Dosage considerations in the combined use of ocular-specific vitamins and nutrients and multivitamin products: A systemic review and analysis

OBJECTIVES

To provide guidance for safe and appropriate vitamin and mineral supplementation regimens for patients who use vitamins marketed for ocular use concurrently with general-purpose multivitamin (MVI) supplementation.

DATA SOURCES

Primary and tertiary evidence was compiled from secondary literature reference databases.

STUDY SELECTION

Dosage exposure with the use of supplements marketed for the prevention of ocular disease, including those recommended by the Age-Related Eye Disease Studies (AREDS), when used in combination with conventional MVI/nutrient products was determined. An analysis of the data was performed to suggest appropriate supplement recommendations.

DATA EXTRACTION

Combined dosages for single and duplicate ingredients found in ocular supplements and select MVI/nutrient supplements were compared with U.S. Food and Drug Administration--recommended daily value intake levels and the National Academy of Medicine recommendations on vitamin and nutrient tolerable upper intake levels (TUILs).

RESULTS

With the exception of copper, all studied product components that conformed to AREDS guidelines for vitamin and nutrient levels far exceeded U.S. Food and Drug Administration--recommended daily value intake level limits. Furthermore, vitamin A and zinc exceeded the National Academies of Medicine TUIL when a multivitamin product was combined with an ocular-specific vitamin or nutrient that conformed with AREDS-recommended dosage levels. Several products marketed specifically for ocular use failed to provide AREDS-recommended vitamin or nutrient levels even when combined with MVI products.

CONCLUSION

With the exception of vitamin A and zinc, the addition of typical multivitamin preparations to AREDS-recommended vitamin and nutrient regimens do not result in vitamin and mineral dosages that exceed TUIL as outlined by the National Academy of Medicine. However, combined AREDS and MVI regimens can create a substantial vitamin or mineral burden that is not appropriate for all older adult populations, particularly those with comorbidities, contributing to susceptibility of component toxicity.

Whole exome sequencing identifies a POLRID mutation segregating in a father and two daughters with findings of Klippel-Feil and Treacher Collins syndromes

We report on a father and his two daughters diagnosed with Klippel-Feil syndrome (KFS) but with craniofacial differences (zygomatic and mandibular hypoplasia and cleft palate) and external ear abnormalities suggestive of Treacher Collins syndrome (TCS). The diagnosis of KFS was favored, given that the neck anomalies were the predominant manifestations, and that the diagnosis predated later recognition of the association between spinal segmentation abnormalities and TCS. Genetic heterogeneity and the rarity of large families with KFS have limited the ability to identify mutations by traditional methods. Whole exome sequencing identified a nonsynonymous mutation in POLR1D (subunit of RNA polymerase I and II): exon2:c.T332C:p.L111P. Mutations in POLR1D are present in about 5% of individuals diagnosed with TCS. We propose that this mutation is causal in this family, suggesting a pathogenetic link between KFS and TCS.

5-year continence rates, satisfaction and adverse events of burch urethropexy and fascial sling surgery for urinary incontinence

PURPOSE

We characterized continence, satisfaction and adverse events in women at least 5 years after Burch urethropexy or fascial sling with longitudinal followup of randomized clinical trial participants.

MATERIALS AND METHODS

Of 655 women who participated in a randomized surgical trial comparing the efficacy of the Burch and sling treatments 482 (73.6%) enrolled in this long-term observational study. Urinary continence status was assessed yearly for a minimum of 5 years postoperatively. Continence was defined as no urinary leakage on a 3-day voiding diary, and no self-reported stress incontinence symptoms and no stress incontinence surgical re-treatment.

RESULTS

Incontinent participants were more likely to enroll in the followup study than continent patients (85.5% vs 52.2%) regardless of surgical group (p<0.0001). Overall the continence rates were lower in the Burch urethropexy group than in the fascial sling group (p=0.002). The continence rates at 5 years were 24.1% (95% CI 18.5 to 29.7) vs 30.8% (95% CI 24.7 to 36.9), respectively. Satisfaction at 5 years was related to continence status and was higher in women undergoing sling surgery (83% vs 73%, p=0.04). Satisfaction decreased with time (p=0.001) and remained higher in the sling group (p=0.03). The 2 groups had similar adverse event rates (Burch 10% vs sling 9%) and similar numbers of participants with adverse events (Burch 23 vs sling 22).

