[Cognitive functions and modifiable risk factors for chronic non-communicable diseases in ageing in a Russian population sample.]

We aimed to investigate the relationship between the indicators of cognitive functions (CF) and modifiable risk factors for chronic non-communicable diseases (NCD) in a cross-sectional analysis in the urban Russian population sample aged 55-84 years. The study investigated a random sample of 3 153 people (men and women 55-84 years old) from a general population cohort of Novosibirsk residents; a sample was examined within the international project HAPIEE. The study protocol included standardized neuropsychological tests (quantitative assessment of memory, semantic verbal fluency, attention and processing speed) and standardized assessment of risk factors, history and treatment of cardiovascular disease and NCD. In cross-sectional analysis we observed a positive relationship of CF indices with level of education and an inverse relationship with metabolic risk factors and smoking in both sexes. The level of total cholesterol and moderate alcohol consumption had positive relationship with CF indices in women. These associations were independent from age and other factors.

[Mitochondrial DNA copy number of leucocytes as ageing marker and risk factors for age-related diseases in human.]

We used quantitative real-time PCR method to analyse mtDNA copy number in a random subsample (n=996; 358 men aged 66,31±7,24 years; 468 women aged 67,62±7,1 years) selected from a population cohort (n=9 630) examined at baseline in international project HAPIEE in Novosibirsk, Russia, in 2003-2005. The participants were re-examined after 12 years in 2015-2017. The average relative number of mtDNA copies in peripheral blood leukocytes was greater in women than in men, independently of age and smoking (p=0,001). mtDNA copy number was inversely correlated with age both in men (p=0,005) and women (p<0,001). In age adjusted analysis, mtDNA copy number was inversely associated with waist, hip and heart rate in both sexes. In addition, mtDNA copy number in women was inversely associated with triglycerides and glucose, aterogenity index and positively with HDL cholesterol. In men, mtDNA copy number was positively associated with physical activity. The age-adjusted mean of mtDNA copy number among male never-smokers was greater than in smokers (p=0,003), and the mean mtDNA copy number was lower in women with diabetes than in women without diabetes (p=0,005). In both sexes, subjects with baseline history of hypertension had lower mtDNA copy number after 12-year follow-up than those without hypertension (p=0,05). This broadly supports the hypothesis that mtDNA copy number may act as biomarker of ageing.

[The forearm fractures in patients with diabetes and without diabetes in population sample aged over 50 years (Novosibirsk)].

BACKGROUND: The attention to the forearm fractures, as to osteoporotic fractures, is important for ensuring early detection of individuals at increased risk of future fractures and taking preventive measures. AIMS: To determine the frequency of a history of forearm fractures in patients with type 2 diabetes mellitus (DM2) and without diabetes, and their association with risk factors for chronic non-communicable diseases (NCD). MATERIAL AND METHODS: In 2015-2017, in Novosibirsk, a random urban population sample of males and females, 58-84 years old (n=3878), was surveyed. The study included persons who signed the informed consent to conduct the study, excluded individuals who wrote a waiver of taking blood to determine biochemical parameters. In total, the analysis included n=3393 people, 718 of them with DM2 (21.2%). Work design is cross-sectional research. The collection of information on fractures during for the last 3 years, the registration of socio-demographic data; and risk factors for NCD, a study of biochemical blood parameters. The analysis of the association of DM2 and a complex of risk factors for NCD with a chance of a forearm fracture. RESULTS: The prevalence of forearm fractures in the last 3 years did not differ in patients with DM2 compared with those examined without diabetes and was 2.4% and 2.8%, respectively (p=0.557). Men with fractures had higher cholesterol and HDL values, women had lower body mass index (BMI), compared with people without fractures. According to the results of a multivariate analysis in women, the chance of a forearm fracture is directly associated with smoking in the past, a total cholesterol level of more than 200 mg/dl and inversely associated with a BMI. In men, associations were found of the chance of a forearm fracture with an increase in the level of cholesterol. There was no evidence of DM2 with forearm fracture. CONCLUSION: The obtained data on the incidence of fractures and their association with risk factors for chronic low risk infections suggest the need for preventive measures for osteoporotic fractures, both in people with and without DM2.

