Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study

Percentage of deaths attributable to poor cardiovascular health lifestyle factors: Findings from the Aerobics Center Longitudinal Study

PURPOSE

We assessed the effects of the four newly defined American Heart Association (AHA) lifestyle factors on mortality by examining the associated population attributable fractions (PAFs) of these factors.

METHODS

Slightly modified AHA cardiovascular health factors (smoking, BMI, cardiorespiratory fitness, and diet) were measured among 11,240 (24% women) participants from the Aerobics Center Longitudinal Study between 1987 and 1999. The cohort was followed to December 31, 2003 or death. PAFs were calculated as the proportionate reduction in death attributable to identified risk factors.

RESULTS

During an average 12 years of follow-up, 268 deaths occurred. Low fitness had the highest PAFs at the 5^th, 10^th, and 15^th year of follow-up, respectively: 6.6%, 6.4%, and 5.5%. Current smokers had the second highest PAFs at the 5^th, 10^th, and 15^th year of follow-up, respectively: 5.4%, 5.2%, and 5.0%. Additional adjusting for other confounders in the model did not change the above associations. The PAFs for overweight or obesity and unhealthy diet were not significant in the current analyses.

CONCLUSIONS

Assuming a causal relationship between smoking, low fitness and mortality, avoidance of both would have prevented 13% of the deaths in the current population. Preventive interventions to increase physical activity and stop smoking would most likely promote longevity.

Health outcomes of a subsidised fruit and vegetable program for Aboriginal children in northern New South Wales

OBJECTIVE

To evaluate the impact of a fruit and vegetable subsidy program on short-term health outcomes of disadvantaged Aboriginal children.

DESIGN, SETTING AND PARTICIPANTS

A before-and-after study involving clinical assessments, health record audits and blood testing of all children aged 0-17 2013s (n = 167) from 55 participating families at baseline and after 12 months at three Aboriginal community-controlled health services in New South Wales. All assessments were completed between December 2008 and September 2010.

INTERVENTION

A weekly box of subsidised fruit and vegetables linked to preventive health services and nutrition promotion at an Aboriginal Medical Service.

MAIN OUTCOME MEASURES

Change in episodes of illness, health service and emergency department attendances, antibiotic prescriptions and anthropometry.

RESULTS

There was a significant decrease in oral antibiotics prescribed (- 0.5 prescriptions/2013; 95% CI, - 0.8 to - 0.2) during 12 months of participation in the program compared with the 12 months before the program. The proportion of children classified as overweight or obese at baseline was 28.3% (38/134) and the proportion in each weight category did not change (P = 0.721) after 12 months. A small but significant increase in mean haemoglobin level (3.1 g/L; 95% CI, 1.4-4.8 g/L) was shown, although the proportion with iron deficiency (baseline, 41%; follow-up, 37%; P = 0.440) and anaemia (baseline, 8%; follow-up, 5%; P = 0.453) did not change significantly.

CONCLUSION

it and vegetable subsidy program was associated with improvements in some indicators of short-term health status among disadvantaged Aboriginal children. A controlled trial is warranted to investigate the sustainability and feasibility of healthy food subsidy programs in Australia.

Social capital, health behaviours and health: a population-based associational study

Background

Social capital is associated with health behaviours and health. Our objective was to explore how different dimensions of social capital and health-related behaviours are associated, and whether health behaviours mediate this association between social capital and self-rated health and psychological well-being.

Methods

We used data from the Health 2000 Survey (n=8028) of the adult population in Finland. The response rate varied between 87% (interview) and 77% (the last self-administered questionnaire). Due to item non-response, missing values were replaced using multiple imputation. The associations between three dimensions of social capital (social support, social participation and networks, trust and reciprocity) and five health behaviours (smoking, alcohol use, physical activity, vegetable consumption, sleep) were examined by using logistic regression and controlling for age, gender, education, income and living arrangements. The possible mediating role of health behaviours in the association between social capital and self-rated health and psychological well-being was also analysed with a logistic regression model.

Results

Social participation and networks were associated with all of the health behaviours. High levels of trust and reciprocity were associated with non-smoking and adequate duration of sleep, and high levels of social support with adequate duration of sleep and daily consumption of vegetables. Social support and trust and reciprocity were independently associated with self-rated health and psychological well-being. Part of the association between social participation and networks and health was explained by physical activity.

Conclusions

Irrespective of their social status, people with higher levels of social capital – especially in terms of social participation and networks – engage in healthier behaviours and feel healthier both physically and psychologically.

Social capital, health behaviours and health: a population-based associational study

BACKGROUND

Social capital is associated with health behaviours and health. Our objective was to explore how different dimensions of social capital and health-related behaviours are associated, and whether health behaviours mediate this association between social capital and self-rated health and psychological well-being.

METHODS

We used data from the Health 2000 Survey (n=8028) of the adult population in Finland. The response rate varied between 87% (interview) and 77% (the last self-administered questionnaire). Due to item non-response, missing values were replaced using multiple imputation. The associations between three dimensions of social capital (social support, social participation and networks, trust and reciprocity) and five health behaviours (smoking, alcohol use, physical activity, vegetable consumption, sleep) were examined by using logistic regression and controlling for age, gender, education, income and living arrangements. The possible mediating role of health behaviours in the association between social capital and self-rated health and psychological well-being was also analysed with a logistic regression model.

RESULTS

Social participation and networks were associated with all of the health behaviours. High levels of trust and reciprocity were associated with non-smoking and adequate duration of sleep, and high levels of social support with adequate duration of sleep and daily consumption of vegetables. Social support and trust and reciprocity were independently associated with self-rated health and psychological well-being. Part of the association between social participation and networks and health was explained by physical activity.

CONCLUSIONS

Irrespective of their social status, people with higher levels of social capital - especially in terms of social participation and networks - engage in healthier behaviours and feel healthier both physically and psychologically.

Adherence to WCRF/AICR cancer prevention recommendations and risk of postmenopausal breast cancer

BACKGROUND

In 2007, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) released eight recommendations related to body fatness, physical activity, and diet aimed at preventing the most common cancers worldwide. However, limited information exists on the association between meeting these recommendations and risks of specific cancers, including breast cancer.

METHODS

We operationalized six recommendations (related to body fatness, physical activity, foods that promote weight gain, plant foods, red and processed meats, and alcohol) and examined their association with invasive breast cancer incidence over 6.7 years of follow-up in the Vitamins and Lifestyle (VITAL) study cohort. Participants included 30,797 postmenopausal women, ages 50-76 years at baseline in 2000-2002 with no history of breast cancer. Breast cancers (n = 899) were tracked through the Western Washington Surveillance, Epidemiology, and End Results database.

