We sought to examine the association of false-positive mammography with depressed mood among women in a screening population. Using data from a state-based mammography registry, women who completed a standardized questionnaire between 7 May 2001 and 2 June 2003, a follow-up questionnaire between 19 June 2003 and 8 October 2004 and who received at least one screening mammogram during this interval were identified. False positives were examined in relation to depressed mood.

Eligibility criteria were met by 13 491 women with a median age of 63.9 (SD = 9.6). In the study population, 2107 (15.62%) experienced at least one false positive mammogram and 450 (3.34%) met criteria for depressed mood. Depressed mood was not significantly associated with false positives in the overall population [OR = 0.96; 95% confidence interval (CI) = 0.72–1.28], but this association was seen among Non-White women (OR = 3.23; 95% CI = 1.32–7.91).

Depressed mood may differentially affect some populations as a harm associated with screening mammography.

A prospective cohort study of 1551 men and women aged around 55 years in 1988 when typical alcohol consumption was recalled using a 7-day grid. An average of 3.4 years later (1990/92), study participants were re-surveyed (n = 1259; 84.7% of the target population) when they responded to nurse-administered enquiries regarding minor psychiatric morbidity, self-perceived health, hypertension, accidents, overweight/obesity and financial difficulties. Study members were followed up for mortality experience over 18 years.

In fully adjusted analyses, surpassing guidelines for sensible alcohol intake was associated with an increased risk of hypertension [daily guidelines only: P-value(trend): 0.012], financial problems [weekly guidelines: P-value(difference): 0.046] and, to a lesser degree, accidents [weekly guidelines: P-value(difference): 0.065]. There was no association between either indicator of alcohol intake and mortality risk.

In the present study, there was some evidence for a detrimental effect on health and social circumstances of exceeding current internationally recognized weekly and daily guidelines for alcohol intake on selected health and social outcomes.

Temporal patterns in BC incidence rates, lung cancer (LC) death rates, smoking prevalence and cigarette consumption across time by sex were analyzed by calculating annual percent changes (APCs), using joinpoint regression, for Spain (1973–97), Sweden (1958–97) and the UK (1960–97).

APCs for overall BC incidence rates were increasing for both sexes, ranging from 1.43% (1.25; 1.60) (British men) to 3.79% (3.15; 4.44) (Spanish men). APCs for overall LC death rates were also increasing in Sweden and Spain, but the UK showed decreasing APCs for LC death rates in men: –0.48% (–0.86; 0.10). Spain showed decreasing APCs for smoking prevalence among men and increasing APCs among women, –1.65% (–1.79; –1.51) and 2.48% (1.97; 3.00), respectively, but no differences by sex were found for the UK and Sweden.

Findings indirectly reflected lag-time of minimum 30 years between smoking and onset of BC. The lack of sex differences for APCs of BC across these countries suggests potential contributions of changes in other population exposure levels.

The 1999 and 2004 Health Survey for England included 996 Bangladeshi women aged 16 years and above, 302 with a valid saliva sample and 694 without. The main outcome measure was the prevalence of under-reported tobacco use.

Fifteen per cent of Bangladeshi women with a saliva sample under-reported their personal tobacco use. Under-reporters were very similar to self-reported users except for being much more likely to report chewing paan without tobacco (47% versus 9%, P < 0.001). Under-reporters differed significantly from cotinine-validated non-users in most respects. Regression analyses confirmed that under-reporters and self-reported users were similar in age, education level and exposure to passive smoking. Under-reporters were older and less educated than cotinine-validated non-users. Both self-reported users [odds ratio (OR): 0.11, 95% confidence interval (CI): 0.04–0.30] and cotinine-validated non-users (OR: 0.42, 95% CI: 0.20–0.89) were far less likely to report chewing paan without tobacco compared with under-reporters.

Contrary to our a priori hypothesis, under-reporters were not young, British-born, English-speaking women likely to be concealing smoking but resembled self-reported tobacco users except for being much more likely to report chewing paan without tobacco.

Semi-structured interviews and focus groups with 109 health, social care and voluntary staff from three London Boroughs.

