Methods: We used register data consisting of 5,832 DUID suspects apprehended by the police. A reference group (n=74,809) was drawn from the general Finnish population. Deaths were traced from National Death Register. Survival and differences in mortality hazard were estimated by using Kaplan-Meier plots and Cox regression models.

Results: The hazard of death was higher among both male (HR 9.6, CI 8.7–10.6) and female (HR 9.1, CI 6.4–12.8) DUID suspects compared to reference population. Among male DUID suspects cause-specific hazards were highest for poisoning/overdose, violence and suicide. 24% of DUID suspects and 8% of references were under the influence of drugs/alcohol during the time of death. Poly-drug findings indicated excess in mortality among drugged drivers. Hazard of death was higher among male DUID suspects who had findings for benzodiazepines only (HR 10.0, CI 8.4–11.9) or benzodiazepines with alcohol (HR 9.6, CI 8.2–11.2) than with findings for amphetamines (HR 4.6, CI 2.7–7.6).

Conclusion: DUID suspects had an increased risk of death in all observed causes of death. Findings for benzodiazepines indicated excessive mortality over findings for amphetamines. Preventive actions should be aimed especially at DUID subgroups using benzodiazepines.

Methods: We analysed data from a cohort study nested within a cluster-randomized trial of breastfeeding promotion in the Republic of Belarus. 17,046 healthy breastfed infants were enrolled from 31 maternity hospitals. 13,889 (81.5%) children were followed-up at 6.5 years. Exposure measures were: any gastrointestinal infection in infancy (to 1 year); hospitalizations for gastrointestinal infection in infancy and in childhood (1-6.5 years). The outcomes were systolic and diastolic blood pressure at age 6.5 years.

Results: The prevalence of any gastrointestinal infection in infancy, and of hospitalization for gastrointestinal infection in infancy or childhood, was 11.4%, 3.2% and 6.0%, respectively. No associations were observed between systolic blood pressure and any gastrointestinal infection (mean difference in those with minus those without infection = -0.04 mmHg; 95% CI: -0.52, 0.43) or hospitalization for gastrointestinal infection (difference = -0.22 mmHg; -1.07, 0.64) in infancy. Nor were associations observed between diastolic blood pressure and any gastrointestinal infection during infancy or hospitalization for gastrointestinal infection during infancy or childhood.

Conclusion: We found no evidence that hospitalization for gastrointestinal infection in infancy or childhood leads to raised blood pressure at age 6.5 years in a developed country setting.

Methods: A Citizens’ Jury was convened in October 2006 to consider these issues against the background of healthy living in general. The Jury was a broadly representative group of 16 people drawn from the community. A number of experts in clinical medicine, pharmacology and public health gave evidence, and were questioned by the jurors. Vascular prophylaxis by daily low-dose of aspirin was used as a case study throughout the discussions.

Results: The judgements of the jury included a clear demand for more information on health issues in general and on prophylactic medicines in particular, together with a desire that the public be more closely and openly involved in decision taking in all matters relevant to health. The jurors were generally receptive to the possible role of medicines in the maintenance of health, and a majority argued that people should be presented with evidence on medicines with possible health benefits, even when there is disagreement between experts about efficacy.

Conclusion: The strategy of the Citizens’ Jury, alongside other deliberative methods, could clearly have an important and valuable role in the formulation of public health and social policy.

Methods: We collected and analysed household and antenatal clinic survey data from 21 districts in Tanzania, annually 2005-2007. We defined optimal voucher protection as giving women access to vouchers for 24 pregnancy weeks (weeks 16 and 40 gestation). We explored the relationship between gestational age and use of ITNs throughout pregnancy.

Results: Coverage of the ITN voucher was high (84% in 2007), but only 61% of optimal voucher protection was achieved. It was reduced by a combination of late attendance to clinic, and staff not distributing vouchers at first visit. Each survey year an increasing trend by gestational age in ITN use was observed, rising in 2007 from 23% of first trimester women to 30% of women post-partum (÷2 = 5.9, p=0.01).

Conclusion: Uptake of malaria interventions is not evenly distributed throughout pregnancy. Including gestational age in pregnancy coverage indicators can enhance understanding of the public health potential available from pregnancy interventions.

Methods: We estimate the impact of micro social capital (trust, membership and social isolation) on individual health in each of eight former Soviet republics using instrumental variables to overcome methodological hazards such as endogeneity and reverse causality. We examine interactions with institutional variables (voice and accountability; effectiveness of the legal system; informal economy) and social protection variables (employment protection; old age and disability benefits; sickness and health benefits).

Results: Most social capital indicators, in most countries, are associated with better health but the magnitude and significance of the impact differ between countries. Some of this variation can be explained by interacting social capital indicators with measures of institutional quality, with membership of organisations bringing greater benefit for health in countries where civil liberties are stronger, whereas social isolation has more adverse consequences where there is a large informal economy. A lesser amount is explained by the interaction of social capital indicators with selected measures of social protection.

Conclusion: When considering interventions to improve social capital as a means of improving population health, it seems advisable to take into account the influence of macro contextual variables, in order not to over- or understate the likely impact of the intervention.

Methods: We analysed associations between self-reported smoking in pregnancy and maternal reports of externalising behaviour in more than 13,000 3-year old boys and girls in the UK Millennium Cohort Study. Conduct and hyperactivity-inattention problems were assessed using the Strength and Difficulties Questionnaire.

Results: Boys whose mothers persistently smoked throughout pregnancy were at significant risk of conduct and hyperactivity-inattention problems compared to sons of non-smokers: the effect was stronger for heavy smokers. After excluding children with co-occurring problems, conduct-only problems remained a significant risk for sons of heavy smokers, and hyperactivity-inattention-only for sons of light or heavy smokers. Daughters of light or heavy smokers were at significant risk of conduct-only problems. Relative to non-smokers, daughters of pregnancy quitters had significantly reduced odds of having conduct or co-occurring problems, although only 79 and 20 girls met these criteria, respectively. All findings were robust to controlling for key social and psychosocial factors.

Conclusions: Associations between maternal smoking during pregnancy and disruptive behaviour in 3 year old children vary by sex, smoking status and whether or not conduct or hyperactivity problems occur together or separately.

Methods: A 10-year prospective study was conducted in Scotland involving all paediatric hospitals and other general hospital departments admitting children. Subjects were children ≤2 years of age, with a diagnosis of ‘suspected NAHI’. Socio-economic characteristics of the index cases were compared to the general population, using the Scottish Index of Multiple Deprivation (SIMD) 2006.

Results: There were highly significant differences (p<0.001) between the SIMD rank scores of the NAHI cases and scores for the whole Scottish population. For the cohort, SIMD ranks ranged from 34 – 6253 (median 1210; mean 1577) compared to the population range of 1 – 6505 (median and mean = 3253). Similar differences were found for each of the component domains of income, employment, health, education, crime and housing (p<0.001). In contrast, the scores for ‘geographic access’ (to essential service) were higher than for the whole population (p<0.001), indicating that the deprivation was not due to lack of local services.

Conclusion: In Scotland, children who present with suspected NAHI originate predominantly from the most deprived areas of the community. Public health and intervention strategies should be focussed in these areas.

Methods: Data came from the Survey of Health, Ageing and Retirement in Europe comprising 27,351 participants ages 50+ in 11 countries. Grip strength was objectively measured using a handheld dynamometer. Estimates were obtained based on multivariate linear regression controlling for a wide set of confounders, demographics, health and disability measures, and behavioural risk factors.

Results: In the total sample, education, occupational class, income and wealth predicted grip strength among men, whereas only education and wealth predicted grip strength among women. While education and income effects were inconsistent in most countries, wealth consistently predicted grip strength in each country. A one-point increase in the log of wealth was associated with 0.38kg (95%CI 0.31 to 0.45) higher grip strength in men and 0.18kg (95%CI 0.15 to 0.21) in women. While education, income and occupation effects disappeared after adjustment for health measures, log of wealth effects remained significant in both men (0.22, 95%CI 0.15 to 0.29) and women (0.08, 95%CI 0.05 to 0.11). Wealth effects were particularly evident in the two lowest quintiles.

Conclusion: Old-age socioeconomic and financial circumstances as measured by wealth are associated with grip strength particularly among the least wealthy, while circumstances defined earlier in life as measured by education, income and occupation do not consistently predict grip strength.

Methods: Childhood obesity was defined by body mass index, using cross-sectional height and weight data for children aged 3-13 years (obesity > 98th centile; British reference dataset). Relationships between childhood obesity and twelve simulated obesogenic variables were assessed using geographically weighted regression. These results were applied to three wards with different socio-economic backgrounds, tailoring local obesity prevention policy.

Results: The spatial distribution of childhood obesity varied, with high prevalence in deprived and affluent areas. Key local covariates strongly associated with childhood obesity differed: in the affluent ward they were perceived neighbourhood safety and fruit and vegetable consumption; in the deprived ward, expenditure on food, purchasing school meals, multiple television ownership, and internet access; in all wards, perceived access to supermarkets and leisure facilities. Accordingly, different interventions/strategies may be more appropriate/effective in different areas.

Conclusions: These analyses identify the covariates with the strongest local relationships with obesity and suggest how policy can be tailored to the specific needs of each micro-area: solutions need to be tailored to the locality to be most effective. This paper demonstrates the importance of small-area analysis in order to provide health planners with detailed information that may help them to prioritise interventions for maximum benefit.

Methods: Using multi-stage proportional sampling methods, a population-based cross-sectional study was conducted in Nanjing between September and November 2004 (n=2375; mean age=13.9±1.0 years old; 46.2% boys; survey response rate=89.3%). Body mass index was calculated from self-reported body weight and height. Overweight, the main outcome variable, was defined as a BMI ≥85 percentile value for age- and gender-specific reference data according to the recommendation for Chinese adolescents. The primary explanatory variable was the residential density of the urban districts. Mixed-effects logistic regression models were used for the analysis.

Results: Students in the higher and middle tertiles of residential density had a 2.17 times (95%CI: 1.41-3.33) and 1.89 times (95%CI: 1.22-2.92) higher likelihood of being overweight, respectively, compared to those in the lower tertile. The associations were slightly attenuated but still significant after adjusting for time spent in recreational physical activity and sedentary behaviour (viewing TV and sitting for academic study).

Conclusions: Residential density was positively associated with overweight among urban Chinese adolescents. Our findings warrant further research examining attributes of urban environments associated with adolescents¡ obesity in China and potential mechanisms between them.

Method: In a population-based sample of 2,149, familial loading and family SEP were assessed at baseline by parent reports. Offspring psychopathology was assessed by reports from multiple informants (parent, self, and teachers). Multiple linear regression was used to assess the independent associations of parental loading and family SEP on offspring psychopathology and their potential interaction.

Results: Both family SEP and familial loading had significant independent main effects on offspring internalising and externalising problems. However, the interaction terms were not significant and did not add any explanatory power to the model.

Conclusions: Lower levels of family SEP appear not to confer additional risks for mental health problems in offspring of parents with high loading on psychopathology. During early adolescence, parental psychopathology and low family SEP seem independent risk factors for offspring mental health problems. Results do not support the social push or vulnerability hypothesis as no evidence of interactions between parental loading and family SEP were found.

High ambient summer temperatures have been shown to influence daily mortality in cities across Europe. Quantification of the population mortality burden attributable to heat is crucial to the development of adaptive approaches. We evaluated the impact of summer heat on mortality for 15 European cities during the 1990s, under hypothetical temperature scenarios warmer and cooler than the mean and under future scenarios derived from the Intergovernmental Panel on Climate Change Special Report on Emission Scenarios (SRES).

It is not known to what extent the reported regional variations in renal replacement therapy (RRT) acceptance rates in England and Wales are due to differences in the socio-demographic characteristics of the population.

Health effects of ozone (O3) have been observed in numerous studies. However, analyses for more cause-specific morbidity or mortality outcomes have rarely been performed. Therefore, we determined the short-term associations of ozone with cause-specific cardiorespiratory mortality and morbidity by age groups.

To determine the impact of comorbid chronic diseases on mortality in the elderly.

Although COPD is a common cause of death and disability, little is known about the effects of socioeconomic status (SES) and race-ethnicity on health outcomes.

Indigenous populations tend to have the poorest health outcomes worldwide and they have limited opportunities to present their own perspectives of their situation and shape priorities in research and policy. This paper aims to explain low health care utilisation rates and opportunities to cope with illness among a deprived indigenous group – based on their own experiences and views.

Several psychosocial work environment factors have been shown to be related to symptoms of mental health problems, but whether associations are causal remains disputable.

Polypharmacy represents a growing public health concern for its associations with drug-related adverse events, poor adherence, medication errors, and increased health care cost.

Earlier investigations have shown mortality effects of community socio-economic resources. However, the sex differences have not been clear and the estimates may well have been biased because of inadequate control for community factors affecting both the socio-economic resources and mortality. The objective of this study was to see whether effects appeared when time-invariant community characteristics were controlled by including community dummies (fixed effects) and whether there were differences between women and men.

