Health Questionnaire Data Research Articles

The role of leadership in establishing a positive staff culture in a secondary school

This Australian case study explored the implementation of strategies to support the development of a positive school culture among whole school staff. A participatory action research approach was used to involve leadership staff in the development of a mixed method assessment of the school organisation. Baseline data from the School Organisational Health Questionnaire ( n = 28) and qualitative data from focus groups ( n = 15) were collected and presented to the leadership team who identified four foci for the study: appraisal and recognition, participative decision-making, professional growth and supportive leadership. After a range of interventions, findings from both post-test surveys ( n = 22) and qualitative data ( n = 30) suggested a change in leadership style was a key factor of school cultural change across all factors. The case study highlights a number of visible strategies that were employed to increase morale and improve staff wellbeing.

Harmonization of the Health and Risk Factor Questionnaire data of the Canadian Partnership for Tomorrow Project: a descriptive analysis.

The Canadian Partnership for Tomorrow Project is a multistudy platform integrating the British Columbia Generations Project, Alberta's Tomorrow Project, the Ontario Health Study, CARTaGENE (Quebec) and the Atlantic Partnership for Tomorrow's Health. This paper describes the process used to harmonize the Health and Risk Factor Questionnaire data and provides an overview of the key information required to properly use the core data set generated. This is a descriptive analysis of the harmonization process that was developed on the basis of the Maelstrom Research guidelines for retrospective harmonization. Core variables (DataSchema) to be generated across cohorts were defined and the potential for cohort-specific data sets to generate the DataSchema variables was assessed. Where relevant, algorithms were developed and applied to process cohort-specific data into the DataSchema format, and information to be provided to data users was documented. The Health and Risk Factor Questionnaire DataSchema (version 2.0, October 2017) comprised 694 variables. The assessment of harmonization potential for the variables over 12 cohort-specific data sets resulted in 6799 (81.6%) of the variables being considered as harmonizable. A total of 307 017 participants were included in the harmonized data set. Through the cohort data portal, researchers can find information about the definitions of variables, harmonization potential, algorithms applied to generate harmonized variables and participant distributions. The harmonization process enabled the creation of a unique data set including data on health and risk factors from over 307 000 Canadians. These data, in combination with complementary data sets, can be used to investigate the impact of biological, environmental and behavioural factors on cancer and chronic diseases.

Health Assessment of Electronic Waste Workers in Chile: Participant Characterization.

Little research has been done to evaluate the occupational health of electronic waste (e-waste) recycling workers in Latin America. The objective of this study was to complete comprehensive health evaluations on e-waste recycling workers in Chile and to compare those that work in informal (i.e., independent) to those that work in formal (i.e., established company) settings. A cross-sectional study in the summer of 2017 recruited 78 informal recycling workers from two cities and 15 formal e-waste recycling workers from a single recycling facility to assess exposures and health outcomes. Participants completed a health questionnaire and underwent a full health assessment. Herein, only health questionnaire data are reported. Participants were primarily male, middle-aged, married with children, and had worked in e-waste recycling for an average of 12 years. Participants generally reported good health status, and their prevalence of chronic diseases was comparable to national rates. Workers frequently reported exposures to several occupational stressors, including noise and insufficient income, as well as other mental health stressors. Occupational injuries were commonly reported and use of safety equipment was low. Only a few significant differences, generally of a rather small magnitude, were found between informal and formal workers. In conclusion, from survey data, we did not identify major risks to health among e-waste workers, and only minor differences between workers in informal and formal settings.

Depression and Other Phenotypes In Uk Biobank

One million samples may be needed to develop useful genetic predictors for treatment responses and differential diagnosis in depression. The UK Biobank (UKB) is a unique resource with very broad phenotyping across physical traits that is being expanded to include psychiatry (on >250K) with CIDI based mental health questionnaire and neuroimaging (on 100K). We are studying depression and anxiety in UKB using the new mental health questionnaire and available brief phenotyping data. This presents an opportunity to enlarge the sample size for depression GWAS by >150K cases. I will present preliminary analyses of the depression phenotypes in the UKB 500K GWAS data using the new mental health questionnaire data and the brief phenotyping available.

