Patterns of physical activity among Russian youth: The Russian Longitudinal Monitoring Survey

Background: This paper describes physical activity the patternsof 2,101 Russian youth enrolled in the Russian LongitudinalMonitoring Survey (RLMS). The RLMS is a nationally representativehousehold sample survey. Methods: Youth 14–18 years andparents of youth 6–13 years responded to survey questionsabout hours per week of light (cooking and laundry), moderate(walking, bicycling and sports), and vigorous physical activities(karate, wrestling and gymnastics). Sedentary activities (e.g.watching TV, music, homework) were categorized separately. Subjectswere categorized for analyses by sex (boys n=1,072 and girlsn=1,029) and age was grouped by school year: 6–11 years(elementary school), 12–16 years (high school), and 17–18years. Mean hours per week by age and sex were computed fortime spent in sedentary (1 MET), light (1.1–2.9 METs),moderate (3–6 METs), and vigorous (6 METs) activities.The proportion of youth meeting International PA Guidelines1 (any intensity physical activity 30 mln/day, 5 days per week)and 2 (moderate to vigorous physical activity for three sessionsper week) was computed for each group. Results: Russian boysand girls spent approximately 28 h/week in sedentary activities.Boys spent more time than girls in moderate (5.2 versus 4.1h/week) and vigorous (2.5 versus 1.8 h/week) intensity activities;girls spent more time in household activities. Nearly 70% ofRussian youth met Guideline 1, and fewer than 45% met Guideline2. Conclusions: The results suggest that most Russian youthenrolled in the RLMS obtain sufficient amounts of any levelof physical activity per week, but that efforts may be neededto promote more regular moderate to vigorous physical activity.     

Waist circumference home measurement--a device to find out patients in cardiovascular risk

Background: New strategies are needed to prevent the globalepidemic of diabetes and subsequent rise in cardiovascular diseases.We describe a community-based, two-stage screening strategyusing home waist circumference measurement and a risk factorquestionnaire as a primary screening tool. Methods: We maileda tape for measurement of waist and a risk factor questionnaireto every inhabitant aged 45–70 years living in the ruraltown of Harjavalta in Finland. Thereafter we performed an oralglucose tolerance test, anthropometric variables and blood pressureof subjects having at least one risk factor for type 2 diabetesor cardiovascular disease. People with previously known diabetesor vascular disease were excluded. Results: Seventy-three percent(2085/2856) of the invited inhabitants participated, and 84%of the respondents had at least one pre-specified risk factor.Waist circumference 80 cm in women and 94 cm in men (n = 1168),positive metabolic syndrome criteria of the International DiabetesFederation (n = 681) or the Finnish Diabetes Risk Score questionnaire12 points (n = 697) identified 95, 92 and 63% of the new casesof type 2 diabetes and 84, 75 or 62% of pre-diabetes, respectively.Conclusion: The International Diabetes Federation criteria forelevated waist circumference are very sensitive but lack specificityin diagnosing glucose disorders. The criteria for metabolicsyndrome and the Finnish Diabetes Risk Score questionnaire aremore efficient tools for the selection of patients for furtherrisk stratification in general practise.     

Epidemiology and cost of treatment of genital warts in Spain

Background: Genital warts (GW) are common and increasing inyoung people. Ninety percent of GW are due to Human Papillomavirus(HPV) types 6 and 11. The objective of this study was to assessthe epidemiology and management costs associated with GW inSpain. Methods: A 1-year (2005) retrospective observational study wasperformed among a sample of gynaecologists, dermatologists andurologists in six autonomous regions in Spain. Men and womenwith newly diagnosed, recurrent or resistant GW were included.We estimated the incidence (new and recurrent cases) and prevalence(also including resistant cases) of GW. Healthcare resourceuse were collected and combined with unit costs to assess themean cost of GW management per patient. These figures were extrapolatedto the 14- to 64-year-old Spanish population to estimate thetotal cost of GW management from the Third Party Payer (TPP)and societal perspectives. Results: The overall annual incidence of GW was estimated at160.4 cases per 100 000. Overall prevalence was calculated as182.1 cases per 100 000, corresponding to 56 446 GW cases annually(14- to 64-year-old population). The mean management cost was833 and 1056 per patient from the TPP and societal perspective,respectively. The overall annual cost was estimated at 47 millionand 59.6 million, from the TPP and societal perspective, respectively. Conclusion: This study provides a first overview of the burdenof GW in Spain. A quadrivalent HPV vaccine that prevents HPV6, 11, 16, 18 related diseases will have the potential to significantlydecrease the socio-economic burden associated with GW in Spain.     

