Neurocysticercosis—Retrospective Study of Autopsy Reports,a 17-Year Experience

Neurocysticercosis (NCC) is a common central nervous system (CNS) infection caused by Taenia solium metacestodes. The objective of this study is to describe the incidence of cysticercosis diagnosed at autopsies and describe the epidemiological and clinical characteristics of NCC. Retrospective study analyzing 6,500 reports of autopsies between 1977 and 1994 from a school hospital in Curitiba, PR, southern of Brazil. The following data was obtained, age, gender, site of cysticercosis, NCC as cause of death. The diagnosis of cysticercosis was established in 52 (0.8%) autopsies. From 1977 to 1987 (0.7%) and from 1988 to 1994 (1.1%). In the autopsies with cysticercosis 75% were male; age (mean ± SD) was 43 ± 20. NCC was present in 96% of cases, and seizures was the most frequent clinical manifestation. Asymptomatic cases in 54%. These data classify our area as hiperendemic, according with OMS criteria. The present study reinforces the necessity to develop adequate control programs.     

Does Abdominal Obesity Increase All-Cause,Cardiovascular Disease,and Cancer Mortality Risks in Older Adults? A 10-Year Follow-Up Analysis

There is insufficient evidence on the impact of abdominal obesity (AO) on mortality in older adults. Therefore, the objective to analyze the 10-year impact of AO, assessed using different diagnostic criteria, on all-cause, cardiovascular disease (CVD), and cancer mortality in older adults. In this prospective cohort study of older adults (≥60 years), sociodemographic, lifestyle, clinical history, laboratory test, and anthropometric data were analyzed. The considered were used for AO diagnostic: waist circumference (WC) of ≥88 cm for women and ≥102 cm for men; WC of ≥77.8 cm for women and ≥98.8 cm for men; and increased waist-to-hip ratio (WHR), being the highest tertile of distribution by sex. Multivariate Cox regression and Kaplan–Meier analyses were performed. A total of 418 individuals, with an average age of 70.69 ± 7.13 years, participated in the study. In the analysis adjusted for sex and age, WHR was associated with a high risk of all-cause mortality (p = 0.044). Both cutoff points used for the WC were associated with an increased CVD mortality risk. None of the AO parameters were associated with cancer mortality. An increased WHR was associated to a higher all-cause mortality risk factor, while an increased WC was a risk factor for a higher CVD mortality in older adults.     

Breast Cancer Screening,Area Deprivation,and Later-Stage Breast Cancer in Appalachia: Does Geography Matter?

Objective

To model the relationship of an area-based measure of a breast cancer screening and geographic area deprivation on the incidence of later stage breast cancer (LSBC) across a diverse region of Appalachia.

Data Source

Central cancer registry data (2006–2008) from three Appalachian states were linked to Medicare claims and census data.

Study Design

Exploratory spatial analysis preceded the statistical model based on negative binomial regression to model predictors and effect modification by geographic subregions.

Principal Findings

Exploratory spatial analysis revealed geographically varying effects of area deprivation and screening on LSBC. In the negative binomial regression model, predictors of LSBC included receipt of screening, area deprivation, supply of mammography centers, and female population aged >75 years. The most deprived counties had a 3.31 times greater rate of LSBC compared to the least deprived. Effect of screening on LSBC was significantly stronger in northern Appalachia than elsewhere in the study region, found mostly for high-population counties.

Conclusions

Breast cancer screening and area deprivation are strongly associated with disparity in LBSC in Appalachia. The presence of geographically varying predictors of later stage tumors in Appalachia suggests the importance of place-based health care access and risk.     

