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1.  Peak flow rate and death due to coronary heart disease: 30-year results from the Northwick Park Heart cohort study 
Open Heart  2014;1(1):e000164.
Objective
Numerous studies have reported that chronic obstructive pulmonary disease or impaired lung function are associated with later coronary heart disease (CHD). However, it is unclear if lung function is an independent risk factor, as many of these studies have included only limited measures of other factors associated with CHD.
Methods
In total 2167 men of all ages in the first Northwick Park Heart Study were followed for a median of 30 years. Cox regression models were used to assess the relationship between peak flow rate (PFR) and CHD mortality adjusted for potential confounders measured at baseline. Analyses allowed for missing data, and secondary analyses for repeat measures on some men and competing risks of CHD death.
Results
There were 254 CHD deaths with some evidence of an association between PFR and CHD mortality. The adjusted HRs (95% CIs) from the lowest to the highest of four PFR quartiles were 1.53 (1.04 to 2.25), <430 L/min; 1.43 (0.99 to 2.08), 430 – <490 L/min; and 1.31 (0.93 to 1.86), 490 – <550 L/min; compared with the reference group of ≥550 L/min (trend test p=0.025). Other associations with CHD mortality were observed for systolic blood pressure (p<0.0001), body mass index (p=0.0002), smoking status (p=0.015), blood cholesterol (p=0.005), plasma fibrinogen (p=0.001) and high-risk ECG (p=0.021). There were no strong associations for factors V and VIII or platelet count.
Conclusions
After allowing for a range of other risk factors associated with CHD, there was only limited evidence of a relation between PFR and CHD mortality.
doi:10.1136/openhrt-2014-000164
PMCID: PMC4195218  PMID: 25332831
2.  Rich micronutrient fortification of locally produced infant food does not improve mental and motor development of Zambian infants: a randomised controlled trial 
The British journal of nutrition  2011;107(4):556-566.
It is uncertain whether multiple micronutrients benefit the mental and psychomotor development of young children in developing countries. We conducted a randomised double-blind controlled trial to evaluate the effect of a richly micronutrient-fortified v. a basal fortified porridge on mental and psychomotor development in Zambian infants. Infants (n 743) were randomised at age 6 months to receive either the richly fortified or the basal fortified infant food and were followed up until 18 months of age. All the infants were evaluated monthly for achievement of a series of developmental milestones. The Bayley scales of infant development II were administered to a subsample of 502 infants at 6, 12 and 18 months. Rich micronutrient fortification had no significant benefit on the following: (a) number of developmental milestones achieved (rate ratio at 12 months = 1·00; 95 % CI 0·96, 1·05; P=0·81, adjusted for sex, socio-economic status and maternal education, with similar results at 15 and 18 months); (b) ages of walking unsupported (hazard ratio (HR) 1·04; 95 % CI 0·88, 1·24; P=0·63, adjusted for the above covariates) and of speaking three or four clear words (HR 1·01; 95 % CI 0·84, 1·20; P=0·94, adjusted for the above covariates); (c) mental development index (MDI) and psychomotor development index (PDI) of the Bayley scales (scores difference adjusted for baseline scores, age at the assessment, sex, socio-economic status, maternal education, language, age and HIV status: MDI 0·3 (95 % CI −0·5, 1·1), P=0·43; PDI −0·1 (95 % CI −0·9, 0·7), P=0·78). In conclusion, the results do not support the hypothesis that rich micronutrient fortification improves Zambian infants’ mental and motor development.
doi:10.1017/S0007114511003217
PMCID: PMC3787297  PMID: 21733297
Micronutrient-fortified food; Mental and psychomotor development; Bayley scales of infant development; Developmental milestones
3.  Alcohol-Related Dysfunction in Working-Age Men in Izhevsk, Russia: An Application of Structural Equation Models to Study the Association with Education 
PLoS ONE  2013;8(5):e63792.
Background
Acute alcohol-related dysfunctional behaviours, such as hangover, are predictive of poor health and mortality. Although much is known about the association of education with alcohol consumption, little is known about its association with these dysfunctional behaviours.
Methods
The study population was 1,705 male drinkers aged 25–54 years resident in the city of Izhevsk, Russia who participated in a cross-sectional survey (2003–6). Structural equation modelling was used to examine the relationships between education, beverage and non-beverage alcohol intake, drinking patterns, and acute alcohol-related dysfunction score among these drinkers.
