Inequalities in cardiovascular disease mortality : the role of behavioural, physiological and social risk factors

Background While the relationship between socio-economic disadvantage and cardiovascular disease (CVD) is well established, the role that traditional cardiovascular risk factors play in this association remains unclear. The authors examined the association between education attainment and CVD mortality and the extent to which behavioural, social and physiological factors explained this relationship.

Methods Adults (n=38 355) aged 40–69 years living in Melbourne, Australia were recruited in 1990–1994. Subjects with baseline CVD risk factor data ascertained through questionnaire and physical measurement were followed for an average of 9.4 years with CVD deaths verified by review of medical records and autopsy reports.

Results CVD mortality was higher for those with primary education only, compared with those who had completed tertiary education, with an HR of 1.66 (95% CI 1.10 to 2.49) after adjustment for age, country of birth and gender. Those from the lowest educated group had a more adverse cardiovascular risk factor profile compared with the highest educated group, and adjustment for these risk factors reduced the HR to 1.18 (95% CI 0.78 to 1.77). In analysis of individual risk factors, smoking and waist circumference explained most of the difference in CVD mortality between the highest and lowest education groups.

Conclusions Most of the excess CVD mortality in lower socio-economic groups can be explained by known risk factors, particularly smoking and overweight. While targeting cardiovascular risk factors should not divert efforts from addressing the underlying determinants of health inequalities, it is essential that known risk factors are addressed effectively among lower socio-economic groups.

Daily eating frequency and cardiometabolic risk factors in young Australian adults : cross-sectional analyses

Eating frequency may be important in the development of overweight and obesity and other cardiometabolic risk factors; however, the evidence is inconsistent. The aim of the present study was to examine the associations between the number of eating occasions and cardiometabolic risk factors in a national population-based sample of young adults. A cohort of 1273 men and 1502 women, aged 26–36 years, completed a meal pattern chart to record when they had eaten during the previous day (in hourly intervals). The total number of eating occasions was calculated. Diet quality was assessed, waist circumference was measured and a fasting blood sample was taken. Dietary intake was compared with the Australian Guide to Healthy Eating. The associations between the number of eating occasions and cardiometabolic risk factors were calculated using linear regression. Analyses were adjusted for age, education and physical activity. Most men ate three to five times per d and most women ate four to six times. The proportion of participants meeting dietary recommendations increased with the number of eating occasions. For men, an additional eating occasion was associated with reductions in mean values for waist circumference ( − 0·75 cm), fasting glucose ( − 0·02 mmol/l), fasting insulin ( − 0·34 mU/l; 2·04 pmol/l), TAG ( − 0·03 mmol/l), total cholesterol ( − 0·08 mmol/l) and LDL-cholesterol ( − 0·06 mmol/l). Adjustment for waist circumference attenuated the results. Significant trends were not observed for women. In conclusion, a higher number of eating occasions were associated with reduced cardiometabolic risk factors in men. Many associations were mediated by waist circumference.

Preventive strategies in depression : gathering evidence for risk factors and potential interventions

This editorial critiques the recent literature concerning both vitamin D deficiency in major depression and supplementation as a treatment strategy, and contextualises it within a broader approach to the prevention of depression, based on the recent evidence for lifestyle as a risk factor for depression and anxiety.

Emerging nutritional and lifestyle risk factors for bone health in young women: a mixed longitudinal twin study

