Early-Life Temperamental Differences as Longitudinal Predictors of Unintentional Injuries.

OBJECTIVE: Unintentional injuries are the leading cause of hospitalization and death among children. Compared to environmental factors, less attention in injury preventive efforts has been paid to how individual characteristics relate to the risk of injury. Using a large prospective cohort, the current study assessed the longitudinal impact of early-life temperament on the cumulative number of injuries until mid-adolescence. METHODS: The data came from the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ). Temperament was evaluated by mothers when children were 3 years old (N = 3,545). The main outcome was the pediatrician-reported sum of child's injuries from age 3 to 15 (seven timepoints). Latent profile analysis (LPA) was used to determine classes based on temperamental dimensions and then extended to a mixture model with a distal count outcome. The covariates included maternal conflict and attachment, sex, family structure, and maternal education. RESULTS: The LPA determined the existence of three classes: shy children (8.1% of the sample; lowest activity/highest shyness), outgoing children (50.8%; highest activity/lowest shyness), and average: children (41.1%; middle values). Results from a mixture model showed that the outgoing temperament was associated with the highest longitudinal risk for injuries, as both average children (IRR = 0.89 [0.80, 0.99]), and the shy children (IRR = 0.80 [0.68, 0.95]) had lower risk. CONCLUSIONS: Early childhood temperamental differences can have long-term effects on injury risk. Highly active children showed the highest risk for future injuries, suggesting that these characteristics make them more likely to be involved in novel and potentially dangerous situations.

Living in poverty and accelerated biological aging: evidence from population-representative sample of U.S. adults.

BACKGROUND: Biological aging reflects a decline in the functions and integrity of the human body that is closely related to chronological aging. A variety of biomarkers have been found to predict biological age. Biological age higher than chronological age (biological age acceleration) indicates an accelerated state of biological aging and a higher risk of premature morbidity and mortality. This study investigated how socioeconomic disadvantages influence biological aging. METHODS: The data from the National Health and Nutrition Examination Survey (NHANES) IV, including 10 nationally representative cross-sectional surveys between 1999-2018, were utilized. The analytic sample consisted of N = 48,348 individuals (20-84 years). We used a total of 11 biomarkers for estimating the biological age. Our main outcome was biological age acceleration, indexed by PhenoAge acceleration (PAA) and Klemera-Doubal biological age acceleration (KDM-A). Poverty was measured as a ratio of family income to the poverty thresholds defined by the U.S. Census Bureau, adjusted annually for inflation and family size (5 categories). The PAA and KDM-A were regressed on poverty levels, age, their interaction, education, sex, race, and a data collection wave. Sample weights were used to make the estimates representative of the U.S. adult population. RESULTS: The results showed that higher poverty was associated with accelerated biological aging (PAA: unstandardized coefficient B = 1.38 p <.001, KDM: B = 0.96, p = .026 when comparing the highest and the lowest poverty level categories), above and beyond other covariates. The association between PAA and KDM-A and age was U-shaped. Importantly, there was an interaction between poverty levels and age (p <.001), as the effect of poverty was most pronounced in middle-aged categories while it was modest in younger and elderly groups. CONCLUSION: In a nationally representative US adult population, we found that higher poverty was positively associated with the acceleration of biological age, particularly among middle-aged persons.

Association between depressive symptoms and all-cause mortality in Chilean adult population: prospective results from two national health surveys.

PURPOSE: Depression is a prevalent disorder with effects beyond mental health. A positive association with mortality has been mostly reported, however, evidence comes from a few high-income countries. This study aims to assess the association between depressive symptoms and all-cause mortality in the Chilean population and assess a potential secular effect in this association. METHODS: This prospective study used data from the Chilean National Health Survey (CNHS). Data from 3151 and 3749 participants from the 2003 and 2010 CNHS, respectively, were linked to mortality register data. Cox survival analysis was performed. The main exposure was depressive symptoms, measured with CIDI-SF (cut-off ≥ 5), and the outcome all-cause mortality. The study period was limited to 8.5 years to allow for the same length of follow-up. RESULTS: 10% and 8.5% of participants from the 2003 and 2010 cohort died during the follow-up. Adjusting for age and sex, those with depressive symptoms had 1.58 (95% CI 1.18-2.13) and 1.65 (95% CI 1.14-2.12) times the risk to die than those without symptoms in the 2003 and 2010 cohort, respectively. In models adjusted for demographic, socioeconomic, behavioural variables and comorbidities, participants with depressive symptoms had 1.42 (95% CI 1.05-1.92) and 1.46 (95% CI 1.07-- 1.99) times the risk to die compared to those without symptoms in the 2003 and 2010 cohort, respectively. CONCLUSION: Chilean adults with depressive symptoms are at higher risk of all-cause mortality compared to those without symptoms. The effect size was similar regardless of the economic development of the country.

