ALSPAC parents' descriptions of childhood stresses in their parents and grandparents.

Background: There is evidence that childhood stresses or traumas influence individuals' descendants' health and wellbeing through epigenetic mechanisms. However, few longitudinal studies have details of such ancestral data. Methods: Nearly 7,000 parents of the original Avon Longitudinal Study of Parents and Children (ALSPAC) cohort completed questionnaires concerning their parents' and grandparents' childhoods. As part of a questionnaire validation exercise  we conducted recorded interviews with 100 of these parents. Here we describe some of the vivid accounts from these interviews of stresses encountered by the parents' ancestors. Results: The interviews provided insights into the childhoods of two previous generations of this cohort, most of whom had lived through one, if not two, World Wars. Many children were brought up, not by their parents but by relatives or acquaintances and/or left home very young to 'go into service' or start work. A few interviewees had wealthy relatives with nannies and governesses and attended expensive boarding schools but by far the most frequent accounts were of poverty, often severe, with related lack of education and illiteracy, alcoholism and violence, alongside devastating effects of the World Wars. Conclusions: Although the interviews focussed on stresses in childhood and therefore the accounts seemed somewhat negative, many interviewees described their relatives as having secure, stable childhoods. Of the many struggling families though, the predominant impression was their remarkable resilience; all went on to have children or grandchildren who are stable enough to participate for three decades, entirely altruistically, in ALSPAC.

The ALSPAC fetal and neonatal resource: detailed data abstracted from the clinical records of the new-born.

In a previous Data Note, we outlined the data obtained from clinical obstetric records concerning many details of the pregnancies resulting in the births of the children in the Avon Longitudinal Study of Parents and Children (ALSPAC). Here we describe the data that have been abstracted from medical records concerning the fetus and neonate. Full details concerning the selection biases regarding the data abstracted are outlined in the previous Data Note. The records that have been abstracted, and described in this Data Note, concern the health of the fetus (measured in relation to the results of fetal monitoring, presentation at various stages of pregnancy, and the method of delivery) as well as the status of the newborn immediately post-delivery. Details of signs, symptoms and treatments of this population of new-born babies, as recorded in the clinical records, are described for the time during which they were in hospital or under the care of a designated midwife. These data add depth to the information collected from elsewhere concerning this period of the child's life: from the questionnaires completed at the time by the mother; and clinical details from neonatal intensive or special care units which will be detailed in a further Data Note.

The mother during pregnancy and the puerperium: Detailed data abstracted from the clinical obstetric records of ALSPAC pregnancies.

Background: When the Avon Longitudinal Study of Parents and Children (ALSPAC) was planned, it was assumed that the clinical obstetric data would be easily accessible from the newly developed National Health Service computerised 'STORK' system. Pilot studies, however, showed that, although fairly accurate in regard to aspects of labour and delivery, it was, at the time (1990-2), inadequate for identifying the full antenatal and postnatal details of clinical complications and treatments of the women in the Study. Methods: A scheme was therefore developed to train research staff to find and abstract relevant details from clinical records onto proformas designed for the purpose. Extracting such data proved very time consuming (up to six hours for complicated pregnancies) and consequently expensive. Funding for the enterprise was obtained piecemeal using specific focussed grants to extract data for subsamples of the Study, including a random sample to serve as controls. Results: To date, detailed records have been completed for 8369 pregnancies, and a further 5336 (13,705 in total) have complete details on specific prenatal areas, including serial measures of maternal blood pressure, proteinuria and weight. In this Data Note we describe the information abstracted from the obstetric medical records concerning the mother during pregnancy, labour, delivery and the first two weeks of the puerperium. Information abstracted relating to the fetus (including fetal monitoring, presentation, method of delivery) and neonate (signs of asphyxia, resuscitation, treatment and well-being) have been described in a further Data Note. Conclusions: These data add depth to ALSPAC concerning ways in which the signs and symptoms, procedures and treatments of the mother prenatally, intrapartum and postnatally, may impact on the long-term health and development of both mother and child. They augment the data collected from the mothers' questionnaires (described elsewhere) and the 'STORK' digital hospital data.

Ancestral childhood environmental exposures occurring to the grandparents and great-grandparents of the ALSPAC study children.

Background: Cohort studies tend to be designed to look forward from the time of enrolment of the participants, but there is considerable evidence that the previous generations have a particular relevance not only in the genes that they have passed on, their cultural beliefs and attitudes, but also in the ways in which previous environmental exposures may have had non-genetic impacts, particularly for exposures during fetal life or in childhood. Methods: To investigate such non-genetic inheritance, we have collected information on the childhoods of the ancestors of the cohort of births comprising the original Avon Longitudinal Study of Parents and Children (ALSPAC). The data collected on the study child's grandparents and great grandparents comprise: (a) countries of birth; (b) years of birth; (c) age at onset of smoking; (d) whether the ancestral mothers smoked during pregnancy; (e) social class of the household; (f) information on 19 potentially traumatic situations in their childhoods such as death of a parent, being taken into care, not having enough to eat, or being in a war situation; (g) causes of death for those ancestors who had died. The ages at which the individual experienced the traumatic situations distinguished between ages <6; 6-11, and 12-16 years. The numbers of ancestors on which data were obtained varied from 1128 paternal great-grandfathers to 4122 maternal great grandmothers. These ancestral data will be available for analysis to bona fide researchers on application to the ALSPAC Executive Committee.

