Used infant mattresses and sudden infant death syndrome in Scotland: case-control study

<P>OBJECTIVE: To examine the proposition that a used infant mattress is associated with an increased risk of sudden infant death syndrome. DESIGN: Case-control study. SETTING: Scotland (population 5.1 million, with about 53 000 births a year).</P> <P>PARTICIPANTS: 131 infants who died of sudden infant death syndrome between 1 January 1996 and 31 May 2000 and 278 age, season, and obstetric unit matched control infants.</P> <P>MAIN OUTCOME MEASURES: Routine use of an infant mattress previously used by another child and place of last sleep.</P> <P>RESULTS: Routine use of an infant mattress previously used by another child was significantly associated with an increased risk of sudden infant death syndrome (multivariate odds ratio 3.07, 95% confidence interval 1.51 to 6.22). Use of a used infant mattress for last sleep was also associated with increased risk (6.10, 2.31 to 16.12). The association was significantly stronger if the mattress was from another home (4.78, 2.08 to 11.0) than if it was from the same home (1.64, 0.64 to 4.2).</P> <P>CONCLUSION: A valid significant association exists between use of a used infant mattress and an increased risk of sudden infant death syndrome, particularly if the mattress is from another home. Insufficient evidence is available to judge whether this relation is cause and effect.</P&gt

Optimal modelling of hearing impairment in middle age in relation to hearing in childhood as measured by audiograms

NCDS (National Child Development Survey) data include detailed audiograms at childhood ages 7,11,16 years and a ‘cut down’ audiogram at 45 years(frequencies 1 and 4 kHz only). A range of models relating data in childhood to adulthood is examined. Hearing losses at all childhood ages contribute independently and with comparable relationships to adult hearing loss: such models should include adjustments at all ages and at all frequencies in combination. This is possible through polynomial contrasts between frequencies at each age. Models which use the logarithm of the adult hearing measure as dependent variable are compared with those which use the raw score. Residuals from raw score models are found to have unacceptable distributional properties which are avoided by models of the log hearing loss. However, care needs to be taken in the interpretation of the coefficients in these models which can be easily transformed into an additive contribution due to the effects of further explanatory variables at specified values of existing variables. For categorical variables such as gender this will be a particular category and for continuous variables, such as childhood hearing, usually the mean. A range of multiple imputation models is compared with a complete case analysis. The complete case analysis excludes more than half of the data in models. In these cases I recommend the use of multiple imputation models. These models are can be estimated using recent macros in ‘off-the-peg’ statistical software (e.g. Mice in STATA). Mixed-effects and latent trajectory growth models are alternatives to the conditional models used here. These allow each individual to have a unique (growth) trajectory over time. Their advantages are limited in the case of these data due to the concentration of hearing loss data in childhood resulting from the absence of measurements of hearing loss in early adulthoo

Unemployed, uneducated and sick: the effects of socioeconomic status on health duration in the European Union

This paper employs a logistic model to measure the effect of socioeconomic and individual characteristics on the length of time an individual remains in good health. It employs an objective measure of physical health, the Physical and Mental Health Problems, Illnesses and Disabilities (PMID) measure in the ECHP dataset, for 13 European countries, for the years 1994-2002. The results show that socioeconomic status does affect the likelihood of individuals entering bad health. In particular, unemployment increases and education decreases the probability of a person ceasing to enjoy good health. Income effects, are however, somewhat weaker, being confined to a small number of countries and being mainly observed only for the highest income quartile. Interesting age and gender effects are also found

Hearing in 44–45 year olds with m.1555A>G, a genetic mutation predisposing to aminoglycoside-induced deafness: a population based cohort study