Low fruit and vegetable intake is associated with poor self-rated health in the Czech part of the HAPIEE study.

Background: Although fruits and vegetables are considered a pillar of healthy eating, previous evidence suggests that their consumption in Eastern European countries is low, and their association with health outcomes has rarely been researched in this region. Aim: To examine the effect of fruit and vegetable intake on self-rated health (SRH) in the Czech arm of the Health, Alcohol and Psychosocial factors in Eastern Europe prospective cohort study. Methods: Dietary data on fruit and vegetable intake was measured at baseline using food frequency questionnaires, and SRH from the second wave was chosen as the main outcome. The relationship between fruit and vegetable intake and SRH was analysed using multivariable ordinal regression. Results: A total of 4255 persons aged 45-69, in good and very good SRH at baseline were included in the longitudinal analysis, with a median follow-up time of 3.7 years. In the second wave, 218 (5.1%) individuals reported poor or very poor SRH. In the fully adjusted model, individuals in the lowest fruit and vegetable intake quartile had higher odds of poor SRH compared to those in the highest quartile (OR = 1.24, 95% CI: 1.01-1.52). When examined separately, the results were similar: for vegetables (OR = 1.25, 95% CI: 1.03-1.51) and fruit (OR = 1.18, 95% CI: 0.97-1.44). Conclusion: The observed longitudinal association suggests that low fruit and vegetable intake is associated with poor SRH in the Czech Republic. Considering almost half of our sample reported less than the daily recommended intake of 400 grams of fruits and vegetables, higher consumption should be supported.

Impaired lung function and mortality in Eastern Europe: results from multi-centre cohort study.

BACKGROUND: The association between impaired lung function and mortality has been well documented in the general population of Western European countries. We assessed the risk of death associated with reduced spirometry indices among people from four Central and Eastern European countries. METHODS: This prospective population-based cohort includes men and women aged 45-69 years, residents in urban settlements in Czech Republic, Poland, Russia and Lithuania, randomly selected from population registers. The baseline survey in 2002-2005 included 36,106 persons of whom 24,993 met the inclusion criteria. Cox proportional hazards models were used to estimate the hazard ratios of mortality over 11-16 years of follow-up for mild, moderate, moderate-severe and very severe lung function impairment categories. RESULTS: After adjusting for covariates, mild (hazard ratio (HR): 1.25; 95% CI 1.15‒1.37) to severe (HR: 3.35; 95% CI 2.62‒4.27) reduction in FEV1 was associated with an increased risk of death according to degree of lung impairment, compared to people with normal lung function. The association was only slightly attenuated but remained significant after exclusion of smokers and participants with previous history of respiratory diseases. The HRs varied between countries but not statistically significant; the highest excess risk among persons with more severe impairment was seen in Poland (HR: 4.28, 95% CI 2.14‒8.56) and Lithuania (HR: 4.07, 95% CI 2.21‒7.50). CONCLUSIONS: Reduced FEV1 is an independent predictor of all-cause mortality, with risk increasing with the degree of lung function impairment and some country-specific variation between the cohorts.

Prenatal psychosocial stress and children's sleep problems: Evidence from the ELSPAC-CZ study.

Prenatal exposure to maternal stress may increase the risk of developing sleep problems in childhood. This study examined the association between prenatal stressful life events (PSLE) and children's sleep problems, taking into consideration their trajectory over time. Data were obtained from the Czech portion of the European Longitudinal Cohort Study of Pregnancy and Childhood (ELSPAC-CZ; N = 4,371 children). Mothers reported PSLE using an inventory of 42 life events and child sleep problems at five time-points (child age of 1.5, 3, 5, 7, and 11 years). The association was tested by a Poisson latent growth model, controlling for maternal and family demographics, birth characteristics, maternal depression, and alcohol use in pregnancy. The average rate of sleep problems was 2.06 (p < 0.001) at the age of 1.5 years and the rate of sleep problems decreased in a linear fashion over time (estimate = -0.118; p < 0.001). A higher number of PSLE was associated with a higher rate of sleep problems at the age of 1.5 years (incidence rate ratio [IRR] per interquartile range = 1.08, 95% confidence interval [CI] 1.05-1.12, p < 0.001) and with a reduced rate of decrease in sleep problems between the ages of 1.5 and 11 years (p < 0.001). Thus, PSLE were associated with chronicity of sleep problems in addition to their amount during early childhood. Prenatal exposure to stress may predispose individuals to the development of sleep problems in later life.

