TY  - JOUR
AB  - Objective To determine if circulating concentrations of vitamin D are causally associated with risk of cancer.Design Mendelian randomisation study.Setting Large genetic epidemiology networks (the Genetic Associations and Mechanisms in Oncology (GAME-ON), the Genetic and Epidemiology of Colorectal Cancer Consortium (GECCO), and the Prostate Cancer Association Group to Investigate Cancer Associated Alterations in the Genome (PRACTICAL) consortiums, and the MR-Base platform).Participants 70 563 cases of cancer (22 898 prostate cancer, 15 748 breast cancer, 12 537 lung cancer, 11 488 colorectal cancer, 4369 ovarian cancer, 1896 pancreatic cancer, and 1627 neuroblastoma) and 84 418 controls.Exposures Four single nucleotide polymorphisms (rs2282679, rs10741657, rs12785878 and rs6013897) associated with vitamin D were used to define a multi-polymorphism score for circulating 25-hydroxyvitamin D (25(OH)D) concentrations.Main outcomes measures The primary outcomes were the risk of incident colorectal, breast, prostate, ovarian, lung, and pancreatic cancer and neuroblastoma, which was evaluated with an inverse variance weighted average of the associations with specific polymorphisms and a likelihood based approach. Secondary outcomes based on cancer subtypes by sex, anatomic location, stage, and histology were also examined.Results There was little evidence that the multi-polymorphism score of 25(OH)D was associated with risk of any of the seven cancers or their subtypes. Specifically, the odds ratios per 25 nmol/L increase in genetically determined 25(OH)D concentrations were 0.92 (95% confidence interval 0.76 to 1.10) for colorectal cancer, 1.05 (0.89 to 1.24) for breast cancer, 0.89 (0.77 to 1.02) for prostate cancer, and 1.03 (0.87 to 1.23) for lung cancer. The results were consistent with the two different analytical approaches, and the study was powered to detect relative effect sizes of moderate magnitude (for example, 1.20-1.50 per 25 nmol/L decrease in 25(OH)D for most primary cancer outcomes. The Mendelian randomisation assumptions did not seem to be violated.Conclusions There is little evidence for a linear causal association between circulating vitamin D concentration and risk of various types of cancer, though the existence of causal clinically relevant effects of low magnitude cannot be ruled out. These results, in combination with previous literature, provide evidence that population-wide screening for vitamin D deficiency and subsequent widespread vitamin D supplementation should not currently be recommended as a strategy for primary cancer prevention.
AU  - Dimitrakopoulou, V.I.*
AU  - Tsilidis, K.K.*
AU  - Haycock, P.C.*
AU  - Dimou, N.L.*
AU  - Al-Dabhani, K.*
AU  - Martin, R.M.*
AU  - Lewis, S.J.*
AU  - Gunter, M.J.*
AU  - Mondul, A.*
AU  - Shui, I.M.*
AU  - Theodoratou, E.*
AU  - Nimptsch, K.*
AU  - Lindström, S.*
AU  - Albanes, D.*
AU  - Kuhn, T.*
AU  - Key, T.J.*
AU  - Travis, R.C.*
AU  - Vimaleswaran, K.S.*
AU  - Collaboration (Wichmann, H.-E.)
AU  - Pierce, B.L.*
AU  - Schildkraut, J.M.*
C1  - 52323
C2  - 43865
TI  - Circulating vitamin D concentration and risk of seven cancers: Mendelian randomisation study.
JO  - BMJ:Br. Med. J.
VL  - 359
PY  - 2017
SN  - 1756-1833
ER  - 