RESULTS

Breast cancer risk was reduced by 60% in women who met at least five recommendations compared with those who met none [HR: 0.40; 95% confidence interval (CI): 0.25-0.65; Ptrend < 0.001]. Further analyses that sequentially removed individual recommendations least associated with reduced risk suggested that this reduction is due to meeting recommendations related to body fatness, plant foods, and alcohol (HR for meeting vs. not meeting these three recommendations: 0.38; 95% CI: 0.25-0.58; Ptrend < 0.001).

CONCLUSIONS

Meeting the WCRF/AICR cancer prevention recommendations, specifically those related to alcohol, body fatness, and plant foods, is associated with reduced postmenopausal breast cancer incidence.

IMPACT

Increased adherence to the WCRF/AICR cancer prevention recommendations could substantially reduce postmenopausal breast cancer risk in U.S. women.

Predictors of change differ for moderate and vigorous intensity physical activity and for weekdays and weekends: a longitudinal analysis

BACKGROUND

Predictors of physical activity (PA) change are rarely investigated separately for different PA intensities and for weekdays/weekends. We investigated whether individual-level predictors of one-year change in objectively-measured physical activity differ for moderate PA (MPA) and vigorous PA (VPA) and for weekends and weekdays.

METHODS

Accelerometer-assessed PA (mins) was obtained at baseline and +1 year (n = 875, 41.5% male, Mean ± SD baseline age: 9.8 ± 0.4 years-old). Potential predictors (n = 38) were assessed at baseline from psychological (e.g., self-efficacy), socio-cultural (e.g., parent support) and environmental domains (e.g., land use). Associations between predictors and change in MPA (2000-3999 counts/minute (cpm)) and VPA (≥4000 cpm) separately for weekdays and weekends were studied using multi-level linear regression. Analyses were adjusted for school clustering, sex and baseline PA.

RESULTS

Weekend PA declined (MPA decline 4.6 ± 21.8 mins/day; VPA decline: 2.1 ± 20.1 mins/day; both p < 0.001) whereas weekday PA did not significantly change. Higher baseline PA and being a girl were associated with greater PA declines in all four outcomes; remaining predictors differed for MPA and VPA and/or weekdays and weekends. Family logistic support was associated with less of a decline in weekend MPA (CI 95%) 0.15 (0.05, 0.25) and VPA 0.19 (0.09, 0.29), and peer support with less of a decline in weekday MPA 0.18 (0.02, 0.34) and VPA 0.22 (0.06, 0.38).

CONCLUSIONS

Results highlight the relevance of investigating predictors of PA change separately for different PA intensities and for weekdays/weekends. In addition to continued focus on school PA promotion, more effort to target interventions during weekends, such as in the family and community appears important. Encouraging peer support to increase weekday PA and targeting parent support for weekend PA may be health promotion priorities.

Job strain and health-related lifestyle: findings from an individual-participant meta-analysis of 118,000 working adults

OBJECTIVES

We examined the associations of job strain, an indicator of work-related stress, with overall unhealthy and healthy lifestyles.

METHODS

We conducted a meta-analysis of individual-level data from 11 European studies (cross-sectional data: n = 118,701; longitudinal data: n = 43,971). We analyzed job strain as a set of binary (job strain vs no job strain) and categorical (high job strain, active job, passive job, and low job strain) variables. Factors used to define healthy and unhealthy lifestyles were body mass index, smoking, alcohol intake, and leisure-time physical activity.

RESULTS

Individuals with job strain were more likely than those with no job strain to have 4 unhealthy lifestyle factors (odds ratio [OR] = 1.25; 95% confidence interval [CI] = 1.12, 1.39) and less likely to have 4 healthy lifestyle factors (OR = 0.89; 95% CI = 0.80, 0.99). The odds of adopting a healthy lifestyle during study follow-up were lower among individuals with high job strain than among those with low job strain (OR = 0.88; 95% CI = 0.81, 0.96).

CONCLUSIONS

Work-related stress is associated with unhealthy lifestyles and the absence of stress is associated with healthy lifestyles, but longitudinal analyses suggest no straightforward cause-effect relationship between work-related stress and lifestyle.

Effects of low-volume walking programme and vitamin E supplementation on oxidative damage and health-related variables in healthy older adults

Background

Both exercise and vitamin E supplementation have been shown to reduce oxidative stress and cardiovascular disease risk in older adults, and when combined there is evidence suggesting that they act synergistically. The currently recommended amount of exercise for older adults is 150 min/week of moderate-intensity exercise; however, the minimum amount of exercise necessary to achieve health benefits is not known. The purpose of this study was to investigate the effects of 12 weeks of participation in a low-volume walking exercise programme (i.e. 90 min/week) combined with daily vitamin E supplementation on thiobarbituric acid reactive substances (TBARS) and oxidised low-density lipoprotein (LDL) concentrations in older adults.

Methods

The participants were recruited from the following four groups separately: 1) control (CG, n = 14), 2) vitamin E supplementation (SG, n = 10), 3) walking (WG, n = 7), or 4) walking + supplementation (WSG, n = 7). In the CG, participants were advised to maintain their normal lifestyle during the study. Participants in both the SG and WSG received 450 IU (300 mg) /day of α-tocopherol for 12 weeks. The exercise programme for the WG and WSG consisted of two 30–60 minute sessions weekly for 12 weeks (average walking time was 44.5 ± 1.6 min/session). Blood samples were collected at baseline and at 12 weeks.

Results

Delta plasma oxidised LDL concentrations did not differ among four groups (One-factor ANOVA, P = 0.116). However, negative delta plasma TBARS, a marker of oxidative damage, concentrations were observed in the WG, WSG and SG relative to the CG at the end of the study period (One-factor ANOVA, P = 0.001; post hoc tests; CG compared with WG, WSG and SG, P = 0.005; P = 0.021; P = 0.024, respectively).

Conclusion

These findings suggest that a low-volume of physical activity and/or vitamin E supplementation may be an effective intervention strategy for reducing TBARS concentrations of older adults.

Trial registration

UMIN000008304

Predictors of patterns of change in health-related quality of life in older women over 7 years: evidence from a prospective cohort study

BACKGROUND

the evaluation of the determinants of change over time in health-related quality of life (HR-QoL) in older people is limited. This study aims to identify patterns of change in HR-QoL over 7 years and their determinants using data from the British Women's Heart and Health Study, a representative sample of older women (n = 4286).

METHODS

longitudinal latent class analysis was used to identify subpopulations of women with similar HR-QoL trajectories from 1999-2000 to 2007. HR-QoL was measured using the EQ-5D. Multivariate multinomial logistic regression was used to model the association of identified trajectories with baseline predictors after multiple imputation of missing data.

RESULTS

four distinct EQ-5D trajectories were suggested: high (19% of women), high decline (22%), intermediate (42%) and low decline (16%). Prevalent arthritis (OR = 13.4; 95% CI: 8.8, 20.5), diabetes (OR = 4.6; 95% CI: 1.5, 14.2) and obesity (OR = 3.9; 95% CI: 2.5, 6.0) were the strongest predicting health conditions of adverse changes in HR-QoL and physical activity the strongest predicting lifestyle factor (OR = 2.8; 95% CI: 2.0, 3.9).

