Coronary heart disease, hypertension and use of biomass fuel among women: Comparative cross-sectional study

Objectives: To explore the associations of hypertension and coronary heart disease (CHD) with use of biomass fuel for cooking.Design: Comparative cross-sectional study.Setting: Rural villages in Sindh, Pakistan.Participants: Women aged ≥40 years who had used biomass fuel for cooking for at least the last year (n=436), and a comparison group (n=414) who had cooked only with non-biomass fuel during the last year were recruited through door-to-door visits. None of those who were invited to take part declined.Primary and secondary outcome measures: Hypertension was determined from blood pressure measurements and use of medication. CHD was assessed by three measures: history of angina (Rose angina questionnaire), previous history of \u27heart attack\u27, and definite or probable changes of CHD on ECG. Potentially confounding risk factors were ascertained by questionnaire and anthropometry. Associations of hypertension and CHD with use of biomass and other risk factors were assessed by logistic regression, and summarised by ORs with 95% CIs.Results: After adjustment for potential confounders, there was no association of hypertension (OR: 1.0, 95% CI 0.8 to 1.4) angina (OR: 1.0, 95% CI 0.8 to 1.4), heart attack (OR: 1.2, 95% 0.7 to 2.2) or ECG changes of CHD (OR: 0.8, 95% CI 0.6 to 1.2) with current use of biomass for cooking. Nor were any associations apparent when analyses were restricted to long-term (≥10 years) users and non-users of biomass fuel.Conclusions: A linked air monitoring study indicated substantially higher airborne concentrations of fine particulate matter in kitchens where biomass was used for cooking. It is possible that associations with CHD and hypertension were missed because most of the comparison group had used biomass for cooking at some time in the past, and risk remains elevated for many years after last exposure

The relationship between dietary quality and the local food environment differs according to level of educational attainment: A cross-sectional study.

There is evidence that food outlet access differs according to level of neighbourhood deprivation but little is known about how individual circumstances affect associations between food outlet access and diet. This study explored the relationship between dietary quality and a measure of overall food environment, representing the balance between healthy and unhealthy food outlet access in individualised activity spaces. Furthermore, this study is the first to assess effect modification of level of educational attainment on this relationship. A total of 839 mothers with young children from Hampshire, United Kingdom (UK) completed a cross-sectional survey including a 20-item food frequency questionnaire to measure diet and questions about demographic characteristics and frequently visited locations including home, children's centre, general practitioner, work, main food shop and physical activity location. Dietary information was used to calculate a standardised dietary quality score for each mother. Individualised activity spaces were produced by creating a 1000m buffer around frequently visited locations using ArcGIS. Cross-sectional observational food outlet data were overlaid onto activity spaces to derive an overall food environment score for each mother. These scores represented the balance between healthy and unhealthy food outlets using weightings to characterise the proportion of healthy or unhealthy foods sold in each outlet type. Food outlet access was dominated by the presence of unhealthy food outlets; only 1% of mothers were exposed to a healthy overall food environment in their daily activities. Level of educational attainment moderated the relationship between overall food environment and diet (mid vs low, p = 0.06; high vs low, p = 0.04). Adjusted stratified linear regression analyses showed poorer food environments were associated with better dietary quality among mothers with degrees (β = -0.02; 95%CI: -0.03, -0.001) and a tendency toward poorer dietary quality among mothers with low educational attainment, however this relationship was not statistically significant (β = 0.01; 95%CI: -0.01, 0.02). This study showed that unhealthy food outlets, like takeaways and convenience stores, dominated mothers' food outlet access, and provides some empirical evidence to support the concept that individual characteristics, particularly educational attainment, are protective against exposure to unhealthy food environments. Improvements to the imbalance of healthy and unhealthy food outlets through planning restrictions could be important to reduce dietary inequalities

Morbidities Among Older Workers And Work Exit : The Heaf Cohort

Funding: The HEAF study is funded by grant awards from Versus Arthritis (formerly Arthritis Research UK) (19817 and 20665) and the Medical Research Council programme grant (MC_UU_12011/5); and the Economic and Social Research Council and Medical Research Council jointly (ES/L002663/1); the study is coordinated by the MRC Lifecourse Epidemiology Unit, Southampton. GN and CHL receive financial support from the MRC Versus Arthritis Centre for Musculoskeletal Health and Work. Acknowledgements: We wish to thank Professor Keith Palmer for his work incepting the HEAF cohort and Dr Stephen Duffield for his contribution to the coding of the CPRD data. Also, we are grateful to the Clinical Practice Research Datalink and the 24 general practices that supported data collection, the staff of the MRC Lifecourse Epidemiology Unit who provided data entry and computing support (notably Vanessa Cox). Finally, we thank the HEAF participants for giving their time so generously to participate in the study.Peer reviewedPostprin