TY  - JOUR
AB  - OBJECTIVE: To quantify the association between long working hours and alcohol use. DESIGN: Systematic review and meta-analysis of published studies and unpublished individual participant data. DATA SOURCES: A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies. REVIEW METHODS: The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression. RESULTS: Cross sectional analysis was based on 61 studies representing 333 693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100 602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and ≥55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate. CONCLUSIONS: Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.
AU  - Virtanen, M.*
AU  - Jokela, M.*
AU  - Nyberg, S.T.*
AU  - Madsen, I.E.*
AU  - Lallukka, T.*
AU  - Ahola, K.*
AU  - Alfredsson, L.*
AU  - Batty, G.D.*
AU  - Bjorner, J.B.*
AU  - Borritz, M.*
AU  - Burr, H.*
AU  - Casini, A.*
AU  - Clays, E.*
AU  - de Bacquer, D.*
AU  - Dragano, N.*
AU  - Erbel, R.*
AU  - Ferrie, J.E.*
AU  - Fransson, E.I.*
AU  - Hamer, M.*
AU  - Heikkilä, K.*
AU  - Jöckel, K.-H.*
AU  - Kittel, F.*
AU  - Knutsson, A.*
AU  - Koskenvuo, M.*
AU  - Ladwig, K.-H.
AU  - Lunau, T.*
AU  - Nielsen, M.L.*
AU  - Nordin, M.*
AU  - Oksanen, T.*
AU  - Pejtersen, J.H.*
AU  - Pentti, J.*
AU  - Rugulies, R.*
AU  - Salo, P.*
AU  - Schupp, J.*
AU  - Siegrist, J.*
AU  - Singh-Manoux, A.*
AU  - Steptoe, A.*
AU  - Suominen, S.B.*
AU  - Theorell, T.*
AU  - Vahtera, J.*
AU  - Wagner, G.G.*
AU  - Westerholm, P.J.*
AU  - Westerlund, H.*
AU  - Kivimaki, M.*
C1  - 43097
C2  - 36064
CY  - London
TI  - Long working hours and alcohol use: Systematic review and meta-analysis of published studies and unpublished individual participant data.
JO  - BMJ:Br. Med. J.
VL  - 350
PB  - Bmj Publishing Group
PY  - 2015
SN  - 1756-1833
ER  - 

TY  - JOUR
AB  - Objectives: To study the effect of long term exposure to airborne pollutants on the incidence of acute coronary events in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE). Design: Prospective cohort studies and meta-analysis of the results. Setting: Cohorts in Finland, Sweden, Denmark, Germany, and Italy. Participants: 100 166 people were enrolled from 1997 to 2007 and followed for an average of 11.5 years. Participants were free from previous coronary events at baseline. Main outcome measures: Modelled concentrations of particulate matter <2.5 μm (PM 2.5), 2.5-10 μm (PMcoarse), and <10 μm (PM 10) in aerodynamic diameter, soot (PM2.5 absorbance), nitrogen oxides, and traffic exposure at the home address based on measurements of air pollution conducted in 2008-12. Cohort specific hazard ratios for incidence of acute coronary events (myocardial infarction and unstable angina) per fixed increments of the pollutants with adjustment for sociodemographic and lifestyle risk factors, and pooled random effects meta-analytic hazard ratios. Results: 5157 participants experienced incident events. A 5 μg/m3 increase in estimated annual mean PM2.5 was associated with a 13% increased risk of coronary events (hazard ratio 1.13, 95% confidence interval 0.98 to 1.30), and a 10 μg/m3 increase in estimated annual mean PM10 was associated with a 12% increased risk of coronary events (1.12, 1.01 to 1.25) with no evidence of heterogeneity between cohorts. Positive associations were detected below the current annual European limit value of 25 μg/m3 for PM2.5 (1.18, 1.01 to 1.39, for 5 μg/m 3 increase in PM2.5) and below 40 μg/m3 for PM10 (1.12, 1.00 to 1.27, for 10 μg/m3 increase in PM10). Positive but non-significant associations were found with other pollutants. Conclusions: Long term exposure to particulate matter is associated with incidence of coronary events, and this association persists at levels of exposure below the current European limit values.
AU  - Cesaroni, G.*
AU  - Forastiere, F.*
AU  - Stafoggia, M.*
AU  - Andersen, Z.J.*
AU  - Badaloni, C.*
AU  - Beelen, R.*
AU  - Caracciolo, B.*
AU  - de Faire, U.*
AU  - Erbel, R.*
AU  - Eriksen, K.T.*
AU  - Fratiglioni, L.*
AU  - Galassi, C.*
AU  - Hampel, R.
AU  - Heier, M.
AU  - Hennig, F.*
AU  - Hilding, A.*
AU  - Hoffmann, B.*
AU  - Houthuijs, D.*
AU  - Jöckel, K.-H.*
AU  - Korek, M.*
AU  - Lanki, T.*
AU  - Leander, K.*
AU  - Magnusson, P.K.E.*
AU  - Migliore, E.*
AU  - Östenson, C.-G.*
AU  - Overvad, K.*
AU  - Pedersen, N.L.*
AU  - Pekkanen, J.J.*
AU  - Penell, J.*
AU  - Pershagen, G.*
AU  - Pyko, A.*
AU  - Raaschou-Nielsen, O.*
AU  - Ranzi, A.*
AU  - Ricceri, F.*
AU  - Sacerdote, C.*
AU  - Salomaa, V.*
AU  - Swart, W.*
AU  - Turunen, A.W.*
AU  - Vineis, P.*
AU  - Weinmayr, G.*
AU  - Wolf, K.
AU  - de Hoogh, K.*
AU  - Hoek, G.*
AU  - Brunekreef, B.*
AU  - Peters, A.
C1  - 30564
C2  - 33705
CY  - London
TI  - Long term exposure to ambient air pollution and incidence of acute coronary events: Prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE project.
JO  - BMJ:Br. Med. J.
VL  - 348
PB  - Bmj Publishing Group
PY  - 2014
SN  - 1756-1833
ER  - 

