Impact of Nutrition on the Next Generation: The INCAP Longitudinal Study.

BACKGROUND: The design of the original nutrition supplementation trial that was conducted from 1969 to 1977 in 4 villages in rural Guatemala to evaluate the benefits of improving nutrition during pregnancy and early childhood, combined with several follow-up studies, provides unique data to examine the effects of improving nutrition on the next generation. OBJECTIVE: This article provides a summary of the key findings from the INCAP Longitudinal Study on the intergenerational effects of improving nutrition on the growth and well-being of the next generation. METHODS: The key outcomes include offspring birth size as well as attained size and body composition through age 11 years. The sample sizes varied from approximately 200 to 800 depending on the timing of the follow-up studies and data collection protocols. The effects of parental birth size, maternal linear growth from birth through adulthood, and exposure to the nutrition intervention, that is, Atole versus Fresco during critical periods from prenatal through age 15 years, have been examined using complex models and approaches. RESULTS: Overall, these publications demonstrate clear improvements in the growth of the next generation. Effects were seen primarily for maternal exposure to Atole and were larger for boys compared to girls. Stunting during early childhood among girls was also a significant predictor of offspring birth size, and younger age at first pregnancy (<20 years) was associated with an increased risk of stunting in the offspring. CONCLUSIONS: These studies have contributed significantly to our understanding of the importance of investing in nutrition, especially during early childhood for future generations.

Social Network Types, Health, and Health-Care Use Among South Korean Older Adults.

This study examines the associations among social network types, multiple health conditions, and various health-care use. Data came from the 2006 and 2008 wave of the Korean Longitudinal Study of Aging. A two-step cluster analytical approach was used to identify social network types. Regression models determined associations between social network types, health changes, and health-care use, including checkups, outpatient service, traditional medicine use, and hospitalization. Four social network types (restricted, couple focused, friend, and diverse) were found. Compared with the restricted type, individuals in the couple-focused type were more likely to use traditional medicine and outpatient care; members in the diverse type were more likely to use traditional medicine. The interaction model revealed varying associations between health change and social network on health-care use. Findings reveal the culturally contextualized association among multiple health conditions and how social network type moderates the relationship with health-care use.

Hipovitaminosis D y factores asociados a los 4 años en el norte de España / Hypovitaminosis D and associated factors in 4-year old children in northern Spain

INTRODUCCIÓN: La vitamina D es una prohormona esencial en la homeostasis del calcio y el fósforo. Estudios recientes muestran una elevada frecuencia de insuficiencia/deficiencia de vitamina D en población general a nivel mundial. Nuestro objetivo ha sido estimar la prevalencia de deficiencia e insuficiencia de vitamina D sérica [25(OH)D3] y examinar sus factores asociados en la infancia. MATERIAL Y MÉTODOS: Se ha estudiado a 283 niños participantes en la cohorte INMA-Asturias. Se determinó la 25(OH)D3 mediante cromatografía líquida de alta resolución. Se han estimado las prevalencias de deficiencia ([25(OH)D3 < 20 ng/ml) e insuficiencia (20-29,9 ng/ml) de vitamina D y se ha analizado la distribución de 25(OH)D3 por mes de extracción, ingesta y otros factores. RESULTADOS: La 25(OH)D3 media fue 20,1 ng/ml (rango 2,7-49,8). El 8,8% tenía 25(OH)D3 ≥ 30 ng/ml, el 38,5% entre 20-20,9 ng/ml y el 52,7% < 20 ng/ml. Se halló variación estacional con menores valores en invierno. No se encontró relación entre los niveles plasmáticos y la ingesta de vitamina D (mediana 2,7 g/día, rango 0,81-12,62), el tiempo al aire libre (mediana 3 h, rango: 0:21-6:55), el índice de masa corporal, ni el sexo, pero sí con los niveles de sus madres durante la gestación. CONCLUSIONES: Existe una elevada prevalencia de deficiencia/insuficiencia de vitamina D a los 4 años. La exposición solar podría no ser suficiente en nuestra región. Se deberían promover actividades al aire libre con una adecuada exposición a la luz solar. Dado el déficit de ingesta en la infancia, es necesario hacer recomendaciones de una alimentación variada rica en vitamina D en este periodo especialmente durante el invierno, valorando la necesidad de suplementar con vitamina D en los niños de riesgo

