Aims-To compare the respiratory health and function at 8 to 9 years of age of a total population based cohort of 300 very low birthweight (VLBW) children with that of two classroom controls (n=590) matched for age and sex. Study design-Cohort study with controls. Setting-Schools throughout Scotland. Results-The VLBW children were more likely than their peers to use an inhaler, to be absent from school, and to be admitted to hospital because of respiratory illness. They were significantly shorter than their classroom controls, but even after adjusting for differences in height, the VLBW children had reduced forced vital capacity (FVC); this was associated with a history of prolonged ventilation (>28 days) and pneumothorax in the neonatal period. There were no significant differences between the groups in forced expiratory volume in one second (FEV,)/FVC but twice as many (7.9% v 3.7%) of the VLBW children had ratios <700/0, denoting obstructive airways disease. Poor expiratory function was associated with neonatal respiratory distress syndrome, prolonged ventilation, and the need for >40Gb oxygen. Exercise induced airway narrowing was increased in VLBW children (odds ratio=2-0; 95% confidence interval 1*2 to 3.4) and was very little changed by adjustment for inhaler use and exposure to cigarette smoke.Conclusions-As in other low birthweight cohorts, respiratory morbidity was increased. Unlike previous studies, FVC was more affected than expiratory function in this VLBW population. Our findings support the hypothesis that poorer lung function is associated with very low birth weight, but not with intrauterine growth retardation.

SUMMARY The prevalence of learning problems and of cognitive and motor impairment in a total geographically based very‐low‐birthweighl population (N=324) was compared at eight years of age with that in a population comprising two classroom peers, matched for gender and age (N=590). 15 per cent of those with birthweights less than 1000g and 6 per cent of those weighing 1000 to 1499g attended special schools. Index children in main‐stream schools performed significantly less well in tests of neuromotor function than their comparison groups. Their mean IQs were 90.4 and 93.7 for those below and above 1000g, respectively, while their comparison groups' IQs were 102.5 and 101.2. In all cognitive subscalcs apart from that testing short‐term auditory sequential memory, both index groups were less competent. They were also less able in Word Reading and Basic Number Skills. These children placed heavy demands on mainstream schools, with 52 per cent and 37 per cent of the index groups, respectively, requiring learning support compared with 16 per cent in both comparison groups. RÉSUMÉ Résultats scolaires, capacité cognitive et foniction mot rice dans l'ensemble de la population écossaise de très faible poids de naissance à I âge de huit ans: étude contrôle La prévalence des problèmes d';apprentissage et de troubles cognitifs et moteurs dans une population totale pour une région des enfants de très faible poids de naissance (N=324) a été compareéà l'âge de huit ans à une population de pairs de deux écoles appariés pour le sexe et l'âge (N=590). Quinze pour cent des enfants avec un poids de naissance de moins de 1000 grammes et 6 pour cent des enfants avec un poids de naissance compris entre 1000 et 1499 grammes fréquentaient des écoles spéciales. Les enfants index maintenus dans les écoles normales avaient des résultats significativement moins bons aux tests de fonction neuromotrice que les gropes de comparaison. Les QI moyens étaient respectivement de 90.4 et de 93.7 pour les enfants avec poids de naissance au dessus ou au dessous de 1000 grammes tandis que les QI des groupes de comparaison étaient de 102.5 et 101.2. Dans tous les items cognitifs isolés en dehors de la mémoire de répétition des chiffres, tous les résultats pour les groupes index étaient moins bons. L'efficience était également moindre aux épreuves de lecture et de numération de base. Ces enfants exigeaient une attention particulière importante dans les écoles ordinaires avec respectivement 52 pour cent et 37 pour cent des groupes index exigeant une assistance de formation alors que le pourcentage était de 16 pour les deux groupes de comparaison. ZUSAMMENFASSUNG Schulleistungen, skognitive Fähigkeiten und Moiorfunktionen im Alter von acht Jahren bei schottischen Kindern mit.sehr niedriegem Gerbutsgewicht – eine konirollierte Studie Die Häufigkeit von Lernschwierigkeilen und kognitiven und motorischcn Problemen in einer Gesamtpopulation mit sehr niedrigem Geburtsgewicht (N‐324) in einer bestimmten geographischen Region wurde ini Alter von acht Jahren mit ei...

Objectives To measure the impact of socioeconomic deprivation on rates of teenage pregnancy and the extent of local variation in pregnancy rates in Scotland, and to examine how both have changed over time. Design Population study using routine data from hospital records, aggregated for small areas. Subjects Female teenagers resident in Scotland who were treated for pregnancy in an NHS hospital in either 1981-5 (62 338 teenagers) or 1991-5 (48 514) and who were aged 13-19 at the time of conception. Main outcome measures Pregnancy rates per 1000 in age group and the proportions of pregnancies resulting in a maternity (live birth or stillbirth) in teenagers aged 13-15, 16-17, and 18-19.

Methods-Multilevel logistic regression to separate eVects of patients, areas and hospitals.Results-During the study period, 8% (n=626) of the study population received chemotherapy within six months of their first admission. Adjusting for comorbidities and emergency admissions, both age and deprivation were significantly associated with the treatment. The odds ratios (OR) of chemotherapy relative to patients aged 65-74 were 2.13 and 4.50 for patients aged 55-64 and under 55 respectively. Relative to patients resident in the most aZuent areas, the OR of chemotherapy for patients resident in the most deprived areas was 0.73. Area level availability of the treatment was not significantly associated with a patient's odds of receiving the treatment while on site provision of chemotherapy at the hospital of first admission was (OR=4.32). There was significant unexplained variation between hospitals of first admission but not between areas of residence; between hospital variation decreased by 22% during the study period. Conclusion-DiVerences according to age may reflect both clinical and patient decisions regarding the benefits of the treatment relative to its toxicity. Lower treatment rates in deprived areas may indicate inequitable access to services. Hospital diVerences may reflect consultant eVects and it would be expected that these should decrease now that the eYcacy of the treatment has been recognised and guidelines have been issued. (J Epidemiol Community Health 1999;53:775-781)