PurposeThe Warwick–Edinburgh Mental Well-being Scale (WEMWBS), 14 positively worded statements, is a validated instrument to measure mental wellbeing on a population level. Less is known about the population distribution of the shorter seven-item version (SWEMWBS) or its performance as an instrument to measure wellbeing.MethodsUsing the Health Survey for England 2010–2013 (n = 27,169 adults aged 16+, nationally representative of the population), age- and sex-specific norms were estimated using means and percentiles. Criterion validity was examined using: (1) Spearman correlations (ρ) for SWEMWBS with General Health Questionnaire (GHQ-12), happiness index, EQ-VAS (2) a multinomial logit model with SWEMWBS (low, medium and high wellbeing) as the outcome and demographic, social and health behaviours as explanatory variables. Relative validity was examined by comparing SWEMWBS with WEMWBS using: (1) Spearman correlations (continuous data), and (2) the weighted kappa statistic (categorical), within population subgroups.ResultsMean (median) SWEMWBS was 23.7 (23.2) for men and 23.2 (23.2) for women (p = 0.100). Spearman correlations were moderately sized for the happiness index (ρ = 0.53, P < 0.001), GHQ-12 (ρ = −0.52, p < 0.001) and EQ-VAS (ρ = 0.40, p < 0.001). Participants consuming <1 portion of fruit and vegetables a day versus ≥5 (odds ratio = 1.43 95% Confidence Interval = (1.22–1.66)) and current smokers versus non-smokers (1.28 (1.15–1.41)) were more likely to have low vs medium wellbeing. Participants who binge drank versus non-drinkers were less likely to have high versus medium wellbeing (0.81 (0.71–0.92)). Spearman correlations between SWEMWBS and WEMWBS were above 0.95; weighted kappa statistics showed almost perfect agreement (0.79–0.85).ConclusionSWEMWBS distinguishes mental wellbeing between subgroups, similarly to WEMWBS, but is less sensitive to gender differences.Electronic supplementary materialThe online version of this article (doi:10.1007/s11136-016-1454-8) contains supplementary material, which is available to authorized users.
BackgroundGovernments worldwide recommend daily consumption of fruit and vegetables. We examine whether this benefits health in the general population of England.MethodsCox regression was used to estimate HRs and 95% CI for an association between fruit and vegetable consumption and all-cause, cancer and cardiovascular mortality, adjusting for age, sex, social class, education, BMI, alcohol consumption and physical activity, in 65 226 participants aged 35+ years in the 2001–2008 Health Surveys for England, annual surveys of nationally representative random samples of the non-institutionalised population of England linked to mortality data (median follow-up: 7.7 years).ResultsFruit and vegetable consumption was associated with decreased all-cause mortality (adjusted HR for 7+ portions 0.67 (95% CI 0.58 to 0.78), reference category <1 portion). This association was more pronounced when excluding deaths within a year of baseline (0.58 (0.46 to 0.71)). Fruit and vegetable consumption was associated with reduced cancer (0.75 (0.59–0.96)) and cardiovascular mortality (0.69 (0.53 to 0.88)). Vegetables may have a stronger association with mortality than fruit (HR for 2 to 3 portions 0.81 (0.73 to 0.89) and 0.90 (0.82 to 0.98), respectively). Consumption of vegetables (0.85 (0.81 to 0.89) per portion) or salad (0.87 (0.82 to 0.92) per portion) were most protective, while frozen/canned fruit consumption was apparently associated with increased mortality (1.17 (1.07 to 1.28) per portion).ConclusionsA robust inverse association exists between fruit and vegetable consumption and mortality, with benefits seen in up to 7+ portions daily. Further investigations into the effects of different types of fruit and vegetables are warranted.