Patient Preferences in Surveillance: Findings From a Discrete Choice Experiment in the “My Follow-Up” Study

ObjectivesApproximately 800 000 people die globally from colorectal cancer (CRC) every year. Prevention programs promote early detection, but for people with precancerous lesions, tailoring surveillance to include lifestyle-change programs could enhance prevention potential and improve outcomes.MethodsThose with intermediate or high-risk polyps removed during CRC screening colonoscopy within the Northern Ireland CRC Screening Programme were invited to complete 8 discrete choice questions about tailored surveillance, analyzed using random-parameters logit and a latent class modeling approach.ResultsA total of 231 participants (77% male) self-reported comorbid hypertension (53%), high cholesterol (48%), and mean body mass index of 28.7 (overweight). Although 39% of participants were unaware of their CRC risk status, 30.9% indicated they were already making changes to reduce their risk. Although all respondents were significantly risk- and cost-averse, the latent class analysis identified 3 segments (classes):1. Class 1 (26.8%) significantly favored phone or email support for a lifestyle change, a 17-month testing interval, and noninvasive testing.2. Class 2 (48.4%) preferred the status quo.3. Class 3 (24.7%) significantly favored further risk reduction and invasive testing.ConclusionsThis is the first documented preference study focusing on postpolypectomy surveillance offering lifestyle interventions. Although current care is strongly preferred, risk and cost aversion are important for participants. Latent class analysis shows that some respondents are willing to change diet and lifestyle behaviors, reflecting a teachable moment, with opportunities to personalize and optimize surveillance. Significant discordance between perceived and known risk of recurrence and limited recall of risk information provided within current practice suggest necessary improvements to surveillance programs.     

Vitamin D Status and Risk of Breast Cancer in Iranian Women: A Case–Control Study

Objective: Considering the rising incidence of breast cancer and high prevalence of vitamin D deficiency in Iran, this case–control study aimed to investigate the relationship between serum concentration and intake of vitamin D and risk of breast cancer.

Methods: A total of 135 incident breast cancer cases at the Cancer Research Center of Shahid Beheshti University of Medical Sciences were matched with 135 controls by age and menopausal status. A validated and reliable 168-item food frequency questionnaire was completed by participant interviews. To determine the vitamin D content of foods we used the U.S. Department of Agriculture (USDA) nutrient database. To analyze the food frequency questionnaires we used the data collected in the Iranian Household Food Pattern Study, conducted by the National Nutrition and Food Technology Research Institute and the Iranian Ministry of Agriculture. Five-milliliter blood samples were collected to measure serum 25-hydroxyvitamin D (25(OH)D) using an enzyme-linked immunosorbent assay method.

Results: Women in the fourth quartile of serum 25(OH)D level had 3 times lower risk of developing breast cancer compared to those in the first quartile. In the adjusted model the inverse relationship remained significant (odds ratio [OR] = 0.269; 95% confidence interval [CI], 0.122–0.593). In the stratified model by menopausal status the inverse association was only seen in premenopausal women (OR = 0.25; 95% CI, 0.094–0.687).

Dietary intake of vitamin D was inversely associated with risk of breast cancer (OR fourth quartile [Q4] vs first quartile [Q1] = 0.39; 95% CI, 0.196–0.784; p = 0.008). After adjusting for the confounding factors, this inverse association remained significant.

Conclusion: Results from this case–control study support the protective effect of higher serum concentration of 25(OH)D against breast cancer. Moreover, dietary but not total intake of vitamin D was associated with decreased risk of breast cancer.     

Vehicular Traffic–Related Polycyclic Aromatic Hydrocarbon Exposure and Breast Cancer Incidence: The Long Island Breast Cancer Study Project (LIBCSP)

Background

Polycyclic aromatic hydrocarbons (PAHs) are widespread environmental pollutants, known human lung carcinogens, and potent mammary carcinogens in laboratory animals. However, the association between PAHs and breast cancer in women is unclear. Vehicular traffic is a major ambient source of PAH exposure.

Objectives

Our study aim was to evaluate the association between residential exposure to vehicular traffic and breast cancer incidence.

