Swimming pools and health-related behaviours: results of an Italian multicentre study on showering habits among pool users

Objectives

Showering before entering a swimming pool is highly recommended to reduce the risk of biological and chemical contamination. This study evaluated the behaviour of indoor swimming pool users; analysed the variables associated with lack of showering; and assessed awareness of the importance of showering.

Study design

Cross-sectional study.

Methods

A self-administered questionnaire was used to collect data about users of swimming pools located in five different Italian cities. The association between specific variables and the lack of showering was assessed. P < 0.05 was considered to indicate statistical significance.

Results

In total, 4356 questionnaires were analysed. Sixty-five percent of interviewees always showered before entering the pool. The main reason given for pre-swim showering was ‘to wash oneself’ (50.5%); or ‘to get used to the temperature of the water’ (44.3%); and 5.2% answered ‘for both reasons’. Risk factors significantly associated with lack of showering were: female sex (odds ratio (OR) 1.37, 95% confidence interval (CI) 1.2–1.59), age 14–17 years (OR 5.09, 95% CI 3.40–7.64); not reading the swimming pool rules (OR 1.24, 95% CI 1.10–1.41); living in Central Italy (OR 3.3, 95% CI 2.65–4.1) or Southern Italy (OR 1.35, 95% CI 1.18–1.55); and previous/current attendance of a swimming course (OR 1.7, 95% CI 1.48–1.97).

Conclusions

The results revealed low compliance with the rule of showering before entering a swimming pool, and little awareness of the preventive role of showering in the hygienic management of swimming pools. There is a need for targeted educational interventions to inform swimming pool users of the reasons for the importance of showering before entering a pool.     

Investigation of ultrasound screening efficiency for neural tube defects during pregnancy in rural areas of China

Objectives

To understand the uptake and efficacy of ultrasound screening for neural tube defects (NTDs) during pregnancy, and the outcomes when NTDs were detected in rural areas of China.

Study design

Prevalence study.

Methods

Four hundred and twenty-four women who delivered or gestated babies/fetuses with NTDs were selected at random in 20 counties of two provinces of China from March 2008 to January 2009. The uptake of ultrasound screening, NTD detection rate and termination of pregnancy (TOP) rate were calculated and analyzed. Generalized estimating equations were employed to control for potential confounding factors.

Results

The uptake of ultrasound screening was 98.8%. Among the study subjects, 361 (85.1%) NTDs were detected and 63 (14.9%) were not detected by prenatal ultrasound screening. The total detection rate was 43.3% (15.6%, 49.6% and 52.2% in the first, second and third trimesters, respectively; P < 0.05). Taking the possibility of NTD detection in the first trimester as 1.0, the possibilities in the second and third trimesters were 10.9 [95% confidence interval (CI) 6.5–18.3] and 25.2 (95% CI 13.3–47.6), respectively. The detection rate at the township health centres (THCs), family planning centres (FPCs), maternal and child care service centres (MCSCs) and hospitals was 24.5%, 29.1%, 53.6% and 78.1%, respectively (P < 0.05). Taking the possibility of NTD detection at THCs as 1.0, the possibilities at FPCs, MCSCs and hospitals were 0.9 (95% CI 0.5–1.6), 3.4 (95% CI 1.9–6.1) and 2.1 (95% CI 1.3–3.4), respectively. Three hundred and fifty-five (98.3%) of the 361 NTDs detected at prenatal ultrasound screening ended in TOP.

Conclusions

The uptake of ultrasound screening was satisfactory, but the NTD detection rate was low. Ultrasound screening did not play its full role in the secondary prevention of NTDs in the study areas. Medical institutions in rural areas in China need to improve their ultrasound screening skills in order to increase the efficacy of NTD control.     

Name analysis to classify populations by ethnicity in public health: validation of Onomap in Scotland

Objectives

Health inequalities between ethnic minorities and the general population are persistent. Addressing them is hampered by the inability to classify individuals’ ethnicity accurately. This is addressed by a new name-based ethnicity classification methodology called ‘Onomap’. This paper evaluates the diagnostic accuracy of Onomap in identifying population groups by ethnicity, and discusses applications to public health practice.