Perinatal epidemiology in Belgium

Data on the civil registration of all births and deaths recordedin 1987 in Belgium were analysed following WHO rules. The followingstatistics with significant regional variations were recorded:2.5% of teenage pregnancies, 7% of late pregnancies (35 years),6.1% of low birth weights and 5.3% of preterm deliveries. Pretermbirth rates did not improve during the last decade and are higherthan in neighbouring countries. Infant mortality rate is 9.74per 1000. This rate has remained unchanged since the early 1980sbut the relative importance of post-neonatal mortality is increasing.Congenital anomalies account for 26% of all infant deaths followedby the sudden infant death syndrome (17%). Maternal conditionssuch as eclampsia are related to 29% of the infants' deaths.     

Effect of the application of the new diagnostic criteria of diabetes mellitus in the prevalence estimates and diagnostic level in the general population

Background: The objective was to study the effect of the applicationof the new diagnostic criteria for diabetes mellitus on itsprevalence in Galicia (northwest Spain). Methods: Analysis using‘old’ and ‘new’ criteria (diabetes undertreatment and/or fasting glycaemia 140 mg/dl or 126 mg/dl respectively)was performed in a cross-sectional study (1,275 participants)in the general population aged 40–69 years. Results: Prevalenceof diabetes rose from 7.5 (95% Cl: 6.1–9.1) to 10.4% (95%Cl: 8.8–12.2) with the new criteria. The proportion ofnon diagnosed diabetes rose from 22.2 to 37.8%. Conclusions:The new diagnostic criteria for diabetes mellitus make it necessaryto increase previous prevalence estimates by 30–35% Inmiddle age (40–69 years).     

Impact of health education on health-related quality of life among elderly persons: results from a community-based intervention study in rural Bangladesh

This study examines the change in health-related quality oflife (HRQoL) among (60 years) elderly persons as a result ofhealth education intervention. A community-based interventionstudy was performed in eight randomly selected villages (Intervention:n = 4; Control: n = 4) in rural Bangladesh. A total of 1135elderly persons was selected for this study. The analyses include839 participants (Intervention: n = 425; Control: n = 414) whoparticipated in both baseline and post-intervention surveys.Participants in the intervention area were further stratifiedinto compliant (n = 315) and non-compliant (n = 110) groupsbased on the reported compliance to the intervention activities.The intervention includes, for example, physical activity, adviceon healthy food intake and other aspects of management. To createan enabling environment, social awareness was provided by meansof information about the contribution of and challenges facedby elderly persons at home and the community, including informationabout elderly persons' health and health care. The interventionactivities were provided to the elderly persons, caregivers,household members and community people for 15 months. The HRQoLwas assessed using a multi-dimensional generic instrument designedfor elderly persons. Multivariate analyses revealed that inthe non-compliant group the probabilities of increased scoreswere less likely in overall HRQoL (OR 0.52, 95% CI 0.32–0.82).Among the Control group, increased scores were less likely inthe physical (OR 73, 95% CI 0.54–0.99), social (OR 0.37,95% CI 0.27–0.50), spiritual (OR 0.60, 95% CI 0.34–0.94),environment (OR 0.36, 95% CI 0.26–0.49) dimensions andoverall HRQoL (OR 0.44, 95% CI 0.32–0.59) (adjusted forage, sex, literacy, marital status and economic status). Thisstudy concludes that provision of community-based health educationintervention might be a potential public health initiative toenhance the HRQoL in old age.     