TY  - JOUR
AB  - OBJECTIVE: To investigate the association between serum 25-hydroxyvitamin D concentrations (25(OH)D) and mortality in a large consortium of cohort studies paying particular attention to potential age, sex, season, and country differences. DESIGN: Meta-analysis of individual participant data of eight prospective cohort studies from Europe and the US. SETTING: General population. PARTICIPANTS: 26 018 men and women aged 50-79 years MAIN OUTCOME MEASURES: All-cause, cardiovascular, and cancer mortality. RESULTS: 25(OH)D concentrations varied strongly by season (higher in summer), country (higher in US and northern Europe) and sex (higher in men), but no consistent trend with age was observed. During follow-up, 6695 study participants died, among whom 2624 died of cardiovascular diseases and 2227 died of cancer. For each cohort and analysis, 25(OH)D quintiles were defined with cohort and subgroup specific cut-off values. Comparing bottom versus top quintiles resulted in a pooled risk ratio of 1.57 (95% CI 1.36 to 1.81) for all-cause mortality. Risk ratios for cardiovascular mortality were similar in magnitude to that for all-cause mortality in subjects both with and without a history of cardiovascular disease at baseline. With respect to cancer mortality, an association was only observed among subjects with a history of cancer (risk ratio, 1.70 (1.00 to 2.88)). Analyses using all quintiles suggest curvilinear, inverse, dose-response curves for the aforementioned relationships. No strong age, sex, season, or country specific differences were detected. Heterogeneity was low in most meta-analyses. CONCLUSIONS: Despite levels of 25(OH)D strongly varying with country, sex, and season, the association between 25(OH)D level and all-cause and cause-specific mortality was remarkably consistent. Results from a long term randomised controlled trial addressing longevity are being awaited before vitamin D supplementation can be recommended in most individuals with low 25(OH)D levels.
AU  - Schöttker, B.*
AU  - Jorde, R.*
AU  - Peasey, A.*
AU  - Thorand, B.
AU  - Jansen, E.H.J.M.*
AU  - de Groot, L.*
AU  - Streppel, M.*
AU  - Gardiner, J.R.*
AU  - Ordóñez-Mena, J.M.*
AU  - Perna, L.*
AU  - Wilsgaard, T.*
AU  - Rathmann, W.*
AU  - Feskens, E.*
AU  - Kampman, E.*
AU  - Siganos, G.*
AU  - Njølstad, I.*
AU  - Mathiesen, E.B.*
AU  - Kubínová, R.*
AU  - Pajak, A.*
AU  - Topor-Madry, R.*
AU  - Tamosiunas, A.*
AU  - Hughes, M.*
AU  - Kee, F.*
AU  - Bobak, M.*
AU  - Trichopoulou, A.*
AU  - Boffetta, P.*
AU  - Brenner, H.*
C1  - 31635
C2  - 35993
CY  - London
TI  - Vitamin D and mortality: Meta-analysis of individual participant data from a large consortium of cohort studies from Europe and the United States.
JO  - BMJ:Br. Med. J.
VL  - 348
PB  - Bmj Publishing Group
PY  - 2014
SN  - 1756-1833
ER  - 