Study design

Onomap was applied to three independent reference datasets (birth registration, pupil census and register of Polish health professionals) collected in Britain and Poland at individual level (n = 260,748).

Methods

Results were compared with the reference database ethnicity ‘gold standard’. Outcome measures included sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Ninety-five percent confidence intervals and Chi-squared tests were used.

Results

Onomap identified the majority of those in the British participant group with high sensitivity and PPV (>95%), and low misclassification (<5%), although specificity and NPV were lowest in this group (56–87%). Outcome measures for all other non-British groupings were high for specificity and NPV (>98%), but variable for sensitivity and PPV (17–89%). Differences in misclassification by gender were statistically significant. Using maiden name rather than married name in women improved classification outcomes for those born in the British Isles (0.53%, 95% confidence interval 0.26–0.8%; P < 0.001) but not for South Asian or Polish groups.

Conclusions

Onomap offers an effective methodology for identifying population groups in both health-related and educational datasets, categorizing populations into a variety of ethnic groups. This evaluation suggests that it can successfully assist health researchers, planners and policy makers in identifying and addressing health inequalities.     

Simplified follow-up after early medical abortion: 12-month experience of a telephone call and self-performed low-sensitivity urine pregnancy test

Objective

The objective was to determine if simplified follow-up after early medical abortion, consisting of a telephone call 2 weeks after the procedure plus a self-performed low-sensitivity urine pregnancy (LSUP) test, was successful for screening for ongoing pregnancies in the year following its introduction as standard service.

Study design

A retrospective computerized database review of 1084 women at a hospital abortion service in Edinburgh, UK, who had a medical abortion (≤ 9 weeks) and went home to expel the pregnancy was performed. Women who screened ‘positive’ at telephone follow-up on the basis of ongoing pregnancy symptoms, scant bleeding or LSUP test result were scheduled for an ultrasound. The main outcome measures were the proportion of women scheduled for telephone follow-up successfully contacted and the proportion of ongoing pregnancies detected.

Results

A total of 943 women were scheduled for telephone follow-up. Ten women presented to the hospital before the time of the follow-up call. Of the remaining 933 women, 656 [70%, 95% confidence interval (CI) 67.7-73.2] were successfully contacted. Five hundred seventy-three (87%, 95% CI 84.5–89.7) of those contacted screened ‘negative’; no false negatives occurred. Eighty-three (13%, 95% CI 10.2–15.5) screened ‘positive,’ and of those, three had ongoing pregnancies. Of the 277 (30%, 95% CI 26.7–32.7) who were not contacted, two ongoing pregnancies occurred. The sensitivity of telephone follow-up with LSUP to detect ongoing pregnancy was 100% (95% CI 30.9%–100%), and specificity was 88% (95% CI 84.9%–90.1%). The negative predictive value was 100% (95% CI 99.1%–100%), and positive predictive value was 3.6% (95% CI 0.9%–10.9%).

Conclusion

A telephone call and LSUP test at 2 weeks are suitable as a standard method of follow-up for screening for ongoing pregnancy after early medical abortion.

Implications statement

For most women, a routine clinic follow-up after early medical abortion (to exclude ongoing pregnancy) can be replaced with a telephone call and a self-performed LSUP test at 2 weeks postprocedure.     

Association between documented family history of cancer and screening for breast and colorectal cancer

Background

Previous research on ascertainment of cancer family history and cancer screening has been conducted in urban settings.

Purpose

To examine whether documented family history of breast or colorectal cancer is associated with breast or colorectal cancer screening.

Methods

Medical record reviews were conducted on 3433 patients aged 55 and older from four primary care practices in two rural Oregon communities. Data collected included patient demographic and risk information, including any documentation of family history of breast or colorectal cancer, and receipt of screening for these cancers.

