Prior alcohol consumption and mortality following acute myocardial infarction

CONTEXT: Studies have found that individuals who consume 1 alcoholic drink every 1 to 2 days have a lower risk of a first acute myocardial infarction (AMI) than abstainers or heavy drinkers, but the effect of prior drinking on mortality after AMI is uncertain. OBJECTIVE: To determine the effect of prior alcohol consumption on long-term mortality among early survivors of AMI. DESIGN AND SETTING: Prospective inception cohort study conducted at 45 US community and tertiary care hospitals between August 1989 and September 1994, with a median follow-up of 3.8 years. PATIENTS: A total of 1913 adults hospitalized with AMI between 1989 and 1994. MAIN OUTCOME MEASURE: All-cause mortality, compared by self-reported average weekly consumption of beer, wine, and liquor during the year prior to AMI. RESULTS: Of the 1913 patients, 896 (47%) abstained from alcohol, 696 (36%) consumed less than 7 alcoholic drinks/wk, and 321 (17%) consumed 7 or more alcoholic drinks/wk. Compared with abstainers, patients who consumed less than 7 drinks/wk had a lower all-cause mortality rate (3.4 vs 6.3 deaths per 100 person-years; hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.43-0.71) as did those who consumed 7 or more drinks/wk (2.4 vs 6.3 deaths per 100 person-years; HR, 0.38; 95% CI, 0.25-0.55; P<.001 for trend). After adjusting for propensity to drink and other potential confounders, increasing alcohol consumption remained predictive of lower mortality for less than 7 drinks/wk, with an adjusted HR of 0.79 (95% CI, 0.60-1.03), and for 7 or more drinks/wk, with an adjusted HR of 0.68 (95% CI, 0.45-1.05; P =.01 for trend). The association was similar for total and cardiovascular mortality, among both men and women, and among different types of alcoholic beverages. CONCLUSION: Self-reported moderate alcohol consumption in the year prior to AMI is associated with reduced mortality following infarction.     

国内3个城市综合医院急诊饮酒模式和伤害风险的相关性研究

目的：探讨饮酒模式(饮酒量与频率)与伤害类型(故意伤害和非故意的交通伤害)之间的相关性。方法：对年龄≥18岁,受伤时间在6 h以内,且为首次治疗的伤害患者1 539 例进行调查。主要内容为：伤害类型、伤害前6 h时是否饮酒、饮酒量及频率和过去1年饮酒情况等。数据统计用logistic回归分析和病例交叉分析。结果：伤害前6 h饮酒者遭受故意伤害的风险高于伤前未饮酒者(OR=3.63),过去一年中的饮酒频率≥1次者遭受故意伤害的风险高于未饮酒者(OR=1.986)。过去1年中分别饮酒5~11个标准杯和饮酒12个标准杯及以上的频率≥1次者遭受故意伤害的风险均高于未饮酒者(OR分别为1.854和1.572)。伤害前6 h内饮酒者遭受交通伤害的风险高于伤前未饮酒者(OR=2.091)。过去1年中饮酒频率≥1次者发生交通伤害的风险高于未饮酒者(OR=1.533)。病例交叉分析法发现伤前6 h内饮酒者的所有伤害风险都高于伤前未饮酒者(OR=5.15)。伤前饮酒量分别低于6个标准杯、6~9个标准杯和9个标准杯以上的伤害风险均高于伤前未饮酒者(OR值分别为3.83,8.64和9.58)。结论：伤害前6 h饮酒增加了故意伤害和非故意的交通伤害风险。过去1年中饮酒频率≥1次者发生故意伤害和非故意的交通伤害的风险增加。伤害前6 h 内饮酒增加所有伤害发生的风险,随着饮酒量的增加,伤害发生的风险随之增加。伤害前6 h饮酒及过去1年的饮酒模式与伤害发生关系密切,为酒的相关政策的制定提供了科学依据。     