TY  - JOUR
AB  - Objective To use genetic variants as unconfounded proxies of C reactive protein concentration to study its causal role in coronary heart disease.Design Mendelian randomisation meta-analysis of individual participant data from 47 epidemiological studies in 15 countries. Participants 194 418 participants, including 46 557 patients with prevalent or incident coronary heart disease. Information was available on four CRP gene tagging single nucleotide polymorphisms (rs3093077, rs1205, rs1130864, rs1800947), concentration of C reactive protein, and levels of other risk factors. Main outcome measures Risk ratios for coronary heart disease associated with genetically raised C reactive protein versus risk ratios with equivalent differences in C reactive protein concentration itself, adjusted for conventional risk factors and variability in risk factor levels within individuals. Results CRP variants were each associated with up to 30% per allele difference in concentration of C reactive protein (P<10(-34)) and were unrelated to other risk factors. Risk ratios for coronary heart disease per additional copy of an allele associated with raised C reactive protein were 0.93 (95% confidence interval 0.87 to 1.00) for rs3093077; 1.00 (0.98 to 1.02) for rs1205; 0.98 (0.96 to 1.00) for rs1130864; and 0.99 (0.94 to 1.03) for rs1800947. In a combined analysis, the risk ratio for coronary heart disease was 1.00 (0.90 to 1.13) per 1 SD higher genetically raised natural log (ln) concentration of C reactive protein. The genetic findings were discordant with the risk ratio observed for coronary heart disease of 1.33 (1.23 to 1.43) per 1 SD higher circulating ln concentration of C reactive protein in prospective studies (P=0.001 for difference.Conclusion Human genetic data indicate that C reactive protein concentration itself is unlikely to be even a modest causal factor in coronary heart disease.
AU  - C Reactive Protein Coronary Heart Disease Genetics Collaboration (CCGC) (Thorand, B.
AU  - Baumert, J.J.
AU  - Peters, A.)
C1  - 6045
C2  - 28756
CY  - London
TI  - Association between C reactive protein and coronary heart disease: Mendelian randomisation analysis based on individual participant data.
JO  - BMJ:Br. Med. J.
VL  - 342
PB  - British Medical Assoc.
PY  - 2011
SN  - 1756-1833
ER  - 