Physical Activity and Television Watching in Relation to Risk of Type 2 Diabetes: The Black Women's Health Study

Few modifiable risk factors for type 2 diabetes have been documentedin the high-risk population of US black women. The authors useddata from 45,668 black women aged 21–69 years, followedbiennially from 1995 to 2005 in the Black Women's Health Study,to estimate incidence rate ratios for type 2 diabetes comparingvarious levels of physical activity and television watching.Cox proportional hazards models were used to control confoundingfactors. During 10 years of follow-up, 2,928 incident casesof type 2 diabetes were identified. Vigorous activity was inverselyassociated with type 2 diabetes risk (P_trend < 0.0001); theincidence rate ratio for 7 hours per week was 0.43 (95% confidenceinterval (CI): 0.31, 0.59) relative to no activity. Brisk walkingfor 5 hours per week was associated with reduced type 2 diabetesrisk (incidence rate ratio = 0.67, 95% CI: 0.49, 0.92) relativeto no walking. Television watching was associated with an increasedtype 2 diabetes risk: The incidence rate ratio was 1.86 (95%CI: 1.54, 2.24) for 5 hours relative to <1 hour of televisionper day, independent of physical activity. These observationaldata suggest that black women might reduce their risk of developingtype 2 diabetes by increasing their time spent walking or engagedin vigorous physical activity and by limiting television watching. African continental ancestry group; diabetes mellitus, type 2; exercise; incidence; motor activity; television; walking; women's health     

Overtime work and stress response in a group of Japanese workers

Background Working long overtime hours is considered a causeof mental health problems among workers but such a relationshiphas yet to be empirically confirmed. Aim To clarify the influence of overtime work on response tostress and to assess the role of other stress-related factorson this relationship. Methods The study was conducted among 24 685 employees of acompany in Japan. Stress response, job stressors and socialsupports were assessed by the Brief Job Stress Questionnaire.Participants were divided into five categories of overtime (0–19,20–39, 40–59, 60 h of overtime per month and exemptedemployees). Results The nonadjusted odds ratios for stress response for40–59 and 60 overtime hours per month in reference to0–19 overtime hours were 1.11 [95% confidence interval(CI) 1.03–1.19] and 1.62 (95% CI 1.50–1.76), respectively.After adjustment for self-assessed amount of work, mental workloadand sleeping time, the association between overtime work andstress response disappeared. Conclusions This large cross-sectional study shows that overtimework appears to influence stress response indirectly throughother stress factors such as self-assessed amount of work, mentalworkload and sleeping time.     

Trends in oral contraceptive use in a Southern German population: Results of the MONICA project Augsburg: surveys 1984/85 and 1989/90

In the surveys of the MONICA project Augsburg, conducted in1984/85 (S1) and 1989/90 (S2), data on oral contraceptive (OC)use were gathered in two independent representative population-basedsamples of women aged 25–44 years (medication historyover the previous seven days). OCs were categorized accordingto their oestrogen content (< 50mg, 50mg) and according totheir progestogen component. The prevalence of OC use was unchangedbetween the two points in time (23.4% in S1 and 23.7% in S2).OCs with low oestrogen content were used in 49.0% of the OCusers in S1 and in 76.6% in S2. The use of the progestogen componentchanged also: norethindrone (acetate), levonorgestrel, and lynestrenolwere used less, desogestrel more often in S2. Gestoden and norgestimatewere used by 15% of the OC users in S2. In conclusion, we cansay that there was no change in the prevalence of OC use inthe study population; however, a change in hormone content towardspreparations with lower hormone content was observed.     

Relationship between job, lifestyle, age and occupational injuries

Background Physical job demands (PJD), age, disability and lifestylemay influence the risk of occupational injury. Aim To assess the relationships between PJD, lifestyle and injuryin workers of various ages. Methods A total of 2888 randomly selected workers from northeasternFrance, aged 15, completed a postal questionnaire. The PJD scorewas defined as the total number of the following reported jobdemands: using pneumatic tools, other vibrating hand tools,hammers, machine tools or vibrating platforms and exposure tomanual handling tasks, awkward postures, high pace of work,high physical workload, work at heights, work in adverse climatesor exposure to noise, cold or heat. Data were analysed usinglogistic regression. Results Nine per cent of subjects reported an injury duringthe previous 2 years. The PJD score was related to the injuryrate for workers aged 45: crude odds ratio (OR) 3.5 (95% confidenceinterval = 1.5–8.0) for PJD = 1, 5.0 (2.2–11.3)for PJD = 2–3 and 14.5 (6.5–32.2) for PJD 4, versusPJD = 0. Lower ORs were found for those aged <30 (1.4, 4.2and 9.9, respectively) and 30–44 (1.5, 4.4 and 6.5, respectively).The differences between age groups remained when controllingfor all factors studied. Obesity, smoking and musculoskeletaldisorders were associated with injury risk in workers aged 45(adjusted ORs 1.7–2.6). Smoking was also an injury riskfactor for workers aged <30. Conclusions PJD and lifestyle have a higher impact on injuryrates among older workers than among younger ones. Injury preventionshould address reducing PJD and improving relevant lifestylefactors, especially for older workers.     