[Length telomere leukocytes as ageing markers and risk factors for age-related diseases in humans].

The purpose of the research was studying of leukocyte telomere length association with age, sex, risk factors for age-related diseases in Russian people of pre-retirement and retirement age. By quantitative real-time PCR method we studied the leukocyte telomere length in 398 men (56,3±7,2 years) and 365 women (56,6±7,1 years) selected from a population sample of 45-69 year-old residents of the Oktyabrsky and Kirovsky districts of Novosibirsk (9 400 people). The selection was formed in the course of work on the international project HAPIEE. As a result, an inverse correlation of telomere length with age (r=-0,159, р<0,001), with the ratio waist / hips (r=-0,107, p=0,003) was found out. The average length of telomeres in women significantly more than in men, p=0,031.The correlation of telomere length in males with weight (r=0,140, p=0,005), waist size (r=0,111, p=0,027) was found out. In women, there is an inverse correlation of telomere length with a waist size (r=-0,127, p=0,015), the ratio of waist / hips (r=-0,141, p=0,007). The length of telomeres is an inverse correlation with correlation with quantity of the cigarettes smoked (r=-0,121, р=0,024). The length of telomeres leukocytes correlates with age, smoking, and a number of phenotypical signs. In men with the family anamnesis burdened by malignancies leucocytes telomere length was found to be greater than in men without such anamnesis.

Association between fasting plasma triglycerides, all-cause and cardiovascular mortality in Czech population. Results from the HAPIEE study.

Dyslipidemia is the risk factor of cardiovascular disease, but the relationship between the plasma triglyceride (TG) levels and total/cardiovascular mortality has not yet been analyzed in Slavs. The aim of our study was to analyze the association between the fasting TG levels and all-cause/cardiovascular mortality. We have examined 3,143 males and 3,650 females, aged 58.3+/-7.1 years. 729 deaths (274 cardiovascular deaths) have been registered during up to 11.8 years of follow-up. Age-sex adjusted all-cause mortality was higher in individuals with TG values 3.01-4.00 mmol/l (HR 1.37, 95 % CI 1.02-1.83, P=0.035) and over 4.00 mmol/l (HR 1.66, 95 % CI 1.21-2.27, P=0.002) when compared with a reference group (TG 1.41-1.80 mmol/l). Elevated risk remains significant when adjusted for education, marital status and unemployment. When further adjusted for smoking, BMI and dyslipidemia interventions, HR for those in above 4.00 mmol/l group decreased (1.42, P=0.04). The results have been similar when cardiovascular mortality has been examined, however, results reached statistical significance only for the TG over 4.0 mmol/l (P=0.028). Our results confirmed that enhanced plasma levels of plasma triglycerides are dose dependently associated with increased risk of all-cause mortality, however, it seems that individuals with TG values 1.8-3.0 mmol/l are not in higher risk of death.

Age at natural menopause in three central and eastern European urban populations: the HAPIEE study.

OBJECTIVES: To investigate the age at menopause in three urban populations in Central and Eastern Europe and to assess whether the (suspected) differences can be explained by a range of socioeconomic, reproductive and behavioural factors. METHODS: The Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) Study examined random samples of populations aged 45-69 years in Novosibirsk (Russia), Krakow (Poland) and six Czech towns. Participants completed a questionnaire and attended an examination in clinic. A total of 12,676 of women were included in these analyses. RESULTS: The median age at menopause was 50 years in Novosibirsk, 51 years in Czech towns and 52 years in Krakow; the Cox regression hazard ratios of menopause, compared with Krakow, were 1.47 (95% CI 1.40-1.55) for Novosibirsk and 1.10 (1.04-1.16) for Czech women. In multivariate analyses, higher education, using vitamin and mineral supplements and ever use of oral contraceptives were associated with later menopause, while smoking, abstaining from alcohol and low physical activity were associated with earlier menopause. These factors, however, did not explain the differences between populations; the multivariate hazard ratios of menopause, compared with Krakow, were 1.48 (1.40-1.57) for Novosibirsk and 1.11 (1.05-1.17) for Czech women. CONCLUSIONS: In this large population based study, differences in age at menopause between Central and Eastern Europe populations were substantial and unexplained by a range of risk factors. Associations of age at menopause with risk factors were largely consistent with studies in other populations.