Results

A positive breast cancer family history was associated with an increased likelihood of being up-to-date for mammography screening (OR 2.09, 95% CI 1.45–3.00 relative to a recorded negative history). A positive family history for colorectal cancer was associated with an increased likelihood of being up-to-date with colorectal cancer screening according to U.S. Preventive Services Task Force low risk guidelines for males (OR 2.89, 95% CI 1.15–7.29) and females (OR 2.47, 95% CI 1.32–4.64) relative to a recorded negative family history. The absence of any recorded family cancer history was associated with a decreased likelihood of being up-to-date for mammography screening (OR 0.70, 95% CI 0.56–0.88 relative to recorded negative history) or for colorectal cancer screening (OR 0.75, 95% CI 0.60–0.96 in females, OR 0.68, 95% CI 0.53–0.88 in males relative to recorded negative history).

Conclusion

Further research is needed to determine if establishing routines to document family history of cancer would improve appropriate use of cancer screening.     

Association of Web-Based Weight Loss Information Use With Weight Reduction Behaviors in Adolescent Women

Purpose

To examine the association between seeking weight loss information from the Internet and weight loss behaviors.

Methods

A self-administered survey was conducted on 3,181 women, aged 16–24 years, between August 2008 and August 2010. Questions were asked on use of the Internet to obtain weight loss information and various weight loss practices. Multivariate logistic regression analyses were performed to examine the association between seeking weight loss information online and practicing these weight loss behaviors.

Results

In all, 39% used the Internet to seek weight loss information. Women who obtained weight loss information from the Internet were more likely to exercise (odds ratio [OR]: 1.31, 95% confidence interval [CI]: 1.07–1.60), use diet pills (OR: 4.14, 95% CI: 2.93–5.84), laxatives (OR: 2.02, 95% CI: 1.15–3.54), diuretics (OR: 7.89, 95% CI: 2.88–21.61), vomit after eating (OR: 2.56, 95% CI: 1.24–5.30), skip meals (OR: 2.77, 95% CI: 2.26–3.39), smoke more cigarettes (OR: 1.56, 95% CI: 1.14–2.14), and stop eating carbohydrates (OR: 3.09, 95% CI: 1.81–5.26) after adjusting for age, race/ethnicity, body mass index, and education.

Conclusions

Many young women engage in unhealthy weight loss behaviors which they may learn online. Interventions are needed to instruct young women on safe practices to lose weight.     

Urinary bisphenol A and obesity: NHANES 2003-2006

Background

Bisphenol A (BPA) is a chemical suspected of causing endocrine and metabolic disruption in animals and humans. In rodents, in utero exposure to low-dose BPA is associated with weight gain. Detectable levels of BPA are found in most Americans due to its widespread use in the manufacture of food and drink packaging. We hypothesized that urinary BPA concentrations would be positively associated with general and central obesity.

Methods

Cross-sectional analysis of urinary BPA concentrations, body mass index, and waist circumference in 2747 adults (aged 18–74), using pooled data from the 2003/04 and 2005/06 National Health and Nutrition Examination Surveys.

Results

The creatinine-adjusted geometric mean urinary BPA concentration was 2.05 μg/g creatinine (25th percentile: 1.18, 75% percentile: 3.33). Relative to those in the lowest BPA quartile, participants in the upper BPA quartiles were more likely to be classified as obese (quartile 2 odds ratio (OR): 1.85, 95% confidence interval (CI): 1.22, 2.79; quartile 3 OR: 1.60, 95% CI: 1.05–2.44; quartile 4 OR: 1.76, 95% CI: 1.06–2.94). Higher BPA concentration was also associated with abdominal obesity (quartile 2 OR: 1.62, 95% CI: 1.11, 2.36; quartile 3 OR: 1.39, 95% CI: 1.02–1.90; quartile 4 OR: 1.58, 95% CI: 1.03–2.42).