Relationship Between Oral Health and Fractures in Community-Dwelling Older Japanese Adults

ObjectiveTo investigate the relationship between poor oral health and the incidence of fall-related fractures in older Japanese individuals.DesignA 9-year prospective cohort study.Setting and ParticipantsParticipants comprised 937 community-dwelling older Japanese adults aged 70 years or older. They all lived in the Tsurugaya district, a suburban area of Sendai city, and underwent comprehensive geriatric assessment, including an oral examination, in a public facility.MeasurementsThe exposure variables were related to oral health status (posterior occlusal support, number of remaining teeth, and occlusal force). The outcome measure was the incidence of fall-related fractures, which was determined by National Health Insurance data. Analyzed covariates included age, sex, medical history, smoking, alcohol drinking, educational level, depressive symptoms, cognitive impairment, physical function, body mass index, and history of falls. Statistical relationships were examined by calculating hazard ratios (HRs) at 95% confidence intervals (CIs) using the Cox proportional hazard model.ResultsIn the multivariate analysis, the HRs of fall-related fractures were significantly higher in those with unilateral posterior occlusal support (HR, 2.72; 95% CI, 1.13-6.55) and no posterior occlusal support (HR, 2.58; 95% CI, 1.29-5.15) than in those with bilateral posterior occlusal support. The HRs (95% CIs) of fall-related fractures in individuals with 10-19 and 1-9 teeth and edentulous individuals were 1.77 (0.81-3.89), 2.67 (1.24-5.75), and 2.31 (1.01-5.28), respectively, compared to those with ≥20 teeth.Conclusions and ImplicationsPoor oral health status is a risk factor for the incidence of fall-related fractures in community-dwelling older Japanese individuals. The findings suggest that attention should be focused on oral health status to further understand the risk of fall-related fractures among community-dwelling older adults.     

CUNNINGHAM CONCERNING 'REGRESSION TO THE MEAN: WHAT DOES IT MEAN?'

We agree that our interpretation of our results regarding acognitive behaviour alcohol programme compared with post-mailedminimal intervention (Johnsson and Berglund, 2006) is conservativein that we did     

Association of executive function impairment, history of falls and physical performance in older adults: A cross-sectional population-based study in Eastern France

Objective

To estimate: 1) the association between executive function (EF) impairment and falls; and 2) the association of EF impairment on tests of physical function used in the evaluation of fall risk.

Design

Cross-sectional study.

Setting

Thirteen health examination centres in Eastern France.

Participants

Four thousand four hundred and eighty one community-dwelling older adults without dementia aged 65 to 97 years (mean age 71.8±5.4, women 47.6%).

Measurements

Participants underwent a comprehensive medical assessment that included evaluations of EF using the Clock Drawing Test and of physical performance using the Timed Up & Go Test (TUG). Analysis used multivariable modified Poisson regression to evaluate the association between impaired EF and each of the fall outcomes (any fall, recurrent falls, fall-related injuries). Multivariable linear regression was used to evaluate the association between EF impairment and performance on the TUG and grip strength.

Results

EF impairment, assessed using the clock drawing test, was present in 24.9% of participants. EF impairment was independently associated with an increased risk of any fall (RR=1.13, 95% CI (1.03, 1.25)) and major soft tissue fall-related injury (RR= 2.42, 95% CI (1.47, 4.00)). Additionally, EF impairment was associated with worse performance on the TUG (p<0.0001).