Modelling the association between health indicators and commute mode choice: a cross-sectional study in southern Sweden

The impact of commuting on health depends, in part, on the mode of travel. A sizeable body of literature addresses associations between mode choice and health status, but little is known about how a person's health affects commuting mode choice. Stress, exhaustion and obesity are threats to public health that increase in modern societies. Understanding how these concerns impact mode choice is important in order to plan effective interventions. Differences in health status among different groups and geographical areas could influence the effectiveness of policy interventions to promote greater use of particular modes, such as public transit and cycling. We investigated associations between health and commuting mode choice using a cross-sectional population-based public health questionnaire data collected from 7574 commuters in southern Sweden in 2012, integrated with register data on residential and location, information on transportation networks, and other spatial data. Discrete Multinomial Logit (MNL) models were used to study the relationships between health indicators (everyday stress, vitality, long term illness, walking difficulties, and body mass index) and commuting mode (active, car and public transportation). Along with the health indicators, the models included conventional mode choice indicators such as socio-demographic attributes, commuting characteristics, and spatial variables. Everyday stress, obesity, and difficulty walking were negatively associated with the use of active and public modes. Understanding the relationship between health and mode choice in commuting, in relation to conventional indicators, can help support decision-makers and transportation planners develop more efficient interventions aimed at encourage car commuter's switch to more environmentally friendly and healthy modes such as active and public transportation.

Stages of Biological Development across Age: An Analysis of Canadian Health Measure Survey 2007-2011.

The stages of biological development are not clearly defined despite the fact that they have been used to refer to concepts such as adolescence and aging. This study aimed to (1) propose and test a framework to search for stages of representative components and determine stages of stability and transition, (2) identify stages of biological development based on health questionnaire and biomarker data, and (3) interpret the major trajectories in a health and biomarker database. This study analyzed the data on the Canadian Health Measures Survey (CHMS) interviewees from cycle 1 to 3 (2007-2013) in Canada. We selected 282 variables containing information from questionnaire and on biomarkers after removing redundant variables based on high correlation. Fifty-nine nominal variables were replaced by 122 binominal variables, leaving 345 variables for analysis. Principal component (PC) analysis was conducted to summarize the data and the loadings were used to interpret the PCs. A stable stage was assumed to be the age groups without significantly different values of PCs. The CHMS interviewed 16,340 Canadians. Of all, 51.25% were female. The age ranged from 6 to 79 years (mean = 34.41 years, 95% CI = 34.74-34.08). The proportions of total variance explained by the first three PCs were 12.14, 4.03, and 3.19%, respectively. The differences of the first PC were not significant, especially between age 22 and 33, 34 and 40, 41 and 45, 46 and 71, and 72 and 79 years (adjusted p > 0.05 for all). The leading variable, in terms of the variance contributed to PC1, was time spent in physical activities, followed by variables related to alcohol consumption, and smoking. The 13 leading contributors to PC2 variances were all lung function measures. There are stages of stability and transition across all age groups based on the first PCs. The first and second PCs are related to physical development and lung function. The identification of stable stages is the first step to understanding how human biology develops in a population perspective and will be important for research that relies on a research population with similar characteristics to draw samples for observation or intervention.

High burden of atopy in immigrant families in substandard apartments in Sweden – on the contribution of bad housing to poor health in vulnerable populations

