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.

Everything all right in method comparison studies?

Researchers and clinicians often need to know whether a new method of measurement is equivalent to an established one that is already in use. For this problem, the estimation of limits of agreement advocated by Bland and Altman is a widely used solution. However, this approach ignores two vital issues in method comparisons. First, does the appropriate re-scaling of the test method bring the methods into agreement? Second, independent of lying 'adequately' between the limits of agreement or not, it is important to know whether one method is equal to or better than another. This article proposes an approach and a model, where both these questions will be addressed simultaneously. In this model, the error variation of the standard method stands for 'acceptable' precision in measurements. Accordingly, the between-subject component of the measurements by the standard method will be used as a 'gold standard' against which the properties of the test method will be evaluated. Application of the model is demonstrated using the peak expiratory flow rate data of Bland and Altman.

Going to scale: a nonrandomized nationwide trial of the KiVa antibullying program for grades 1-9.

OBJECTIVE: The effects of school-based antibullying programs have typically been examined on small samples, with number of schools ranging from 1 to 78 (Farrington & Ttofi, 2009). This study investigated the effectiveness of the KiVa antibullying program in the beginning of its nationwide implementation in Finland. METHOD: At each time point, the participants included 888 schools with approximately 150,000 students in 11,200 classrooms in Grades 1-9 (8-16 years of age; 51% boys and 49% girls). Victims and bullies were identified with the global questions from the Revised Olweus Bully/Victim Questionnaire (Olweus, 1996), utilizing the criteria suggested by Solberg and Olweus (2003). The program effects were examined by calculating odds ratios based on a cohort-longitudinal design, correcting the standard errors for clustering. RESULTS: During the first 9 months of implementation, the KiVa program reduced both victimization and bullying, with a control/intervention group odds ratio of 1.22 (95% CI [1.19, 1.24]) for victimization and 1.18 (95% CI [1.15, 1.21]) for bullying. CONCLUSIONS: Generalized to the Finnish population of 500,000 students, this would mean a reduction of approximately 7,500 bullies and 12,500 victims.

Social capital as a determinant of self-rated health and psychological well-being.

OBJECTIVE: To examine whether specific dimensions of social capital are related to self-rated health and psychological well-being. METHODS: Cross-sectional data from a health survey representing the adult Finnish population (N = 8,028) were used. Logistic regression analysis was used to reveal and quantify the possible associations between three dimensions of social capital (social support; social participation and networks; trust and reciprocity) and two general health indicators (self-rated health and psychological well-being). The roles of age, gender, education, living arrangements, income, type of region, functional capacity, and long-standing illness were also assessed. RESULTS: Good self-rated health was associated with high levels of social participation and networks and trust and reciprocity, but social support did not remain statistically significant after adjustment for socio-demographic factors, long-standing illness, and functional capacity. The association between social support and psychological well-being was explained by the other two dimensions of social capital. The strong positive association between trust and psychological well-being persisted after controlling for all the other factors in our model. CONCLUSIONS: Our findings suggest that trust and reciprocity and social participation and networks contribute to good self-rated health and psychological well-being.

Health-related quality-of-life profiles in nonalexithymic and alexithymic subjects from general population.

OBJECTIVE: Earlier studies have shown an association between alexithymia and health-related quality of life (HRQoL). There has been some controversy as to whether this is attributable solely to psycho-social domains of HRQoL or also to physical domains. Furthermore, there are no studies on HRQoL profiles in representative general population samples controlling for sociodemographic variables, mental health and somatic health. METHODS: The study forms part of the Health 2000 Study. Altogether 5090 participants from general population, aged 30-97 years, filled in the 20-item Toronto Alexithymia Scale and the 15D HRQoL scale. Depressive and anxiety disorders were assessed in a structured psychiatric interview. Physical health was examined by physicians. The 15-dimension HRQoL profiles of both alexithymic and non-alexithymic subjects were obtained by analysis of covariance, controlling for sociodemographic and health-related variables. RESULTS: The alexithymic group had significantly (P<.001) lower mean scores on every dimension of the 15D even after controlling for confounding demographic variables, somatic diagnoses and depressive and anxiety disorders. The differences were greatest in the psycho-social domains. CONCLUSIONS: Alexithymia seems to be a personality trait with a statistically significant association to every dimension of HRQoL, not only to psychosocial domains. However, the associations between alexithymia and some somatic dimensions may be of little clinical significance.

