ObjectiveTo evaluate the risk of childhood hospitalization associated with infant feeding patterns at 6-8 weeks of age in Scotland.Study designA retrospective population level study based on the linkage of birth, death, maternity, infant health, child health surveillance, and admission records for children born as single births in Scotland between 1997 and 2009 (n = 502 948) followed up to March 2012. Descriptive analyses, Kaplan Meier tests, and Cox regression were used to quantify the association between the mode of infant feeding and risk of childhood hospitalization for respiratory, gastrointestinal, and urinary tract infections, and other common childhood ailments during the study period.ResultsWithin the first 6 months of life, there was a greater hazard ratio (HR) of hospitalization for common childhood illnesses among formula-fed infants (HR 1.40; 95% CI 1.35-1.45) and mixed-fed infants (HR 1.18; 95% CI 1.11-1.25) compared with infants exclusively breastfed after adjustment for parental, maternal, and infant health characteristics. Within the first year of life and beyond, a greater relative risk of hospitalization was observed among formula-fed infants for a range of individual illnesses reported in childhood including gastrointestinal, respiratory, and urinary tract infections, otitis media, fever, asthma, diabetes, and dental caries.ConclusionsUsing linked administrative data, we found greater risks of hospitalization in early childhood for a range of common childhood illnesses among Scottish infants who were not exclusively breastfed at 6-8 weeks of age.

ObjectivesTo compare the mortality in those previously hospitalised for mental disorder in Scotland to that experienced by the general population.DesignPopulation-based historical cohort study using routinely available psychiatric hospital discharge and death records.SettingAll Scotland.ParticipantsIndividuals with a first hospital admission for mental disorder between 1986 and 2009 who had died by 31 December 2010 (34 243 individuals).OutcomesThe main outcome measure was death from any cause, 1986–2010. Excess mortality was presented as standardised mortality ratios (SMRs) and years of life lost (YLL). Excess mortality was assessed overall and by age, sex, main psychiatric diagnosis, whether the psychiatric diagnosis was ‘complicated’ (ie, additional mental or physical ill-health diagnoses present), cause of death and time period of first admission.Results111 504 people were included in the study, and 34 243 had died by 31 December 2010. The average reduction in life expectancy for the whole cohort was 17 years, with eating disorders (39-year reduction) and ‘complicated’ personality disorders (27.5-year reduction) being worst affected. ‘Natural’ causes of death such as cardiovascular disease showed modestly elevated relative risk (SMR1.7), but accounted for 67% of all deaths and 54% of the total burden of YLL. Non-natural deaths such as suicide showed higher relative risk (SMR5.2) and tended to occur at a younger age, but were less common overall (11% of all deaths and 22% of all YLL). Having a ‘complicated’ diagnosis tended to elevate the risk of early death. No worsening of the overall excess mortality experienced by individuals with previous psychiatric admission over time was observed.ConclusionsEarly death for those hospitalised with mental disorder is common, and represents a significant inequality even in well-developed healthcare systems. Prevention of suicide and cardiovascular disease deserves particular attention in the mentally disordered.

BackgroundProviding infants with the ‘best possible start in life’ is a priority for the Scottish Government. This is reflected in policy and health promotion strategies to increase breast feeding, which gives the best source of nutrients for healthy infant growth and development. However, the rate of breast feeding in Scotland remains one of the lowest in Europe. Information is needed to provide a better understanding of infant feeding and its impact on child health. This paper describes the development of a unique population-wide resource created to explore infant feeding and child health in Scotland.MethodsDescriptive and multivariate analyses of linked routine/administrative maternal and infant health records for 731 595 infants born in Scotland between 1997 and 2009.ResultsA linked dataset was created containing a wide range of background, parental, maternal, birth and health service characteristics for a representative sample of infants born in Scotland over the study period. There was high coverage and completeness of infant feeding and other demographic, maternal and infant records. The results confirmed the importance of an enabling environment—cultural, family, health service and other maternal and infant health-related factors—in increasing the likelihood to breast feed.ConclusionsUsing the linked dataset, it was possible to investigate the determinants of breast feeding for a representative sample of Scottish infants born between 1997 and 2009. The linked dataset is an important resource that has potential uses in research, policy design and targeting intervention programmes.

This review aims to describe school nutrition interventions implemented in Asia and quantify their effects on school-aged children’s nutritional status. We searched Web of Science, Embase, Ovid MEDLINE, Global Health, Econlit, APA PsycInfo, and Social Policy and Practice for English articles published from January 2000 to January 2021. We quantified the pooled effects of the interventions on the changes in body mass index (BMI) and body mass index z score (BAZ), overall and by type of intervention. In total, 28 articles were included for this review, of which 20 articles were multi-component interventions. Twenty-seven articles were childhood obesity studies and were included for meta-analysis. Overall, school nutrition interventions reduced school-aged children’s BMI and BAZ. Multi-component interventions reduced the children’s BMI and BAZ, whereas physical activity interventions reduced only BMI and nutrition education did not change BMI or BAZ. Overweight/obesity reduction interventions provided a larger effect than prevention interventions. Parental involvement and a healthy food provision did not strengthen school nutrition interventions, which may be due to an inadequate degree of implementation. These results suggested that school nutrition interventions should employ a holistic multi-component approach and ensure adequate stakeholder engagement as well as implementation to maximise the effects.

Background Schools are a potential stressor for adolescents and may contribute to emergency hospital admissions. Aims We describe rates of stress-related presentations (SRPs) among school-aged adolescents (11–17 years) during school terms and holidays, and explore differences by age and gender. Method Using national administrative hospital data, we defined an SRP as an emergency hospital admission with a primary diagnosis related to pain, psychosomatic symptoms (e.g. fatigue) or mental health problems, or with self-harm indicated in any diagnostic position. We estimated incidence rate ratios for weekly SRPs in term time versus holidays from 2014–2015 to 2017–2018, using negative binomial regression models, stratified by age and gender. We estimated the cumulative incidence of any SRP between 11 and 17 years by analysing prior hospital admission histories of adolescents with an SRP in 2017–2018. Results Over the 4-year study period, 305 491 SRPs in 171 013 school-aged adolescents accounted for 31% of emergency admissions for this group. SRPs were predominantly for mental health problems or self-harm (38%), or pain (35%). Weekly admission rates for SRPs were higher in term time than holidays for all ages (age-specific incidence rate ratios were 1.15–1.49 for girls and 1.08–1.60 for boys). Rates were highest for girls aged 14 and 15 years. The estimated cumulative incidence of any SRP between 11 and 17 years was 7.9% for girls and 4.1% for boys. Conclusions Hospital admissions for SRPs are common among adolescents, affecting around two girls and one boy in every classroom. Higher rates in term time than holidays suggest that school factors may contribute.