Are there sensitive subgroups for the effects of airborne particles?

Recent studies have shown that particulate air pollution is a risk factor for hospitalization for heart and lung disease; however, little is known about what subpopulations are most sensitive to this pollutant. We analyzed Medicare hospital admissions for heart disease, chronic obstructive pulmonary disorders (COPD) and pneumonia in Chicago, Cook County, Illinois, between 1985 and 1994. We examined whether previous admissions or secondary diagnoses for selected conditions predisposed persons to having a greater risk from air pollution. We also considered effect modification by age, sex, and race. We found that the air-pollution-associated increase in hospital admissions for cardiovascular diseases was almost doubled in subjects with concurrent respiratory infections. The risk was also increased by a previous admission for conduction disorders. For COPD and pneumonia admissions, diagnosis of conduction disorders or dysrhythmias increased the risk of particulate matter < 10 microm in aerodynamic diameter (PM(10))-associated admissions. Persons with asthma had twice the risk of a PM(10)-associated pneumonia admission and persons with heart failure had twice the risk of PM(10)-induced COPD admissions. The PM(10) effect did not vary by sex, age, and race. These results suggest that patients with acute respiratory infections or defects in the electrical control of the heart are a risk group for particulate matter effects.     

Is there harvesting in the association of airborne particles with daily deaths and hospital admissions?

Although many studies have shown that airborne particles are associated with increased daily death and hospitalization rates, some have questioned whether these events are occurring in persons who would die or enter the hospital within a few days in any case. This hypothesis is usually called the harvesting effect. Harvesting is postulated to occur because the size of the pool of susceptibles decreases as a result of air pollution. I have developed a framework for examining this hypothesis. I used a smoothing technique that allowed me to examine the association between daily deaths and daily hospital admissions net of any such rebound that occurred within a fixed time scale. By varying that time scale I could look at effects net of rebounds on successively larger time scales, ranging from 15 to 60 days. I examined daily deaths and hospital admissions in Chicago for the years 1988-1993. In baseline analyses, particulate matter less than 10 microm in aerodynamic diameter (PM10) was associated with increased daily deaths and hospital admissions for heart disease, pneumonia, and chronic obstructive pulmonary disease. A 10 microg/m3 increase in PM10 was associated with a 0.89% increase in daily deaths (95% confidence interval = 0.61-1.16%), for example. Using smoothing to look at effects net of short-term rebounds, the effect-size estimates for daily deaths and for chronic obstructive pulmonary disease admissions more than doubled. They did not change for pneumonia and heart disease admissions. The increased effect size for daily deaths occurred only for deaths outside of the hospital. These results are consistent with air pollution increasing the size of the risk pool and for most of the deaths being advanced by months to years.     

Are neighbourhood characteristics associated with depressive symptoms? A review of evidence

A review of published observational studies of neighbourhoods and depression/depressive symptoms was conducted to inform future directions for the field. Forty-five English-language cross-sectional and longitudinal studies that analysed the effect of at least one neighbourhood-level variable on either depression or depressive symptoms were analysed. Of the 45 studies, 37 reported associations of at least one neighbourhood characteristic with depression/depressive symptoms. Seven of the 10 longitudinal studies reported associations of at least one neighbourhood characteristic with incident depression. Socioeconomic composition was the most common neighbourhood characteristic investigated. The associations of depressive symptoms/depression with structural features (socioeconomic and racial composition, stability and built environment) were less consistent than with social processes (disorder, social interactions, violence). Among the structural features, measures of the built environment were the most consistently associated with depression but the number of studies was small. The extent to which these associations reflect causal processes remains to be determined. The large variability in studies across neighbourhood definitions and measures, adjustment variables and study populations makes it difficult to draw more than a few general qualitative conclusions. Improving the quality of observational work through improved measurement of neighbourhood attributes, more sophisticated consideration of spatial scale, longitudinal designs and evaluation of natural experiments will strengthen inferences regarding causal effects of area attributes on depression.     

Are adolescents' perceptions of dietary practices associated with their dietary behaviors?

Despite interventions designed to change behavior, many adolescents continue to consume unhealthy foods. Dietary patterns are important for disease prevention, making it necessary to understand the reasons for these poor choices. This cross-sectional study explored the relationship between perception of dietary practices and dietary behaviors among adolescents. Participants (n=15,283; mean age=15 years; 50.7% female) completed the 2004-2005 Texas School Physical Activity and Nutrition survey. Perception of dietary practices included fat content of foods usually eaten and healthiness of usual eating habits. Dietary behavior was measured by self-report of foods eaten the day before survey administration. Composite scores of unhealthy and healthy eating were created. Regression analyses examined whether perception of dietary practices was consistent with actual dietary behavior, controlling for sex, grade, and race/ethnicity, and accounting for the complex sampling design. Higher perceived fat content was associated with increased consumption of unhealthy foods, while higher perceived healthiness of eating was associated with increased consumption of healthy foods. For perceived fat content, the difference in the Healthy Eating Index between extreme categories was 26% (P<0.001), while the difference in the Unhealthy Eating Index between extreme categories was 81% (P<0.001). For perceived healthiness, the difference in the Healthy Eating Index between extreme categories was 23% (P<0.001), while the difference for the Unhealthy Eating Index was 44% (P<0.001). Self-perceptions of dietary practices were significantly associated with dietary behaviors, indicating awareness about the relative nutrient content of foods consumed. Interventions that move beyond dietary knowledge and create changes in the social and physical environment are needed.     