FTO variant, energy intake, physical activity and basal metabolic rate in Caucasians. The HAPIEE study.

The FTO gene variants are the most important genetic determinants of body weight and obesity known so far, but the mechanism of their effect remains unclear. We have analyzed FTO rs17817449 variant (G>T in first intron) in 6024 adults aged 45-69 years to assess the potential mediating role of diet and physical activity. Diet was assessed by a 140-item food frequency questionnaire. Physical activity was measured by hours spent during a typical week by sport, walking and other activities outside of work requiring heavy and medium physical activity. Basal metabolic rate was calculated according Schofield formula. The FTO variant was significantly associated with body mass index (means in GG, GT and TT carriers were 28.7, 28.2 and 27.8 kg/m(2), p<0.001) and basal metabolic rate (BMR) (means in GG, GT and TT were 1603, 1588 and 1576 kcal per day, respectively, p<0.008) but it was not associated with physical activity, total energy intake or with energy intakes from fat, carbohydrates, proteins or alcohol. Results were essentially similar in men and women and the adjustment for physical activity or dietary energy intake did not reduce the effect of the FTO polymorphism. Means of BMR per kg of body weight was lowest in GG carriers (20.09, 20.21 for GT and 20.30 for TT, p<0.006) and this effect was more pronounced in females. These results suggest that the effect of the FTO rs17817449 variant on BMI in Caucasian adults is not mediated by energy intake or physical activity, but some effect on BMR per kg of body weight is possible.

[Gastrointestinal symptoms in adult population of Novosibirsk city: prevalence and risk factors].

AIM: To study prevalence of dyspepsia symptoms, gastroesophageal reflux (GER) and irritable bowel syndrome (ICS) in city population and to detect relevant risk factors. MATERIAL AND METHODS: Gastrointestinal symptoms were investigated with a validated questionnaire Bowel Disease Questionnaire and dyspepsia, GER, ICS syndromes were identified in a representative sample of adult Novosibirsk population (1040 patients, 492 males and 548 females aged 45-69 years). Risk factors were studied by social-demographic and antropometric parameters, smoking, drinking and administration of nonsteroidal anti-inflammatory drugs (NSAD). Depression was assessed by CESD questionnaire. Helicobacter pylori infection and the level of pepsinogen I were studied with enzyme immunoassay Biohit GastroPanel (Biohit, Finland). RESULTS: Incidence of dyspepsia was 38%, GER--30%, ICS--19%. One of the illnesses was found in 56% cases, combination of the conditions--in 24%. Females had dyspepsia and ICS much more frequently. Social-demographic parameters (age, marital status, education, labor activity), alcohol consumption, intake of NSAD, Helicobacter pylori infection had no significant effect on the incidence of gastrointestinal symptoms. GER occurred more frequently in smoking males. Overweight was characteristic both for GER males and females. Severe depression was associated with the risk of dyspepsia and ICS both in females and males. Hyperpepsinogenemia increased the rate of GER detection in males and dyspepsia in females. CONCLUSION: Dyspepsia, GER and ICS were seen in 50% adult population and often combine, but the risk factors differ. Some of the latter can be modified and prevented.

Changes in smoking prevalence in Russia, 1996-2004.