Verbal autopsy (VA) is currently the only option for obtaining cause of death information in most populations with a widespread HIV/AIDS epidemic.

We aimed to investigate whether job insecurity predicts incident use of antidepressant medication and whether the association is modified by a history of prolonged unemployment.

Both physical environmental factors and chronic stress may independently increase susceptibility to asthma; however, little is known on how these different risks may interact. We examined the relationship between maternal intimate partner violence (IPV), housing quality and asthma among children in the Fragile Families and Child Wellbeing Study (N=2013).

When examining the association between prenatal alcohol exposure and fetal effects, epidemiological studies have ignored the timing and intensity of the exposure. This study investigates the effect of using dose, pattern and timing of consumption (‘composite’ method) for examining the association between prenatal alcohol exposure and fetal effects.

To examine seasonal variations in self-reported physical activity among an urban population of Calgarian adults.

There has been an ongoing debate about the extent and nature of gender differences in the experience of intimate partner violence (IPV). Disagreement about the appropriate definition of IPV is central to this debate.

The objective of this study was to analyse inequalities in cirrhosis mortality at individual and area level, using data from Barcelona for two periods.

This study was carried out in 10 of a rural district’s 25 primary health centre in Burkina Faso. Village selection committees (VSC) made lists of worst-off. A process evaluation was implemented through documentation analysis, accounting calculation, focus group and in-depth interviews.

The 124 VSCs selected 566 persons. The 10 local commitees retained 269 persons (48%), i.e. 2.81 per 1,000 inhabitants. The annual profits thanks to the user fees schemes could support on average 6 times more indigents than the mean number selected by the VSCs. The action was well received by the stakeholders.

In the rural African context, villagers are capable of selecting those who should be exempted from user fees according to their own perspective. Health centres have a certain financial capacity to take care of indigents. In a community-based targeting approach using endogenous resources generated from BI profits, local perceptions of the health centres’ financial viability, coupled with the hierarchical social context, led to a very restrictive selection of candidates for exemption.

Punjab has been reported to be having high degree of water pollution due to heavy metals from untreated industrial effluent discharge and high pesticides consumption in agriculture. Present study ascertained the association of heavy metal and pesticide exposure on reproductive and child health outcomes in Punjab, India.

Observational studies and controlled experiments have provided evidence that airborne particulate matter (PM) is capable of acutely increasing blood pressure (BP) in certain scenarios. The goal of this study is to evaluate whether and to what extent obesity and community location affect relationships between fine particulate matter (PM2.5) and blood pressure (BP) measures.

Due to increasing urbanisation people face the prospect of living in environments with few green spaces. There is increasing evidence for a positive relation between green space in people's living environment and self-reported indicators of physical and mental health. This study investigates whether physician assessed morbidity is also related to green space in people's living environment.

The Advisory Committee on Immunization Practices encourages dormitory residents to receive influenza vaccination. To our knowledge, there are no studies that have directly examined factors associated with vaccination uptake among university students residing in dormitories. We therefore sought to examine the influence of demographic, social, and health behaviors on influenza vaccination coverage among college dormitory students.

We compared the magnitude of educational inequalities in mortality avoidable by medical care in 16 European populations and determined the contribution of inequalities in avoidable mortality to educational inequalities in life expectancy in Europe.

Several European studies have found significant small area variation in childhood-onset (Type 1) Diabetes (T1D) risk, which has been interpreted as evidence for contextual determinants of T1D. However, this conclusion may be fallacious since the limited number of newborns and the low risk for T1D is a source of spurious variability not properly handled by usual statistical methods. This study investigates the existence of contextual effects in the genesis of T1D, confronts conclusions in previous reports with results obtained in a multilevel regression framework, and highlights analysis of variance as a useful approach in Public Health.

Inverse associations between IQ and stroke have been reported in a few studies, but none of them has investigated subtypes of stroke, nor have they studied both fatal and non-fatal stroke separately. Stroke is a heterogenic disease and strength of associations with IQ and putative causal pathways cannot be assumed to be identical for different subtypes of stroke.

While risk factors for suicide have been established, the impact of social context in moderating the impact of these factors is poorly understood.

A growing body of literature regarding the contextual influences of 'place' effects on health increasingly demonstrates that living in neighbourhoods with high levels of deprivation is associated with worse cardiovascular outcomes; however little research has explored whether neighbourhood deprivation has a differential impact on the cardiovascular health of men and women. The purpose of this study was to explore gender differences in the association between neighbourhood deprivation and the prevalence of hypertension among non-institutionalized Canadian adults.

Obesity implies costs not only for the individual but also for society . We explore the opinions of stakeholders on the potential of taxes or subsidies, as measures for tackling obesity in Europe.

While the relationship between socioeconomic disadvantage and cardiovascular disease (CVD) is well established, the role that traditional cardiovascular risk factors play in this association remains unclear. We examined the association between education attainment and CVD mortality and the extent to which behavioural, social and physiological factors explained this relationship.

Smoking has been shown to be associated with carotid atherosclerosis in cross-sectional and prospective studies in Western populations. However, few studies have examined the reversal of risk resulting from quitting smoking, and the results are conflicting.

Rates of violence in Russia are among the highest in the world, and violent victimization represents a major public health threat in the country. As yet, however, little research has been undertaken on what factors are associated with non-lethal violent victimization in this setting. This study used data from the 'Moscow Health Survey 2004' to examine the effects of binge drinking and social capital on individuals' risk of non-fatal violent victimization.

To determine the effectiveness and impact of the Dutch childhood hepatitis B virus (HBV) vaccination policy targeted at children with at least one parent born in an HBV endemic country.

In January 2008, the Saudi Arabian health authority included mandatory testing for HIV, HBV and HCV viruses in the premarital screening programme. Epidemiologically, there were few justifications for their inclusion as disease prevalences and distributions are poorly understood in the population. This study aims to provide information about HBV, HCV and HIV prevalences and risk factors for disease transmission, and so produce evidence for informed decision-making on the inclusion of these infectious diseases in the screening programme.

Previous studies that found increased crash risks for young drivers of low socioeconomic status (SES) have failed to adjust for factors such as driving exposure and rural residence. This study aims to examine the independent effect of SES on crash risk, adjusting for such factors, as well as to examine the relationship between injury severity following a crash and SES.

Despite different levels of economic development, Costa Rica and the United States have similar mortality rates among adults. However, in the United States there are substantial differences in mortality by educational attainment, and in Costa Rica there are only minor differences. This contrast motivates an examination of behavioral and biological correlates underlying this difference.

Delivery attended by skilled professionals is essential to reducing maternal mortality. Although the facility delivery rate in Ethiopia’s rural areas is extremely low, little is known about which health system characteristics most influence women’s preferences for delivery services. We investigated women’s preferences for attributes of health facilities for delivery in rural Ethiopia.

Despite the decline in cervical cancer incidence in Australia as a result of population screening, a substantial proportion of women in NSW screen less regularly than the recommended two-yearly interval, or do not screen. With higher rates of cervical cancer in un- and under-screened women, and despite the introduction of the Human Papillomavirus vaccine, there remains a need to continue to remind women to screen. Mass media has been shown to be effective at improving participation in cervical screening. Accordingly, we examine a 2007 television advertising campaign to promote cervical screening in New South Wales (NSW) women.

This paper assessed the impact of air quality warnings associated with ground-level ozone on outdoor activities in Southern California.

Effective condom use can prevent sexually transmitted infections and unwanted pregnancy. We conducted a systematic review and methodological appraisal of randomised controlled trials of interventions to promote effective condom use.

In this paper the link between (1) psychosocial working conditions (job demands, job autonomy, task variation, social support), (2) self-reported health (persistent fatigue, musculoskeletal complaints, emotional well-being) and (3) socio-economic position (skill levels, occupational status) is explored. The two theoretical pathways linking the psychosocial work environment to socio-economic differences in health are explored: differential exposure and differential vulnerability. Previously the focus has been often on social inequalities in exposure to the stressors. The pathway of differential vulnerability in different socio-economic positions is often neglected.

People who score poorly in intellectual ability tests have shorter life expectancy. We studied whether this association is different in people from different socio-economic backgrounds.

In the United Kingdom, overall stroke mortality has declined. A similar trend has been seen in coronary heart disease, although recent reports suggest this decline might be levelling off in middle-aged adults.

Individual socioeconomic position -like education, social class, social status, and income -are all associated with mortality. Inequalities in death also appear along household measures. It is however less clear how the socioeconomic position of one marital/cohabiting partner influences the mortality of the other partner. We examine the independent effect on mortality of own and partner's positions regarding these four socioeconomic factors.

Methods: Data was derived from a longitudinal study using a 1953 cohort born in Stockholm, Sweden: The Stockholm Birth Cohort Study (1953-2003). Peer status was sociometrically assessed in 6th grade (1966). Hazard ratios for adult disease-specific morbidity based on information on in-patient care (1973-2003) were calculated by peer status category for men and women separately, using Cox regression.

Results: The results indicate that the lower the childhood peer status, the higher the overall adult disease risk. There were however differences in the degree and magnitude to which disease-specific in-patient care varied with peer status. Some of the steepest gradients were found for mental and behavioural disorders (e.g. alcohol abuse and drug dependence), external causes (e.g. suicide) and various lifestyle-related diseases (e.g. ischaemic heart disease and diabetes). The results were not explained by childhood social class.

Conclusion: The present study underscores the importance of recognizing children's social position, apart from that of their family, for later health. Not only psychologically related diseases but also those related to behavioural risk factors demonstrate some of the largest relative differences by peer status, suggesting that health-related behaviour may be one important mechanism in the association between peer status and morbidity.

Methods: We analysed data from 12 576 singleton children age five years in the UK Millennium Cohort Study. Mothers reported information about their employment patterns. Mothers also reported on indicators of their child’s dietary (crisps/sweets, fruit/vegetables, sweetened beverage, fruit consumption), physical activity (participation in organised exercise, transport to school), and inactivity (television/computer use) habits at age five.

Results: After adjustment for potential confounding and mediating factors, children whose mothers worked part-time or full-time were more likely to primarily drink sweetened beverages between meals (compared to other beverages), use the television/computer at least two hours daily (compared to 0-2), or be driven to school (compared to walk/cycle) than children whose mothers had never been employed. Children whose mothers worked full-time were less likely to primarily eat fruit/vegetables between meals (compared to other snacks) or eat three or more portions of fruit daily (compared to two or fewer). Although in unadjusted analyses children whose mothers used flexible work arrangements engaged in healthier behaviours, relationships were no longer significant after adjustment.

Conclusions: For many families the only parent or both parents are working. This may limit parents’ capacity to provide their children with healthy foods and opportunities for physical activity. Policies and programmes are needed to help support parents and create a health promoting environment.

Methods: The study included 5,470 female and 1,464 male employees of the City of Helsinki, surveyed in 2000-2002. These data were prospectively linked to sickness absence records until the end of 2005, providing a mean follow-up time of 3.9 years. Poisson regression was used to examine the incidence of medically certified sickness absence pisodes lasting 4 days or more.

Results: Medically certified sickness absence was roughly three times more common among manual workers than among managers and professionals in both women and men. Physical working conditions were strongest explanatory factors for occupational class differences in sickness absence, followed by smoking and relative weight. Work arrangements and family-related factors had very small effects only. The effects of psychosocial working conditions were heterogeneous: job control narrowed occupational class differences in sickness absence while mental strain and job demands tended to widened them. Overall, the findings were quite similar in women and men.

Conclusions: Physical working conditions provided strongest explanations for occupational class differences in sickness absence. Smoking and relative weight, which are well-known determinants of health, also explained part of the excess sickness absence in lower occupational classes. Applying tailored work arrangements to employees on sick leave, reducing physically heavy working conditions and promoting healthy behaviours provide potential routes to narrow occupational class differences in sickness absence.

Study design: A prospective matched case-control study of children born in Western Australia between 1990-2005 using de-identified record linked Child Protection and Hospital Morbidity data. Rates of prior hospital admissions for cases versus controls were calculated and conditional logistic regression used to estimate the effect of hospital admission rate on the risk of child maltreatment allegation and substantiated allegation.

Results: Children with child maltreatment allegations and substantiations had higher mean prior admission rates compared to controls. Higher rates of general admissions and admissions for injuries, infections, mental and behavioural disorders, and external causes of morbidity, were associated with a markedly increased risk of child maltreatment allegations and substantiation.

Conclusions: The hospital system plays an important role both in the surveillance of maltreatment related injuries and conditions, but also in the role of prevention, in the referral of families who may need support and assistance in ensuring the health and safety of their children. This research highlights the importance of moving to electronic patient records in identifying children who have high rates of admissions and the types of conditions they have previously presented with, particularly for injuries, mental and behavioural disorders and external causes of admissions.

Methods: Parents (n=421) reported their child’s time spent outdoors in 2001, 2004 and 2006 (age 5-6 and 10-12 years at baseline). In 2001, individual, social and physical environmental factors were self-reported by parents. Generalized estimating equations examined longitudinal relationships between baseline predictors and average change in time outdoors over five years.