CONCLUSIONS

findings suggest that older women without obesity or pre-existing health conditions who undertake more physical activity are more likely to experience high HR-QoL, reinforcing the importance of these factors for healthy ageing.

Survey of surgery and anesthesia infrastructure in Ethiopia

BACKGROUND

Information regarding surgical capacity in the developing world is limited by the paucity of available data regarding surgical care, infrastructure, and human resources in the literature. The purpose of this study was to assess surgical and anesthesia infrastructure and human resources in Ethiopia as part of a larger study by the Harvard Humanitarian Initiative examining surgical and anesthesia capacity in ten low-income countries in Africa.

METHODS

A comprehensive survey tool developed by the Harvard Humanitarian Initiative was used to assess surgical capacity of hospitals in Ethiopia. A total of 20 hospitals were surveyed through convenience sampling. Eight areas of surgical and anesthesia care were examined, including access and availability, access to human resources, infrastructure, outcomes, operating room information and procedures, equipment, nongovernmental organization delivery of surgical services, and pharmaceuticals. Results were obtained over a 1-month period during October 2011.

RESULTS

There is wide variation in accessibility, with hospital-to-population ratios ranging from 1:99,010 to 1:1,082,761. The overall physician to population ratio ranges from 1:4715 to 1:107,602. The average hospital has one to two operating rooms, 4.2 surgeons, one gynecologist, and 4.5 anesthesia providers-although in all but three hospitals anesthesiology was provided by nonphysician personnel only (i.e., a nurse anesthetist). Access to continuous electricity, running water, essential medications, and monitoring systems is very limited in all hospitals surveyed, although such access did vary across regions.

CONCLUSIONS

This survey of Ethiopia's hospital resources attempts to identify specific areas of need where resources, education, and development can be targeted. Because the major surgical mortality comes from late presentations, increasing accessibility through infrastructure development would likely provide a major improvement in surgical morbidity and mortality rates. Infrastructure limitations of electricity, water, oxygen, and blood banking do not prove to be significant barriers to surgical care. The increasing number of physicians is promising, although efforts should be directed specifically toward increasing the number of anesthesiologists and surgeons in the country.

Physical activity and fruit and vegetable intake: correlations between and within adults in a longitudinal multiethnic cohort

PURPOSE

To determine if changes in physical activity were associated with changes in fruit and vegetable intake.

DESIGN

Prospective cohort.

SETTING

Hawaii.

SUBJECTS

Seven hundred adults (18+ years) sampled from the general population.

MEASURES

Computer-assisted telephone interviews conducted at 0, 3, 6, 9, 12, 18, and 24 months; the International Physical Activity Questionnaire; the National Cancer Institute's Fruit and Vegetable Screener.

ANALYSIS

Between-individual correlations of each individual's mean physical activity and mean fruit and vegetable intake were estimated with Pearson correlations. Correlations of physical activity and fruit and vegetable intake within individuals over time were calculated from analysis of covariance models to factor out the variation between individuals.

RESULTS

Individuals with a higher mean physical activity duration tended to eat more fruits and vegetables (r = .30, p < .0001). Within individuals, no average correlation between physical activity and intake of fruit and vegetables was observed over time (r = .03). The variation was great in that some individuals, these behaviors changed simultaneously, but in others, they did not.

CONCLUSION

Although individuals who are more physically active tend to eat more fruits and vegetables (i.e., there is a weak correlation between individuals), on average, individuals do not simultaneously change these behaviors. Implications are that health behaviors may not covary, or that intervention is necessary to bring about covariation in health behaviors. The great variation from individual to individual in the extent to which these two behaviors covaried needs to be studied to determine if the individual tendency for behaviors to covary could be measured and used to individually tailor multiple behavior interventions.

Treatment-enhanced paired action contributes substantially to change across multiple health behaviors: secondary analyses of five randomized trials

The dominant paradigm of changing multiple health behaviors (MHBs) is based on treating, assessing, and studying each behavior separately. This study focused on individuals with co-occurring baseline health-risk behavior pairs and described whether they changed over time on both or only one of the behaviors within each pair. Data from five randomized trials of computer-tailored interventions (CTIs) that simultaneously treated MHBs were analyzed. The differences between treatment and control proportions that achieved paired action and singular action at 24 months follow-up, and the proportional contribution of paired action to overall change on each behavior, were assessed across 12 behavior pairs (including energy balance, addictive, and appearance-related behaviors). CTIs consistently produced more paired action across behavior pairs. Paired action contributed substantially more to the treatment-related outcomes than singular action. Studying concurrent changes on MHBs as demonstrated allows the effect of simultaneously treating MHBs to be assessed.

Combined impact of traditional and non-traditional health behaviors on mortality: a national prospective cohort study in Spanish older adults

BACKGROUND

Data on the combined effect of lifestyles on mortality in older people have generally been collected from highly selected populations and have been limited to traditional health behaviors. In this study, we examined the combined impact of three traditional (smoking, physical activity and diet) and three non-traditional health behaviors (sleep duration, sedentary time and social interaction) on mortality among older adults.

METHODS

A cohort of 3,465 individuals, representative of the Spanish population aged ≥60 years, was established in 2000/2001 and followed-up prospectively through 2011. At baseline, the following positive behaviors were self-reported: never smoking or quitting tobacco >15 years, being very or moderately physically active, having a healthy diet score ≥ median in the cohort, sleeping 7 to 8 h/d, spending <8 h/d in sitting time, and seeing friends daily. Analyses were performed with Cox regression and adjusted for the main confounders.

RESULTS

During an average nine-year follow-up, 1,244 persons died. Hazard ratios (95% confidence interval) for all-cause mortality among participants with two, three, four, five and six compared to those with zero to one positive behaviors were, respectively, 0.63 (0.46 to 0.85), 0.41 (0.31 to 0.55), 0.32 (0.24 to 0.42), 0.26 (0.20 to 0.35) and 0.20 (0.15 to 0.28) (P for trend <0.001). The results were similar regardless of age, sex and health status at baseline. Those with six vs. zero to one positive health behaviors had an all-cause mortality risk equivalent to being 14 years younger. Adding the three non-traditional to the four traditional behaviors improved the model fit (likelihood ratio test, P <0.001) and the accuracy of mortality prediction (c-statistic: + 0.0031, P = 0.040).

CONCLUSIONS

Adherence to some traditional and non-traditional health behaviors may substantially reduce mortality risk in older adults.