Few frontline staff were aware of the Plan. Most respondents did not perceive heatwaves to be a sufficiently frequent event to require prioritization within their routine summer workloads. They highlighted the complexities associated with defining vulnerability and identifying vulnerable individuals as well as barriers to implementation of the Plan. Respondents suggested a multi-faceted approach to interventions including a public health campaign, community engagement and increasing the responsiveness of statutory services.

The issues highlighted could hinder effective implementation of the Heatwave Plan. Ensuring continuity of care so that timely information can be recorded and disseminated may address the problems associated with shifting vulnerability. Best practice with respect to inter-sectoral collaboration should be identified and innovative multi-faceted interventions should be designed and evaluated.

Hospital Episode Statistics were used to explore inequalities in the provision of primary hip/knee operations in English NHS hospitals in 2002. Multilevel Poisson regression modelling was used to estimate rates of surgical provision by socio-demographic, hospital and distance variables. GIS software was used to estimate road travel times and create hospital catchment areas.

Rates of joint replacement increased with age before falling in those aged 80+. Women received more operations than men. People living in the most deprived areas obtained fewer hip, but more knee operations. Those in urban areas received less hip surgery, but there was no association for knee replacement. Controlling for hospital and distance measures did not attenuate the effects. Geographical variation across districts was observed with some districts showing inequality in socio-demographic factors, whereas others showed none at all.

This study found evidence of inequalities in the provision of joint replacement surgery. However, before we can conclude that there is inequity in receipts of healthcare, future research must consider whether these patterns are explained by variations in need across socio-demographic groups.

Paper-based proformas were completed by TB nurses, and then analysed using EpiInfo/SAS statistical software.

Forty community contacts (11%) became cases, 45 (13%) were recommended chemoprophylaxis and 270 (76%) were discharged clear of infection. The highest transmission rate was among contacts exposed to two or more cases (29% became cases) and close contacts of sputum smear-positive cases (22%). Other risk factors were being male and exposure to drug-using cases or cases with prison links. The number needed to be screened (NNS) to detect one case was lowest [5 (95% CI: 4–8)] for contacts of sputum smear-positive pulmonary cases, although the NNS was still only 20 (95% CI:8–72) for casual contacts of smear-positive cases.

Transmission of disease to contacts was high (11%) compared with other documented outbreaks (0.7–2%). The results support recommended guidelines for contact tracing but also provide grounds to recommend, for outbreak cases, screening of casual contacts of smear-positive cases and contacts exposed to more than one case, drug users or prisoners.

In June 2005, a convenience sample of five countries was selected to evaluate the implementation of RED. Evaluation teams consisting of key partners conducted site visits to the national, district and health facility levels using standardized qualitative questionnaires.

RED was implemented in a similar manner in all five countries, i.e. starting with training and micro-planning. All RED components were implemented to some degree in the countries. Common implementation factors included development of plans, expanding outreach services (defined as services provided in sites outside fixed immunization sites), planning of supervisory visits and efforts to link with communities and utilize community volunteers. Monitoring tools such as wall charts and maps were observed and reportedly used.

Evaluation of the RED implementation process provided evidence of improvement in delivery of routine immunization services. The RED framework should continue to be used to strengthen the immunization delivery system to meet continuing new demands, such as the introduction of new vaccines and integrated delivery of other child survival interventions.

Two local channels and three national channels, during a period of 7 h on weekday afternoons and 6 h on weekend mornings, were recorded for 7 days. A total of 235 h were recorded and analyzed.

A total of 8299 advertisements were registered; 22% were food-related and 50% were geared toward children. The average of food-related advertisements (FRAs) per half an hour was 4, and half of them were geared toward children. During the time that children may be watching television, 50% of all FRAs were potato and corn chips, desserts and cakes, juices, sweetened cereals, candies, cookies, sweetened beverages and fast foods, which comprises a higher percentage of adult-oriented FRA (32 versus 22%).

Children are systematically more exposed than adults to advertisements for high-energy-dense foods.

