Background:
Efforts to prevent the development of overweight and obesity have increasingly focused early in the life course as we recognise that both metabolic and behavioural patterns are often established within the first few years of life. Randomised controlled trials (RCTs) of interventions are even more powerful when, with forethought, they are synthesised into an individual patient data (IPD) prospective meta-analysis (PMA). An IPD PMA is a unique research design where several trials are identified for inclusion in an analysis before any of the individual trial results become known and the data are provided for each randomised patient. This methodology minimises the publication and selection bias often associated with a retrospective meta-analysis by allowing hypotheses, analysis methods and selection criteria to be specified a priori.
Methods:
The Early Prevention of Obesity in CHildren (EPOCH) Collaboration was formed in 2009. The main objective of the EPOCH Collaboration is to determine if early intervention for childhood obesity impacts on body mass index (BMI) z scores at age 18-24 months. Additional research questions will focus on whether early intervention has an impact on children’s dietary quality, TV viewing time, duration of breastfeeding and parenting styles. This protocol includes the hypotheses, inclusion criteria and outcome measures to be used in the IPD PMA. The sample size of the combined dataset at final outcome assessment (approximately 1800 infants) will allow greater precision when exploring differences in the effect of early intervention with respect to pre-specified participant- and intervention- level characteristics.DiscussionFinalisation of the data collection procedures and analysis plans will be complete by the end of 2010. Data collection and analysis will occur during 2011-2012 and results should be available by 2013.Trial registration number: ACTRN12610000789066
Association of socio-economic, gender and health factors with common mental disorders in women: a population-based study of 5703 married rural women in India
Acute stress reaction and completed suicide
Study protocol: The Early Prevention of Obesity in CHildren (EPOCH) Collaboration – an Individual Patient Data Prospective Meta-Analysis
No health without public mental health
Socio-cultural determinants of adiposity and physical activity in preschool children: a cross-sectional study
Background:
Both individual socio-cultural determinants such as selected parental characteristics (migrant background, low educational level and workload) as well as the regional environment are related to childhood overweight and physical activity (PA). The purpose of the study was to compare the impact of distinct socio-cultural determinants such as the regional environment and selected parental characteristics on adiposity, PA and motor skills in preschool children.
Methods:
Forty preschools (N=542 children) of two culturally different urban regions (German and French speaking part of Switzerland) participated in the study (Ballabeina Study). Outcome measures included adiposity (BMI and skinfold thickness), objectively measured inactivity and PA (accelerometers) and agility performance (obstacle course). Parental characteristics (migrant status, educational level and workload) were assessed by questionnaire.
Results:
Children from the French speaking areas had higher adiposity, lower levels of total and of more intense PA, were more inactive and less agile than children from the German speaking regions (percent differences for all outcome parameters except for BMI [greater than or equal to]10%; all p[less than or equal to]0.04). Differences in skinfold thickness, inactivity and agility, but not in PA, were also found between children of Swiss and migrant parents, though they were [less than or equal to]8% (p[less than or equal to]0.02). While paternal workload had no effect, maternal workload and parental education resulted in differences in some PA measures and/or agility performance (percent differences in both: [less than or equal to]9%, p[less than or equal to]0.008), but not in adiposity or inactivity (p=NS). Regional differences in skinfold thickness, PA, inactivity and agility performance persisted after adjustment for parental socio-cultural characteristics, parental BMI and, where applicable, children’s skinfolds (all p[less than or equal to]0.01).
Conclusions:
The regional environment, especially the broader social environment, plays a prominent role in determining adiposity, PA and motor skills of young children and should be implicated in the prevention of obesity and promotion of PA in children.Trial Registrationclinicaltrials.gov NCT00674544
The impact of economic recession on maternal and infant mortality: lessons from history
Background:
The effect of the recent world recession on population health has featured heavily in recent international meetings. Maternal health is a particular concern given that many countries were already falling short of their MDG targets for 2015.
Methods:
We utilise 20th century time series data from 14 high and middle income countries to investigate associations between previous economic recession and boom periods on maternal and infant outcomes (1936 to 2005). A first difference logarithmic model is used to investigate the association between short run fluctuations in GDP per capita (individual incomes) and changes in health outcomes. Separate models are estimated for four separate time periods.
Results:
The results suggest a modest but significant association between maternal and infant mortality and economic growth for early periods (1936 to 1965) but not more recent periods. Individual country data display markedly different patterns of response to economic changes. Japan and Canada were vulnerable to economic shocks in the post war period. In contrast, mortality rates in countries such as the UK and Italy and particularly the US appear little affected by economic fluctuations.
Conclusions:
The data presented suggest that recessions do have a negative association with maternal and infant outcomes particularly in earlier stages of a country’s development although the effects vary widely across different systems. Almost all of the 20 least wealthy countries have suffered a reduction of 10% or more in GDP per capita in at least one of the last five decades. The challenge for today’s policy makers is the design and implementation of mechanisms that protect vulnerable populations from the effects of fluctuating national income.