Reliability and predictive validity of two scales of self-rated health in China: results from China Health and Retirement Longitudinal Study (CHARLS).

BACKGROUND: Despite the widespread use of the single item self-rated health (SRH) question, its reliability has never been evaluated in Chinese population. METHODS: We used data from the China Health and Retirement Longitudinal Study, waves 1-4 (2011-2019). In wave 1, the same SRH question was asked twice, separated by other questions, on a subset of 4533 subjects, allowing us to examine the test-retest reliability of SRH. In addition, two versions of SRH questions (the WHO and US versions) were asked (n = 11,429). Kappa (κ), weighted kappa ([Formula: see text]), and polychoric correlation coefficient (ρ) were used for reliability assessment. Cox proportional-hazards models were estimated to assess the predictive validity of SRH measurement for mortality over 7 years of follow up. To do so, relative index of inequality (RII) and slope index of inequality (SII) were estimated for each SRH scale. RESULTS: There was moderate to substantial test-retest reliability (κ = 0.54, [Formula: see text]=0.63) of SRH; 31% of respondents who used the same scale twice changed their ratings after answering other questions. There was strong positive association between the two SRH measured by the two scales (ρ > 0.8). Compared with excellent/very good SRH, adjusted hazard ratios (HR) of death are 2.30 (95% CI, 1.70-3.13) for the US version and 1.86 (95% CI, 1.33-2.60) for the WHO version. Using slope indices of inequality, the WHO version estimated slightly larger mortality differences (RII = 3.50, SII = 15.53) than the US version (RII = 3.25, SII = 14.80). CONCLUSIONS: In Chinese middle-aged and older population, the reliability of SRH is generally good, although the two commonly used versions of SRH scales could not be compared directly. Both indices predict mortality, with similar predictive validity.

Prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolemia, and associated risk factors in the Czech Republic, Russia, Poland and Lithuania: a cross-sectional study.

BACKGROUND: Empirical evidence on the epidemiology of hypertension, diabetes and hypercholesterolemia is limited in many countries in Central and Eastern Europe. We aimed to estimate the prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolemia in the Czech Republic, Russia, Poland and Lithuania, and to identify the risk factors for the three chronic conditions. METHODS: We analysed cross-sectional data from the HAPIEE study, including adults aged 45-69 years in the Czech Republic, Russia, Poland and Lithuania, collected between 2002 and 2008 (total sample N = 30,882). Among prevalent cases, we estimated awareness, treatment, and control of hypertension, diabetes and hypercholesterolemia by gender and country. Multivariate logistic regression was applied to identify associated risk factors. RESULTS: In each country among both men and women, we found high prevalence but low control of hypertension, diabetes, and hypercholesterolemia. Awareness rates of hypertension were the lowest in both men (61.40%) and women (69.21%) in the Czech Republic, while awareness rates of hypercholesterolemia were the highest in both men (46.51%) and women (51.20%) in Poland. Polish participants also had the highest rates of awareness (77.37% in men and 79.53% in women), treatment (71.99% in men and 74.87% in women) and control (30.98% in men and 38.08% in women) of diabetes. The common risk factors for the three chronic conditions were age, gender, education, obesity and alcohol consumption. CONCLUSIONS: Patterns of awareness, treatment and control rates of hypertension, diabetes and hypercholesterolemia differed by country. Efforts should be made in all four countries to control these conditions, including implementation of international guidelines in everyday practice to improve detection and effective management of these conditions.

Traditional Eastern European diet and mortality: prospective evidence from the HAPIEE study.