Background Atopic disorders are a global concern. Studies in migrant populations can illuminate the interplay of genetic and environmental factors. Exposures related to bad housing (indoor dampness, mould growth, crowding etc.) are likely to play a role in how socioeconomic inequalities can turn into health disparities for disadvantaged populations. The sizable immigrant population living in very poor-quality housing in Malmö, Sweden, became the focus of a cross-sectional study.Objective To describe atopic disorders and sensitizations in a population living in substandard housing in Malmö, Sweden, with an emphasis on their relation to harmful exposures from the built environment.Methods Families were recruited via identification of any children with symptomatic airway afflictions from health care records, and also asymptomatic children from school lists. Interviewer-led health questionnaire data and data from self-reports about living conditions were obtained together with data from home inspections carried out by health communicators. Families underwent skin prick tests (SPT) against common aeroallergens.Results As could be expected from background demographic information, it turned out that we effectively studied an immigrant population inhabiting very precarious housing outside the center of Malmö. A total of 359 children from 130 families (total 650 participants) were included. Overall the prevalence of potentially harmful environmental exposures was high (signs of moisture or mould in more than 50% of apartments, indoor smoking in 37% of households). Atopic disorders were common among both adults and children. SPTs showed a spectrum of sensitizations consistent with unselected populations in Sweden. Paternal sensitization in the SPT was associated with higher risk of sensitization for offspring than maternal sensitization. Few statistically significant associations of atopic sensitization with studied environmental exposures were detected (for example objective signs of dampness /mould in bathrooms). There were marked discrepancies between asthma diagnoses obtained from the health records and parental reports of such diagnoses and treatment for their children.Conclusions The atopic burden in this selected immigrant population was high, and results point to unmet medical needs. Health care systems caring for such populations need to be aware of their specific health needs; comprehensive asthma and allergy care should include consideration of harmful environmental exposures, adhering to the precautionary principle.

Psycho-social and medical patterns of psychiatric disorders in multiple sclerosis patients, Baghdad-Iraq

Objective: Multiple sclerosis is a common neurological disease that causes physical and psychological morbidity. Psychological disorders, especially the mood disorder, are the most common manifestation of psych. Morbidity in multiple sclerosis and the adjustment disorders is the commonest psychiatric disorder.Aim: This study aims to estimate the rate of psychiatric disorders among patients with multiple sclerosis and to know the commonest psychiatric disorders.Methods: The sample consists of 63 patients are attending a multiple sclerosis clinic in Baghdad Teaching Hospital in Medical City. Diagnostic statistical of mental health disorder-version V (DSM-V) criteria, general health questionnaire (GHQ) and socio demographic data were used for the diagnosis.Results: The results showed that 63 patients have mental disorders. There is a significant relationship between mental disorders and patients who use the treatment of interferon 22.64% of the total number of patient samples with suicidal ideas.Conclusions: Multiple sclerosis is a common neurological disease. The mental state of patients with multiple sclerosis may be affected by the disease sequel and/or its drug treatment producing variable clinical manifestations. In this study, significant correlations between socio-demographic characteristics and psychiatric disorders in multiple sclerosis, adjustment disorders are the most common psychiatric disorder in multiple sclerosis. The psychiatric disorders were higher in women than in men. There is a significant relation between psychiatric disorders and patients’ treatment with Rebif B-interferon high percentage (23.809%) of patients have suicidal ideations most of them suffer from major depressive disorder (MDD).

Quality of life of Hurler syndrome patients after successful hematopoietic stem cell transplantation.

Hurler syndrome (HS) is a lysosomal storage disease characterized by multisystem morbidity and death in early childhood. Hematopoietic stem cell transplantation (HSCT) results in long-term survival, although with significant residual disease burden. How this residual disease affects the health-related quality of life is unknown. Therefore, we conducted a multicenter cohort study on functional and psychosocial health and compared the outcomes to normative data using the Child Health Questionnaire and Pediatric Outcomes Data Collection Instrument. Perception of care was evaluated by the Measure of Processes of Care questionnaire. Sixty-three HS patients receiving HSCT with at least 3 years of follow-up after HSCT were included. The influence of potential predictors was analyzed using linear regression analysis, and correlation analysis was performed using Spearman rank correlation. Functional health of transplanted HS patients was significantly diminished compared with normative data (median physical summary z score, -2.4 [range, -3.5 to -1.6]; median global functioning z score, -3.2 [range, -4.8 to -1.8]). Psychosocial health was comparable or only slightly reduced compared with healthy peers (median psychosocial summary z score, 0.15 [range, -0.7 to 0.8]). A higher obtained lysosomal enzyme level post-HSCT predicted for superior functional health. Overall, parents were satisfied with the care received. Functional health of transplanted HS patients appeared significantly more affected than psychosocial health. To improve functional health, the use of only noncarrier donors and striving to achieve full-donor chimerism, both resulting in higher enzyme levels, is advised. Assessing the health-related quality of life could play an important role in evaluating outcomes of HS patients receiving novel (cell) therapies, including autologous gene-transduced HSCT.