CONCLUSIONS

Continence rates in both groups decreased substantially during 5 years, yet most women reported satisfaction with their continence status. Satisfaction was higher in continent women and in those who underwent fascial sling surgery, despite the voiding dysfunction associated with this procedure.

Microarray expression profiling of p53-dependent transcriptional changes in an immortalized mouse embryo fibroblast cell line

The ability of p53 to transcriptionally regulate genes involved with cell cycle progression and apoptosis is critical to its role as a tumor suppressor. Although numerous p53 regulated genes have been identified over the last several years, ablation of any one of these genes cannot account for the full p53-mediated cellular response. Therefore, we performed microarray analysis using two related p53 temperature sensitive cell lines, Val5 and Vm10, to identify novel p53 regulated genes. The Val5 cells undergo p53-mediated cell cycle arrest and the Vm10 cells undergo p53-mediated apoptosis when p53 is in the wild-type conformation. By using these two cell lines, we can compare which genes are regulated by p53 in two different conditions as well as analyze which genes are common to both cell lines. Using the information obtained in the microarray analysis, we confirmed whether a small sub-set of the genes was regulated by p53 using northern blot analysis. By identifying and confirming the regulation of specific genes by p53, we can further characterize biologically why p53 transcriptionally regulates these genes.

Nicotine replacement prescription practices of obstetric and pediatric clinicians

OBJECTIVE

To assess smoking cessation counseling and nicotine replacement therapy prescription and recommendation practices among obstetric and pediatric providers.

METHODS

We sent out a self-administered survey to 61 obstetric and pediatric nurse practitioners and physicians at six community health centers in the Boston area.

RESULTS

Obstetric providers were more likely to view smoking cessation counseling as their responsibility in treating pregnant women than pediatric providers did in treating infants with mothers who smoked (mean +/- standard deviation [95% confidence interval] 4.5 +/- 0.76 [4.2, 4.8] versus 4.0 +/- 0.8 [3.7, 4.3] on a five-point scale; P <.05). Obstetric providers believed that smoking cessation counseling was more effective than did pediatric providers (3.45 +/- 1.1 [3.0, 3.9] versus 2.8 +/- 0.8 [2.5, 3.1] on a five-point scale; P <.05) and were more likely to report provision of cessation assistance than pediatric providers (63% [44%, 82%] versus 17% [5%, 29%]; P <.05). Obstetric providers were more likely to prescribe or recommend over-the-counter nicotine replacement therapy than pediatric providers (44% [25%, 63%] versus 11% [1%, 21%], P =.004). Reasons for not prescribing nicotine replacement differed according to specialty; however, perceived lack of efficacy was not a typical reason given by clinicians in either specialty. Only two of 47 practitioners who did not prescribe or recommend those therapies listed that as a factor in their decisions.

CONCLUSION

We found that nicotine replacement therapies are commonly prescribed or recommended to pregnant smokers by obstetric providers, but less commonly to lactating women by pediatric providers.

Results of employee involvement in planning and implementing the Treatwell 5-a-Day work-site study

When work-site health promotion programs incorporate theories of community organization, it is likely that employee ownership and participation are enhanced. This article reports quantitative indicators of involvement of Employee Advisory Board (EAB) members in the Treatwell 5-a-Day work-site study and examines relationships between EAB member time spent on project activities and work-site size, with indicators of the extent of implementation and variables associated with behavior change and work-site support. The results reported here indicate that a greater number of EAB member hours spent on program activities was associated with a greater number of events implemented. Smaller work-site size was associated with greater employee awareness of the program and greater participation in project activities as reported on the employee survey. These results suggest that the number of hours employee representatives devote to project activities might be an important consideration in planning employee involvement in work-site health promotion programming.

Process tracking results from the Treatwell 5-a-Day Worksite Study

PURPOSE

To report findings from Treatwell 5-a-Day process tracking.

DESIGN

Worksites were randomly assigned to a minimal intervention control, worksite-only condition, or worksite-plus-family condition.

SETTING

Twenty-two small community health centers in Massachusetts.

SUBJECTS

Employees of the community health centers.

INTERVENTION

Both intervention conditions included the formation of employee advisory boards; activities such as nutrition discussions and taste tests targeting individual behavior change; and point-of-purchase labeling as an environmental strategy. Worksite-plus-family sites incorporated activities such as family contests, campaigns, and picnics.

