and carnitine metabolites, as well as lower amounts of lactose and creatine phosphate. Lower concentrations of milk PFOS were associated with lower levels of fatty acids. Our findings suggest that elevated PFOA in human milk is related to metabolomic profiles consistent with enlarged milk fat globule membranes and altered fatty acid metabolism. Further, our study supports the theory that PFAS share mammary epithelial membrane transport mechanisms with fatty acids and associate with metabolic markers of reduced milk production.

Immigrant Generation, Ethnicity, and Early-life Education Outcomes: Evidence from the Born in Bradford Family Cohort Study

Abstract This paper examines the relationship between ethnicity and immigrant generation in relationship to early educational outcomes and their potential determinants. Using Born in Bradford, a large longitudinal birth cohort, and its linked education and health records, we investigated the associations between ethnicity, immigration generations and education measures (Early Years Foundation Stage Profile and National Curriculum Key Stage One). We looked at the children of both first- and second-generation immigrants and compared them with White British non-immigrant children. Logistic regressions were used to examine the explanatory factors of the differences. On the Early Years Foundation Stage Profile, children of first-generation Pakistani immigrants did less well than White British non-immigrant children. This was largely related to language barriers. There were no significant differences between the children of second-generation Pakistani families and children of White British non-immigrant families. In Key Stage One results, there were no differences in reading and maths between children of first-generation Pakistani immigrants and the White British children, however, children of first-generation Pakistani immigrants had better scores in Key Stage One writing. Children of second-generation Pakistani immigrants had better odds of achieving expected standards in most models for reading and writing (but not maths) than the White British children. This might be attributed to better socioeconomic circumstances. Immigrant generation is an independent predictor for early educational outcomes. There are different patterns associated with different immigrant generations. Early life policy interventions to help children of first-generation immigrant with their English language before school could improve these children’s school readiness.

In vitro fertilization and long-term child health and development: nationwide birth cohort study in Japan

AbstractThe aim of this study is to compare long-term health outcomes between IVF-conceived children and non-IVF-conceived children in Japan, in the context of strong recommendation for single embryo transfer. Using data from a nationwide birth cohort linked with perinatal database, this study analyzed 2140 children born in Japan in May 2010. It compared child health and development outcomes up to 9 years of age between IVF-conceived and non-IVF-conceived children (binary exposure). A Poisson regression with robust variance to estimate the risk ratios for the association between IVF and various long-term child health and developmental outcomes. After adjusting for confounding factors, no significant differences were observed between IVF-conceived and naturally conceived children for most outcomes, including hospitalization, obesity, and developmental milestones. IVF-conceived children showed a slightly lower risk of attention problems at 8 years (adjusted Risk Ratio [aRR]: 0.73, 95% CI: 0.53–1.00). In subgroup analyses, IVF-conceived term children and singletons demonstrated reduced risk of cognitive delays at 5.5 years (aRR: 0.31, 95% CI: 0.10–0.96 and aRR: 0.37, 95% CI: 0.14–0.98, respectively).Conclusion: In this Japanese cohort, IVF conception was not associated with adverse long-term health or developmental outcomes. These findings provide reassurance about the safety of IVF, particularly in the context of single embryo transfer policies. Further research is needed to explore specific IVF protocols and subgroups. What is known:• Long-term health and developmental outcomes of IVF-conceived children remain inconsistent across studies and populations, despite the widespread use of this technology. What is new:• A nationwide population-based cohort study in Japan did not show adverse effects of IVF on long-term child health and development through age 9.• These findings provide reassurance about the safety of IVF, while indicating the need for careful monitoring in specific subgroups such as preterm and multiple births.

Deficiency of FABP7 Triggers Premature Neural Differentiation in Idiopathic Normocephalic Autism Organoids