OBJECTIVES: In Russia, smoking prevalence has historically been high in men and relatively low in women. Female smoking prevalence is predicted to rise but assessment of changes has been limited by the lack of comparable data. Changes in the prevalence of smoking in Russia between 1996 and 2004, and whether theses changes differed by sociodemographic groups, were investigated. DESIGN: Repeated national interview surveys in 1996 (731 men and 868 women) and 2004 (727 men and 864 women) aged 18 years or more. MAIN OUTCOME MEASURE: Prevalence of current smoking. RESULTS: The age standardised prevalence of smoking in 1996 and 2004 was 61% and 63%, respectively in men and 15% and 16%, respectively in women (both p values > 0.4). In men, the prevalence of smoking seemed to decline in those with university education (from 51% to 40%, p = 0.085). Among women, smoking appeared to increase in those with university education (from 10% to 17%, p = 0.071) and low levels of self-reported material deprivation (from 11% to 18%, p = 0.053). There was a pronounced increase in prevalence among women living in villages (from 8% to 14%, p = 0.049); the strong urban/rural gradient seen in 1996 became considerably weaker by 2004. CONCLUSIONS: Overall smoking prevalence in both men and women in Russia remained stable between 1996 and 2004 but, given the sample size, a moderate increase in female smoking cannot be ruled out. In men, smoking increased among the least educated and declined in the most educated. In women the opposite appeared to occur, in addition to an increase in smoking in rural areas. More long term monitoring of smoking patterns in Russia, especially among women, using sufficiently large surveys, is required.

Beer and obesity: a cross-sectional study.

OBJECTIVE: There is a common notion that beer drinkers are, on average, more 'obese' than either nondrinkers or drinkers of wine or spirits. This is reflected, for example, by the expression 'beer belly'. However, the few studies on the association between consumption of beer and abdominal obesity produced inconsistent results. We examined the relation between beer intake and waist-hip ratio (WHR) and body mass index (BMI) in a beer-drinking population. DESIGN: A cross-sectional study. SETTINGS: General population of six districts of the Czech Republic. SUBJECTS: A random sample of 1141 men and 1212 women aged 25-64 y (response rate 76%) completed a questionnaire and underwent a short examination in a clinic. Intake of beer, wine and spirits during a typical week, frequency of drinking, and a number of other factors were measured by a questionnaire. The present analyses are based on 891 men and 1098 women who where either nondrinkers or 'exclusive' beer drinkers (ie they did not drink any wine or spirits in a typical week). RESULTS: The mean weekly beer intake was 3.1 l in men and 0.3 l in women. In men, beer intake was positively related to WHR in age-adjusted analyses, but the association was attenuated and became nonsignificant after controlling for other risk factors. There appeared to be an interaction with smoking: the relation between beer intake and WHR was seen only among nonsmokers. Beer intake was not related to BMI in men. In women, beer intake was not related to WHR, but there was a weak inverse association with BMI. CONCLUSION: It is unlikely that beer intake is associated with a largely increased WHR or BMI.

Smoke intake among smokers is higher in lower socioeconomic groups.

OBJECTIVE: To analyse socioeconomic differences in serum thiocyanate concentrations among current smokers, and whether such differences persist after adjustment for the number of cigarettes smoked. SETTING: General population of six districts of the Czech Republic in 1992. PARTICIPANTS: 451 male and 282 female current smokers. MAIN OUTCOME MEASURE: Serum concentration of thiocyanate. RESULTS: There was a clear educational gradient in serum thiocyanate among male smokers; car ownership and crowding were not related to thiocyanate. Age adjusted mean concentrations in men with primary, vocational, secondary, and university education were 168.6, 158.2, 148.2, and 141.8 micromol/l, respectively (p for trend 0.032). Adjustment for the average daily number of cigarettes explained a part of this gradient. Socioeconomic differences in serum thiocyanate were not seen in women. CONCLUSION: The strong gradient in men suggests that smokers from lower socioeconomic groups have a preference for higher smoke intake and so may be more nicotine dependent. This finding, if confirmed, would have important implications for anti-smoking programmes.