Conclusions

EF impairment among older adults without dementia was highly prevalent and was independently associated with an increased risk for falls, fall-related injuries and with decreased physical function. The use of the Clock Drawing Test is an easy to administer measure of EF that can be used routinely in comprehensive fall risk evaluations.     

Age, health and the measurement of the socio-economic status of individuals

Indicators of socio-economic status (SES) are associated withage. The aim of this paper is to analyse the modifying effectsof age on the interpretation of a commonly used SES indicator,education level, in relation to health. A population-based healthinterview survey was conducted in 1992 and 1993 in Amsterdam,The Netherlands. Participants were members of the non-institutionalizedpopulation aged 16 years and over, selected randomly from themunicipal population register after stratification for age andborough (N=5, 121; response rate 61.4%). The relative differencesin poor self-rated health between educational levels vary stronglywith age group. Among men the risk of poor health for the lowesteducation level relative to the mean for the age group concernedvaries from 1.67 for the 16–34 years age group to 1.10for the 65 years group. Logistic regression indicates that agemodifies the relation of education level with self-rated health.We conclude that the interpretation of SES indicators differsby age group, especially if indicators are strongly associatedwith age. This modifying effect of age on the interpretationof SES needs to be corrected for in research on socio-economichealth differences.     

Risk factors for coronary artery disease in Isfahan, Iran

Coronary artery disease (CAD) is the leading cause of deathin Western industrialized and less developed countries. Themajor modifiable determinate of each population CAD levels isthe risk factor status of that population. Great variationsexist in the prevalence of CAD major risk factors at differentage groups both In men and women in various population. Themain goal of this study was to determine the prevalence andmeans of risk factors for CAD. This survey was carried out among2, 200 men and women aged between 19 and 70 years randomly selectedfrom 40 random dusters in the urban area of Isfahan city. Peoplewere Interviewed by specially trained medical students by completinga standard questionnaire containing questions regarding themajor risk factors, then blood samples were obtained after 14h fasting state. Fasting blood glucose (FBG), plasma total andhigh density lipoprotein cholesterol (HDL cholesterol) and triglyceridswere determined by enzymatic methods. Low density lipoproteincholesterol (LDL cholesterol) was calculated according to theFriedewald formula. The main results showed that two or morerisk factors (hypertension and/or current smoking and/or hypercholesterolaemlaand/or diabetes and/or obesity) were seen in 32% of men and41% of women. Nearly 33 and 52% of our population had LDL cholesterolof 4.2 mmol/l and HDL cholesterol of <0.9 mmol/l, respectively.A body mass index (BMI) of 30 or more was present in 16%, diabetesin approximately 6%, hypertension in 21%, current smoking in11% and sedentary life style in 53% of our population. Hypercholesterolaemia,an increased BMI and hypertension were significantly higheramong women than men (p<0.05), while hypertriglyceridamlaand smoking were higher among men (p<0.05). Similar sex-specificdifferences were observed between the mean values of these variables.The results observed in this study will be used when the prevalenceand incidence data from other ongoing studies are analysed,but in the meantime they provide useful information that canbe incorporated into our national programme for primary preventionwhich will come into action in the near future.     

A feasible model for prevention of functional decline in older home-dwelling people--the GP role. A municipality-randomized intervention trial

Background. Danish municipalities are required by state lawto offer two annual home visits to all non-disabled citizens75 years. Visits are primarily carried out by district nurses.GPs are rarely directly involved. Objective. To evaluate the effects of offering an educationalprogramme to home visitors and GPs on mortality, functionalability and nursing home admissions among home-dwelling olderpeople. Methods. Design: Municipality pair-matched randomized trial. Setting: Danish primary care. Subject: 2863 home-dwelling 75-year-olds and 1171 home-dwelling80-year-olds living in 34 municipalities. Intervention: Home visitors received regular education for aperiod of 3 years. In nine of 17 intervention municipalities,GPs participated in one small group training session duringthe first year. Main outcome measures: Mortality, functional ability and nursinghome admission during 4 years of follow-up. Results. Intervention was not associated with mortality. Homevisitor education was associated with reduction in functionaldecline among home-dwelling 80-year-olds after the three interventionyears in municipalities where GPs accepted and participatedin small group-based training. Effects did not persist afterthe intervention ended. When analyses were restricted to baselinenon-disabled persons, intervention was associated with beneficialeffects on functional ability after three intervention yearsamong 80-year-olds, regardless of education was given to homevisitors alone or to visitors and GPs. Nursing home admissionrates were lower among the 80-year-olds living in the interventionmunicipalities. Conclusion. A brief, practicable interdisciplinary educationalprogramme for primary care professionals postponed functionaldecline in non-disabled 80-year-old home-dwelling persons. Keywords. Education, municipality intervention, older people, preventive home visits, primary care.     

