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1.  Childhood adversities and adult-onset asthma: a cohort study 
BMJ Open  2012;2(5):e001625.
Objectives
Childhood adversities may be important determinants of later illnesses and poor health behaviour. However, large-scale prospective studies on the associations between childhood adversities and the onset of asthma in adulthood are lacking.
Design
Prospective cohort study with 7-year follow-up.
Setting
Nationally representative study. Data were collected from the Health and Social Support (HeSSup) survey and national registers.
Participants
The participants represent the Finnish population from the following age groups: 20–24, 30–34, 40–44, and 50–54 years at baseline in 1998 (24 057 survey participants formed the final cohort of this study). The occurrence of childhood adversities was assessed at baseline with a six-item survey scale. The analyses were adjusted for sociodemographic characteristics, behavioural health risks and common mental disorders.
Primary and secondary outcomes
The survey data were linked to data from national health registers on incident asthma during a 7-year follow-up to define new-onset asthma cases with verified diagnoses.
Results
A total of 12 126 (59%) participants reported that they encountered a childhood adversity. Of them 3677 (18% of all) endured three to six adversities. During a follow-up of 7 years, 593 (2.9%) participants were diagnosed with incident asthma. Those who reported three or more childhood adversities had a 1.6-fold (95% CI 1.31 to 2.01) greater risk of asthma compared to those without childhood adversities. This hazard attenuated but remained statistically significant after adjustment for conventional risk factors (HR 1.33; 95% CI 1.06 to 1.67).
Conclusions
Adults who report having encountered adversities in childhood may have an increased risk of developing asthma.
doi:10.1136/bmjopen-2012-001625
PMCID: PMC3488721  PMID: 23069774
Psychiatry; Epidemiology
2.  Non-response in a nationwide follow-up postal survey in Finland: a register-based mortality analysis of respondents and non-respondents of the Health and Social Support (HeSSup) Study 
BMJ Open  2012;2(2):e000657.
Objective
To examine difference in mortality between postal survey non-respondents and respondents.
Design
A prospective cohort study with baseline survey in 1998 and comprehensive linkage to national mortality registers until 2005, the Health and Social Support study.
Setting
A population-based postal survey of the working-aged population in Finland in 1998.
Participants
The original random sample comprised 64 797 working-aged individuals in Finland (20–24, 30–34, 40–44, 50–54 years of age; 32 059 women and 32 716 men), yielding 25 898 (40.0%) responses in the baseline postal survey in 1998.
Primary outcome measure
Registry-based primary causes of death encoded with the International Classification of Diseases (ICD-10).
Results
In women, HR for total mortality was 1.75 (95% CI 1.40 to 2.19) times higher among the non-respondents compared with the respondents. In men, non-response was associated with a 1.41-fold (1.21–1.65) excess risk of total mortality. Non-response associated in certain age groups with deaths due to diseases in women and with deaths due to external causes in men. The most prominent excess mortality was seen for total mortality for both genders and for mortality due to external causes among men.
Conclusions
Postal surveys result in slight underestimation of illness prevalence.
Article summary
Article focus
Women and individuals from upper social strata tend to participate more actively in postal health surveys.
What this exactly means in terms of health selection among respondents is unclear.
Postal health surveys are believed to produce underestimates of illness prevalence.
Key messages
Total mortality was consistently and for women in the age group ≥50 years and for men in the age groups ≥40 years significantly higher among non-respondents compared with respondents during a 7-year follow-up among a total Finnish nationwide sample in working age comprising almost 65 000 individuals.
The excess mortality observed was 1.5–2 fold. Among men, it was explained by external causes, whereas among women, it was due to diseases and was statistically significant only in the age group 50–54 years.
Postal surveys result in slight underestimation of illness prevalence.
Strengths and limitations of the study
The linkage to mortality data was successful for virtually all individuals of the original sample comprising nearly 65 000 individuals. The sample size secures the reliability of the conclusions drawn. Furthermore, the registry data on mortality in Finland can be considered as reliable. To the best of the authors' knowledge, a corresponding study based on an as large a sample as in this study has not previously been carried out.
Some inaccuracy concerning the final diagnosis of death is possible. A further study limitation is that data of socioeconomic status or educational level of non-respondents were not available, and hence, adjustments of the statistical analyses for these variables were not possible.
doi:10.1136/bmjopen-2011-000657
PMCID: PMC3307122  PMID: 22422917
3.  Change in physical activity and weight in relation to retirement: the French GAZEL Cohort Study 
BMJ Open  2012;2(1):e000522.
Objectives
To examine the trajectories of physical activity from preretirement to postretirement and to further clarify whether the changes in physical activity are associated with changes in body weight.
Design
Prospective.
Setting
French national gas and electricity company (GAZEL cohort).
Participants
From the original sample of 20 625 employees, only those retiring between 2001 and 2008 on a statutory basis were selected for the analyses (analysis 1: n=2711, 63% men; analysis 2: n=3812, 75% men). Persons with data on at least one preretirement and postretirement measurement of the outcome were selected.
Primary and secondary outcome measures
All outcome data were gathered by questionnaires. In analysis 1, the annual prevalence of higher physical activity (walking ≥5 km/week) 4 years before and after retirement was analysed. In analysis 2, changes in leisure-time sport activities (engagement, frequency and manner) from preretirement to postretirement were analysed with simultaneous changes in body weight (kilogram).
Results
In analysis 1 (n=2711), prevalence estimates for 4 years before and 4 years after retirement showed that higher leisure-time physical activity (walking at least 5 km/week) increased by 36% in men and 61% in women during the transition to retirement. This increase was also observed among people at a higher risk of physical inactivity, such as smokers and those with elevated depressive symptoms. In a separate sample (analysis 2, n=3812), change in weight as a function of preretirement and postretirement physical activity was analysed. Weight gain preretirement to postretirement was 0.85 (95% CI 0.48 to 1.21) to 1.35 (0.79 to 1.90) kg greater among physically inactive persons (decrease in activity or inactive) compared with those physically active (p<0.001).
Conclusions
Retirement transition may be associated with beneficial changes in lifestyle and may thus be a good starting point to preventive interventions in various groups of individuals in order to maintain long-term changes.
Article summary
Article focus
The main focus of this article was to examine whether statutory retirement is associated with changes in physical activity.
Especially, we wanted to clarify what happens during the actual retirement transition (ie, the year of retirement ±1 year).
Furthermore, we examined whether there were changes in body weight as a function of preretirement and postretirement physical activity level.
Key messages
We were able to show that during a 9-year follow-up physical activity increased most during the retirement transition, both in men and women.
Beneficial changes were noticed also among those usually considered as low physical activity groups, such as smokers.
Physically inactive persons were most prone to gain weight during the follow-up.
Strengths and limitations of this study
The main strength of this study was yearly measurements of the outcome, which enabled us to get accurate estimates of physical activity during the actual retirement transition.
Large and stable occupational cohort, prospective study design, accurate register-based data on retirement and long follow-up both preretirement and postretirement were other strengths of this study.
The main limitation was the use of self-report data of the outcome.
doi:10.1136/bmjopen-2011-000522
PMCID: PMC3277904  PMID: 22318663
Body weight changes; exercise; longitudinal studies; retirement

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