Results: Children’s time outdoors significantly declined over time. ‘Indoor tendencies’ inversely predicted time outdoors among younger and older boys, and younger girls. Social opportunities positively predicted time outdoors among younger boys, while ‘outdoor tendencies’ positively predicted time outdoors among older boys. Parental encouragement for activity positively predicted time outdoors among younger and older girls, while lack of adult supervision for active play outdoors after school inversely predicted time outdoors among older girls and older boys.

Conclusion: Individual (indoor and outdoor tendencies) and social factors (social opportunities, parental encouragement and parental supervision) predicted children’s time outdoors over five years. Interventions targeting reduced indoor tendencies, increased outdoor play with others, and increased parental encouragement and supervision are warranted.

Methods: We present and reanalyze the data reported by Villermé to study the mortality-rate variations across the 12 districts (arrondissements) of Paris, i.e., 1817–1826 Parisian death rates by district, population density and income indicators.

Results: Results obtained with today’s statistical techniques (correlation analysis) support Villermé’s claims of a direct poverty–high death-rate link: the three income indicators that he chose were significantly correlated with at-home mortality: taxation index (r= –0.83, p<0.002), average rent (r= –0.83, p<0.002), trade taxation index (r= –0.67, p<0.05), while population-density variables were not associated with mortality.

Conclusion: Villermé was not only a forerunner of social epidemiology, he was also a scientific pioneer by relying on data, not opinions, to challenge or support medical hypotheses.

Methods: A single-blinded randomised controlled trial of heating intervention in 409 households containing an asthmatic child aged 6-12 years, where the previous heating was an open fire, plug-in electric heater or un-flued gas heater. The intervention was the installation of a more effective heater of at least 6 kW prior to the winter of 2006 in half the houses. Demographic and health information was collected both before and after the intervention. Each child’s school was contacted directly and term-by-term absence information for that child obtained for 2006 and previous years where available.

Results: Complete absence data were obtained for 269 out of 409 children. Compared with the control group, children in households receiving the intervention experienced on average 21 percent (p=0.02) fewer days of absence after allowing for the effects of other factors.

Conclusion: More effective, non-indoor polluting heating reduces school absence for asthmatic children.

Methods: A cross-sectional survey was conducted from 2000 to 2001 in a nationally representative sample of 15, 540 Chinese adults aged 35 to 74 years. The diabetes risk level (DRL) was assessed by classification and regression tree (CART) analysis using four predictors: age, body mass index, waist-hip ratio (WHR) and waist circumference (WC).

Results: The significant predictors for type 2 diabetes were WHR and age for women, and WC and age for men. The categories generated by CART analysis stratified women into 8 DRLs and men into 5 DRLs. The prevalence of type 2 diabetes increased with the increasing of DRLs in both women and men. A DRL ≥ 6 predicted type 2 diabetes status with a sensitivity of 0.61 (95% confidence interval [CI]: 0.55, 0.67), specificity of 0.71 (95% CI: 0.70, 0.73) in women, and a DRL ≥ 3 predicted type 2 diabetes status with a sensitivity of 0.59 (95% CI: 0.52, 0.65), specificity of 0.63 (95% CI: 0.62, 0.65) in men.

Conclusions: This study demonstrates that application of the DRLs has identified a substantial proportion of individuals with type 2 diabetes in the Chinese general population. It suggests that there is a great potential of applying the self-assessment tool in health care limited settings.

Methods: Drawing upon an extensive practical experience of conducting various types of systematic reviews of complex social interventions in the field of public health policy, this brief guide is intended to help dispel these concerns by providing an accessible overview for novices of a "real" approach to conducting systematic reviews.

Results: It discusses what a systematic review is and how definitions vary. It describes the stages of a review in simple terms. It then outlines five "do’s and don’ts" of the method in practice outlining debates and potential ways to save time and resources.

Conclusion: It concludes with a reflection on the flexibility and value of the method.

Methods: A cluster randomised controlled trial was conducted, with two waves of assessment directly before the start and immediately after the end of the prevention programme. Some 3,490 students were recruited from 84 secondary schools in Germany, of whom 3,123 students (90%) provided data from both waves. Classes from the intervention group participated in the Smokefree Class Competition, committing themselves to stay smokefree for a period of six months, and self-monitoring their smoking status on a weekly basis. Classes that refrained from smoking were eligible for a prize draw. To test the hypotheses that participation in the competition might foster bullying, we measured students’ self report of (a) being victimised, (b) engaging in bullying, and (c) being isolated.

Results: There was a strong association between daily smoking and higher odds of bullying others at baseline (Adjusted proportional odds ratio=4.66; 95% confidence interval, 3.38-6.43). No significant pre-post differences across treatment assignment groups were found on any bullying measure using generalized linear latent and mixed models. For being isolated, the trends suggested that the programme, if anything, fostered lower levels of isolation at follow-up, especially for those who perceived high levels of isolation at baseline.

Conclusion: Participation in the intervention had no effect on bullying or perceptions of isolation.

Trial registration: ISRCTN27091233 in Current Control Trial Register

Methods: Participants were recruited by telephone and randomised into one of three groups. They completed weekly sexual behaviour diaries for three months by SMS, online, or paper (by post). An online survey was conducted at the end of three months to compare retrospective reports to the diaries, and assess opinions on the diary collection method.

Results: 72 participants were enrolled in the study, 24 to each group. Online diaries were more likely to be submitted late than SMS diaries (p<0.001). 3.9% of SMS diaries, 3.1% of paper diaries and 0.5% of online diaries were incomplete (p=0.001). Online data collection was the preferred mode for 51%. 65 participants completed the end point retrospective questionnaire. The correlation between the diary and questionnaire on sexual risk classification was substantial (kappa=0.74) regardless of diary mode.

Conclusions: SMS is a convenient and timely method of collecting brief behavioural data, but online data collection was preferable to most participants and more likely to be complete. Data collected in retrospective sexual behaviour questionnaires were found to agree substantially with data collected through weekly self-reported diaries.

Methods: A cross-sectional study design was used to assess awareness of HPV and acceptability of HPV vaccination. Participants were recruited using quota sampling to ensure adequate representation of ethnic minority women: Indian, Pakistani, Bangladeshi, Caribbean, African, and Chinese women (n=750). A comparison sample of white British women (n=200) was also recruited.

Results: Awareness of HPV was lower among ethnic minority women than white women (6%-18% vs 39% in white women) and this was not explained by generational status or language spoken at home. In a subsample who were mothers (n=601), ethnicity and religion were strongly associated with acceptability of HPV vaccination. Acceptability was highest among white mothers (63%) and lowest among South Asians (11%-25%). Those from non-Christian religions were also less accepting of the vaccine (17-34%). The most common barriers to giving HPV vaccination were a need for more information, sex-related concerns and concern about side-effects. South Asian women were the most likely to cite sex-related concerns, they were also least likely to believe the vaccine would offer their daughter protection.

Conclusion: These findings suggest some cultural barriers that could be addressed in tailored information aimed at ethnic minority groups. They also highlight the importance of recording ethnicity as part of HPV vaccine uptake data.

Design: Cross-sectional study.

Setting: Population-based U.S. survey, the Third National Health and Nutrition Examination Survey (NHANES III), merged with U.S. Census data describing respondents’ neighborhoods.

Participants: 13,184 adults from 83 counties and 1,805 census tracts who completed NHANES III interviews and medical examinations and whose residential addresses could be reliably geocoded to census tracts.

Main outcome measures: A summary measure of biological risk, incorporating nine biomarkers that together represent AL across metabolic, cardiovascular, and inflammatory subindices.

Results: Being male, older, having lower income, less education, being Mexican-American, and being both Black and female were all independently associated with worse AL. After adjusting for these characteristics, living in a lower SES neighborhood was associated with worse AL (coeff. = -0.46; CI -0.079,-0.012). The relationship between NSES and AL did not vary significantly by gender or race/ethnicity.

Conclusions: Living in a lower SES neighborhood in the United States is associated with significantly greater biological wear and tear as measured by AL, and this relationship is independent of individual SES characteristics. Our findings demonstrate that where one lives is independently associated with AL, thereby suggesting that policies that improve NSES may also yield health returns.

Methods: A systematic random sample of general practice attendees was recruited in seven Spanish provinces between October 2005 and February 2006. Major depression was diagnosed using the Composite International Diagnostic Interview and a set of 39 individual and environmental risk factors for depression were assessed at baseline and after 6 and 12 months of follow-up. We used multilevel logistic regression.

Results: We selected 7,777 primary care attendees aged 18-75 years, of whom 1,251 (16.1%) were excluded. Of the remaining 6,526, 1,084 (16.6%) refused to participate. Thus, 5,442 patients (attending 231 family physicians in 41 health centers) were interviewed at baseline, of whom 3,804 (70%) and 3,567 (66%) remained at 6 and 12 months of follow-up, respectively. The province and sociodemographic factors were stronger predictors of attrition than psychosocial factors. Depression and anxiety had no effect but other psychosocial factors affected attrition. We also found different profiles for the patients lost at 12 months when we included predictors measured at baseline versus 6 months.

Conclusions: These findings suggest several psychosocial factors might be considered factors of attrition in primary care cohorts and confirm that baseline characteristics are insufficient for analysing non-response in longitudinal studies, suggesting that different retention strategies should be applied for patients interviewed at 6 and 12 months.

Methods: Individual data of participation and aggregate socioeconomic data, from respectively the structure responsible for organising screening and the French census, were analysed simultaneously by a multilevel model.

Results: Uptake was significantly higher in women than in men; odds ratio (OR=1.33; 95%CI: 1.21-1.45); and significantly lower in the youngest (50-59 years) and in the oldest (70-74 years) persons, compared with intermediate ages 60-69 years with respectively OR=0.70 (95%CI: 0.63-0.77) and OR=0.82 (95%CI: 0.72-0.93). Uptake fell with increasing level of deprivation, there was a significant difference of uptake probability between the least deprived and the most deprived areas (OR=0.68; 95%CI: 0.59-0.79). No significant influence of the general practitioners density was found.

Conclusion: Multilevel analysis allowed to detect areas of weak uptake linked to areas of strong deprivation. These results suggest that targeting populations with a risk of low compliance, as identified both socially and geographically in our study, could be adopted to minimise inequalities in screening.

Methods: Data were from a subset of participants in the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), a population-based cohort study in eastern Finland. Information on childhood factors was collected from school health records (n=952), from the 1930s to 1950s. Adult data were obtained from baseline examinations of the KIHD cohort (n=2682) in 1984-1989.

Results: The men who had poor hygiene in childhood had on average 4.07 mmHg (95% CI: 0.53-7.61) higher systolic blood pressure than the men who had good or satisfactory hygiene in childhood in the age-adjusted analysis. Reports of diarrhoea were not associated with adult blood pressure.

Conclusions: Our findings suggest that poor hygiene and living in poor social conditions in childhood are associated with higher systolic blood pressure in adulthood. Reported childhood diarrhoea did not explain the link between hygiene and high blood pressure in adulthood.

Methods: Cross-sectional analysis using data from phase 5 of the Whitehall II study (1997-1999), including retrospective information on past socioeconomic position (SEP) for 4598 participants (44-69 years). The effect of social mobility and social accumulation, from childhood social class to educational attainment to current employment grade, on prevalent adult overweight and obesity was examined.

Results: Upwardly socially mobile participants did not have lower prevalence of overweight and obesity compared to the socially stable at low SEP (62.3 vs. 63.9% in women). Downwardly socially mobile participants had higher prevalence of overweight and obesity than the socially stable at high SEP (52.0% vs. 36.1% in women). The odds of adult overweight and obesity increased with social accumulation of disadvantage.

Among women, 1 life phase in low SEP was associated with 61% higher odds (1.61:1.05; 2.47), 2 phases low with 66% higher odds (1.66: 1.14; 2.42) and all phases low with 2.6 times the odds (2.61: 1.79; 3.78) of overweight and obesity compared to women with all phases in high SEP.

Conclusions: Social mobility and social accumulation can operate simultaneously across the life-course. Prevention of downward social mobility and social accumulation of disadvantage could reduce the overall prevalence of adult overweight and obesity.

Methods: We reviewed published estimates of the general summertime temperature-mortality relationship characterized in different settings around the world. Then, in order to explain heterogeneity of effects, we applied a random-effects meta-regression to the estimates in relation to a number of standardized city-level characteristics of demography, economy and climate.

Results: Estimates of heat thresholds and slopes were identified for 64 locations across 6 continents, with most evidence to date coming from North American and European populations. Heat thresholds were generally higher in communities closer to the equator, suggesting some degree of population adaptation. In almost half of the locations, the risk of mortality increased by between 1% - 3% per 1°C change in high temperature, including in cities where annual heat exposure may not previously have been perceived to be a problem. Heat impacts were noticeably small in many US cities. In random-effects meta-regression models, increasing population density, decreasing city GDP and increasing percentage of people aged 65 or more were all independently associated with an increase in the heat slope.