Parental smoking, socioeconomic factors, and risk of invasive meningococcal disease in children: a population based case-control study.

AIMS: To investigate the effects of parental smoking, socioeconomic characteristics, and indoor environment on the risk of invasive meningococcal disease in children. METHODS: Population based case-control study. A total of 68 incident cases of invasive meningococcal disease in children less than 15 years old were compared with 135 controls selected from the same school and matched for year of birth, sex, and place of residence. Information on exposures was obtained in interviews with parents. RESULTS: Invasive meningococcal disease was strongly associated with parental smoking; rate ratios adjusted for socioeconomic factors were 3.5 (95% confidence interval 1.4-8.7) for smoking of mother, 3.2 (1.5-6.9) for smoking of father, and 2.7 (1.3-5.4) for every 20 cigarettes smoked at home on an average day. The risk of the disease was strongly inversely related to maternal education and, less strongly, to ownership of a car and of a weekend house, father's education, crowding, and the number of siblings, but these associations were reduced or eliminated in multivariate models. The type of heating and cooking (used as proxies for indoor air pollution) were not associated with the disease. CONCLUSION: The risk of invasive meningococcal disease in children is strongly influenced by parental smoking and unfavourable socioeconomic circumstances.

The effect of air pollution on infant mortality appears specific for respiratory causes in the postneonatal period.

To examine the association between individual lifetime measures of mean exposure to air pollution and postneonatal respiratory deaths, we have conducted a matched population-based case-control study covering all births registered in the Czech Republic from 1989 to 1991 that were linked to death records. For each case of infant death, we have randomly selected 20 controls from infants of the same sex born on the same day and alive when the case died. Exposure was assigned as the arithmetic mean of all 24-hour air pollution measurements in the district of residence of each case and control for the period between the birth and death of the index case. We used conditional logistic regression to estimate the effects of suspended particles, sulfur dioxide, and nitrogen oxides on risk of death in the neonatal and postneonatal period, controlling for maternal socioeconomic status and birth weight, birth length, and gestational age. There were 2,494 infant deaths with exposure data on at least one pollutant, 133 of them from respiratory causes. The effects of all pollutants were strongest in the postneonatal period and were specific for respiratory causes. For these, rate ratios for a 50 microg/m3 increase in particles, sulfur dioxide, and nitrogen oxides were 1.95 [95% confidence interval (CI) = 1.09-3.50], 1.74 (95% CI = 1.01-2.98), and 1.66 (95% CI = 0.98-2.81), respectively, after controlling for all covariates. Only particles showed a consistent association when all pollutants were entered in one model. We found no evidence of a relation between any pollutant and mortality from other causes. These results indicate that the effects of air pollution on infant mortality are specific for respiratory causes in the postneonatal period, are independent of socioeconomic factors, and are not mediated by birth weight or gestational age.

An ecological study of determinants of coronary heart disease rates: a comparison of Czech, Bavarian and Israeli men.

