A Cluster Randomised Controlled Trial of a Brief Child Health Nurse Intervention to Reduce Infant Secondhand Smoke Exposure

Background Exposure to secondhand smoke (SHS) is a significant contributor to ill health in children. A study was undertaken to determine the effectiveness of two brief multi-strategic child health nurse delivered interventions in: decreasing the prevalence of infants exposed to SHS; decreasing the prevalence of smoking amongst parent/carers of infants and increasing the prevalence of household smoking bans. Methods This study was a 3 arm, cluster randomised controlled trial. Clusters were 39 community based well child health clinics in one local area health service. Clinics were stratified according to annual number of client appointments and then randomly assigned in a 1:1:1 ratio, (Intervention 1: Intervention 2: Control), with 13 clinics in each cluster. Parents/carers of infants in the intervention groups received a brief multi-strategic intervention from child health nurses during clinic consultations. Treatment condition 1 included computer delivered risk assessment and feedback and nurse brief advice. Treatment condition 2 included all elements of Treatment condition 1 with the addition of biochemical feedback of infant SHS exposure. Results When compared to the Control group at 12 months, no significant differences in the prevalence of infant exposure to SHS were detected from baseline to follow-up for Treatment condition 1 (OR 1.16, 95 % CI 0.73–1.85, p = 0.53) or Treatment condition 2 (OR 1.30, 95 % CI 0.88–1.92, p = 0.19) Similarly, no significant differences were detected in the proportion of parent/carers who reported that they were smokers (T1:OR 0.95, 95 % CI 0.78–1.15, p = 0.58 and T2:OR 0.97, 95 % CI 0.80–1.18, p = 0.77), or in the proportion of households reported to have a complete smoking ban (T1:OR 1.21, 95 % CI 0.89–1.64, p = 0.23 and T2:OR 1.06, 95 % CI 0.79–1.43, p = 0.68). Conclusions Further research is required to identify effective interventions that can be consistently provided by child health nurses if the potential of such settings to contribute to reductions in child SHS exposure is to be realised.     

Glutathione S-Transferase Polymorphisms,Passive Smoking,Obesity, and Heart Rate Variability in Nonsmokers

Background

Disturbances of heart rate variability (HRV) may represent one pathway by which second-hand smoke (SHS) and air pollutants affect cardiovascular morbidity and mortality. The mechanisms are poorly understood.

Objectives

We investigated the hypothesis that oxidative stress alters cardiac autonomic control. We studied the association of polymorphisms in oxidant-scavenging glutathione S-transferase (GST) genes and their interactions with SHS and obesity with HRV.

Methods

A total of 1,133 nonsmokers > 50 years of age from a population-based Swiss cohort underwent ambulatory 24-hr electrocardiogram monitoring and reported on lifestyle and medical history. We genotyped GSTM1 and GSTT1 gene deletions and a GSTP1 (Ile105Val) single nucleotide polymorphism and analyzed genotype–HRV associations by multiple linear regressions.

Results

Homozygous GSTT1 null genotypes exhibited an average 10% decrease in total power (TP) and low-frequency-domain HRV parameters. All three polymorphisms modified the cross-sectional associations of HRV with SHS and obesity. Homozygous GSTM1 null genotypes with > 2 hr/day of SHS exposure exhibited a 26% lower TP [95% confidence interval (CI), 11 to 39%], versus a reduction of −5% (95% CI, −22 to 17%) in subjects with the gene and the same SHS exposure compared with GSTM1 carriers without SHS exposure. Similarly, obese GSTM1 null genotypes had, on average, a 22% (95% CI, 12 to 31%) lower TP, whereas with the gene present obesity was associated with only a 3% decline (95% CI, −15% to 10%) compared with nonobese GSTM1 carriers.

Conclusions

GST deficiency is associated with significant HRV alterations in the general population. Its interaction with SHS and obesity in reducing HRV is consistent with an impact of oxidative stress on the autonomous nervous system.     

Egg consumption and risk of GI neoplasms: dose–response meta-analysis and systematic review

Purpose

Previous epidemiological studies on egg consumption and the risk of gastrointestinal (GI) neoplasms suggest a positive association; however, data are limited and the evidence remains controversial. This study aims to investigate and quantify the potential dose–response relationship with an evaluation of cancer site-specific differences.