Conclusion: Improved care of the elderly, residential architecture and urban planning measures which help to reduce high temperatures in densely populated areas are likely to play a key role alongside more targeted heat-health warning systems in reducing future heat burdens.

Methods: Risk factor exposure can be expressed as a categorical or a continuous variable. For a categorical risk factor a change in risk factor exposure can be expressed as a change in the proportion of the population in each category ("proportions shift"). For a continuous risk factor the change is expressed as a change in its parameters ("distribution shift"). A third method ("relative risk shift"), takes elements of both the categorical and the continuous approach. We compare the three calculation methods using hypothetical data on body mass index and an intervention that affects the obese category.

Results: The "proportion shift" calculation produces non-linear artifacts, and is best avoided. The "relative risk shift" and "distribution shift" calculation require the estmation of a relative risk function to describe excess risk, but perform much better.

Conclusion: The "proportion shift" calculation is best avoided. The "relative risk shift" and "distribution shift" calculation produce virtually the same results. For evaluating high risk strategies the "relative risk shift" calculation is the simplest and therefore preferred. The "distribution shift" is best suited for evaluating population strategies.

Methods: Two cross sectional population-based surveys in Yaounde (urban area) and Evodoula (rural area) in 1994 (1762 subjects) and 2003 (1398 subjects) used similar methodologies in women and men aged > 24 years. Data on systolic and diastolic blood pressures (SBP and DBP), body mass index, educational level, alcohol consumption and tobacco smoking were collected during the two periods.

Results: Between 1994 and 2003, blood pressure levels significantly increased in rural women (SBP +18.2 mmHg, DBP +11.9 mmHg) and men (SBP +18.8 mmHg, DBP +11.6 mmHg), all p<0.001. In the urban area, SBP increased in women (+8.1 mmHg, p<0.001) and men (+6.5 mmHg, p<0.001), and DBP increased only in women (+3.3 mmHg, p<0.001). The odds ratio (95% CI) adjusted on confounders comparing the prevalence of hypertension (blood pressure > 140/90 mmHg and/or treatment) between 2003 and 1994 ranged from 1.5 (1.1-2.2) in urban men to 5.3 (3.2-8.9) in rural men.

Discussion: Blood pressure levels of this population have deteriorated over time and the prevalence of hypertension has increased by two to five folds. Adverse effects of risk factors could account for some of these changes. Prevention and control programs are needed to reverse these trends and to avoid the looming complications.

Methods: PubMed and Embase were searched to identify Italian studies about HCV intrafamilial transmission. Used keywords were: "HCV", "Hepatitis C", "intrafamilial", "family", and "Italy". Selected studies were reviewed to assess the quality and meta-analysed using StatsDirect software.

Results: Twenty five studies were selected. The pooled overall prevalence was 9% (95%CI: 7.1%- 11.1%). The highest pooled prevalence was found among sexual partners of index cases: it was 14.7% (95%CI: 10.7%-19.2%) globally and 9.9% (95%CI: 3.6%-18.8%) and 17.6% (95%CI: 12.1%-24%) respectively in northern and central-southern regions. High quality studies meta-analysis yielded the lowest HCV prevalence.

Conclusion: To be a household of a HCV patient is a risk factor for HCV. Counselling to households of HCV patients should be thus provided.

Methods: Medians and confidence intervals were obtained using the United States National Survey of Family Growth Cycle 6 conducted in 2002.

Results: Results found a significant gender difference in the monogamous to single status length (medians 38 for females, and 19.3 mo. for males). Other status lengths were similar between genders (S-M: 20 females, 18 males; M-C: 16 females, 13 males; and C-M: 5 for both females and males). Respondents younger than the median age at first marriage showed shorter status lengths compared to older ones. Median status lengths were comparable between heterosexuals and bisexuals. Percentage of concurrency in one year was 3.3% for females and 3.8% for males.

Conclusions: One of new status length (M-C) qualitatively indicates the transmission risk to an upcoming concurrent partner. The set of four status lengths may be useful in the context of epidemiological models with partnership dynamics.

Methods: We fitted sex-specific Poisson models to cancer incidence in Hong Kong (1974-2003) to examine age, period and birth cohort effects. Cancers were grouped as: hormonally-modulated (including breast, endometrium, ovary and prostate), infection-related (cervix, liver, nasopharynx, lymphoma and stomach) and lifestyle-related (colorectum and lung).

Results: Age-standardised incidence of hormonally-modulated female cancers increased for the first generation (women born ~1940) to experience puberty in the transitioning environment of Hong Kong. Prostate cancer incidence increased, despite a downturn for the first generation growing up in Hong Kong. Incidence of infection-related cancers decreased, mainly due to birth cohort effects; coinciding with birth in Hong Kong for liver cancer and lymphoma, with reaching adulthood in Hong Kong for cervix and male nasopharynx cancers, and with a generation in Hong Kong for stomach cancer. Lifestyle-related cancers had sex-specific declines by birth cohort.

Conclusion: With economic transition and the associated lifestyle changes, environmentally determined levels of pubertal female hormones may drive inter-generational increases in hormonally-related female cancers. Economic development, via improved living conditions, may also reduce infection-related cancers, possibly including prostate cancer, however the effects depend on transmission dynamics and perhaps specific public health initiatives. In traditional societies, males may benefit from economic development sooner than females.

Methods: A cohort of 657 women recruited during the first trimester of pregnancy from a Mediterranean area with high seafood intakes was followed through birth. Dietary intakes were estimated using a validated questionnaire. Multivariable logistic regression was used to estimate associations between SGA and intakes of fatty fish, lean fish, canned tuna, crustaceans and other shellfish, adjusting for parity, child sex, parental anthropometry, socioeconomic factors, and serum levels of several POPs, including several polychlorinated biphenyls (PCBs), hexachlorobenzene (HCB), and dichlorodiphenyldichloroethylene (DDE).

Results: Overall, 7.8% of infants were SGA. Maternal consumption of crustaceans (>once/week) and canned tuna (>once/week was associated with a significantly increased risk of SGA. Fatty fish (>once/week) was associated with weaker and generally non-significant increases in risk, while lean fish and other shellfish were not associated with SGA. Adjusting for contaminants did not meaningfully change results.

Conclusions: Higher maternal intakes of crustaceans and canned tuna, but not other types of seafood, were associated with increased risk of SGA independently of several POPs. Future studies exploring seafood subtypes and additional contaminants are needed to determine whether these associations are causal and identify mechanisms involved.

Method: A cross-sectional, population based household survey was conducted in Belgrade as part of the World Health Organization Multi-Country study on Women’s Health and Domestic Violence, using a standard questionnaire. Face to face interviews were conducted with 1,456 women 15-49 years old. Data used in this paper were from a subset of 886 women who ever cohabited with their male intimate partners. The association between various factors at individual and relationship level and reported physical or sexual partner violence, or both, was assessed by univariate and multivariate logistic regression analysis.

Results: Multivariate logistic regression modelling revealed that partner violence was significantly associated with a number of factors relating to the male partner: daily alcohol consumption (AOR 4.25; 95% CI 1.78-10.11), having affairs (AOR 3.97; 95% CI 1.62-9.57; fighting with other men (AOR 3.62; 95% CI 1.91-6.88); his mother having experienced spousal abuse (AOR 2.71; 95% CI 1.40-5.23), and he himself being beaten as a child (AOR 3.14; 95% CI 1.48-6.63). Among the factors related to the women, only forced or unwanted first sexual intercourse was independently associated with exposure to partner violence (AOR 2.50; 95% CI 1.05-5.96).

Conclusion: The majority of factors associated with intimate partner violence related to the male partner; in particular his childhood experiences of violence in his own family. Long term violence prevention programmes should target boys growing up in families with domestic violence.

Methods: Two population-based cross-sectional surveys were carried out in the city of Pelotas, Brazil, in 2002 and 2007. Their multi-stage sampling strategies were virtually identical. The first study included 3,182 and the second 2,986 adults aged 20 years or older. The short version of the International Physical Activity Questionnaire (IPAQ) was used in both surveys, and individuals were classified as insufficiently active if reporting less than 150 minutes per week, according to a score combining moderate and vigorous-intensity physical activity.

Results: Prevalence of insufficient physical activity increased from 41.1% (95%CI 37.4; 44.9) in 2002 to 52.0% (95%CI 49.1; 53.8) in 2007. A 70% increase in prevalence of insufficient physical activity (p=0.008) was observed among poor individuals, whereas there was no significant change in the better-off. In contrast to the direct association between insufficient physical activity and socioeconomic level found in 2002, the 2007 survey showed no association. In the 2007 multivariable analysis, insufficient physical activity was directly associated with age and inversely with schooling.

Conclusion: Effective interventions for the promotion of physical activity are urgently required in order to overcome the decline in physical activity levels in this population, particularly among the poor.

Methods: The Western Australian Pregnancy Cohort (Raine) Study provided comprehensive data from 2,900 pregnancies. Smoking was assessed at 18 weeks gestation, and children were followed up at ages one, two, three, five, eight, ten and 14 years. The Child Behaviour Checklist (CBCL) was used to measure problem child behaviour with continuous z-scores and clinical cut-points at age two, five, eight, ten and 14 years. Potential confounders included maternal and family sociodemographic characteristics and alcohol exposure.

Results: After adjusting for confounders, children of light smokers who quit smoking by 18 weeks gestation had significantly lower CBCL total z-scores, indicative of better behaviour, than children of women who never smoked, children of heavy smokers who quit, and continuing smokers. Maternal smoking during pregnancy resulted in higher CBCL total, internalizing and externalizing scores and a higher risk of clinically meaningful behaviour problems in children from ages two-14.

Conclusion: The maternal decision not to quit smoking, or the inability to quit smoking, during pregnancy appears to be a particularly strong marker for poor behavioural outcomes in children. There is a need for a greater understanding of the psychosocial characteristics associated with the decision and ability to quit smoking in pregnancy.

Methods: Multilevel logistic regressions were applied to data from the 1999 and 2004 Health Survey for England linked to ethnic density data from 2001 census.

Results: Respondents living in non-White area types and areas of higher co-ethnic density reported decreased odds of being current drinkers relative to their counterparts. A statistically significant reduction in the odds of exceeding sensible drinking recommendations was observed for Caribbeans in Black area types, Africans in areas of higher co-ethnic density, and Indian people living in Indian area types.

Conclusion: Results confirmed a protective ethnic density effect for current alcohol consumption, but showed a less consistent picture of an ethnic density effect for adherence to sensible drinking guidelines. Previous research has shown that alcohol use is increasing among ethnic minorities, and so a greater understanding of alcohol-related behaviour among UK ethnic minority people is important to establish their need for preventative care and advice on safe drinking practices.

Methods: The study was conducted in a multinational forest industry corporation with domicile in Finland. Participants were 8029 Finnish industrial employees aged 18-65 at baseline (1986). Questionnaire survey data on SOC and other factors were collected at baseline; records of hospital admissions for psychiatric disorders and suicide attempt were derived from the National Hospital Discharge Register while records of deaths due to suicide were derived from the National Death Registry up until 2006.

Results: During the 19-year follow-up, 406 participants with no prior admissions were admitted to hospital for psychiatric disorders (n=351) or suicide attempt (n=25) or committed a suicide (n=30). A strong SOC was associated with about 40% decreased risk of psychiatric disorder. This association was not accounted for by mental health-related baseline characteristics, such as sex, age, marital status, education, occupational status, work environment, risk behaviours or psychological distress. The result was replicated in a sub-cohort of participants who did not report an elevated level of psychological distress at baseline (hazard ratio=0.59, 95% confidence interval from 0.40 to 0.86).

Conclusions: A strong SOC is associated with reduced risk of psychiatric disorders during a long time period.

Methods: In this population-based study, trends in five-year relative survival from leukaemia were evaluated for children with and without DS who were diagnosed in Great Britain during 1971-2000 and followed to the end of 2004.

Results: For all children, with and without DS, survival has increased dramatically over the 30-year study period. For lymphoid leukaemia, survival in children with DS has increased, but remains lower than for other children (five-year survival 59% vs 83% during 1996-2000). For acute non-lymphoblastic leukaemia (ANLL), however, five-year survival has improved substantially for children with DS, from less than 1% in the early 1970s to over 80% in the 1990s. For other children, survival increased from 6% to 64% during the same period.

Conclusion: Survival for all children diagnosed with leukaemia has improved during the last three decades. For lymphoid leukaemia, the inferior outcome observed on more recent treatment protocols in children with DS remains an area for concern. For ANLL, the improvement in survival for children with DS is due to a number of factors, namely increased recruitment of these children to clinical trials, changes in clinical practice and important differences in the biology of myeloid leukaemia in young children with DS, resulting in a better response to some chemotherapeutic agents.

Methods: A total of 18,734 individuals were invited to participate in the study, out of which 11,441 (61 %) enrolled. Of the participants 9,756 answered the questionnaire for those who work and 1,685 answered the version for non-workers.