TY  - JOUR
AB  - OBJECTIVE: To examine the association between pre-diagnostic circulating vitamin D concentration, dietary intake of vitamin D and calcium, and the risk of colorectal cancer in European populations. DESIGN: Nested case-control study. Setting The study was conducted within the EPIC study, a cohort of more than 520 000 participants from 10 western European countries. PARTICIPANTS: 1248 cases of incident colorectal cancer, which developed after enrolment into the cohort, were matched to 1248 controls MAIN OUTCOME MEASURES: Circulating vitamin D concentration (25-hydroxy-vitamin-D, 25-(OH)D) was measured by enzyme immunoassay. Dietary and lifestyle data were obtained from questionnaires. Incidence rate ratios and 95% confidence intervals for the risk of colorectal cancer by 25-(OH)D concentration and levels of dietary calcium and vitamin D intake were estimated from multivariate conditional logistic regression models, with adjustment for potential dietary and other confounders. RESULTS: 25-(OH)D concentration showed a strong inverse linear dose-response association with risk of colorectal cancer (P for trend <0.001). Compared with a pre-defined mid-level concentration of 25-(OH)D (50.0-75.0 nmol/l), lower levels were associated with higher colorectal cancer risk (<25.0 nmol/l: incidence rate ratio 1.32 (95% confidence interval 0.87 to 2.01); 25.0-49.9 nmol/l: 1.28 (1.05 to 1.56), and higher concentrations associated with lower risk (75.0-99.9 nmol/l: 0.88 (0.68 to 1.13); >or=100.0 nmol/l: 0.77 (0.56 to 1.06)). In analyses by quintile of 25-(OH)D concentration, patients in the highest quintile had a 40% lower risk of colorectal cancer than did those in the lowest quintile (P<0.001). Subgroup analyses showed a strong association for colon but not rectal cancer (P for heterogeneity=0.048). Greater dietary intake of calcium was associated with a lower colorectal cancer risk. Dietary vitamin D was not associated with disease risk. Findings did not vary by sex and were not altered by corrections for season or month of blood donation. CONCLUSIONS: The results of this large observational study indicate a strong inverse association between levels of pre-diagnostic 25-(OH)D concentration and risk of colorectal cancer in western European populations. Further randomised trials are needed to assess whether increases in circulating 25-(OH)D concentration can effectively decrease the risk of colorectal cancer.
AU  - Jenab, M.*
AU  - Bueno-de-Mesquita, H.B.*
AU  - Ferrari, P.*
AU  - van Duijnhoven, F.J.*
AU  - Norat, T.*
AU  - Pischon, T.*
AU  - Jansen, E.H.J.M.*
AU  - Slimani, N.*
AU  - Byrnes, G.*
AU  - Rinaldi, S.*
AU  - Tjonneland, A.*
AU  - Olsen, A.*
AU  - Overvad, K.*
AU  - Boutron-Ruault, M.C.*
AU  - Clavel-Chapelon, F.*
AU  - Morois, S.*
AU  - Kaaks, R.*
AU  - Linseisen, J.
AU  - Boeing, H.*
AU  - Bergmann, M.M.*
AU  - Trichopoulou, A.*
AU  - Misirli, G.*
AU  - Trichopoulos, D.*
AU  - Berrino, F.*
AU  - Vineis, P.*
AU  - Panico, S.*
AU  - Palli, D.*
AU  - Tumino, R.*
AU  - Ros, M.M.*
AU  - van Gils, C.H.*
AU  - Peeters, P.H.*
AU  - Brustad, M.*
AU  - Lund, E.*
AU  - Tormo, M.J.*
AU  - Ardanaz, E.*
AU  - Rodriguez, L.*
AU  - Sánchez, M.J.*
AU  - Dorronsoro, M.*
AU  - González, C.A.*
AU  - Hallmans, G.*
AU  - Palmqvist, R.*
AU  - Roddam, A.*
AU  - Key, T.J.*
AU  - Khaw, K.T.*
AU  - Autier, P.*
AU  - Hainaut, P.*
AU  - Riboli, E.*
C1  - 2869
C2  - 28070
TI  - Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations: A nested case-control study.
JO  - BMJ:Br. Med. J.
VL  - 340
PB  - BMJ Publishing Group
PY  - 2010
SN  - 1756-1833
ER  - 