Conclusions

Higher BPA exposure is associated with general and central obesity in the general adult population of the United States. Reverse causation is of concern due to the cross-sectional nature of this study; longitudinal studies are needed to clarify the direction of the association.     

Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel

Background

Emergency contraception (EC) does not always work. Clinicians should be aware of potential risk factors for EC failure.

Study Design

Data from a meta-analysis of two randomized controlled trials comparing the efficacy of ulipristal acetate (UPA) with levonorgestrel were analyzed to identify factors associated with EC failure.

Results

The risk of pregnancy was more than threefold greater for obese women compared with women with normal body mass index (odds ratio (OR), 3.60; 95% confidence interval (CI), 1.96–6.53; p<.0001), whichever EC was taken. However, for obese women, the risk was greater for those taking levonorgestrel (OR, 4.41; 95% CI, 2.05–9.44, p=.0002) than for UPA users (OR, 2.62; 95% CI, 0.89–7.00; ns). For both ECs, pregnancy risk was related to the cycle day of intercourse. Women who had intercourse the day before estimated day of ovulation had a fourfold increased risk of pregnancy (OR, 4.42; 95% CI, 2.33–8.20; p<.0001) compared with women having sex outside the fertile window. For both methods, women who had unprotected intercourse after using EC were more likely to get pregnant than those who did not (OR, 4.64; 95% CI, 2.22–8.96; p=.0002).

Conclusions

Women who have intercourse around ovulation should ideally be offered a copper intrauterine device. Women with body mass index >25 kg/m² should be offered an intrauterine device or UPA. All women should be advised to start effective contraception immediately after EC.     

Association of Socioeconomic Status, Problem Behaviors, and Disordered Eating in Mexican Adolescents: Results of the Mexican National Health and Nutrition Survey 2006

Purpose

To explore the association of socioeconomic status (SES) with disordered eating behaviors (DEB) in Mexican adolescents, and the coexistence of DEB and other problem behaviors.

Methods

Information about adolescents (10–19 years) was retrieved from the Mexican National Health and Nutrition Survey 2006 database. Associations were evaluated through ordinal regression.

Results

Higher SES was associated with DEB (odds ratio [OR]: 2.05, 95% confidence interval [CI]: 1.52–2.75). Use of tobacco (OR: 2.10, 95% CI: 1.58–2.81), alcohol (OR: 2.03, 95% CI: 1.51–2.56), and suicide intent (OR: 5.13, 95% CI: 3.46–7.60) were associated with DEB.

Conclusion

DEB were more frequent among adolescents from higher SES households. The lack of association between SES and DEB reported by other studies might be because of the lack of variability in samples. The association of DEB and other problem behaviors highlights the importance of an integral approach to teenagers' mental health.     

Safety of inactivated monovalent pandemic (H1N1) 2009 vaccination during pregnancy: A population-based study in Taiwan

Background

Pregnant women were prioritized for H1N1 vaccination during the 2009–2010 pandemic. Safety concerns exist with vaccinating pregnant women, particularly in their first trimesters.

Methods

We linked computerized data on H1N1 vaccination, National Health Insurance, and Taiwan Birth Registry and identified events of spontaneous abortions (SABs) and all singleton births that occurred/delivered during November 1, 2009–September 30, 2010. The observation period for each case of SAB (6–19 weeks gestation) was divided into period at risk (1–28 days after vaccination) and control periods (the remaining person-days until SAB). The self-controlled case series method for truncated observational periods assessed the incidence rate ratio (IRR) of SAB during the 1–28 days compared with those in the control period. The case-control design matched each case of adverse fetal outcomes to up to 10 controls on fetal sex and year/month of pregnancy onset, and calculated matched odds ratio (OR) on H1N1 vaccination at <14 or ≥14 weeks gestation.