MEASURES

Documentation of the number and type of activities for extent of implementation; number of participants in activities for reach; program awareness and participation from the follow-up employee survey (n = 1306, representing 76% [range, 56%-100%] of the sample); change in fruit and vegetable consumption from a comparison between the follow-up and baseline surveys (n = 1359, representing 87% [range, 75%-100%] of the sample).

RESULTS

A higher number of activities per employee was significantly correlated with greater program awareness (.68; p = .006) and greater change in fruit and vegetable consumption (.55; p = .04). Greater participation in activities was significantly correlated with greater awareness (.67; p = .007), higher participation (.61; p = .02), and increase in fruit and vegetable consumption. (.55; p = .04).

CONCLUSIONS

These results provide quantitative indicators of a dose-response relationship between the number of intervention activities per employee and higher percentage of employee participation and observed increases in fruit and vegetable consumption.

Increasing fruit and vegetable consumption through worksites and families in the treatwell 5-a-day study

OBJECTIVES

We report on the results of the Treatwell 5-a-Day study, a worksite intervention aimed at increasing consumption of fruits and vegetables.

METHODS

Twenty-two worksites were randomly assigned to 3 groups: (1) a minimal intervention control group, (2) a worksite intervention, and (3) a worksite-plus-family intervention. The interventions used community-organizing strategies and were structured to target multiple levels of influence, following a socioecological model. Data were collected by self-administered employee surveys before and after the intervention; the response rate was 87% (n = 1359) at baseline and 76% (n = 1306) at follow-up. A process tracking system was used to document intervention delivery.

RESULTS

After control for worksite, gender, education, occupation, race/ethnicity, and living situation, total fruit and vegetable intake increased by 19% in the worksite-plus-family group, 7% in the worksite intervention group and 0% in the control group (P = .05). These changes reflect a one half serving increase among workers in the worksite-plus-family group compared with the control group (P = .018).

CONCLUSIONS

The worksite-plus-family intervention was more successful in increasing fruit and vegetable consumption than was the worksite intervention. Worksite interventions involving family members appear to be a promising strategy for influencing workers' dietary habits.

Worksite and family education for dietary change: the Treatwell 5-a-Day program

The National Cancer Institute's '5-a-Day for Better Health Campaign is examining the efficacy of interventions in increasing the consumption of fruits and vegetables to five or more servings a day. This paper presents the study design, intervention and baseline survey results of the Treatwell 5-a-Day project, a randomized, controlled worksite-based intervention study. Twenty-two community health centers were randomly assigned to either a Minimal Intervention, Worksite Intervention or Worksite Plus Family Intervention. The Worksite Intervention included participation of employee advisory boards, programs aimed at individual behavior change and programs aimed at changes in the worksite environment. The Worksite Plus Family Intervention incorporated family-focused interventions into the worksite program, including a learn-at-home program, family newsletter, family festival and materials mailings. A self-administered survey was conducted prior to randomization (mean response rate: 87%, n = 1359). Twenty-three percent reported consuming five or more servings of fruits and vegetables a day. Consumption of fruits and vegetables was directly associated with level of household support for healthy eating. The Treatwell 5-a-Day intervention model has the potential to enhance existing worksite-based intervention through incorporation of its family focus, especially given the association of household support with individual eating habits.

The effects of a health promotion-health protection intervention on behavior change: the WellWorks Study

OBJECTIVES

This study assessed the effects of a 2-year integrated health promotion-health protection work-site intervention on changes in dietary habits and cigarette smoking.

METHODS

A randomized, controlled intervention study used the work site as the unit of intervention and analysis; it included 24 predominantly manufacturing work sites in Massachusetts (250-2500 workers per site). Behaviors were assessed in self-administered surveys (n = 2386; completion rates = 61% at baseline, 62% at final). Three key intervention elements targeted health behavior change: (1) joint worker-management participation in program planning and implementation, (2) consultation with management on work-site environmental changes, and (3) health education programs.

RESULTS

Significant differences between intervention and control work sites included reductions in the percentage of calories consumed as fat (2.3% vs 1.5% kcal) and increases in servings of fruit and vegetables (10% vs 4% increase). The intervention had a significant effect on fiber consumption among skilled and unskilled laborers. No significant effects were observed for smoking cessation.