TY  - JOUR
AB  - A 28 year old white man presented to the dermatology clinic because of raised, yellow-white coloured skin lesions on the glans of his penis that had been increasing in number over two years. Repeated attempts had been made to cure the affected areas with topical antimycotic drugs, antibiotics, and virostatic agents. Macroscopic inspection showed a penile mucosa covered by densely aggregated yellow-white, minute papules. Lesional swabs to look for colonisation with bacteria, fungi, or viruses were unremarkable.
AU  - Möhrenschlager, M.*
AU  - Engst, R.
AU  - Ring, J.
C1  - 956
C2  - 28244
CY  - London
TI  - Picture quiz: Painless non-itching yellow-white spots on genital mucosa.
JO  - BMJ:Br. Med. J.
VL  - 340
PB  - BMJ Publishing Group
PY  - 2010
SN  - 1756-1833
ER  - 

TY  - JOUR
AU  - Timmer, A.
AU  - Obermeier, F.*
C1  - 1690
C2  - 26145
SP  - 781
TI  - Reduced risk of ulcerative colitis after appendicectomy.
JO  - BMJ:Br. Med. J.
VL  - 338
IS  - 7698
PB  - B M J Publishing Group
PY  - 2009
SN  - 1756-1833
ER  - 

TY  - JOUR
AU  - Kappler, M.*
AU  - Krauss-Etschmann, S.
AU  - Diehl, V.*
AU  - Zeilhofer, H.*
AU  - Koletzko, S.*
C1  - 4496
C2  - 23319
SP  - 213-214
TI  - Detection of secretory IgA antibodies against gliadin and human tissue transglutaminase in stool to screen for coeliac disease in children: Validation study.
JO  - BMJ:Br. Med. J.
VL  - 332
PY  - 2006
SN  - 1756-1833
ER  - 

TY  - JOUR
AB  - Objective To determine the risk of lung cancer associated with exposure at home to the radioactive disintegration products of naturally occurring radon gas
      				
      					Design Collaborative analysis of individual data from 13 case-control studies of residential radon and lung cancer.
      				
      					Setting Nine European countries.
      				
      					Subjects 7148 cases of lung cancer and 14 208 controls.
      				
      					Main outcome measures Relative risks of lung cancer and radon gas concentrations in homes inhabited during the previous 5-34 years measured in becquerels (radon disintegrations per second) per cubic metre (Bq/m3) of household air.
      				
      					Results The mean measured radon concentration in homes of people in the control group was 97 Bq/m3, with 11% measuring > 200 and 4% measuring > 400 Bq/m3. For cases of lung cancer the mean concentration was 104 Bq/m3. The risk of lung cancer increased by 8.4% (95% confidence interval 3.0% to 15.8%) per 100 Bq/m3 increase in measured radon (P = 0.0007). This corresponds to an increase of 16% (5% to 31%) per 100 Bq/m3 increase in usual radon—that is, after correction for the dilution caused by random uncertainties in measuring radon concentrations. The dose-response relation seemed to be linear with no threshold and remained significant (P = 0.04) in analyses limited to individuals from homes with measured radon < 200 Bq/m3. The proportionate excess risk did not differ significantly with study, age, sex, or smoking. In the absence of other causes of death, the absolute risks of lung cancer by age 75 years at usual radon concentrations of 0, 100, and 400 Bq/m3 would be about 0.4%, 0.5%, and 0.7%, respectively, for lifelong non-smokers, and about 25 times greater (10%, 12%, and 16%) for cigarette smokers.
      				
      					Conclusions Collectively, though not separately, these studies show appreciable hazards from residential radon, particularly for smokers and recent ex-smokers, and indicate that it is responsible for about 2% of all deaths from cancer in Europe.
      			