To monitor the health of the public in England, UK, the Central Health Monitoring Unit within the UK Department of Health commissioned an annual health examination survey, which became known as the Health Survey for England (HSE). The first survey was completed in 1991. The HSE covers all of England and is a nationally representative sample of those residing at private residential addresses. Each survey year consists of a new sample of private residential addresses and people. The HSE collects detailed information on mental and physical health, health-related behaviour, and objective physical and biological measures in relation to demographic and socio-economic characteristics of people aged 16 years and over at private residential addresses. There are two parts to the HSE; an interviewer visit, to conduct an interview and measure height and weight, then a nurse visit, to carry out further measurements and take biological samples. Since 1994, survey participants aged 16 years and over have been asked for consent to follow-up through linkage to mortality and cancer registration data, and from 2003, to the Hospital Episode Statistics database, thus converting annual cross-sectional survey data into a longitudinal study. Annual survey data (1994-2009) are available through the UK Data Archive.
Mendelian randomization (MR) studies typically assess the pathogenic relevance of environmental exposures or disease biomarkers, using genetic variants that instrument these exposures. The approach is gaining popularity—our systematic review reveals a greater than 10-fold increase in MR studies published between 2004 and 2015. When the MR paradigm was first proposed, few biomarker- or exposure-related genetic variants were known, most having been identified by candidate gene studies. However, genome-wide association studies (GWAS) are now providing a rich source of potential instruments for MR analysis. Many early reviews covering the concept, applications and analytical aspects of the MR technique preceded the surge in GWAS, and thus the question of how best to select instruments for MR studies from the now extensive pool of available variants has received insufficient attention. Here we focus on the most common category of MR studies—those concerning disease biomarkers. We consider how the selection of instruments for MR analysis from GWAS requires consideration of: the assumptions underlying the MR approach; the biology of the biomarker; the genome-wide distribution, frequency and effect size of biomarker-associated variants (the genetic architecture); and the specificity of the genetic associations. Based on this, we develop guidance that may help investigators to plan and readers interpret MR studies.
Transport first became a significant source of air pollution after the problems of sooty smog from coal combustion had largely been solved in western European and North American cities. Since then, emissions from road, air, rail and water transport have been partly responsible for acid deposition, stratospheric ozone depletion and climate change. Most recently, road traffic exhaust emissions have been the cause of much concern about the effects of urban air quality on human health and tropospheric ozone production. This article considers the variety of transport impacts on the atmospheric environment by reviewing three examples: urban road traffic and human health, aircraft emissions and global atmospheric change, and the contribution of sulphur emissions from ships to acid deposition. Each example has associated with it a different level of uncertainty, such that a variety of policy responses to the problems are appropriate, from adaptation through precautionary emissions abatement to cost-benefit analysis and optimised abatement. There is some evidence that the current concern over the transport contribution to urban air quality is justified, but aircraft emissions should also give cause for concern given that air traffic is projected to continue to increase. Emissions from road traffic are being reduced substantially by the introduction of technology especially three-way catalysts and also, most recently, by local traffic reduction measures especially in western European cities. In developing countries and Eastern Europe, however, there remains the possibility of great increase in car ownership and use, and it remains to be seen whether these countries will adopt measures now to prevent transport-related air pollution problems becoming severe later in the 21 st century.Key words: Vehicle emissions, Aerosol urban, Health impact, Ship emissions, Aircraft emissions 1 Introduction Transport is widely recognised to be a significant and increasing source of air pollution world wide. Several previous reviews have focused on individual modes of transport and/or single environmental impacts of transport. For example, OECD (1988) briefly considers regional and global impacts of transport emissions of air pollution, but is mostly concerned with the impact of emissions on local urban air quality, and considers only road transport. The Third International Symposium on Transport and Air Pollution (Joumard, 1996) also has an emphasis on road traffic and urban air quality, but the Special Edition of Science of the Total Environment presenting highlights of the symposium also includes a few papers covering air and sea transport. Joumard comments on the value of the contributions from developing countries including Africa and Latin America; a review of road transport emissions and their impact on the environment at all scales from local to global was also published a couple of years earlier by Faiz (1993). One of the most comprehensive recent reviews of the environmental impacts of transport is that of the Royal Commi...
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