INTRODUCTION: Vitamin D is an essential prohormone in calcium and phosphorus homeostasis. Recent studies show a high frequency of insufficiency/deficiency of vitamin D in the general population worldwide. Our objective was to estimate the prevalence of circulating vitamin D [25(OH)D3] deficiency and insufficiency in children and examine the associated factors. MATERIAL AND METHODS: A total of 283 children, participants in the cohort INMA-Asturias, were studied. The 25(OH)D3 concentrations were quantified by high performance liquid chromatography. The prevalence of deficiency [25(OH)D3 < 20 ng/ml] and insufficiency [20-29.9 ng/ml] of vitamin D was estimated. Distribution of 25(OH)D3 for month of extraction of specimen, ingestion, and other factors were analysed. RESULTS: The mean 25(OH)D3 was 20.1 ng/ml (range 2.7-49.8), with 8.8% ≥ 30 ng/ml, 38.5% from 20-20.9 ng/ml, and 52.7% < 20 ng/ml. Seasonal variation was found, with lower values in winter. There was no relationship between plasma levels and intake of vitamin D (median 2.7 g/day, range 0.81-12.62), time outdoors (mean 3 hours, range: 0:21-6:55), or BMI or gender, but there was one found with the mother's levels during gestation. CONCLUSIONS: There is a high prevalence of vitamin D deficiency/insufficiency in children at 4 years. Solar exposure might not be enough in our region. Healthy children should be encouraged to follow adequate outdoor activities with associated sun exposure. Due the deficit of intake in childhood, recommendations are needed about a varied diet with vitamin D-containing foods in this age group, especially during the winter, and assessing the need of vitamin D supplementation in children at risk

Associations of breast-feeding patterns and introduction of solid foods with childhood bone mass: The Generation R Study.

Breast-feeding has been associated with later bone health, but results from previous studies are inconsistent. We examined the associations of breast-feeding patterns and timing of introduction of solids with bone mass at the age of 6 years in a prospective cohort study among 4919 children. We collected information about duration and exclusiveness of breast-feeding and timing of introduction of any solids with postnatal questionnaires. A total body dual-energy X-ray absorptiometry scan was performed at 6 years of age, and bone mineral density (BMD), bone mineral content (BMC), area-adjusted BMC (aBMC) and bone area (BA) were analysed. Compared with children who were ever breast-fed, those never breast-fed had lower BMD (-4·62 mg/cm2; 95 % CI -8·28, -0·97), BMC (-8·08 g; 95 % CI -12·45, -3·71) and BA (-7·03 cm2; 95 % CI -12·55, -1·52) at 6 years of age. Among all breast-fed children, those who were breast-fed non-exclusively in the first 4 months had higher BMD (2·91 mg/cm2; 95 % CI 0·41, 5·41) and aBMC (3·97 g; 95 % CI 1·30, 6·64) and lower BA (-4·45 cm2; 95 % CI -8·28, -0·61) compared with children breast-fed exclusively for at least 4 months. Compared with introduction of solids between 4 and 5 months, introduction <4 months was associated with higher BMD and aBMC, whereas introduction between 5 and 6 months was associated with lower aBMC and higher BA. Additional adjustment for infant vitamin D supplementation did not change the results. In conclusion, results from the present study suggest that ever breast-feeding compared with never breast-feeding is associated with higher bone mass in 6-year-old children, but exclusive breast-feeding for 4 months or longer was not positively associated with bone outcomes.

Two-generation diet-induced obesity model producing mice with increased amount of body fat in early adulthood.

The aim of our study was to develop a model producing obese mice in early adulthood (4-6 weeks) based on their over-nutrition during fetal and early postnatal development. The fertilized dams of the parental generation were fed the standard diet supplemented with high-energy nutritional product Ensure Plus during gestation and lactation. Delivered weanlings were then fed with standard or supplemented diet and assessed for body fat deposits using EchoMRI at the time of early and late adulthood. Maternal over-feeding during the period before weaning had the most significant effect on obesity development in the filial generation. In weanlings, significantly higher body fat deposits and average body weight were recorded. Later, further significant increase in percentage of body fat in both male and female mice was observed. Withdrawal of the Ensure Plus supplement caused a decrease in the percentage of body fat in part of the filial generation. In offspring fed the standard diet, higher fat deposits persisted till the time of late adulthood. We conclude that this diet-induced obesity model might be used in exploration of the effects of elevated body fat on physiological functions of various organ systems during juvenile and early adulthood periods of life of a human being.

