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Telomere length is a molecular marker of biological aging. Here we investigated whether early-life exposure to residential air pollution was associated with leukocyte telomere length (LTL) at 8 y of age. In a multicenter European birth cohort study, HELIX (Human Early Life Exposome) ([Formula: see text]), we estimated prenatal and 1-y childhood exposure to nitrogen dioxide ([Formula: see text]), particulate matter with aerodynamic diameter [Formula: see text] ([Formula: see text]), and proximity to major roads. Average relative LTL was measured using quantitative real-time polymerase chain reaction (qPCR). Effect estimates of the association between LTL and prenatal, 1-y childhood air pollution, and proximity to major roads were calculated using multiple linear mixed models with a random cohort effect and adjusted for relevant covariates. LTL was inversely associated with prenatal and 1-y childhood [Formula: see text] and [Formula: see text] exposures levels. Each standard deviation (SD) increase in prenatal [Formula: see text] was associated with a [Formula: see text] (95% CI: [Formula: see text], [Formula: see text]) change in LTL. Prenatal [Formula: see text] was nonsignificantly associated with LTL ([Formula: see text] per SD increase; 95% CI: [Formula: see text], 0.6). For each SD increment in 1-y childhood [Formula: see text] and [Formula: see text] exposure, LTL shortened by [Formula: see text] (95% CI: [Formula: see text], [Formula: see text]) and [Formula: see text] (95% CI: [Formula: see text], 0.1), respectively. Each doubling in residential distance to nearest major road during childhood was associated with a 1.6% (95% CI: 0.02, 3.1) lengthening in LTL. Lower exposures to air pollution during pregnancy and childhood were associated with longer telomeres in European children at 8 y of age. These results suggest that reductions in traffic-related air pollution may promote molecular longevity, as exemplified by telomere length, from early life onward. https://doi.org/10.1289/EHP4148.

Telomere length is considered a biomarker of biological aging. Shorter telomeres and obesity have both been associated with age-related diseases. To evaluate the association between various indices of obesity with leukocyte telomere length (LTL) in childhood, data from 1,396 mother-child pairs of the multi-centre European birth cohort study HELIX were used. Maternal pre-pregnancy body mass index (BMI) and 4 adiposity markers in children at age 8 (6–11) years were assessed: BMI, fat mass, waist circumference, and skinfold thickness. Relative LTL was obtained. Associations of LTL with each adiposity marker were calculated using linear mixed models with a random cohort effect. For each 1 kg/m² increment in maternal pre-pregnancy BMI, the child’s LTL was 0.23% shorter (95%CI: 0.01,0.46%). Each unit increase in child BMI z-score was associated with 1.21% (95%CI: 0.30,2.11%) shorter LTL. Inverse associations were observed between waist circumference and LTL (−0.96% per z-score unit; 95%CI: −2.06,0.16%), and skinfold thickness and LTL (−0.10% per z-score unit; 95%CI: −0.23,0.02%). In conclusion, this large multicentric study suggests that higher child adiposity indicators are associated with short telomeres in children, and that associations are stronger for child BMI than for maternal pre-pregnancy BMI.