PURPOSE: Cardiovascular disease (CVD) and cancer mortality rates in Eastern Europe are among the highest in the world. Although diet is an important risk factor, traditional eating habits in this region have not yet been explored. This analysis assessed the relationship between traditional dietary pattern and mortality from all-causes, CVD and cancer in Eastern European cohorts. METHODS: Data from the Health, Alcohol and Psychosocial factors in Eastern Europe prospective cohort were used, including participants from Russia, Poland and the Czech Republic. Based on food frequency questionnaire data, we constructed an Eastern European diet score (EEDS) from nine food groups which can be considered as traditional in this region. The relationship between categorical (low, moderate, high) and continuous (range 0-18) EEDS and mortality was estimated with Cox-regression. RESULTS: From 18,852 eligible participants, 2234 died during follow-up. In multivariable adjusted models, participants with high adherence to the traditional Eastern European diet had significantly higher risk of all-cause (HR 1.23; 95% CI 1.08-1.42) and CVD (1.34; 1.08-1.66) deaths compared to those with low adherence. The association with cancer mortality was only significant in Poland (high vs. low EEDS: 1.41; 1.00-1.98). From the specific EEDS components, high consumption of lard was significantly positively related to all three mortality outcomes, while preserved fruit and vegetable consumption showed consistent inverse associations. CONCLUSION: Our results suggest that traditional eating habits may contribute to the poor health status, particularly the high CVD mortality rates, of populations in Eastern Europe. Adequate public health nutritional interventions in this region are essential.

Dietary pattern longitudinality during 8 years in children: results from the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ).

OBJECTIVE: Dietary pattern analysis constitutes a suitable method for identifying complex food preferences as well as a useful tool for comparing dietary behaviour across individual populations. In addition to a lack of information on Central European dietary patterns, dietary data featuring a longitudinal aspect are likewise largely unavailable for the region. Our study thus strives to address this gap by analysing children's dietary patterns, their stability and possible changes at 7, 11 and 15 years in the Czech part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ). DESIGN: We analysed dietary data based on the self-reported semi-quantitative FFQ obtained in 1998, 2002 and 2006. Dietary patterns were derived using factor analysis for each period, followed by the determination of dietary pattern stability across the individual periods. SETTING: The analysis of dietary patterns was based on longitudinal children's dietary data from the geographical region that was undergoing massive socio-economic changes at the time of birth of the study subjects. PARTICIPANTS: All participants were children. At 7 years the analysis included 3220 children, at 11 years the analysis included 2509 children and at 15 years the analysis included 1589 children. RESULTS: Two stable children's dietary patterns labelled as 'prudent' and 'junk food' were identified across all three time points (7, 11 and 15 years). CONCLUSIONS: This study identifies stable longitudinal trends in the dietary behaviour of children enrolled in the ELSPAC-CZ study.

Development and validation of two SCORE-based cardiovascular risk prediction models for Eastern Europe: a multicohort study.

AIMS: Cardiovascular disease (CVD) risk prediction models are used in Western European countries, but less so in Eastern European countries where rates of CVD can be two to four times higher. We recalibrated the SCORE prediction model for three Eastern European countries and evaluated the impact of adding seven behavioural and psychosocial risk factors to the model. METHODS AND RESULTS: We developed and validated models using data from the prospective HAPIEE cohort study with 14 598 participants from Russia, Poland, and the Czech Republic (derivation cohort, median follow-up 7.2 years, 338 fatal CVD cases) and Estonian Biobank data with 4632 participants (validation cohort, median follow-up 8.3 years, 91 fatal CVD cases). The first model (recalibrated SCORE) used the same risk factors as in the SCORE model. The second model (HAPIEE SCORE) added education, employment, marital status, depression, body mass index, physical inactivity, and antihypertensive use. Discrimination of the original SCORE model (C-statistic 0.78 in the derivation and 0.83 in the validation cohorts) was improved in recalibrated SCORE (0.82 and 0.85) and HAPIEE SCORE (0.84 and 0.87) models. After dichotomizing risk at the clinically meaningful threshold of 5%, and when comparing the final HAPIEE SCORE model against the original SCORE model, the net reclassification improvement was 0.07 [95% confidence interval (CI) 0.02-0.11] in the derivation cohort and 0.14 (95% CI 0.04-0.25) in the validation cohort. CONCLUSION: Our recalibrated SCORE may be more appropriate than the conventional SCORE for some Eastern European populations. The addition of seven quick, non-invasive, and cheap predictors further improved prediction accuracy.

Education as inefficient resource against depressive symptoms in the Czech Republic: cross-sectional analysis of the HAPIEE study.