Grand-maternal smoking in pregnancy and grandchild's autistic traits and diagnosed autism.

Although there is considerable research into the genetic background of autism spectrum disorders, environmental factors are likely to contribute to the variation in prevalence over time. Rodent experiments indicate that environmental exposures can have effects on subsequent generations, and human studies indicate that parental prenatal exposures may play a part in developmental variation. Here we use the Avon Longitudinal Study of Parents and Children (ALSPAC) to test the hypothesis that if the mother or father (F1) had been exposed to their own mother's (F0) smoking during pregnancy, the offspring (F2) would be at increased risk of autism. We find an association between maternal grandmother smoking in pregnancy and grand daughters having adverse scores in Social Communication and Repetitive Behaviour measures that are independently predictive of diagnosed autism. In line with this, we show an association with actual diagnosis of autism in her grandchildren. Paternal grandmothers smoking in pregnancy showed no associations.

Towards a hit for every target.

Technological advances coupled with novel collaborative strategies for compound sourcing and management are poised to transform the utility of high-throughput screening.

Ethics and governance of a longitudinal birth cohort.

All longitudinal birth cohorts should be undertaken with a detailed ethical strategy and policy on governance. Here we outline the various factors that should be taken into consideration and describe ways in which these issues may be addressed.

Enrollment and response rates in a longitudinal birth cohort.

For the scientific credibility of study results, longitudinal cohort studies need to invest time, money and creative thought in establishing and maintaining the maximum number of study participants. Although success depends to a large extent on the resources available, much can be achieved by establishing a culture of integrity and enthusiasm among study staff that is conveyed to participants at all times. In this paper we outline various strategies that can be included in order to maximise the response rates.

United States.

The 'Green House' effect; the rise of community care; and suicide awareness Baltimore: When he took a parttime job in a nursing home, Harvard-trained physician Bill Thomas realised that the biggest problems residents faced were not their illnesses but 'loneliness, helplessness and boredom'. He went on to found the Eden Alternative, 'a movement to de-institutionalise nursing homes', and has since revolutionised older people's residential care around Baltimore, replacing nursing homes with clusters of small homes, each for up to ten residents. Called 'Green Houses', Dr Thomas now has a $10 million (£5.6 million) grant to replace more than 100 nursing homes in all 50 US states with these small dwellings. Last month he began teaching an experimental class at the University of Maryland, Baltimore County's Erickson School on Aging, Management and Policy: 'Aging 100: You Say You Want a Revolution'. Classes will be broadcast on YouTube.

In Japan, more older people are becoming carers, while in America, a pioneer in geriatric care is starting a new education class. And New Zealand is struggling to care for its older population appropriately.

Petition over staffing levels and care complaints The New Zealand Nurses Organisation (NZNO) is calling on the government to mandate minimum staffing levels in older people's residential care facilities. Together with the Service and Food Workers Union: Nga Ringa Tota, the NZNO has gathered a 10,000-signature petition from the public supporting their request. NZNO chief executive officer Geoff Annals said: 'Our experience shows that actual staffing levels routinely fall well below [2005guidelines] and there is no way that we can enforce them. Short staffing leads to nurses and caregivers becoming overworked, stressed and unable to deliver the kind of care they know their residents deserve.'

Japan.

Survey shows huge rise in older carers The number of older people looking after older people has doubled in the past 20 years in Japan. A new report, 2007 Basic Survey of National Life, shows there are an estimated 48.03 million households in Japan, of which 19.26 million have at least one member aged 65 or older - nearly double the number reported in the 1986 survey. In 60 per cent of households, a family member living under the same roof provided the care, and in 34 per cent of these, the carer was aged 70 or above. Of the family members who cared for other family members in their seventies, 44 per cent were themselves also in their seventies.

Telehealth and telecare news.

Swindon Primary Care Trust (PCT) last month became the latest trust to make a substantial expansion to its telehealth service. It joins three other PCTs which have greatly increased their use of remote monitoring in the last six months.

News round-up for Wales.

Wales has increased its continuing healthcare budget by £37 million. Deputy minister for social services, Gwenda Thomas, announced the additional funding last month. It comes on top of the recurrent £50 million allocated to local health boards. The money supports people who leave hospital and go home or into care. The most recent statistics show an improvement in delayed discharge in Wales. The number of patients unable to leave hospital for appropriate placement was 552 in July, a decrease of 8 per cent on the previous month and 51 per cent down from a September 2003 high of 1,116. The number of dependant older people in Wales will increase by 70 per cent between 2001-2031, and one in two women and one in three men who reach retirement age will need some form of long-term care.

Scientific approach to nursing recommended.

Parameters that are particularly important to the nursing care of older people feature heavily in a new report by researchers at the National Nursing Research Unit at King's College, London, which is aimed at helping nurses see the impact of the care they deliver.