Environmental estrogen-like endocrine disrupting chemicals and breast cancer

BackgroundEstrogen-mimicking endocrine disruptors (EEDs) such as polychlorinated biphenyls (PCBs), bisphenol A (BPA), and phthalates have been found ubiquitously throughout our environment. Although exposure to EEDs has the ability to interfere with endocrine control of reproductive function and development in both humans and wildlife, inconsistent reports have made it difficult to draw conclusions concerning the hypothesized increased risk of breast cancer associated with EEDs. ObjectivesThe purpose of this study was to examine the cross-sectional relationship between exposure to PCBs, BPA or phthalates; and risk of breast cancer in U.S. women using the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES) data between 1999 and 2004. MethodsWe analyzed data from female participants (20 years of age and older) collected by NHANES between 1999 and 2004 for exposure assessment based on lipid adjusted serum levels of 6 individual PCB congeners (PCB 074, 099, 118, 138, 153, and 180), the sum of dioxin-like PCBs (074 and 118), and the sum of non-dioxin-like PCBs (099 + 138 + 153 + 187). Levels of urinary BPA and seven phthalate metabolites mono-n-butyl phthalate (MnBP), mono-isobutyl phthalate (MiBP), mono-ethyl phthalate (MEP), mono-(3-caroxypropyl) phthalate (MCPP), mono-benzyl phthalate (MZP), and three metabolites of di (2-ehtylhexyl) phthalate (DEHP): [mono-2-ethylhexyl phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), and mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP)] were obtained from the 2003–2010 yearly survey cycles in participants aged 6 years and older. Assessments of EEDs or their metabolites were analyzed in conjunction with medical and reproductive health questionnaire data. Age, race/ethnicity, age at menarche, body mass index (BMI; kg/m2), and lactation were considered as potential confounders in our final models. Geometric means (GM) were calculated to compare PCB, BPA or phthalate concentrations in women who self-reported a breast cancer diagnosis versus women who self-reported never being diagnosed with breast cancer. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the association between PCB, BPA or phthalate measurements and breast cancer. ResultsIn age, race/ethnicity, and BMI adjusted models, PCB138 was the only congener found to be significantly associated with breast cancer [OR of 3.16; 95% CI: 1.14–8.76]. We also found the sum of non-dioxin-like PCBs to be significantly associated with breast cancer [OR of 1.14; 95% CI: 1.00–1.29]. Risk of breast cancer, however, was not found to be significantly associated with phthalate, phthalate metabolites, and BPA in unadjusted or adjusted logistic regression models. ConclusionsOur results suggest a link between environmental exposures to PCB 138 and breast cancer. There were no significant associations between phthalates or BPA and breast cancers. These findings should be interpreted with caution because of the use of cross-sectional self-reported data and a small sample size of breast cancer subjects. Nonetheless, our finding emphasizes a need of comprehensive environmental molecular epidemiologic study to determine the potential role of environmental exposures to PCBs, phthalates, and BPA in the development of breast cancer.

Imaging and Clinical Outcomes in 20 Dogs Treated with Thin Film Banding for Extrahepatic Portosystemic Shunts.

To prospectively evaluate the efficacy of thin film band attenuation of congenital extrahepatic portosystemic shunts (CEPSS) in dogs using clinical, biochemical, and imaging-related outcome measures. Prospective case series. Dogs with CEPSS (n=20). Client-owned dogs with CEPSS were enrolled and thin film banding of the shunting vessel was performed. Before and at least 6 months after surgery, serum bile acids and computed tomography (CT) angiography were performed and owners completed a health questionnaire regarding the dog's clinical signs. Postoperative CT images were assessed for the effectiveness of band closure, change in portal vein/aorta ratio, change in liver volume/weight ratio, and whether the band was placed in the appropriate location. Preoperative and postoperative health questionnaire data and serum bile acids were compared. The band resulted in complete closure of the vessel around which it was placed in 13 dogs. In the remaining 7 dogs, the vessel lumen was narrowed but not completely closed. In 8 dogs the band location was suboptimal, allowing systemic drainage of visceral blood or secondary shunting branches to persist. Liver volume/body weight ratios and portal vein/aorta diameter ratios increased in most dogs. Serum bile acids decreased in all but 1 dog and owners reported improved health in 19 dogs. Thin film banding resulted in complete occlusion of many, but not all vessels around which it was placed. Even in dogs with inappropriate band location or with incomplete closure, clinical improvement can be expected based on our results.