Influences on the diet quality of pre-school children:importance of maternal psychological characteristics

OBJECTIVE: To test the hypothesis that maternal psychological profiles relate to children's quality of diet. DESIGN: Cross-sectional study. Mothers provided information on their health-related psychological factors and aspects of their child's mealtime environment. Children's diet quality was assessed using an FFQ from which weekly intakes of foods and a diet Z-score were calculated. A high score described children with a better quality diet. Cluster analysis was performed to assess grouping of mothers based on psychological factors. Mealtime characteristics, describing how often children ate while sitting at a table or in front of the television, their frequency of takeaway food consumption, maternal covert control and food security, and children's quality of diet were examined, according to mothers' cluster membership. SUBJECTS: Mother-child pairs (n 324) in the Southampton Initiative for Health. Children were aged 2-5 years. SETTING: Hampshire, UK. RESULTS: Two main clusters were identified. Mothers in cluster 1 had significantly higher scores for all psychological factors than mothers in cluster 2 (all P < 0.001). Clusters were termed 'more resilient' and 'less resilient', respectively. Children of mothers in the less resilient cluster ate meals sitting at a table less often (P = 0.03) and watched more television (P = 0.01). These children had significantly poorer-quality diets (β = -0.61, 95% CI -0.82, -0.40, P ≤ 0.001). This association was attenuated, but remained significant after controlling for confounding factors that included maternal education and home/mealtime characteristics (P = 0.006). CONCLUSIONS: The study suggests that mothers should be offered psychological support as part of interventions to improve children's quality of diet

The development of a protocol for diagnosing hand dermatitis from photographic images

Background: A hand photography protocol was needed to ascertain the presence and severity of dermatitis in a trial testing the effectiveness of a behaviour change intervention to prevent hand dermatitis in nurses. Methods: We developed the protocol in three stages: (i) established a procedure for collecting hand photographs; (ii) conducted a stepwise validation process to agree rules for diagnosing and determining severity of hand dermatitis and; (iii) trained a research nurse to screen out ‘clear’ cases. Results: We developed and trained fieldworkers (n=97) in a procedure for collecting hand photographs. Study dermatologists established interpretation rules to diagnose and determine the severity of dermatitis from photographs. Prior to the establishment of the rules, inter-observer agreement between the two dermatologists on the presence or absence of hand dermatitis was moderate (kappa 0.5). At the final stage of the validation process, the dermatologists agreed on 88% cases from independent assessments, with consensus reached for the remaining 12% following joint deliberation. Following training, a subgroup analysis of 250 cases screened by the nurse and characterised as ‘clear’ found two (0.8%) ‘positive’ cases were missed. Conclusion: We have developed a hand photography protocol, which may be used in other studies or in hand dermatitis health surveillance programmes

Healthy conversation skills:increasing competence and confidence in front-line staff

OBJECTIVE: (i) To assess change in confidence in having conversations that support parents with healthy eating and physical activity post-training. (ii) To assess change in staff competence in using 'open discovery' questions (those generally beginning with 'how' and 'what' that help individuals reflect and identify barriers and solutions) post-training. (iii) To examine the relationship between confidence and competence post-training. DESIGN: A pre-post evaluation of 'Healthy Conversation Skills', a staff training intervention. SETTING: Sure Start Children's Centres in Southampton, England. SUBJECTS: A total of 145 staff working in Sure Start Children's Centres completed the training, including play workers (43%) and community development or family support workers (35%). RESULTS: We observed an increase in median confidence rating for having conversations about healthy eating and physical activity (both P < 0·001), and in using 'open discovery' questions (P < 0·001), after staff attended the 'Healthy Conversation Skills' training. We also found a positive relationship between the use of 'open discovery' questions and confidence in having conversations about healthy eating post-training (r = 0·21, P = 0·01), but a non-significant trend was observed for having conversations about physical activity (r = 0·15, P = 0·06). CONCLUSIONS: The 'Healthy Conversation Skills' training proved effective at increasing the confidence of staff working at Sure Start Children's Centres to have more productive conversations with parents about healthy eating. Wider implementation of these skills may be a useful public health nutrition capacity building strategy to help community workers support families with young children to eat more healthy foods

Associations of sickness absence for pain in the low back, neck and shoulders with wider propensity to pain