Background The mitochondrial DNA mutation m.1555A>G predisposes to permanent idiosyncratic aminoglycoside-induced deafness that is independent of dose. Research suggests that in some families, m.1555A>G may cause non-syndromic deafness, without aminoglycoside exposure, as well as reduced hearing thresholds with age (age-related hearing loss). Objectives To determine whether adults with m.1555A>G have impaired hearing, a factor that would inform the cost-benefit argument for genetic testing prior to aminoglycoside administration. Design Population-based cohort study. Setting UK. Participants Individuals from the British 1958 birth cohort. Measurements Hearing thresholds at 1 and 4 kHz at age 44-45 years; m.1555A>G genotyping. Results 19 of 7350 individuals successfully genotyped had the m.1555A>G mutation, giving a prevalence of 0.26% (95% CI 0.14% to 0.38%) or 1 in 385 (95% CI 1 in 714 to 1 in 263). There was no significant difference in hearing thresholds between those with and without the mutation. Single-nucleotide polymorphism analysis indicated that the mutation has arisen on a number of different mitochondrial haplogroups. Limitations No data were collected on aminoglycoside exposure. For three subjects, hearing thresholds could not be predicted because information required for modelling was missing. Conclusions In this cohort, hearing in those with m.1555A>G is not significantly different from the general population and appears to be preserved at least until 44-45 years of age. Unbiased ascertainment of mutation carriers provides no evidence that this mutation alone causes non-syndromic hearing impairment in the UK. The findings lend weight to arguments for genetic testing for this mutation prior to aminoglycoside administration, as hearing in susceptible individuals is expected to be preserved well into adult life. Since global use of aminoglycosides is likely to increase, development of a rapid test is a priority

"Getting sicker quicker": does living in a more deprived neighbourhood mean your health deteriorates faster?

Data from the longitudinal West of Scotland Twenty-07 Study: Health in the Community was used to examine whether, over a 20 year period, the self-reported health of people living in deprived areas became poorer faster compared to those living in more affluent areas. Three cohorts (born in the early 1930s, 1950s and 1970s) are included, covering 60 years of the life span. Using multilevel growth curve models, a 40% probability of reporting poor health was predicted among residents of more deprived areas at an earlier age (66) compared to those living in more affluent areas (83). Wider area differences were seen for men than for women. Our findings indicate that attempts to reduce area differences in health should start young but also continue throughout the lifespan

Incidence of Dyspnea and Assessment of Cardiac and Pulmonary Function in Patients With Stable Coronary Artery Disease Receiving Ticagrelor, Clopidogrel, or Placebo in the ONSET/OFFSET Study

ObjectivesWe prospectively assessed cardiac and pulmonary function in patients with stable coronary artery disease (CAD) treated with ticagrelor, clopidogrel, or placebo in the ONSET/OFFSET (A Multi-Centre Randomised, Double-Blind, Double-Dummy Parallel Group Study of the Onset and Offset of Antiplatelet Effects of AZD6140 Compared With Clopidogrel and Placebo With Aspirin as Background Therapy in Patients With Stable Coronary Artery Disease) study.BackgroundTicagrelor reduces cardiovascular events more effectively than clopidogrel in patients with acute coronary syndromes. Dyspnea develops in some patients treated with ticagrelor, and it is not known whether this is associated with changes in cardiac or pulmonary function.MethodsIn all, 123 stable aspirin-treated CAD patients randomly received either ticagrelor (180 mg load, then 90 mg twice daily; n = 57), clopidogrel (600 mg load, then 75 mg daily; n = 54), or placebo (n = 12) for 6 weeks in a double-blind, double-dummy design. Electrocardiography, echocardiography, serum N-terminal pro-brain natriuretic peptide, and pulmonary function tests were performed before (baseline) and 6 weeks after drug administration and/or after development of dyspnea.ResultsAfter drug administration, dyspnea was reported by 38.6%, 9.3%, and 8.3% of patients in the ticagrelor, clopidogrel, and placebo groups, respectively (p < 0.001). Most instances were mild and/or lasted <24 h, although 3 patients discontinued ticagrelor because of dyspnea. Eight of 22 and 17 of 22 ticagrelor-treated patients experiencing dyspnea did so within 24 h and 1 week, respectively, after drug administration. In all treatment groups, and in ticagrelor-treated patients with dyspnea, there were no significant changes between baseline and 6 weeks in any of the cardiac or pulmonary function parameters.ConclusionsDyspnea is commonly associated with ticagrelor therapy, but was not associated in this study with any adverse change in cardiac or pulmonary function. (A Multi-Centre Randomised, Double-Blind, Double-Dummy Parallel Group Study of the Onset and Offset of Antiplatelet Effects of AZD6140 Compared With Clopidogrel and Placebo With Aspirin as Background Therapy in Patients With Stable Coronary Artery Disease [ONSET/OFFSET]; NCT00528411