Results

Sixty-five women with SAB had received H1N1 vaccination at 6–19 weeks gestation. The IRR of SAB for the risk period 1–28 days was 1.03 (95% confidence interval [CI] 0.55–1.93). Among the 147,294 live births and 1354 stillbirths, maternal H1N1 vaccine receipt at <14 weeks gestation was associated with significantly reduced likelihood of small for gestational age (SGA) birth (OR 0.72, 95% CI 0.61–0.84) and birth defect (OR 0.46, 95% CI 0.22–1.00), whereas receipt at ≥14 weeks gestation was associated with significantly reduced likelihood of stillbirth (OR 0.63, 95% CI 0.46–0.86), prematurity (OR 0.90, 95% CI 0.83–0.97), low birth weight (OR 0.81, 95% CI 0.74–0.88), and SGA birth (OR 0.90, 95% CI 0.84–0.97).

Conclusions

H1N1 vaccination during pregnancy did not increase risk of SAB or adverse fetal outcomes.     

Determinants of intrauterine contraception provision among US family physicians: a national survey of knowledge, attitudes and practice

Background

Poor contraception adherence contributes to unintended pregnancy. Intrauterine contraception (IUC) is user-independent thus adherence is not an issue, yet few US women use IUC. We compared family physicians (FPs) who do and do not insert IUC in order to ascertain determinants of inserting IUC.

Study design

We surveyed 3500 US FPs. The primary outcome variable was whether a physician inserts IUC in their current clinical practice. We also sought to describe their clinical practice with IUC insertions.

Results

FPs who insert IUC had better knowledge about IUC (adjusted OR 1.85, 95% CI 1.32–2.60), more comfort discussing IUC (adjusted OR 2.35, 95% CI 1.30–4.27), and were more likely to believe their patients are receptive to discussing IUC (adjusted OR 2.96, 95% CI 2.03–4.32). The more IUC inserted during residency, the more likely to insert currently (adjusted OR 1.44, 95% CI 1.12–1.84). Only 24% of respondents inserted IUC in the prior 12 months.

Conclusions

US FPs have training and knowledge gaps, as well as attitudes, that result in missed opportunities to discuss and provide IUC for all eligible patients.     

Unintended pregnancy and postpartum contraceptive use in women with and without chronic medical disease who experienced a live birth

Background

Maternal chronic medical disease and unintended pregnancies increase the risk of maternal and infant morbidity and mortality. Little is known regarding the relationship between chronic medical disease status and pregnancy intendedness or contraceptive use.

Study Design

We compared pregnancy intention and postpartum contraception use in women with and without chronic medical disease who experienced a live birth using data from the Florida Pregnancy Risk Assessment Monitoring System 2004–2005.

Results

Women aged ≥20 years with chronic medical disease were more likely to report that the index pregnancy was unintended (odds ratio [OR]=1.56, 95% confidence interval [CI] 1.28–2.03) and reported similar postpartum contraception nonuse (OR=0.85, 95% CI 0.60–1.19) compared to those without chronic medical disease. Women aged <20 years with chronic medical disease were less likely to report that the index pregnancy was unintended (OR=0.50, 95% CI 0.28–0.88) and reported similar postpartum contraception nonuse (OR=0.99, 95% CI 0.54–1.82) compared to those without chronic medical disease.

Conclusions

In our study population, age and chronic medical disease were associated with different risks of pregnancy intention in the index pregnancy. Women with and without chronic disease in both age groups reported similar postpartum contraception use.     

Future abortion provision among US graduating obstetrics and gynecology residents, 2004

Background

This study was conducted to identify characteristics associated with US obstetric and gynecology graduating residents' intention to provide pregnancy termination services in their clinical practice.

Study Design

In this cross-sectional study, we surveyed all 1148 fourth-year residents in obstetrics and gynecology graduating from US training programs in 2004.

Results

Of 494 respondents, 187 (39%) planned to perform elective abortions after residency. In multivariable analysis controlling for various factors, the following were independently associated with plans to perform pregnancy termination in the future: pre-residency intentions to provide pregnancy termination [odds ratio (OR), 10; 95% confidence interval (CI), 5.3–18.9; p<.001], performing more than 50 first-trimester abortions during residency (OR, 5.1; 95% CI, 1.3–19.6; p=.02) and plans to enter academic practice (OR, 2.5; 95% CI 1.1–6.2; p=.04).