Findings: The most important findings are that 31 % in the working population and 36 % in the non-working population report either hearing loss or tinnitus or both. The prevalence of hearing problems increases with age, is higher among men and persons with low self-rated SES, and co-varies with exposure to noise at work. Severe hearing problems are already present in men and women under 40 years of age who are exposed to work-related noise.

Interpretation: Prevalence of hearing problems is far more common than previously estimated and is associated with socioeconomic status and noise exposure history. Hearing problems have a gradual onset that can take years to become recognized. In order to proactively intervene and prevent this deleterious, yet avoidable handicap, statistics need to be regularly updated.

Methods: We calculated odds ratios [OR] with allergic comorbidity and various environmental factors considered as confounders and sleeping problems hypothesised to act as a potential effect modifier.

Results: The lifetime prevalence of AE and ADHD was 14.7% (male 14.4%; female 14.9%) and 4.9% (male 7.8%; female 2.0%), respectively. There was an association between ADHD and AE (odds ratio 1.54; 95%-confidence interval [95%CI] 1.24-1.93; p<.001), which was independent of sociodemographic factors, parental smoking, breastfeeding, number of siblings, perinatal health problems, and atopic comorbidity. Further analyses of a subgroup of 6,484 children age 3 to 11 confirmed the hypothesis that the association between AE and ADHD was modified by sleeping problems (interaction effect AE*sleep problems OR 2.02 95%CI 1.03-3.97; p=.04). There was a strong association between AE and ADHD in children with SP (OR 2.67 95%CI 1.51-4.71; p=.001; n=1,112), but not in children without SP (OR 1.24 95%CI 0.83-1.84; p=.30; n=5,796).

Conclusions: ADHD and AE appear to be strongly and independently associated in children with sleeping problems, but not in children without sleeping problems. A substantial part of diagnoses met for ADHD might be engendered by presence of AE and concomitant sleeping problems.

Methods: Pregnant women from Dutch, Turkish and Surinamese origin were recruited between 2006 and 2008 from community midwifery or obstetrical practices in the Netherlands. Each woman was personally interviewed 3 weeks (mean) after booking for prenatal care. Knowledge, attitude and participation in prenatal screening were assessed following the ‘Multidimensional Measure of Informed Choice’ that has been developed and applied in the UK.

Results: In total, 71% of the Dutch women were classified as informed decision-makers compared to 5% of the Turkish and 26% of the Surinamese women. Differences between Surinamese and Dutch women could to a large extent be attributed to differences in educational level and age. Differences between Dutch and Turkish women could mainly be attributed to differences in language skills and gender emancipation.

Conclusion: Women from ethnic minority groups less often made an informed decision whether or not to participate in prenatal screening. Interventions to decrease these ethnic differences should first of all be aimed at overcoming language barriers and increasing comprehension among women with a low education level. To further develop diversity-sensitive strategies for counseling it should be investigated how women from different ethnic backgrounds value informed decision-making in prenatal screening, what decision-relevant knowledge they need, and what they take into account when considering participation in prenatal screening.

Methods: A mixed methods research study focussing on ethnic options of young ‘mixed race’ people (n=326) recruited in colleges and universities investigated respondents’ preferences with respect to concepts, terminology, and classifications.

Results: The overwhelming generic term of choice was ‘mixed race’, widely interpreted by respondents to include mixed minority groups. Respondents were able to assign themselves in a valid way to a 12-category extended 2001 England and Wales Census classification for ‘mixed’, which collapses into five main groupings and also maps back to the census categories. Amongst options tested for census purposes, multi-ticking performed poorly and is not recommended.

Conclusions: A more finely granulated classification for ‘mixed’ is feasible where needed but this requires more extensive testing before it can be judged preferable to a ‘tick one or more’ option that has been shown to have poor reproducibility in validation surveys.

Methods: Data on employment status, socio-economic position (SEP), and self-rated heath were obtained for people of working age (25-59) who had ever worked from a 3% sample of the 2001 English census. The age adjusted prevalence differences in not good general health for four separate measures of SEP were compared to the prevalence differences obtained after additional adjustment for employment status.

Results: Prevalence differences for not good health were reduced by 50% or over when adjusting for employment status (for men ranging from 57% to 81%, for women 50% to 74%).

Discussion: The social gradient in employment status contributes greatly to the social gradient in self-reported health. Understanding why this is the case could be important for tackling social inequalities in health.

Methods: Assuming a log-normally distributed continuous outcome, a three-level and a binary independent variable, we evaluated the results that would be obtained by logistic regression after dichotomization. Different cutoffs, predictor effects and dispersions were examined, with a special focus on interaction terms.

Results: Depending on the specific parameter combination, dichotomization introduced sometimes substantial spurious interactions between the two predictor variables regarding their association with the outcome. These interactions could be assigned statistical significance even with modest sample sizes. Real-life data on sex x weight as determinants of gamma-glutamyltransferase provided a practical example of these issues.

Conclusions: The findings presented add a new aspect to the controversy surrounding dichotomization of continuous variables. Researchers should critically examine whether the validity of their results might be hampered by such phenomena.

Methods: Using a prospective longitudinal design, we studied the relationships between organizational justice and sickness-related absences both before and after a major life event among 25459 public sector employees working in 2551 work units. Sickness absences covered the period from 36 months prior to the event until 30 months after the event.

Results: The increase in sickness absences after the event was bigger and stayed at a higher level even 30 months after the event, among those who perceived the management practices in their work unit to be relatively unfair. Similar patterns were found for each of the distributive, procedural and interactional dimensions of organizational justice.

Conclusions: Fair organizational and managerial procedures may buffer the negative health effects of psychosocial health risks outside work.

Methods: A computer-aided search of Medline, EMBASE, CINAHL and PsychINFO, January 1966 to November 2007 was conducted to identify studies investigating the relationship between urban or rural locality and the occurrence of hip fracture. Their methodological quality was assessed, and a best-evidence synthesis used to summarise the results.

Results: Fourteen cohort studies and one case-control study were identified for inclusion in this review, indicating a lack of literature in the field. Best evidence analysis identified moderate evidence for residents of rural regions to have lower risk of hip fracture compared to urban residents.

Conclusion: Examining principal mechanisms for the observed relationship between urban/rural locality and hip fracture, such as factors at the person or area level, may help to identify modifiable risk factors and inform appropriate prevention strategies.

Methods: This cross-sectional study was carried out in a large public maternity in Sao Paulo, Brazil. During June 2006 to February 2007, 301 women aged 15-24 years who gave birth to their first child were recruited between 43 and 60 days after delivery. Detection of HPV DNA in cervical specimens was performed using a standardized polymerase chain reaction (PCR) protocol with PGMY09/11 primers. The association of selected factors with HPV infection was assessed by using Generalized Linear Model.

Results: Any HPV DNA was detected in 58.5% (95% confidence interval [CI], 52.7%-64.0%) of the enrolled young women. Most common types of HPV found were: HPV16, HPV51, HPV52, HPV58 and HPV71. The overall prevalence of HPV types targeted by the HPV prophylactic vaccines was: HPV16 -12.0%, HPV18 -2.3% and HPV 6+11-4.3%. In the multivariate analysis, only age (inversely, P for trend=0.02) and smoking habits were independently associated with HPV infection.

Conclusions: Our findings show that these young primiparous women had high cervical HPV prevalence, suggesting that this is a high risk group for cervical cancer development. Nevertheless, 17.3% were positive to any of the four HPV types included in HPV vaccines (HPV6, 11, 16 or 18), with 13.3% positive for HPV 16 or 18, and only 1.0% of them had both vaccine related oncogenic HPV types. Thus, young primiparous women could benefit from catch-up HPV vaccination programs.

Methods: Descriptive study of local investigations of UK vCJD cases, who had lived close together at some point since 1980.Main outcome measures: domestic, educational, occupational, health care associated, social and recreational links between cases; common dietary, iatrogenic and other possible routes of exposure to vCJD infection; locally elevated vCJD risk.

Results: A cluster of five cases of vCJD in a rural area in North Leicestershire was investigated in 2000, (P=0.004). A further 12 investigations of geographically associated cases of vCJD have been undertaken in the UK. In nine of the 12 locations, some or all of the local cases had consumed beef purchased from the same local retail outlets or provided by a common supplier of school meals, or had some aspect of their medical-dental care in common. In only three of these locations were circumstances identified where the local risk of transmission might have been elevated. In none of the locations was there strong evidence to exclude chance as a likely explanation for the local occurrence of these vCJD cases (P≥0.7 for all locations, except Northern Ireland where analysis not performed).

Conclusion: Although it is possible that in some parts of the UK local factors may have increased the risk of acquiring vCJD, most cases that were geographically close to each other are likely due to the same factors that gave rise to the large majority of other vCJD cases in the UK.

Methods: The study included all patients in the Skåne region of Sweden who received a statin prescription between July 2005 and December 2005; 15 581 patients in 139 privately-administered HCPs and 24 593 patients in 142 publicly-administered HCPs. Socioeconomic status was established using data from LOMAS (Longitudinal Multilevel Analysis in Skåne), and stratified multilevel regression analysis was performed.

Results: The proportion of patients receiving recommended statins was lower among privately-administered HCPs than among publicly-administered HCPs (65% vs. 80%). Among men (but not women), low income (PRprivateHCP = 1.04 (1.01–1.09) and PRpublicHCP = 1.02 (0.99–1.07)) and cohabitation (PRprivateHCP = 1.04 (1.04–1.08) and PRpublicHCP = 1.03 (1.01–1.07)) were associated with higher adherence to guidelines.

Conclusion: The physician’s decision to prescribe a recommended statin is conditioned by the socioeconomic and demographic characteristics of the patient. Beyond individual characteristics, the contextual circumstances of the HCP were also associated with adherence to guidelines. An increased understanding of the connection between the patient’s socioeconomic status and the decisions made by the physician might be of relevance when planning interventions aimed at promoting efficient and evidence-based prescription.

Methods: A cohort of 25 763 Finnish public sector employees who were initially free from depression was followed up on average 3.5 years for new self-reported physician-diagnosed depression and recorded antidepressant prescriptions derived from national registers.

Results: Factor analysis confirmed the existence of vertical and horizontal components of workplace social capital. The odds for new physician-diagnosed depression and antidepressant treatment were 30-50% higher for employees with low vertical or horizontal workplace social capital than for their counterparts with high social capital at work. In mutually adjusted models, vertical and horizontal social capital remained independent predictors of physician-diagnosed depression and antidepressant treatment.

Conclusion: These results highlight the importance of both vertical and horizontal components of workplace social capital as predictors of employee mental health.

Methods: Weight and height were measured and food intake was based on food-frequency questionnaire. A probabilistic samples of about 1,000 women 35 years or older participated in each survey.

Results: Prevalence of obesity (BMI >30 kg/m2) increased in the ten-year period (17% to 24%), as well as energy intake (2.408 to 2.912 Kcal) (p-value <0.0001). These changes were largely dependent on education, but not on income. Over the 10 year-period there was an increase of carbohydrate intake adjusted for energy, but lipid intake decreased among those women of low education, but not among the more educated ones. An overall reduction in the intake of cholesterol was also observed (273 mg vs. 212 mg; p-value <0.001).

Conclusion: In line with advertised reduction on fat intake, Brazilian women at greatest risk of obesity had a reduction of fat intake and cholesterol, and increased intake of carbohydrate. This group needs be given a clear message regarding energy reduction in order to curb the obesity epidemic.

Methods: An analysis was conducted of all singleton deliveries in a defined geographic area of Inner Mongolia from December 1996 to December 1999 (n = 9,890). Outcome and covariate data were abstracted from prenatal care records. Exposure was based on well-water measures for the maternal subvillage. Mean birthweight at term was compared across four arsenic categories using analysis of covariance. Odds ratios (ORs) for stillbirth, preterm birth, and neonatal death were estimated by logistic regression with arsenic exposure dichotomised at 50 µg/L.

Main results: Term birthweight was 0.05 kg higher (95% CI 0.02 to 0.08) in the highest exposure category (>100 µg/L) compared to the referent (below limit of detection to 20 µg/L). Arsenic >50 µg/L was associated with an increased risk of neonatal death (OR 2.01, 95% CI 1.12 to 3.59). No relationship was found between maternal arsenic exposure and preterm or stillbirth delivery.

Conclusions: At the levels observed in our study, arsenic does not appear to contribute to adverse birth outcomes. Exposure may play a role in neonatal death, but the neonatal death rate in this population was low and this potential association merits further research.

Methods: A large population-based cohort study including 167 331 adults aged 35 to 90, living in a rural area, was followed-up during a 7-year mean duration for all-cause mortality and cardiovascular diseases (CVD) deaths. At baseline, casual BP was measured and lifestyle was assessed through a questionnaire. Mortality rates were calculated according to the systolic and diastolic BP, and their association was examined in a multivariate analysis, among all subjects, stratified by sex and age-groups.