CONCLUSIONS

Although the size of the effects of this intervention are modest, on a populationwide basis effects of this size could have a large impact on cancer-related and coronary heart disease end points.

Social support and readiness to make dietary changes

This article examines the relationship between reported social support and readiness to increase fruit and vegetable consumption, based on the Transtheoretical Stage of Change Model. Data were collected as part of the baseline assessments for a work site intervention study promoting increased consumption of fruits and vegetables. Among workers who did not live alone, household support was significantly higher for those of Hispanic and African American heritage than other groups, and was also higher among men, nonsmokers, and those living with adults compared to those living only with children. In multivariate analyses, coworker support was significantly associated with being in preparation compared to precontemplation/contemplation. Household support was not significantly related to readiness to change in multivariate analyses. The effectiveness of work site nutrition education interventions is likely to be enhanced by teaching participants to provide social support to coworkers and family members.

Planned versus actual duration of drug abuse treatment. Reconciling observational and experimental evidence

The purpose of the study was to evaluate the associations of planned versus actual duration of drug abuse treatment with psychosocial outcomes and drug use at follow-up. A randomized trial was conducted in a modified therapeutic community in which 444 clients were assigned to programs with planned durations of either 3 or 6 months. Outcomes were psychosocial measures assessing changes in mood and in stage of behavior change between admission and exit and return to drug use and patterns of use 2 to 6 months after exit. Planned duration was not associated with any of the outcomes. A longer actual length of stay was, however, associated with greater improvements in the mood variables; lower rates of drug use at follow-up; and, among those using drugs at follow-up, a longer time from exit to first drug use. Intention-to-treat analyses supported these results. Randomized controlled trials are needed to distinguish the effects of planned duration and actual length of stay.

Double jeopardy: workplace hazards and behavioral risks for craftspersons and laborers

PURPOSE

To address three specific questions in a sample of craftspersons and laborers: (1) Do craftspersons and laborers exposed to workplace hazards have higher behavioral risks, such as smoking and high-fat diets, than those with few job risks? (2) Compared to workers with few job risks, do workers exposed to risks on the job have higher intentions to reduce their behavioral risks? (3) Does concern about the level of exposure to risks on the job increase workers' intentions to reduce behavioral risks?

DESIGN

A cross-sectional self-administered survey was conducted in participating worksites.

SETTING

Twenty-two predominantly manufacturing worksites in Massachusetts.

SUBJECTS

Craftspersons and laborers responding to the survey and employed in these 22 worksites (completion rate = 61%, N = 1841).

MEASURES

By using standardized items, this survey measured self-reported exposure to workplace hazards, concern about job exposures, smoking status, fat and fiber intake, readiness to quit smoking, plans to reduce fat intake, plans to eat more fruits and vegetables, and sociodemographic variables.

RESULTS

Workers reporting exposure to chemical hazards on the job were significantly more likely to be smokers than were unexposed workers, even when results were controlled for gender. Compared with unexposed workers, smokers exposed to chemical hazards were significantly more likely to be thinking of quitting or taking action to quit, when results were controlled for gender, race, and education. Among workers exposed to occupational chemical hazards, concern about this exposure was significantly associated with intentions to decrease fat intake and increase fruit and vegetable intake, and, among men, intentions to quit smoking.

CONCLUSIONS

Efforts aimed at integrating health promotion and health protection are needed to address simultaneously the job risks and personal risks these workers face.

Worker participation in an integrated health promotion/health protection program: results from the WellWorks project

According to prior reports, blue-collar workers are less likely to participate in worksite health promotion programs than are white-collar workers. This study examined worker participation in the WellWorks worksite cancer prevention intervention, which integrated health promotion and health protection. Analyses were conducted to assess relationships among participation in health promotion and health protection programs, and workers' perceptions of management changes to reduce potential occupational exposures. Results indicate that blue-collar workers were less likely to report participating in health promotion activities than white-collar workers. A significant association was observed between participation in nutrition- and exposure-related activities, suggesting that participation in programs to reduce exposures to occupational hazards might contribute to blue-collar workers' participation in health promotion activities. Furthermore, when workers were aware of changes their employer had made to reduce exposures to occupational hazards, they were more likely to participate in both smoking control and nutrition activities, even when controlling for job category. These findings have clear implications for future worksite cancer prevention efforts.