Methods

Relevant studies were identified after the literature search via electronic databases until January 2014. Subgroup analysis for serving portions was performed using two standardized classification methods: (1) less than 3, or 3 or more eggs per week; (2) less than 3, 3–5, or more than 5 eggs per week. Method two excludes studies that only reported consumption frequency. Pooled adjusted odds ratios (ORs) comparing highest and lowest categories of dietary pattern scores were calculated using a random-effects model.

Results

Thirty-seven case–control and seven cohort studies were included for meta-analysis, which contained a total of 424,867 participants and 18,852 GI neoplasm cases. The combined odds ratio (OR) was calculated to 1.15 (95 % CI 1.09–1.22; p value heterogeneity <0.001), showing only a slight increase in risk. The correlation was stronger for colon cancers 1.29 (95 % CI 1.14–1.46; p value heterogeneity <0.22). Dose–response analysis revealed similar results with stratification methods, and the ORs for an intake of <3 and ≥3 eggs per week were 1.14 (95 % CI 1.07–1.22; p value heterogeneity = 0.38) and 1.25 (95 % CI 1.14–1.38; p value heterogeneity = 0.25), respectively. With method 2, the ORs for an intake of <3, 3–5, and >5 eggs per week were 1.13 (95 % CI 1.06–1.21; p value heterogeneity = 0.25), 1.14 (95 % CI 1.01–1.29; p value heterogeneity = 0.06), and 1.19 (95 % CI 1.01–1.39; p value heterogeneity <0.001), respectively.

Conclusion

This study provides evidence that egg consumption is associated with a positive dose–response association with the development of GI neoplasms.     

Environmental cadmium exposure and osteoporosis: a review

Objectives

To review the published literature investigating the association between cadmium exposure and osteoporosis.

Methods

A review of published peer-reviewed literature based on a priori criteria was completed. Odds ratios (OR) were abstracted or estimated from observational studies to calculate a pooled OR using inverse variance weighted random effects models.

Results

The review identified seven studies with a pooled OR of OR = 2.22 (95 % CI: 1.16, 4.28) [I ² = 54.8 % (p < 0.05)] (comparing highest urine cadmium category to lowest). In women over the age of 50 years, the pooled OR was 1.82 (95 % CI: 1.63, 2.02) [I ² = 73.1 % (p < 0.05)]. A dose response evaluation (six studies) suggested increasing odds for osteoporosis with increasing urine cadmium levels.

Conclusions

This review detected an association between cadmium exposure and the occurrence of osteoporosis in a small number of cross-sectional studies which requires confirmation in using prospective study design.     

Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis

Objectives

To determine whether depression and anxiety in adulthood are associated with abuse exposure in childhood.

Methods

A search of PUBMED, EMBASE and PSYCHINFO databases (2002–2012) was supplemented by hand searches of bibliographies of articles and reviews. We included studies contrasting abuse exposure vs. no-abuse exposure before age 16 years to depression and anxiety after age 16 years. Data on sample and exposure and outcome instruments, covariates and odds ratios (ORs) with the respective 95 % confidence intervals (CI) were extracted. Combined ORs and 95 % CI were calculated using random effects models. Heterogeneity was quantified using the I ² test.

Results

Inclusion criteria were met by 19 studies with 115,579 study participants, for assessing depression (n = 14) and anxiety (n = 13). The combined ORs for depression were 2.04 (95 % CI: 1.65–2.53) for sexual abuse and 1.49 (95 % CI: 1.29–1.72) for physical abuse. The combined ORs for anxiety were 2.52 (95 % CI: 2.12–2.98) for sexual abuse and 1.70 (95 % CI: 1.33–2.18) for physical abuse.

Conclusions

High levels of depression, anxiety and distress are reported in adults exposed to childhood sexual and physical abuse. These findings require increased awareness for the potential needs of adults exposed to child abuse and public health interventions to prevent child abuse.     

