Michelle Heys

OBJECTIVES: In western populations, young age of menarche is associated with increased cardiovascular risk. Little is known about the potential impact of menarche on the metabolic syndrome (as a proxy for cardiovascular risk) in rapidly economically developing populations where age of menarche is falling. We sought to determine the relation between age of menarche and the metabolic syndrome in a rapidly developing Chinese population. METHODS: We carried out a retrospective historical cohort study of 7349 women from the Guangzhou Biobank Cohort Study, China, enrolled in 2003-2004. Cardiovascular risk factors were obtained from physical examination; age of menarche was obtained from self-report. The main outcome measure was the metabolic syndrome and its components. RESULTS: Adjusted for age, education, and number of pregnancies, young age of menarche (<12.5 years) compared with age of menarche > or =14.5 years was associated with a higher risk of the metabolic syndrome (odds ratio = 1.49; 95% confidence interval = 1.22-1.82), central obesity (1.35; 1.10-1.65), raised blood pressure (1.34; 1.09-1.65), raised fasting glucose (1.40; 1.15-1.71), and higher triglyceride levels (1.36; 1.12-1.67). Further adjustment by waist circumference attenuated these effects, but the odds ratios remained elevated. CONCLUSIONS: Earlier age of menarche experienced by younger women in China today, now 12.5 years on average in urban populations, may contribute to an increase in the metabolic syndrome and thereby an increase in cardiovascular disease as these women age. These results further highlight the importance of childhood antecedents of adulthood disease.

OBJECTIVE: To assess the impact of a Hib vaccination booster campaign targeting children aged 6 months to 4 years between May and September 2003, following a nationwide increase in the number of invasive Haemophilus influenzae serotype b (Hib) cases in all age groups after 1999. DESIGN: The Health Protection Agency Centre for Infections prospectively monitors all cases of H influenzae disease in England and Wales and collects data from primary care trusts (PCTs) on coverage for vaccines in the childhood programme. POPULATION: Adults and children in England and Wales (January 1991 to December 2006) RESULTS: Data on vaccine coverage during the Hib booster campaign were available for 288/303 (95%) PCTs in England and revealed coverage of 71.8% for the 6-12-month age group and 63.2% for the 13-48-month age group. The Hib booster campaign resulted in a dramatic reduction in cases within 12 months in the age groups targeted for the booster. This decline was followed by a reduction in the number of cases reported among older children and adults. Since the campaign, however, there has been an increase in the number of cases reported among 1-3-year-old children (13 cases in 2004, 26 cases in 2005 and 32 cases in 2006), primarily in children who were too young to be vaccinated in the booster campaign. This group of children will be targeted in the pre-school catch-up programme that began in September 2007. CONCLUSIONS: The Hib booster campaign has helped to re-establish herd immunity in the UK. The increase in Hib disease among toddlers after 2004 supports the decision to introduce routine boosting for Hib at 12 months of age.

OBJECTIVE: To evaluate the effect of two postnatal professional support interventions on the duration of any and exclusive breastfeeding. DESIGN: Multicentre, three-arm, cluster randomised controlled trial. POPULATION: A cohort of 722 primiparous breastfeeding mothers with uncomplicated, full-term pregnancies. METHODS: The three study interventions were: (1) standard postnatal maternity care; (2) standard care plus three in-hospital professional breastfeeding support sessions, of 30-45 minutes in duration; or (2) standard care plus weekly post-discharge breastfeeding telephone support, of 20-30 minutes in duration, for 4 weeks. The interventions were delivered by four trained research nurses, who were either highly experienced registered midwives or certified lactation consultants. MAIN OUTCOME MEASURES: Prevalence of any and exclusive breastfeeding at 1, 2, and 3 months postpartum. RESULTS: Rates of any and exclusive breastfeeding were higher among participants in the two intervention groups at all follow-up points, when compared with those who received standard care. Participants receiving telephone support were significantly more likely to continue any breastfeeding at 1 month (76.2 versus 67.3%; odds ratio, OR 1.63, 95% confidence interval, 95% CI 1.10-2.41) and at 2 months (58.6 versus 48.9%; OR 1.48, 95% CI 1.04-2.10), and to be exclusively breastfeeding at 1 month (28.4 versus 16.9%; OR 1.89, 95% CI 1.24-2.90). Participants in the in-hospital support group were also more likely to be breastfeeding at all time points, but the effect was not statistically significant. CONCLUSIONS: Professional breastfeeding telephone support provided early in the postnatal period, and continued for the first month postpartum, improves breastfeeding duration among first-time mothers. It is also possible that it was the continuing nature of the support that increased the effectiveness of the intervention, rather than the delivery of the support by telephone specifically.