Methods

Residential histories of 1,508 participants with breast cancer (case participants) and 1,556 particpants with no breast cancer (control participants) were assessed in a population-based investigation conducted in 1996–1997. Traffic exposure estimates of benzo[a]pyrene (B[a]P), as a proxy for traffic-related PAHs, for the years 1960–1995 were reconstructed using a model previously shown to generate estimates consistent with measured soil PAHs, PAH–DNA adducts, and CO readings. Associations between vehicular traffic exposure estimates and breast cancer incidence were evaluated using unconditional logistic regression.

Results

The odds ratio (95% CI) was modestly elevated by 1.44 (0.78, 2.68) for the association between breast cancer and long-term 1960–1990 vehicular traffic estimates in the top 5%, compared with below the median. The association with recent 1995 traffic exposure was elevated by 1.14 (0.80, 1.64) for the top 5%, compared with below the median, which was stronger among women with low fruit/vegetable intake [1.46 (0.89, 2.40)], but not among those with high fruit/vegetable intake [0.92 (0.53, 1.60)]. Among the subset of women with information regarding traffic exposure and tumor hormone receptor subtype, the traffic–breast cancer association was higher for those with estrogen/progesterone-negative tumors [1.67 (0.91, 3.05) relative to control participants], but lower among all other tumor subtypes [0.80 (0.50, 1.27) compared with control participants].

Conclusions

In our population-based study, we observed positive associations between vehicular traffic-related B[a]P exposure and breast cancer incidence among women with comparatively high long-term traffic B[a]P exposures, although effect estimates were imprecise.

Citation

Mordukhovich I, Beyea J, Herring AH, Hatch M, Stellman SD, Teitelbaum SL, Richardson DB, Millikan RC, Engel LS, Shantakumar S, Steck SE, Neugut AI, Rossner P Jr., Santella RM, Gammon MD. 2016. Vehicular traffic–related polycyclic aromatic hydrocarbon exposure and breast cancer incidence: the Long Island Breast Cancer Study Project (LIBCSP). Environ Health Perspect 124:30–38; http://dx.doi.org/10.1289/ehp.1307736     

Diet Quality,Obesity and Breast Cancer Risk: An Epidemiologic Study in Córdoba,Argentina

Abstract

Breast cancer (BC) is a multifactorial disease. Environmental factors, specifically, obesity and diet quality, have been linked with an increased risk of BC in women. This research was aimed at assessing the association of diet quality with BC risk, considering nutritional status, in Córdoba province (Argentina). A case-control study was conducted during the period 2008–2016 (346 cases/566 controls). A diet quality score was calculated for each woman based on fifteen dietary components related to low-grade inflammation. Dietary information was obtained through a validated questionnaire. A score (0, 0.5, or 1) was assigned to each variable depending on compliance with dietary recommendations. The higher the score, the higher the degree of adherence to a poor quality diet, which carries a potential inflammatory effect. A multiple logistic regression analysis was used to assess the association between BC occurrence and diet quality, adjusting by body mass index. The mean score of women was 6.86 (1.83). Of total women studied, 20% were obese. A 39% increase in BC risk was observed for each unit of increase in the score in this group (Odds Ratio: 1.39; 95% Confidence Interval: 1086–1796). Obese women with poorer quality diet have a greater risk of BC occurrence in Córdoba (Argentina).     

Survival of the Fittest in a Parasuicidal Group — A Twenty-Year Follow-Up of Suicide in Sweden

Objectives: A longitudinal prospective twenty-year follow-up of the survival of patients who had been brought to the Department of Internal Medicine at the Serafimer Hospital in Stockholm, Sweden because of attempted suicide (parasuicidal poisonings) compared with matched general population controls.

Methods: There were 538 parasuicidal patients (probands), 201 males and 337 females, who were followed from 1972 to 1992. The age range was 16-75 years. The matched general population controls recruited at the same time as the suicide attempts of the probands were stratified with regard to age and a sample was drawn up of men and women, 500 of each, with 70-72 persons in each of the age groups 16-19, 20-29 etc. to 70-79 years. Data were analysed by the Chi-square test and relative risk in the statistical analyses and means were compared by t-tests.