AbstractAutism spectrum disorder (ASD), which is caused by heterogeneous genetic and environmental factors, is characterized by diverse clinical phenotypes linked to distinct pathological mechanisms. ASD individuals with a shared clinical phenotype might contribute to revealing the molecular mechanism underlying ASD progression. Here, it is generated induced pluripotent stem cell (iPSC)‐derived cerebral organoids from normocephalic individuals with ASD in a prospective birth cohort with a shared clinical diagnosis. Multiple cell lines and time series scRNA‐seq combined with a histomorphological analysis revealed premature neural differentiation of neural stem cells (NSCs) and decreased expression of Fatty acid binding protein 7 (FABP7) in ASD organoids. It is subsequently revealed alterations in the phosphorylation levels of Mitogen‐Activated Protein Kinase Kinase 1/2 (MEK1/2), which are downstream of FABP7, and the regulation of the FABP7/MEK pathway reversed improper neural differentiation in the ASD organoids. Moreover, both Fabp7‐knockdown and MEK2‐overexpressing mice exhibited repetitive stereotyped behaviors and social defects relevant to autism. This study reveals the role of the FABP7/MEK pathway in abnormal NSC differentiation in normocephalic individuals with ASD, which might provide a promising therapeutic target for ASD treatment.

A prospective multicenter birth cohort in China: pregnancy health atlas.

The China Prospective Multi-Center Birth Cohort Study was launched in 2022. In collaboration with medical centers in 12 cities, it aims to establish a high-quality, multidimensional cohort comprising 20,000 natural pregnancy and assisted reproductive families. As of June 26, 2024, 12,911 pregnant women have participated in this study, and 161,122 biological samples have been collected. These samples cover four critical periods (early pregnancy, mid-pregnancy, late pregnancy, and postpartum) and comprise 10 different types such as serum, plasma, and urine. The study has collected comprehensive information from early pregnancy to newborns. The participants have an average age of 29.76years, an average height of 160.46cm, an average pre-pregnancy BMI of 23.11, and an average BMI of 27.25 before delivery. The cohort includes individuals from 26 ethnic groups, with 25 minority groups comprising 5.03% of the population. Guizhou Province exhibits the highest percentage of ethnic minorities at 24.96% and Guangdong Province owns the highest proportion (12.22%)of women with two or more children. The prevalence of thalassemia in Guangdong Province is seven times higher than in other provinces. Among pregnant women over 35years old, the prevalence of gestational diabetes mellitus is twice that of women under 35. Additionally, the prevalence of preeclampsia in women with assisted reproductive pregnancies is more than twice that of those with natural pregnancies. The study extensively collected diverse data and biological samples, making this cohort an ideal candidate for DOHaD field and multi-omics research.

Mental health, risk behaviors, and social life factors in relation to adolescents' suicide ideation, plans and attempt.

This study investigated differences in mental health and well-being, risk behaviors, and social life factors among adolescents who experienced different forms of suicidality. We examined 18-years-olds in the Danish National Birth Cohort (N = 47,852). Suicidality was defined with mutually exclusive categories ranging from no suicidality, self-reported suicide ideation, plans, and attempt as well as hospital-recorded suicide attempt. The proportion of adolescents with self-reported poor mental health and well-being, risk behaviors, and social life factors were compared across forms of suicidality. Sample weights were applied. Depressive symptoms were reported by 14% (95% CI 13%;14%) of girls with no suicidality, 44% (95% CI 43%;45%) of girls with suicide ideation, and 68% (95% CI 65%;72%) 66% (95% CI 60%;72%) of girls with self-reported suicide attempt or hospital-recorded suicide attempt respectively. Among boys, depressive symptoms were reported by 5% (95% CI 4%;5%) of those with no suicidality, 27% (95% CI 26%;28%) of those with suicide ideation, and 51% (95% CI 45%;57%) and 40% (95% CI 22%;58%) of those with self-reported suicide attempt or hospital-recorded suicide attempt respectively. Likewise, other aspects of poor mental health and well-being gradually increased relative with more severe forms of suicidality, while no notable differences were identified between adolescents with self-reported and hospital-recorded suicide attempt. Similar tendencies were observed for risk behaviors and social life factors. These findings suggest that adolescents with suicidality, including the large proportion with suicide ideation only, faces challenges across several parameters of mental health and well-being, risk behavior, and social life factors. This emphasizes the need for community-based interventions to identify and support the large group of adolescents experiencing both more and less severe forms of suicidality. Clinicians should prioritize comprehensive psychiatric intervention to address the complex needs of suicidal adolescents effectively.

The Legacy of Redlining: Increasing Childhood Asthma Disparities through Neighborhood Poverty.

