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Background Evidence is conflicting regarding the relationship between low maternal alcohol consumption and birth outcomes. This paper aimed to investigate the association between alcohol intake before and during pregnancy with birth weight and gestational age and to examine the effect of timing of exposure. Methods A prospective cohort in Leeds, UK, of 1303 pregnant women aged 18-45 years. Questionnaires assessed alcohol consumption before pregnancy and for the three trimesters separately. Categories of alcohol consumption were divided into ≤2 units/week and ≥2 units/week with a nondrinking category as referent. This was related to size at birth and preterm delivery, adjusting for confounders including salivary cotinine as a biomarker of smoking status. Results Nearly two-thirds of women before pregnancy and over half in the first trimester reported alcohol intakes above the Department of Health (UK) guidelines of ≤2 units/week. Associations with birth outcomes were strongest for intakes ≥2 units/week before pregnancy and in trimesters 1 and 2 compared to non-drinkers. Even women adhering to the guidelines in the first trimester were at significantly higher risk of having babies with lower birth weight, lower birth centile and preterm birth compared to non-drinkers, after adjusting for confounders (p<0.05). Conclusions We found the first trimester to be the period most sensitive to the effect of alcohol on the developing fetus. Women adhering to guidelines in this period were still at increased risk of adverse birth outcomes. Our findings suggest that women should be advised to abstain from alcohol when planning to conceive and throughout pregnancy. [ABSTRACT FROM AUTHOR]

Background Improving Access to Psychological Therapies (IAPT) is a new programme designed to reduce disease burden to the individual and economic burden to the society of common mental health problems (CMHP). This is the first study to look at the impact of IAPT on health service utilisation and sickness absence using routine data. Method The authors used pseudonymised secure and privately linked (SAPREL) routinely collected primary, secondary care and clinic computer data from two pilot localities. The authors explored antidepressant prescribing, accident and emergency and outpatients attendances, inpatient stays, bed days, and sick certification. The authors compared the registered population with those with CMHP. The authors then made a 6 months before and after comparison of people referred to IAPT with age-sex and practice-matched controls. Results People with CMHP used more health resources than those without CMHP: more prescriptions of antidepressants 5.25 (95% CI 5.38 to 5.13), inpatient episodes 4.89 (95% CI 5.0 to 4.79), occupied bed days 1.25 (95% CI 0.95 to 1.55), outpatient 1.5 (95% CI 1.40 to 1.63) and emergency department attendances 0.34 (95% CI 0.31 to 0.37), and medical certificates 0.29 (95% CI 0.26 to 0.32). Comparison of service utilisation 6 months before and after referral to IAPT was associated with reduced use of emergency department attendances (mean difference: 0.12 (95% CI 0.06 to 0.19, p<0.001)). However, the number of prescriptions of antidepressants increased mean difference 0.15 (95% CI 0.020.29, p=0.028). Conclusions People with CMHP use more healthcare resources. Referral to the IAPT programme is associated with a subsequent reduction in emergency department attendances, sickness certification and improved adherence to drug treatment. [ABSTRACT FROM AUTHOR]

Background Active commuting is associated with various health benefits, but little is known about its causal relationship with body mass index (BMI). Methods We used cohort data from three consecutive annual waves of the British Household Panel Survey, a longitudinal study of nationally representative households, in 2004/2005 (n=15 791), 2005/2006 and 2006/2007. Participants selected for the analyses (n=4056) reported their usual main mode of travel to work at each time point. Self-reported height and weight were used to derive BMI at baseline and after 2 years. Multivariable linear regression analyses were used to assess associations between switching to and from active modes of travel (over 1 and 2 years) and change in BMI (over 2 years) and to assess dose-response relationships. Results After adjustment for socioeconomic and health-related covariates, the first analysis (n=3269) showed that switching from private motor transport to active travel or public transport (n=179) was associated with a significant reduction in BMI compared with continued private motor vehicle use (n=3090; -0.32 kg/m², 95% CI -0.60 to -0.05). Larger adjusted effect sizes were associated with switching to active travel (n=109; -0.45 kg/m², -0.78 to -0.11), particularly among those who switched within the first year and those with the longest journeys. The second analysis (n=787) showed that switching from active travel or public transport to private motor transport was associated with a significant increase in BMI (0.34 kg/m², 0.05 to 0.64). Conclusions Interventions to enable commuters to switch from private motor transport to more active modes of travel could contribute to reducing population mean BMI. [ABSTRACT FROM AUTHOR]

