We are interested in the long-term health consequences associated with severe starvation and war trauma, and whether certain "age windows" exist when exposure to such events are particularly harmful.The siege of Leningrad (now St. Petersburg) during World War II provided an opportunity to study this. For 872 days, German troops prevented supplies from reaching Leningrad. Simultaneously, there was a food blockade and a steady and merciless bombardment by shells from guns and from the air. The first winter, 1941/42, represents the most severe food shortage, amounting to mass starvation or semi-starvation. Our late colleague, Professor Dimitri Shestov, had suffered the consequences of the Leningrad siege as a boy and believed that it had taken a toll on people beyond its immediate short- and medium-range consequences. He was particularly concerned about its long-term consequences for circulatory disease. A 1973 US-Soviet agreement, the socalled Lipid Research Clinics Collaboration, gave him an opportunity to study this. From 1975 to 1982 men and women living in Leningrad (now St. Petersburg) were randomly sampled and invited to examine their health and cardiovascular functioning. Dimitri Shestov added a simple question to this examination: "Were you in Leningrad during the blockade?" A third of the participants were. They had experienced peak starvation (in January 1942) at ages 1-31 (women) or 6-26 (men).The mortality follow-up began immediately after the first clinical examinations in 1975 and continued for three decades, until the end of 2005. Our analyses show that the siege of Leningrad, particularly when experienced in puberty, has had long-term effects on blood pressure both in men and women.We also found a raised IHD and stroke risk among those men. This was partly mediated via blood pressure but not by any other measured biological, behavioral, or social factors.Girls experiencing the siege around puberty suffered an elevated risk of dying from breast cancer later in life.The fact that the effect of siege exposure is modified by the age at exposure is highly interesting from a scientific point of view. It may suggest that a reprogramming of physiological systems can occur at specific age windows in response to starvation and/or war trauma. The team that worked from 1975-2005 to collect clinical information and death certificates for participants in the study included Svetlana Plavinskaya, born in Leningrad during the siege. Dimitri Shestov and Svetlana Plavinskaya died in 2010 and 2011, respectively. We dedicate this chapter to their memory.

Over a four-decade long period, a health gap has opened up between European countries, in particular along the East/West dimension. One could speak of a European health divide. The divide is growing larger and, at the same time, shifting eastwards, leaving countries such as Russia, Ukraine, Belarus and Moldova at an increasing health disadvantage. Health inequalities, or differences between social classes, within European countries also seem to have been growing for the last couple of decades. Those countries that were previously led by communist regimes today show larger health inequalities than do countries in Western Europe. The countries that were once part of the Soviet Union demonstrate the most alarming health trends, with large segments of the population actually experiencing falling life expectancies. Reducing global and European health inequalities so that the health chances of a newborn child are not dependent on which country and social class he or she is born in, is a truly formidable task, which implies an entirely new way of seeing human development.

The population of Leningrad suffered from severe starvation, coldand psychological stress during the siege in World War II in1941–1944. We investigated the long-term effects of the siege oncancer mortality in 3,901 men and 1,429 women, born between1910 and 1940. All study subjects were residents of St. Petersburg,formerly Leningrad, between 1975 and 1982. One third of themhad experienced the siege as children, adolescents or young adults(age range, 1–31 years at the peak of starvation in 1941–1942).Associations of siege exposure with risk of death from cancer werestudied using a multivariable Cox regression, stratified by genderand period of birth, adjusted for age, smoking, alcohol and socialcharacteristics, from 1975 to 1977 (men) and 1980 to 1982, respectively(women), until the end of 2005. Women who were 10–18 years old at the peak of starvation were taller as adults (ageadjusteddifference, 1.7 cm; 95% CI, 0.5–3.0) and had a higherrisk of dying from breast cancer compared with unexposedwomen born during the same period (age-adjusted HR, 9.9; 95%CI, 1.1–86.5). Mortality from prostate cancer was nonsignificantlyhigher in exposed men. The experience of severe starvation andstress during childhood and adolescence may have long-termeffects on cancer in surviving men and women.