Hip fractures and femoral bone mineral density in male former elite athletes.

INTRODUCTION: We studied whether vigorous physical activity in young adulthood is associated with higher femoral bone density and lower risk of hip fracture at older age in men. MATERIALS: A cohort of former male elite athletes (n=2147) and matched control subjects (n=1467) were studied for their leisure physical activity, and for fragility fractures at the hip (proximal femur) by Cox regression. Areal bone mineral densities (aBMD) at femoral neck and trochanter region were measured using dual-energy X-ray absorptiometry in a subgroup of the former athletes (n=87; median age 59 years) and in a population-based control group (n=194) and compared by general linear models. RESULTS: After their active sporting careers, the former athletes participated in leisure physical activity more than the matched control subjects (p<0.0001). The hazard ratio (HR) of osteoporotic hip fracture adjusted for the occupational group was 0.77 (95% CI 0.45 to 1.32, p=0.34) in the athletes compared with the control subjects. The mean age at the time of the fracture event was 76.9 years (95% CI 73.2 to 78.8) for the athletes and 70.6 years (95% CI 67.1 to 72.9) for the matched control subjects (p=0.005). Adjusted for age and body mass index, aBMD at the proximal femur was significantly higher in the former athletes compared with the population-based control group (p<0.0001 for both measurement sites). CONCLUSIONS: Osteoporotic hip fractures were sustained at a significantly older age among former athletes compared with control subjects. Clear skeletal benefits of long-term physical loading were also observed in comparative DXA measurements of aBMD.

Rorschach Comprehensive System data for a sample of 343 adults from Finland.

This article combines Rorschach Comprehensive System (CS; Exner, 1990, 1993) data from four projects conducted in Finland between 1990 and 1995. The projects studied a stratified random sample of Finnish nonpatients, a cohort of twins, a group of elderly men, and a random sample collected to investigate sleep difficulties. The 343 records from these four studies provide a representative survey of Rorschach responding throughout the Finnish population.

Effect of co-morbidity on the association of high body mass index with walking limitation among men and women aged 55 years and older.

BACKGROUND AND AIMS: Obesity among older persons is rapidly increasing, thus affecting their mobility negatively. The aim of this study was to examine the association of high body mass index (BMI) with walking limitation, and the effect of obesity-related diseases on this association. METHODS: In a representative sample of the Finnish population of 55 years and older (2055 women and 1337 men), maximal walking speed, chronic diseases, and BMI were ascertained in a health examination. Walking limitation was defined as maximal walking speed of less than 1.2 m/s or difficulty in walking 500 meters. To analyze the effects of chronic conditions, smoking, marital status, and education on BMI class differences in walking limitation, covariates were sequentially adjusted in logistic regression analyses. RESULTS: In women, an increasing gradient in the age-adjusted risk of walking limitation was observed with higher BMI: overweight (OR 1.47, 95% CI 1.10-1.96), obese (OR 2.77, 95% CI 2.01-3.82), and severely obese (OR 5.80, 95% CI 3.52-9.54). In men, the risk was significantly increased among the obese (OR 1.63, 95% CI 1.04-2.55) and severely obese (OR 4.33, 95% CI 2.20- 8.53). After adjustment of multiple covariates, the association remained significant among the obese (OR 1.99, 95% CI 1.38-2.86) and severely obese women (OR 3.64, 95% CI 2.12-6.26), as well as severely obese men (OR 2.78, 95% CI 1.30-5.95). Knee osteoarthritis in women and diabetes in men contributed most to the excess risk of walking limitation among obese persons, 18 and 32% respectively. CONCLUSIONS: Obesity increases the risk of walking limitation, independent of obesity-related diseases, smoking, marital status, and education, especially in older women. The results of this study emphasize the importance of maintaining normal body weight, in order to prevent obesity-related health risks and loss of functioning in older age.

Obesity history as a predictor of walking limitation at old age.