Socioeconomic status, health behavior, and leukocyte telomere length in the National Health and Nutrition Examination Survey, 1999-2002

The purpose of this study was to examine the association between socioeconomic status (SES) and leukocyte telomere length (LTL) - a marker of cell aging that has been linked to stressful life circumstances - in a nationally representative, socioeconomically and ethnically diverse sample of US adults aged 20-84. Using data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002, we found that respondents who completed less than a high school education had significantly shorter telomeres than those who graduated from college. Income was not associated with LTL. African-Americans had significantly longer telomeres than whites, but there were no significant racial/ethnic differences in the association between education and telomere length. Finally, we found that the association between education and LTL was partially mediated by smoking and body mass index but not by drinking or sedentary behavior.

Individualizing cancer screening in older adults: a narrative review and framework for future research

Older adults often have multiple chronic conditions that may decrease additional life expectancy. Research evaluating the benefits and harms of screening must include consideration of competing morbidities and patient heterogeneity (beyond age), potentially increased harms of screening, and patient preferences. Other areas in need of additional research include the lack of evidence for older adults on the harms of screening tests; the overdiagnosis of disease; the burden of disease labeling; the effects of inaccurate test results; the harms of disease treatment; and harms related to prioritization of healthcare (e.g., for a particular patient, lifestyle counseling may be more important than screening). Nontraditional outcomes, such as the effects on family caregivers, are also relevant. Studies comparing trajectories of quality-adjusted survival with and without screening to assess net benefit are typically lacking. There is little evidence on the preferences of older adults for deciding whether to be screened, the process of being screened, and the health states associated with being or not being screened. To enhance the quality and quantity of evidence, older adults need to be enrolled in screening trials and clinical studies. Measures of functional status and health-related quality of life (HRQL) need to be included in trials, registries, and cohort studies. This article addresses these challenges, and presents a framework for what research is needed to better inform screening decisions in older adults.

Multiple behavior interventions to prevent substance abuse and increase energy balance behaviors in middle school students

This study examined the effectiveness of two transtheoretical model-tailored, computer-delivered interventions designed to impact multiple substance use or energy balance behaviors in a middle school population recruited in schools. Twenty middle schools in Rhode Island including sixth grade students (N=4,158) were stratified and randomly assigned by school to either a substance use prevention (decreasing smoking and alcohol) or an energy balance (increasing physical activity, fruit and vegetable consumption, and limiting TV time) intervention group in 2007. Each intervention involved five in-class contacts over a 3-year period with assessments at 12, 24, and 36 months. Main outcomes were analyzed using random effects modeling. In the full energy balance group and in subsamples at risk and not at risk at baseline, strong effects were found for physical activity, healthy diet, and reducing TV time, for both categorical and continuous outcomes. Despite no direct treatment, the energy balance group also showed significantly lower smoking and alcohol use over time than the substance use prevention group. The energy balance intervention demonstrated strong effects across all behaviors over 3 years among middle school students. The substance use prevention intervention was less effective than the energy balance intervention in preventing both smoking and alcohol use over 3 years in middle school students. The lack of a true control group and unrepresented secular trends suggest the need for further study.

Patient health information materials in waiting rooms of family physicians: do patients care?

BACKGROUND

Patient health information materials (PHIMs), such as leaflets and posters are widely used by family physicians to reinforce or illustrate information, and to remind people of information received previously. This facilitates improved health-related knowledge and self-management by patients.

OBJECTIVE

This study assesses the use of PHIMs by patient. It also addresses their perception of the quality and the impact of PHIMs on the interaction with their physician, along with changes in health-related knowledge and self-management.

METHODS

QUESTIONNAIRE SURVEY AMONG PATIENTS OF FAMILY PRACTICES OF ONE TOWN IN BELGIUM, ASSESSING: (1) the extent to which patients read PHIMs in waiting rooms (leaflets and posters) and take them home, (2) the patients' perception of the impact of PHIMs on interaction with their physician, their change in health-related knowledge and self-management, and (3) the patients judgment of the quality of PHIMs.

RESULTS

We included 903 questionnaires taken from ten practices. Ninety-four percent of respondents stated they read PHIMs (leaflets), 45% took the leaflets home, and 78% indicated they understood the content of the leaflets. Nineteen percent of respondents reportedly discussed the content of the leaflets with their physician and 26% indicated that leaflets allowed them to ask fewer questions of their physician. Thirty-four percent indicated that leaflets had previously helped them to improve their health-related knowledge and self-management. Forty-two percent reportedly discussed the content of the leaflets with others. Patient characteristics are of significant influence on the perceived impact of PHIMS in physician interaction, health-related knowledge, and self-management.

CONCLUSION

This study suggests that patients value health information materials in the waiting rooms of family physicians and that they perceive such materials as being helpful in improving patient-physician interaction, health-related knowledge, and self-management.

Genetic determinants of obesity and related vascular diseases

Obesity is one of the major risk factors of vascular diseases, and its prevalence is increasing worldwide. In the past decade, progress has been made in the understanding of genetic determinants of obesity and obesity-associated diseases. Genome-wide association studies identified a number of genetic variants associated with obesity. In addition to common variants, FTO and MC4R, new loci, such as TMEM18, KCTD15, GNPDA2, SH2B1, MTCH2, and NEGR1 have been detected. In the past years, abdominal obesity has been shown to be a more important vascular risk factor than the body mass index. In the context of vascular risk assessment, identification of genetic polymorphisms associated with accumulation of visceral fat is of special importance. Some polymorphisms associated with abdominal obesity, such as variants of gene encoding microsomal triglyceride transfer protein, have been already discovered. In this chapter, we provide a review of genetic determinants of obesity and discuss their role in obesity-related vascular diseases.

Food subsidy programs and the health and nutritional status of disadvantaged families in high income countries: a systematic review

Background

Less healthy diets are common in high income countries, although proportionally higher in those of low socio-economic status. Food subsidy programs are one strategy to promote healthy nutrition and to reduce socio-economic inequalities in health. This review summarises the evidence for the health and nutritional impacts of food subsidy programs among disadvantaged families from high income countries.

Methods

Relevant studies reporting dietary intake or health outcomes were identified through systematic searching of electronic databases. Cochrane Public Health Group guidelines informed study selection and interpretation. A narrative synthesis was undertaken due to the limited number of studies and heterogeneity of study design and outcomes.

Results

Fourteen studies were included, with most reporting on the Special Supplemental Nutrition Program for Women, Infants and Children in the USA. Food subsidy program participants, mostly pregnant or postnatal women, were shown to have 10–20% increased intake of targeted foods or nutrients. Evidence for the effectiveness of these programs for men or children was lacking. The main health outcome observed was a small but clinically relevant increase in mean birthweight (23–29g) in the two higher quality WIC studies.

Conclusions

Limited high quality evidence of the impacts of food subsidy programs on the health and nutrition of adults and children in high income countries was identified. The improved intake of targeted nutrients and foods, such as fruit and vegetables, could potentially reduce the rate of non-communicable diseases in adults, if the changes in diet are sustained. Associated improvements in perinatal outcomes were limited and most evident in women who smoked during pregnancy. Thus, food subsidy programs for pregnant women and children should aim to focus on improving nutritional status in the longer term. Further prospective studies and economic analyses are needed to confirm the health benefits and justify the investment in food subsidy programs.