Although low pre-morbid IQ is an established risk factor for severe mental illness, its association with personality disorder (PD) is unclear. We set out to examine whether there is a prospective association between childhood intelligence and PD in adulthood. Using a population-based prospective cohort study, we linked childhood IQ scores to routinely collected hospital discharge records in adulthood. Lower IQ scores were related to higher risk of being hospitalized with a PD across the full range of IQ scores, (odds ratio per one SD increase in IQ was 0.60; 95% CI: 0.49–0.75; p(trend) = 0.001). Adjusting for potential confounding variables had virtually no impact. We conclude that low childhood IQ predicts hospitalization with PD and may be an important factor in the development of PD.

BACKGROUND:

Post-communist transition has had a huge impact on mortality in Eastern Europe. We examined how educational inequalities in mortality changed between 1990 and 2000 in Estonia, Lithuania, Poland and Hungary.

METHODS:

Cross-sectional data for the years around 1990 and 2000 were used. Age-standardized mortality rates and mortality rate ratios (for total mortality only) were calculated for men and women aged 35-64 in three educational categories, for five broad cause-of-death groups and for five (seven among women) specific causes of death.

RESULTS:

Educational inequalities in mortality increased in all four countries but in two completely different ways. In Poland and Hungary, mortality rates decreased or remained the same in all educational groups. In Estonia and Lithuania, mortality rates decreased among the highly educated, but increased among those of low education. In Estonia and Lithuania, for men and women combined, external causes and circulatory diseases contributed most to the increasing educational gap in total mortality.

CONCLUSIONS:

Different trends were observed between the two former Soviet republics and the two Central Eastern European countries. This divergence can be related to differences in socioeconomic development during the 1990s and in particular, to the spread of poverty, deprivation and marginalization. Alcohol and psychosocial stress may also have been important mediating factors.

The specific health benefits achieved from different formsand patterns of leisure-time physical activity are not established.We analyzed the mortality in a cohort of Swedishgolf players. We used the Swedish Golf Federation’s membershipregistry and the nationwide Mortality Registry. Wecalculated standardized mortality ratios (SMR) with stratificationfor age, sex, and socioeconomic status. The cohortincluded 300 818 golfers, and the total number of deaths was1053. The overall SMR was 0.60 [95% confidence intervals(CIs): 0.57–0.64]. The mortality reduction was observed inmen and women, in all age groups, and in all socioeconomiccategories. Golfers with the lowest handicap (the mostskilled players) had the lowest mortality; SMR50.53(95% CI: 0.41–0.67) compared with 0.68 (95% CI: 0.61–0.75) for those with the highest handicap. While we cannotconclude with certainty that all the 40% decreased mortalityrates are explained by the physical activity associatedwith playing golf, we conclude that most likely this is part ofthe explanation. To put the observed mortality reduction incontext, it may be noted that a 40% reduction of mortalityrates corresponds to an increase in life expectancy of about5 years.

Class inequalities in cardiovascular disease (CVD) mortality are well documented, but the impact of intergenerational class mobility on CVD mortality among women has not been studied thoroughly. We examined whether women's mobility trajectories might contribute to CVD mortality beyond what could be expected from their childhood and adult social class position. The Swedish Work and Mortality Data Base provided childhood (1960) and adulthood (1990) social indicators. Women born 1945–59 (N = 791 846) were followed up for CVD mortality 1990–2002 (2019 deaths) by means of logistic regression analysis. CVD mortality risks were estimated for 16 mobility trajectories. Gross and net impact of four childhood and four adult classes, based on occupation, were analysed for mortality in ischemic heart disease (IHD), stroke, other CVD, – and all CVD. Differences between the two most extreme trajectories were 10-fold, but the common trajectory of moving from manual to non-manual position was linked to only a slight excess mortality (OR = 1.26) compared to the equally common trajectory of maintaining a stable non-manual position (reference category). Moving into adult manual class resulted in an elevated CVD mortality whatever the childhood position (ORs varied between 1.42 and 2.24). After adjustment for adult class, childhood class had some effect, in particular there was a low risk of coming from a self-employed childhood class on all outcomes (all ORs around = 0.80). A woman's own education had a stronger influence on the mortality estimates than did household income. Social mobility trajectories among Swedish women are linked to their CVD mortality risk. Educational achievement seems to be a key factor for intergenerational continuity and discontinuity in class-related risk of CVD mortality among Swedish women. However, on mutual adjustment, adult class was much more closely related to CVD mortality than was class in childhood.

