Publications on adherence to statin medication in clinical trials and in normal practice were systematically reviewed. Data on CVD-free members of a large southern hemisphere cohort study were used to simulate the expected benefits of contrasting strategies to increase the use of statins. Risks of incident CVD and death from CVD were estimated.

A strategy to enhance statin adherence among cohort members meeting NICE statin-prescribing guidelines resulted in about twice as large a reduction in the aggregate risk of CVD death as did a strategy to lower treatment thresholds.

The benefits from increased spending on statin medication will be much greater if they result from enhanced adherence rather than from lowering the medication threshold.

Maori patients diagnosed as having colon cancer between 1996 and 2003 were identified from the New Zealand Cancer Registry and compared with a randomly selected sample of non-Maori patients. Clinical and outcome data were obtained from medical records, pathology reports and the national mortality database. Cancer-specific survival was examined using Kaplan–Meier survival curves and Cox hazards modelling with multivariable adjustment.

301 Maori and 328 non-Maori patients with colon cancer were compared. Maori had a significantly poorer cancer survival than non-Maori (hazard ratio (HR)=1.33, 95% CI 1.03 to 1.71) that was not explained by demographic or disease characteristics. The most important factors contributing to poorer survival in Maori were patient comorbidity and markers of healthcare access, each of which accounted for around a third of the survival disparity. The final model accounted for almost all the survival disparity between Maori and non-Maori patients (HR=1.07, 95% CI 0.77 to 1.47).

Higher patient comorbidity and poorer access and quality of cancer care are both important explanations for worse survival in Maori compared with non-Maori New Zealanders with colon cancer.

From the Prevention of Allergy among Children in Trondheim study, a prospective birth cohort study in primary healthcare 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.

The 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 OR (aOR) for any kind of fish 0.62 (95% CI 0.42 to 0.91 p=0.02), for oily fish aOR 0.21 (95% CI 0.05 to 0.86 p=0.03) and for lean fish aOR 0.67 (95% CI 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.

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 polyunsaturated fatty acids, was most important in preventing eczema.

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

Lower parental education was associated with a higher risk of mortality during the whole period of 1990–2004. The differentials were largest among 1–4-year-old children (RII=2.4, 95% CI 1.57 to 3.56 for males and RII=4.5, 2.71 to 7.32 for females) and among young men aged 15–19 (RII=2.4, 2.00 to 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.

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.

The authors 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 modelling was used to evaluate the independent effects of maternal and community education levels on LRI risk.

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.

LRI risk among Alaskan children is affected by the formal education levels of the child's mother and other adults in their 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.

Eligible subjects were SJV residents (2001 California Health Interview Survey) who reported physician-diagnosed asthma (n=1502, 14.6%). The authors considered two outcomes indicative of uncontrolled asthma: (1) daily or weekly asthma symptoms and (2) asthma-related ED visits or hospitalisation in the past year. Based on residential zip code, subjects were assigned annual average concentrations of ozone, PM₁₀ and PM_2.5 for the 1-year period prior to the interview date from their closest government air monitoring station within an 8 km (5 miles) radius.

Adjusting for age, gender, race/ethnicity, poverty level and insurance status, the authors 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 to 1.60 per 10 ppb; OR_PM10 1.29, 95% CI 1.05 to 1.57 per 10 µg/m³; and OR_PM2.5 1.82; 95% CI 1.11 to 2.98 per 10 µg/m³). The authors also observed increased odds of asthma-related ED visits or hospitalisations for ozone (OR 1.49, 95% CI 1.05 to 2.11 per 10 ppb) and a 29% increase in odds for PM₁₀ (OR 1.29, 95% CI 0.99 to 1.69 per 10 µg/m³).

Overall, these findings suggest that individuals with asthma 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 hospitalisations.

A cross-sectional community-based survey was conducted in which 1904 women in reproductive age group and 1762 children below 12 years of age from 35 villages in three districts of Punjab were interviewed on a semistructured schedule for systemic and general health morbidities. Medical doctors conducted a clinical examination and review of records where relevant. Out of 35 study villages, 25 served as target (exposed) and 10 as non-target (less exposed or reference). Effluent, ground and surface water, fodder, vegetables and milk (bovine and human) samples were tested for chemical composition, heavy metals and pesticides.