Combined impact of lifestyle factors on prospective change in body weight and waist circumference in participants of the EPIC-PANACEA study

Background

The evidence that individual dietary and lifestyle factors influence a person’s weight and waist circumference is well established; however their combined impact is less well documented. Therefore, we investigated the combined effect of physical activity, nutrition and smoking status on prospective gain in body weight and waist circumference.

Methods

We used data of the prospective EPIC-PANACEA study. Between 1992 and 2000, 325,537 participants (94,445 men and 231,092 women, aged between 25–70) were recruited from nine European countries. Participants were categorised into two groups (positive or negative health behaviours) for each of the following being physically active, adherent to a healthy (Mediterranean not including alcohol) diet, and never-smoking for a total score ranging from zero to three. Anthropometric measures were taken at baseline and were mainly self-reported after a medium follow-up time of 5 years.

Results

Mixed-effects linear regression models adjusted for age, educational level, alcohol consumption, baseline body mass index and follow-up time showed that men and women who reported to be physically active, never-smoking and adherent to the Mediterranean diet gained over a 5-year period 537 (95% CI −706, −368) and 200 (−478, −87) gram less weight and 0.95 (−1.27, −0.639) and 0.99 (−1.29, −0.69) cm less waist circumference, respectively, compared to participants with zero healthy behaviours.

Conclusion

The combination of positive health behaviours was associated with significantly lower weight and waist circumference gain.

Influence of individual and combined healthy behaviours on successful aging

BACKGROUND

Increases in life expectancy make it important to remain healthy for as long as possible. Our objective was to examine the extent to which healthy behaviours in midlife, separately and in combination, predict successful aging.

METHODS

We used a prospective cohort design involving 5100 men and women aged 42-63 years. Participants were free of cancer, coronary artery disease and stroke when their health behaviours were assessed in 1991-1994 as part of the Whitehall II study. We defined healthy behaviours as never smoking, moderate alcohol consumption, physical activity (≥ 2.5 h/wk moderate physical activity or ≥ 1 h/wk vigorous physical activity), and eating fruits and vegetables daily. We defined successful aging, measured over a median 16.3-year follow-up, as good cognitive, physical, respiratory and cardiovascular functioning, in addition to the absence of disability, mental health problems and chronic disease (coronary artery disease, stroke, cancer and diabetes).

RESULTS

At the end of follow-up, 549 participants had died and 953 qualified as aging successfully. Compared with participants who engaged in no healthy behaviours, participants engaging in all 4 healthy behaviours had 3.3 times greater odds of successful aging (95% confidence interval [CI] 2.1-5.1). The association with successful aging was linear, with the odds ratio (OR) per increment of healthy behaviour being 1.3 (95% CI 1.2-1.4; population-attributable risk for 1-4 v. 0 healthy behaviours 47%). When missing data were considered in the analysis, the results were similar to those of our main analysis.

INTERPRETATION

Although individual healthy behaviours are moderately associated with successful aging, their combined impact is substantial. We did not investigate the mechanisms underlying these associations, but we saw clear evidence of the importance of healthy behaviours for successful aging.

A transformative subfield in rehabilitation science at the nexus of new technologies, aging, and disability

We argue that a silo research and training approach is no longer sufficient to provide real solutions to the complex humanitarian, social, and financial problems brought about by global trends in aging and the increased prevalence of multiple chronic conditions that limit independence and activities of daily living. This perspective highlights the opportunities for collaborative research and training in a new multidisciplinary science of rehabilitation enabled by growing knowledge and information along scientifically and clinically meaningful lines. The recent proliferation of eHealth technologies offers opportunities for development of low-cost, simple, interactive media prevention, health maintenance, and continued functional recovery programs using a chronic care model designed to promote engagement and participation. With two examples - long-term disability consequential to (1) hip fracture and (2) manual wheelchair use - we outline the developing science for a collaborative and transformative nexus team capable of accelerating an understanding of ways to restore independence and improve quality of life, in the long-term. We conclude with a set of recommendations for the design of interactive media systems to both increase acceptability and stimulate research.

A prospective cohort study of health behavior profiles after age 50 and mortality risk

Background

This study examines the mortality risk associated with distinct combinations of multiple risk behaviors in middle-aged and older adults, and assesses whether the mortality risks of certain health behaviors are moderated by the presence of other risk behaviors.

Methods

Data for this prospective cohort study are from the Health and Retirement Study (HRS), a nationwide sample of adults older than 50 years. Baseline data are from respondents (n = 19,662) to the 1998 wave of the HRS. Twelve distinct health behavior profiles were created, based on each respondent’s smoking, physical activity, and alcohol use status in 1998. Mortality risk was estimated through 2008 using Cox regression.

Results

Smoking was associated with elevated risk for mortality within all behavioral profiles, but risk was greatest when combined with heavy drinking, both for middle-aged (ages 51–65) and older (ages 66+) adults. Profiles that included physical inactivity were also associated with increased mortality risk in both age groups. However, the impact of inactivity was clearly evident only among non-smokers; among smokers, the risk of inactivity was less evident, and seemingly overshadowed by the risk of smoking. Moderate drinking was protective relative to abstinence among non-smokers, and relative to heavy drinking among smokers.

Conclusions

In both middle-aged and older adults, multiple unhealthy behaviors increase mortality risk. However, the level of risk varies across unique combinations of unhealthy behaviors. These findings highlight the role that lifestyle improvements could play in promoting healthy aging, and provide insight into which behavioral combinations should receive top priority for intervention.

Adherence to clusters of health behaviors and successful aging

OBJECTIVE

Analyses examine the extent to which adherence to recommendations regarding health behaviors cluster among older adults, whether people who adhere to multiple health behaviors are more likely to age successfully than those who adhere to fewer health behaviors, and whether some health behavior clusters are more closely associated with successful aging than others.

METHOD

Cross-sectional data were collected using structured telephone interviews from 5,688 persons aged 50 to 74 living in New Jersey.

RESULTS

Prevalence odds ratio analyses indicated that differential cluster patterns exist. Logistic regression revealed that as the number of adherent behaviors increased so did the likelihood of aging successfully and that adherence to some health behavior clusters was more closely associated with successful aging than adherence to others.

DISCUSSION

Although adherence to more health behaviors was associated with a greater likelihood of successful aging, it is possible to age successfully by adhering to specific clusters of health behaviors.

The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis

OBJECTIVE

Lifestyle factors are related to mortality. Although much is known about the impact of single factors, the current evidence about the combined effects of lifestyle behaviors on mortality has not yet been systematically compiled.

METHOD

We searched Medline, Embase, Global Health, and Somed up to February 2012. Prospective studies were selected if they reported the combined effects of at least three of five lifestyle factors (obesity, alcohol consumption, smoking, diet, and physical activity). The mean effect sizes that certain numbers of combined lifestyle factors have on mortality were compared to the group with the least number of healthy lifestyle factors by meta-analysis. Sensitivity analyses were conducted to explore the robustness of the results.