Results: The death rate was significantly higher for the male probands (56%) and the female probands (40%); 46% of the men and 40% of the women died as early as at the ages of 16-49 years. The mortality for the general population controls from this region of Greater Stockholm during the 20-year follow-up period was only 18% for the men and 13% for the women.

Conclusions: The part of the proband sample that survived suicidal attempts came significantly less often from broken homes or had parents with alcohol or drug abuse, nervous problems and successful or attempted suicide. They had fewer problems during childhood and no problems at school. This is a group that is better equipped to survive than those who came from homes which predisposed them to succeed in their suicidal attempts. Parasuicidal poisonings should be followed up because these individuals run the highest risk of repeated suicide attempts. We found that the best help for parasuicidal patients and the most effective way to prevent new suicidal attempts was to have the patients' GPs give supporting therapy for several     

Obesity Can Benefit Survival—A 9-Year Prospective Study in 1614 Chinese Nursing Home Residents

ObjectiveWeight loss has been considered predictive of early mortality in nursing home residents. Lower body mass index, irrespective of weight loss, has also been considered detrimental for survival in community-dwelling older persons. We examined which of the 2 is more important for survival in nursing home residents and at what body mass index (BMI) cut-offs survival benefits are gained or lost.DesignProspective study.SettingNursing homes.ParticipantsOne thousand six-hundred fourteen nursing home residents.MeasurementMinimum Data Set at baseline and mortality status assessed at 6 months, 1, 2, 4, and 9 years later. Relationship between mortality and significant weight loss (≥5% over 30 days or ≥10% over 180 days), and BMI, was studied by Cox regression with both variables in the same model, adjusted for age, sex, medical conditions (cancer, renal failure, heart disease, dementia, hip fracture, diabetes mellitus), tube-feeding, 25% food left uneaten, swallowing problem, and the activities of daily living hierarchy scale.ResultsOne thousand six-hundred fourteen residents (69.5% female) with mean age 83.7 ± 8.4 years and mean BMI 21.7 ± 4.8 were studied. Mortality rates were 6.3% (6-month), 14.3% (1-year), 27.1% (2-year), 47.3% (4-year), and 78.1% (9-year). Significant weight loss was not associated with higher mortality at all follow-up durations, whereas higher BMI was significantly protective: mortality reduction per 1 unit increase in BMI were 9% at 6 months, 10% at 1 year, 9% at 2 years, 7% at 4 years, and 5% at 9 years, all at P < .001. Having ≥25% of food left uneaten (51.2% of participants) had no relationship to survival at all follow-up durations. At 9 years, compared with those with BMI < 18.5kg/m², the normal weight (BMI 18.5–22.9 kg/m², Asia Pacific cut-off), overweight (BMI 23–25 kg/m², Asia Pacific cut-off) and obese (BMI > 25 kg/m², Asia Pacific cut-off) had significantly lower mortality (hazard ratio 0.65, 0.62, and 0.47, respectively, all P < .001).ConclusionsSignificant weight loss as defined by the Minimum Data Set was not associated with short- or long-term survival in Chinese nursing home residents. BMI, however, is predictive of short- and long-term survival irrespective of weight loss in this population. Low BMI, detectable at a single point of time, may be another readily available alternative trigger point for possible interventions in reducing mortality risk. Obese residents had the lowest mortality compared with those with normal weight.     

Women’s Benefits and Harms Trade-Offs in Breast Cancer Screening: Results from a Discrete-Choice Experiment

Background

Over the past decade, the benefits and harms balance of breast cancer (BC) screening has been widely debated.