Results
Dysfunction was related to all other drinking variables, with the strongest predictors being spirit intake, non-beverage alcohol consumption and drinking patterns. There was a strong relationship between education and acute dysfunction which was not explained by adjusting for alcohol intake and drinking patterns (mean adjusted dysfunction score 0.35 SD (95% CI 0.10, 0.61) lower in men with higher versus secondary education).
Conclusions
Although by definition one or more aspects of alcohol consumption should explain the educational differences in alcohol-related dysfunction, detailed information on drinking only partly accounted for the observed patterns. Thus beyond their intrinsic interest, these results illustrate the challenges in constructing statistical models that convincingly identify the pathways that link educational differences to health-related outcomes.
doi:10.1371/journal.pone.0063792
PMCID: PMC3648513  PMID: 23667673
4.  Social origin, schooling and individual change in intelligence during childhood influence long-term mortality: a 68-year follow-up study 
Background Intelligence at a single time-point has been linked to health outcomes. An individual's IQ increases with longer schooling, but the validity of such increase is unclear. In this study, we assess the hypothesis that individual change in the performance on IQ tests between ages 10 and 20 years is associated with mortality later in life.
Methods The analyses are based on a cohort of Swedish boys born in 1928 (n = 610) for whom social background data were collected in 1937, IQ tests were carried out in 1938 and 1948 and own education and mortality were recorded up to 2006. Structural equation models were used to estimate the extent to which two latent intelligence scores, at ages 10 and 20 years, manifested by results on the IQ tests, are related to paternal and own education, and how all these variables are linked to all-cause mortality.
Results Intelligence at the age of 20 years was associated with lower mortality in adulthood, after controlling for intelligence at the age of 10 years. The increases in intelligence partly mediated the link between longer schooling and lower mortality. Social background differences in adult intelligence (and consequently in mortality) were partly explained by the tendency for sons of more educated fathers to receive longer schooling, even when initial intelligence levels had been accounted for.
Conclusions The results are consistent with a causal link from change in intelligence to mortality, and further, that schooling-induced changes in IQ scores are true and bring about lasting changes in intelligence. In addition, if both these interpretations are correct, social differences in access to longer schooling have consequences for social differences in both adult intelligence and adult health.
doi:10.1093/ije/dyr139
PMCID: PMC3324451  PMID: 22493324
Intelligence; socioeconomic factors; public health; mortality; child; adolescent; child development; parents
5.  Years of sunlight exposure and cataract: a case-control study in a Mediterranean population 
BMC Ophthalmology  2007;7:18.
Background
We aimed to investigate the relation between sunlight exposure and risk of cataract.
Methods
We carried out a frequency-matched case-control study of 343 cases and 334 controls attending an ophthalmology outpatient clinic at a primary health-care center in a small town near Valencia, Spain.
All cases were diagnosed as having a cataract in at least one eye based on the Lens Opacification Classification system (LOCS II). Controls had no opacities in either eye. All cases and controls were interviewed for information on outdoor exposure, "usual" diet, history of severe episodes of diarrhea illness, life-style factors and medical and socio-demographic variables. Blood antioxidant vitamin levels were also analyzed. We used logistic regression models to estimate sex and age-adjusted odds ratios (ORs) by quintiles of years of occupational outdoor exposure, adjusting for potential confounders such as smoking, alcohol consumption, serum antioxidants and education.
Results
No association was found between years of outdoor exposure and risk of cataract. However, exploratory analyses suggested a positive association between years of outdoor exposure at younger ages and risk of nuclear cataract later in life.
Conclusion
Our study does not support an association with cataract and sunlight exposure over adult life.
doi:10.1186/1471-2415-7-18
PMCID: PMC2234085  PMID: 18039367
6.  The cognitive cost of being a twin: evidence from comparisons within families in the Aberdeen children of the 1950s cohort study 
BMJ : British Medical Journal  2005;331(7528):1306.
Objectives To determine whether twins have lower IQ scores in childhood than singletons in the same family and, if so, whether differences in fetal growth explain this deficit.
Design Cohort study.
Setting Scotland.
Participants 9832 singletons and 236 twins born in Aberdeen between 1950 and 1956.