Examining the relationship between childhood health conditions and health service utilisation at school entry and subsequent academic performance in a large cohort of Australian children.

Chronic health conditions are associated with poor academic outcomes. This study examines the relationship between health conditions, specialist health service utilisation and academic performance in Australian children. This was a quasi-longitudinal study where School Entrant Health Questionnaire (a survey tool with parent report on children's health) data for 24 678 children entering school in 2008 was matched with the 2011 National Assessment Program - Literacy and Numeracy (NAPLAN). Linear and logistic regressions were used to examine associations between health conditions, use of a specialist health service and reading and numeracy scores. The study comprised 24 678 children. Children with allergies, very low birth weight, developmental delay, diabetes, spina bifida, cystic fibrosis, birth abnormality, speech problems, intellectual disability and attention-deficit/hyperactivity disorder had lower numeracy scores than those without any of these conditions (P < 0.05). The same children had higher odds (1.2-5.8) of being at or below the national minimum standard for numeracy. Children with developmental delay, epilepsy, dental problems, speech, intellectual disabilities and low birth weight had lower reading scores than those without these conditions (P < 0.05) and had higher odds of being at (odds ratio: 1.3) or below (odds ratio: 3.7) the national minimum standard for reading. Children with health conditions who had ever accessed specialist health services did not differ in their academic performance from those that had not used specialist health services. Some health conditions put children at risk of poorer academic performance, and interventions to prevent this such as appropriate support services in schools should be considered.

Application of fuzzy consensus for oral pre-cancer and cancer susceptibility assessment

Health questionnaire data assessment conventionally relies upon statistical analysis in understanding disease susceptibility using discrete numbers and fails to reflect physician’s perspectives and missing narratives in data, which play subtle roles in disease prediction. In addressing such limitations, the present study applies fuzzy consensus in oral health and habit questionnaire data for a selected Indian population in the context of assessing susceptibility to oral pre-cancer and cancer. Methodically collected data were initially divided into age based small subgroups and fuzzy membership function was assigned to each. The methodology further proposed the susceptibility to oral precancers (viz. leukoplakia, oral submucous fibrosis) and squamous cell carcinoma in patients considering a fuzzy rulebase through If-Then rules with certain conditions. Incorporation of similarity measures using the Jaccard index was used during conversion into the linguistic output of fuzzy set to predict the disease outcome in a more accurate manner and associated condition of the relevant features. It is also expected that this analytical approach will be effective in devising strategies for policy making through real-life questionnaire data handling.

한국인 남녀에서 이상지질혈증 관련 건강생활 실천 규명 -국민건강영양조사 2012년 자료 이용-

본 연구의 목적은 이상지질혈증군과 정상군을 구분하여 한국인 남녀에서 이상지질혈증 발생과 건강생활 실천의 영향을 파악하기 위함이다. 연구대상은 제5기(2010년~2012년) 국민건강영양조사에서 공개된 제3차년도(2012년) 자료 중에서 건강 설문 자료를 분석대상으로 하였으며, 대상자는 우리나라의 질병 발생 양상 및 의료 환경 등을 고려해 만든 한국지질 동맥경화학회(KSLA: Korean Society of Lipidology and Atherosclerosis, 2009)의 이상지질혈증 치료지침을 적용하여 만 19세 이상 이상지질혈증군 2,092명(남자 1,042명, 여자 1,050명)과 정상군 1,944명(남자 740명, 여자 1,204명)인 4,036명이었다. 본 연구는 SPSS 18.0 프로그램을 이용하여 서술적 통계의 t-test와 <TEX>${\chi}^2-test$</TEX>, 로지스틱 회귀분석을 사용하였다. 본 연구의 결과를 토대로 이상지질혈증 관련 건강생활 실천 프로그램은 혈청 지질 농도에 차이를 보이고 있는 한국인 남녀의 특성을 고려하여 적용하여야 하며, 이를 위해 지속적인 연구 및 건강생활 실천의 효과를 적용한 체계적인 국가 차원의 맞춤교육이 필요하다고 사료된다. The purpose of the present study is to determine the occurrence of dyslipidemia and the effects of health life practices among Korean males and females. The study subjects were 4,036 persons aged at least 19 years, as selected from the health questionnaire data out of the third year data(2012) Korea National Health and Nutrition Examination Survey. They were divided into a dyslipidemia group of 2,092 subjects (male 1,042, female 1,050) and a normal group of 1,944 subjects (male 740, female 1,204) by applying the dyslipidemia treatment guidelines of the Korean Society of Lipidology and Atherosclerosis. In the present study, the SPSS 18.0 program was used to conduct t-tests, a <TEX>${\chi}^2-test$</TEX>, and a logistic regression analysis of descriptive statistics. Therefore, dyslipidemia-related healthy life practice programs should apply the characteristics of Korean males and females that show differences in serum lipid concentrations and to this end, continued studies, and national-level customized education applying the effects of healthy life practices is considered necessary.