Objectives: To explore the association of sickness absence ascribed to pain at specific anatomical sites with wider propensity to musculoskeletal pain.Methods: As part of the CUPID (Cultural and Psychosocial Influences on Disability) study, potential risk factors for sickness absence from musculoskeletal pain were determined for 11 922 participants from 45 occupational groups in 18 countries. After approximately 14 months, 9119 (78%) provided follow-up information about sickness in the past month because of musculoskeletal pain, including 8610 who were still in the same job. Associations with absence for pain at specific anatomical sites were assessed by logistic regression and summarised by ORs with 95% CIs.Results: 861 participants (10%) reported absence from work because of musculoskeletal pain during the month before follow-up. After allowance for potential confounders, risk of absence ascribed entirely to low back pain (n=235) increased with the number of anatomical sites other than low back that had been reported as painful in the year before baseline (ORs 1.6 to 1.7 for ≥4 vs 0 painful sites). Similarly, associations with wider propensity to pain were observed for absence attributed entirely to pain in the neck (ORs up to 2.0) and shoulders (ORs up to 3.4).Conclusions: Sickness absence for pain at specific anatomical sites is importantly associated with wider propensity to pain, the determinants of which extend beyond established risk factors such as somatising tendency and low mood. Better understanding of why some individuals are generally more prone to musculoskeletal pain might point to useful opportunities for prevention

Drivers of international variation in prevalence of disabling low back pain: Findings from the cultural and psychosocial influences on disability study

Background: Wide international variation in the prevalence of disabling low back pain (LBP) among working populations is not explained by known risk factors. It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally.Methods: Baseline information about musculoskeletal pain and risk factors was elicited from 11 710 participants aged 20-59 years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterized by the number of anatomical sites outside the low back that had been painful in the 12 months before baseline (\u27pain propensity index\u27). After a mean interval of 14 months, 9055 participants (77.3%) provided follow-up data on disabling LBP in the past month. Baseline risk factors for disabling LBP at follow-up were assessed by random intercept Poisson regression.Results: After allowance for other known and suspected risk factors, pain propensity showed the strongest association with disabling LBP (prevalence rate ratios up to 2.6, 95% CI: 2.2-3.1; population attributable fraction 39.8%). Across the 45 occupational groups, the prevalence of disabling LBP varied sevenfold (much more than within-country differences between nurses and office workers), and correlated with mean pain propensity index (r = 0.58).Conclusions: Within our study, major international variation in the prevalence of disabling LBP appeared to be driven largely by factors predisposing to musculoskeletal pain at multiple anatomical sites rather than by risk factors specific to the spine.Significance: Our findings indicate that differences in general propensity to musculoskeletal pain are a major driver of large international variation in the prevalence of disabling low back pain among people of working age

Assessing diets of 3-year-old children:evaluation of an FFQ

OBJECTIVE: To evaluate the use of an administered eighty-item FFQ to assess nutrient intake and diet quality in 3-year-old children. DESIGN: Frequency of consumption and portion size of the foods listed on the FFQ during the 3 months preceding the interview were reported by the child's main caregiver; after the interview a 2 d prospective food diary (FD) was completed on behalf of the child. Nutrient intakes from the FFQ and FD were estimated using UK food composition data. Diet quality was assessed from the FFQ and FD according to the child's scores for a principal component analysis-defined dietary pattern ('prudent' pattern), characterised by high consumption of fruit, vegetables, water and wholemeal cereals. SETTING: Southampton, UK. SUBJECTS: Children (n 892) aged 3 years in the Southampton Women's Survey. RESULTS: Intakes of all nutrients assessed by the FFQ were higher than FD estimates, but there was reasonable agreement in terms of ranking of children (range of Spearman rank correlations for energy-adjusted nutrient intakes, r s = 0·41 to 0·59). Prudent diet scores estimated from the FFQ and FD were highly correlated (r = 0·72). Some family and child characteristics appeared to influence the ability of the FFQ to rank children, most notably the number of child's meals eaten away from home. CONCLUSIONS: The FFQ provides useful information to allow ranking of children at this age with respect to nutrient intake and quality of diet, but may overestimate absolute intakes. Dietary studies of young children need to consider family and child characteristics that may impact on reporting error associated with an FFQ

Variety and quality of healthy foods differ according to neighbourhood deprivation

This study addresses a gap in the food environment literature by investigating spatial differences in the inter relationship of price, variety and quality of food in southern England. We conducted a survey of all grocery stores (n=195) in the city of Southampton, UK, and ranked neighbourhoods according to national quintiles of deprivation. We found no difference in availability or cheapest price across neighbourhoods. However, the poorest neighbourhoods had less variety of healthy products and poorer quality fruit and vegetables than more affluent neighbourhoods. Dietary inequalities may be exacerbated by differences in the variety and quality of healthy foods sold locally; these factors may influence whether or not consumers purchase healthy foods