Incorporating Equity–Efficiency Interactions in Cost-Effectiveness Analysis—Three Approaches Applied to Breast Cancer Control

BackgroundThe past decade, medical technology assessment focused on cost-effectiveness analysis, yet there is an increasing need to consider equity implications of health interventions as well. This article addresses three equity–efficiency trade-off methods proposed in the literature. Moreover, it demonstrates their impact on cost-effectiveness analyses in current breast cancer control options for women of different age groups.MethodsWe adapted an existing breast cancer model to estimate cost-effectiveness and equity effects of breast cancer interventions. We applied three methods to quantify the equity–efficiency trade-offs: 1) targeting specific groups, comparing disparities at baseline and in different intervention scenarios; 2) equity weighting, valuing low and high health gains differently; and 3) multicriteria decision analysis, weighing multiple equity and efficiency criteria. We compared the resulting composite league tables of all approaches.ResultsThe approaches show that a comprehensive breast cancer program, including screening, for women below 75 years of age was most attractive in both the group targeting approach and the equity weighting approach. Such control programs would reduce disparities with 56% and at €1908 per equity quality-adjusted life-year gained. In the multicriteria approach, a comprehensive treatment program for women below 75 years of age and treatment in stage III breast cancer were most attractive, with both an 82% selection probability, followed by screening programs for the two age groups.ConclusionIn the three equity weighing approaches, targeting women below 75 years of age was more cost-effective and led to more equitable distributions of health. This likely is similar in other fatal diseases with similar age distributions. The approaches may lead to different outcomes in nonfatal disease.     

Is Dairy Intake Associated to Breast Cancer? A Case Control Study of Iranian Women

Current epidemiologic data lack consistent evidence for an association between consumption of dairy products and breast cancer risk. In this study we assessed the relationship between consumption of dairy products and the odds of breast cancer. This case-control study was conducted on 275 women (100 cases and 175 controls). Data regarding sociodemographic factors, medical history, medications, and anthropometric measurements were collected. Dietary data were assessed using a validated food frequency questionnaire. The odds [95% confidence interval (CI)] of breast cancer were estimated across quartile categories of energy-adjusted dairy intake using multiple logistic regression models with adjustment for confounders. We observed that higher consumption of total dairy intake was accompanied with reduced breast cancer risk [odds ratio (OR) = 0.14, 95% CI = 0.04–0.38]. A similar inverse association was also observed for higher intakes of low-fat and fermented dairy products (P for trend <0.05). Lower intake of high-fat dairy was associated with reduced odds of breast cancer, and no significant association was found between nonfermented dairy and breast cancer risk. Our study demonstrates the protective effects of high intakes of total dairy, low-fat and fermented dairy, as well as low intakes of high-fat dairy products against breast cancer risk and shows no association with nonfermented dairy.     

Timeliness of Breast Cancer Diagnosis and Initiation of Treatment in the National Breast and Cervical Cancer Early Detection Program, 1996�C2005