Conclusions

Intentions before residency to provide pregnancy termination services was the strongest predictor of future abortion provision.     

Social correlates of total cancer in adults and the very old: UK Understanding Society Cohort, 2009–2010

Objective

Understanding of the social determinants of cancer in adults and the very old is still limited. The aim of this study was to provide recent evidence on the social correlates of adult total cancer in a national and population-based setting.

Study design

A cross-sectional study in the recent years between 2009 and 2010.

Method

Data was retrieved and analysed from the UK Longitudinal Household Survey. Information on demographics, living and work conditions, self-reported cancer and age of onset was obtained by household interview. Analyses included Chi-squared test, t-test, and multilevel logistic regression modelling.

Results

Of 50,994 people included in the cohort, 1623 (3.5%) had ever cancer. Of these, 1592 (98.0%) occurred in adulthood (16y+) and only 109 people had their first cancer (incident cancer) at the age when they were interviewed. In the middle-aged and young adults, being female (OR 1.57, 95%CI 1.20–2.06, P = 0.001 and OR 2.04, 95%CI 1.07–3.87, P = 0.03, respectively), not born in the UK (OR 0.54, 95%CI 0.34–0.88, P = 0.01 and OR 0.31, 95%CI 0.09–1.02, P = 0.05, respectively), and being obese/overweight (OR 1.49, 95%CI 1.07–2.07, P = 0.02 and OR 2.34, 95%CI 1.17–4.66, P = 0.02, respectively) were associated with total cancer. However, no associated social factors of cancer in the very old were found. Moreover, prevalence was higher in East Midlands (OR 1.73, 95%CI 1.00–3.00, P = 0.05) but not other regions, compared to London region.

Conclusion

Social environment seems to continue playing a role in the aetiology of cancer in adults, although novel and/or pooled investigation for the very old would be warranted.     

Barriers and Facilitators of Colon Cancer Screening Among Patients At Faith-Based Neighborhood Health Centers

We determined the barriers to and facilitators of colorectal cancer (CRC) screening among two faith-based, inner city neighborhood health centers in Southwestern Pennsylvania. Data from a random sample of patients 50 years and older (n=375) were used to estimate logistic regression equations to compare and contrast the predictors of four different CRC screening protocols: (1) fecal occult blood test (FOBT) 2 years ago, (2) colonoscopy 10 years ago, (3) lower endoscopy (colonoscopy or sigmoidoscopy) 10 years ago, and (4) any of these screening measures. Racial differences (between African Americans or Caucasians) in type of colon cancer screening were not found. Controlling for covariates, logistic regression equations showed that a physicians support of colon cancer screening was positively associated with the receipt of colonoscopy (OR: 19.47, 95 CI: 5.45–69.54), lower endoscopy (OR: 10.96, 95 CI: 3.77–31.88) and any colon cancer screening (OR: 10.12, 95 CI: 3.36–30.46). Patients who see their physicians more frequently were also more likely to be screened for CRC. Unlike other studies, the faith-based environment in which these patients are treated may explain the lack of racial disparity specific to our measures of CRC screening.     

Factors associated with uptake of subdermal contraceptive implants in a young Kenyan population

Background

Subdermal contraceptive implants may be a reasonable option for young women in sub-Saharan Africa; little is known about factors associated with method uptake in this subpopulation.

Study Design

Four hundred women aged 18–24 years who sought short-acting hormonal contraception were offered an opportunity to use an implant instead. Cross-tabulations and logistic regression analysis were used to examine participant characteristics and other factors associated with choosing an implant.

Results

Twenty-four percent of participants chose the implant. Participants with greater than 4 years of contraceptive need were over three times more likely to choose an implant [odds ratio (OR), 3.4; 95% confidence interval (CI), 1.6–6.9]. Women with health concerns over short-acting hormonal methods (OR, 2.2; 95% CI, 1.3–3.6) and those who expressed some difficulty returning to a clinic (OR, 1.9; 95% CI, 1.1–3.1) were about twice as likely to choose an implant. Product attributes such as long-acting protection and convenience were cited reasons for choosing an implant.