Knowledge and valuation of Andean agroforestry species: the role of sex, age, and migration among members of a rural community in Bolivia.

BACKGROUND: Agroforestry is a sustainable land use method with a long tradition in the Bolivian Andes. A better understanding of people's knowledge and valuation of woody species can help to adjust actor-oriented agroforestry systems. In this case study, carried out in a peasant community of the Bolivian Andes, we aimed at calculating the cultural importance of selected agroforestry species, and at analysing the intracultural variation in the cultural importance and knowledge of plants according to peasants' sex, age, and migration. METHODS: Data collection was based on semi-structured interviews and freelisting exercises. Two ethnobotanical indices (Composite Salience, Cultural Importance) were used for calculating the cultural importance of plants. Intracultural variation in the cultural importance and knowledge of plants was detected by using linear and generalised linear (mixed) models. RESULTS AND DISCUSSION: The culturally most important woody species were mainly trees and exotic species (e.g.Schinus molle, Prosopis laevigata, Eucalyptus globulus). We found that knowledge and valuation of plants increased with age but that they were lower for migrants; sex, by contrast, played a minor role. The age effects possibly result from decreasing ecological apparency of valuable native species, and their substitution by exotic marketable trees,loss of traditional plant uses or the use of other materials (e.g. plastic) instead of wood. Decreasing dedication to traditional farming may have led to successive abandonment of traditional tool uses, and the overall transformation of woody plant use is possibly related to diminishing medicinal knowledge. CONCLUSIONS: Age and migration affect how people value woody species and what they know about their uses.For this reason, we recommend paying particular attention to the potential of native species, which could open promising perspectives especially for the young migrating peasant generation and draw their interest in agroforestry. These native species should be ecologically sound and selected on their potential to provide subsistence and promising commercial uses. In addition to offering socio-economic and environmental services,agroforestry initiatives using native trees and shrubs can play a crucial role in recovering elements of the lost ancient landscape that still forms part of local people's collective identity.

Age-period-cohort effect on mortality from cervical cancer.

OBJECTIVE: To estimate the effect of age, period and birth cohort on mortality from cancer of the cervix. METHODS: Mortality data for cervical cancer in women aged over 30, between 1980 and 2009, for the municipalities of Rio de Janeiro and Sao Paulo, Southeastern Brazil,were extracted from the Mortality Information System. The estimated annual percentage change was calculated for the periods 1980-1994 and 1995-2009. Age, period and cohort effects were assessed employing the Poisson regression model, using estimated functions, deviations, curvatures and drift through the library Epi statistical program R version 2.7.2. RESULTS: The average mortality rate per 100,000 women for the period in Rio de Janeiro was 15.90 and 15.87 in Sao Paulo. There was a significant reduction in mortality from cervical cancer in the two periods (1980-1994 and 1995-2009) in both Rio de Janeiro, -1.20% (95%CI -2.20;-0.09) -1.46% (95%CI -2.30;0.61) and in Sao Paulo, -2.58% (95%CI -3.41;1.76) and -3.30% (95%CI -4.30;2.29). The analysis of effects of curvature indicated reduction in deaths in successive cohorts (RR < 1 in women born after the 1960s). There was marked reduction in relative risk (RR) from the 2000s onwards. CONCLUSIONS: The study showed that, in the time period analyzed, the period had an effect on the reduction in mortality rates for cervical cancer, bearing in mind that there was a protective effect (RR < 1) from the year 2000 onwards and in women born after the 1960s.