Background Whole system approaches to public health challenges such as low physical activity levels have the potential to create sustained behaviour change at a population level and tackle health inequalities. However, there is currently little evidence of the nature or effectiveness of adopting whole system approaches. This study evaluated whether a whole system physical activity intervention (JU:MP), was effective at improving accelerometry measured physical activity in five- to eleven-year-olds. Methods A non-randomised controlled trial with two-arms (JU:MP intervention and control), was conducted in multi-ethnic and socioeconomically deprived areas of Bradford, UK with data collected at baseline and 24-months follow-up. Habitual physical activity was measured via accelerometry. Mixed effects regression models identified group differences at 24 months. The primary outcome was moderate-to-vigorous intensity physical activity (MVPA). Secondary outcomes included: accelerometery measured - sedentary time (ST), counts per minute (CPM); BMI z-score, waist circumference, and children’s social, emotional and behavioural health, and quality-of-life via parental and teacher completed questionnaires. An exploratory analysis compared intervention effects between sub-groups. Results 1,453 children were recruited. 330 children with valid wear-time at baseline and 24-months (JU:MP group n  = 175, control group n  = 155) were included in the final analysis of physical activity outcomes. The JU:MP group improved levels of MVPA (+ 4.99 min/day, (CI = 1.01, 8.96), standardised mean difference (SMD) = 0.29), ST ( -8.69 min/day, CI = -16.76, -0.61), SMD = -0.20) and CPM (+ 32.72, CI = 5.93, 59.53, SMD = 0.28) compared to controls. There were minor differences between groups in all secondary outcomes, favouring the JU:MP group. Exploratory sub-group analysis revealed that MVPA improved for boys (+ 7.34 min/days, CI = 0.70, 13.99, SMD = 0.36) and South Asian heritage children (+ 7.20 min/day, CI = 1.67, 12.72, SMD = 0.52) in the JU:MP group compared to the control group. Conclusion This study provides evidence that a whole system, community-based intervention can improve physical activity levels in primary school-aged children, particularly among boys and South Asian children, in deprived and ethnically diverse settings. The findings suggest that whole systems approaches may be effective in mitigating age-related declines in activity and addressing inequalities at scale. Trial registration This study was retrospectively registered with the ISRCTN registry (ISRCTN14332797) on 17/02/2022. Available at: https://www.isrctn.com/ISRCTN14332797 .

Background There is growing interest in the role of patients in improving patient safety. One such role is providing feedback on the safety of their care. Here we describe the development and feasibility testing of an intervention that collects patient feedback on patient safety, brings together staff to consider this feedback and to plan improvement strategies. We address two research questions: i) to explore the feasibility of the process of systematically collecting feedback from patients about the safety of care as part of the PRASE intervention; and, ii) to explore the feasibility and acceptability of the PRASE intervention for staff, and to understand more about how staff use the patient feedback for service improvement. Method We conducted a feasibility study using a wait-list controlled design across six wards within an acute teaching hospital. Intervention wards were asked to participate in two cycles of the PRASE (Patient Reporting & Action for a Safe Environment) intervention across a six-month period. Participants were patients on participating wards. To explore the acceptability of the intervention for staff, observations of action planning meetings, interviews with a lead person for the intervention on each ward and recorded researcher reflections were analysed thematically and synthesised. Results Recruitment of patients using computer tablets at their bedside was straightforward, with the majority of patients willing and able to provide feedback. Randomisation of the intervention was acceptable to staff, with no evidence of differential response rates between intervention and control groups. In general, ward staff were positive about the use of patient feedback for service improvement and were able to use the feedback as a basis for action planning, although engagement with the process was variable. Gathering a multidisciplinary team together for action planning was found to be challenging, and implementing action plans was sometimes hindered by the need to co-ordinate action across multiple services. Discussion The PRASE intervention was found to be acceptable to staff and patients. However, before proceeding to a full cluster randomised controlled trial, the intervention requires adaptation to account for the difficulties in implementing action plans within three months, the need for a facilitator to support the action planning meetings, and the provision of training and senior management support for participating ward teams. Conclusions The PRASE intervention represents a promising method for the systematic collection of patient feedback about the safety of hospital care.

Observational studies indicate children whose mothers have poor mental health are at increased risk of socio-emotional behavioural difficulties, but it is unknown whether these outcomes vary by the mothers’ mental health recognition and treatment status. To examine this question, we analysed linked longitudinal primary care and research data from 1078 women enrolled in the Born in Bradford cohort. A latent class analysis of treatment status and self-reported distress broadly categorised women as (a) not having a common mental disorder (CMD) that persisted through pregnancy and the first 2 years after delivery ( N  = 756, 70.1 %), (b) treated for CMD ( N  = 67, 6.2 %), or (c) untreated ( N  = 255, 23.7 %). Compared to children of mothers without CMD, 3-year-old children with mothers classified as having untreated CMD had higher standardised factor scores on the Strengths and Difficulties Questionnaire ( d  = 0.32), as did children with mothers classified as having treated CMD ( d  = 0.27). Results were only slightly attenuated in adjusted analyses. Children of mothers with CMD may be at risk for socio-emotional and behavioural difficulties. The development of effective treatments for CMD needs to be balanced by greater attempts to identify and treat women.