Study profile: the Durban Diabetes Study (DDS): a platform for chronic disease research.

The Durban Diabetes Study (DDS) is a population-based cross-sectional survey of an urban black population in the eThekwini Municipality (city of Durban) in South Africa. The survey combines health, lifestyle and socioeconomic questionnaire data with standardised biophysical measurements, biomarkers for non-communicable and infectious diseases, and genetic data. Data collection for the study is currently underway and the target sample size is 10000 participants. The DDS has an established infrastructure for survey fieldwork, data collection and management, sample processing and storage, managed data sharing and consent for re-approaching participants, which can be utilised for further research studies. As such, the DDS represents a rich platform for investigating the distribution, interrelation and aetiology of chronic diseases and their risk factors, which is critical for developing health care policies for disease management and prevention. For data access enquiries please contact the African Partnership for Chronic Disease Research (APCDR) at data@apcdr.org or the corresponding author.

A Practice Improvement Education Program Using a Mentored Approach to Improve Nursing Facility Depression Care-Preliminary Data.

Depression is common in nursing facility residents. Depression data obtained using the Minimum Data Set (MDS) 3.0 offer opportunities for improving diagnostic accuracy and care quality. How best to integrate MDS 3.0 and other data into quality improvement (QI) activity is untested. The objective was to increase nursing home (NH) capability in using QI processes and to improve depression assessment and management through focused mentorship and team building. This was a 6-month intervention with five components: facilitated collection of MDS 3.0 nine-item Patient Health Questionnaire (PHQ-9) and medication data for diagnostic interpretation; education and modeling on QI approaches, team building, and nonpharmacological depression care; mentored team meetings; educational webinars; and technical assistance. PHQ-9 and medication data were collected at baseline and 6 and 9 months. Progress was measured using team participation measures, attitude and care process self-appraisal, mentor assessments, and resident depression outcomes. Five NHs established interprofessional teams that included nursing (44.1%), social work (20.6%), physicians (8.8%), and other disciplines (26.5%). Members participated in 61% of eight offered educational meetings (three onsite mentored team meetings and five webinars). Competency self-ratings improved on four depression care measures (P = .05 to <.001). Mentors observed improvement in team process and enthusiasm during team meetings. For 336 residents with PHQ-9 and medication data, depression scores did not change while medication use declined, from 37.2% of residents at baseline to 31.0% at 9 months (P < .001). This structured mentoring program improved care processes, achieved medication reductions, and was well received. Application to other NH-prevalent syndromes is possible.

Trauma and posttraumatic stress symptoms in patients in German primary care settings

Primary care settings have an important gatekeeping function to detect mental diseases, including trauma and posttraumatic stress disorders. To assess the prevalence of trauma and posttraumatic symptoms in a first sample of northeast German primary care patients and to evaluate the diagnostic sensitivity and specificity of the general practitioners. Traumatic experiences and posttraumatic stress disorders (PTSD) were assessed with self-rating questionnaires in a sample of N = 400 patients from 3 primary care facilities. Additionally, knowledge and diagnostic accuracy of the general practitioners were evaluated. According to the results of the patient health questionnaire (PHQ-15) data from all patients, the majority of patients questioned showed slight to moderate stress from somatic symptoms. Of the patients with complete data 7 % (n = 25) had a complete PTSD according to the results of the questionnaire, which was also identified in the medical assessment with a sensitivity of 40 %. The stress resulting from posttraumatic symptoms was closely associated with the extent of somatic complaints. Patients with a history of trauma and posttraumatic symptoms are prevalent in primary care settings. An early diagnosis by the general practitioner can help patients to receive adequate treatment. Patients with somatoform disorders in particular should be screened for trauma and posttraumatic symptoms.