The effectiveness of alternative planned durations of residential drug abuse treatment

Randomized controlled trials were conducted at two residential drug abuse treatment facilities to compare programs that differed in planned duration. One trial compared a 6-month and a 12-month therapeutic community program (n = 184), and the second compared a 3-month and a 6-month relapse prevention program (n = 444). Retention rates over comparable time periods differed minimally by planned treatment duration, and the longer programs had lower completion rates. There was no effect in either trial of planned treatment duration on changes in psychosocial variables between admission and exit or on rates or patterns of drug use at follow-up between 2 and 6 months after exit.

A model for worksite cancer prevention: integration of health protection and health promotion in the WellWorks Project

OBJECTIVES

To describe a theoretic approach and rationale for the integration of health protection and health promotion in worksite cancer prevention programs and to describe an intervention study designed to implement this integration.

METHODS

Twenty-four worksites were recruited to participate in this randomized, controlled study. The theoretically based intervention model integrates health promotion and health protection through (1) joint worker-management participation in program planning and implementation, (2) consultation on worksite changes, and (3) educational programs targeting health behavior change.

RESULTS

Although the primary purpose of this paper is to describe a theoretic approach to the integration of health promotion and health protection, preliminary results are also noted. In these predominantly manufacturing worksites, many workers faced the double jeopardy of exposures to occupational carcinogens and personal risks such as smoking or poor dietary habits. Production workers' job responsibilities frequently limited their full participation. Barriers to participation were identified early in the project, and strategies were developed to facilitate maximal worker involvement and worksite changes.

CONCLUSIONS

Lifestyle changes such as smoking cessation or dietary changes may be more effectively promoted among blue collar audiences when programs also encourage management actions to reduce occupational exposures. Public health professionals trained in health promotion and health protection must work together to effectively address the health concerns of this population.

The Working Well Trial: baseline dietary and smoking behaviors of employees and related worksite characteristics. The Working Well Research Group

BACKGROUND

The Working Well Trial, the largest randomized worksite health promotion trial to date, tests the effects of cancer prevention and control interventions on dietary and smoking behaviors of employees and the worksite environment. The trial is a 5-year cooperative agreement conducted in 57 matched pairs of worksites in 16 states by four study centers, a coordinating center, and the National Cancer Institute. The dual aims of this paper are to: (a) present a baseline description of the dietary and smoking habits of 20,801 employees, who are predominantly blue-collar workers; and (b) describe the social and physical environments of their worksites that may facilitate or hinder health behavior changes.

METHODS

The self-administered baseline survey of individuals consisted of a core set of questions common across all study centers on diet and smoking. The organizational survey consisted of eight instruments administered via interviews with key informants in each worksite. Continuous variable were analyzed by a mixed linear model and binary data were analyzed by the Generalized Estimating Equation.

RESULTS

The population represented is largely male (67.5%) and blue collar (53.5%). Mean levels of fat and fiber intakes were close to the national averages (36.6% of calories as fat and 13.1 g of fiber). Smoking prevalence (25.2%) was slightly lower than the national average. The worksites had a high level of health promotion activities (42% had nutrition programs, 53% had smoking control programs), but lacked environmental support for dietary behavior change and perceived support for smoking cessation.

CONCLUSIONS

These findings replicate and extend previous research results to a large sample of diverse, largely blue-collar worksites. In addition the baseline results lay a foundation for the development of new insights into the relationship between individual and organizational level variables that may interact to influence behavioral and cultural norms.

Cocaine use and risky injection and sexual behaviors

The association between cocaine use (crack and injection cocaine) and risky behaviors for human immunodeficiency virus (HIV) infection was investigated among participants in a multi-site study at drug treatment and non-drug treatment sites in Worcester, Massachusetts. Cocaine use was more prevalent among young, African-American men. Compared to heroin injectors cocaine injectors had higher risk injection and sexual behaviors. Among non-injectors, crack users were more likely to have multiple partners and receive money or drugs for sex. Cocaine use, either injected or smoked as crack, should be considered a high risk behavior for HIV infection.