We examined medical records of all patients 1 year of age or older admitted to a Hong Kong hospital between 2003 and 2008 with confirmed salmonellosis diagnosis. Data were collected on length of stay, age, sex, comorbidities, antibiotics and other medication use, diagnostic tests completed, serotype and susceptibility characteristics of isolated and the circumstances of discharge from hospital. We used Cox proportional regression to determine the differences in lengths of stay and quantile regression for differences in hospital costs.

Median duration of hospitalization among QR salmonellosis patients was 1 day (33%; 95% CI: 13–47%) longer than those with QS salmonellosis, adjusting for confounders. Adjusted median costs were US $399 (35%) and 75th percentile costs were US $760 (43%) higher in the QR group than those in the QS group, indicating a greater difference among sicker patients.

The finding of substantially longer stays and higher costs associated with QR indicates that interventions that decrease QR prevalence will lead to significant savings for the health system in the management of hospitalized salmonellosis cases.

In-depth phone interviews were conducted with 24 parents (4 males) of 10–11-year-old children recruited from six primary schools in Bristol.

Parents perceived that a lack of appropriate spaces in which to be active, safety, traffic, the proximity of friends and older children affected children's ability to be independently physically active. The final year of primary school was perceived as a period when children should be afforded increased licence. Parents managed physical activity licence by placing time limits on activity, restricting activity to close to home, only allowing activity in groups or under adult supervision.

Strategies are needed to build children's licence to be independently active; this could be achieved by developing parental self-efficacy to allow children to be active and developing structures such as safe routes to parks and safer play areas. Future programmes could make use of traffic-calming programmes as catalysts for safe independent physical activity.

Injury and illness data were collected prospectively in the longitudinal Cambridge study in delinquent development at age 43–48. Hypotheses were that childhood predictors of antisocial behaviour and offending and antisocial behaviour at ages up to 32 would be associated with poorer health at age 48.

Childhood and parental predictors of offending, self-reported delinquency at age 32 and convictions were significantly associated with death and disability by age 48. A model comprising three factors: any antisocial behaviour and any parental risk factor at age 8–10 and any antisocial behaviour at age 27–32 best discriminated death or disability. Two factors: conviction between ages 10–18 and any antisocial behaviour at age 8–10 discriminated almost as well.

Death and disability by age 48 were strongly associated with antisocial behaviour at ages 8–10 and 27–32, convictions and impulsivity during adolescence and parental predictors of offending at age 8–10. Preventing childhood and adolescent antisocial behaviour and offending may also prolong life and prevent disability among those who would otherwise offend.

We analyzed the LBW proportion of single live babies born to 2032 first-time mothers between 2004 and 2005. Data were analyzed using the chi-square test, analysis of variance, the Scheffe test and logistic regression.

About 14.8% of Aboriginal mothers and 18.7% of Aboriginal teen mothers gave birth to infants of LBW. Aboriginal mothers were found to be at higher risk of delivering LBW infants; however, after controlling for marital status and education, the influence of aboriginality and age was no longer significant.

Marital status and education are more important determinants of LBW than aboriginality and age in mountain townships of Taiwan.

Previous estimates of NHS costs attributable to alcohol consumption were identified by systematic literature review. The mortality and morbidity due to alcohol consumption was calculated using information from the World Health Organization Global Burden of Disease Project and routinely collected mortality data. Direct health-care costs were derived using information on population attributable fractions for conditions related to alcohol consumption and NHS cost data.

We estimate that alcohol consumption was responsible for 31 000 deaths in the UK in 2005 and that alcohol consumption cost the UK NHS £3.0 billion in 2005–06. Alcohol consumption was responsible for 10% of all disability adjusted life years in 2002 (male: 15%; female: 4%) in the UK.

Alcohol consumption is a considerable public health burden in the UK. The comparison of the health and economic burden of various lifestyle factors is essential in prioritizing and resourcing public health action.

We conducted a retrospective analysis of the General Internal Medicine (GIM) inpatient service at our institution for years 2005 and 2006, which included 5088 patients under GIM care.