BACKGROUND: Increasing educational level of the population could be a strategy to prevent depression. We investigated whether education may offer a greater benefit for mental health to women and to individuals living in socioeconomically disadvantaged areas. METHODS: We performed a cross-sectional study using data on 6964 Czech participants of the Health, Alcohol and Psychosocial factors in Eastern Europe study (on average 58 years old; 53% women). Binary logistic regression was used to examine the association of education with depressive symptoms, adjusting for several groups of covariates. Interactions were tested between education and sex as well as between education and socioeconomic advantage of the area of residence. RESULTS: Higher education was strongly associated with lower odds of depressive symptoms, independently of sociodemographic characteristics, health behavior and somatic diseases. This association was attenuated after adjusting for other markers of individual socioeconomic position (work activity, material deprivation and household items). There were no interactions between education and either sex or socioeconomic advantage of the area of residence. CONCLUSIONS: We did not find an independent association between education and depressive symptoms after controlling for other socioeconomic markers in a sample with a formative history of communistic ideologies. Women or individuals from socioeconomically disadvantaged areas do not seem to gain a larger mental health benefit from education.

Alcohol Screening and Brief Advice in NHS General Dental Practices: A Cluster Randomized Controlled Feasibility Trial.

AIM: To assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice to eligible patients attending NHS dental practices in London. METHODS: A two-arm cluster randomized controlled feasibility trial was conducted. Twelve dental practices were recruited and randomized to intervention and control arms. Participants attending for a dental check were recruited into the study and were eligible if they consumed alcohol above recommended levels assessed by the AUDIT-C screening tool. All eligible participants were asked to complete a baseline socio-demographic questionnaire. Six months after the completion of baseline measures, participants were contacted via telephone by a researcher masked to their allocation status. The full AUDIT tool was then administered. Alcohol consumption in the last 90 days was also assessed using the Form 90. A process evaluation assessed the acceptability of the intervention. RESULTS: Over a 7-month period, 229 participants were recruited (95.4% recruitment rate) and at the 6 months follow-up, 176 participants were assessed (76.9% retention rate). At the follow-up, participants in the intervention arm were significantly more likely to report a longer abstinence period (3.2 vs. 2.3 weeks respectively, P = 0.04) and non-significant differences in AUDIT (44.9% vs. 59.8% AUDIT positive respectively, P = 0.053) and AUDIT C difference between baseline and follow-up (-0.67 units vs. -0.29 units respectively, P = 0.058). Results from the process evaluation indicated that the intervention and study procedures were acceptable to dentists and patients. CONCLUSIONS: This study has demonstrated the feasibility and acceptability of dentists screening for alcohol misuse and providing brief advice.

Association of Glutathione S-Transferase Polymorphisms with Dietary Composition but Not Anthropometry in Obese as Well as Nonobese Individuals.

OBJECTIVES: Glutathione S-transferases (GSTs) are detoxifying enzymes for a number of substrates, including some food compounds. Selected GST polymorphisms have been proven to significantly affect enzymatic activity; however, it is unclear whether this altered metabolism influences dietary composition. The objective of this study was to locate the correlation between GST polymorphisms and selected nutritional parameters, namely, fiber and vitamin C intake. METHODS: This study was conducted on a cohort of 472 individuals (mean age 45.26 years; mean body mass index [BMI] 32.36) from the South Moravian region of the Czech Republic. Basic anthropometrical parameters were measured and no association was found for the selected polymorphisms. Polymorphisms in GSTA1, GSTM1, and GSTT1 were genotyped using a polymerase chain reaction (PCR)-based methodology. Food intake was monitored using a self-administered 7-day questionnaire that was subsequently analyzed with a special focus on vitamin C intake, fiber intake, and total energy intake. RESULTS: For GSTA1 and GSTM1 polymorphisms, an association was observed with fiber intake. Though no association was found with vitamin C intake, mean vitamin C intake was found to be higher than recommended daily values. No association was found with either daily energy intake or anthropometric parameters. CONCLUSION: Based on our results, GST polymorphisms seem to affect dietary composition; however, they have no effect on total energy intake or any association with obesity.

Psychosocial and socioeconomic determinants of cardiovascular mortality in Eastern Europe: A multicentre prospective cohort study.