The use of the CAGE questionnaire in a cohort of homosexually active men

The prevalence and correlates of alcohol-related problems measured by the CAGE questionnaire were investigated in a population of 249 homosexually active men at a Boston community health center. Two hundred eight men (79.4%) reported alcohol use during the past 6 months and 22.9% (27.4% of alcohol users) were CAGE positive (two or more positive responses). Increased frequency of alcohol use was strongly associated with CAGE positivity (p < .001). Controlling for frequency of alcohol use, cigarette smoking was independently associated with a positive CAGE score. Other substance use and demographic variables were not independently associated with CAGE problems.

Impact of a breast cancer screening community intervention

BACKGROUND

Efforts to detect breast cancer in its early stages are necessary to reduce breast cancer-associated mortality. This study evaluated the impact of a multicomponent intervention implemented between 1987 and 1990 to increase a community's utilization of breast cancer screening by women over 50 years of age.

METHODS

The study used a pretest/post-test two-community design, with one community assigned as the intervention community and the other as the comparison. The intervention consisted of a comprehensive physician involvement component and a community education effort. To assess the overall impact of the interventions, we measured women's participation in screening via random digit dial telephone surveys at three time points, each approximately 18 months apart.

RESULTS

Over the course of the study, there were dramatic improvements in breast cancer screening participation in both communities. However, the intervention city showed more improvement in selected variables than did the comparison community in the early phases of the project between baseline and midpoint. These included increased advice by physicians to have mammograms, increased awareness that screening is necessary in the absence of symptoms, increased awareness that many women over 50 have mammograms, decreased perception of barriers to clinical breast exam, and an increase in the proportion of women having a clinical breast exam. In addition, significantly fewer women in the intervention city than in the comparison city reported never having had a mammogram at midpoint.

CONCLUSIONS

The findings demonstrate limited impact of a community intervention during a period of increasing adoption of mammography screening, in part, due to this rapidly rising secular trend. Additionally, increased activities in the comparison community were documented. Therefore, as incidence of screening increases, targeted activities aimed at population subgroups are warranted, and evaluation designs need to include multiple comparison groups or broader geographic random samples.

Changes in mammography use: economic, need, and service factors

OBJECTIVES

The purpose of this study was to document changes in mammography use between 1987 and 1990 and assess the relationship of use to selected economic, need, and health system factors.

METHODS

Independent random-digit-dialed telephone surveys of women between 52 and 75 years of age were conducted.

RESULTS

Between 1987 and 1990, the proportion of women who had had a mammogram in the past year increased from 31% to 51%. Though income was significantly related to overall patterns of use, it was not associated with recent mammogram use in 1990. Women with a family history of breast cancer reported greater use at both times, as did women who reported having a regular physician (particularly a gynecologist or internist). When all other variables were controlled for, women were over nine times more likely to have had multiple and recent mammograms in 1990 than in 1987.

CONCLUSIONS

Mammography use dramatically increased between 1987 and 1990. There were strong relationships between the type of regular physician and mammography screening and between economic and personal history and repeated and recent mammography use.

The risk factors of age and family history and their relationship to screening mammography utilization

OBJECTIVE

To study the association of two well known risk factors for breast cancer and the association of knowledge of those risk factors with mammography utilization.

DESIGN

Cross sectional: two independent random telephone surveys.

SETTING

Two Northeastern metropolitan communities surveyed in 1987 and in 1989.

PARTICIPANTS

Women without breast cancer who spoke English and who were between 45 and 75 years of age.

MAIN OUTCOME MEASURES

The two risk factors measured were a family history of breast cancer and being 65 or older. Participants were surveyed about their knowledge of risk factors, presence of risk factors, selected beliefs, attitudes, reinforcing factors and mammography use. Results were analyzed for women 50-75.

RESULTS

There was a substantial increase in mammography use over the 2-year period. Having a positive family history or being older is not associated with increased mammography utilization. Knowledge that family history and/or age are risks is associated with increased utilization. However, knowledge of risk factors is not associated with having those risks. Older women have lower utilization than younger women regardless of their knowledge of age as a risk. Increased physician recommendation is associated with increased utilization.

CONCLUSION

Since knowing that a factor is a risk and having a physician recommend mammography are each associated with increased use, we conclude that the primary care physicians' role in increasing mammography utilization is critical.