Analysis of smoking prevalence and smoking‐related diseases in the Estonian Genome Bank data (834.10)

Estonian Genome Bank is a population based biobank what combines DNA samples with general health questionnaire data. This repository contains data of more than 50,000 people. Database involves general data about the donors lifestyle (smoking, dinking, education, jobs etc) and about their health. We included to our analysis only these persons who responded about their smoking habits. Smoking status was divided into three categories: current smoker, former smoker and persons never smoked. Half of smokers have smoking duration over 20 years. Health status describes the disease people have. Our analysis focused on the smoking behaviour and its relations to the heart and lung disease and to the malignancies. Preliminary data analysis indicated that former smokers had higher prevalence of COPD and lung cancer than current smokers and never smokers. This finding may reflect that former smoker quit smoking due to emerging health problem.

Microbial secondary metabolites in indoor environments

Background: Secondary metabolites produced by fungi and bacteria are part of a complex exposure situation in damp buildings and may contribute to adverse health outcomes in residents. Aims: To assess the occurrence of fungal and bacterial secondary metabolites in school buildings in relation to moisture damage and dampness and to explore their relevance in respiratory health. Methods: Settled dust samples (N=1390) were collected from schools in Spain, The Netherlands and Finland. School buildings were categorized as either 'index' or 'reference' based on observations of moisture damage, dampness and visible mould. Dust samples were analyzed for the presence of a wide variety of microbial secondary metabolites (&gt;190) using mass-spectrometry based methods. Respiratory health questionnaire data from 645 teachers were used to explore associations of crude sum of concentrations of metabolites in dust versus respiratory symptoms. Results: Microbial secondary metabolites were detected in 55% of settled dust samples. 30 different metabolites were detected, with up to 10 compounds measurable from a single dust sample. We observed both, geographical and seasonal differences in indoor metabolite patterns. Higher numbers of metabolites at elevated levels were detected in index compared to reference school buildings, however, only few statistically significant differences were seen for the occurrence of individual compounds. Preliminary, crude analyses indicated a significant, dose-response association of microbial toxins in dust with nasal symptoms in teachers in Finland. Conclusions: Microbial secondary metabolites are common findings in school buildings. Moisture damage and dampness seem to somewhat increase levels of a number of those compounds, but it is evident that their indoor occurrence is also affected by outdoor sources. Associations of microbial toxin load in dust with respiratory symptoms in Finnish teachers will be further explored.

Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women

The FRAXtr algorithm uses clinical risk factors (CRF) and bone mineral density (BMD) to predict fracture risk but does not include falls history in the calculation. Using results from the Hertfordshire Cohort Study, we examined the relative contributions of CRFs, BMD and falls history to fracture prediction. We studied 2299 participants at a baseline clinic that included completion of a health questionnaire and anthropometric data. A mean of 5.5years later (range 2.9–8.8years) subjects completed a postal questionnaire detailing fall and fracture history. In a subset of 368 men and 407 women, bone densitometry was performed using a Hologic QDR 4500 instrument. There was a significantly increased risk of fracture in men and women with a previous fracture. A one standard deviation drop in femoral neck BMD was associated with a hazards ratio (HR) of incident fracture (adjusted for CRFs) of 1.92 (1.04–3.54) and 1.77 (1.16–2.71) in men and women respectively. A history of any fall since the age of 45years resulted in an unadjusted HR of fracture of 7.31 (3.78–14.14) and 8.56 (4.85–15.13) in men and women respectively. In a ROC curve analysis, the predictive capacity progressively increased as BMD and previous falls were added into an initial model using CRFs alone. Falls history is a further independent risk factor for fracture. Falls risk should be taken into consideration when assessing whether or not to commence medication for osteoporosis and should also alert the physician to the opportunity to target falls risk directly.