Body Mass Index, abdominal adiposity, obesity, and cardiovascular reactions to psychological stress in a large community sample

OBJECTIVE: To examine the association between adiposity and the magnitude of cardiovascular reactions to acute psychological stress cross-sectionally and prospectively in a large community sample.\ud \ud METHODS: Blood pressure and heart rate (HR) were measured at rest and in response to a brief time-pressured mental arithmetic stress in 1647 adults. At the same session and 5 years later, height, weight, waist and hip circumference were measured and body mass index (BMI) and waist-hip ratio were computed. Obesity was defined as a body mass index of > or = 30 kg/m(2).\ud \ud RESULTS: Contrary to expectations, the most robust and consistent results to emerge from cross-sectional analyses were negative associations between all three measures of adiposity and HR reactivity; those with greater BMI and waist-hip ratios and those categorized as obese displayed smaller HR reactions to stress. In prospective analyses, high HR reactivity was associated with a reduced likelihood of becoming obese in the subsequent 5 years.\ud \ud CONCLUSIONS: Our analyses suggest that it is low, not high, HR reactivity that is related to adiposity. Low HR reactivity, probably by reflecting generally blunted sympathetic nervous system reactions to challenge, may be a risk marker for developing obesity.\ud \u

Social deprivation and exposure to health promotion. A study of the distribution of health promotion resources to schools in England

This article has been made available through the Brunel Open Access Publishing Fund and is available from the specified link - Copyright @ 2010 Chivu and ReidpathBACKGROUND: Area deprivation is a known determinant of health. It is also known that area deprivation is associated with lower impact health promotion. It is less well known, however, whether deprived areas are less responsive to health promotion, or whether they are less exposed. Using data from a national, school-based campaign to promote vaccination against the human papilloma virus (HPV), the relationship between area deprivation and exposure was examined. METHODS: Taking advantage of a health promotion campaign to provide information to schools about HPV vaccination, a cross sectional study was conducted to examine the relationship between area level, social deprivation, and take-up of (i.e., exposure to) available health promotion material. The sample was 4,750 schools across England, including government maintained and independent schools. The relationship between area deprivation and exposure was examined using bi- and multivariate logistic regression. RESULTS: It was found that schools in the least deprived quintile had 1.32 times the odds of requesting health promotion materials than schools in the most deprived areas (p = .01). This effect was independent of the school size, the type of school, and the geographic region. Conclusion The relationship between area deprivation and the impact of health promotion may be due, at least in part, to differential levels of exposure. The study was limited in scope, pointing to the need for more research, but also points to potentially important policy implications

The importance of both setting and intensity of physical activity in relation to non-clinical anxiety and depression

Physical activity is associated with good physical and mental health. Current recommendations suggest that people should achieve 30 minutes of moderate-intensity activity most days of the week to gain health benefits. This activity may be accumulated in leisure time, in active commuting, at work or in the home. Here we look at the cross-sectional relationship between physical activity and mental health as measured by the HADS anxiety and depression scores in a sample of 1,742 participants from a Scottish general population survey. The participants were men and women in three age cohorts aged around 24, 44 and 64 years who, in 1995, were interviewed face to face and also self-completed the HADS depression and anxiety scale. Respondents reported their levels of physical activity at work, in the home and in leisure time; the intensities of activity were also determined. Physical activity was related to depression scores but not to anxiety scores. There was no relationship between work physical activity and depression score. Among women, depression score increased with each additional episode of vigorous home activity. In both sexes, depression score decreased with each additional episode of vigorous leisure activity, but among men the decrease in depression score with moderate leisure activity was reversed if a lot of moderate activity was undertaken. We have found a variable relationship between depression scores and various settings for physical activity. Researchers, policymakers and practitioners who are interested in the relationship between physical activity and mental health should take into account the setting for activity as well as frequency, duration and intensity of activity