We investigated whether BMI predicts type 2 diabetes in twins and to what extent that is explained by common genetic factors.
This was a population-based twin cohort study. Monozygotic (n = 4,076) and dizygotic (n = 9,109) non-diabetic twin pairs born before 1958 answered a questionnaire in 1975, from which BMI was obtained. Information on incident cases of diabetes was obtained by linkage to nationwide registers until 2005.
Altogether, 1,332 twins (6.3% of men, 5.1% of women) developed type 2 diabetes. The HR for type 2 diabetes increased monotonically with a mean of 1.22 (95% CI 1.20-1.24) per BMI unit and of 1.97 (95% CI 1.87-2.08) per SD of BMI. The HRs for lean, overweight, obese and morbidly obese participants were 0.59, 2.96, 6.80 and 13.64 as compared with normal weight participants. Model heritability estimates for bivariate variance due to an additive genetic component and non-shared environmental component were 75% (men) and 71% (women) for BMI, and 73% and 64%, respectively for type 2 diabetes. The correlations between genetic variance components (r (g)) indicated that one fifth of the covariance of BMI and type 2 diabetes was due to shared genetic influences. Although the mean monozygotic concordance for type 2 diabetes was approximately twice the dizygotic one, age of onset of diabetes within twin pair members varied greatly, irrespective of zygosity.
A 28-year follow-up of adult Finnish twins showed that despite high trait heritability estimates, only a fraction of covariation in BMI and incident type 2 diabetes was of genetic origin.
To examine which individual and environmental factors correlate with unmet physical activity need in old age and predict development of unmet physical activity need (the feeling that one's level of physical activity is inadequate and thus distinct from the recommended amount of physical activity) over a 2-year follow-up.
Observational prospective cohort study and cross-sectional analyses.
Community and research center.
A total of 643 community-living ambulatory people aged 75 to 81 took part in face-to-face interviews and examinations at baseline and 314 at the 2-year follow-up.
Unmet physical activity need and its potential individual and environmental correlates were assessed at baseline. Development of unmet physical activity need was assessed over the 2-year follow-up period.
At baseline, all participants were able to walk at least 500 m outdoors, but 14% perceived unmet physical activity need. Unmet physical activity need was more prevalent in those with musculoskeletal diseases, depressive symptoms, and mobility limitations. Hills in the nearby environment, lack of resting places, and dangerous crossroads correlated with unmet physical activity need at baseline; the association was especially strong in those with walking difficulties. Significant baseline predictors for incident unmet physical activity need (15%) included fear of moving outdoors, hills in the nearby environment, and noisy traffic.
Unmet physical activity need is common in ambulatory community-living older people who have health and mobility problems and report negative environmental features in their neighborhood. Solutions to overcome barriers to physical activity need to be developed to promote equal opportunities for physical activity participation.
Individuals who are small at birth are at increased risk of cardiovascular disease later in life. To enhance understanding of the mechanisms underlying this association we examined the link between infants' birth weight and mortality in their parents and grandparents.
We used the Uppsala birth cohort to examine all-cause and circulatory disease mortality among 14,129 mothers, 13,863 fathers, 3992 maternal and 3910 paternal grandmothers and 3896 maternal and 3798 paternal grandfathers. Follow-up time lasted up to 2002 with median of 21.6 years for parents and 47.8 years for grandparents.
Hazard models controlling for socio-demographic characteristics indicated an inverse linear association between offspring's birth weight and maternal circulatory disease mortality [hazards ratio (HR) = 0.74; 95% confidence interval (CI): 0.56-0.99]. No association was observed for fathers. The association between birth weight of grandchildren and grandparental mortality varied. No association was detected for maternal grandmothers for the whole period examined; only among grandmothers whose grandchild was born prior to 1977 was a U-shaped association observed for circulatory disease mortality. There was a U-shaped association between birth weight of grandchildren and maternal grandfather's overall and circulatory disease mortality (quadratic term: HR = 1.05; 95% CI: 1.01-1.09). An inverse linear relationship was found for circulatory disease mortality in paternal grandmothers (HR = 0.93; 95% CI: 0.85-1.00). For paternal grandfathers there was an inverse association between grandchildren's birth weight and overall mortality; for circulatory disease mortality an effect was found only for grandfathers whose grandchild was born prior to 1977.