Spontaneous abortion (20.6 per 1000 live births) and premature births (6.7 per 1000 live births) were significantly higher in area affected by heavy metal and pesticide pollution (p<0.05). Stillbirths were about five times higher as compared with a meta-analysis for South Asian countries. A larger proportion of children in target area were reported to have delayed milestones, language delay, blue line in the gums, mottling of teeth and gastrointestinal morbidities (p<0.05). Mercury was found in more than permissible limits (MPL) in 84.4% samples from the target area. Heptachlor, chlorpyriphos, β-endosulfan, dimethoate and aldrin were found to be more than MPL in 23.9%, 21.7%, 19.6%, 6.5% and 6.5% ground water samples respectively.

Although no direct association could be established in this study, heavy metal and pesticide exposure may be potential risk factors for adverse reproductive and child health outcomes.

Data on all births in Michigan from 2000 to 2005 were collected. Bivariate ² tests and multivariable logistic regression models were used to assess the relation between residence in areas with a high Arab–American concentration and risk for LBW among AEM. As a control, analyses were replicated among non-Arab white mothers.

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

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

Using data from a contemporary UK cohort of children at age 9 months (N = 18 114) and 3 years (N = 13 718), Poisson regression was used to explore the association between childcare type (parental, informal, formal) and the risk of unintentional injury, overall and by socioeconomic group.

At age 9 months there was no overall association between childcare and injury. However, when stratifying the analyses, infants from higher socioeconomic groups were less likely to be injured if they were cared for in formal childcare (compared with being cared for only by a parent), whereas those from lower social groups were more likely to be injured. At age 3 years informal childcare was associated with an increased risk of injury overall; in the stratified analyses this increased risk occurred only in less affluent groups. Formal childcare was no longer associated with injury at age 3 in any strata.

Previous findings have shown that childcare can have a positive influence on childhood injury; however, a recent Unicef report highlighted that a lack of access to high-quality childcare could lead to a widening of inequalities. Our analyses indicate that childcare does have the potential to widen inequalities in injury; further research is required to understand why childcare has a differential impact on unintentional injury and how this might be prevented.

Participants were children aged 2–10 and adolescents aged 11–18 years from general population households in England studied using repeated cross-sectional surveys. Obesity was computed using international standards. Prevalence projections to 2015 were based on extrapolation of linear and non-linear trends.

Obesity prevalence increased from 1995 to 2007 from 3.1% to 6.9% among boys, and 5.2% to 7.4% among girls. There are signs of a levelling off trend past 2004/5. Assuming a linear trend, the 2015 projected obesity prevalence is 10.1% (95% CI 7.5 to 12.6) in boys and 8.9% (5.8 to 12.1) in girls, and 8.0% (4.5, 11.5) in male and 9.7% (6.0, 13.3) in female adolescents. Projected prevalence in manual social classes is markedly higher than in non-manual classes [boys: 10.7% (6.6 to 14.9) vs 7.9% (3.7 to 12.1); girls: 11.2% (7.0 to 15.3) vs 5.4% (1.3 to 9.4); male adolescents: 10.0% (5.2 to 14.8) vs 6.7% (3.4 to 10.0); female adolescents: 10.4% (5.0 to 15.8) vs 8.3% (4.3 to 12.4)].

If the trends in young obesity continue, the percentage and numbers of obese young people in England will increase considerably by 2015 and the existing obesity gap between manual and non-manual classes will widen further. This highlights the need for public health action to reverse recent trends and narrow social inequalities in health.

In a prospective cohort study of 24 999 men and 25 089 women free from cardiovascular disease at baseline, Cox proportional hazard models were used to estimate adjusted hazard ratios of death from IHD related to RHR measured at baseline. The combined effect of RHR and self-reported PA on the risk of death from IHD was also assessed.

During a mean of 18.2 (SD 4) years of follow-up, 2566 men and 1814 women died from cardiovascular causes. For each increment of 10 heart beats per minute, risk of death from IHD was 18% higher in women <70 years of age (p<0.001); no such association was observed among women ≥70 years. Among men, there was a corresponding 10% higher risk in the younger (p = 0.004), and 11% higher risk in the older age group (p = 0.01). Among women, the risk associated with high RHR was substantially attenuated in those who reported a high level of PA, whereas in men, there was no clear indication that PA could modify the positive effect of RHR.

RHR is positively associated with the risk of death from IHD, and among women, the results suggest that by engaging in PA, the risk associated with a high RHR may be substantially reduced.