Multiple behavioral risk factors for chronic diseases in adults aged 50+: regional differences across eleven European countries

Aim

The aim of this study was to estimate the differences in prevalence of multiple behavioral risk factors (MBRFs) for chronic diseases in European adults, from eleven North, Central and South European countries.

Subjects and methods

We used data from 26,656 adults, aged 50+ years, participating in the Survey of Health, Ageing and Retirement in Europe (2004/05). Physical inactivity, high body weight, smoking and risky alcohol consumption were assessed and estimated based on sampling weights, controlling for socioeconomic characteristics.

Results

53.4 % of adults had 2+ MBRFs. Prevalence in the total sample was highest for physical inactivity (71.2 %) and lowest for smoking (18.1 %). The cluster of high body weight and physical inactivity had the highest prevalence of MBRFs (35.4 %), with higher prevalence in Southern Europe (p?<?0.05). Smoking and alcohol consumption presented the greatest degree of clustering (observed to expected ratio?=?2.44). Spain and Greece had the highest prevalence of clustering 2+ MBRFs, whereas Southern European countries had a higher mean number of MBRFs, compared to North and Central European regions (p?<?0.05).

Conclusion

Prevalence of MBRFs varied between countries, with Southern European countries engaging in more risky behaviors. Primary prevention programmes should be developed to reduce MBRFs in this population.     

Composition and chemical health hazards of the most common electronic cigarette liquids in nine European countries

Abstract

Background: The aim of the present study was to identify the composition and reported chemical health hazards of the most common electronic cigarette liquids (e-liquids) in nine European Union (EU) Member States (MS) prior to adoption of the Tobacco Product Directive (TPD).

Materials and methods: Within the Horizon2020, EUREST-PLUS study, 122 of the most commonly sold e-liquids in 9 EU MS were randomly selected and purchased. A quantitative and qualitative chemical analysis was performed using a previously validated based gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry method. The most commonly detected compounds were then divided according to the Danger Globally Harmonized System of Classification and Labelling of Chemicals (GHS) and Warning GHS codes.

Results: Within our qualitative analysis, 171 different compounds were detected. Discrepancies in measured versus reported nicotine concentration were identified. Forty-one (85.4%) of the most commonly detected compounds were registered with Warning GHS codes, 11 with Danger GHS codes and 9 with both codes. Of the total number of the detected compounds, 293 were attributable to fruits flavor, followed by tobacco flavor (204), nonalcoholic drinks (n?=?64), desserts–sweets (n?=?50), menthol – mint (n?=?42) and alcohol (n?=?39). Menthol which is classified as a strong irritant to skin and eye was the most frequently detected compound.

Conclusion: A large plethora of compounds with varying warning codes was identified in e-cigarette samples. The systematic monitoring and chemical evaluation of e-liquids are warranted, so as to ensure consumer protection.     

Synthesis, in vivo antileukemic evaluation and comparative study of novel 5alpha-7-keto steroidal esters of chlorambucil and its active metabolite

Recent structure-antileukemic activity studies showed that the steroidal part of complex molecules containing DNA alkylators does not play only the role of the "biological carrier". New such compounds designed to possess an allylic 7-ketone showed enhanced antileukemic potency compared with derivatives with a simple steroidal skeleton. In order to investigate whether the enhancement of the antileukemic potency is attributed to the introduction of the 7-ketone or to the Delta5-7-keto conjugated steroidal system we decided to reduce the Delta5 double bond. The 5alpha-7-keto-steroidal skeletons synthesized were tethered to chlorambucil and phenyl acetic acid's nitrogen mustard and studied against leukemia P338 in vivo. The reduction of the double bond had a negative impact on the antileukemic potency since the comparative study of the novel derivatives showed that a series of very potent Delta 5-7-keto-steroidal esters were converted by this modification to compounds with marginally accepted activity.     

Mediterranean diet adherence during pregnancy and fetal growth: INMA (Spain) and RHEA (Greece) mother-child cohort studies

Dietary intake of specific nutrients or food groups during pregnancy could influence fetal growth, but scant evidence is available on effects of dietary patterns. The aim of this study was to evaluate the impact of Mediterranean diet (MD) adherence during pregnancy on fetal growth in two population-based mother-child cohorts in Spain and Greece. We studied 2461 mother-newborn pairs from the Spanish multi-centre 'INMA' study (Atlantic area: INMA-Atlantic; Mediterranean area: INMA-Mediterranean), and 889 pairs from the 'RHEA' study in Crete, Greece. Maternal diet during pregnancy was assessed by FFQ and MD adherence was evaluated through an a priori score. Fetal growth restriction was based on a customised model, and multivariate log-binomial and linear regression models were used to adjust for several confounders. MD scores differ significantly between the cohorts with women in INMA-Atlantic reporting higher intakes of fish and dairy products, while women in the Mediterranean area reported higher intakes of cereals, vegetables and fruits. Women with high MD adherence had a significantly lower risk of delivering a fetal growth-restricted infant for weight (risk ratios: 0·5; 95?% CI 0·3, 0·9) in the INMA-Mediterranean cohort. Stratified analysis by smoking revealed that higher MD adherence increased birth weight and birth length in smoking mothers, whereas this effect was not apparent in non-smoking mothers. The results of the present study show that several types of MD exist across European Mediterranean regions. High MD adherence may modify the detrimental effect of smoking on birth size, but overall effects of diet were not universal for the studies in this analysis.     