Objectives. To determine the effects of program policy changes, we examined service delivery benchmarks for breast cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).Methods. We analyzed NBCCEDP data for women with abnormal mammogram or clinical breast examination (n = 382 416) from which 23 701 cancers were diagnosed. We examined time to diagnosis and treatment for 2 time periods: 1996 to 2000 and 2001 to 2005. We compared median time for diagnostic, treatment initiation, and total intervals with the Kruskal–Wallis test. We calculated adjusted proportions (predicted marginals) with logistic regression to examine diagnosis and treatment within program benchmarks (≤ 60 days) and time from screening to treatment (≤ 120 days).Results. Median diagnostic intervals decreased by 2 days (25 vs 23; P < .001). Median treatment initiation intervals increased by 2 days (12 vs 14; P < .001). Total intervals decreased by 3 days (43 vs 40; P < .001). Women meeting the 60-day benchmark for diagnosis improved the most for women with normal mammograms and abnormal clinical breast examinations from 77% to 82%.Conclusions. Women screened by the NBCCEDP received diagnostic follow-up and initiated treatment within preestablished program guidelines.Screening for breast cancer reduces morbidity and mortality from breast cancer when women receive timely follow-up and appropriate treatment.¹ There are few data to indicate what the optimal diagnostic and treatment intervals are that might ensure the best chances of survival from breast cancer detected by screening with mammography.^2,3 Recent information from organized screening programs in Canada and the United Kingdom showed that women who waited longer than 6 to 12 months for diagnostic workup were more likely to have larger cancers and more positive lymph nodes, which might lead to poorer survival.^2,3 In the case of symptomatic women, delays greater than 3 to 6 months to start therapy are associated with poorer survival.⁴Recent modeling studies have shown that the declines in mortality are attributable to both early detection and subsequent treatment.¹ Minority women, uninsured women, and women from lower socioeconomic backgrounds often do not have access to early detection.^5–7 These women are less likely to participate in mammography screening,⁸ less likely to have timely and complete follow-up after an abnormal screening test result,^9,10 more likely to be diagnosed with late-stage breast cancer,^6,7,11 more likely to die from breast cancer once diagnosed,^6,7 and might be more likely to receive suboptimal treatment.^12–15The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was authorized by Congress in 1990 to reach underserved women.¹⁶ Since the inception of the program, the NBCCEDP has established service delivery benchmarks to ensure timely and complete diagnostic follow-up and treatment initiation for underserved women screened through the program.¹⁷ Previous analysis of program benchmarks demonstrated that the national program was meeting its predefined quality standards of having a diagnosis within 60 days of an abnormal screening test result and initiation of treatment within 60 days of diagnosis.¹⁸ Legislation for program enhancements that added case management services, which was fully implemented in 2000, and a Medicaid waiver authorized by Congress in 2000 and fully implemented in 2003, should have improved the program''s ability to meet these standards.^19–22Accordingly, we hypothesized that NBCCEDP service delivery benchmarks would improve over time with shortening of time intervals after an abnormal mammogram or clinical breast examination (CBE) finding to final diagnosis, as well as the interval to treatment initiation after diagnosis, and the interval to treatment initiation after abnormal screening test result. We investigated this by using 2 time periods, 1996 to 2000 and 2001 to 2005,²⁰ to examine the effects of program policy changes on intervals in the 2001–2005 period.^20–22     

A Case–Control Study of Lung Cancer Nested in a Cohort of European Asphalt Workers

Background

We conducted a nested case–control study in a cohort of European asphalt workers in which an increase in lung cancer risk has been reported among workers exposed to airborne bitumen fume, although potential bias and confounding were not fully addressed.

Objective

We investigated the contribution of exposure to bitumen, other occupational agents, and tobacco smoking to the risk of lung cancer among asphalt workers.

Methods

Cases were cohort members in Denmark, Finland, France, Germany, the Netherlands, Norway, and Israel who had died of lung cancer between 1980 and the end of follow-up (2002–2005). Controls were individually matched in a 3:1 ratio to cases on year of birth and country. We derived exposure estimates for bitumen fume and condensate, organic vapor, and polycyclic aromatic hydrocarbons, as well as for asbestos, crystalline silica, diesel motor exhaust, and coal tar. Odds ratios (ORs) were calculated for ever-exposure, duration, average exposure, and cumulative exposure after adjusting for tobacco smoking and exposure to coal tar.

Results

A total of 433 cases and 1,253 controls were included in the analysis. The OR was 1.12 [95% confidence interval (CI), 0.84–1.49] for inhalation exposure to bitumen fume and 1.17 (95% CI, 0.88–1.56) for dermal exposure to bitumen condensate. No significant trend was observed between lung cancer risk and duration, average exposure, or cumulative exposure to bitumen fume or condensate.

Conclusions

We found no consistent evidence of an association between indicators of either inhalation or dermal exposure to bitumen and lung cancer risk. A sizable proportion of the excess mortality from lung cancer relative to the general population observed in the earlier cohort phase is likely attributable to high tobacco consumption and possibly to coal tar exposure, whereas other occupational agents do not appear to play an important role.     