There is no doubt that coronavirus disease 2019 (COVID-19) has huge economic implications as highlighted by the media, but there are also a myriad of considerable direct and indirect health, social, and educational consequences for children and families experiencing homelessness, while living in temporary or insecure accommodation (eg, staying with friends or family, sofa surfing, shelters, bed and breakfast lodging). In particular, young children (aged ≤5 years) living in temporary accommodation have an invisible plight that might not seem obvious to many people because they are not on the streets as homeless (eg, rough sleepers), but are perhaps the most susceptible to viral infection because of pre-existing conditions (eg, diabetes, asthma, epilepsy, anxiety, depression).1Story A Slopes and cliffs in health inequalities: comparative morbidity of housed and homeless people.Lancet. 2013; 382: S93Summary Full Text Full Text PDF Google Scholar Additionally, these children rarely have the ability to self-isolate and adhere to social distancing, with previous extreme inequalities and inequities in accessing health care becoming exacerbated. In 2019, the charity Shelter reported that a child loses their home every 8 min in Great Britain, which is the equivalent of 183 children per day.2Reynolds L Dzalto A Generation homeless: the numbers behind the story.https://england.shelter.org.uk/__data/assets/pdf_file/0009/1876518/Generation_homeless.pdfDate: Dec 3, 2019Date accessed: January 15, 2020Google Scholar The total number of children who were homeless and in temporary accommodation increased to 126 020 in England in 2019, of whom 88 080 were in London.2Reynolds L Dzalto A Generation homeless: the numbers behind the story.https://england.shelter.org.uk/__data/assets/pdf_file/0009/1876518/Generation_homeless.pdfDate: Dec 3, 2019Date accessed: January 15, 2020Google Scholar The Children's Commissioner suggested that there could be more than 210 000 homeless children in temporary accommodation or sofa surfing and approximately 585 000 who are either homeless or at risk of becoming homeless in England.3Children's CommissionerBleak houses: tackling the crisis of family homelessness in England.https://www.childrenscommissioner.gov.uk/wp-content/uploads/2019/08/cco-bleak-houses-report-august-2019.pdfDate: Aug 21, 2019Date accessed: March 30, 2020Google Scholar How do these children cope during this pandemic? Homeless children aged 5 years and younger are not only at high risk of exposure and transmission due to overcrowding in substandard housing, but also of immediate and long-term effects on growth, optimal health, and brain development. According to UNICEF, “The first 1000 days can shape a child's future. We have one chance to get it right”,4UNICEFEarly moments matter.https://www.unicef.org/early-momentsDate accessed: March 18, 2020Google Scholar which also extends to the first 5 years. Many children already do not reach development potential or struggle to grow and develop because of multilevel barriers, including those resulting from poverty or homelessness. However, COVID-19 has added a whole new layer of risk. First, many families have to live in a single bedroom with shared kitchen and toilet facilities, causing overcrowding and making self-isolation impossible in confined spaces.5Garvie D Self-isolation? Try it as a homeless family living in one room.https://blog.shelter.org.uk/2020/03/self-isolation-try-it-as-a-homeless-family-living-in-one-room/Date: March 20, 2020Date accessed: March 20, 2020Google Scholar Often, children have inadequate space to crawl or play and no access to fresh air. Second, no regulation on temporary accommodation exists regarding what is deemed suitable or how long someone can stay in temporary housing. With COVID-19, these children will stay in temporary accommodation for extended periods because no applications or services are being processed or provided. Third, handwashing and hygiene are reduced because of minimal access to soap, water, disinfectants, and bathrooms. Another issue is that no face-to-face contact with general practitioners and health outreach services is available, including health visitors, which limits routine checks such as early identification of need and risk, health and development reviews with screening assessments, immunisations, promotion of social and emotional development, support for parenting, promotion of health and behavioural change, prevention of obesity, and promotion of breastfeeding.6Department of HealthHealthy child programme: pregnancy and the first five years of life.https://www.gov.uk/government/publications/healthy-child-programme-pregnancy-and-the-first-5-years-of-lifeDate: October 2009Date accessed: February 19, 2020Google Scholar Furthermore, for these families, access to basic essentials (eg, food, nappies) is scarce, with no resources to shop online and many charities and dropins now closed. Additionally, they do not have regular support services (eg, legal advice, weekly allowances, housing or immigration, online access to resources from the National Health Service via WiFi). A further consideration is that risks to parental mental health are increased, especially among single mothers, given that housing instability is associated with an increased risk of depression in mothers.7Marcal K Timing of housing crises: impacts on maternal depression.Soc Work Ment Health. 2018; 16: 266-283Crossref PubMed Scopus (11) Google Scholar Finally, existing vulnerabilities and risk factors for safeguarding are exacerbated by additional factors introduced by the pandemic. Because the duration of the outbreak is unclear and these children are more vulnerable to both primary and secondary effects, it is absolutely vital that they are not further marginalised. The UK Government needs to take necessary steps and work collaboratively with all sectors, health services, and the housing sector (eg, possibly use hotels with space availability due to no incoming tourists) to reduce overcrowding and transmission of COVID-19 to protect some of the most vulnerable in our society. We declare no competing interests. COVID-19 puts societies to the testAs of April 21, the coronavirus outbreak has infected more than 2·3 million people and taken 162 956 lives—35 884 in the USA, 24 114 in Italy, 20 852 in Spain, 20 233 in France, 16 509 in the UK, 5209 in Iran, 4642 in China—all underestimates most probably. Beyond these numbers are people, families, communities, societies that have been affected in unprecedented ways. The coronavirus pandemic puts societies to the test: it is a test of political leadership, of national health systems, of social care services, of solidarity, of the social contract—a test of our very own fabric. Full-Text PDF Open Access