      		
      	
      
      
      	 
AU  - Darby, S.*
AU  - Heid, I.M.
AU  - Schaffrath Rosario, A.
AU  - Wichmann, H.-E.
C1  - 2188
C2  - 22531
SP  - 223-227
TI  - Radon in homes and risk of lung cancer: Collaborative analysis of individual data from 13 European case-control studies.
JO  - BMJ:Br. Med. J.
VL  - 330
PY  - 2005
SN  - 1756-1833
ER  - 

TY  - JOUR
AB  - OBJECTIVE: To investigate international variations in smoking associated with educational level. DESIGN: International comparison of national health, or similar, surveys. SUBJECTS: Men and women aged 20 to 44 years and 45 to 74 years. SETTING: 12 European countries, around 1990. MAIN OUTCOME MEASURES: Relative differences (odds ratios) and absolute differences in the prevalence of ever smoking and current smoking for men and women in each age group by educational level. RESULTS: In the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal. CONCLUSIONS: These international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries.  
AU  - Cavelaars, A.E.*
AU  - Kunst, A.E.*
AU  - Geurts, J.J.*
AU  - Crialesi, R.*
AU  - Grötvedt, L.*
AU  - Helmert, U.*
AU  - Lahelma, E.*
AU  - Lundberg, O.*
AU  - Matheson, J.*
AU  - Mielck, A.
AU  - Rasmussen, N.K.
AU  - Regidor, E.*
AU  - do Rosário-Giraldes, M.*
AU  - Spuhler, T.*
AU  - Mackenbach, J.P.*
C1  - 21530
C2  - 19651
SP  - 1102-1107
TI  - Educational differences in smoking: International comparison.
JO  - BMJ:Br. Med. J.
VL  - 320
IS  - 7242
PB  - BMJ Publishing
PY  - 2000
SN  - 1756-1833
ER  - 

TY  - JOUR
AU  - Hense, H.W.
AU  - O'Brien, E.T.
AU  - Atkins, N.
AU  - Conroy, R.M.
AU  - O'Malley, K.O.
C1  - 40291
C2  - 38008
SP  - 562-563
TI  - The Hawksley random zero sphygmomanometer: Comparison with mercury instrument is illogical [11].
JO  - BMJ:Br. Med. J.
VL  - 307
IS  - 6903
PY  - 1993
SN  - 1756-1833
ER  - 

TY  - JOUR
AB  - Objectives - To examine whether road traffic in a big city has a direct effect on pulmonary function and respiratory symptoms in children. Design - Cross sectional study. Setting - Of all 7445 fourth grade children (aged 9-11 years) in Munich, 6537 were examined. Of the children with German nationality and the same residence during the past five years and known exposure data, 4678 questionnaires and 4320 pulmonary function tests could be analysed. Main outcome measures - Variables of pulmonary function by forced expiration and respiratory symptoms reported in a questionnaire; census data on car traffic collected in the school district. Results - Density of car traffic ranged from 7000 to 125 000 cars per 24 hours. Multiple regression analysis of peak expiratory flow showed a significant decrease of 0·71% (95% confidence interval 1·08% to 0·33%) per increase of 25 000 cars daily passing through the school district on the main road. Maximum expiratory flow when 25% vital capacity had been expired was decreased by 0·68% (1·11% to 0·25%). In contrast, response to cold air challenge was not increased. The adjusted odds ratio for the cumulative prevalence of recurrent wheezing with the same exposure was 1·08 (1·01 to 1·16). Cumulative prevalence of recurrent dyspnoea was increased, with an odds ratio of 1·10 (1·00 to 1·20). Lifetime prevalence of asthma (odds ratio 1·04; 0·89 to 1·21) and recurrent bronchitis (1·05; 0·98 to 1·12) were not significantly increased. Conclusions - High rates of road traffic diminish forced expiratory flow and increase respiratory symptoms in children.
AU  - Wjst, M.
AU  - Reitmeir, P.
AU  - Dold, S.*
AU  - Wulff, A.
AU  - Nicolai, T.*
AU  - von Loeffelholz-Colberg, E.F.*
AU  - von Mutius, E.*
C1  - 34128
C2  - 38975
SP  - 596-600
TI  - Road traffic and adverse effects on respiratory health in children.
JO  - BMJ:Br. Med. J.
VL  - 307
IS  - 6904
PY  - 1993
SN  - 1756-1833
ER  - 