BACKGROUND: The large differences in cardiovascular disease rates between Eastern and Western Europe have largely developed over the last few decades, and are only partly explained by classical risk factors. This study was set up to identify other potential determinants of these differences. METHODS: This was an ecological study comparing random samples of men aged 45-64 years selected from three cities representing populations with different rates of cardiovascular mortality: Pardubice (Czech Republic), Augsburg (Bavaria, Germany), and Jerusalem (Israel). In total, 191 (response rate 70%), 153 (70%) and 162 (62%) men, respectively, participated. All centres followed the same study protocol. Lifestyle, anthropometry and biochemical risk factors were assessed by identical questionnaires, standardized medical examination, and central analyses of fasting blood samples. RESULTS: The mortality rates in the study populations, as well as the prevalence of coronary heart disease in study samples, were highest in Czech, intermediate in Bavarian and low in Israeli men. This pattern was replicated across the three samples by mean blood pressure (P < 0.001), cigarette smoking (not significant), triglycerides (P < 0.05), fibrinogen or D-dimer levels (P < 0.05). On the other hand, the prevalence of diabetes and obesity were similar; total and high density lipoprotein (HDL)-cholesterol, apolipoprotein B, lipoprotein (Lp(a)) and glucose did not differ between Czech and Bavarian men; and Czechs had particularly low levels of serum insulin and factor VIIc. Israelis had low fasting glucose and total cholesterol, as well as HDL-cholesterol levels and a high Lp(a) (each P < 0.001) compared with the two other samples. Striking differences were found for plasma homocysteine (10.5 in Czechs versus 8.9 mumol/l in Bavarians, P < 0.001) and for alpha-carotene (geometric mean in Czechs 16, Bavarians 21 and Israelis 30 micrograms/l), beta-carotene (60, 110 and 102 micrograms/l), and lycopene (84, 177 and 223 micrograms/l), respectively; all P-values < 0.001). Adjustment for obesity or smoking did not change these estimates. There were no differences in the levels of tocopherol and retinol. CONCLUSIONS: Czech men had high levels of blood pressure, triglycerides, fibrinogen and D-dimer but many other traditional risk factors, as well as indicators of metabolic disorders and vitamins A and E, did not differ between the study samples. The low levels of carotenoids and high concentrations of homocysteine in Czech men seem to reflect their low dietary intakes of fruit and vegetables. The results provide indirect support for the importance of dietary factors in the East-West morbidity and mortality divide.

Socioeconomic status and cardiovascular risk factors in the Czech Republic.

BACKGROUND: In western countries, prevalence of cardiovascular diseases and most risk factors is higher in lower socioeconomic groups. The social gradients in the former communist societies are less well known. Because in western countries different indicators of socioeconomic status (SES) are correlated, this gradient is found with a number of different measures of SES. We have analysed the presence and magnitude of the socioeconomic gradient in cardiovascular risk factors in a former communist country. As the relationship between material conditions and education has been much weaker than in the west, we have also attempted to separate their effects. METHODS: A cross-sectional survey examined a random sample of men and women resident in six Czech districts participating in the MONICA study in 1992. Participants completed a questionnaire, underwent anthropometric and blood pressure measurements, and provided a blood sample. Two indicators of SES were used: education and material conditions, the indicator constructed from car ownership and crowding. Linear regression was employed to analyse the relation between SES and total and high-density lipoprotein (HDL) cholesterol, body mass index (BMI), waist-hip ratio (WHR) and height. Logistic regression was used to assess the association between SES and smoking and hypertension. RESULTS: A total of 1141 men and 1212 women (overall response rate 75%) participated in the study. After controlling for age, all risk factors were associated with education, except HDL cholesterol in women and BMI in men; only smoking in both sexes and WHR in women and height in men were significantly related to material conditions. In mutually adjusted analyses, educational gradients persisted but associations with material conditions disappeared or became substantially weaker. The magnitude of the educational differences was similar to those found in western countries. CONCLUSIONS: Socioeconomic differences in cardiovascular risk factors in Czech Republic in 1992 had the same direction and similar magnitude as in Western Europe, and were strongly related to education rather than material conditions. Materialist explanations for the social differences seem unlikely in this population.

Alcohol consumption in a national sample of the Russian population.