Results: Forty-five percent of the study subjects had hypertension. The nadir of CVD mortality rates was observed at 110 mmHg for casual systolic BP and 75-80 mmHg for casual diastolic BP. In the multivariate analysis, risks of all-cause mortality, ischemic heart disease and stroke increased significantly from systolic BP of 140 mmHg and diastolic BP of 100 mmHg. High systolic and diastolic BP values were greater predictors of mortality in the young age-group (34-44) than in the old age-group (65+). Systolic BP was a stronger independent predictor of CVD than diastolic BP.

Conclusions: The findings of our study are consistent with the current WHO recommendations for hypertension definition. Measurement limited to systolic BP alone would be effective in screening for hypertension in large populations.

Methods: Time series analysis by ARIMA models of 29113 fatalities in road traffic accidents (at the accident scene or within 24 hours thereafter), between January 2000 and December 2007. The model permitted estimation of an intervention parameter, together with its 95% confidence interval, to calculate the number of fatalities that would have occurred if the DPS had not been implemented, after controlling for the effect of other measures introduced in 2004.

Results: It was estimated that 618 persons (95% CI = 259 to 977) would have died in traffic accidents in the 18 months after implementation of the DPS had it not been in effect, which represents a reduction of 14.5% (95% CI = 6.1% to 23.0%) from a total of 4252 deaths.

Conclusion: Implementation of the DPS in Spain has led to a significant reduction in the number of traffic accident deaths in the context of a downward trend after the implementation of the 2004 measures.

Methods: The article suggests a four-point evaluation criteria to child development theories based on ability to communicate in (1) Cross-disciplines, (2) an Overarching facility to address various developmental domains, (3) the capacity to link child development with Lifelong developmental potentials and, most importantly, (4) Epidemiological capability to provide supporting empirical evidence for community based public health interventions (COLE criteria).

Results: Key child development theories have been reviewed by broadly grouping them into three categories on the basis of content and approach: descriptive theories, psychological construct based theories, and context-based theories. The strengths and challenges of these theories have been evaluated on the basis of COLE criteria.

Conclusion: Though most of the these theories can contribute at different level in child development initiatives but Context based theories have been particularly proposed to practitioners, researchers and policy makers for community based programming, principally for its potential to address issues of social inequality, poverty and child care practices which are at the core of public health initiatives and provide multiple level of opportunities to intervene.

Methods: Data about all births in Michigan from 2000-2005 were collected. We used bivariate chi-square tests and multivariable logistic regression models to assess the relation between residence in areas with high Arab-American concentration and risk for LBW among Arab ethnicity mothers. As a control, analyses were replicated among non-Arab white mothers.

Results: Both residence in Dearborn (OR=0.85, 95% CI=0.75, 0.97), the city with the highest Arab-American concentration in the US, and residence in 48126(OR=0.81, 95% CI=0.71, 0.93), the zip code with the highest concentration of Arab ethnicity mothers in Dearborn, were associated with lower risk for LBW compared to residence in the rest of Michigan in multivariable models adjusted for potential confounders. Neither residence in Dearborn nor in 48126 was associated with LBW risk among non-Arab white mothers.

Conclusions: Residence in areas with high Arab-American concentrations was associated with lower LBW risk among Arab ethnicity mothers. Future work should directly measure acculturation, a plausible mediator of this observed relation.

Methods: A random sample of 43,598 respondents (54% female) aged 18 to 85 years participated in the present study via a postal survey questionnaire. Sense of coherence was measured by the SOC-13 and well-being by the GHQ-12 questionnaire.

Results: Males had both stronger SOC and well-being compared to females. There was a relationship between SOC and age, with stronger SOC in the older age groups. We also found that a larger proportion of individuals experienced well-being as a function of age. In addition, an increase in SOC was related to a decrease in GHQ, i.e., a stronger SOC corresponded to higher well-being.

Conclusion: Males showed a stronger SOC and more well-being than females. Moreover SOC and well-being increased with age in both sexes. Our findings suggest that SOC may develop over a whole lifetime.

Methods: Females diagnosed with invasive breast cancer between 1998 and 2000 in one UK region were identified (n=11,781). Multilevel logistic regression was performed using standard regression and LCA. Models included SEB (2001 Townsend Index), age and stage (‘missing’ stage (8.0%) modelled as a separate category). The association of SEB with stage was also assessed.

Results: Using standard regression, there was a substantial association between SEB and death within 5 years, with and without adjustment for stage. Using LCA, patients were assigned to a large good prognosis group and a small poor prognosis group. The association between SEB and survival was substantive in both classes for the model without stage but only in the larger class for the model with stage. Increasing deprivation was associated with more advanced stage at diagnosis.

Conclusions: LCA categorises patients into prognostic groups according to patient and tumour characteristics, providing an alternative strategy to the usual statistical adjustment for stage.

Methods: We conducted a systematic review and meta-regression analyses using three-level logistic models to account for the heterogeneity between studies and between subgroups within studies.

Results: Twenty four studies, involving more than 30 million singleton births, met inclusion criteria. Compared to US-born Black women, Black migrant women were at lower odds of delivering LBW and PTB babies. Hispanic migrants also exhibited lower odds for these outcomes, but Asian and White migrants did not. Sub-Saharan African and Latin American and Caribbean women were at higher odds of delivering LBW babies in Europe but not in the US and South-Central Asians were at higher odds in both continents, compared with the native-born populations.

Conclusions: The association between migration and adverse birth outcomes varies by migrant subgroup and it is sensitive to the definition of the migrant and reference groups.

Methods: Systematic review methodology was used to identify systematic reviews (from 2000-2007, developed countries only) that described the health effects of any intervention based on the wider social determinants of health: water and sanitation, agriculture and food, access to health and social care services, unemployment and welfare, work conditions, housing and living environment, education, and transport.

Results: Thirty systematic reviews were identified. Certain categories of intervention may impact positively on health, in particular interventions in the fields of housing and work. However, there were clear gaps in the evidence, and the effects of interventions on health inequalities were unclear.

Conclusion: Intervention studies which address inequalities in health are a priority area for future public health research.

Methods: We conducted a cross-sectional analysis of the Women’s Health and Aging Studies using multivariable ordinal logistic regression modeling to estimate the relationship between SES measures with frailty status in 727 older women. Control variables included race, age, smoking status, insurance status, and co-morbidities.

Results: Ten per cent of the sample were frail, 46% were intermediately frail, and 44% were robust. In adjusted models, older women with less than a high school degree had a threefold greater odds of frailty compared to their more educated counterparts. Those with less than $10,000 yearly income had two times greater odds of frailty than their wealthier counterparts. These findings are independent of age, race, health insurance status, co morbidity, and smoking status. African Americans were more likely to be frail than Caucasians (p<0.01). However, after adjusting for education, race was not associated with frailty. The effect of race was confounded by socioeconomic position.

Conclusions: In this population-based sample, odds of frailty were increased for those of low education or income regardless of race. The growing population of older adults with low levels of education and income render these findings important.

Methods: We used data from four epidemiological studies: the HAPIEE Study (Poland, Russia, and the Czech Republic), the Hungarian Epidemiological Panel (Hungary), the Heinz Nixdorf Recall Study (Germany) and the Whitehall II Study (United Kingdom). The overall sample consisted 18 494 male and female workers aged 35-65.

Results: High effort-reward imbalance at work was associated with poor self-rated health. The adjusted odds ratios for the highest vs. lowest quartile of the effort-reward ratio were 3.8 (95% CI 1.9-7.7) in Hungary, 3.6 (95% CI 2.3-5.7) in the Czech Republic, 2.5 (95% CI 1.5-4.1) in the UK, 2.3 (95% CI 1.6-3.5) in Germany, 1.5 (95% CI 1.0-2.1) in Poland and 1.4 (95% CI 1.1-1.8) in Russia. The differences in odds ratios between countries were statistically significant (p<0.05). A similar pattern was observed with regard to the effect of overcommitment on poor health.

Conclusion: The association of effort-reward imbalance at work and of a high degree of work-related overcommitment with poor self-rated health was seen in all countries but the size of the effects differed considerably. It does not appear that the effects in Eastern Europe are systematically stronger than in the West.

Methods: The NPHS used a nationally representative sample of the Canadian general population. In this analysis, participants (n = 9,589) were followed from 2000/01 (baseline) to 2006/07.

MDE was assessed using the Composite International Diagnostic Interview – Short Form for Major depression.

Results: Low education level (OR = 1.86, 95% CI: 1.28, 2.69) and financial strain (OR = 1.65, 95% CI: 1.19, 2.28) were associated with an increased risk of MDE in participants who worked in the past 12 months. In those who did not work in the past 12 months, participants with low education were at a lower risk of MDE (OR = 0.43, 95% CI: 0.25, 0.76), compared to those with high education. Financial strain was not associated with MDE in participants who did not work. Working men who reported low household income (12.9%) and participants who did not work and reported low personal income (5.4%) had a higher incidence of MDE than others.

Conclusions: SES inequalities in the risk of MDE exist in the general population. However, the inequalities may depend on measures of SES, gender and employment status. These should be considered in interventions of reducing inequalities in MDE. MDE history is an important factor in studies examining inequalities in MDE.

Methods: A prospective study was conducted of a total of 15,256 men aged 18 to 67 with no previous history of mental disorders employed in six manufacturing factories located in several regions of Japan. At baseline, they were surveyed using a self-administered questionnaire, including self-reported measures of job strain, as well as its components (job overload and job control), role stressors (role ambiguity and role conflict), social support at work, job insecurity, and other demographic and psychological covariates. During the follow-up, a long-term sick leave of 30 days or more due to depressive disorders was recorded.

Results: During 5.14 years of follow-up on average, 47 incident cases of sick leave of 30 days or more due to depressive disorders were observed. High job control at baseline was associated with a lower risk of long-term sick leave due to depressive disorders, after adjusting for demographic variables, depressive symptoms, and neuroticism at baseline (hazard ratio, 0.28 [95% confidence interval, 0.11-0.71]); high role ambiguity was associated with the higher risk (hazard ratio, 3.49 [95% confidence interval, 1.43-8.49]).

Conclusion: Job control and role ambiguity may be important predictors of long-term sick leave due to depressive disorders among male employees, independent of depressive symptoms and neuroticism.

Methods: The Achenbach System of Empirically Based Assessment (ASEBA) and the Strengths and Difficulties Questionnaire (SDQ), used to measure psychopathology, were administered to parent, agency carer and adolescent (if older than 11). Data of 292 children aged 3-17 (mean age: 12.13) with at least one respondent of four types of placement, namely, foster care, residential care, day care and home based care, were included (response rate: 78%). Socio-economic characteristics and psychopathology were examined across these four types of placement.

Results: Overall, the proportion of children scoring within the clinical range according to at least one informant was 56% according to the SDQ and 54% according to the ASEBA. Rates were highest among children living at home and significantly lower among children in out-of-home placement, even after correcting for age, income, and duration of the ongoing placement. Adolescents scored themselves lower on psychopathology in comparison to their parents and the agency carer.

Conclusions: The prevalence of psychopathology in this child welfare population was very high, however the findings were consistent with results obtained in previous studies. The prevalence estimates differed depending on the type of placement: the highest rates were found among children in home based care, children in foster care suffered less psychopathology. The findings stress the vulnerable mental status of children in child welfare and the need for additional support for child welfare professionals and children, as well as their parents, especially for those living with their parents.

Methods: 254 women >50yr were selected 5yr after a bone densitometry (BMD) diagnosis of osteoporosis. At the outset information about osteoporosis was sent to the General Practitioner (GP). Women were not under pressure at the outset to start or comply and they and their GP were unaware that follow-up studies would take place. Patient survival was identified from the NHS Strategic Tracing Service; prescription data from GP records and baseline data from the initial questionnaire. Persistence was defined as at least 1 prescription issued/year, compliance as having a medicines possession ratio (MPR) of ≥80% for each of 5yr.

Results: Thirty eight percent failed to start treatment. Failure was associated with higher BMD Z-score and residence in a nursing/residential home (NRH). Half of those starting and alive at 5yr persisted with treatment, whereas only 23% achieved MPR≥80%. Persistence was associated with a lower co-morbidity index and compliance with a lower BMD Z-score and a fall before starting treatment.

Conclusions: Treatment was low, especially in NRH where known low treatment prevalence appears to be associated with non-initiation. The degree of depression of BMD (not just low BMD) was associated with better initiation and compliance. The association of falls with compliance suggests that falls clinics may be able to play a part in improving osteoporosis management.

Methods: A population-based birth cohort from Southern Spain was followed up from the age of 4 yrs for one year. Complete data for analyses were gathered on 210 children living in urban and rural areas. NO₂ exposure was predicted by means of land use regression models. A standardized version of the McCarthy Scales of Children's Abilities (MSCA) was used to assess children's motor and cognitive abilities. Multivariate analyses were performed to evaluate the relation between exposure to NO₂ and MSCA outcomes, adjusting for potential confounders.