Autonomic nerve system responses for normal and slow rewarmers after hand cold provocation: effects of long-term cold climate training

Purpose

Differences among individuals concerning susceptibility to local cold injury following acute cold exposure may be related to function of the autonomic nervous system. We hypothesized that there are differences in heart rate variability (HRV) between individuals with normal or more pronounced vasoconstriction following cold exposure and that there is an adaptation related to prolonged cold exposure in autonomic nervous system response to cold stimuli.

Methods

Seventy-seven young men performed a cold provocation test, where HRV was recorded during cold hand immersion and recovery. Forty-three subjects were re-examined 15 months later, with many months of cold weather training between the tests. Subjects were analyzed as ‘slow’ and ‘normal’ rewarmers according to their thermographic rewarming pattern.

Results

For the ‘pre-training’ test, before cold climate exposure, normal rewarmers had higher power for low-frequency (P_LF) and high-frequency (P_HF) HRV components during the cold provocation test (ANOVA for groups: p = 0.04 and p = 0.005, respectively). There was an approximately 25 % higher P_HF at the start in normal rewarmers, in the logarithmic scale. Low frequency-to-high frequency ratio (P_LF/P_HF) showed lower levels for normal rewarmers (ANOVA for groups: p = 0.04). During the ‘post-training’ cold provocation test, both groups lacked the marked increase in heart rate that occurred during cold exposure at the ‘pre-training’ setting. After cold acclimatization (post-training), normal rewarmers showed lower resting power values for the low-frequency and high-frequency HRV components. After winter training, the slow rewarmers showed reduced low-frequency power for some of the cold provocation measurements but not all (average total P_LF, ANOVA p = 0.05), which was not present before winter training.

Conclusions

These HRV results support the conclusion that cold adaptation occurred in both groups. We conclude that further prospective study is needed to determine whether cold adaptation provides protection to subjects at higher risk for cold injury, that is, slow rewarmers.     

Prognostic value of quality of life measured after treatment on subsequent survival in patients with nasopharyngeal carcinoma

Purpose

Pretreatment quality of life (QoL) has been used to predict survival in cancer patients. In this study, we examined the prognostic value of QoL measured after treatment on subsequent survival in patients with nasopharyngeal carcinoma (NPC).

Methods

We enrolled 273 patients with NPC who had been curatively treated for more than 1 year. The EORTC QLQ-C30 and H&N35 questionnaires were completed 1 year after radiotherapy. The predictability of QoL variables on disease-specific survival (DSS) and overall survival (OS) was analyzed using Cox’s proportional hazards models.

Results

Twenty-nine (10.6 %) patients developed locoregional relapse and 27 (9.9 %) had distant metastasis after the QoL survey with subsequent 5-year DSS and OS rates of 87.9 % and 84.0 %, respectively. Based on the QLQ-C30, scales of physical functioning, fatigue, and appetite loss significantly predicted DSS and OS (p < 0.05). In the H&N35, only sexuality was significantly correlated with DSS and OS (p < 0.05). An increment of 10 points in physical functioning (HR: 0.69; 95 % CI: 0.48–0.90; p = 0.004) or a decline of 10 points in fatigue problems (HR: 1.40; 95 % CI: 1.19–1.61; p = 0.0002), appetite loss (HR: 1.21; 95 % CI: 1.03–1.40; p = 0.02), and sexuality (HR: 1.14; 95 % CI: 1.02–1.25; p = 0.019) was associated with better OS.

Conclusion

Some QoL variables measured after the treatment provide prognostic value on subsequent survival in patients with NPC.     

Organizational factors associated with work-related sleep problems in a nationally representative sample of Korean workers

Purpose

The purpose of this study was to assess the association of organizational factors with work-related sleep problems (WRSP) among Korean workers.

Methods

The data were derived from the First Korean Working Conditions Survey conducted in 2006 with a representative sample of the Korean working population (n = 10,039).