Prospective Study of Physical Activity and Lung Cancer by Histologic Type in Current, Former, and Never Smokers

Increased physical activity has been associated with decreasedlung cancer risk. However, no previous investigation has examinedphysical activity in relation to lung cancer histologic typesby smoking status. The authors investigated these relationsin the National Institutes of Health–AARP Diet and HealthStudy among 501,148 men and women aged 50–71 years atbaseline in 1995–1996. During follow-up to 2003, 6,745lung carcinomas occurred (14.8% small cell, 40.3% adenocarcinoma,19.7% squamous cell, 6.1% undifferentiated large cell, 7.2%non-small cell not otherwise specified, and 11.8% carcinomanot otherwise specified). Among former smokers, the multivariaterelative risks of small cell, adenocarcinoma, squamous cell,and undifferentiated large cell carcinomas comparing the highestwith the lowest activity level (5 times/week vs. inactive) were0.93 (95% confidence interval (CI): 0.67, 1.28), 0.79 (95% CI:0.67, 0.94), 0.73 (95% CI: 0.57, 0.93), and 0.61 (95% CI: 0.38,0.98), respectively. Among current smokers, corresponding valueswere 0.77 (95% CI: 0.58, 1.02), 0.76 (95% CI: 0.61, 0.95), 0.85(95% CI: 0.65, 1.11), and 1.10 (95% CI: 0.69, 1.78). In contrast,physical activity was unrelated to lung carcinoma among neversmokers (P_interaction between physical activity and smokingfor total lung carcinomas = 0.002). The inverse findings amongformer and current smokers in combination with the null resultsfor physical activity among never smokers may point toward residualconfounding by cigarette smoking as an explanation for the relationsobserved. lung neoplasms; motor activity; neoplasms by histologic type; prospective studies; smoking     

Separate and Joint Effects of Alcohol and Smoking on the Risks of Cirrhosis and Gallbladder Disease in Middle-aged Women

The separate and joint effects of alcohol and smoking on incidencesof liver cirrhosis and gallbladder disease were examined ina prospective study of 1,290,413 United Kingdom women (meanage, 56 years) recruited during 1996–2001. After a meanfollow-up of 6.1 years (1996–2005), incidence rates ofcirrhosis and gallbladder disease were 1.3 per 1,000 persons(n = 2,105) and 15 per 1,000 persons (n = 23,989), respectively,over 5 years. Cirrhosis risk increased with increasing alcoholconsumption, while the risk of gallbladder disease decreased(P_trend < 0.0001 for each). Comparing women who drank 15units/week with those who drank 1–2 units/week, the relativerisk was 4.32 (95% confidence interval (CI): 3.71, 5.03)) forcirrhosis and 0.59 (95% CI: 0.55, 0.64) for gallbladder disease.Increasing numbers of cigarettes smoked daily increased therisk of both conditions (P_trend < 0.0001 for each). Comparingcurrent smokers of 20 cigarettes/day with never smokers, therelative risk was 3.76 (95% CI: 3.25, 4.34) for cirrhosis and1.29 (95% CI: 1.22, 1.37) for gallbladder disease. Effects ofalcohol and smoking were more than multiplicative for cirrhosis(P_interaction = 0.02) but not for gallbladder disease (P_interaction= 0.4). Findings indicate that alcohol and smoking affect therisks of the 2 conditions in different ways. For cirrhosis,alcohol and smoking separately increase risk, and their jointeffects are particularly hazardous. For gallbladder disease,alcohol reduces risk and smoking results in a small risk increase. alcohol drinking; gallbladder diseases; liver cirrhosis; liver diseases, alcoholic; prospective studies; smoking