Rationale: Identifying the root causes of racial disparities in childhood asthma is critical for health equity. Objectives: To determine whether the racist policy of redlining in the 1930s led to present-day disparities in childhood asthma by increasing community-level poverty and decreasing neighborhood socioeconomic position (SEP). Methods: We categorized census tracts at the birth address of participants from the Children's Respiratory and Environmental Workgroup birth cohort consortium into categories A, B, C, and D as defined by the Home Owners Loan Corporation, with D being the highest perceived risk. Surrogates of present-day neighborhood-level SEP were determined for each tract, including the percentage of low-income households, the CDC's Social Vulnerability Index, and other tract-level variables. We performed causal mediation analysis, which, under the assumption of no unmeasured confounding, estimates the direct and mediated pathways by which redlining may cause asthma disparities through tract-level mediators adjusting for individual-level covariates. Measurements and Main Results: Of 4,849 children, the cumulative incidence of asthma through age 11 was 26.6%, and 13.2% resided in census tracts with a Home Owners Loan Corporation grade of D. In mediation analyses, residing in Grade-D tracts (adjusted odds ratio = 1.03 [95% confidence interval = 1.01, 1.05]) was significantly associated with childhood asthma, with 79% of this increased risk mediated by percentage of low-income households; results were similar for the Social Vulnerability Index and other tract-level variables. Conclusions: The historical structural racist policy of redlining led to present-day asthma disparities in part through decreased neighborhood SEP. Policies aimed at reversing the effects of structural racism should be considered to create more just, equitable, and healthy communities.

Snus and cardiometabolic health markers among Swedish young adults.

Snus is suggested as a risk factor for cardiometabolic disease, but little is known about health effects in young populations, particularly in women. We aimed to investigate associations between snus and cardiometabolic health markers among young men and women. This study was conducted within the BAMSE birth cohort and included participants followed up around 24 years (n=2256) and 26 years (n=1011). Snus use was assessed at 24 years by questionnaires. Cardiometabolic health markers were recorded at clinical examinations at 24 and 26 years. Associations between snus use and cardiometabolic markers were assessed by multivariable linear regression. Snus was used by 6.4% (n=81) among women and 21.9% (n=219) among men. Compared to no tobacco use, daily exclusive snus use among women at 24 years was associated with higher body mass index (BMI) (adjusted β: 1.93kg/m2, 95% CI: 0.54, 3.33) and waist circumference (WC) (aβ: 3.80cm, 95% CI: 0.41, 7.18) at 24 years, and with higher BMI (aβ: 2.73kg/m2, 95% CI: 0.53-4.93) at 26 years. Among men, using ≥4 cans/week was associated with increased BMI (aβ: 2.48kg/m2, 95% CI: 0.73, 4.24) and a tendency toward increased body fat (aβ: 2.31%, 95% CI: -0.53, 5.14) at 26 years. Snus use was not associated with glycemic status or blood pressure. Our results suggest that snus is associated with increased BMI, and possibly other measures of adiposity, among young women and heavy using young men. Given the cross-sectional study design, the results should be interpreted with caution. We found cross-sectional associations between snus use and measures of increased adiposity in a cohort of Swedish young adults, including BMI and waist circumference among women and BMI among heavy snus using men. We did not find associations between snus use and body fat %, glycemic status or blood pressure. This is one of few studies to investigate health effect of snus among both women and men as well as cardiometabolic health markers in young adults. Given the recent trends of increased snus use among young adults, our findings highlight the need for further research on snus on cardiometabolic health.

The role of neighborhood on preterm birth among a high-risk group of birthing people in Boston, MA.

Preterm birth (PTB) is associated with adverse short- and long-term health. There are known racial, ethnic, and socioeconomic inequities in PTB. Because of historical de jure and modern-day de facto segregation and neighborhood divestment, neighborhoods are a source of structural racism and disenfranchisement and a potential target for policies and interventions to reduce PTB inequity. However, the role of neighborhoods on PTB, specifically among high-risk birthing people, is largely unexplored. The Boston Birth Cohort is a longitudinal birth cohort of birthing people-infant dyads at a safety-net hospital in Boston, MA between 2000 and 2018. The primary outcome was preterm birth at 35 weeks or prior. The primary predictor was neighborhood defined by census tract. We used generalized linear mixed effects models to test our hypothesis that neighborhood accounts for a signficiant proportion of PTB risk among socially at-risk birthing people. In multilevel models, neighborhoods were a significant predictor of preterm birth, yet accounted for only 3% of the variability in outcome. In models stratified by race, individual-level factors such as prior preterm birth, nativity status, and advanced birthing person age were significant predictors of PTB. Neighborhood is a significant, though small, predictor of preterm birth in a high-risk birthing population. These findings suggest that individual-level interventions, rather than neighborhood-level policies, may be more effective in reducing preterm birth among high-risk birthing populations.