Results

The overall prevalence of WRSP was 5.1  % (95  % confidence interval (CI) 4.7–5.5). Those who experienced sexual harassment at work (adjusted odds ratio (aOR) 3.47: 95 % CI 1.77–6.81), discrimination due to sex (aOR 2.44: 95 % CI 1.36–4.36) or age (aOR 2.22: 95 % CI 1.52–3.23), violence at work (aOR 1.98: 95 % CI 1.06–3.68), threat of violence (aOR 1.96: 95 % CI 1.05–3.66), poor work-life balance (aOR 1.78: 95 % CI 1.44–2.20), low job satisfaction (aOR 1.69: 95 % CI 1.37–2.09), high cognitive (OR 1.64: 95 % CI 1.32–2.03) and emotional (aOR 1.53: 95 % CI 1.22–1.91) demands, job insecurity (aOR 1.32: 95 % CI 1.07–1.63), and high work intensity (aOR 1.55: 95 % CI: 95 % CI 1.25–1.92) had an increased risk of WRSP compared to their respective counterparts (p < 0.01). Low social support was not significantly associated with WRSP (aOR 0.88: 95 % CI 0.67–1.15).

Conclusion

The results revealed that poor psychosocial working conditions may be related to a high prevalence of WRSP among representative Korean workers.     

Association between sleep quality and cardiovascular health: a door-to-door survey in rural Ecuador

Objectives

Cardiovascular correlates of sleep disorders have not been well investigated in underserved populations. The aim of this door-to-door survey was to evaluate the association between sleep quality and cardiovascular health status in persons aged ≥40 years living in a village that is representative of rural Ecuador.

Methods

All stroke-free Atahualpa residents aged ≥40 years were screened with a validated Spanish version of the Pittsburgh Sleep Quality Index and the seven cardiovascular health (CVH) metrics proposed by the American Heart Association to assess the CVH status.

Results

A total of 635 persons (mean age 59 ± 13 years; 58 % women) were identified. A poor sleep quality was present in 27 % of the subjects (95 % CI 24–31 %) and a poor cardiovascular health in 69 % (95 % CI 63–71 %). In a multivariate logistic regression model, a poor sleep quality was associated with some CVH metrics in the poor range, including smoking status (p = 0.026), physical activity (p = 0.01) and blood glucose levels (p = 0.036).

Conclusions

A poor sleep quality may be linked to individual cardiovascular risk factors in this underserved Latin American population. This finding provides useful insights for the implementation of regional prevention priorities.     

Work-related psychosocial and mechanical risk factors for neck/shoulder pain: a 3-year follow-up study of the general working population in Norway

Purpose

This study examines the impact of work-related psychosocial and mechanical exposure on the development of neck/shoulder pain in the general working population.

Methods

A randomly drawn cohort from the general population in Norway aged 18–66 was followed up for 3 years (n = 12,550, response rate = 67 %). Eligible respondents were in paid work during the reference week in 2006 and 2009, or temporarily absent from such work (n = 6,745). Four work-related psychosocial factors and six mechanical exposures were measured. Outcomes of interest were moderate or severe neck/shoulder pain at follow-up adjusted for baseline neck/shoulder pain.

Results

In total, 16.9 % (1,138 individuals) reported neck/shoulder pain during the last month at follow-up. Work related psychosocial predictors of neck/shoulder pain were high job demands (highest OR 1.41, 95 % CI 1.11–1.78) and low levels of supportive leadership (highest OR 1.66, 95 % CI 1.08–2.54). Mechanical factors were neck flexion (highest OR 1.77, 95 % CI 1.31–2.39) and lifting in awkward postures (highest OR 1.81, 95 % CI 1.21–2.71). The estimated population risk attributable to these factors was about 23 %. The relative risk for neck/shoulder pain associated with psychosocial exposure was slightly influenced by adjustment for physical risk factors, and vice versa. There was no substantial confounding related to age, gender, education, occupation or psychological distress.

Conclusions

Highly demanding jobs, neck flexion and awkward lifting appear as the most important predictors of neck/shoulder pain.     

Compliance with the smoking ban in Italy 8 years after its application

Objectives

The aim of this paper is to report compliance with the smoking ban and the spread of smoke-free homes after 3–8 years since the Italian smoking ban implementation, according to the ongoing Italian surveillance system for behavioural risk factors (PASSI).

Methods

PASSI is based on representative annual samples of the Italian population aged 18–69 years. We considered questions on smoking habits, self-reported compliance with the ban, and on smoke-free homes of 176,236 interviews conducted in 2008–2012.