BACKGROUND: Eastern European countries have some of the highest rates of cardiovascular disease (CVD) mortality, much of which cannot be adequately accounted for by conventional CVD risk factors. Psychosocial and socioeconomic factors may affect risk of CVD, but relatively few studies on this issue have been undertaken in Eastern Europe. We investigated whether various psychosocial factors are associated with CVD mortality independently from each other and whether they can help explain differences in CVD mortality between Eastern European populations. METHODS: Participants were from the Health, Alcohol and Psychological factors in Eastern Europe (HAPIEE) cohort study in Russia, Poland and the Czech Republic, including a total of 20,867 men and women aged 43-74 years and free of CVD at baseline examination during 2002-2005. Participants were followed-up for CVD mortality after linkage to national mortality registries for a median of 7.2 years. RESULTS: During the follow-up, 556 participants died from CVD. After mutual adjustment, six psychosocial and socioeconomic factors were associated with increased risk of CVD death: unemployment, low material amenities, depression, being single, infrequent contacts with friends or relatives. The hazard ratios [HRs] for these six factors ranged between 1.26 [95% confidence interval 1.14-1.40] and 1.81 [95% confidence interval 1.24-2.64], fully adjusted for each other, and conventional cardiovascular risk factors. Population-attributable fractions ranged from 8% [4%-13%] to 22% [11%-31%] for each factor, when measured on average across the three cohorts. However, the prevalence of psychosocial and socioeconomic risk factors and their HRs were similar between the three countries. Altogether, these factors could not explain why participants from Russia had higher CVD mortality when compared to participants from Poland/Czech Republic. Limitations of this study include measurement error that could lead to residual confounding; and the possibilities for reverse causation and/or unmeasured confounding from observational studies to lead to associations that are not causal in nature. CONCLUSIONS: Six psychosocial and socioeconomic factors were associated with cardiovascular mortality, independent of each other. Differences in mortality between cohorts from Russia versus Poland or Check Republic remained unexplained.

Allelic variants in vitamin D receptor gene are associated with adiposity measures in the central-European population.

BACKGROUND: There is an increasing body of evidence suggesting that vitamin D is involved in ethiopathogenesis of obesity and therefore the aim of the study was to investigate whether 5 selected SNPs in VDR (vitamin D receptor) gene are associated also with anthropometry in the obese and non-obese Central-European population. METHODS: A total of 882 Central European Caucasian individuals of Czech origin were recruited (n = 882, 232 M/650 F) and weight, height, BMI, lean body mass, fat mass, body fat, waist and hip circumference, waist-hip ratio (WHR) and skinfold thickness were measured. Univariate and multivariate models were constructed in order to investigate the relationship between anthropometry and VDR polymorphisms. RESULTS: In the univariate modeling, the CC genotype of FokI SNP was associated with reduced waist circumference (ß = -3.48; 95%CI:-7.11;0.15; p = 0.060), sum of skin fold thickness (ß = -6.53, 95% CI: -12.96;-0.11; p = 0.046) as well as total % of body fat (ß = -3.14, 95% CI: -5.18;-1.09; p = 0.003) compared to TT genotype. The AC genotype of ApaI SNP was associated with reduced waist circumference compared to AA genotype (ß = -4.37, 95% CI: -7.54;-1.20; p = 0.007). GG genotype of EcoRV SNP was associated with reduced sum of skin fold thickness compared to AA genotype (ß = -7.77, 95% CI: -14.34;-1.21; p = 0.020). In the multivariate modelling, multiple significant associations of VDR with investigated traits were observed, too. CONCLUSION: Our study suggests that genetic variability in the VDR region may be an important factor influencing anthropometric characteristics associated with obesity.

Association of Adherence to a Healthy Diet with Cognitive Decline in European and American Older Adults: A Meta-Analysis within the CHANCES Consortium.

AIM: To examine the association between a healthy diet, assessed by the Healthy Diet Indicator (HDI), and cognitive decline in older adults. METHODS: Data from 21,837 participants aged ≥55 years from 3 cohorts (Survey in Europe on Nutrition and the Elderly, a Concerted Action [SENECA], Rotterdam Study [RS], Nurses' Health Study [NHS]) were analyzed. HDI scores were based on intakes of saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, fruits and vegetables, and fiber. The Telephone Interview for Cognitive Status in NHS and Mini-Mental State Examination in RS and SENECA were used to assess cognitive function from multiple repeated measures. Using multivariable-adjusted, mixed linear regression, mean differences in annual rates of cognitive decline by HDI quintiles were estimated. RESULTS: Multivariable-adjusted differences in rates in the highest versus the lowest HDI quintile were 0.01 (95% CI -0.01, 0.02) in NHS, 0.00 (95% CI -0.02, 0.01) in RS, and 0.00 (95% CI -0.05, 0.05) in SENECA with a pooled estimate of 0.00 (95% CI -0.01, 0.01), I2 = 0%. CONCLUSIONS: A higher HDI score was not related to reduced rates of cognitive decline in European and American older adults.