Results: A negative effect of NO₂ was found across all MSCA sub-scales, despite low predicted NO₂ exposure levels (5-36 µg/m³). Children exposed to higher NO₂ (>24.75 µg/m³) showed a decrease of 4.19 points in general index score and decreases of 6.71, 7.37, and 8.61 points in quantitative, working memory, and gross motor areas, respectively. However, except for gross motor function, associations were not statistically significant.

Conclusion: Although results were not statistically significant, the associations found between exposure to NO₂ and cognitive functions suggest that traffic-related air pollution may have an adverse effect on neurodevelopmentween, especially early in life, even at low exposure levels.

Methods: Prospective occupational cohort study of 15,320 employees (73% men) aged 37 to 51. Sickness absence records in 1990-1992, including 13 diagnostic categories, were examined in relation to self-rated health measured annually for the years 1993-2006.

Results: 3,385 employees (22%) had >30 days of sickness absence and 5,564 (36%) 1-30 days during the 3-year exposure window. Repeated-measures logistic regression analysis adjusted for age, sex, occupational status and chronic diseases show employees with >30 absence days, compared to those with no absences, had 2.14 (95% CI 2.00-2.29) times higher odds for suboptimal health over the 14 years of follow-up. Retirement did not dilute this association. 9 sickness absence diagnostic categories, such as diseases of the nervous, circulatory, metabolic, musculoskeletal, sensory and gastro-intestinal systems, cancer, mental disorders and external causes, independently predicted increased risk of sustained sub-optimal health.

Conclusions: There is a remarkably persistent association between sickness absence and future long-term self-rated health status for the majority of diagnostic categories for sickness absence. This suggests that the association between sickness absence and health is ubiquitous and not driven by a limited number of rare and severe diseases.

Methods: We linked several national registers, supplying personal data on biological and social variables from childhood to young adult age. Participants were all Norwegians live born during the period 1967-1976, followed up through 2004. Persons who died or emigrated before the year of their 19th birthday, at which age follow-up started, were excluded. Thus, the study population comprised 610 359 persons, and the study outcome was completed suicide.

Results: 1406 suicides (0.23%) were recorded, the risk being four times higher in males than in females. Suicide risk factors included: not being first born (adjusted HR in males and females (95% confidence intervals): 1.19 (1.05 to 1.36) and 1.42 (1.08 to 1.88)), instability of maternal marital status during childhood, parental suicide (mainly in females), low BMI (only investigated in males), low education, and indications of severe mental illness.

Conclusions: Suicide in young adults may be rooted in early childhood, and the effect is likely to act through several mechanisms, some of which may be linked to the composition and stability of the parental home. A life course perspective may add to our understanding of suicide.

Design: Comparison of nationally representative, cross-sectional, class based surveys carried out in the same schools before and after legislation.

Participants 2532 primary schoolchildren (primary 7; aged around 11 years) surveyed in January 2006 (before legislation) and 2389 in January 2007 (after legislation).

Outcome measures: Salivary cotinine concentrations, self-reported family socioeconomic classification (family SEC) and family affluence scale (FAS).

Results: After adjusting for number of smoking parents mean cotinine concentration varied significantly across both family SEC and FAS groups, and increased significantly stepwise from high to low family SEC/FAS. Mean cotinine fell in all family SEC/FAS groups after legislation. The relative drop in mean cotinine was equal across all family SEC/FAS groups. Adding an interaction term between survey year and family SEC/FAS to the model, showed an increase in inequalities over time, but was only significant at the 93% level using FAS and 73% using family SEC.

Conclusion: Inequalities in SHS exposure exist among 11 year old children in Scotland. Smoke-free legislation has reduced exposure to SHS among all children. Although the greatest absolute reduction in cotinine is observed in the lowest SEC/FAS group, cotinine levels remain highest for this group and there is a suggestion of possible increases in inequalities which may warrant longer-term monitoring.

Methods: The study was conducted using population-based administrative data from Manitoba, Canada. PD cases were identified from diagnoses in hospital and physician records. Area-level census data on average household income and residential postal codes in health insurance registration files were used to assign PD cases to urban and rural income quintiles. Annual adjusted prevalence and incidence estimates were calculated for fiscal years 1987/88 to 2006/07. Hypotheses about differences between quintiles in average estimates and average rates of change were tested using generalized linear models with generalized estimating equations.

Results: The estimated prevalence of PD increased over the twenty-year period but incidence remained unchanged. In urban regions, average prevalence and incidence estimates were significantly higher for the lowest income quintile than the highest quintile. In rural regions, average prevalence estimates were significant higher for the lowest quintile than for the highest quintile but incidence estimates were not significantly different. The annual rate of increase in the PD prevalence was significantly different for the lowest urban and rural income quintiles.

Conclusions: There is a greater burden of PD in low income areas. An understanding of socioeconomic inequalities is useful when formulating hypotheses about factors associated with disease onset and developing equity-oriented policies about access to healthcare resources.

Methods: From the Prevention of Allergy among Children in Trondheim study (PACT), a prospective birth cohort study in primary health care in Trondheim, Norway, 3086 children were followed prospectively from 1 year to approximately 2 years of age.

The primary outcome variable was parental reported asthma and eczema at 2 years.

Results: Mean age for introducing fish in the diet was 9.1 months. Excluding children with incident eczema before 1 year, a reduced risk of developing eczema was found if the child was eating fish once a week or more, adjusted odds ratio (aOR) for any kind of fish 0.62 (CI 95% 0.42 to 0.91 p= 0.02), for oily fish, aOR 0.21 (CI 95% 0.05 to 0.86 p= 0.03), for lean fish, aOR 0.67 (CI 95% 0.41 to 1.08 p= 0.10). The associations between maternal diet and eczema at 2 years and between the dietary factors and doctor-diagnosed asthma were all insignificant.

Conclusions: Fish consumption in infancy was more important than maternal fish intake during pregnancy in preventing eczema in childhood. The intake of fish per se, not specifically n-3 PUFAs, was most important in preventing eczema.

Methods: We evaluated the association between community and maternal educational attainment and LRI risk among Medicaid-enrolled children age <2 years in Alaska, which has one of the highest LRI incidences ever reported. An individual-level database was created by linking Medicaid data to birth certificate files. A community-level database was created by calculating community LRI incidence rates and linking these values to Department of Labor census variables. Multilevel modeling was used to evaluate the independent effects of maternal and community education levels on LRI risk.

Results: Statewide outpatient and inpatient LRI incidences were high at 42 and 6 per 100 child-years. When controlling for potential individual and community level confounding variables, a child’s risk of outpatient and inpatient LRI was independently predicted in a dose response manner by the child’s mother’s educational attainment and the educational attainment of other adults in the child’s community. The latter variable had a stronger association and higher community education levels substantially mitigated the risk of poor maternal education.

Conclusions: LRI risk among Alaskan children is affected by the formal education levels of the child’s mother and other adults in his or her community. The mechanisms by which community education might influence LRI risk remain unknown and may include access to medical knowledge or acceptance of scientific versus traditional beliefs.

Methods: Critical essay and literature review.

Results: The present essay promotes (a) the application of measures of variance and clustering to evaluate the boundaries one uses in defining collective levels of analysis (e.g., neighbourhoods), (b) the combined use of measures of variance and means-centric measures of association, and (c) the investigation of causes of health variation (variance-altering causation).

Conclusions: Both measures of variance and means-centric measures of association need to be included when performing contextual analyses. The variance approach, a new aspect of contextual analysis that cannot be interpreted in means-centric terms, allows us to expand our perspectives.

Methods: Annual survey data from 2001–2006 were gathered in 22 communities. Trends in the prevalence of age-standardized blood cholesterol screening were examined for four racial/ethnic groups (black, Hispanic, Asian, and American Indian/Alaska Native), stratified by education level, and compared with national data from the Behavioral Risk Factor Surveillance System.

Results: The prevalence of cholesterol screening increased among persons in black, Hispanic, and Asian REACH communities (p<0.001), whereas prevalence decreased in the total US and Hispanic populations (p<0.001), and remained similar among blacks and Asians nationwide. The relative disparity between the total US population and most REACH communities decreased (p<0.05). Relative disparity in cholesterol screening related to education level decreased (p<0.05) within REACH communities, whereas relative disparity related to education level nationwide remained similar in blacks and increased (p<0.001) in Hispanics.

Conclusion: The REACH project decreased racial and ethnic disparities in cholesterol screening between REACH communities and the total US population, as well as disparities related to education level within REACH communities.

Methods: Non-systematic review of literature and mathematical data-simulation.

Results: Standard stratification and regression techniques will often be appropriate but propensity scores may be useful where many confounders need to be controlled and data are limited. All these techniques require that key putative confounders are measured accurately. Instrumental variables offer, in theory, a solution to the problem of unknown or unmeasured confounders but identifying an instrument which meets the required conditions will often be challenging. Obtaining measurements of the outcome variable in both intervention and control groups before the intervention is introduced allows balance to be assessed, and these data may be used to help control confounding. However, imbalance in outcome measures at baseline poses challenges for the analysis and interpretation of the evaluation, highlighting the value of adopting a design strategy that maximizes the likelihood of achieving balance. Finally, when it is not possible to have any concurrent control group, making multiple measures of outcome pre- and post-intervention can enable the estimation of intervention effects with appropriate statistical models.

Conclusion: For non-randomised designs careful statistical analysis can help reduce bias by confounding in estimating intervention effects. However, investigators must report their methods thoroughly and be conscious and critical of the assumptions they must make whenever they adopt these designs.

The aim of this study was to assess if the positive association of a clustering of cardiovascular risk factors (CRF) with CVD mortality could be weakened by exercise training.

Methods: We followed 53542 individuals who were free from known cardiovascular disease, among which 3751 had CRF, from baseline between 1984 and 1986 until the date of death from any cause, or until the end of follow-up December, 31st 2004. We used the Cox proportional hazards model to estimate hazard ratios (HR) of cardiovascular death.

Results: The HR of death from CVD among people with CRF was 1.38 (95% CI, 1.28-1.48) compared to those without CRF. The association was stronger among women than in men. In people with CRF, cardiovascular mortality was inversely related to physical activity: risk was 24% lower (HR, 0.76, 95% CI, 0.61-0.95) in the physically active compared to the inactive group. Compared to inactive people without CRF, people with CRF who reported no activity had 41% higher risk of cardiovascular death (HR, 1.41, 95% CI, 1.16-1.70).

Conclusion: These data show that individuals with CRF are at greater risk of premature cardiovascular death compared to people without CRF, and that the risk of people with CRF who were physically active appears to be comparable to that of inactive individuals without CRF.

Methods: Longitudinal individual level data was used in a register follow-up of 15 years. The data includes an 11% sample of the Finnish population with an over-sample of 80% of all deaths between ages 1-24. Mortality rates and relative indices of inequality (RII) were calculated by parental education, sex, age group and cause of death.

Results: Lower parental education was associated with a higher risk of mortality during the whole period 1990-2004. The differentials were largest among 1-4-year-old children (RII=2.4, 95% CI 1.57-3.56 for males and RII=4.5, 2.71-7.32 for females) and among young men aged 15-19 (RII=2.4, 2.00-2.98). The educational gradient was sharper in accidental and violent causes of death, but deaths from diseases contributed to differentials for both sexes among the youngest and the oldest.

Conclusion: The association between parental education and mortality in young age was consistent, although distinctively patterned by sex, age, and cause of death. The results provide some support for the idea of equalisation of health inequalities during the child-youth transition. The convergence of differences in late childhood, and re-emergence in early adulthood particularly among men was, however, related to changes in the cause-composition of deaths.

Methods: Eligible subjects were SJV residents (CHIS 2001) who reported physician-diagnosed asthma (n=1,502, 14.6%). We considered two outcomes indicative of uncontrolled asthma: (1) daily or weekly asthma symptoms, and (2) asthma-related ED visits or hospitalization in the past year. Based on residential zip code, subjects were assigned annual average concentrations of ozone, PM₁₀ and PM_2.5 for the one-year period prior to the interview date from their closest government air monitoring station within a 5-mile radius.

Results: Adjusting for age, gender, race/ethnicity, poverty level, and insurance status, we observed increased odds of experiencing daily or weekly asthma symptoms for ozone, PM₁₀ and PM_2.5 (OR_ozone: 1.23, 95% CI: 0.94, 1.60 per 10 ppb; OR_PM10: 1.29, 95% CI: 1.05, 1.57 per 10 µg/m³; and OR_PM2.5: 1.82; 95% CI: 1.11, 2.98 per 10 µg/m³) We also observed a 49% increase in asthma-related ED visits or hospitalizations for ozone (OR: 1.49, 95% CI: 1.05, 2.11 per 10 ppb) and a 29% increase in odds for PM₁₀ (OR: 1.29, 95% CI: 0.99, 1.69 per 10 µg/m³).

Conclusions: Overall, these findings suggest that asthmatic individuals living in areas of the SJV with high ozone and particulate pollution levels are more likely to have frequent asthma symptoms and asthma-related ED visits and hospitalizations.