Late adolescence and early adulthood are times of major behavioral transition in young women as they become more independent and make choices about lifestyle that will affect their long-term health. We prospectively evaluated nutritional and lifestyle factors in 566 15 30-year-old female twins participating in a mixed longitudinal study of diet and lifestyle.Twins completed 790 visits including questionnaires and measures of anthropometry. Nonparametric tests (chi-square, Mann-Whitney U, and Kruskal-Wallis; SPSS) were used to examine age-related differences in selected variables. Dietary calcium intake by short food frequency questionnaire was relatively low [511 (321,747)] mg/day (median, IQR; 60 % of estimated daily total) and did not vary significantly with age. The number of young women who reported ever consuming alcohol (12+ standard drinks ever) increased from 50 % under 18 years to 93 99 % for the 18+ age groups. Of those who consumed alcohol in the preceding year, monthly intake doubled from under 18 years (5.7, 3.9, 19.0 standard drinks; median, IQR) to 18+ years (12.0, 4.7, 26.0; P < 0.001) with the highest consumers being 21 23 and 27 29 years. At age 15 17 years, 14 % reported ever smoking and by age 27–29, 51 % had smoked (P = 0.002). Under the age of 20 years, average cigarette consumption in smokers was six cigarettes per day, increasing to ten above age 20 (P < 0.001). Participation in sporting activity decreased with age (P < 0.001): 47.5 % of 15–17-year-olds undertook 4 or more hour/week of sport, compared with 23.5 % at age 27–29 years. Conversely, sedentary behavior increased with age: 25.0 % of 15–17-year-olds reported 1 or less hour/week of exercise compared with 50.0 % at age 27–29 years. BMI increased with age (P = 0.011), from 21.3 (19.5, 23.6; median, IQR) in the youngest to 23.1 (21.5, 25.9) in the oldest. These highly significant changes in behavior in young women as they transitioned into independent adult living are predicted to impact adversely on bone and other health outcomes in later life. It is crucial to improve understanding of the determinants of these changes and to develop effective interventions to improve long-term health outcomes in young women.

Prevalence and community variation in harmful levels of family conflict witnessed by children: implications for prevention

 Abstract
Children’s reports of high family conflict consistently predict poor outcomes. The study identified criteria for high family conflict based on prospective prediction of increased risk for childhood depression. These criteria were subsequently used to establish the prevalence of high family conflict in Australian communities and to identify community correlates suitable for targeting prevention programs. Study 1 utilised a longitudinal design. Grade 6 and 8 students completed a family conflict scale (from the widely used Communities That Care survey) in 2003 and depression symptomotology were evaluated at a 1-year follow-up (International Youth Development Study, N = 1,798). Receiver-operating characteristic analysis yielded a cut-off point on a family conflict score with depression symptomatology as a criterion variable. A cut-off score of 2.5 or more (on a scale of 1 to 4) correctly identified 69 % with depression symptomology, with a specificity of 77.2 % and sensitivity at 44.3 %. Study 2 used data from an Australian national survey of Grade 6 and 8 children (Healthy Neighbourhoods Study, N = 8,256). Prevalence estimates were calculated, and multivariate logistic regression with multi-level modelling was used to establish factors associated with community variation in family conflict levels. Thirty-three percent of Australian children in 2006 were exposed to levels of family conflict that are likely to increase their future risk for depression. Significant community correlates for elevated family conflict included Indigenous Australian identification, socioeconomic disadvantage, urban and state location, maternal absence and paternal unemployment. The analysis provides indicators for targeting family-level mental health promotion programs.

Potential links between the emerging risk factors for food allergy and vitamin D status

A variety of hypotheses have been proposed to explain the recently described increase in food allergy among children living in developed countries. In this study, we summarize the emerging risk factors for IgE-mediated food allergy in early life, and then review the evidence for and against an association between low vitamin status (VDS) and food allergy.

We consider whether each of the epidemiological variables that have been associated with food allergy may also be associated with VDS; and argue that future studies must adequately account for the potential relationships between risk factors for food allergy and VDS, and must also discriminate between vitamin D derived by sun exposure, diet and oral supplementation.

Risk factors for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory: a matched case-control study

Background
Side effects of the medications used for procedural sedation and analgesia in the cardiac catheterisation laboratory are known to cause impaired respiratory function. Impaired respiratory function poses considerable risk to patient safety as it can lead to inadequate oxygenation. Having knowledge about the conditions that predict impaired respiratory function prior to the procedure would enable nurses to identify at-risk patients and selectively implement intensive respiratory monitoring. This would reduce the possibility of inadequate oxygenation occurring.

Aim
To identify pre-procedure risk factors for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory.

Design
Retrospective matched case–control.

Methods
21 cases of impaired respiratory function were identified and matched to 113 controls from a consecutive cohort of patients over 18 years of age. Conditional logistic regression was used to identify risk factors for impaired respiratory function.

Results
With each additional indicator of acute illness, case patients were nearly two times more likely than their controls to experience impaired respiratory function (OR 1.78; 95% CI 1.19–2.67; p = 0.005). Indicators of acute illness included emergency admission, being transferred from a critical care unit for the procedure or requiring respiratory or haemodynamic support in the lead up to the procedure.

Conclusion
Several factors that predict the likelihood of impaired respiratory function were identified. The results from this study could be used to inform prospective studies investigating the effectiveness of interventions for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory.