A multidimensional approach to understanding the context of physical activity in early adolescence is needed because factors in several domains are relevant. The correlates of physical activity and sedentary behaviors are distinct in this age group, and there are also important gender differences.

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Purpose This study was conducted in order to systematically review the costs of hip fractures globally and identify drivers of differences in costs. Methods A systematic review was conducted to identify studies reporting patient level fragility hip fracture costs between 1990 and 2015. We extracted data on the participants and costs from these studies. Cost data concerning the index hospitalisation were pooled, and a meta-regression was used to examine its potential drivers. We also pooled data on the first-year costs following hip fracture and considered healthcare, social care as well as other cost categories if reported by studies. Results One hundred and thirteen studies reported costs of hip fracture based on patient level data. Patients developing complications as well as patients enrolled in intervention arms of comparative studies were found to have significantly higher costs compared to the controls. The pooled estimate of the cost for the index hospitalisation was $10,075. Health and social care costs at 12 months were $43,669 with inpatient costs being their major driver. Meta-regression analysis identified age, gender and geographic region as being significantly associated with the differences in costs for the index hospitalisation. Conclusion Hip fracture poses a significant economic burden and variation exists in their costs across different regions. We found that there was a considerable variation across studies in terms of study design, methodology, follow-up period, costs considered and results reported that highlights the need for more standardisation in this area of research.

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This article describes a trial of a psychoeducational intervention designed to modify negative attitudes toward flexible sigmoidoscopy screening and thereby increase screening attendance. The intervention materials addressed the multiple barriers shown to be associated with participation in earlier studies. Adults ages 55-64 (N = 2,966), in a "harder-to-reach" group were randomized either to receive an intervention brochure or to a standard invitation group. Attitudes and expectations were assessed by questionnaire, and attendance at the clinic was recorded. Compared with controls, the intervention group had less negative attitudes, anticipated a more positive experience, and had a 3.6% higher level of attendance. These results indicate that psychoeducational interventions can provide an effective means of modifying attitudes and increasing rates of screening attendance.

Objective: Community studies relating depression to obesity in adolescents have generated inconsistent results. It has been argued that the variability in findings is due to effect modification by demographic characteristics that vary across samples. The aim of this study was to test the hypothesis that the strength of the obesity-depression association is moderated by gender, ethnicity and socioeconomic status (SES). Research methods and procedures: Data were from two large, school-based, studies of adolescent health and well-being (n ¼ 4320; n ¼ 1824). Students completed one of two measures of depressive symptoms (SDQ; CES-D) in school and were weighed and measured. Gender and ethnicity were self-reported and SES was indexed by residential neighbourhood characteristics or individual family deprivation. Results: There was barely any association between obesity and depressive symptoms in either sample. There was also no evidence that obese participants who were female, white or from higher SES backgrounds were especially vulnerable to depressive symptoms. Discussion: The results indicate that in community samples of adolescents, regardless of gender, SES or ethnicity, reports of depressive symptoms are not significantly higher in obese than normal-weight groups. The results are discussed in terms of obese adolescents' resilience in the face of multiple social adversities.

Objective-To investigate predictors of attendance in the United Kingdom flexible sigmoidoscopy screening trial. Design-Prospective design in which participants completed a postal questionnaire before being sent their invitation for screening. Setting-Welwyn Garden City and Leicester, United Kingdom. Participants-A total of 2758 patients aged 55 to 64, registered with general practices in the two centres, who (a) expressed interest in having the screening test, (b) completed a postal questionnaire, and (c) were subsequently invited for screening. Main results-The attendance rate among questionnaire responders was 76.1%. Multiple logistic regression analysis yielded a final model that included nine independent predictors of attendance. Patients with the following characteristics were more likely to attend: men; home owners; non-smokers; those who had regular check ups at the dentist; those with better subjective health; those who minded less about having medical tests; those who said they would definitely rather than probably take up the oVer of sigmoidoscopy screening; and those who perceived less barriers and more benefits to having the test. Conclusions-The findings are broadly consistent with previous studies of screening participation, although subjective health emerged as an important predictor in this study. There was no evidence for "reverse targeting": attenders were not at lower (or higher) risk for colorectal cancer compared with non-attenders. The findings relating to attitudes and beliefs could be used in eVorts to improve attendance, for example by developing information leaflets that address barriers to screening. Other findings could be used to target interventions to subgroups that have relatively low rates of screening participation. (J Med Screen 2000;7:99-104) Keyword: sigmoidoscopy Colorectal cancer is the second most common cause of cancer death in the western world. Screening by "once only" flexible sigmoidoscopy around the age of 60 has been proposed as a way of preventing colorectal cancer by finding and removing precancerous adenomas. 1In 1995, a multicentre, randomised controlled trial was started in the United Kingdom to evaluate this screening method. 2Identifying factors associated with participation is an important part of the evaluation of a new screening procedure. Such information is relevant for interpreting the eYcacy findings. For instance, so called "reverse targeting" may occur: participants may tend to be at lower than average risk for the condition being screened.3 Such information can also be used to identify groups with low attendance that can be targeted in interventions designed to improve uptake, and to inform the development of such interventions. In the longer term, information about the factors associated with participation will need to be considered when deciding whether, and how, a national screening programme should be implemented. Identifying predictors of attendance also contributes to the wider literature on factors that influence individuals' decis...