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This paper considers the extent to which awareness of the growing number of older people with intellectual disability in the UK has translated into action. It does so by looking at current policy, training and services for older people with intellectual disability. Information was collected from two sources: an analysis of the 1993/1994 Community Care Plans and a national survey on policy, training and services for older people with intellectual disability. The analysis of Community Care Plans revealed that 67% made no reference to older people with intellectual disability. The remaining 33% mentioned such people mainly in the context of the need for service development. 82% of the 236 replies to the national survey indicated that there was no policy in relation to older people with intellectual disability and 74% indicated an absence of specific staff training. 53% of respondents were aware of services in their area specifically for older people with intellectual disability and 76% were aware of generic services for the elderly in their area that were used by older people with intellectual disability. Finally, the results of a consultation exercise regarding the development of a training pack in ageing and intellectual disability are presented. The results highlight a lack of consensus about how services should be provided and, in many cases, a lack of provision.

ABSTRACTObjectiveMaternal obesity during pregnancy is a risk factor for increased childhood body mass index (BMI) and the mechanism may be causal or confounded by lifestyle common to mother and child. We studied BMI in siblings and their mothers to test the hypothesis that siblings born after maternal weight gain will have increased BMI compared to older siblings. ApproachThis was a whole population data linkage study using data from North East Scotland, UK. Databases containing details from pregnant mothers and their five-year-old children born between 1997 and 2005 were linked using the community health index number. Childhood BMI and the difference between siblings BMI were related to maternal weight gain between pregnancies. Covariates included maternal obesity, smoking, socioeconomic status and the child's birth weight.ResultsMaternal weight gain between pregnancies was determined for 5,863 mothers in whom 718 had >2 pregnancies. Childhood BMI z score was increased in association with maternal obesity (mean increase 0.47 [95% CI 0.39, 0.56]) and with ≥10% maternal weight gain between pregnancies (mean increase 0.14 [95% CI 0.06, 0.21]), independent of covariates. In contrast, increased BMI z score for younger siblings, compared to older siblings, was not associated with maternal obesity in the earlier pregnancy or maternal weight gain between pregnancies. BMI z score was higher in younger compared to older siblings in association with deprivation (mean difference between most and least affluent categories 0.29 [0.08, 0.37]), persistent or new onset maternal smoking (increased by mean of 0.10[0.00, 0.19] for always smokers and 0.20[0.03, 0.38] for those starting compared to never smoked) and increased birth weight (BMI z score increased by 0.11 for each increase in birth weight z score [0.07, 0.14]).ConclusionWhen within-family confounding is considered, poverty, persistent and new onset maternal smoking during pregnancy and increased birth weight, but not maternal obesity or weight gain, are independent predictors of increased BMI in young children.

This retrospective population-based analysis assessed variations in urgent healthcare use by children and young people (CYP) across UK nations (England, Scotland and Wales) between 2007 and 2017. The study focused on urgent hospital admissions, short stay urgent admissions (SSUA) and Emergency Department (ED) attendances among CYP aged <25 years, stratified by age groups and Index of Multiple Deprivation (IMD) quintile groups. A linear mixed model was used to assess trends in healthcare activity over time and across deprivation quintiles. Urgent admissions, SSUA and ED attendances increased across all deprivation quintiles in all studied nations. Increasing deprivation was consistently associated with higher urgent healthcare utilisation. In England, the rise in urgent admissions and SSUA for CYP was slower for CYP from the quintile of greatest deprivation compared those from the least deprived quintile (respective mean differences 0.69/1000/y [95% CI 0.53, 0.85] and 0.25/1000/y [0.07, 0.42]), leading to a narrowing in health inequality. Conversely, in Scotland, urgent admissions and SSUA increased more rapidly for CYP from all deprivation quintiles, widening health inequality. Understanding the differences we describe here could inform changes to NHS pathways of care across the UK which slow the rise in urgent healthcare use for CYP.

Background Many children are exposed to second-hand smoke in the home and are at increased risk of asthma and other respiratory conditions. In Scotland, a public health mass-media campaign was launched on March 24, 2014, called Take it Right Outside (TiRO), with a focus on reducing the exposure of children to domestic second-hand smoke. In this study, our aim was to establish whether the TiRO campaign was followed by a decrease in hospital admissions for childhood asthma and other respiratory conditions related to second-hand smoke exposure across Scotland. Methods For an interrupted time-series analysis, data were obtained on all hospital admissions in Scotland between 2000 and 2018 for children aged younger than 16 years. We studied changes in the monthly incidence of admissions for conditions potentially related to second-hand smoke exposure (asthma, lower respiratory tract infection, bronchiolitis, croup, and acute otitis media) per 1000 children following the 2014 TiRO campaign, while considering national legislation banning smoking in public spaces from 2006. We considered asthma to be the primary condition related to second-hand smoke exposure, with monthly asthma admissions as the primary outcome. Gastroenteritis was included as a control condition. The analysis of asthma admissions considered subgroups stratified by age and area quintile of the Scottish Index of Multiple Deprivations (SIMD). Findings 740 055 hospital admissions were recorded for children. 138 931 (18·8%) admissions were for respiratory conditions potentially related to second-hand smoke exposure, of which 32 342 (23·3%) were for asthma. After TiRO in 2014, we identified a decrease relative to the underlying trend in the slope of admissions for asthma (−0·48% [–0·85 to −0·12], p=0·0096) in younger children (age

BACKGROUND:Many children are exposed to second-hand smoke in the home and are at increased risk of asthma and other respiratory conditions. In Scotland, a public health mass-media campaign was launched on March 24, 2014, called Take it Right Outside (TiRO), with a focus on reducing the exposure of children to domestic second-hand smoke. In this study, our aim was to establish whether the TiRO campaign was followed by a decrease in hospital admissions for childhood asthma and other respiratory conditions related to second-hand smoke exposure across Scotland. METHODS:For an interrupted time-series analysis, data were obtained on all hospital admissions in Scotland between 2000 and 2018 for children aged younger than 16 years. We studied changes in the monthly incidence of admissions for conditions potentially related to second-hand smoke exposure (asthma, lower respiratory tract infection, bronchiolitis, croup, and acute otitis media) per 1000 children following the 2014 TiRO campaign, while considering national legislation banning smoking in public spaces from 2006. We considered asthma to be the primary condition related to second-hand smoke exposure, with monthly asthma admissions as the primary outcome. Gastroenteritis was included as a control condition. The analysis of asthma admissions considered subgroups stratified by age and area quintile of the Scottish Index of Multiple Deprivations (SIMD). FINDINGS:740 055 hospital admissions were recorded for children. 138 931 (18·8%) admissions were for respiratory conditions potentially related to second-hand smoke exposure, of which 32 342 (23·3%) were for asthma. After TiRO in 2014, we identified a decrease relative to the underlying trend in the slope of admissions for asthma (-0·48% [-0·85 to -0·12], p=0·0096) in younger children (age <5 years), but not in older children (age 5-15 years). Asthma admissions did not change after TiRO among children 0-15 years of age when data were analysed according to area deprivation quintile. Following the 2006 legislation, ...