Objectives To establish whether differences in early IQ explain why people with longer education live longer, or whether differences in father’s or own educational attainment explain why people with higher early IQ live longer.Design Population based longitudinal study. Mortality risks were estimated with Cox proportional hazards regressions.Setting Malmö, Sweden.Participants 1530 children who took IQ tests at age 10 and were followed up until age 75.Results Own educational attainment was negatively associated with all cause mortality in both sexes, even when early IQ and father’s education were adjusted for (hazard ratio (HR) for each additional year in school 0.91 (95% CI 0.85 to 0.97) for men and HR 0.88 (95 % CI 0.78 to 0.98) for women). Higher early IQ was linked with a reduced mortality risk in men, even when own educational attainment and father’s education were adjusted for (HR for one standard deviation increase in IQ 0.85 (95 % CI 0.75 to 0.96)). In contrast, there was no crude effect of early IQ for women, and women with above average IQ had an increased mortality risk when own educational attainment was adjusted for, but only after the age of 60 (HR 1.60 (95 % CI 1.06 to 2.42)). Adding measures of social career over and above educational attainment to the model (for example, occupational status at age 36 and number of children) only marginally affected the hazard ratio for women with above average IQ (<5%).Conclusions Mortality differences by own educational attainment were not explained by early IQ. Childhood IQ was independently linked, albeit differently, to male adult mortality and to female adult mortality even when father’s education and own educational attainment was adjusted for, thus social background and own social career seem unlikely to be responsible for mortality differences by childhood IQ. The clear difference in the effect of IQ between men and women suggests that the link between IQ and mortality involves the social and physical environment rather than simply being a marker of a healthy body to begin with. Cognitive skills should, therefore, be addressed in our efforts to create childhood environments that promote health.

This study contributes to the understanding of how social mortality patterns are reproduced across generations by documenting associations of women's marital status at childbirth in the beginning of last century with selected health indicators across three subsequent generations of their offspring, and by highlighting a special set of plausible mechanisms linked to this particular event in history. We use the Multigenerational Uppsala Birth Cohort Study (UBCoS) database consisting of 12,168 individuals born at Uppsala University Hospital in 1915-1929 (UG1), their children (UG2) and grandchildren (UG3). Results showed that men and women born outside wedlock (BOW) in early twentieth century Sweden were at an increased risk of adult mortality compared to those who were born in wedlock (BIW), and the men were also significantly less likely to reach their 80th birthday. The question of childhood social disadvantage and its long-term consequences for health is then taken one step further by examining their offspring in two subsequent generations in terms of four specific anthropometric and psychological outcomes at the time of military conscription, all known to predict disease and mortality later in life. Results showed that sons of men BOW as well as sons and grandsons of women BOW had significantly lower psychological functioning and cognitive ability. Regarding body mass index and height, however, significant associations were found only among descendants of men BOW. The anthropometric and psychological disadvantages found among descendents of individuals BOW were partly mediated by their social class background. The four outcomes observed early in the lives of UG2s and UG3s do in fact constitute early health determinants, each potentially influencing longevity and mortality risk in these generations. We conclude that the social disadvantage imposed on those BOW in early twentieth century Sweden appears to be reproduced as a health disadvantage in their children and grandchildren, with likely consequences for mortality among these.

This study examines attitudes towards violenceagainst women among the populace in Moscow, Russiausing data drawn from the Moscow Health Survey.Information was obtained from 1,190 subjects (510 menand 680 women) about their perceptions of whetherviolence against women was a serious problem in contemporaryRussia, and under what circumstances they thoughtit was justifiable for a husband to hit his wife. Less thanhalf the respondents thought violence was a seriousproblem, while for a small number of interviewees therewere several scenarios where violence was regarded asbeing permissible against a wife. Being young, divorced orwidowed, having financial difficulties, and regularly consumingalcohol were associated with attitudes moresupportive of violence amongst men; having a loweducational level underpinned supportive attitudes amongboth men and women. Results are discussed in terms of the public reemergence of patriarchal attitudes in Russia in thepost-Soviet period.