Efeito idade-periodo-coorte na mortalidade por cancer do colo uterino / Age-period-cohort effect on mortality from cervical cancer

OBJETIVO: Estimar o efeito da idade, período e coorte de nascimento na mortalidade por câncer do colo do útero. MÉTODOS: Foram analisados dados de mortalidade por câncer do colo do útero em mulheres ≥ 30 anos nos municípios do Rio de Janeiro, RJ, e São Paulo, SP, de 1980 a 2009. Os dados foram extraídos do Sistema de Informação Sobre Mortalidade. A variação percentual anual estimada foi calculada para os períodos de 1980-1994 e 1995-2009. O efeito da idade, período e coorte de nascimento foi calculado pelo modelo de regressão de Poisson, utilizando funções estimáveis: desvios, curvaturas e drift , por meio da biblioteca Epi do programa estatístico R versão 2.7.2. RESULTADOS: A taxa de mortalidade média do período por 100.000 mulheres foi 15,90 no Rio de Janeiro e 15,87 em São Paulo. Houve redução significativa na mortalidade por câncer do colo do útero nos dois períodos: no Rio de Janeiro, -1,20% (IC95% -2,20;-0,09) e -1,46% (IC95% -2,30;-0,61), e em São Paulo, -2,58% (IC95% -3,41;-1,76) e -3,30% (IC95% -4,30;-2,29). A análise da curvatura dos efeitos indicou tendência de redução do risco de morte nas sucessivas coortes (RR < 1 nas mulheres nascidas após a década de 1960). Observou-se redução acentuada no risco relativo (RR) a partir dos anos 2000. CONCLUSÕES: O estudo evidenciou efeito de período na redução das taxas de mortalidade por câncer do colo do útero no período analisado, tendo em vista que houve efeito de proteção (RR < 1) a partir dos anos 2000 e nas mulheres nascidas após a década de 1960. .

OBJETIVO: Estimar el efecto de la edad, período y cohorte de nacimiento en la mortalidad por cáncer del cuello del útero MÉTODOS: Se analizaron datos de mortalidad por cáncer del cuello del útero en mujeres ≥ 30 años en los municipios de Rio de Janeiro, RJ, y Sao Paulo, SP (Brasil), de 1980 a 2009. Los datos fueron extraídos del Sistema de Información sobre Mortalidad. La variación porcentual anual estimada fue calculada para los períodos de 1980-1994 y 1995-2009. El efecto de la edad, período y cohorte de nacimiento fue calculado por el modelo de regresión de Poisson, utilizando funciones estimables: desviaciones, curvaturas y drift, por medio de la biblioteca Epi del programa estadístico R versión 2.7.2. RESULTADOS: La tasa de mortalidad promedio del período por 100.000 mujeres fue 15,90 en Rio de Janeiro y 15,87 en Sao Paulo. Hubo reducción significativa en la mortalidad por cáncer del cuello de útero en los dos períodos, en Rio de Janeiro: 1,20% (IC95% -2,2;-0,09) -1,46% (IC95% -2,30;-0,61), y en Sao Paulo: 2,58% (IC95% -3,41;-1,76) y -3,30% (IC95% -4,30;-2,29). El análisis de la curvatura de los efectos indicó tendencia de reducción de muerte en las sucesivas cohortes (RR ˂ 1 en las mujeres nacidas posterior a la década de 60). Se observó reducción acentuada en el RR a partir de los años 2000. CONCLUSIONES : El estudio evidenció efecto de período en la reducción de las tasas de mortalidad por cáncer del cuello del útero en el período analizado. Teniendo en cuenta que hubo efecto de protección (RR˂1) a partir de los años 2000, y en las mujeres nacidas posterior a la década de 1960. .

OBJECTIVE To estimate the effect of age, period and birth cohort on mortality from cancer of the cervix. METHODS Mortality data for cervical cancer in women aged over 30, between1980 and 2009, for the municipalities of Rio de Janeiro and Sao Paulo, Southeastern Brazil,were extracted from the Mortality Information System. The estimated annual percentage change was calculated for the periods 1980-1994 and 1995-2009. Age, period and cohort effects were assessed employing the Poisson regression model, using estimated functions, deviations, curvatures and drift through the library Epi statistical program R version 2.7.2. RESULTS The average mortality rate per 100,000 women for the period in Rio de Janeiro was 15.90 and 15.87 in Sao Paulo. There was a significant reduction in mortality from cervical cancer in the two periods (1980-1994 and 1995-2009) in both Rio de Janeiro, -1.20% (95%CI -2.20;-0.09) -1.46% (95%CI -2.30;0.61) and in Sao Paulo, -2.58% (95%CI -3.41;1.76) and -3.30% (95%CI -4.30;2.29). The analysis of effects of curvature indicated reduction in deaths in successive cohorts (RR < 1 in women born after the 1960s). There was marked reduction in relative risk (RR) from the 2000s onwards. CONCLUSIONS The study showed that, in the time period analyzed, the period had an effect on the reduction in mortality rates for cervical cancer, bearing in mind that there was a protective effect (RR < 1) from the year 2000 onwards and in women born after the 1960s .