Moderate alcohol consumption and risk of heart failure among older persons

CONTEXT: Heavy consumption of alcohol can lead to heart failure, but the relationship between moderate alcohol consumption and risk of heart failure is largely unknown. OBJECTIVE: To determine whether moderate alcohol consumption predicts heart failure risk among older persons, independent of the association of moderate alcohol consumption with lower risk of myocardial infarction (MI). DESIGN: Prospective cohort study conducted from 1982 through 1996, with a maximum follow-up of 14 years. SETTING AND PARTICIPANTS: Population-based sample of 2235 noninstitutionalized elderly persons (mean age, 73.7 years; 41.2% male; 21.3% nonwhite) residing in New Haven, Conn, who were free of heart failure at baseline. Persons who reported alcohol consumption of more than 70 oz in the month prior to baseline were excluded. MAIN OUTCOME MEASURE: Time to first fatal or nonfatal heart failure event, according to the amount of alcohol consumed in the month prior to baseline. RESULTS: Increasing alcohol consumption in the moderate range was associated with decreasing heart failure rates. For persons consuming no alcohol (50.0%), 1 to 20 oz (40.2%), and 21 to 70 oz (9.8%) in the month prior to baseline, crude heart failure rates per 1000 years of follow-up were 16.1, 12.2, and 9.2, respectively. After adjustment for age, sex, race, education, angina, history of MI and diabetes, MI during follow-up, hypertension, pulse pressure, body mass index, and current smoking, the relative risks of heart failure for those consuming no alcohol, 1 to 20 oz, and 21 to 70 oz in the month prior to baseline were 1.00 (referent), 0.79 (95% confidence interval [CI], 0.60-1.02), and 0.53 (95% CI, 0.32-0.88) (P for trend =.02). CONCLUSIONS: Increasing levels of moderate alcohol consumption are associated with a decreasing risk of heart failure among older persons. This association is independent of a number of confounding factors and does not appear to be entirely mediated by a reduction in MI risk.     

Effect of community-based interventions on high-risk drinking and alcohol-related injuries

CONTEXT: High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings. OBJECTIVES: To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults. DESIGN AND SETTING: A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site. INTERVENTIONS: Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning. MAIN OUTCOME MEASURES: Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals. RESULTS: Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1. 29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0. 77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%. CONCLUSION: A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults. JAMA. 2000;284:2341-2347.     

Efficacy of mandatory seat-belt use legislation. The North Carolina experience from 1983 through 1987

The North Carolina General Assembly approved a law effective in October 1985 that mandated seat-belt use by front-seat occupants of passenger vehicles. In January 1987, a $25 fine for infractions of this law went into effect. This study examined numbers of car occupants with severe and fatal injuries in crashes in North Carolina, controlling for the amount of vehicle damage as a measure of crash severity. After the law, significant decreasing trends were seen in the percentages of front-seat occupants who had severe or fatal injuries in crashes, although the involvement of alcohol in crashes was still associated with an increased risk of such injury. Projections indicate that a reduction of approximately 1100 severe or fatal injuries per year can be attributed to the seat-belt law in North Carolina. This study supports the hypothesis that the societal burden of crash-associated injury can be reduced by mandating seat-belt use.     

Risk of fatal and near-fatal asthma in relation to inhaled corticosteroid use.

OBJECTIVE--To examine the relationship between patterns of use of inhaled beclomethasone dipropionate and the risk of fatal and near-fatal asthma. DESIGN--Nested case-control analysis of a historical cohort; a further analysis. SETTING--The 12,301 residents of Saskatchewan aged 5 to 54 years who were dispensed 10 or more asthma drugs from 1978 to 1987. PATIENTS--The 129 persons who experienced asthma death (n = 44) and near-death (n = 85) and their 655 controls matched as to age and date of entry into the cohort, with the additional matching criteria of at least one hospitalization for asthma in the prior 2 years, region of residence, and having received social assistance. MAIN OUTCOME--Life-threatening attacks of asthma defined as death due to asthma or the occurrence of hypercarbia, intubation, and mechanical ventilation during an acute attack of asthma. RESULTS--After accounting for the risk associated with use of other medications and adjustment for markers of risk of adverse events related to asthma, subjects who had been dispensed, on average, one or more metered-dose inhalers of beclomethasone per month over a 1-year period had a significantly lower risk of fatal and near-fatal asthma (odds ratio, 0.1; 95% confidence interval, 0.02 to 0.6). CONCLUSION--These data support recent guidelines from several countries that recommend the use of inhaled corticosteroids in moderate and severe asthma.     