We showed, for the first time, associations between fetal growth in one generation and mortality in the previous two generations. Genetic and/or environmental pathways accounting for these associations should be further explored.
Comment In: Int J Epidemiol. 2010 Oct;39(5):1276-820591985
The lifestyle of schoolchildren in a large industrial town was studied in relation to the residence (industrial and administrative areas) and the type of an education establishment (general education schools and innovative education establishments). The spread of lifestyle defects (sleep and walk irregularities, inactivity, bad habits, employment) was shown to be higher in the schoolchildren living in the industrial areas, in general education school pupils in particular. That of lifestyle defects was higher in girls (sleep and diet irregularities, inactivity) than in boys. The findings provide evidence that there is a need for a differential approach to molding a healthy lifestyle in schoolchildren, by keeping in mind the environmental and socioeconomic situation of a residence, the type of an education establishment, age, and gender.
Exposure to methylmercury (MeHg) from fish and marine mammal consumption continues to present a public health concern. To date, developmental neurotoxicity is the most sensitive health outcome, forming the basis for health-risk assessments and the derivation of biomonitoring guidance values. This article summarizes existing Health Canada MeHg blood guidance values for general population and expands them to include a harmonized provisional interim blood guidance value of 8 microg/L based on the existing provisional Tolerable Daily Intake for children, pregnant women and women of childbearing age. Associated public health actions, according to age, sex, and level of exposure are recommended.
Schools are supposed to be places where children learn and thrive; not where they, teachers, and other staff get sick. The hazards are many but recognition of those hazards is hard to come by in schools in Canada and the United States. The result can be an uphill fight for school-based organizations and unions. Representatives of four such groups, two each from Canada and the United States, discuss the hazards and their effects. They also have many-often unrecognized-successes and related lessons to share. These include taking comprehensive approaches, looking for broad sweeps and entrees, using building sciences and strategies of solid information, acting with respect and with persistence, including students and parents, going for green cleaners, and using participatory methods. The representatives build on these to discuss what else needs to be done. The ideas are underpinned by the creativity, dedication, and persistence evident in their work to date.
Pesticides have been implicated as likely environmental risk factors for Parkinson disease (PD), but assessment of past exposure to pesticides can be difficult. No prior studies of pesticide exposure and PD used biomarkers of exposure collected before the onset of PD. Our investigation examined the association between prospective serum biomarkers of organochlorine pesticides and PD.
We conducted a nested case-control study within the Finnish Mobile Clinic Health Examination Survey, with serum samples collected during 1968-1972, and analyzed in 2005-2007 for organochlorine pesticides. Incident PD cases were identified through the Social Insurance Institution's nationwide registry and were confirmed by review of medical records (n = 101). Controls (n = 349) were matched for age, sex, municipality, and vital status. Adjusted odds ratios (ORs) of PD were estimated using logistic regression.
Little association emerged with a summary score of the 5 organochlorine pesticides found at high levels, and only increasing dieldrin concentrations trended toward a higher risk of PD (OR per interquartile range [IQR] 1.28, 95% confidence interval [CI] 0.97-1.69, p = 0.08). Because of possible strong confounding by cigarette smoking among smokers, we ran additional analyses restricted to never smokers (n = 68 cases, 183 controls). In these analyses, increasing dieldrin concentrations were associated with increased odds of PD (OR per IQR 1.95, 95% CI 1.26-3.02, p = 0.003). None of the other organochlorine pesticides were associated with PD in these analyses.
These results provide some support for an increased risk of Parkinson disease with exposure to dieldrin, but chance or exposure correlation with other less persistent pesticides could contribute to our findings.
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This paper is a report of an investigation into whether insecure work contract and shiftwork are associated with reduced wellbeing indicators, such as psychological distress, low job involvement and low work ability.
Insecure work contracts and shiftwork have repeatedly been found to contribute to the development and continuation of negative outcomes among healthcare professionals. In particular, nurses are generally considered as being at high risk of work-related stress and reduced wellbeing.
Cross-sectional survey data from the Finnish Health Care Professional Study collected in 2006 were used. The random sample of Finnish Registered Nurses comprised 2100 women and men aged 22-65 years. Information on the work contract and shiftwork were self-reported. The wellbeing indicators used were psychological distress (GHQ-12), work ability and job involvement. Psychosocial work characteristics were measured using the Job Content Questionnaire and an organizational justice scale.