Body mass index and breast cancer risk in premenopausal and postmenopausal East Asian women: a pooled analysis of 13 cohort studies.

It has been suggested that the association between body mass index and breast cancer risk differs between Asian women and Western women. We aimed to assess the associations between body mass index and breast cancer incidence in East Asian women. Pooled analyses were performed using individual participant data of 319,189 women from 13 cohort studies in Japan, Korea, and China. Participants' height and weight were obtained by measurement or self-reports at cohort baseline. Breast cancer was defined as code C50.0-C50.9 according to the International Classification. Using a Cox proportional hazards model, hazard ratios of breast cancer were estimated for each body mass index category, with the reference group set as the group with a body mass index of 21 to < 23 kg/m2. The hazard ratio for a 5kg/m2 increase in body mass index was also calculated. During a mean 16.6 years of follow-up, 4819 women developed breast cancer. Similar to Westerners, a steady increase in breast cancer risk with increasing body mass index was observed in postmenopausal women, but the slope of the risk increase appeared to slow at a body mass index of 26-28 kg/m2. In premenopausal women, the inverse association seen in Westerners was not observed. The risk of developing breast cancer after 50 years of age increased slightly with increasing body mass index, which was more pronounced in the older birth cohort. There was no significant association between body mass index and the risk of developing breast cancer before 50 years of age, but the risk estimates changed from positive to negative as the birth cohort got younger. In East Asia, the role of body mass index in breast cancer in premenopausal women may be changing along with the increase in obesity and breast cancer. The increased risk of postmenopausal breast cancer with a higher body mass index was as robust as that of Western women.

Trends of extreme hyperbilirubinemia related infant mortality in select European countries (1990-2019).

Limited data exist on population-level mortality outcomes related to extreme neonatal hyperbilirubinemia (EHB) and this study examines trends in annual infant mortality rate (IMR) attributed to hemolytic and perinatal jaundice among Germany, France, Italy, Portugal, Greece and Spain from 1990 to 2019. Data on annual incident cases and disability-adjusted life years were collected from the 2019 Global Burden of Disease study. Live birth cohort data were sourced from UN World Population Prospects. We quantified temporal trends, with relative percent changes. Average annual percent changes (AAPCs) were evaluated using the Joinpoint Regression Program. EHB-related infant mortality decreased from 21.4 (95%CI: 16.1, 27.1) in 1990 to 4.2 (95%CI: 1.9, 7.6) per million live births in 2019. Germany demonstrated lowest AAPC of -3.2% (95% CI: -3.8, -2.5), while Portugal had the highest AAPC of -8.6% (95% CI -11.9, -5.1) in reducing infant mortality due to EHB. There were distinct divergences in the trajectories of declining EHB mortality among the studied countries. This study highlights a significant decline in infant mortality due to extreme hyperbilirubinemia, emphasizing the need for national surveillance and tailored guidelines to prevent bilirubin induced neurological damage. This cross-sectional analysis revealed a marked decline in infant mortality rates attributed to extreme hyperbilirubinemia across the selected European countries. The rates of decline varied significantly between countries, demonstrating notable heterogeneity in mortality trends when stratified by age at death. Implementing data-driven surveillance systems can optimize the alignment of equitable healthcare services, strengthen accountability measures, and identify critical operational inefficiencies. In the European Union, country-specific hyperbilirubinemia guidelines should be reinforced to ensure effective screening and post-discharge follow-up protocols that are tailored to risk burden and available healthcare resources.

Long term links between maternal diet during pregnancy and offspring health.