Age of drinking onset and unintentional injury involvement after drinking

CONTEXT: In 1997, unintentional injury was the leading cause of death for persons aged 1 to 34 years. Approximately one third of deaths due to unintentional injury in the United States are estimated to be alcohol related. Onset of drinking at an early age has been found to be associated with alcohol dependence, but whether early-onset drinking increases risk for unintentional injury while drinking is unknown. OBJECTIVE: To explore whether persons who started drinking at an early age are more likely to have experienced unintentional injuries while under the influence of alcohol. DESIGN AND SETTING: The National Longitudinal Alcohol Epidemiology Survey, a cross-sectional survey conducted in 1992 of a representative sample of the US population. PARTICIPANTS: A total of 42,862 randomly selected adults (response rate, 90%; mean age, 44 years). MAIN OUTCOME MEASURES: Unintentional injury involvement while under the influence of alcohol by age of drinking onset (categorized as <14 years, each age from 14-20 years, or >/=21 years). RESULTS: Relative to respondents who began drinking at age 21 years or older, those who started before age 14 years as well as those who started at each intervening age up to 21 years were significantly more likely to have been injured while under the influence of alcohol, even after controlling for history of alcohol dependence, heavy drinking frequency during the period that they drank most, family history of alcoholism, and other characteristics associated with earlier onset of drinking. After adjusting for these variables, odds ratios for having been injured while under the influence of alcohol were as follows: for younger than 14 years, 2.98 (95% confidence interval [CI], 2.29-3.89); age 14 years, 2.96 (95% CI, 2.26-3.88); age 15 years, 3.14 (95% CI, 2.48-3.97); age 16 years, 2.38 (95% CI, 1.90-2.98); age 17 years, 2.12 (95% CI, 1.66-2.71); age 18 years, 1. 33 (95% CI, 1.08-1.64); age 19 years, 1.42 (95% CI, 1.07-1.89); and age 20 years, 1.39 (95% CI, 1.01-1.91). CONCLUSION: Drinking onset at ages younger than 21 years is associated with having experienced alcohol-related injuries. JAMA. 2000;284:1527-1533     

Weapon involvement and injury outcomes in family and intimate assaults.

OBJECTIVE--To compare the risk of death and the risk of nonfatal injury during firearm-associated family and intimate assaults (FIAs) with the risks during non-firearm-associated FIAs. DESIGN--Records review of police incident reports of FIAs that occurred in 1984. Victim outcomes (death, nonfatal injury, no injury) and weapon involvement were examined for incidents involving only one perpetrator. SETTING--City of Atlanta, Ga, within Fulton County. PARTICIPANTS--Stratified sample (n = 142) of victims of nonfatal FIAs, drawn from seven nonfatal crime categories, plus all fatal victims (n = 23) of FIAs. MAIN OUTCOME MEASURES--Risk of death (vs nonfatal injury or no injury) during FIAs involving firearms, relative to other types of weapons; risk of nonfatal injury (vs all other outcomes, including death) during FIAs involving firearms, relative to other types of weapons. RESULTS--Firearm-associated FIAs were 3.0 times (95% confidence interval, 0.9 to 10.0) more likely to result in death than FIAs involving knives or other cutting instruments and 23.4 times (95% confidence interval, 7.0 to 78.6) more likely to result in death than FIAs involving other weapons or bodily force. Overall, firearm-associated FIAs were 12.0 times (95% confidence interval, 4.6 to 31.5) more likely to result in death than non-firearm-associated FIAs. CONCLUSIONS--Strategies for limiting the number of deaths and injuries resulting from FIAs include reducing the access of potential FIA assailants to firearms, modifying firearm lethality through redesign, and establishing programs for primary prevention of violence among intimates.     