AIMS: Alcohol has been suggested as an important determinant of mortality in Russia but survey data on individuals' alcohol consumption in Russia are sparse. We have analysed the levels and distribution of alcohol consumption in a national sample of the Russian population. DESIGN: Cross-sectional survey. PARTICIPANTS: A multi-stage random sample of men and women of the Russian Federation (N = 1599, response rate 66%). MEASUREMENTS: Data on frequency of drinking alcohol and the average amount consumed at one occasion were collected in an interview. Information was also collected on smoking, self-rated health and a broad range of socio-economic factors and political attitudes. FINDINGS: Nine per cent of men and 35% of women reported that they never drink alcohol; 10% of men and 2% women drink several times a week; 44% of men and 6% of women reported that they drink an equivalent of 25 cl of vodka or more at one occasion and 31% of men and 3% of women would do so at least once a month (25 cl of vodka contains 78.5 g of absolute alcohol). There were differences in alcohol consumption between geographical areas. Material deprivation was not related to alcohol consumption. Among men, smokers, unmarried, unemployed and men reporting poor health consumed more alcohol; women with higher education, widows, non-smoking and with worse health consumed less alcohol. Variables related to reaction to economic and political changes, rating of family economic situation general satisfaction or political preferences were not related to alcohol consumption. CONCLUSIONS: While the overall levels of alcohol consumption appeared low, possibly due to under-reporting, the proportion of men who can be considered as "binge drinkers" was relatively high. The absence of sizable socio-economic differences suggest that drinking may be spread relatively uniformly in Russia, especially among males. Alcohol consumption seems unrelated to individuals' perception of the recent societal changes.

Could antioxidants play a role in high rates of coronary heart disease in the Czech Republic?

OBJECTIVES: To compare plasma levels of antioxidant vitamins in the Czech population with those in a western European population, and to investigate whether plasma levels of antioxidant vitamins in Czech population are related to risk of MI. DESIGN: The study has two parts: a cross-sectional survey and a population based case-control study. SETTING: Adult population in two districts of the Czech Republic, and London based civil servants group as the comparison. SUBJECTS: A random sample of men and women aged 25-64y resident in two districts were selected for the cross- sectional survey. Subjects in the age group 40-49 y were compared to a sample of British civil servants of the same age enrolled in the Whitehall II Study. Men in the Czech sample served as controls to 52 male cases of first non-fatal myocardial infarction (MI) which occurred in the same population. Plasma samples were obtained from venepuncture during an interview in hospital in the population sample and immediately after hospitalization in the MI cases. MAIN OUTCOME MEASURES: Plasma levels of beta-carotene and alpha-tocopherol, and the event of MI. Identical protocol and one laboratory was used for all analyses. RESULTS: The mean plasma levels of beta-carotene and alpha-tocopherol in healthy Czech men and women were substantially lower than in a subsample of British civil servants examined in the same laboratory. Smoking was strongly related to beta-carotene in both populations but differences between Czechs and Brits were present in both smokers and non-smokers. In the case-control study among Czech men, low levels of the vitamins were strongly related to an increases risk of MI. Age-adjusted odds ratios for concentrations below the median were 3.33 (95% confidence interval 1.43-8.33) for beta-carotene and 1.89 (0.94-3.45) for alpha-tocopherol; further adjustment for a range of variables reduced these estimates only slightly. CONCLUSIONS: Plasma concentrations of antioxidants in the Czech population appeared to be very low, and men with low levels of these substances are at increased risk of MI. This indicates that sub-optimal intake of antioxidants or related dietary factors may have played a role in the high rates of coronary heart disease in this population.

Patterns of smoking in Russia.

BACKGROUND: Tobacco is a leading cause of avoidable death in Russia but there is, as yet, relatively little information in the public domain on who is smoking and how this is changing. This information is important for those seeking to develop effective policies to tackle this issue. OBJECTIVE: To determine the prevalence of smoking in Russia and its association with sociodemographic factors. DESIGN: Cross-sectional survey on patterns of tobacco consumption. SETTING: Data were collected using the New Russia Barometer, a multi-stage stratified-sample survey of the population of the Russian Federation undertaken in the summer of 1996. PARTICIPANTS: Data were available on 1587 individuals (response rate 65.7%). Respondents differed little from the overall Russian population in terms of age, sex, education, and voting intention. MAIN OUTCOME MEASURES: Prevalence of current and past smoking. RESULTS: Smoking is common among males of all ages and in all areas. Of those aged 18-24 years, 65% smoke, rising to 73% in those aged 25-34 and then falling steadily to reach 41% in those aged 65 and older. Among women, smoking is much more common among the young (27% in those aged 18-34) than among the middle-aged and elderly (5% in those aged 55 and older), and more common among those living in urban areas than in rural areas. Smoking is also more common among men and women suffering material deprivation but there is no independent association with education. Among men, but not women, church attendance is inversely associated with smoking. In both sexes, but especially women, heavy drinking and smoking are associated. CONCLUSIONS: Tobacco poses a major threat to the health of future generations in Russia, especially among women. A robust policy response is required.