Results

Ninety percent of respondents in 2012 reported that the smoking ban was enforced in hospitality premises (HPs), with a significant 3 % increase from 2008. Similarly, 91.3 % in 2012 reported a high compliance in workplaces other than HPs, with a significant 5 % increase. Perception of compliance did not change among smokers and non-smokers. Seventy-eight percent of respondents in 2012 reported smoke-free homes, with a significant increase from 2008 to 2012.

Conclusions

The high compliance with the ban that is still increasing even after 8 years since its implementation may partially have caused the concurrent increase in smoke-free homes.     

Impaired parent-reported health-related quality of life of underweight and obese children at elementary school entry

Purpose

Examine the health-related quality of life of 5–6-year-old underweight, overweight and obese children.

Methods

Our cross-sectional study included 3,227 parent–child dyads from the “Be active, eat right” study. Parents completed questionnaires regarding child and parental characteristics. Health-related quality of life of the child was measured using the Child Health Questionnaire Parent Form 28. Children were classified normal weight, overweight, obese, severely obese, and underweight according to the international age and gender BMI cutoff points. Bootstrap analyses were performed for general linear models corrected for potential confounding variables.

Results

Severely obese children (β, ?2.60; 95 % CI, ?4.80 to ?0.57, p < 0.01) and underweight children (β, ?1.11; 95 % CI, ?1.85 to ?0.39, p < 0.01) had lower parent-reported scores on the physical summary scale. On the physical functioning profile scale parents of overweight and severely obese children also reported statistically significant lower scores (p < 0.05 and p < 0.01, respectively).There were no significant differences regarding the psychosocial summary scale scores between the different weight categories.

Conclusion

Underweight and overweight children experience impaired health-related quality of life on the physical functioning domain. Physicians, teachers and parents should be aware of the possible negative impact on health-related quality of life in underweight and overweight 5–6-year-old children.     

Effects of an HIV-Care-Program on immunological parameters in HIV-positive patients in Yaoundé, Cameroon: a cluster-randomized trial

Objectives

To measure the effects of an HIV-Care-Program, focusing on nutrition and lifestyle, which can be provided at scale to HIV-infected patients, on clinical and anthropometrical parameters, and health status.

Methods

A cluster-randomized trial, including 5 health facilities randomized to intervention n = 100 (HIV-Care-Program) or control n = 101 (Usual-Care). The HIV-Care-Program consisted of counseling lessons for 6 months, on: nutrition, hygiene, coping with stigma and discrimination, embedded in practical activities. Outcome variables were CD4 count after 6 months and time to antiretroviral therapy (ARV) initiation, using analysis of covariance and Kaplan–Meier method, respectively.

Results

After 6 months, CD4 count dropped by 46.3 cells (7.7 %) (intervention) and 129 (23 %) (control) (p = 0.003). Mean time to ARV; 5.9 months 95 % CI (5.9, 6.0) (intervention); 4.9 months 95 % CI (4.7, 5.2) (control) (p < 0.004). There was a partial correlation between CD4 count and initial viral load (r = ?0.190, p = 0.017).

Conclusions

The intervention provides a low-cost alternative improving health status, slowing down CD4 cell decline, delaying initiation of ARV and thus freeing local ARV capacities for patients in urgent need.     

The use of household cleaning products during pregnancy and lower respiratory tract infections and wheezing during early life

Objective

To evaluate the effects of household use of cleaning products during pregnancy on infant wheezing and lower respiratory tract infections (LRTI).

Methods

In four prospective Spanish birth cohorts (n = 2,292), pregnant women reported the use of household cleaning products. When infants were 12–18 months old, current cleaning product use and infant’s wheezing and LRTI were reported. Cohort-specific associations between the use of specific products and respiratory outcomes were evaluated using multivariable regression analyses and estimates were combined using random-effects meta-analyses.

Results

The period prevalence of LRTI was higher when sprays (combined odds ratio (OR) = 1.29; 95 % confidence interval (CI) 1.04–1.59) or air fresheners (OR = 1.29; CI 1.03–1.63) were used during pregnancy. The odds of wheezing increased with spray (OR = 1.37; CI 1.10–1.69) and solvent (OR = 1.30; CI 1.03–1.62) use. The associations between spray and air freshener use during pregnancy and both outcomes remained apparent when these products were not used after pregnancy. Nevertheless, the estimates were higher when post-natal exposure was included.