Use of alcohol as a risk factor for bicycling injury

CONTEXT: Bicycling is one of the leading causes of recreational injuries. Elevated blood alcohol concentrations (BACs) are found in about one third of fatally injured bicyclists aged 15 years or older. OBJECTIVE: To assess the relative risk of fatal and serious bicycling injury according to BAC. DESIGN: Matched case-control study. SETTING AND SUBJECTS: Bicyclists aged 15 years or older who were fatally or seriously injured while riding a bicycle during the day in Maryland in 1985-1997 (cases, n = 124) and bicyclists aged 15 years or older who were interviewed and given a breath test for estimated BAC during roadside surveys that took place in June 1996 through May 1998 at the same site, time of day, day of week, and month of year in which a case bicyclist was injured (controls, n = 342). MAIN OUTCOME MEASURE: Odds ratio of bicycling injury according to estimated BAC. RESULTS: An estimated positive BAC (>/=0.02 g/dL) was detected in 12.9% of the case bicyclists (23.5% of the 34 fatally injured and 8.9% of the 90 seriously injured) compared with 2.9% of the control bicyclists (P<.001). Relative to an estimated BAC of less than 0.02 g/dL, the adjusted odds ratio of bicycling injury was 5.6 (95% confidence interval [CI], 2.2-14.0) for a BAC of 0.02 g/dL or higher and was 20.2 (95% CI, 4.2-96.3) for a BAC of 0.08 g/dL or higher. Rates of helmet use at the time of injury or interview were 5% and 35%, respectively, for those with and without a positive BAC (P =.007). CONCLUSION: Alcohol use while bicycle riding is associated with a substantially increased risk of fatal or serious injury.     

531 名急诊患者外伤与饮酒的相关性研究

目的：探讨饮酒与外伤风险之间的关系。方法：对年龄≥18 岁,受伤时间在6 h 以内,且为首次治 疗的外伤患者531 例,采用美国国立卫生研究院(National Institutes of Health,NIH) 提供的问卷对外伤类型、 外伤前是否饮酒及饮酒量、过去1 年饮酒情况等进行调查,采用病例交叉分析方法,研究饮酒与外伤风险的关系。 结果：受伤前6 h 饮酒者遭受故意伤害风险高于伤前未饮酒者(OR=2.79,95%CI：1.61~4.84);与遭受非故意伤 害者相比,遭受故意伤害者中男性、醉酒、酒精测试阳性者居多。与伤前未饮酒者相比,受伤前6 h 内饮酒增 加交通伤害的风险(OR=2.41,95%CI：1.29~4.51)。受伤前6 h 饮酒者的外伤风险高于伤前未饮酒者(OR=11.86, 95%CI：5.48~25.65);受伤前6 h 饮酒>6 个标准杯者的外伤风险远高于伤前未饮酒者(OR=24.52,95%CI： 5.84~102.86)。结论：受伤前6 h 内饮酒增加外伤发生及遭受故意伤害的风险,同时也增加与交通伤害有关的风 险,因而需要控制不良饮酒行为,减少与酒相关的外伤的发生。     

Trends in alcohol consumption by pregnant women. 1985 through 1988

To examine trends in alcohol consumption among pregnant women, we examined data collected from 21 states participating in the Behavioral Risk Factor Surveillance System for 4 consecutive years: 1985 through 1988. Overall, 429 (25%) of 1712 pregnant women and 19,903 (55%) of 36,057 nonpregnant women 18 to 45 years of age reported using alcohol in the previous month. Pregnant women who used any alcohol reported consuming a median of four drinks per month, whereas nonpregnant women who used any alcohol reported nine. The prevalence of alcohol consumption among pregnant women declined steadily, from 32% in 1985 to 20% in 1988, but the median number of drinks per month for pregnant women who drank did not change. No decline was observed among the less educated or those under the age of 25 years. In 1988, the prevalence of alcohol use among pregnant women remained highest among smokers (37%) and the unmarried (28%). Although the overall consumption of alcohol by pregnant women in the United States appears to be declining, special efforts are needed to reduce alcohol use among pregnant women who are smokers, unmarried, less educated, or younger, women who may already be at high risk of a poor pregnancy outcome.     

Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study.

CONTEXT: Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults. OBJECTIVE: To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score). DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues. MAIN OUTCOME MEASURE: Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce. RESULTS: The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience-suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively. CONCLUSIONS: A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.     