Conclusions

The implant appears to be an attractive option for a fairly large proportion of young women in Kenya. Within this age group of implant users, homogeneity of demographic characteristics relative to short-acting users suggests that the product has broad appeal.     

Elevated manganese and cognitive performance in school-aged children and their mothers

Background

Growing evidence suggests that excess manganese (Mn) in children is associated with neurobehavioral impairments. In Brazil, elevated hair Mn concentrations were reported in children living near a ferro-manganese alloy plant.

Objectives

We investigated these children’s and caregivers’ cognitive function in relation to bioindicators of Mn exposure.

Methods

In this cross-sectional study, the WISC-III was administered to 83 children aged between 6 and 12 years; the Raven Progressive Matrix was administered to the primary caregivers (94% mothers), who likewise responded to a questionnaire on socio demographics and birth history. Mn in hair (MnH) and blood (MnB) and blood lead (PbB) were measured by graphite furnace atomic absorption spectrometry (GFAAS).

Results

Children’s mean MnB and MnH were 8.2 μg/L (2.7–23.4) and 5.83 μg/g (0.1–86.68), respectively. Mean maternal MnH was 3.50 μg/g (0.10–77.45) and correlated to children’s MnH (rho=0.294, p=0.010). Children’s MnH was negatively related to Full-Scale Intelligence Quotient (IQ) and Verbal IQ; β coefficients for MnH were −5.78 (95% CI −10.71 to −0.21) and −6.72 (−11.81 to −0.63), adjusted for maternal education and nutritional status. Maternal MnH was negatively associated with performance on the Raven’s (β=−2.69, 95% CI −5.43 to 0.05), adjusted for education years, family income and age.

Conclusions

These findings confirm that high MnH in children is associated with poorer cognitive performance, especially in the verbal domain. Primary caregiver’s IQ is likewise associated to Mn exposure, suggesting that, in this situation, children’s cognition may be affected directly and indirectly by Mn exposure.     

Fruit and vegetable consumption and the risk of proximal colon, distal colon, and rectal cancers in a case-control study in Western Australia

Background

Fruits and vegetables (F/V) have been examined extensively in nutrition research in relation to colorectal cancer (CRC). However, their protective effect is subject to debate, possibly because of different effects on different subsites of the large bowel.

Objective

To determine whether any association between F/V consumption and risk of CRC differed by subsite of the bowel (proximal colon, distal colon, and rectum).

Design

The Western Australian Bowel Health Study is a population-based, case-control study conducted between June 2005 and August 2007. Complete food frequency questionnaire data were analysed from 834 CRC cases and 939 controls. Logistic regression analysis was used to estimate the effects of quartiles of F/V intake on risk of CRC at different subsites. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for CRC overall and for the three separate subsites.

Results

Risk of proximal colon cancer and rectal cancer was not associated with intakes of total F/V, total vegetable, or total fruit. Brassica vegetable intake was inversely related with proximal colon cancer (Q4 vs Q1 OR 0.62; 95% CI 0.41 to 0.93). For distal colon cancer, significant negative trends were seen for total F/V, and total vegetable intake. Distal colon cancer risk was significantly decreased for intake of dark yellow vegetables (Q4 vs Q1 OR 0.61; 95% CI 0.41 to 0.92) and apples (Q4 vs Q1 OR 0.51; 95% CI 0.34 to 0.77). An increased risk for CRC was found to be associated with intake of fruit juice (Q4 vs Q1 OR 1.74; 95% CI 1.24 to 2.45).

Conclusions

Our results suggest that different F/V may confer different risks for cancer of the proximal colon, distal colon, or rectum. Future studies might consider taking into account the location of the tumor when examining the relation between F/V consumption and risk of CRC.