Conclusion

The use of cleaning sprays, air fresheners and solvents during pregnancy may increase the risk of wheezing and infections in the offspring.     

Stigma related to sex work among men who engage in transactional sex with men in Ho Chi Minh City,Vietnam

Objectives

Male sex workers (MSW) in Vietnam face high levels of stigma related to sex work, which may be associated with depression and increased vulnerability to HIV.

Methods

In 2010, 300 MSW completed a behavioral and psychosocial survey. Multivariable models assessed factors associated with sex work-related stigma and the association between stigma and depression.

Results

Factors associated with increased stigma included having disclosed sexual orientation to healthcare workers (b 1.75, 95 % CI 0.69–2.80), meeting clients in the street/park (b 1.42, 95 % CI 0.32–2.52), and having been forced to have sex without a condom (b 2.36, 95 % CI 1.27–3.45). Factors associated with decreased stigma included meeting clients via the telephone or internet (b ?1.26, 95 % CI ?2.39 to ?0.12) and receiving financial support from family or friends (b ?1.31, 95 % CI ?2.46 to ?0.17). Stigma was significantly associated with increased odds of depression (AOR 1.07, 95 % CI 1.01–1.15).

Conclusions

Addressing stigma and depression in HIV prevention interventions is crucial for tailoring these programs to MSWs’ needs, and may result in decreased HIV spread.     

Health-related quality of life in rural children living in four European countries: the GABRIEL study

Objective

Measuring children’s health-related quality of life (HRQOL) is of growing importance given increasing chronic diseases. By integrating HRQOL questions into the European GABRIEL study, we assessed differences in HRQOL between rural farm and non-farm children from Germany, Austria, Switzerland and Poland to relate it to common childhood health problems and to compare it to a representative, mostly urban German population sample (KIGGS).

Methods

The parents of 10,400 school-aged children answered comprehensive questionnaires including health-related questions and the KINDL-R questions assessing HRQOL.

Results

Austrian children reported highest KINDL-R scores (mean: 80.9; 95 % CI [80.4, 81.4]) and Polish children the lowest (74.5; [73.9, 75.0]). Farm children reported higher KINDL-R scores than non-farm children (p = 0.002). Significantly lower scores were observed in children with allergic diseases (p < 0.001), with sleeping difficulties (p < 0.001) and in overweight children (p = 0.04). The German GABRIEL sample reported higher mean scores (age 7–10 years: 80.1, [79.9, 80.4]; age 11–13 years: 77.1, [74.9, 79.2]) compared to the urban KIGGS study (age 7–10 years: 79.0, [78.7–79.3]; age 11–13 years: 75.1 [74.6–75.6]). Socio-demographic or health-related factors could not explain differences in HRQOL between countries.

Conclusions

Future increases in chronic diseases may negatively impact children’s HRQOL.     

Sick building syndrome (SBS) and sick house syndrome (SHS) in relation to psychosocial stress at work in the Swedish workforce

Purpose

Medical symptoms called sick building syndrome (SBS) and sick house syndrome (SHS) are usually investigated separately: in this study, SBS and SHS were explored simultaneously. The significance of personal factors, perceptions of air quality, and psychosocial work situation in explaining SBS and SHS were investigated.

Methods

A random sample of 1,000 subjects (20–65 year) received a postal questionnaire including questions on personal factors, medical symptoms, and the psychosocial demand-control-support model. The response rate was 70 % (n = 695), of which 532 were occupationally active.

Results

In logistic regression models, atopy, poor air quality at work, and low social support, especially low supervisor support, were associated with both SBS and SHS when age, gender, smoking, and BMI were introduced. The general work-related symptoms (headache, tiredness, nausea, and sensation of a cold) were also related to low control over work.

Conclusions

The perception of poor physical environmental conditions is associated with common medical symptoms that are both work and home related. The associations between medical symptoms and poor air quality are still present, even when controlling for the psychosocial environment.     