The characteristics of cocaine users among young adults in Sydney

OBJECTIVE: To describe the prevalence and pattern of cocaine use among young Sydney adults interviewed during a study of the "market position" of cocaine. DESIGN: A telephone survey of young Sydney adults. PARTICIPANTS: A total of 499 young Sydney men and women aged between 14 and 35 were selected to ensure a sample of 300 persons who used alcohol and tobacco at least weekly, and who had been offered or had tried at least one illicit drug. MAIN OUTCOME MEASURES: These were the prevalence of having ever used cocaine, the frequency of cocaine use, the prevalence of daily alcohol and tobacco use, and of ever having tried marijuana, sedatives, designer drugs, amphetamines and heroin. RESULTS: Thirteen per cent of the sample (95% confidence interval [CI], 10%-16%) had ever tried cocaine, of whom only 20% (CI, 15%-25%) were current users. Cocaine users were distinguished from non-users by being more likely to be daily users of tobacco (odds ratio, 2.1; CI, 1.3-3.6) and alcohol (odds ratio, 3.0; CI, 1.7-5.6), and to have tried marijuana (odds ratio, 7.1; CI, 3.2-15.9), sedatives (odds ratio, 11.4; CI, 6.4-20.7), designer drugs (odds ratio, 17.2; CI, 9.2-32.2), amphetamines (odds ratio, 27.1; CI, 14.3-51.3), and heroin (odds ratio, 36.5; CI, 14.0-94.9). The odds of having tried cocaine increased with the number of different types of illicit drugs that the person had tried. CONCLUSIONS: The prevalence of ever having tried cocaine was low among a sample of young adults selected to ensure an over-representation of illicit drug users. Cocaine users were more likely to have experimented with a variety of different types of illicit drugs. Only a minority of those who had ever tried cocaine were current users.     

The probability of dying of injuries by the year 2000

Life tables in which the probability of dying of injuries in the United States from 1985 to 1999 are determined may be useful for clinicians in counseling persons concerning the risk of fatal injuries. Overall, more than 1% of persons aged 10 to 34 years in 1985 probably will die of injuries by the year 2000. For white males aged 5 to 29 years in 1985, white females aged 5 to 19 years in 1985, and black males aged 5 to 24 years in 1985, over half of all the estimated deaths during the next 15 years will be probably due to injuries.     

A meta-analysis of alcohol consumption in relation to risk of breast cancer

Epidemiologic findings regarding the relation between alcohol consumption and risk of breast cancer have been inconsistent. We performed a meta-analysis (a quantitative review) of the available data. To evaluate whether there was a dose-response relation between alcohol consumption and risk of breast cancer, we fitted mathematical models to the pooled data. There was strong evidence to support a dose-response relation in both the case-control and follow-up epidemiologic data. Using the dose-response curves that we calculated, the risk of breast cancer at an alcohol intake of 24 g (1 oz) of absolute alcohol daily (about two drinks daily) relative to nondrinkers was 1.4 (95% confidence interval, 1.0 to 1.8) in the case-control data and was 1.7 (95% confidence interval, 1.4 to 2.2) in the follow-up data. We interpret these findings not as proof of causality, but as strongly supportive of an association between alcohol consumption and risk of breast cancer.     

Risk factors for fireworks-related injury in Washington State

To determine the frequency and effects of and risk factors for fireworks -related injury, we identified all 146 persons who were injured by fireworks and sought emergency care during the 1983 July 4 holiday in the Seattle area. The mean charge for medical care for the injuries received was +562; 7.1% of those injured required hospitalization. In a matched-pair case-control study, use of either of two fireworks types-- firecrackers or aerial devices--was significantly associated with injury (odds ratios [ORs], 3.3 and 2.9, respectively; 95% confidence intervals [CI], 1.2, 8.5, and 1.2, 6.6, respectively). Also associated with injury were several fireworks misuse behaviors, including lack of adult supervision of children (OR, 11.5; CI, 2.8, 100.6). We conclude that fireworks cause serious injuries that theoretically could be prevented by behavioral changes or decreased availability of high-risk fireworks devices.     