Are self-reported physical activity levels associated with perceived desirability of activity-friendly communities?

People living in activity-friendly communities (AFCs) are more active but the self-selection influence is unknown. From 4856 respondents we explored mediating variables with expressed desire to live in AFCs. Association with desire to live in AFCs included ages 18-24 years (odds ratio [OR]=1.9), African American (OR=1.9) or Hispanic (OR=1.5), and believing AFCs would support activity-based transportation (OR=2.4). Regular physical activity (PA) was marginally associated with desire to live in AFCs (OR=1.3). These findings suggest that PA may be a significant factor in communities of this style. Strategies for social marketing along with changes to the built environment to increase PA levels are discussed.     

Are caregiving responsibilities associated with non-attendance at breast screening?

Background  

Previous research showed that deprived individuals are less likely to attend breast screening and those providing intense amounts of informal care tend to be more deprived than non-caregivers. The aim of this study was to examine the relationship between informal caregiving and uptake of breast screening and to determine if socio-economic gradients in screening attendance were explained by caregiving responsibilities.     

Are intrinsic motivational factors of work associated with functional incapacity similarly regardless of the country?

Background: Many psychosocial models of wellbeing at work emphasise the role of intrinsic motivational factors such as job autonomy, job complexity, and innovativeness. However, little is known about whether the employees of multinational enterprises differ from country to country with regard to intrinsic motivational factors, and whether these factors are associated with wellbeing similarly in the different countries. The purpose of this study was to examine the level of intrinsic motivational factors and their impact on functional incapacity in different countries in a multinational corporation. Methods: In 2000, data were collected from a globally operating corporation with a questionnaire survey. The participants were 13 795 employees (response rate 59%; 56% under age 45; 80% men; 61% blue collar employees), who worked in similar industrial occupations in five countries (Canada, China, Finland, France, and Sweden). Results: The Chinese employees reported higher autonomy and lower complexity at work than the employees from the other countries. After adjustment for age, sex, socioeconomic status, and physical work environment, job autonomy, and job complexity at work were associated with functional incapacity in most countries, whereas in China the impact was significantly stronger. In Finland and in China employees with low innovativeness at work were more prone to functional incapacity than corresponding employees in other countries. Conclusions: The level of intrinsic motivational factors varied between the Chinese employees and those in other countries. In line with theoretical notions, the relation between intrinsic motivational factors of work and functional incapacity followed a similar pattern in the different countries. However, these country specific results show that a culture specific approach to employee wellbeing should also be applied.     

Cardiovascular damage by airborne particles: are diabetics more susceptible?

BACKGROUND: Convincing evidence now exists that particulate air pollution exacerbates heart and lung disease, leading to increased morbidity and mortality. The populations particularly susceptible to these exposures are still unclear. Recent work on potential mechanisms of action of particulate air pollution point to pathways also influenced by diabetes. METHODS: We examined effect modification by concurrent diagnosis of diabetes overall and by age group in a hierarchical model for four U.S. cities. In the first stage, separate Poisson regressions were fit in each city and within each stratum of age and diabetes. In the second stage, the estimated effect size for PM (particulate air matter with aerodynamic diameter less than 10 microns) within city and strata was regressed against the stratification variables, allowing for a random effect. We used Medicare data for Chicago, IL, Detroit, MI, Pittsburgh, PA, and Seattle, WA, for the years 1988-1994. RESULTS: We found that diabetics have double the risk of a PM10 -associated cardiovascular admission compared with nondiabetics. We also found that persons 75 years of age and older had higher risk, and that the interaction between the two categories (diabetes and age) was less than additive. If the latter is confirmed, it may represent a survivor effect among diabetes, enhanced susceptibility among nondiabetics, or both. CONCLUSIONS: We conclude that diabetics are a population that is particularly susceptible to cardiovascular damage by airborne particles.     

Are infant behavioural feeding difficulties associated with congenital heart disease?