Background: Teenage pregnancy is a known social problem which has been previously described using a number of deprivation measures. This study aimed to explore the temporal patterns of teenage pregnancy in Aberdeen, Scotland and to assess the discriminating ability of three measures of socioeconomic status. Methods: This was a population-based study from 1950 to 2010, using data from the Aberdeen Maternity Neonatal Databank (AMND). The main outcome variable was conceptions occurring in women aged less than 20 years. This study used two area-based measures, the Scottish Index of Multiple Deprivation (SIMD) and the Carstairs index, and one individual-based measure the Social Class based on Occupation (SCO). These measures were compared for their association with teenage conceptions using logistic regression models. The models were used to determine receiver operating characteristic (ROC) curves showing the discriminating ability of the measures. Results: There was an overall decline in teenage conceptions over the 60-year period, but an increase in the rate ratio for deprived areas. All the measures of socioeconomic status were highly associated with teenage pregnancy. The adjusted OR of SIMD and teenage conception was 5.72 (95% CI 4.62 to 7.09), which compared the most deprived decile with the least deprived decile. The use of ROC curves showed that socioeconomic measures performed better than chance at determining teenage conceptions (χ2=21.67, p≤0.0001). They further showed that the SIMD had the largest area under the curve (AUC) with a value of 0.81 (95% CI 0.80 to 0.82), followed by the Carstairs index with an AUC of 0.80 (95% CI 0.78 to 0.80), then by SCO with an AUC of 0.79 (95% CI 0.78 to 0.80). Conclusions: Despite a slight decline in teenage pregnancies over the past decades, there is still an evident association between deprivation and teenage pregnancy. This study shows that all the measures of socioeconomic status were highly associated with teenage pregnancy, with the SIMD having the greatest discriminatory effect. [ABSTRACT FROM AUTHOR]

Background Retirement is associated with an increase in recreational physical activity but its impact on other domains of activity (at home, for transport) and sedentary behaviour, such as time spent watching television (TV) is unknown. We examined the association between retirement and changes in domain-specific and overall activity and TV viewing. Methods Data were derived from the population-based EPIC (European Prospective Investigation into Cancer)– Norfolk cohort. Physical activity and TV viewing time were self-reported at baseline (1997–2000) and followup 2 (2006–2007) by 3334 participants employed at baseline, of whom 785 (24%) were retired at follow-up 1 (2002–2006). Multivariable regression models were fitted to estimate the association between retirement and changes in physical activity and weekly TV viewing time. Results Compared with continued employment, retirement was associated with a decline in overall activity (men: non-manual, −40.9 MET h/wk; manual, −49.6 MET h/wk; women: non-manual, −26.9 MET h/wk; manual, −31.6 MET h/wk; all p<0.001 (MET, metabolic equivalent of task)). Domain-specific activity declined for transport and occupational (p<0.001) and increased for recreational (p<0.02) and household (p≤0.002) activity. We observed significant interaction between retirement and social class in respect of overall and domain-specific activity apart from household activity. Retirement was associated with a mean increase in TV viewing time, with the largest increase among manual social classes (men: +3.9 h/wk; women: +2.8 h/wk; both p<0.001). Conclusions Interventions should aim to promote household and transport as well as recreational activity. Further research on the impact of retirement on sedentary behaviour is needed. [ABSTRACT FROM AUTHOR]

Background Non-drinkers are shown to have worse health than moderate drinkers in later life. We examine the preceding health status of non-drinkers in early adulthood, and secondly whether persistent poor health is associated with persistent non-drinking. Methods Using two prospective British birth cohort studies established in 1958 (National Child Development Study (NCDS)) and in 1970 (British Cohort Study (BCS)), participants who reported 'never' or 'never had an alcoholic drink' to drinking status questions in successive waves from 23 to 26 years in the NCDS/BCS were derived as 'lifetime abstainers'. Logistic regression on the odds of being a lifetime abstainer was carried out on changes in limiting long-standing illness (LLSI) in the NCDS and long-standing illness (LSI) in the BCS, adjusting for sex, education, poor psychosocial health, marital and parental status. Results Participants with an LLSI in consecutive waves since 23 years had 4.50 times the odds of someone who did not have an LLSI of being a lifetime abstainer at 33 years (95% CI 1.99 to 10.18) and 7.02 times the odds at 42 years (2.39 to 20.66) after adjusting for all factors. Similarly, in the BCS, having an LSI in consecutive waves resulted in higher odds of being a lifetime abstainer at 30 years (OR 2.80, 1.88 to 4.18) and 34 years (OR 3.33, 2.01 to 5.53). Conclusions Persistent LSI was associated with remaining a non-drinker across adulthood. Studies comparing the health outcomes of moderate drinkers to lifetime abstainers that do not account for pre-existing poor health may overestimate the better health outcomes from moderate alcohol consumption. [ABSTRACT FROM AUTHOR]