RESULTS

21 studies (18 cohorts) met the inclusion criteria of which 15 were included in the meta-analysis that comprised 531,804 people with a mean follow-up of 13.24 years. The relative risks decreased proportionate to a higher number of healthy lifestyle factors for all cause mortality. A combination of at least four healthy lifestyle factors is associated with a reduction of the all cause mortality risk by 66% (95% confidence interval 58%-73%).

CONCLUSION

Adherence to a healthy lifestyle is associated with a lower risk of mortality.

The prevalence and correlates of behavioral risk factors for cardiovascular health among Southern Brazil adolescents: a cross-sectional study

Background

The adoption of health-related behaviors is an important part of adolescence. This study examined the prevalence and correlates of the isolated and simultaneous presence of behavioral risk factors for cardiovascular health (BRFCH) among adolescents in Curitiba, Southern Brazil.

Methods

A cross-sectional study was performed with 1,628 adolescents (aged 11-17.9 years, 52.5% males) that were randomly selected from 44 public schools. Self-report instruments were used to assess the variables. Six BRFCH were analyzed: insufficiently active, excessive TV watching, current alcohol and tobacco use, daily soft drinks consumption and inadequate fruit and vegetable consumption. Sociodemographic and behavioral variables were studied as possible correlates of the presence of BRFCH.

Results

The BRFCH with the highest prevalence were insufficiently active (50.5%, 95% confidence interval [95% CI]: 48.0-52.9) and daily soft drinks consumption (47.6%, 95% CI: 45.1-50.0). Approximately 30% of the adolescents presented three or more BRFCH simultaneously. Girls, adolescents who did not participate in organized physical activity, and who used computer/video games daily were the main high-risk subgroups for insufficiently active. Boys and those who used computer/video games daily were the high-risk subgroups for daily soft drinks consumption. For excessive TV watching, we identified to be at risk those who were from a high economic class, unemployed, and who used computer/video games daily. For current alcohol use, we identified older adolescents, who were from a high economic class and who worked to be at risk. Older adolescents, who worked and who spent little active time during a physical education class were the high-risk subgroups for current tobacco use. For inadequate fruit and vegetable consumption, we identified those who did not participate in organized physical activity to be at risk. Older adolescents, who were from a high economic class, who did not participate in organized physical activity and who used computer/video games daily were the high-risk subgroups for simultaneous BRFCH.

Conclusions

We found a high prevalence of BRFCH among adolescents, both isolated and simultaneously. The correlates of the presence of BRFCH can contribute to healthy policies among Brazilian adolescents, mainly focusing on high-risk subgroups for a health risk behavior.

Effects of a combined lifestyle score on 10-year mortality in Korean men and women: a prospective cohort study

Background

Most studies that have evaluated the association between combined lifestyle factors and mortality outcomes have been conducted in populations of Caucasian origin. The objective of this study was to examine the association between combined lifestyle scores and the risk of mortality in Korean men and women.

Methods

The study population included 59,941 Koreans, 30–84 years of age, who had visited the Severance Health Promotion Center between 1994 and 2003. Cox regression models were fitted to establish the association between combined lifestyle factors (current smoker, heavy daily alcohol use, overweight or obese weight, physical inactivity, and unhealthy diet) and mortality outcomes.

Results

During 10.3 years of follow-up, there were 2,398 cases of death from any cause. Individual and combined lifestyle factors were found to be associated with the risk of mortality. Compared to those having none or only one risk factor, in men with a combination of four lifestyle factors, the relative risk for cancer mortality was 2.04-fold, for non-cancer mortality 1.92-fold, and for all-cause mortality 2.00-fold. In women, the relative risk was 2.00-fold for cancer mortality, 2.17-fold for non-cancer mortality, and 2.09-fold for all-cause mortality. The population attributable risks for all-cause mortality for the four risk factors combined was 44.5% for men and 26.5% for women.

Conclusion

This study suggests that having a high (unhealthy) lifestyle score, in contrast to a low (healthy) score, can substantially increase the risk of death by any cause, cancer, and non-cancer in Korean men and women.

Associations between fruit and vegetable intake, leisure-time physical activity, sitting time and self-rated health among older adults: cross-sectional data from the WELL study

Background

Lifestyle behaviours, such as healthy diet, physical activity and sedentary behaviour, are key elements of healthy ageing and important modifiable risk factors in the prevention of chronic diseases. Little is known about the relationship between these behaviours in older adults. The purpose of this study was to explore the relationship between fruit and vegetable (F&V) intake, leisure-time physical activity (LTPA) and sitting time (ST), and their association with self-rated health in older adults.

Methods

This cross-sectional study comprised 3,644 older adults (48% men) aged 55–65 years, who participated in the Wellbeing, Eating and Exercise for a Long Life (“WELL”) study. Respondents completed a postal survey about their health and their eating and physical activity behaviours in 2010 (38% response rate). Spearman’s coefficient (rho) was used to evaluate the relationship between F&V intake, LTPA and ST. Their individual and shared associations with self-rated health were examined using ordinal logistic regression models, stratified by sex and adjusted for confounders (BMI, smoking, long-term illness and socio-demographic characteristics).

Results

The correlations between F&V intake, LTPA and ST were low. F&V intake and LTPA were positively associated with self-rated health. Each additional serving of F&V or MET-hour of LTPA were associated with approximately 10% higher likelihood of reporting health as good or better among women and men. The association between ST and self-rated health was not significant in the multivariate analysis. A significant interaction was found (ST*F&V intake). The effect of F&V intake on self-rated health increased with increasing ST in women, whereas the effect decreased with increasing ST in men.

Conclusions

This study contributes to the scarce literature related to lifestyle behaviours and their association with health indicators among older adults. The findings suggest that a modest increase in F&V intake, or LTPA could have a marked effect on the health of older adults. Further research is needed to fully understand the correlates and determinants of lifestyle behaviours, particularly sitting time, in this age group.

Clustering of health behaviours in adult survivors of childhood cancer and the general population

BACKGROUND

Little is known about engagement in multiple health behaviours in childhood cancer survivors.

METHODS

Using latent class analysis, we identified health behaviour patterns in 835 adult survivors of childhood cancer (age 20-35 years) and 1670 age- and sex-matched controls from the general population. Behaviour groups were determined from replies to questions on smoking, drinking, cannabis use, sporting activities, diet, sun protection and skin examination.

RESULTS

The model identified four health behaviour patterns: 'risk-avoidance', with a generally healthy behaviour; 'moderate drinking', with higher levels of sporting activities, but moderate alcohol-consumption; 'risk-taking', engaging in several risk behaviours; and 'smoking', smoking but not drinking. Similar proportions of survivors and controls fell into the 'risk-avoiding' (42% vs 44%) and the 'risk-taking' cluster (14% vs 12%), but more survivors were in the 'moderate drinking' (39% vs 28%) and fewer in the 'smoking' cluster (5% vs 16%). Determinants of health behaviour clusters were gender, migration background, income and therapy.