Objectives To compare a new co-designed, patient incident reporting tool with three established methods of detecting patient safety incidents and identify if the same incidents are recorded across methods. Method Trained research staff collected data from inpatients in nine wards in one university teaching hospital during their stay. Those classified as patient safety incidents were retained. We then searched for patient safety incidents in the corresponding patient case notes, staff incident reports and reports to the Patient Advice and Liaison Service specific to the study wards. Results In the nine wards, 329 patients were recruited to the study, of which 77 provided 155 patient reports. From these, 68 patient safety incidents were identified. Eight of these were also identified from case note review, five were also identified in incident reports, and two were also found in the records of a local Patient Advice and Liaison Service. Reports of patients covered a range of events from their immediate environment, involving different health professionals and spanning the entire spectrum of care. Conclusion Patient safety incidents reported by patients are unlikely to be found through other established methods of incident detection. When hospitalized patients are asked about their care, they can provide a unique perspective on patient safety. Co-designed, real-time reporting could be a helpful addition to existing methods of gathering patient safety intelligence.

Background Growing evidence shows that dysregulated metabolic intrauterine environments can affect offspring’s neurodevelopment and behaviour. However, the results of individual cohort studies have been inconsistent. We aimed to investigate the association between maternal diabetes before pregnancy and gestational diabetes mellitus (GDM) with neurodevelopmental, cognitive and behavioural outcomes in children. Methods Harmonised data from > 200 000 mother-child pairs across ten birth cohorts in Europe and Australia were available. Mother-child pairs were included for analysis to determine whether GDM was recorded (yes or no) and whether at least one neurodevelopmental, cognitive and behavioural outcome was available in children aged 3 to 13 years. Confounder-adjusted regression models were used to estimate associations between maternal diabetes and child outcomes using two-stage individual participant data (IPD) meta-analysis. Model 1 included a crude estimate. The full adjustment model (model 2) included adjustment for child sex, maternal age, pre-pregnancy BMI, pregnancy weight gain, maternal smoking during pregnancy, plurality, parity and maternal education. Results Children (aged 7–10 years) born to mothers with GDM had higher attention-deficient hyperactive disorder (ADHD) symptoms compared to non-exposed controls (model 2, regression coefficient (β) 3.67 (95% CI 1.13, 6.20), P  = 0.001). Moreover, children (aged 4–6 years) born to mothers with GDM exhibited more externalising problems than those born to mothers without GDM (model 2, β 2.77 (95% CI 0.52, 5.02), P  = 0.01). A pre-existing maternal history of type 1 and type 2 diabetes mellitus was associated with ADHD symptoms at 4–6 years (model 1, β 8.82 (95% CI 2.21, 15.45, P  = 0.009) and β 7.90 (95% CI 0.82, 14.98, P  = 0.02), respectively). The association was no longer apparent in further adjustments. Conclusions This study found that children between 4 - 6 and 7–10 years of age born to mothers with GDM have a greater likelihood of developing externalising problems and ADHD symptoms, respectively. Externalising problems often co-exist with ADHD symptoms and precede formal ADHD diagnosis. Overall, this large-scale multi-cohort study suggested that a dysregulated metabolic environment during pregnancy may contribute to ADHD symptoms and externalising problems in young children.

Economic, physical, built, cultural, learning, social and service environments have a profound effect on lifelong health. However, policy thinking about health research is dominated by the ‘biomedical model’ which promotes medicalisation and an emphasis on diagnosis and treatment at the expense of prevention. Prevention research has tended to focus on ‘downstream’ interventions that rely on individual behaviour change, frequently increasing inequalities. Preventive strategies often focus on isolated leverage points and are scattered across different settings. This paper describes a major new prevention research programme that aims to create City Collaboratory testbeds to support the identification, implementation and evaluation of upstream interventions within a whole system city setting. Prevention of physical and mental ill-health will come from the cumulative effect of multiple system-wide interventions. Rather than scatter these interventions across many settings and evaluate single outcomes, we will test their collective impact across multiple outcomes with the goal of achieving a tipping point for better health. Our focus is on early life (ActEarly) in recognition of childhood and adolescence being such critical periods for influencing lifelong health and wellbeing.