AIM: To compare the feeding patterns and difficulties of infants with congenital heart disease (CHD) and healthy controls. Information was gathered via parental questionnaires. METHODS: A matched case controlled study of 64 infants with CHD compared with 64 healthy controls. RESULTS: The main findings were: (1) Feeding patterns: mothers with infants with CHD used bottle-feeding as a first method of feeding their babies more often (CHD, 20%, controls, 2%); (2) Specific feeding difficulties: (a) infants with CHD were significantly more breathless when feeding (CHD = 16%, controls, 0%), (b) had more vomiting at mealtimes (CHD = 23%, controls = 11%), but (c) had significantly less spitting (CHD = 19%, controls, 41%); and (3) infants with CHD showed significantly reduced growth. CONCLUSIONS: The feeding difficulties are related to the organic condition and not specific difficulties in mother-infant interaction. Professional support may be required for mothers of infants with CHD to maintain feeding routines and to deal with the difficulties that arise.     

Are mental health problems associated with use of Accident and Emergency and health-related harm?

BACKGROUND: Previous findings indicate that mental health problems are common in Emergency departments; however, there are few studies of the extent of health-related problems and emergency service use in mental health populations as a whole. METHODS: Record linkage methods were used to map the association between mental health, age, gender, and health-related harm across total health and mental health care populations in one geographical area, over three years. By examining patterns of health-related harm, an accurate profile of mentally ill Emergency patients was generated enabling identification of factors that increased vulnerability to harm. RESULTS: Of the total population of 625 964 individuals, 10.7% contacted Accident and Emergency (A&E) over three years, this proportion rose to 28.6% among the total secondary care mental health population. Young men and older women were more likely to contact A&E, both overall and within mental health populations and were also more likely to be frequent attendees at A&E. Four distinct groups (typologies) of mental health patients attending A&E emerged: young, male frequent attendees with self-inflicted and other traumatic injuries; young females also presenting with self-harm; older patients with multiple medical conditions; and very old patients with cardiac conditions and fractures. CONCLUSION: The study indicates increased A+E service use and unmet health-related need within a total mental health population. It identifies specific 'care populations' particularly vulnerable to accidents and self-harm and highlights the need for targeted services for mentally ill groups who may not access traditional health and social care services effectively.     

Are women ready for more liberal delivery of emergency contraceptive pills?

OBJECTIVE: To investigate the knowledge, use and attitudes towards emergency contraception (EC) among women attending family planning clinics. DESIGN: Self-administered questionnaire survey. SETTINGS: Eight birth control clinics and three youth health care centers of The Family Planning Association of Hong Kong. SUBJECTS: A total of 2454 women aged 15 to 53 attending the clinics between 1 November 2003 and 13 December 2003 were recruited. RESULTS: A total of 1405 completed questionnaires were analyzed. 63.7% of women had heard of EC and 51.8% knew that they had to take it within 72 h. 15.7% had used EC before. More advertising on EC was considered desirable by 46.3% of subjects. 48.7% of subjects supported advanced provision of emergency contraceptive pills (ECPs) and 25.7% supported over-the-counter sales. CONCLUSION: The awareness and use of EC were low in our study population. They were not ready for more liberal delivery of ECPs as less than 50% of women supported these new delivery modes and their knowledge on ECPs use was inadequate.     

Are eating disorders associated with borderline personality disorder? a critical review

Seven studies using structured diagnostic interviews have assessed the prevalence of borderline personality disorder among patients with eating disorders, yielding rates from 0% to 42% in different samples. However, many patients with eating disorders suffer from depression, and there is substantial overlap between the symptoms of depression and those of borderline personality disorder. Thus, structured interviews for borderline personality disorder–most of which are of untested or uncertain specificity–may perhaps frequently produce false-positive diagnoses of borderline personality disorder in patients with eating disorders and hence yield exaggerated estimates of the true prevalence of borderline personality disorder in this population. Considering the grave implications of the borderline diagnosis, one must remain critical of studies in this area until further data, using instruments of documented specificity, blind ratings, and suitable control groups, become available.     

Are eating habits associated with physical fitness in primary school children?

ObjectiveChildren's eating habits have mainly been related to anthropometric characteristics but less is known about their association with physical fitness.Methods278 French school children (131 boys and 147 girls) filled in eating habit questionnaires and completed anthropometric measurement (weight, height, skinfolds) and physical fitness tests. The 20-m Shuttle run test and the Squat Jump test were used to assess aerobic fitness and anaerobic (lower limb muscle power) fitness respectively.ResultsBreakfast consumption was associated with both aerobic fitness (p < 0.05) and lower limb muscle power (p < 0.01) while snacking was negatively related to Squat Jump performances (p < 0.05). There was no association between physical fitness and either the type of the consumed-beverages or TV watching during diner and lunch meals. Cumulated unhealthy eating habits was negatively associated with CRF stages and lower limb muscle power performances (p < 0.05).ConclusionFrench primary school children physical fitness is associated with their eating habits and decreases with the number of unhealthy eating behaviors cumulated.