Weekend discharge rate was more than 50% lower compared with reference rates whereas Friday rates were 24% higher. Holiday Monday discharge rates were 65% lower than regular Mondays, with an increase in pre-holiday discharge rates. Teams that were on-call or that were on call the next day had 15% higher discharge rates compared with reference whereas teams that were post-call had 20% lower rates. Individual attending physicians and length of attending coverage contributed small variations in discharge rates. Resident scheduling was not a significant predictor of discharge rates.

Day of the week and holidays followed by team organization and scheduling are significant predictors of daily variation in discharge rates. Introducing greater holiday and weekend capacity as well as reorganizing internal processes such as admitting and attending schedules may potentially optimize discharge rates.

A cross-sectional study among 120 patients was conducted in two primary health-care centers. The test of functional health literacy in adults, a 50-item reading comprehension and 17-item numerical ability test (score, 0–100) were administered. Chi-square test and logistic regression analyses were applied.

Inadequate and marginal health literacy existed in 43 participants (41.0%), and adequate health literacy was present in 62 participants (59.0%). Functional health literacy was significantly different by location, gender, age, marital status, employment, education, material status, self-perception of health and presence of chronic conditions. Based on the multivariate analysis, health literacy was significantly associated with the participant's age (odds ratio [OR], 4.86; 95% confidence interval [CI], 2.41–9.80; P = 0.000), level of education (OR, 4.48; 95% CI, 1.73–11.57; P = 0.002) and chronic conditions (OR, 1.90; 95% CI, 1.16–3.11; P = 0.010).

These results provide evidence that limitations in functional health literacy are widespread among primary health-care patients and encourage efforts for further monitoring. Low health literacy may impair a patient's understanding of health messages and limit their ability to attend to their medical problems.

We demonstrate the possibility of creating anonymous links between individual residences and the local environment using digital map data and a data linkage system.

Digital map data were used successfully to anonymously link 1.3 million addresses to the local environment. The data linkage system allows detailed environment data surrounding each residence to be linked both to each resident therein and to their medical records.

Local environment data specific to each house can be effectively and anonymously linked to the population registered with the National Health Service. Our integrated approach potentially enables flexible fine-scale, large-area observational studies of communities and health.

Prevalence ratios were calculated for 3740 children aged 1–59 months from 92 randomly selected villages of rural Pakistan using a cluster-adjusted log-binomial model. Level 1 variables included child and household characteristics and level 2 included village characteristics.

There were 25 more girl deaths than boys per 1000 live births (95% CI: 13.9, 48.6) among post-neonates and 38 more among children aged 12–59 months (95% CI: 10.5, 65.5). However, in adjusted analysis, gender was not a significant predictor of illness reporting, visit to health facilities, choice of provider, hospitalization and health expenditure. Significant predictors of health care were child's age, illness characteristics, number of children in the family, household socio-economic status and absence of girls' school in the village.

Differential care seeking for boys and girls is not seen in Thatta despite clear differences in mortality ratios. This calls for more creative research to identify pathways for gender differential in child mortality. Factors identified as influencing child health care and amenable to modification include poverty alleviation and girls' education.

We evaluate the effect of keeping all encounters as compared with removing repeat encounters. Using the prospective space–time permutation scan statistic, we performed daily analyses on all encounters versus on episodes defined as encounters new within 2, 6 or 12 weeks. Data were taken from a Massachusetts Health Maintenance Organization (HMO) for the calendar year 1999 for four different syndromes.

We found extensive disagreement in the number of signals detected: 70, 68, 21 and 15 signals when using all encounters versus 15–20, 3, 4–5 and 0 signals when using only new episodes for lower respiratory, lower gastrointestinal, upper gastrointestinal and neurologic syndromes, respectively.

Using all encounters in syndromic surveillance may not only create too many signals but may also miss some signals by masking the anomalies generated by actual episodes. However, it is also possible to miss signals when using episodes.

Qualitative interviews of poultry farmers, retailers, market stall holders and consumers in Hong Kong (n = 20), Guangzhou (n = 25), Vietnam (n = 38) and Thailand (n = 40) were conducted using purposive sampling and analysed using ethnographic principles.