Association Between Parity and Obesity in Mexican and Mexican–American Women: Findings from the Ella Binational Breast Cancer Study

Obesity at diagnosis of breast cancer is associated with higher all-cause mortality and treatment-associated toxicities. We evaluated the association between parity and obesity in the Ella study, a population of Mexican and Mexican–American breast cancer patients with high parity. Obesity outcomes included body mass index (BMI) ≥30 kg/m², waist circumference (WC) ≥35 in (88 cm), and waist-to-hip-ratio (WHR) ≥0.85. Prevalence of obesity ([BMI] ≥ 30 kg/m²) was 38.9 %. For WC, the multivariate odds ratio (OR) (95 % confidence interval [CI]) for having WC ≥ 35 inches in women with ≥4 pregnancies relative to those with 1–2 pregnancies was 1.59 (1.01–2.47). Higher parity (≥4 pregnancies) was non-significantly associated with high BMI (OR = 1.10; 95 % CI 0.73–1.67). No positive association was observed for WHR. Our results suggest WC is independently associated with high parity in Hispanic women and may be an optimal target for post-partum weight loss interventions.     

Socioeconomic differences in fat intake in a middle-aged population: report from the Malmö Diet and Cancer Study

BACKGROUND: The objective was to investigate whether socioeconomic differences in fat intake may explain socioeconomic differences in cardiovascular diseases. METHODS: The Malm? Diet and Cancer Study is a prospective cohort study. The baseline examinations used in the present cross-sectional study were undertaken in 1992-1994. Dietary habits were assessed using a modified diet history method consisting of a 7-day menu book and a 168-item questionnaire. A subpopulation of 11 837 individuals born 1926-1945 was investigated. This study examined high fat intake, defined as >35.9% among men and >34.8% among women (25% quartile limit) of the proportion of the non-alcohol energy intake contributed by fat. The subfractions saturated, mono-unsaturated and poly-unsaturated fatty acids and the P:S ratio (polyunsaturated/saturated fatty acids) were analysed in the same way. The uppermost quartile (75%) of total and subgroup fat intake was also studied. Socioeconomic differences before and after adjustment for low energy reporting (LER), defined as energy intake below 1.2 x Basal Metabolic Rate, were examined. RESULTS: No socioeconomic differences in fat intake were seen between the SES groups, except for self-employed men, and male and female pensioners. Approximately 20% in most SES groups were LER. The LER and body mass index were strongly related. The SES pattern of fat intake remained unchanged after adjustment for age, country of origin and LER in a logistic regression model. The results for the subfractions of fat and the P:S ratio did not principally differ from the total fat results. CONCLUSIONS: This study provides no evidence that fat intake contributes to the inverse socioeconomic differences in cardiovascular diseases.     

Multiple Social Roles,Health, and Sickness Absence—A Five-Year Follow-Up Study of Professional Women in Sweden

The aim of this study was to analyze associations between changes in social roles and physical health, mental well-being, psychiatric disorder, and long-term sickness absence over a five-year period. The study was part of a general population-based multipurpose project. Professional women from six birth cohorts born in 1935, 1945, 1955, 1965, 1970, or 1975 (N = 532) were interviewed twice. Self-rated information on physical health, mental well-being, long-term sickness absence, and changes in social roles was used. Information on psychiatric disorders was based on Diagnostic and Statistical Manual of Mental Disorders-III-R and Diagnostic and Statistical Manual of Mental Disorders-IV diagnoses. Multivariate logistic regressions were adjusted for age, socio-economic position, alcohol dependence and abuse, and health at baseline. An increase in number of social roles was associated with lower odds for poor mental well-being, odds ratio (OR) 0.4 (confidence interval [CI] 0.2 to 0.8), while a decrease was associated with higher odds for poor mental well-being, OR 4.5 (CI 1.8 to 11.0), psychiatric disorder, OR 2.6 (1.0 to 6.8), and sickness absence, OR 4.4 (1.6 to 11.7). The results indicated that an increase in number of social roles might be protective against poor mental well-being, while a decrease in number of roles might be related to increased psychiatric disorders and long-term sickness absence. More studies on long-term health implications of gender-specific experiences are needed.