An Expert Working Group of the National Heart Foundation of Australia undertook a review of systematic reviews of the evidence relating to major psychosocial risk factors to assess whether there are independent associations between any of the factors and the development and progression of coronary heart disease (CHD), or the occurrence of acute cardiac events. The expert group concluded that (i) there is strong and consistent evidence of an independent causal association between depression, social isolation and lack of quality social support and the causes and prognosis of CHD; and (ii) there is no strong or consistent evidence for a causal association between chronic life events, work‐related stressors (job control, demands and strain), Type A behaviour patterns, hostility, anxiety disorders or panic disorders and CHD. The increased risk contributed by these psychosocial factors is of similar order to the more conventional CHD risk factors such as smoking, dyslipidaemia and hypertension. The identified psychosocial risk factors should be taken into account during individual CHD risk assessment and management, and have implications for public health policy and research.

Objective: To explore a possible association between Helicobacter pylori infection and iron status. Design: Cross‐sectional study. Setting: Ballarat (a major regional city in Victoria), population 78000, October­ November 1997. Participants: 160 women and 152 men, a subsample of participants in a cardiovascular disease risk factor prevalence survey for whom frozen plasma was available. Main outcome measures: H. pylori lgG antibody status by enzyme immunoassay; iron intake; plasma iron, transferrin and ferritin concentrations. Results: 28% of women and 33% of men were infected with H. pylori. The mean (SEM) plasma ferritin concentration of infected women (59.3 (7.6) µg/L) was significantly lower than for non‐infected women (88.8 (7.9) µg/L; P=0.002), after adjusting for age. Mean daily dietary iron intakes were similar in infected and non­ infected women. Conclusions: H. pylori infection appears to be an additional stressor on women's iron status, but the mechanism remains to be determined.

Objective To investigate the prevalence of Helicobacter pylori infection and potential risk factors for infection in an adult Australian population. Design Cross‐sectional study. Setting Ballarat, a major regional city in Victoria (population, 78 000; 92% born in Australia), November 1994 to July 1995. Participants 217 adults randomly selected from the electoral roll. Main outcome measures H. pylori lgG antibody status by enzyme immunoassay; amount of dental plaque; sociodemographic and other potential risk factors; odds ratios for risk factors determined by logistic regression analysis. Results Age‐standardised prevalence of H. pylori infection was 30.6%. After adjustment for age, sex and socioeconomic index, positive H. pylori status was significantly associated with increasing number of tooth surfaces with a high plaque score (odds ratio [OR], 1.7; 95% confidence interval [Cl], 1.1‐2.7), increasing number of years in a job with public contact (OR, 1.7; 95% Cl, 1.3‐2.3), blood group B antigen (OR, 3.1; 95% Cl, 1.1‐9.1), and having lived in a household with more than six members during childhood (OR, 2.5; 95% Cl, 1.1‐5.5). Negative H. pylori status was significantly associated with increasing education, having ever lived on a farm, and having teeth scaled less than once a year. Conclusions H. pylori infection is common. Dental plaque may be a reservoir for H. pylori, which is probably transmitted by person‐to‐person contact, and blood group B antigen may predispose to infection. Community education about effective oral hygiene and adoption of good hygiene practices by those with regular public contact may be important to prevent acquisition and transmission of H. pylori.

SUMMARY Plasma calcium and phosphate concentrations and alkaline phosphatase activities were examined retrospectively in 50 patients with histologically proven osteomalacia and 50 age-and sexmatched control subjects with normal bone histology. An abnormal plasma alkaline phosphatase activity was more useful than an abnormal plasma calcium or phosphate concentration in distinguishing between normal and osteomalacic subjects, producing a false-negative rate of 140% and a falsepositive rate of 8 %. False-negative and false-positive rates of 10 % and 8 % respectively were obtained when the presence of an abnormality in any one of the three biochemical measurements was used as a predictor of histological osteomalacia. When discriminant analysis was applied to plasma calcium, phosphate and alkaline phosphatase together a false-negative rate of 12 %/ and a false-positive rate of 0 % was obtained.Sixty-two patients in whom a diagnosis of osteomalacia was suspected were investigated prospectively, using both single biochemical abnormalities and the classification functions derived from the discriminant analysis of all three biochemical measurements to predict the presence or absence of histological osteomalacia. Plasma alkaline phosphatase activity gave false-negative and falsepositive rates of 10% and 32% respectively but was a more reliable predictor of abnormal bone histology than were plasma calcium or plasma phosphate concentrations or the presence of an abnormality in any one of the three measurements. Discriminant analysis using plasma calcium, phosphate and alkaline phosphatase together produced a false-negative rate of 160% and a falsepositive rate of 10 %.We conclude that plasma alkaline phosphatase activity is the best single routine biochemical screening test for osteomalacia, although a high false-positive rate may occur. Direct discriminant analysis of plasma calcium, phosphate and alkaline phosphatase together provides a more sensitive method of detecting histological osteomalacia which should be useful in determining the prevalence of osteomalacia within high-risk populations.Osteomalacia is characterised histologically by defective bone mineralisation producing an increase in osteoid volume and seam thickness with decreased calcification fronts and a reduced mineralisation rate.The most common clinical manifestations are bone pain and proximal muscle weakness. Biochemically, hypocalcaemia, hypophosphataemia and a raised plasma alkaline phosphatase activity may occur. However, the clinical symptoms and signs are