TY  - JOUR
AB  - OBJECTIVES--To compare the prevalence of asthma and allergic disorders among children in Munich, western Germany, and Leipzig, eastern Germany, where environmental exposure, particularly air concentrations of sulphur dioxide and particulate matter, and living conditions have differed over the past 45 years. DESIGN--Prevalence surveys among school-children aged 9-11 years in Leipzig and Munich. Self completion of written questionnaire by the children's parents and lung function measurements. SUBJECTS--1051 children in Leipzig and 5030 in Munich. SETTING--Primary schools. MAIN OUTCOME MEASURES--Reported lifetime prevalence of asthma and allergic disorders, and bronchial hyperresponsiveness assessed by cold air inhalation challenge. RESULTS--The lifetime prevalence of asthma diagnosed by a doctor was 7.3% (72) in Leipzig and 9.3% (435) in Munich; prevalence of wheezing were 20% (191) and 17% (786) respectively. The prevalence of diagnosed bronchitis was higher in Leipzig than Munich (30.9% (303) v 15.9% (739); p < 0.01). A significant drop in forced expiratory volume (> 9%) after cold air challenge was measured in 6.4% (57) of children in Leipzig and in 7.7% (345) of those in Munich. Hay fever (2.4% (24) v 8.6% (410); p < 0.01) and typical symptoms of rhinitis (16.6% (171) v 19.7% (961); p < 0.05) were reported less often in Leipzig than in Munich. CONCLUSIONS--No significant differences were seen in the lifetime prevalence of asthma, wheezing, and bronchial hyperresponsiveness between children in Leipzig and Munich. The lifetime prevalence of bronchitis was higher in Leipzig than in Munich. The lower prevalence rates of allergic disorders in Leipzig could point toward aetiological factors that are associated with Western lifestyle and living conditions.
AU  - von Mutius, E.
AU  - Fritzsch, C.
AU  - Weiland, S.K.
AU  - Röll, G.
AU  - Magnussen, H.
C1  - 19862
C2  - 13014
SP  - 1395-1399
TI  - The Pevalence of Asthma and Allergic Disorders Among Children in the United Germany: a Descriptive Comparison.
JO  - BMJ:Br. Med. J.
VL  - 305
IS  - 1
PY  - 1992
SN  - 1756-1833
ER  - 

TY  - JOUR
AU  - Culyer, A.J.
C1  - 19703
C2  - 12835
SP  - 1253-1256
TI  - The promise of a reformed NHS: an economist's angle.
JO  - BMJ:Br. Med. J.
VL  - 302
PY  - 1991
SN  - 1756-1833
ER  - 

TY  - JOUR
AU  - Leidl, R.
C1  - 19695
C2  - 12825
SP  - 1081-1082
TI  - How will the Single European Market Affect Healt Care?.
JO  - BMJ:Br. Med. J.
VL  - 303
IS  - 6810
PY  - 1991
SN  - 1756-1833
ER  - 

TY  - JOUR
AU  - Leidl, R.
C1  - 40764
C2  - 12855
SP  - 1081-1082
TI  - How will the single European market affect health care?.
JO  - BMJ:Br. Med. J.
VL  - 303
IS  - 6810
PY  - 1991
SN  - 1756-1833
ER  - 

TY  - JOUR
AU  - Steinberg, H.
AU  - Gefeller, O.
AU  - Keil, U.
AU  - Härtel, U.
AU  - Hense, H.-W.
C1  - 17850
C2  - 10761
TI  - Knowledge and Attitudes Towards Hypertension Control and Management Among Physicians in Major Cities in the Federal Republic of Germany.
JO  - BMJ:Br. Med. J.
PY  - 1989
SN  - 1756-1833
ER  -