Each location produced three comparable themes: ‘viruses’: HPAI exemplified a periodic, natural, disease process therefore, deserving little concern. For some, science had ‘discovered’ something long known to farmers and lived with for generations. Others believe the virus to be new. Viral ecology was reasonably well understood among farmers, but less so by retailers and consumers; ‘husbandry practices’ included poor hygiene, overcrowding and industrial farming, modern commercial feed and veterinary drugs; ‘vulnerability factors’ included uncontrollable ‘external’ explanations involving the weather, seasonal changes, bird migrations and pollution.

Lay explanations were generally ecologically consistent. Nonetheless, beliefs that HPAI is a normal, recurrent process, external factors and roles of industrialized poultry rearing countered health worker claims of H5N1 seriousness for smallholders. These causal beliefs incorporate contemporary models of H5N1 ecology, but in a manner that contradicts public health efforts at control.

Data from the Trent Cancer Registry were used to identify all women with invasive breast cancer, diagnosed in 1998–2006. Risk of diagnosis with late-stage breast cancer was calculated to quantify strength of association between exposure and outcome.

Women outside the age group for routine screening were approximately 30% [<50 years, relative risk (RR) = 1.34 (95% confidence interval, CI: 1.26–1.43) and >70 years, RR = 1.27 (95% CI: 1.19–1.36)] more likely to be diagnosed with late-stage breast cancer; the most deprived women were 37% [RR = 1.37 (95% CI: 1.01–2.56)] more likely to be diagnosed with Stage IV breast cancer; ethnic minority women were 15% [RR = 1.15 (95% CI: 1.09–1.22)] more likely to be diagnosed with late-stage breast cancer and women resident in 5 of 11 Trent Primary Care Trusts (PCT) had a greater than 30% increased risk of diagnosis with late-stage breast cancer than those in Nottingham City PCT.

These findings highlight the need for appropriate targeted interventions to address compositional and contextual inequalities that are evident in breast cancer stage at diagnosis.

An observational study compared the accuracy of needs identification in samples of older people before and after SAP introduction. Participants, at risk of entering care homes, were interviewed using standardized measures. Needs elicited from interviews were compared with those from statutory social services assessments to ascertain the reliability of needs identification at both times. Inter-rater reliabilities were calculated using the kappa (k) statistic. A Chi-squared statistic tested the equality of kappa values pre- and post-SAP.

Most needs were identified more reliably after SAP introduction (range adjusted k = 0.05–0.58) than before (range adjusted k = –0.09 to 0.28), this being statistically significant for 9 out of 15 needs. Depression, and associated apathy, was an exception.

Statutory social services assessments better captured need following the introduction of the SAP. However, the extent to which these findings can be attributed to SAP introduction is limited by the introduction of multiple policy initiatives throughout the study period.

Review of official policies, supplemented with observation of practice and interviews with key informants (potential and actual donors and health workers) in Guizhou province in Southern China.

Interviewees perceived the transfusion system as a mutual social contract. However, some individuals were unwilling to donate because of concerns about health risks, the idea of transferring blood between people, wastage or profits being made from blood. Inappropriate incentives, including cash, were used to encourage donation. Recent reforms have increased confidence in donation and transfusion safety although concerns persist about misuse. There is a need to reduce unnecessary use of blood and its products.

China still relies heavily on blood supplies obtained through quota, purchase or use of incentives. There is scope to expand voluntary donation further. However, as a priority it will be necessary to reduce overuse.

Survey data were collected from a sample of 1294 adolescents 13–20 years of age—from three under-privileged suburbs of Beirut, Lebanon. Scores were calculated to measure the knowledge of and the perceived susceptibility by a series of statements related to the consequences of tobacco use. Bivariate and multivariate methods were used to assess the association of knowledge and perceived susceptibility with smoking, controlling for socio-demographic variables.

A logistic regression model showed that the odds of ever smoking among adolescents who had less knowledge of smoking were 1.9 times those of adolescents with more knowledge. Similar odds were demonstrated for adolescents who did not perceive themselves susceptible to smoking hazards compared with those who did.