Associations of age and birth cohort with total and specific IgE antibody levels.

BACKGROUND: Total and antigen-specific IgE levels vary greatly with age; however, it is unclear whether they are more closely related to patient age or birth cohort. OBJECTIVE: To determine whether birth cohort or age was more strongly correlated with total and specific IgE levels. METHODS: We retrospectively examined the medical records of 5136 asthma patients who were treated at the Niigata Allergic Disease Research Institute Outpatient Clinic during the period from 1997 to 2005. The subjects were divided into four birth cohorts based on their year of birth: the first cohort was born in 1935 or earlier, the second in 1936-1955, the third in 1956-1975, and the fourth in 1976 or later. Their total IgE level and mite-, cedar-, and Candida albicans (Candida)-specific IgE levels were measured using the CAP RAST fluoroenzyme immunoassay test. RESULTS: Univariate analysis revealed that total IgE level and mite-, cedar-, and Candida-specific IgE levels significantly decreased (p < .001) with advancing age. In addition, there were significantly higher IgE levels in later birth cohorts (p < .01). On multivariate analysis, there were associations of total IgE level and mite- and cedar-specific IgE levels with both age and birth cohort. However, there was no significant association between Candida-specific IgE antibody level and either age or birth cohort. CONCLUSIONS: The associations of total and specific IgE levels with age and birth cohort were different. Thus, in comparing the results of IgE antibody testing done in different years, even for patients of the same age, the possibility of a birth cohort effect on IgE levels should be considered.

Ingesta dietética y de suplementos de ácido fólico en mujeres embarazadas de Valencia / Folic acid intake from diet and supplements in a population of pregnant women in Valencia, Spain

Fundamento y objetivos: Analizar la ingesta dietética y de suplementos de ácido fólico (AF) durante el embarazo y los factores asociados al incumplimiento de la ingesta recomendada (IR) de 600μg/d y al incumplimiento de 400μg/d de suplementos para prevenir los defectos del tubo neural. Pacientes y método: Se incluyeron a 782 embarazadas de la cohorte INMA-Valencia. La ingesta dietética se estimó mediante un cuestionario de frecuencia alimentaria en 2 períodos de embarazo, desde preconcepción al mes 2 y desde el mes 3–7. También se recogió información de la suplementación y se estimó la ingesta total de AF (dieta+suplementos). Usando regresión logística múltiple se exploraron los factores asociados al incumplimiento de las recomendaciones. Resultados: La ingesta dietética media periconcepcional de AF fue de 304μg/d. Un 19,2%, 30,2% y 66,2% de embarazadas tomaron suplementos de AF en preconcepción, primer y segundo mes, respectivamente. Por otra parte, alrededor del 30% de las mujeres que tomaban suplementos de AF en periconcepción superó el límite superior tolerable de 1.000μg/d. El ser no española, de bajo nivel de estudios, fumadora, no planificar el embarazo, no haber visitado a ginecólogo privado, haber tenido hijos y no haber tenido antecedentes médicos previos, se asoció al incumplimiento de la IR. Conclusiones: La dieta sola es insuficiente para alcanzar las IR de AF, puesto que la suplementación se hace tarde y mal. La situación se agrava en mujeres jóvenes, de menor nivel educativo y embarazo no planificado (AU)