Methods: Data from each city were analyzed separately using distributed lag models with up to 21 lags. City specific air pollution estimates were regressed on city specific covariates to obtain overall estimates and to explore sources of possible heterogeneity.

Results: We found stronger effects on respiratory mortality that extend to a period of two weeks. A 10 µg/m³ increase in O₃ was associated with 0.36% (95%CI: -0.21, 0.94) increase in respiratory deaths for lag 0 and with 3.35% (95% CI: 1.90, 4.83) for lags 0-20. We also found significant adverse health effects of summer O₃ (June-August) on total and cardiovascular mortality that persist up to a week, but are counterbalanced by negative effects thereafter.

Conclusions: Our results indicate that studies on acute health effects of O₃ using single day exposures may have overestimated the effects on total and cardiovascular mortality, but underestimated the effects on respiratory mortality.

Methods: In this paper we examine the difference between total effects and population intervention parameters, using naïve, G-computation and inverse probability of treatment weighting approaches. We explore the differences between these parameters and the intuitions they provide using data from a 2003 cross-sectional study in rural Mexico.

Results: We discuss the assumptions, specific analytic steps, limitations and interpretations of the total effects and population intervention parameters, and provide code in Stata.

Conclusion: Population intervention parameters are a valuable and straight-forward approach in epidemiologic studies for making causal inference from the data while also supplying information that is relevant for researchers, public health practitioners, and policy makers.

Methods: We analyse four waves of the Health Survey for England, a representative population survey with ethnic minority oversamples. Outcome measures include use of primary (GP and dental) and secondary (out-patient, day-care and in-patient) healthcare services and clinical outcomes of care (controlled, uncontrolled and undiagnosed) for three conditions – hypertension, raised cholesterol, and diabetes.

Results: Ethnic minority respondents were not less likely to use GP services. For example, the adjusted odds ratios for Indian, Pakistani and Bangladeshi versus white respondents were 1.29 (95% Confidence Intervals 1.07-1.54), 1.32 (1.10-1.58) and 1.35 (1.10-1.65) respectively. Similarly, there were no ethnic inequalities for the clinical outcomes of care for hypertension and raised cholesterol, and, on the whole, no inequalities in outcomes of care for diabetes. There were ethnic inequalities in access to hospital services, and marked inequalities in use of dental care.

Conclusion: Ethnic inequalities in access to healthcare and the outcomes of care for three conditions (hypertension, raised cholesterol and diabetes), for which treatment is largely provided in primary care, appear to be minimal in England. While inequalities may exist for other conditions and other health care settings, particularly internationally, the implication is that ethnic inequalities in healthcare are minimal within NHS primary care.

Methods: Using a cross-sectional population study design, psychosocial profiles were assessed in 1130 South Asian and 818 white European healthy men and women aged between 35 and 75 years, who had previously participated in a cardiovascular risk assessment programme in West London. Psychosocial factors potentially contributing to CHD risk were assessed using standardised questionnaires.

Results: UK South Asians reported significantly higher psychosocial adversity compared with UK whites. South Asian men and women experienced greater chronic stress, in the form of financial strain, residential crowding, family conflict, social deprivation and discrimination, than white Europeans. They had larger social networks, but reported lower social support and greater depression and hostility. These effects were largely independent of socioeconomic status.

Conclusion: UK South Asians experience significant psychosocial adversity compared with UK white Europeans. This is consistent with the heightened vulnerability to CHD observed in this population.

Methods: The National Survey of Health and Development is a nationally representative study of births in 1946 in England, Scotland, and Wales followed up through mid-life. Multistate life table analysis utilised 893 women interviewed annually between ages 48 to 54 years.

Results: Women spent an average of 2.6 years with trouble sleeping, and the average length of a continuous episode of trouble sleeping was 2.4 years. Among women who reported at least one episode, the average number of episodes was 1.5. Health-related risk factors at age 43 of number of physical conditions , anxiety and depression symptoms, use of prescription medication, and current or past trouble sleeping were related to increased total and per episode duration of trouble sleeping over the seven year study interval and increased duration per episode. Differences associated with these risk factors ranged from 1.2 – 1.8 years for duration over the study interval and 0.5-0.8 years per episode. There was no association between average number of episodes per woman reporting at least one episode and these health-related risk factors at age 43.

Conclusions: This study provides support for association between increased duration of trouble sleeping, in total and per episode, and health risk factors at age 43, suggesting a long-term relationship between risk factors and sleep.

Methods: Retrospective cohorts of 163,579 unoperated patients with gastric ulcer or duodenal ulcer and 28,112 patients with surgical treatment for ulcer, recorded in the Swedish Inpatient Register since 1965, were followed from the first hospitalization, or operation for the surgery cohort, until death, any cancer, emigration, or December 31, 2003. Standardized mortality ratios (SMRs) were calculated using rates from the age, sex and calendar period-matched Swedish population. Poisson regression produced adjusted relative risk estimates among operated and unoperated patients.

Results: Unoperated patients hospitalized for peptic ulcer showed a 70% excess risk of suicide (SMR=1.7, 95% CI 1.6-1.9) and those who underwent operation had a 60% increased risk (SMR=1.6, 95% CI 1.4-1.8). The risk of suicide was very high during the first year after hospitalization (SMR=4.0, 95% CI 3.4-4.7) and more marked among women, patients younger than 70 and patient who were hospitalized without complications of ulcer. Both gastric ulcer and duodenal ulcer patients had high risk of suicide completion.

Conclusion: Hospitalized patients with gastric ulcer or duodenal ulcer have an increased risk of suicide disregard of surgical treatment. These patients, especially women, are at very high risk during the first year after first hospitalization/operation. The evaluation and management of suicidal thoughts in patients in medical settings should be considered.

Methods: We used HRV and gene data from the Normative Aging Study and PM2.5 from a monitor located a kilometer from the examination site. We fitted a mixed model to investigate the associations between PM2.5 and repeated measurements of HRV by gene polymorphisms of apolipoprotein E (APOE), lipoprotein lipase (LPL) and vascular endothelial growth factor (VEGF) adjusting for potential confounders chosen a priori.

Results: A 10-µg/m³ increase of PM2.5 in the two days before the examination was associated with 3.8% [95% confidence interval (CI): 0.2%, 7.4%], 7.8% [95 CI: 0.4%, 15.3%] and 10.6% [95% CI: 1.8 %, 19.4%] decreases of the standard deviation of normal-to-normal intervals, the low frequency and the high frequency, respectively. Overall, carriers of wild type APOE, LPL and VEGF genes had stronger effects of particles on HRV compared to those with hetero- or homozygous types. Variations of LPL-N291S, LPL-D9N and APOE-G113C significantly modified effects of PM2.5 on HRV.

Conclusion: Associations between PM2.5 and HRV were modified by gene polymorphisms of APOE, LPL and VEGF and biological metabolism remains to be identified.

Method: We did a multilevel analysis of a 3-year cohort study using probabilistic linkage of census and mortality records, and two measures of neighbourhood fragmentation. 2.8 million respondents to the 1996 New Zealand census were followed up for three years for mortality (1101 suicide deaths in the analysis), aged from 20 to 74 at follow-up.

Results: No consistent association was observed between either measure of neighbourhood social fragmentation and suicide, after controlling for individual level confounders and neighbourhood deprivation. There was some evidence of a U shaped relationship neighbourhood fragmentation and suicide, especially for the Congdon(NZ) index. There was no evidence of an association for a nine variable index that captured family type variables as well as the usual attachment type variables. Neighbourhood deprivation remained as an important predictor of suicide rates.

Conclusion: This paper highlights the importance of understanding both the measure and the wider national context when considering neighbourhood effects on suicide.

Methods: Population-based, cross-sectional data from 2002-2003 Joint Canada-United States Survey of Health (JCUSH) with 4953 adult respondents from the United States and 3455 from Canada. Models adjusted for age, sex, foreign-birth, marital status, health insurance, education, income, and home ownership.

Results: Compared to the United States, racial inequities in health were attenuated in Canada. In the US, racial inequities in chronic diseases and fair or poor self-rated health were largely driven by inequities found among the native-born. Strikingly, in Canada, however, there were few significant racial inequities and those occurred exclusively among the foreign-born. Within strata of race and foreign-birth, Canadians fared better, with both whites and nonwhites reporting better health than their American counterparts. Foreign-born Canadians and Americans were more similar to each other in terms of health than native-born Canadians and Americans. Only among the native-born did American whites and American nonwhites have higher adjusted odds of hypertension, diabetes, and obesity, compared to Canadian whites and Canadian nonwhites respectively. Self-rated health was worse for nonwhite Americans compared to nonwhite Canadians regardless of foreign-birth.

Conclusion: The influence of race on health is context dependent. There is no necessary link between race and a variety of health indicators.

Methods: Cross sectional. In 2006, 1,268 (response rate 79 %) ten- and eleven-year-old children in southern Finland, in a classroom situation, filled in a questionnaire assessing meal pattern and food frequency intake. Parents, 816 (response rate 64%), filled in a questionnaire assessing SOC (13-items), and eating patterns. Matching data was found from 772 child-parent pairs. Chi²-tests, factor analysis, univariate analysis of variance and logistic regression analyses were used as statistical methods.

Results: A weaker parental SOC was associated with children’s irregular meal pattern (p= 0.004), more frequent intake of energy rich foods (p=0.002), and less frequent intake of nutrient rich foods (p=0.051). Mediating factors such as availability and accessibility of fruit and vegetables at home, parent’s nutrition knowledge, parent’s own fruit and vegetable intake, and an irregular meal pattern explained the association between parent’s SOC and children’s intake of nutrient dense foods, but not the association with energy rich foods.

Conclusions: Parent’s weaker SOC was associated with children’s unhealthier eating pattern. More research is needed on the associations between parent’s SOC and other health related behaviours of their children.

Methods: Postal questionnaire survey data among 40 to 60 year-old employees of the British Whitehall II Study (n=4551, 27% women) and the Finnish Helsinki Health Study (n=7605, 83% women) cohort were analyzed. Angina pectoris symptoms were the outcome in logistic regression analysis. Karasek’s job strain was examined. Models were adjusted first for age, secondly for occupational class, and finally for smoking, heavy drinking, physical inactivity, unhealthy food habits, and obesity.

Results: Angina pectoris symptoms were reported by 5% of women and 3% of men in Britain, and by 6% of women and 4% of men in Finland. High job strain was associated with angina pectoris symptoms among men in Britain (OR 2.08; CI 95% 1.07-4.02) and women in Finland (OR 1.90; CI 95% 1.36-2.63) independent of age, occupational class, and behavioral risk factors. However, similar associations between job strain and angina pectoris symptoms were not observed among men in Finland or women in Britain.

Conclusion: The results yielded partial support for the association between job strain and angina pectoris symptoms across national contexts.

Methods: Data were collected as part of the SPEEDY study (Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people), a cross-sectional study of 2064 children from schools in Norfolk, England. Data regarding the usual mode of travel to school, attitudes towards and social support for active commuting, perceptions of the neighbourhood and route to school were assessed using questionnaires completed by 2012 children and their parents. Distance to school was estimated using a Geographic Information System and this was used to compare associations between personal and environmental factors and active travel, across different distance categories.

Results: 40% of children reported usually walking to school, with 9% cycling and the remainder using motorised travel. Parental attitudes and safety concerns, the presence of social support from parents and friends, and parent reported neighbourhood walkability were all found to be predictors of active commuting, with children receiving peer and family support and living in supportive environments being more likely to walk or cycle. There was some evidence of a moderating effect of distance whereby attitudes were more important for short distances and safety concerns long.

Conclusion: Both attitudinal and environmental perceptions are associated with children’s active commuting behaviours. Given the difficulty in modifying attitudes directly, the effect on them of interventions to provide more supportive environments should be evaluated.

Methods: This study was based on a cohort of 49 321 Swedish males born 1949/51, tested for compulsory military conscription in 1969/70. Data on employment/unemployment 1990-1994 was based on information from the Longitudinal Register of Education and Labour Market Statistics. Information on childhood circumstances was drawn from National Population and Housing Census 1960. Information on psychiatric diagnosis and behavioral risk factors was collected at conscription testing in 1969/70. Data on mortality and hospitalisation 1973-2004 was collected in national registers.

Results: An increased risk of mortality 1995-2003 was found among individuals who experienced 90 days or more of unemployment during 1992-1994, compared with those still employed (all cause mortality HR = 1.91, 95 % CI: 1.58-2.31. Adjustment for risk factors measured along the life-course considerably lowered the relative risk (all cause mortality HR = 1.30, 95 % CI: 1.06-1.58). Statistically significant increased relative risk was found during the first four years of follow up (all cause mortality, adjusted HR = 1.57, 95 % CI: 1.13-2.18, but not the following four (all cause mortality, adjusted HR = 1.17, 95 % CI: 0.91-1.50).

Conclusion: Our results suggest that a substantial part of the increased relative risk of mortality associated with unemployment may be attributable to confounding by individual risk factors.