OBJECTIVE: To study whether walking limitation at old age is determined by obesity history. RESEARCH METHODS AND PROCEDURES: In a retrospective longitudinal study based on a representative sample of the Finnish population of 55 years and older (2055 women and 1337 men), maximal walking speed, body mass, and body height were measured in a health examination. Walking limitation was defined as walking speed<1.2 m/s or difficulty in walking 0.5 km. Recalled height at 20 years of age and recalled weight at 20, 30, 40, and 50 years of age were recorded. RESULTS: Subjects who had been obese at the age of 30, 40, or 50 years had almost a 4-fold higher risk of walking limitation compared to non-obese. Obesity duration increased the age- and gender-adjusted risk of walking limitation among those who had been obese since the age of 50 (odds ratio, 4.33; 95% confidence interval, 2.59 to 7.23, n=114), among the obese since the age of 40 [6.01 (2.55 to 14.14), n=39], and among the obese since the age of 30 [8.97 (3.06 to 26.29), n=14]. The risk remained elevated even among those who had previously been obese but lost weight during their midlife or late adulthood [3.15 (1.63 to 6.11), n=71]. DISCUSSION: Early onset of obesity and obesity duration increased the risk of walking limitation, and the effect was only partially mediated through current BMI and higher risk of obesity-related diseases. Preventing excess weight gain throughout one's life course is an important goal in order to promote good health and functioning in older age.

Dietary and serum vitamins and minerals as predictors of myocardial infarction and stroke in elderly subjects.

BACKGROUND AND AIM: According to a widespread hypothesis, antioxidative vitamins and trace elements may protect the body against atherosclerotic diseases, especially in the elderly. We assessed dietary and serum vitamins and minerals for prediction of acute myocardial infarction (AMI) and stroke in elderly subjects. METHODS AND RESULTS: In a population-based health survey with special emphasis on the diet, subjects aged 65-99 years were followed up for up to 10 years. The study population consisted of 361 men and 394 women. Information on individual food consumption was elicited by means of dietary history interviews. Serum vitamins and mineral elements were analysed utilizing commonly applied biochemical methods. Prediction analyses were based on 130 cases accumulated in the AMI group, 70 subjects in the stroke group, and corresponding control subjects. The cases were determined on the basis of revised information from the National Register of Cases of Death, and from the National Hospital Discharge Register. Low intake of vitamin D (p = 0.011) and low serum levels of 1,25-dihydroxy-vitamin D (p = 0.0053) were significantly predictive of stroke when adjusted for age, gender, smoking and functional capacity. On the other hand, high dietary intakes of two flavonoids, luteolin (p = 0.0096) and kaempferol (p = 0.002) were associated with lowered risk of AMI. Furthermore, low serum levels of iron predicted both AMI (p = 0.013) and stroke (p = 0.019). The results remained essentially unchanged when adjusted for additional major risk factors of atherosclerosis. CONCLUSIONS: From the items in the dietary interview, low intakes of vitamin D and certain flavonoids emerged as the sole predictors of AMI and stroke. In biochemical analyses, on the other hand, these disorders were predicted only by low levels of 1,25-dihydroxy-vitamin D and iron in the serum.

A note on alternative parameterizations of a model for evaluating agreement between two tests.

The agreement between two competing tests which purport to measure the same trait is a common concern in test development. In this paper three alternative parameterizations of the measurement model useful in this context are presented. Both one-factor and two-factor approaches are applied. Lord's classic example, where the main problem is to investigate whether time limits represent an extra speed component in a vocabulary test, is used to illustrate the ideas.

Long-term prognosis for jumper's knee in male athletes. A prospective follow-up study.

BACKGROUND: Little information is available on the long-term outcome of jumper's knee, a common problem among athletes. PURPOSE: Our aim was to determine the 15-year prognosis of jumper's knee. STUDY DESIGN: Prospective case control. METHODS: The prognosis for jumper's knee was studied using two groups: athletes with jumper's knee and nonsymptomatic control athletes. At baseline, all subjects participated in standardized clinical examinations and measurements, and 15 years later they were asked to respond to a questionnaire. RESULTS: Twenty athletes with jumper's knee and 16 athlete control subjects responded (response rate 74% and 84%, respectively). The jumper's knee group reported significantly more knee symptoms according to their Kujala score and more knee pain after repeated squatting. Fifty-three percent of the subjects in the jumper's knee group (9 of 17) reported that they had quit their sports career because of their knee problem, compared with 7% of the control athletes (1 of 14). Patellar height was associated with knee symptoms at follow-up. CONCLUSION: Jumper's knee causes mild but long-lasting symptoms after an athletic career.