BackgroundIn England and Wales, a significant number of homes—about 3–6%—face severe issues with dampness and mould, affecting approximately 2 million people. These problems aren’t just cosmetic; they can lead to and worsen conditions such as asthma and allergies, making life difficult for those affected. However, we don’t have enough detailed information on which areas are most affected by damp and mould, making it difficult to investigate health impacts and tackle the problem in a proactive way to public health.MethodsThis two-part research project is 1) developing a model to predict and map the spatial distribution of damp and mouldy housing across England. By analysing data from national housing surveys spanning the past decade, we are developing a statistical model that can pinpoint homes that are likely to have issues with damp, mould, or damp and mould, validated by housing data from local authorities and self-reported damp and mould in children’s homes withing the Born-in-Bradford cohort. 2) We are also analysing health data from the Born-in-Bradford cohort, amongst children aged 3–6 years (n=2594) and aged 6–11 years old (n=1543), to estimate confounder adjusted impacts of living in damp and mouldy homes on children’s lung health from young age to adolescence.ResultsThe analysis of this work is on-going; however, early analyses indicate that the spatial damp and mould risk model has a high predictive accuracy (out of sample AUC: 0.86). Furthermore, statistically significant (p-value <0.05) crude odds ratios were observed amongst children aged 3–6 years old between mould in the child’s bedroom wheeze (OR: 1.78) and breathing difficulties (OR: 2.03) in the past 12 months, as well as with prevalent (OR: 2.48) and incident (OR: 2.67) hayfever amongst children 6–11 years old. Other marginally significant odds ratios were identified for other outcomes (e.g., prevalence and incident asthma) as well as other measures of exposure (damp in the home; mould in the home). Future epidemiological models in development will control for a range of confounders and explore effect modification with housing tenure, housing type, and socioeconomic status.ConclusionThis research will provide crucial insights into the health impacts of living in damp and mouldy homes, which will support the development of policies, interventions, and programmes aimed at making homes healthier to live in today and in the future.

BackgroundThe Developmental Origins of Health and Disease (DOHaD) hypothesis suggests that early life environmental exposures, especially during pregnancy, can impact long-term health. Research has largely focused on maternal factors, with less attention given to paternal, postnatal, and broader social determinants. This focus, combined with reliance on correlational evidence, could complicate efforts to determine the most effective strategies for improving population health.MethodsUsing harmonised data across four longitudinal cohort studies, we took a systematic approach to explore associations of prenatal health behaviours (smoking, alcohol, and caffeine consumption) at up to nine timepoints and low socioeconomic position (SEP), in both mothers and their partners, with 69 child health-related outcomes (e.g. outcomes related to body size and composition, cognitive function, mental health, blood pressure, allergy, etc) at up to four ages. Where possible, cohort estimates were meta-analysed, yielding a maximum sample size of over 256,000. We triangulated evidence of causality across analyses with genetic risk scores (Mendelian randomization), maternal-vs-paternal and during-vs-post-pregnancy negative controls, and examining dose-response. This comprehensive set of analyses generated more than 570,000 effect estimates. We developed a web app, EPoCH Explorer (https://gcsharp.shinyapps.io/EPoCH/), to visualise and share our results in an accessible format.ResultsWe did not find strong evidence for widespread or large effects of parental health behaviors on child health and wellbeing. Only 6% of analyses had a Cohen’s D>0.2 and FDR-adjusted P<0.05. In most analyses, the effect estimate was similar for mothers and partners, with 51% showing a larger effect for mothers and 49% for partners. Despite the lack of widespread associations, we found consistent evidence for parental smoking affecting a few offspring outcomes: partner smoking was linked to higher social communication difficulties, while maternal smoking was associated with small for gestational age, higher childhood BMI, depressive symptoms, and behavioural issues. Overall, we found stronger evidence of child outcomes being associated with low SEP than with health behaviors: 15% of results for low SEP had D>0.2 and FDR-P<0.05, compared to 6% for parental smoking, 3% for alcohol, and 0.4% for caffeine.ConclusionOur findings support calls for the DoHAD field to expand the traditional focus on maternal pregnancy effects. Our study also suggests that interventions to improve population health may be most effective if they target wider social inequalities that correlate with socially-patterned parental health behaviours. We encourage researchers to use EPoCH Explorer to prioritise associations for exploration in their own datasets, thus enabling replication and cross-context comparison to validate and extend the generalisability of our findings.