Variance and linear regression analyses showed that insecure work contract was associated with lower work ability and job involvement. Shiftwork was related to psychological distress, low job involvement and low work ability. Support for a mediating role of job demands and job control and a moderating role of relational justice was obtained.
To reduce the negative effects of environmental stressors, such as insecure work contract and shiftwork, it may be better to focus on improving psychosocial work characteristics than on nurses' health-related behaviour.
Falls are a leading cause of occupational injury for workers in healthcare, yet the risk factors of falls in this sector are understudied. Falls resulting in workers' compensation for time-loss from work from 2004-2007 for healthcare workers in British Columbia (BC) were extracted from a standardised incident-reporting database. Productive hours were derived from payroll data for the denominator to produce injury rates; relative risks were derived through Poisson regression modelling. A total of 411 falls were accepted for time-loss compensation. Compared to registered nurses, facility support workers (risk ratio (95% CI) = 6.29 (4.56-8.69)) and community health workers (6.58 (3.76-11.50)) were at high risk for falls. Falls predominantly occurred outdoors, in patients' rooms and kitchens depending on occupation and sub-sector. Slippery surfaces due to icy conditions or liquid contaminants were a leading contributing factor. Falls were more frequent in the colder months (January-March). The risk of falls varies by nature of work, location and worker demographics. The findings of this research will be useful for developing evidence-based interventions. STATEMENT OF RELEVANCE: Falls are a major cause of occupational injury for healthcare workers. This study examined risk factors including occupation type, workplace design, work setting, work organisation and environmental conditions in a large healthcare worker population in BC, Canada. The findings of this research should contribute towards developing evidence-based interventions.
Vancouver's Downtown Eastside (DTES) has long been characterized as Canada's skid row within public narratives that raise concerns about communicable diseases, open drug use, survival sex work, and homelessness. This stigmatizing gaze has bolstered a deficit-oriented philosophy that emphasizes measures to mitigate these threats, ostensibly by erasing the moral and environmental depravity from the landscape. However, such measures threaten to further marginalize DTES residents by perpetuating public sentiments of fear and disgust toward the inner city. In this paper, we challenge this orientation by reporting the results of a research process in which DTES residents chronicled their impressions of the neighbourhood. Our findings reveal a paradoxical therapeutic response to environmental injustice in the inner city, one that enables society's most marginalized people to find support, solidarity, and acceptance in their everyday struggles to survive, even thrive, amidst the structural and physical violence of the urban margins.
To account for use of hearing protection devices (HPDs) in retrospective noise exposure assessment, adjust noise exposure estimates accordingly, and validate the adjusted estimates.
A previous study in the same working population showed a stronger relation for noise and acute myocardial infarction among those who did not wear HPD. Because accurate noise exposure assessment is complicated by the use of HPD, we previously developed a multilevel model of the likelihood of HPD use for British Columbia (Canada) lumber mill workers. Historical estimates of noise exposure can be adjusted according to models predictions and a reduction in misclassifying workers, exposure is expected.
Work history and exposure information were obtained for 13,147 lumber mill workers followed from 1909 until 1998. Audiometric data for the cohort, including hearing threshold levels at several pure tone frequencies, were obtained from the local regulatory agency for the period from 1978 to 2003. Following the modeling of HPD use, noise estimates were adjusted according to models predictions and attenuation factors based on existing research and standards. Adjusted and unadjusted noise metrics were compared by investigating their ability to predict noise-induced hearing loss.
We showed a 4-fold increase in the noise exposure and hearing loss slope, after adjusting for HPD use, while controlling for gender, age, race, as well as medical and non-occupational confounding variables.
While the relative difference before and after adjustment for use of HPD is considerable, we observed a subtle absolute magnitude of the effect. Using noise-induced hearing loss as a 'gold standard' for testing the assessment of retrospective noise exposure estimates should continue to be investigated.
This study examined the six-month prevalence, risk factors, and costs of falls in older people using home support services who are at risk of falling. Of the 109 participants, 70.6 per cent reported >or= one fall in the previous six months, and 27.5 per cent experienced multiple falls. Although there was no statistically significant difference in any fall-related risk factor between fallers (1+ falls) and non-fallers (0 falls), fallers had clinically important trends towards lower levels of physical, social, and psychological functioning. There was no statistically significant difference between fallers and non-fallers in the total per-person costs of use of health services in the previous six months; however, there were significant differences between groups in specific types of health services. The multivariate analysis revealed the presence of five risk factors for falls: neurological disorder (e.g., cognitive impairment, Parkinson's disease), age >or= 85 years, environmental hazards, previous slip or trip, and visual impairment.