CONCLUSION

A comparable proportion of childhood cancer survivors as in the general population engage in multiple health-compromising behaviours. Because of increased vulnerability of survivors, multiple risk behaviours should be addressed in targeted health interventions.

Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study

BACKGROUND

In 2007 the World Cancer Research Fund (WCRF) and the American Institute of Cancer Research (AICR) issued 8 recommendations (plus 2 special recommendations) on diet, physical activity, and weight management for cancer prevention on the basis of the most comprehensive collection of available evidence.

OBJECTIVE

We aimed to investigate whether concordance with the WCRF/AICR recommendations was related to cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

DESIGN

The present study included 386,355 EPIC participants from 9 European countries. At recruitment, dietary, anthropometric, and lifestyle information was collected. A score was constructed based on the WCRF/AICR recommendations on weight management, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, alcoholic drinks, and breastfeeding for women; the score range was 0-6 for men and 0-7 for women. Higher scores indicated greater concordance with WCRF/AICR recommendations. The association between the score and cancer risk was estimated by using multivariable Cox regression models.

RESULTS

Concordance with the score was significantly associated with decreased risk of cancer. A 1-point increment in the score was associated with a risk reduction of 5% (95% CI: 3%, 7%) for total cancer, 12% (95% CI: 9%, 16%) for colorectal cancer, and 16% (95% CI: 9%, 22%) for stomach cancer. Significant associations were also observed for cancers of the breast, endometrium, lung, kidney, upper aerodigestive tract, liver, and esophagus but not for prostate, ovarian, pancreatic, and bladder cancers.

CONCLUSION

Adherence to the WCRF/AICR recommendations for cancer prevention may lower the risk of developing most types of cancer.

Healthy lifestyle behaviors and all-cause mortality among adults in the United States

OBJECTIVE

To examine the links between three fundamental healthy lifestyle behaviors (not smoking, healthy diet, and adequate physical activity) and all-cause mortality in a national sample of adults in the United States.

METHOD

We used data from 8375 U.S. participants aged ≥ 20 years of the National Health and Nutrition Examination Survey 1999-2002 who were followed through 2006.

RESULTS

During a mean follow-up of 5.7 years, 745 deaths occurred. Compared with their counterparts, the risk for all-cause mortality was reduced by 56% (95% confidence interval [CI]: 35%-70%) among adults who were nonsmokers, 47% (95% CI: 36%, 57%) among adults who were physically active, and 26% (95% CI: 4%, 42%) among adults who consumed a healthy diet. Compared with participants who had no healthy behaviors, the risk decreased progressively as the number of healthy behaviors increased. Adjusted hazard ratios and 95% confidence interval were 0.60 (0.38, 0.95), 0.45 (0.30, 0.67), and 0.18 (0.11, 0.29) for 1, 2, and 3 healthy behaviors, respectively.

CONCLUSION

Adults who do not smoke, consume a healthy diet, and engage in sufficient physical activity can substantially reduce their risk for early death.

Alcohol use patterns and trajectories of health-related quality of life in middle-aged and older adults: a 14-year population-based study

OBJECTIVE

A 14-year multiwave panel design was used to examine relationships between longitudinal alcohol-consumption patterns, especially persistent moderate use, and change in health-related quality of life among middle-aged and older adults.

METHOD

A nationally representative sample of 5,404 community-dwelling Canadians ages 50 and older at baseline (1994/1995) was obtained from the longitudinal National Population Health Survey. Alcohol-consumption patterns were developed based on the quantity and frequency of use in the 12 months before the interview. Health-related quality of life was assessed with the Health Utilities Index Mark 3 (HUI3). Latent growth curve modeling was used to estimate the change in HUI3 for each alcohol pattern after adjusting for covariates measured at baseline.

RESULTS

Most participants showed stable alcohol-consumption patterns over 6 years. Persistent non-users, persistent former users, those decreasing their consumption levels, and those with unstable patterns (i.e., U shaped and inverted U shaped) had lower HUI3 scores at baseline compared with persistent moderate drinkers. A more rapid decline in HUI3 scores than that observed for persistent moderate users was seen only in those with decreasing consumption (p < .001). In a subgroup identified as consistently healthy before follow-up, longitudinal drinking patterns were associated with initial HUI3 scores but not rates of change.

CONCLUSIONS

Persistent moderate drinkers had higher initial levels of health-related quality of life than persistent nonusers, persistent former users, decreasing users, U-shaped users, and inverted U-shaped users. However, rates of decline over time were similar for all groups except those decreasing their consumption, who had a greater decline in their level of health-related quality of life than persistent moderate users.

Clustering of multiple healthy lifestyles among older Korean adults living in the community

AIM

Despite the predictive value of combined healthy lifestyles in maintaining physical and cognitive functioning in late life, little is known about the clustering patterns of healthy lifestyle behaviors in older people. The aim of the present study was to examine the prevalence, clustering and population characteristics of adherence to multiple health behaviors in community-dwelling older Korean adults.

METHODS

The study population consisted of a nationally representative sample of 4165 Korean adults aged 65 years and older in 2006. Healthy lifestyles, defined as adherence to recommended guidelines, included non-smoking, no heavy drinking, physical activity and healthy weight. Combinations of behavioral patterns and prevalence odds ratios for pairwise clusters were analyzed. Multinomial logistic regression was used to identify demographic and health-related characteristics associated with the number of adherence to guideline recommendations.

RESULTS

Those who adhered to all four guideline recommendations constituted the minority (11.7%). More women than men engaged in a higher number of healthy lifestyles. Clustering was more pronounced in men for whom no heavy alcohol drinking and physical activity centered around non-smoking. In women, clustering patterns were less obvious. Men, those with low levels of education, income and wealth, and the functionally impaired were less likely to adhere to multiple healthy lifestyles.

CONCLUSION

Clustering of healthy lifestyles, especially among older men, supports the potential benefit of a multiple behavior change approach. Health promotion efforts should target the socially disadvantaged and functionally compromised segment of the older population presenting low adherence to recommended behaviors.