Interventions to reduce inequalities in health and early child development in Europe from a qualitative perspective.

BACKGROUND: Early childhood is a critical stage of development. Inequalities in experiences affect children's wellbeing and determine their development. Early years interventions focusing on children and their parents may help address inequalities during this critical period. Understanding the experiences and perceptions of parents receiving early years programmes and staff providing these may help service development and delivery. The objective of this study was to describe staff and parents' accounts of how early childhood programmes in different European country contexts improved child development. METHODS: Five early years programmes were selected using pre-set criteria out of ten proposed ones. Twenty-five individual interviews and six focus groups were carried out with staff running interventions and with users, children and their families in different EU countries. Investigations of the studies were carried out using qualitative research methods. Data were collected by collaborating partner institutions included in the project. RESULTS: Participants described programmes which aimed to provide activities to stimulate children's learning through structured play and which provided support and assistance for parents. In these, parents were actively involved in activities. Parents and staff referred to establishing long-term trust based relationships as a key element for programmes to improve parents' self-esteem and reduce their stress levels which in turn helped improve their children's development. CONCLUSIONS: Programmes described by staff as being successful, delivered services tailored to parents and their children. Adapting to and understanding the families' circumstances and involving parents was seen by staff as important. Staff also described establishing trust based relationships as a key enabler in programme delivery; their perceptions were that parents should be empowered to develop their own capacities thus strengthening their abilities to assist in their children's learning, which had a positive effect on children.

Mother's education and offspring asthma risk in 10 European cohort studies.

Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3-8 across 10 European countries. Data on 47,099 children were obtained from prospective birth cohort studies across 10 European countries. We calculated cohort-specific prevalence difference in asthma outcomes using the relative index of inequality (RII) and slope index of inequality (SII). Results from all countries were pooled using random-effects meta-analysis procedures to obtain mean RII and SII scores at the European level. Final models were adjusted for child sex, smoking during pregnancy, parity, mother's age and ethnicity. The higher the score the greater the magnitude of relative (RII, reference 1) and absolute (SII, reference 0) inequity. The pooled RII estimate for asthma risk across all cohorts was 1.46 (95% CI 1.26, 1.71) and the pooled SII estimate was 1.90 (95% CI 0.26, 3.54). Of the countries examined, France, the United Kingdom and the Netherlands had the highest prevalence's of childhood asthma and the largest inequity in asthma risk. Smaller inverse associations were noted for all other countries except Italy, which presented contradictory scores, but with small effect sizes. Tests for heterogeneity yielded significant results for SII scores. Overall, offspring of mothers with a low level of education had an increased relative and absolute risk of asthma compared to offspring of high-educated mothers.

Mediterranean diet score and total and cardiovascular mortality in Eastern Europe: the HAPIEE study.

PURPOSE: Mediterranean-type dietary pattern has been associated with lower risk of cardiovascular (CVD) and other chronic diseases, primarily in Southern European populations. We examined whether Mediterranean diet score (MDS) is associated with total, CVD, coronary heart disease (CHD) and stroke mortality in a prospective cohort study in three Eastern European populations. METHODS: A total of 19,333 male and female participants of the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study in the Czech Republic, Poland and the Russian Federation were included in the analysis. Diet was assessed by food frequency questionnaire, and MDS was derived from consumption of nine groups of food using absolute cut-offs. Mortality was ascertained by linkage with death registers. RESULTS: Over the median follow-up time of 7 years, 1314 participants died. The proportion of participants with high adherence to Mediterranean diet was low (25 %). One standard deviation (SD) increase in the MDS (equivalent to 2.2 point increase in the score) was found to be inversely associated with death from all causes (HR, 95 % CI 0.93, 0.88-0.98) and CVD (0.90, 0.81-0.99) even after multivariable adjustment. Inverse but statistically not significant link was found for CHD (0.90, 0.78-1.03) and stroke (0.87, 0.71-1.07). The MDS effects were similar in each country cohort. CONCLUSION: Higher adherence to the Mediterranean diet was associated with reduced risk of total and CVD deaths in these large Eastern European urban populations. The application of MDS with absolute cut-offs appears suitable for non-Mediterranean populations.