A prospective study of folate intake and the risk of breast cancer

CONTEXT: Folate is involved in DNA synthesis and methylation and may reduce breast cancer risk, particularly among women with greater alcohol consumption. OBJECTIVES: To assess the association between folate intake and risk of breast cancer and whether higher folate intake may reduce excess risk among women who consume alcohol. DESIGN: Prospective cohort study performed in 1980, with 16 years of follow-up. SETTING AND PARTICIPANTS: A total of 88818 women who completed the dietary questionnaire section of the Nurses' Health Study in 1980. MAIN OUTCOME MEASURE: Incidence of invasive breast cancer by levels of folate and alcohol intake. RESULTS: A total of 3483 cases of breast cancer were documented. Total folate intake was not associated with overall risk of breast cancer. However, among women who consumed at least 15 g/d of alcohol, the risk of breast cancer was highest among those with low folate intake. For total folate intake of at least 600 microg/d compared with 150 to 299 microg/d, the multivariate relative risk (RR) was 0.55 (95% confidence interval [CI], 0.39-0.76; P for trend = .001). This association was only slightly attenuated after additional adjustment for intake of beta carotene, lutein/zeaxanthin, preformed vitamin A, and total vitamins C and E. The risk of breast cancer associated with alcohol intake was strongest among women with total folate intake of less than 300 microg/d (for alcohol intake > or =15 g/d vs <15 g/d, multivariate RR, 1.32; 95% CI, 1.15-1.50). For women who consumed at least 300 microg/d of total folate, the multivariate RR for intake of at least 15 g/d of alcohol vs less than 15 g/d was 1.05 (95% CI, 0.92-1.20). Current use of multivitamin supplements, the major source of folate, was associated with lower breast cancer risk among women who consumed at least 15 g/d of alcohol (for current users of supplements vs never users, RR, 0.74; 95% CI, 0.59-0.93). CONCLUSIONS: Our findings suggest that the excess risk of breast cancer associated with alcohol consumption may be reduced by adequate folate intake.     

Bicyclist and environmental factors associated with fatal bicycle-related trauma in Ontario.

OBJECTIVE: To identify bicyclist and environmental factors associated with fatal bicycle-related trauma in Ontario. DESIGN: Retrospective study. SETTING: Ontario. PARTICIPANTS: Information was extracted from the provincial coroner's reports on 212 people who had died of bicycle-related injuries in Ontario between 1986 and 1991. OUTCOME MEASURES: Age, sex and helmet use of the bicyclist, time and place of the event, type of bicyclist or motorist error(s) and use of alcohol by bicyclist or motorist. RESULTS: Only 32% of the deaths involved bicyclists under 15 years of age. The male-female ratio was 3.5. Over 75% of the cases involved head injury; however, only 8 (4%) of the bicyclists had been wearing a helmet. In 91% of the cases death occurred as the result of a bicycle-motor vehicle collision. Most (65%) of the deaths for which the time was known occurred between 4 pm and 8 am. Bicyclist error was the main cause of crash for 26 (79%) of the children less than 10 years old; it was also the main cause of crash among the bicyclists aged 10 to 19 years (43 [55%]) and those aged 45 years or more (15 [44%]). However, motorist error was the most common cause of collision in the group of cyclists 20 to 44 years of age (42 [63%]). Alcohol was detected in the blood of 7% of the bicyclists killed; alcohol had been consumed by 30% of the motorists who claimed not to have seen the cyclist. CONCLUSIONS: Bicycle-related deaths result from factors that are generally avoidable. Identifiable risk factors other than lack of helmet use suggest that additional research is required to determine the benefits of preventive interventions aimed at reducing the number of such deaths. Age-specific strategies appear warranted.     

Tobacco smoking and pulmonary tuberculosis: a case-control study

A case-control study was carried out to assess if the tobacco smoking is associated with development of active pulmonary tuberculosis in 153 cases with active pulmonary tuberculosis and 160 control subjects. Detailed information on smoking habits was collected from cases and controls using questionnaire. It was seen that tobacco smoking was associated with pulmonary tuberculosis. The estimated crude odd's ratio (OR) of the association was 1.66 (95% confidence interval: 1.01-2.73) . The age adjusted OR was 1.70 (95% CI: 1.01-2.88), p < 0.05. The increased risk for pulmonary tuberculosis was significant in men who had smoked for over 20 years (OR 3.07; 95% CI: 1.37-6.86). The adjusted OR for heavy smokers (more than 20 bidis per day) was 2.72 (95% CI: 1.19-6.20). There was a dose-response relationship between the number of bidis smoked daily and the risk of development of pulmonary tuberculosis. The study showed that tobacco smoking is associated with pulmonary tuberculosis, with a dose-response relationship with the number of bidis consumed daily.