Background and objectives: We examined the dietary intake and the use of supplements of folic acid (FA) in a cohort of pregnant women. We also explored the factors associated with non-compliance of both the recommended intake (RI) of 600μg/day and the supplement use of 400μg/day provided to prevent neural tube defects (NTD). Pacients and methods: We studied 782 pregnant women from the INMA-Valencia cohort. The dietary intake was estimated using a food frequency questionnaire in two periods of pregnancy; from preconception to the second month and from the 3rd to the 7th month. Information on supplement use was also collected which allowed us to estimate the total FA intake (diet+supplements). We explored factors associated with non-compliance of the recommendations by logistic regression. Results: The periconceptional mean daily FA intake was 304μg/day. FA supplements were taken by 19.2, 30.2 and 66.2% of women in preconception, first and second month of pregnancy, respectively. Among women using supplements in periconception, 30% exceeded the tolerable upper intake level (UL) of 1.000μg/day. Non-compliance with RI was more common among women of foreign origin, of low educational level, who smoked, with unplanned pregnancy, who did not visit a private gynaecologist, who had had children or without previous medical illness. Conclusions: Diet by itself is not sufficient to reach RI for FA during pregnanc and many women initiate supplement use after the recommended period and inadequately. The youngest women, with lowest educational attainment and unplanned pregnancies are more likely not to comply (AU)

Tailoring a diabetes nursing elective course to millennial students.

Tailoring classroom teaching to millennial college students who have grown up as active learners is challenging. Interactive, collaborative teaching methods may be effective with such learners. An innovative class using Diabetes Conversation Maps, a patient self-management tool, was taught as an elective course. Students were assigned the role of a person who received a diagnosis of diabetes; the role included the person's specific age, gender, ethnicity, medication regimen, and predominant emotion. Students were expected to complete the assigned readings to enable them to role-play during five Conversation Map sessions. An updated, modified version of the Michigan Diabetes Research and Training Center's Brief Diabetes Knowledge Test was used to evaluate knowledge in a pretest-posttest format. The new teaching method resulted in an increased knowledge of diabetes and patient education techniques, as well as high student satisfaction.

Effects of chronic uranium exposure on life history and physiology of Daphnia magna over three successive generations.

Daphnia magna was exposed to waterborne uranium (U) at concentrations ranging from 10 to 75 microgL(-1) over three successive generations (F0, F1 and F2). Progeny was either exposed to the same concentration as mothers to test whether susceptibility to this radioelement might vary across generations or returned to a clean medium to examine their capacity to recover after parental exposure. Maximum body burdens of 17, 32 and 54 ng U daphnid(-1) were measured in the different exposure conditions and converted to corresponding internal alpha dose rates. Low values of 5, 12 and 20 microGy h(-1) suggested that radiotoxicity was negligible compared to chemotoxicity. An increasing sensitivity to toxicity was shown across exposed generations with significant effects observed on life history traits and physiology as low as 10 microgL(-1) and a capacity to recover partially in a clean medium after parental exposure to

Long-term trends in the use of complementary and alternative medical therapies in the United States.

BACKGROUND: Although recent research has shown that many people in the United States use complementary and alternative medical (CAM) therapies, little is known about time trends in use. OBJECTIVE: To present data on time trends in CAM therapy use in the United States over the past half-century. DESIGN: Nationally representative telephone survey of 2055 respondents that obtained information on current use, lifetime use, and age at first use for 20 CAM therapies. SETTING: The 48 contiguous U.S. states. PARTICIPANTS: Household residents 18 years of age and older. MEASUREMENT: Retrospective self-reports of age at first use for each of 20 CAM therapies. RESULTS: Previously reported analyses of these data showed that more than one third of the U.S. population was currently using CAM therapy in the year of the interview (1997). Subsequent analyses of lifetime use and age at onset showed that 67.6% of respondents had used at least one CAM therapy in their lifetime. Lifetime use steadily increased with age across three age cohorts: Approximately 3 of every 10 respondents in the pre-baby boom cohort, 5 of 10 in the baby boom cohort, and 7 of 10 in the post-baby boom cohort reported using some type of CAM therapy by age 33 years. Of respondents who ever used a CAM therapy, nearly half continued to use many years later. A wide range of individual CAM therapies increased in use over time, and the growth was similar across all major sociodemographic sectors of the study sample. CONCLUSIONS: Use of CAM therapies by a large proportion of the study sample is the result of a secular trend that began at least a half century ago. This trend suggests a continuing demand for CAM therapies that will affect health care delivery for the foreseeable future.

Generational differences in selenium status of women.