Work-site nutrition intervention and employees' dietary habits: the Treatwell program

In a randomized, controlled study of the Treatwell work-site nutrition intervention program, which focused on promoting eating patterns low in fat and high in fiber, 16 work sites from Massachusetts and Rhode Island were recruited to participate and randomly assigned to either an intervention or a control condition. The intervention included direct education and environmental programming tailored to each work site; control work sites received no intervention. A cohort of workers randomly sampled from each site was surveyed both prior to and following the intervention. Dietary patterns were assessed using a semiquantitative food frequency questionnaire. Adjusting for work site, the decrease in mean dietary fat intake was 1.1% of total calories more in intervention sites than in control sites (P less than .005). Mean changes in dietary fiber intake between intervention and control sites did not differ. This study provides evidence that a work-site nutrition intervention program can effectively influence the dietary habits of workers.

Interval adherence to mammography screening guidelines

The objectives of this research were to document adherence to mammography screening guidelines among women over 50 years of age and to investigate factors related to adherence. Selected sociodemographic variables--personal breast health history, provider-related variables, and medical care utilization--were studied. Data were collected through a random digit dial telephone survey of 693 women from two geographic areas. While 48% had had a mammogram in the last year, only 20% reported at least two recent mammograms at yearly intervals. Adherence was significantly associated with having a higher income, being white, being 51 to 64 years old and having had breast symptoms and/or a family history of breast cancer. Additionally, women who had a regular physician, higher frequency of clinical breast examination, and a recent physician visit were more adherent. Women enrolled in Health Maintenance Organizations (HMOs) and/or covered by commercial plans were more adherent than women with no insurance or with entitlement coverage only. These relationships were generally maintained in multivariate analysis. While this study is consistent with others that demonstrate increasing adoption of mammographic screening, it also illustrates that the goal of regular screening according to guidelines has yet to be achieved.

Oxygen consumption and guanosine diphosphate binding by fetal brown adipose tissue in diabetic pregnancy

Oxygen consumption and 3H-guanosine diphosphate (GDP) binding were determined in brown adipocytes and mitochondria from 28-day gestation fetuses of alloxan-diabetic rabbit does and saline-injected controls. Maternal diabetes was classified as severe or mild determined by whether maternal blood glucose values were greater or less than 200 mg/dL, respectively, at death. Basal oxygen consumption and adipocyte diameters did not vary among groups. A significant reduction in maximal norepinephrine (NE) stimulated O2 consumption by fetal brown adipose tissue (BAT) cells was seen in offspring of severely diabetic pregnancies when compared with control values (248 +/- 53 +/- v482 +/- 32 microL O2/10(6) cells/h; P less than .005). In contrast, a significant increase in maximal NE-stimulated O2 consumption by fetal BAT cells occurred in offspring of mild diabetic pregnancies (807 +/- 60, P less than .001 v controls). A highly significant inverse correlation between serum glucose levels and maximal O2 consumption by fetal BAT was observed in fetuses from mild and severe diabetic pregnancies (r = -.98, P less than .005), and there was no correlation between these two parameters in offspring of normal pregnancies. A significant inverse correlation was observed between maximal O2 consumption by fetal BAT cells and serum insulin levels in offspring of both control and diabetic pregnancy (r = -.74; P less than .02). Tissue cytochrome oxidase activity was lower in offspring of severely affected diabetic does, indicating a reduction in BAT mitochondrial content compared with controls. BAT mitochondria from fetuses of severely diabetic does exhibited reduced 3H-GDP capacity, which was 2.5-fold lower than controls.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of vitamin C supplementation on blood and hair levels of cadmium, lead, and mercury

Fifty-two adult male subjects were randomly assigned to one of three possible treatment groups: supplemental ascorbic acid at one of two levels, 500 mg or 1000 mg, or a placebo. Hair and blood samples were taken before vitamin C or placebo supplementation was started and at monthly intervals thereafter for three months. Samples were analyzed for cadmium, lead, and mercury. Results indicate that vitamin C did not significantly affect levels of these metals in either hair or blood samples.

Scheuermann's disease or spinal osteochondrosis: its frequency and relationship with spondylosis

Spinal osteochondrosis, previously known as Scheuermann's disease and spinal osteochondritis, is common and is probably becoming increasingly prevalent. Its incidence in patients whose primary complaint was of backache was shown to be twice as great as that in the general population. There was also a significantly higher incidence of lower lumbar spondylosis in patients with previous osteochondrosis compared with those without. Osteochondrosis is thereby shown to be an important aetiological factor in spondylosis.