This chapter develops the idea that aspects of socioeconomic environment throughout life affect adult health and disease risk. It discusses etiological studies that examine how variations in adult disease outcomes are related to socioeconomic factors at different life stages to understand better biological chains in risk. It reviews studies of social chains of risk that have investigated either the extent to which individuals experience continuity in their socioeconomic environment or how they interact with their environment in ways that lead to socially patterned exposures that may develop or damage personal and health capital.

CORRESPONDENCEWomen's health in midlife: the influence of the menopause, social factors and health in earlier life Sir,We were grateful to Professor Barlow for highlighting our research on women's health during the menopause (Vol 104, August 1997)' in his recent commentary (Vol 104, August 1997)2 and support his request for multidisciplinary co-operation in this area. As he rightly says, the psychological symptoms experienced by women study members aged 47 years in the MRC National Survey of Health and Development appear in part to reflect underlying factors which were detectable a decade earlier and suggest there is continuity of health in adult life. Professor Barlow also suggests that our study found that the increased problems among women taking hormone replacement therapy could be accounted for by predisposing factors noticeable at 36 years of age. So far we have no evidence that this is so, as we report in the discussion: "One hypothesis is that the relationship between psychological symptoms and HRT use may not be related to the experience of menopause per se but occur because HRT users have been more susceptible to these symptoms, or more inclined to report symptoms, at each life stage. However this hypothesis was not supported in this study which found no evidence that eventual HRT users had been more anxious and depressed at 36 years (data not shown), although both factors were important and independent predictors of psychological symptoms at 47 years."As we are still following these women up and taking a full HRT history we plan to examine in detail the pattern of HRT use in this cohort, its relationship to current symptomatology, and whether long term users differ from the rest of the cohort, either in terms of earlier psychological difficulties or in ways which may have an effect on their future disease risk. This cohort are already heavy users of HRT by the age of 50 years two-fifths of women have tried taking HRT and over one-fifth have taken it for two years or more. No laparoscopic procedure should therefore be considered as banal, because the risk of an accident during insufflation is very real, whatever the indication for the operation. Creation of the pneumoperitoneum and insertion of the trocars must be carried out with extreme caution, using safety checks on every occasion. It is also necessary to cany out further safety checks at the end of the operative procedure in order to exclude bladder, rectal and ureteral injuries. Although we entirely agree with the authors' conclusions conceming diagnostic laparoscopy and tuba1 sterilisation, we do not in any way share their negative view of laparoscopic surgery. The authors clearly stressed that "operative laparoscopic procedures are still hazardous, especially laparoscopic hysterectomy". But this is a very recent technique which still being assessed both as regards its technique and its indications. The results of the French multicentre study* enable us to state that laparoscopic surgery is a safe technique for all the recognised indications for...

Depression in adulthood is influenced by an accumulation of stressors across the life course, including many that originate in the first years of life. Effects of early-life development on mental health appear by adolescence.