Results At age 7, the mean IQ score of twins was 5.3 points lower (95% confidence interval 1.5 to 9.1) and at age 9, 6.0 points lower (1.7 to 10.2) than that of singletons in the same family. Adjustment for sex, mother's age, and number of older siblings had little effect on these differences. Further adjustment for birth weight and gestational age attenuated the IQ difference between twins and singletons: the difference in mean IQ was 2.6 points (-1.5 to 6.7) at age 7 and 4.1 points (-0.5 to 8.8) at age 9.
Conclusions Twins have substantially lower IQ in childhood than singletons in the same family. This effect cannot be explained by confounding due to socioeconomic, maternal, or other family characteristics, or by recruitment bias. The reduced prenatal growth and shorter gestations of twins may explain an important part of their lower IQ in childhood.
doi:10.1136/bmj.38633.594387.3A
PMCID: PMC1298851  PMID: 16299014
7.  Issues in the reporting of epidemiological studies: a survey of recent practice 
BMJ : British Medical Journal  2004;329(7471):883.
Objectives To review current practice in the analysis and reporting of epidemiological research and to identify limitations.
Design Examination of articles published in January 2001 that investigated associations between risk factors/exposure variables and disease events/measures in individuals.
Setting Eligible English language journals including all major epidemiological journals, all major general medical journals, and the two leading journals in cardiovascular disease and cancer.
Main outcome measure Each article was evaluated with a standard proforma.
Results We found 73 articles in observational epidemiology; most were either cohort or case-control studies. Most studies looked at cancer and cardiovascular disease, even after we excluded specialty journals. Quantitative exposure variables predominated, which were mostly analysed as ordered categories but with little consistency or explanation regarding choice of categories. Sample selection, participant refusal, and data quality received insufficient attention in many articles. Statistical analyses commonly used odds ratios (38 articles) and hazard/rate ratios (23), with some inconsistent use of terminology. Confidence intervals were reported in most studies (68), though use of P values was less common (38). Few articles explained their choice of confounding variables; many performed subgroup analyses claiming an effect modifier, though interaction tests were rare. Several investigated multiple associations between exposure and outcome, increasing the likelihood of false positive claims. There was evidence of publication bias.
Conclusions This survey raises concerns regarding inadequacies in the analysis and reporting of epidemiological publications in mainstream journals.
doi:10.1136/bmj.38250.571088.55
PMCID: PMC523109  PMID: 15469946
8.  Gestational-age-specific reference ranges for blood pressure in pregnancy: findings from a prospective cohort 
Journal of Hypertension  2014;33(1):96-105.
Objective:
Pregnancy is a period of considerable change in blood pressure, with an early pregnancy decrease followed by a late pregnancy rise. High blood pressure in pregnancy is associated with adverse perinatal outcomes for the mother and offspring. We aimed to define normal ranges of blood pressure across gestation.
Methods:
We used repeated antenatal blood pressure measurements [median (interquartile range) 10 (9–11) per woman] for 10 327 women. Multilevel models were used to derive longitudinal reference ranges for SBP and DBP from 12 to 40 weeks gestation for the whole cohort, for women with normal pregnancies (without essential hypertension or preeclampsia who delivered an appropriate-size-for-gestational age infant at term) and for subgroups of normal pregnancies defined by different levels of maternal prepregnancy BMI, smoking and parity.
Results:
In normal pregnancies, the mean (95% reference range) SBP and DBP for nulliparous women at 12 weeks gestation were 112.1 (88.6–135.5) and 65.4 (48.9–81.9) mmHg, and at 37 weeks were 116.0 (92.3–139.7) and 70.0 (52.2–87.9) mmHg, respectively. For every additional 10 mmHg of blood pressure at 12 weeks, normal ranges were 2–3 mmHg higher across gestation. Reference ranges for multiparous women were 1–2 mmHg lower throughout pregnancy. Stratified reference ranges were higher for women in higher prepregnancy BMI categories, and lower for smokers than for nonsmokers throughout pregnancy.
Conclusion:
Normal ranges for blood pressure vary with gestation age and by maternal subgroups. Whole population and stratified normograms could be used as a reference to identify abnormal trajectories.
doi:10.1097/HJH.0000000000000368
PMCID: PMC4255761  PMID: 25255393
Avon Longitudinal Study of Parents and Children; blood pressure; longitudinal; pregnancy; reference range

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