Background Socioeconomic inequalities in health outcomes are dynamic and vary over time. Differences between countries can provide useful insights into the causes of health inequalities. The study aims to compare the associations between two measures of socioeconomic position (SEP)--maternal education and family income--and maternal and infant health outcomes between ALSPAC and Pelotas cohorts. Methods Birth cohort studies were started in Avon, UK, in 1991 (ALSPAC) and in the city of Pelotas, Brazil, in 1982, 1993 and 2004. Maternal outcomes included smoking during pregnancy, caesarean section and delivery not attended by a doctor. Infant outcomes were preterm birth, intra-uterine growth restriction (IUGR) and breast feeding for <3 months. The relative index of inequality was used for each measure of SEP so that results were comparable between cohorts. Results An inverse association (higher prevalence among the poorest and less educated) was observed for almost all outcomes, with the exception of caesarean sections where a positive association was found. Stronger income-related inequalities for smoking and education-related inequalities for breast feeding were found in the ALSPAC study. However, greater inequalities in caesarean section and education-related inequalities in preterm birth were observed in the Pelotas cohorts. Conclusions Mothers and infants have more adverse health outcomes if they are from poorer and less well-educated socioeconomic backgrounds in both Brazil and the UK. However, our findings demonstrate the dynamic nature of the association between SEP and health outcomes. Examining differential socioeconomic patterning of maternal and infant health outcomes might help understanding of mechanisms underlying such inequalities. [ABSTRACT FROM AUTHOR]

Background Father's occupational position, education and height have all been used to examine the effects of adverse early life socioeconomic circumstances on health, but it remains unknown whether they predict mortality equally well. Methods We used pooled data on 18 393 men and 7060 women from the Whitehall II and GAZEL cohorts to examine associations between early life socioeconomic circumstances and all-cause and cause-specific mortality. Results During the 20-y follow-up period, 1487 participants died. Education had a monotonic association with all mortality outcomes; the age, sex and cohort-adjusted HR for the lowest versus the highest educational group was 1.45 (95% CI 1.24 to 1.69) for all-cause mortality. There was evidence of a U-shaped association between height and all-cause, cancer and cardiovascular mortality robust to adjustment for the other indicators (HR 1.41, 95% CI 1.03 to 1.93 for those shorter than average and HR 1.36, 95% CI 0.98 to 1.88 for those taller than average for cardiovascular mortality). Greater all-cause and cancer mortality was observed in participants whose father's occupational position was manual rather than non-manual (HR 1.11, 95% CI 1.00 to 1.23 for all-cause mortality), but the risks were attenuated after adjusting for education and height. Conclusions The association between early life socioeconomic circumstances and mortality depends on the socioeconomic indicator used and the cause of death examined. Height is not a straightforward measure of early life socioeconomic circumstances as taller people do not have a health advantage for all mortality outcomes. [ABSTRACT FROM AUTHOR]

Background: A/H1N1, more commonly referred to as swine flu, emerged in Mexico in spring 2009. It rapidly spread across the world and was classed as a global pandemic on 11 June 2009. Objective: To analyse UK newsprint coverage of the swine flu pandemic. Methods: Content analysis of 2374 newsprint articles published in eight UK national newspapers between 1 March 2009 and 28 February 2010. Results: Newsprint coverage of the swine flu epidemic was immense. The threat from swine flu was portrayed as greatest in the spring and summer of 2009 when scientific uncertainties about the impact on the UK and global population were at their height and when swine flu cases in the UK first peaked. Thereafter the number of news articles waned, failing to mirror the October peak in flu cases as the virus failed to be as virulent as first feared. Content analysis found little evidence of the media 'over-hyping' the swine flu pandemic. Conclusions: The news media's role as a disseminator of scientific information is particularly important in areas of risk perception. Despite a succession of health scares in recent years in which the media has been accused of exaggerating the risks and contributing to public misunderstandings of the issues, this analysis suggests that the UK newsprint reporting of swine flu in the 2009--10 outbreak was largely measured. The news media's role as disseminators of factual health information on swine flu is to be welcomed, particularly in relation to their handling and responsible reporting on scientific uncertainty. [ABSTRACT FROM AUTHOR]

Background Most measures of quality of life (QoL) are based on 'expert' opinions. This study describes a new measure of QoL in older age, the Older People's QoL Questionnaire (OPQOL), which is unique in being derived from the views of lay people, cross-checked against theoretical models for assessment of comprehensiveness. Its performance was assessed cross-sectionally and longitudinally. It was compared with two existing QoL measures in the cross-sectional studies in order to identify the optimal measure for use with older populations. Methods Data were taken from three surveys of older people living at home in Britain in 2007-2008: one population survey of people aged 65+, one focused enumeration survey of ethnically diverse older people aged 65+, one follow-up of a population survey of people aged 65+ at baseline in 1999/2000. Measures were QoL (using OPQOL, Control, Autonomy, Satisfaction, Pleasure - 19 items (CASP-19), World Health Organization Quality of Life questionnaire - version for older people (WHOQOL-OLD)), health, social and socioeconomic circumstances. The CASP-19 and WHOQOL-OLD were not administered to the longitudinal sample in order to reduce respondent burden. Results Psychometric tests were applied to each QoL measure. The OPQOL, CASP-19 and WHOQOL-OLD performed well with the cross-sectional samples; however, only the OPQOL met criteria for internal consistency in the Ethnibus samples. Conclusion The OPQOL is of potential value in the outcome assessment of health and social interventions, which can have a multidimensional impact on people's lives. Further research is needed to examine whether differences by ethnicity reflect real differences in QoL, methodological issues, variations in expectations or cultural differences in reporting. [ABSTRACT FROM AUTHOR]