We assessed which of a broad range of determinants of health are most strongly associated with health-related quality of life (HRQL) among people with type 2 diabetes.
Our analysis included respondents from the Canadian Community Health Survey Cycle 1.1 (2000-2001) who were aged 18 years and older and who were identified as having type 2 diabetes. We used regression analyses to assess the associations between the Health Utilities Index Mark 3 and determinants of health.
Comorbidities had the largest impact on HRQL, with stroke (-0.11; 95% confidence interval [CI] = -0.17, -0.06) and depression (-0.11; 95% CI = -0.15, -0.06) being associated with the largest deficits. Large differences in HRQL were observed for 2 markers of socioeconomic status: social assistance (-0.07; 95% CI=-0.12, -0.03) and food insecurity (-0.07; 95% CI=-0.10, -0.04). Stress, physical activity, and sense of belonging also were important determinants. Overall, 36% of the variance in the Health Utilities Index Mark 3 was explained.
Social and environmental factors are important, but comorbidities have the largest impact on HRQL among people with type 2 diabetes.
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The goal of this study was to evaluate the incidence of sensitization to the major molds found in peat dust in workers exposed to stored peat moss and the health impact of this sensitization. Air samples from each plant were obtained to measure the levels of airborne molds, bacteria, and dust. There were 189 workers from 14 peat moss processing plants (3 all-year mixing plants and 11 seasonal plants) recruited for the study. The subjects completed a symptoms questionnaire, underwent spirometric measurements and skin-prick tests, and gave venous blood samples. Blood samples from 43 nonexposed control subjects were also taken. A similar percentage of smokers from both plant types was observed. Twenty-eight percent of the workers tested had a positive serum reaction to at least one of the tested molds. The percentage of positive workers varied from plant to plant, going from none in 4 plants to 14 out of 21 for 1 plant. This variability was not correlated with the airborne levels of molds. FEV tended to be lower in the workers with positive antibodies compared with seronegative workers. IgG positive frequency was higher for those workers employed in the all-year plants, and workers from those plants had lower FEV/FVC than seasonal plant workers. Seasonal plants were more contaminated with molds than all-year mixing plants, suggesting that the duration of exposure may trigger more sensitization than the level of exposure. We conclude that there is a high incidence of mold sensitization in peat moss factory workers and that this sensitization may have a negative respiratory health impact.
Increased urinary calcium excretion commonly is found in patients with hypertension and kidney stone disease (KSD). This study investigated the aggregation of hypertension and KSD in families of patients with KSD and hypercalciuria and explored whether obesity, excessive weight gain, and diabetes, commonly related conditions, also aggregate in these families. Consecutive patients with KSD, aged 18 to 50 yr, were recruited from a population-based Kidney Stone Center, and a 24-h urine sample was collected. The first-degree relatives of eligible patients (n = 333) and their spouse were interviewed by telephone to collect demographic and health information. Familial aggregation was assessed using generalized estimating equations. Multivariate-adjusted odds ratios (OR) revealed significant associations between hypercalciuria in patients and hypertension (OR 2.9; 95% confidence interval 1.4 to 6.2) and KSD (OR 1.9; 95% confidence interval 1.03 to 3.5) in first-degree relatives, specifically in siblings. No significant associations were found in parents or spouses or in patients with hyperuricosuria. Similarly, no aggregation with other conditions was observed. In an independent study of siblings of hypercalciuric patients with KSD, the adjusted mean fasting urinary calcium/creatinine ratio was significantly higher in the hypertensive siblings compared with normotensive siblings (0.60 +/- 0.32 versus 0.46 +/- 0.28 mmol/mmol; P
The objective of this study was to assess respiratory outcomes and environmental exposure levels of workers in cage-housed and floor-housed poultry operations.
Poultry operations were evaluated for total dust, endotoxin, and ammonia, and respiratory symptoms and lung function tests of workers were conducted.
Workers in floor-housed poultry operations had significantly greater exposures to total dust and ammonia, whereas workers from cage-housed poultry operations reported greater frequency of current and chronic symptoms overall and significantly greater current and chronic phlegm (39% vs 18% and 40% vs 11%, respectively). Endotoxin concentration (EU/mg) was a significant predictor (P = 0.05) of chronic phlegm for all poultry workers.