The developmental origins of health and disease hypothesis propose that lifelong health is programmed during foetal development, in utero. The world's population is ageing due to increased longevity but expanding morbidity and the associated burden on health systems around the planet, are associated with this. Consequently, resources are strained and spent largely on treating patients rather than preventing chronic diseases at their source. Research on early life exposures, starting in the womb, is needed to identify new potential biomarkers linked with the development of chronic diseases during adulthood. Evidence from maternal-offspring cohorts investigating associations between pregnancy exposures and childhood metabolic health is reviewed (The GUSTO study in Singapore, the Copenhagen Prospective Studies on Asthma in Childhood, a mother-child cohort in rural Gambia, the MINIMat study in Bangladesh, The Iodine Status in Pregnancy and Offspring Health Cohort in China, the OBESO cohort in Mexico, the Pune Nutrition study in India, The Reus-Tarragona Birth Cohort study in Spain). Collectively, evidence from prospective observational studies, randomised controlled trials and animal studies, supports the hypothesis that maternal diet, lifestyle and nutritional status during pregnancy are associated with childhood metabolic health in the offspring. However, the evidence is scant and further research is needed.

No Socioeconomic Inequalities in Mortality among Catholic Monks: A Quasi-Experiment Providing Evidence for the Fundamental Cause Theory.

We propose a novel approach to test the fundamental cause theory (FCT) by analyzing the association between socioeconomic status (SES), as measured by the order titles "brothers" and "padres," and mortality in 2,421 German Catholic monks born between 1840 and 1959. This quasi-experiment allows us to study the effect of SES on mortality in a population with largely standardized living conditions. Mortality analyses based on Kaplan-Meier product limit estimation show that there were no statistically significant survival differences between the high and lower SES monks. This holds for all birth cohorts, indicating that monastic life offers health protection for monks with a lower SES regardless the disease patterns, causes of death, or main risk factors in a given period. These findings support the FCT: Whereas SES-related differences in mortality are a widely confirmed finding in the general population, a context with largely standardized conditions eliminates the importance of SES-related resources.

Trends in the practice environment of Chinese healthcare professionals from 2008 to 2023: an age period cohort analysis.

Healthcare practice environment plays a vital role in evaluation and the development of health sector in China. However, there are few comprehensive reviews and studies focusing on its state and changing trends. This study aimed to examine the dynamic trends in Chinese healthcare professionals' perceptions of their practice environment from 2008 to 2023 using age period cohort (APC) analysis. Four national cross-sectional surveys of healthcare professionals were conducted in 2008, 2013, 2018, and 2023. APC analysis was performed to distinguish effects of age, period and cohort. Covariates like gender, department, job satisfaction, and doctor-patient relationships were also analyzed. Between 2008 and 2023, healthcare professionals' perceptions of their practice environment first declined and then improved. Those aged 28-38 during 2013-2018 and born between 1978 and 1988 had the most negative perceptions. After 2018, perceptions improved, peaking in 2023. Those under 23 and over 43 exhibited larger age effects. Birth cohorts after 1993 also had more positive effects. Controlling for covariates attenuated APC effects. Females, those in obstetrics and emergency medicine, nurses, technicians, and administrators perceived better environments. Higher job satisfaction and doctor-patient relationship harmony are also associated with more positive perceptions. Income matching efforts and perceptions of promotion fairness had positive impacts, while increasing severity of physical fatigue and psychological anxiety negatively influenced perceptions of the practice environment. The APC analysis provided nuanced insights into evolving practitioner perceptions amid healthcare reforms in China. Tailored policies focused on career stage and generation are needed to address disruptions and sustain improvements. Monitoring feedback on reforms and changes is essential for optimizing the practice environment over time.

Oncoming Revolution in the Next Generation of Cohort Studies

The world is changing rapidly, mainly due to the impact of megatrends that have an impact on the entire human life, particularly in medical sciences. Medical research methodologies such as cohort studies provide very critical information, but it is not clear what would be its destination in the future. In this short article, we have tried to offer a somewhat different perspective on the future of cohort studies by analyzing the texts and their conclusions from the author's viewpoint. According to our assessment, cohorts will play a key role in medical research, but their methodology will significantly change in terms of designing, implementing, analysing, and applying the findings. The new generation of cohort study extracts most of their information from electronic health records, and it is not just restricted to a particular geographic area. With the changes in the levels of occupational exposure, risk factors, and the introduction of Omics, likely, occupational and birth cohorts as well as human diseases will likely undergo fundamental changes in the future. Big data will provide researchers with new opportunities, but information extraction and analysis require a team of specialists from several scientific fields. Furthermore, participants are likely to play a more active role in setting priorities and implementing research findings.