Socioeconomic factors, perceived control and self-reported health in Russia. A cross-sectional survey.

Russia has the lowest life expectancy among industrialised countries, but little is known about other health outcomes and determinants of health in the Russian population. Here we report a cross-sectional study in a national sample of the Russian population of social and psychosocial determinants of two self-reported health indicators: self-rated health (shown to predict mortality in prospective studies) and physical functioning (validated against more objective health measures). A multi-stage sample of the Russian population aged 18 years and more was interviewed (n=1599, response rate 66%). The questionnaire included political attitudes, social and economic circumstances, psychosocial factors, smoking, alcohol consumption, self-rated health and physical functioning (from the SF36 instrument). Scores of perceived control over life and over one's health were calculated from 6 and 3 questions, respectively. Data were analysed in logistic regression for two dichotomised outcomes: poor self-rated health (worse than average) and low physical functioning (less than 60% of maximum). Overall, 25% of subjects rated their health as worse than average; this is substantially more than in western countries. Perceived control over life was strongly related to both outcomes; age- and sex-adjusted OR for 1 standard deviation increase in control were 0.60 (95% CI 0.52-0.69) for poor self-rated health and 0.67 (0.57-0.81) for low physical functioning. Adjustment for a battery of other factors reduced these estimates only slightly. Associations between control over one's health and both outcomes were also significant, but weaker and attenuated in multivariate models. Material deprivation was also strongly related to both outcomes. Education was inversely related to self-rated health, and unmarried men reported poor physical functioning substantially more often. Subjects not approving the economic changes reported poorer health but this association was removed by adjustment for socioeconomic factors and control. Subjects who could not rely on informal social structures when in problems reported worse health; this effect largely persisted in multivariate analyses. These results are consistent with the hypothesis that poor health status in Russia is related to dysfunction of social structures, socioeconomic deprivation, and lack of perceived control. The absence of informal social networks, vital for maintaining general welfare, seems to affect adversely self-rated health. Deprivation and low perceived control may be important mediators between the broad social environment and health in populations undergoing transition and can provide a useful framework for many biological and behavioural factors. Prospective studies are needed to address the issue of temporality and reporting bias, the major problems in interpreting these findings.

Patterns of smoking in Bulgaria.

BACKGROUND: Although the rate of smoking-related deaths in Bulgaria is still relatively low, in international terms, it has been rising rapidly. This is likely to become worse in the future as Bulgaria faces growing pressure from transnational tobacco companies. There is, however, little information on patterns of smoking, which is necessary for development of effective policies to tackle tobacco consumption. OBJECTIVE: To describe the pattern of smoking in Bulgaria and its relationship with sociodemographic factors. DESIGN: Multivariate analysis of data on patterns of tobacco consumption from a multi-stage nationwide survey of 1550 adults. SETTING: Bulgaria, in 1997. MAIN OUTCOME MEASURE: Prevalence of current cigarette smoking. RESULTS: 38.4% of men and 16.7% of women smoke. Smoking rates are strongly associated with age, with 58% of men and 30% of women aged 30-39 smoking whereas only 5% of men aged 70 years and older and almost no women of this age smoke. Smoking is more common in cities, among those who are widowed or divorced, or who do not own their home. There is no clear association with household income or, for men, with education, although there is a suggestion that smoking may be more common among more highly educated women. CONCLUSIONS: The observed pattern of smoking indicates the need for a robust policy to tackle smoking in Bulgaria, especially among the young in large cities, informed by a better understanding of why smoking rates vary among different groups.