These results suggest that awareness campaigns should focus on raising the perceived susceptibility of adolescents by including items that are more within the realm of an adolescent's frame of mind such as smelly clothes and discolored teeth.

Using hospital episode statistics (HES) data for men and women in England, the annual percentages of open and laparoscopic resections for colorectal cancer were calculated between 1997 and 2007.

A total of 182 191 patient spells containing a diagnosis of colorectal cancer plus either a procedure code for surgical resection of the large bowel and/or a laparoscopic procedure were identified: 177 537 (97.4%) were for open resection; 4193 (2.3%) for laparoscopic surgery; and for 461 (0.3%) the procedure was unclear. The annual number of open procedures performed remained stable, whereas the numbers of laparoscopic resections increased steadily.

Despite NICE guidance in 2000 recommending open surgery for colorectal cancer, there was a continuous increase in the laparoscopic approach in England, starting 3 years before the modified guidance supporting this technique. Whether NICE guidance was an effective deterrent and the guidelines protected patients cannot be determined from this retrospective study, but a similar staged approach for the adoption of other complex laparoscopic procedures is recommended.

The study reviewed 58 etoricoxib published trials (54 papers) to determine if they met the gender recommendations of the Guidelines of Food and Drug Administration (1993) and the Sex, Gender and Pain Special Interest Group Consensus Working Group Report (2007).

Women formed 70% of a total of 49 835 subjects included in the etoricoxib trials, but only 31% of the subjects were in Phase I. About 85.7% of trials did not show sex-stratified data. About 90.6 and 93.3% did not provide efficacy and adverse effects data by sex, respectively. There is scarce information about the influence of issues that specifically affect women.

Women are under-represented in the published etoricoxib trials, specifically, in Phase I. Sex-stratified data on efficacy and adverse effects are scarce in etoricoxib trials. Together with the lack of data on women-specific issues, this suggests that etoricoxib may pose the same potential problems for women as other cyclooxygenase-2 inhibitors.

We estimated the EQ-5D scores for respondents from the 2000–2003 Behavioral Risk Factor Surveillance System. We calculated QALYs and QALE lost to morbidity due to obesity/overweight, smoking, low income and chronic diseases.

The mean EQ-5D score for US adults was 0.870. The mean scores ranged from 0.826 (West Virginia) to 0.902 (Hawaii). Smoking contributed from 5.6 (Utah) to 12.3 (Kentucky) percent, obesity/overweight 5.4 (South Dakota) to 13.8 (Louisiana) percent, low income 16.6 (Hawaii) to 39.9 (South Carolina) percent and chronic diseases 8.7 (Minnesota) to 22.9 (Tennessee) percent of explainable QALYs lost. These risks contributed the greatest proportion of explainable QALYs and QALE lost in Kentucky, Tennessee and South Carolina.

We estimated the burden of disease contributed by selected risk factors. Currently, such data are unavailable but are needed to set targets for reducing modifiable health risks and eliminating health disparities among at-risk populations.

Data were collected from a random sample of 4046 Chinese aged 60 years and older in Zhejiang province. Based on the Andersen-Newman service utilization framework, multivariable logistic regression analysis was used to determine independent effects of these variables on the likelihood of having an unmet need for hospitalization service.

Overall, the prevalence of unmet need was 16.2% for hospitalization service. Among predisposing factors, only educational level was statistically significant. Individuals with higher education were less likely to report unmet needs. Among enabling factors, residential area, social support, personal yearly income and personal healthcare expenditure were strongly associated with the presence of unmet need. Those with less enabling resources (e.g. residing in rural areas) were more likely to report unmet need [Odds ratio (OR) = 1.5–6.5]. All the need factors, except for physical function, were strongly associated with the presence of unmet need. Seniors in poorer health (e.g. in fair or poor health) were more likely to report unmet need than their counterparts in better health (OR = 1.5–2.8).

In spite of relatively high insurance coverage rates, unmet need for hospitalization service remains high among the elderly people of Zhejiang province in China. Application of comprehensive intervention strategies such as conducting health education, creating social support, promoting community participation and promoting inter-sectional cooperation may be more effective in reducing unmet need for hospitalization service.