Young children’s screen habits are associated with consumption of sweetened beverages independently of parental norms

Objectives

This study investigated the associations between children’s screen habits and their consumption of sweetened beverages. Because parents might be disposed to regulate their child’s screen and dietary habits in a similar direction, our specific aim was to examine whether these associations were independent of parental norms.

Methods

In the Swedish sample of the European Identification and prevention of dietary and lifestyle-induced health effects in children and infants (IDEFICS) study, parents filled in questionnaires about their 2 to 9-year-old children’s (n = 1,733) lifestyle and diets.

Results

Associations between screen habits and sweetened beverage consumption were found independent of parental norms regarding sweetened beverages. A longitudinal analysis revealed that sweetened beverage consumption at 2-year follow-up was predicted by exposure to commercial TV at baseline (OR 1.4, 95 % CI 1.1–1.9). Cross-sectional analysis showed that the likelihood of consuming sweetened beverages at least 1–3 times per week increased for each hour/day watching television (OR 1.5, 95 % CI 1.2–1.9), and for being exposed to commercials (OR 1.6, 95 % CI 1.3–2.1). TV viewing time and commercial exposure contributed to the associations independently of each other.

Conclusions

The results strengthen the assumption that it is possible to influence children’s dietary habits through their TV habits.     

Unfavourable life-course social gradient of coronary heart disease within Spain: a low-incidence welfare-state country

Objective

Social position has yet to be established as a risk factor of coronary heart disease (CHD). Our aim was to investigate an individual life-course social position gradient link with CHD incidence in the EPIC-Spain cohort.

Methods

41,066 participants, mostly 30–65 years old, and free of cardiovascular disease at baseline (1992–1996) were followed up for a mean of 10.4 years. A combined score of paternal occupation in childhood and own adult education was used to assess individual life-course risk accumulation. Hazard ratios of CHD were estimated using Cox models, stratifying by centre, and age, and adjusting for cardiovascular risk factors.

Results

583 participants (80 % men) developed a definite CHD event. Paternal occupational class IV was associated with CHD in all models in men. The educational gradient remained significant after adjusting for diet and physical activity (p = 0.01). All adjusted risk of incident CHD rose by 23 % (95 % CI 6–42 %) per category increase of life-course social position score in men. No significant associations were found in women.

Conclusions

Individual life-course social position gradient was adversely related to incident CHD in Spanish men.     

Lifetime traumatic events,health-related quality of life,and satisfaction with life in older adults

Purposes

The aims were to assess the association between lifetime traumatic events and post-traumatic stress syndrome (PTSS) and health-related quality of life (HRQOL) and satisfaction with life stratified by gender among a community-dwelling sample of older adults.

Methods

Data used came from the ESA-Services study (2011–2013) and included a large convenience sample of 1811 older adults. Traumatic events were measured using a list of 14 events. PTSS was measured using the Impact of Event Scale-Revised. HRQOL and life satisfaction were measured with the EQ-5D-3L and the Satisfaction With Life Scale. Multivariate regression analyses were used to assess the association between traumatic events, PTSS, and quality of life.

Results

Respondents had a mean age of 73.90 years (SD: 6.13, range 65–97). Our results showed that exposure to violence (OR 4.88, CI 2.72–8.77), an accident (OR 2.33, CI 1.29–4.22), and sexual abuse (OR 2.26 CI 1.17–4.37) was associated with PTSS only in women. No traumatic event was associated only in men. The interaction between gender and exposure to violence and life-threatening disease of a close one was significant. Experiencing violence (β = ?0.04, p < 0.01), a natural disaster (β = ?0.04, p = 0.02), a life-threatening disease (β = ?0.04, p < 0.01), and sexual abuse (β = ?0.04, p < 0.01) were associated with a lower HRQOL only in women. No traumatic event was associated in men. Interactions between event and gender were significant for natural disaster, life-threatening disease of a close one, sexual abuse, and other type of traumatic events. A life-threatening disease (β = ?0.90, p < 0.01) was associated with a reduced life satisfaction only in men and the exposure of violence (β = ?1.18, p < 0.01) was associated with lower life satisfaction in women.

Conclusion

Our study could help healthcare professionals to identify and monitor traumatic events that are at higher risk to be associated with PTSS and a lower quality of life for older men and women.