Inflammation, coagulation and risk of locomotor disability in elderly women: findings from the British Women's Heart and Health Study

This study investigated associations between chronic inflammation and coagulation and incident locomotor disability using prospective data from the British Women's Heart and Health Study. Locomotor disability was assessed using self-reported questionnaires in 1999/2000, and 3 and 7 years later. Scores for inflammation and coagulation were obtained from summation of quartile categories of all available biomarkers from blood samples taken at baseline. 534 women developed locomotor disability after 3 years, 260 women after 7 years, while 871 women remained free of locomotor disability over the whole study period. After adjustment for demographic characteristics, lifestyle factors and health conditions, we found associations between inflammation and incident locomotor disability after three (OR per unit increase in score = 1.08, 95 % confidence interval (CI): 1.03, 1.13) and 7 years (OR = 1.10, 95 % CI: 1.03, 1.18) and between coagulation and incident locomotor disability after 3 (OR = 1.06, 95 % CI: 0.98, 1.14) and 7 years (OR = 1.09, 95 % CI: 1.00, 1.18). This corresponds to ORs between 1.8 and 2.4 comparing women with highest to lowest inflammation or coagulation scores. These results support the role of inflammation and coagulation in the development of locomotor disability in elderly women irrespective of their lifestyle factors and underlying age-related chronic diseases.

Tuberculosis in quebec: a review of trends

The aim of this research was to conduct a thorough review on the literature of tuberculosis in Canada and the Province of Quebec. To achieve this aim, an exhaustive literature review of tuberculosis in the Province of Quebec was undertaken. Data was collected with the goal of creating an epidemiological and public health evidence base to forecast the spread of tuberculosis. A keyword search strategy was used to find relevant articles from the peer-reviewed literature using the electronic search engine PubMed and a search of other relevant federal and provincial government databases. Twenty-nine peer-reviewed publications and twenty government reports containing information about the incidence or prevalence of tuberculosis in the Province of Quebec were included in the analysis. An analysis of the data revealed that while tuberculosis rates have been decreasing in both Canada and Quebec with an overall incidence below 3 per 100,000 of population in 2007, among immigrants and the Inuit communities in Quebec, the incidence and prevalence of the disease still remains high and reached 18 per 100,000 and 100 per 100,000, respectively in 2007. In general, while tuberculosis does not pose a significant burden to the general population, it does continue to affect certain sub-groups disproportionately, including select immigrants and Inuit communities in Quebec. Efforts to ensure that cost-effective healthcare interventions are delivered in a timely fashion should be pursued to reduce the associated morbidity and mortality of tuberculosis in the Province of Quebec.

ACKNOWLEDGMENTS

Funding for this research was provided to Medmetrics Inc., by McGill University, Montreal, Quebec, Génome Québec and the Ministère de Développement Economique, Innovation et Exportation du Gouvernement du Québec. The authors also wish to thank Drs. John White and Marcel Behr, both of McGill University and Dr Suneil Malik of the Infectious Disease Program in the Office of Biotechnology, Genomics and Population Health at the Public Health Agency of Canada for comments and suggestions on earlier drafts of this manuscript.

Cognitive hostility predicts all-cause mortality irrespective of behavioural risk at late middle and older age

BACKGROUND

Most but not all evidence supports hostility-related attributes to increase mortality risk. However, studies usually include single attributes, their effects have been studied predominantly in younger populations, and behavioural pathways explaining the mortality effect seem to differ by age. We examined the relationship between all-cause mortality and cognitive hostility, anger, aggression and rebelliousness, and their independence of health behaviours in a late middle-aged and older population.

METHODS

Data were derived from the longitudinal Dutch Study of Medical Information and Lifestyles in the city of Eindhoven, in the Southeast of the Netherlands study among 2679 late middle-aged and older Dutch people. Psychological characteristics were self-reported in 2004/2005, and mortality was monitored from 2005 to 2010. Cox regression analyses were used to calculate the mortality risk by each unique psychological variable with additional adjustments for the other psychological variables and for health behaviours. Baseline adjustments included age, sex, educational level and prevalent morbidity.

RESULTS

Cognitive hostility was associated with all-cause mortality, independent of health behaviours (on a scale ranging from 6 to 30, the hazard ratio (HR) was 1.05; 95% confidence interval [95% CI): 1.01-1.09]. Anger, aggression and rebelliousness were not associated with mortality risk.

CONCLUSIONS

In diminishing excess mortality risks, hostile cognitions might be acknowledged separately and additionally to the risk posed by unhealthy lifestyles.

Health behaviour interventions to improve physical health in individuals diagnosed with a mental illness: a systematic review

Individuals diagnosed with mental illness experience high rates of morbidity and mortality as a result of poor physical health and unhealthy lifestyle behaviours. The aim of this paper is to systematically review the literature on health behaviour interventions to improve the physical health of individuals diagnosed with a mental illness. A systematic search strategy was undertaken using four of the major electronic databases. Identified articles were screened for inclusion, included articles were coded, and data were extracted and critically reviewed. A total of 42 articles were identified for inclusion. The most commonly targeted physical health behaviour was weight management. The majority of studies reported improvements in health behaviours following interventions. The findings provide evidence for the positive effect of health behaviour interventions in improving the physical health of individuals diagnosed with a serious mental illness. A focus on health behaviour interventions within the mental health nursing profession might lead to improvements in health behaviours and general health in consumers of mental health services.

Health behavior change following chronic illness in middle and later life

OBJECTIVES

Understanding lifestyle improvements among individuals with chronic illness is vital for targeting interventions that can increase longevity and improve quality of life.

METHODS

Data from the U.S. Health and Retirement Study were used to examine changes in smoking, alcohol use, and exercise 2-14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease.

RESULTS

Patterns of behavior change following diagnosis indicated that the vast majority of individuals diagnosed with a new chronic condition did not adopt healthier behaviors. Smoking cessation among those with heart disease was the largest observed change, but only 40% of smokers quit. There were no significant increases in exercise for any health condition. Changes in alcohol consumption were small, with significant declines in excessive drinking and increases in abstention for a few health conditions. Over the long term, individuals who made changes appeared to maintain those changes. Latent growth curve analyses up to 14 years after diagnosis showed no average long-term improvement in health behaviors.

DISCUSSION

Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.

A critical review of major mortality risk factors for all-cause mortality in first-episode schizophrenia: clinical and research implications

A bibliographical search was performed to identify and evaluate the impact in first-episode schizophrenia of the major mortality risk factors as described by the World Health Organisation (2009). We found that at first diagnosis rates of diabetes were only slightly increased, although lipid abnormalities, mild hypertension and being overweight were commonly reported. Levels of drug and alcohol abuse were high, as were pre-diagnosis rates of smoking, physical inactivity and poor cardiorespiratory fitness. During the first year of antipsychotic treatment, there were significant increases in the rates of hyperglycaemia/diabetes, obesity, lipid abnormalities and hypertension, but no changes in fitness levels, smoking or drug and alcohol abuse. In chronic schizophrenia, excess cancer and cardiac deaths seem linked in part to availability and quality of care. Innate risk factors such as abnormal reelin and raised prolactin may also be important. New evidence, such as an inverse relationship between body mass index and suicide in the general population, suggests accepted wisdom may not apply to patients at high risk of ending their own lives. With current knowledge emphasis needs to be placed by early intervention services on physical fitness, smoking and other substance misuse, diabetes and hypertension, as well as focusing on weight reduction only in the obese.