In this cross-sectional study of three generations of women, daughters (19-26 yr), mothers (40-58 yr) and maternal grandmothers (67-84 yr) from the same 10 families in central Ohio were studied to determine the effect of life-cycle differences, including estrogen status, on selenium status. Plasma and red blood cell (RBC) selenium and glutathione peroxidase (GPx) activities were determined and typical dietary selenium intakes were calculated from food-frequency questionnaires. Selenium status was lowest in the oldest generation. Plasma selenium of daughters and grandmothers were significantly lower than those of mothers, and plasma GPx and RBC selenium of grandmothers were also lower than those of the mothers. A positive correlation (r = 0.42, p < 0.04) was found between plasma estrogen and plasma selenium concentrations. Selenium intakes of all groups were adequate and no differences in selenium intakes were found among groups. The results of this study indicate that selenium status fluctuates during the female life cycle and is related to estrogen status.

Alcohol, tobacco and paan use and understanding of oral cancer risk among Asian males in Leicester.

OBJECTIVES: To determine use of alcohol, tobacco and paan among males from the various Asian communities in Leicester; and assess their knowledge and attitudes towards oral cancer risk factors and prevention. Also, to determine any differences regarding habits and attitudes between first and second generation Asians. DESIGN: Volunteers completed a confidential, bilingual questionnaire regarding alcohol, tobacco and paan use and also knowledge about oral cancer risk factors and preventive measures. SETTING: Participants were recruited from sources that included GPs' surgeries, sixth form colleges and places of worship. SUBJECTS: Asian males, i.e. those of Indian, Pakistani, Bangladeshi or Sri Lankan origin; over the age of 16 years and resident in Leicester. MAIN OUTCOME MEASURES: Quantitative figures were obtained from the questionnaires as to the frequency of alcohol, tobacco and paan use and responses regarding oral cancer knowledge, risk factors and preventive measures. RESULTS: The principal Asian community groups in Leicester were Hindu, Sikh, Muslim and Jain. Significant differences were found in males from these groups with regards to habits and oral cancer awareness. Muslim males use tobacco and paan more than the other groups but avoid alcohol. Sikh males drink more alcohol (especially spirits) than the other groups but their use of tobacco and paan is low. Habits of Hindu and Jain males are variable. However, approximately 10% of both 1st and 2nd generation Hindu males combine all three habits of alcohol, tobacco and paan; and are thus considered to be at high risk of developing oral cancer. Seven percent of 1st generation Hindu males were found to chew paans containing tobacco which are strongly associated with oral cancer. More 2nd generation Jains drank alcohol than the 1st generation, and a greater proportion of Hindu, Sikh and Jain 2nd generation males drink spirits than their older counterparts. Knowledge of oral cancer risk factors and preventive measures were variable, the lowest level of knowledge being among the 1st generation Sikh group. Few volunteers realised the risk of alcohol drinking in the aetiology of oral cancer. CONCLUSION: The 'Asian' community in Leicester is not homogeneous, but consists of distinct community groups; each with their own cultural beliefs, habits and attitudes. Knowledge of these differences can be used to provide appropriate health education programmes suitably targeted to reduce the use of the known risk factors for oral cancer.

Tobacco smoking, coffee, cocoa and tea consumption in relation to mortality from urinary bladder cancer in Italy.

This paper examines changes in mortality from urinary bladder cancer in Italy during the years 1950-81 in relation to changes in smoking habits and in coffee, cocoa and tea consumption. The authors found that, in both sexes and for all ages, mortality has been increasing throughout this period, although the rates and relative increase have consistently been much lower and more gradual for women than for men. From the analysis of age-cohort-period variation it seems that bladder cancer mortality can also be influenced by changes in smoking habit patterns and by variation in the quality of diagnoses. The increase in death risk for both sexes in Italy up to cohorts born around 1905-10 can be related to occupational exposures and to high-tar-content tobacco smoking, whereas the tendency for mortality rates to stabilize and decline in cohorts born after 1910 were influenced by changes from high-tar-content and no-filter cigarettes to low-tar-content and filter cigarettes and by prevention measures taken in at-risk working environments. The consumption of coffee, cocoa and tea does not seem to be related to the increase in bladder cancer risk in Italy.