Greater endotoxin concentration in the presence of significantly lower total dust, in conjunction with greater respiratory symptoms in workers from cage-housed poultry operations, as compared with workers from floor-housed poultry operations, appears to indicate that differences in environmental exposures may impact respiratory outcomes of workers.
The purposes of this study were to measure household food security and to determine its association with potential predictor variables related to household and community environments, as well as the relationship between household food insecurity and preschool children's nutritional status.
In this cross-sectional study, household food security was measured in a convenience sample of households (n=142) with children aged 2-5 years in Vancouver in March 2004. We assessed the association between environmental predictors and household food security status, adjusted for household income. Indicators of children's nutrition were compared between categories of household food security.
Household food insecurity was associated with indicators of suboptimal health status in preschoolers. After controlling for household income, parents with less access to food of reasonable quality, fewer kitchen appliances and a lower rating of their cooking skills had greater odds of experiencing household food insecurity.
Our study results support the need to test interventions involving collaborative efforts among government, social planners and public health practitioners to remove barriers to food security for families. Multiple measures, including opportunities to gain practical food skills and household resources that enable convenient preparation of nutrient-dense foods, could be examined. Our findings suggest the need for improved selection and quality at existing small stores and an increase in the number of food outlets in low-income neighbourhoods.
Gambling is a risky behaviour that involves uncertain financial outcomes, can be addictive, and has been associated with strongly adverse social and public health outcomes. We wanted to assess whether socio-economic and gambling-related-opportunity environments of neighbourhoods affected the uptake of video lottery terminal (VLT) gambling among Montréal youth.
Spatial and statistical analyses were conducted to examine geographical patterns of neighbourhood socio-economic conditions, VLT sites (n=407), and high school locations (n=305) within the Montréal Census Metropolitan Area (CMA). VLT concentration within high school neighbourhoods was measured to examine how the number of VLT opportunities varies according to socio-economic status of the school neighbourhood. A student survey was analyzed using logistic regression analysis to explore the role of individual (student) characteristics and environmental (neighbourhood) characteristics in predicting the VLT gambling behaviours reported among a sample (n=1206) of high school students.
Video lottery gambling opportunities are more prevalent near schools located in socio-economically deprived neighbourhoods compared with schools located in more affluent neighbourhoods. The principal individual risk factors for VLT gambling were shown to be male sex, peer VLT-use, substance use, as well as the after-school routines of youth.
The spatial distribution of VLTs reflects local geographies of socio-economic disadvantage and may have a pronounced impact on students attending schools in lower income neighbourhoods, especially those with individual risk factors. Efforts to reduce gambling-related public health costs may want to take into account the socio-spatial distribution of gambling opportunities, particularly in the local environments that youth frequent.
Circadian blood pressure profile (CBPP) is considered to be a functional characteristic of the cardiovascular system, which reflects the severity and pathogenetic peculiarities of arterial hypertension. At the same time, blood pressure dynamics also depends on the state of environmental factors, the heliogeophysical medium in particular, which plays an important part in the formation of northern ecology. The purpose of the study was to evaluate the peculiarities of the correlations between morphofunctional characteristics of the cardiovascular system, circadian blood pressure rhythms in particular, and heliogeophysical environmental factors under North conditions. The data of 24-hour blood pressure monitoring (BPM) and echoCG, and the heliogeophysical factors during different ontogenesis periods in 257 residents of North and medium latitudes with arterial hypertension (AH), were analyzed. A considerable disorder of CBPP, manifesting by an insufficient (less than 10%) night-time decrease in blood pressure, was revealed in 46% of the hypertensive subjects, who lived in North. The circadian rhythm amplitude was low in cases of a high degree of coupling of hemodynamic indices with geomagnetic activity during the study. The study did not reveal such CBPP disturbances in AH patients living in medium latitudes. Left ventricular hypertrophy was more frequent in patients with an insufficient night-time BP decrease vs. patients with a normal one (39.7% and 22.2%, respectively). A test allowing evaluation of the hemodynamic mechanisms of magnetotropic responses to changes in heliogeophysical environment, was developed. This diagnostic test uses EchoCG and testing exposure to constant magnetic field, and is based on evaluation of changes in central hemodynamics allowing for the balance of geomagnetic activity during early ontogenesis and during the study.