Epidemiological approaches in the investigation of environmental causes of cancer: the case of dioxins and water disinfection by-products

I will refer in this paper to difficulties in research in environmental causes of cancer using as examples research on dioxins and on drinking water disinfection by-products (DBPs) that have created considerable controversy in the scientific and wider community. Dioxins are highly toxic chemicals that are animal carcinogens. For many years, evaluation of the carcinogenicity of dioxins in humans was based on case-control or registry based studies. The development of methods to measure dioxins in blood indicated that these studies suffered from extreme exposure misclassification. The conduct of large cohort studies of workers with widely contrasted exposures together with the use of biomarkers and models for exposure assessment, led to convincing evidence on the carcinogenicity of dioxins in humans. The high toxicity of a few dioxin congeners, the availability of a scheme to characterize the toxicity of a mixture of dioxins and related compounds and the long half-life of these compounds facilitated epidemiological research. Contrary to dioxins, trihalomethanes (THMs) and most of the hundreds of DBPs in drinking water are chemicals of low toxicity. For more than 15 years, the main evidence on the carcinogenicity of DBPs was through ecological or death certificate studies. More recent studies based on individual assessment confirmed increases in bladder cancer risk. However even those studies ignored the toxicological evidence on the importance of routes of exposure to DBPs other than ingestion and, probably, underestimated the risk. Persistence of weak study designs together with delays in advanced exposure assessment models led to delays in confirming early evidence on the carcinogenicity of DBPs. The evaluation of only a few chemicals when exposure is to a complex mixture remains a major problem in exposure assessment for DBPs. The success of epidemiological studies in identifying increased risks lies primarily on the wide contrast of exposure to DBPs in the general population that overcomes the significant exposure misclassification. Exposure assessment has been the Achilles heel for studies on dioxins and DBPs and cancer. The combination of powerful study designs, advanced exposure assessment together with a better understanding of mechanisms of disease and the use of biomarkers of exposure, led to the strengthening of the epidemiological evidence.     

Genetic and Non-genetic Predictors of LINE-1 Methylation in Leukocyte DNA

Background: Altered DNA methylation has been associated with various diseases.Objective: We evaluated the association between levels of methylation in leukocyte DNA at long interspersed nuclear element 1 (LINE-1) and genetic and non-genetic characteristics of 892 control participants from the Spanish Bladder Cancer/EPICURO study.Methods: We determined LINE-1 methylation levels by pyrosequencing. Individual data included demographics, smoking status, nutrient intake, toenail concentrations of 12 trace elements, xenobiotic metabolism gene variants, and 515 polymorphisms among 24 genes in the one-carbon metabolism pathway. To assess the association between LINE-1 methylation levels (percentage of methylated cytosines) and potential determinants, we estimated beta coefficients (βs) by robust linear regression.Results: Women had lower levels of LINE-1 methylation than men (β = –0.7, p = 0.02). Persons who smoked blond tobacco showed lower methylation than nonsmokers (β = –0.7, p = 0.03). Arsenic toenail concentration was inversely associated with LINE-1 methylation (β = –3.6, p = 0.003). By contrast, iron (β = 0.002, p = 0.009) and nickel (β = 0.02, p = 0.004) were positively associated with LINE-1 methylation. Single nucleotide polymorphisms (SNPs) in DNMT3A (rs7581217-per allele, β = 0.3, p = 0.002), TCN2 (rs9606756-GG, β = 1.9, p = 0.008; rs4820887-AA, β = 4.0, p = 4.8 × 10^–7; rs9621049-TT, β = 4.2, p = 4.7 × 10^–9), AS3MT (rs7085104-GG, β = 0.7, p = 0.001), SLC19A1 (rs914238, TC vs. TT: β = 0.5 and CC vs. TT: β = –0.3, global p = 0.0007) and MTHFS (rs1380642, CT vs. CC: β = 0.3 and TT vs. CC; β = –0.8, global p = 0.05) were associated with LINE-1 methylation.Conclusions: We identified several characteristics, environmental factors, and common genetic variants that predicted DNA methylation among study participants.     

Considerations of circadian impact for defining 'shift work' in cancer studies: IARC Working Group Report

Based on the idea that electric light at night might account for a portion of the high and rising risk of breast cancer worldwide, it was predicted long ago that women working a non-day shift would be at higher risk compared with day-working women. This hypothesis has been extended more recently to prostate cancer. On the basis of limited human evidence and sufficient evidence in experimental animals, in 2007 the International Agency for Research on Cancer (IARC) classified 'shift work that involves circadian disruption' as a probable human carcinogen, group 2A. A limitation of the epidemiological studies carried out to date is in the definition of 'shift work.' IARC convened a workshop in April 2009 to consider how 'shift work' should be assessed and what domains of occupational history need to be quantified for more valid studies of shift work and cancer in the future. The working group identified several major domains of non-day shifts and shift schedules that should be captured in future studies: (1) shift system (start time of shift, number of hours per day, rotating or permanent, speed and direction of a rotating system, regular or irregular); (2) years on a particular non-day shift schedule (and cumulative exposure to the shift system over the subject's working life); and (3) shift intensity (time off between successive work days on the shift schedule). The group also recognised that for further domains to be identified, more research needs to be conducted on the impact of various shift schedules and routines on physiological and circadian rhythms of workers in real-world environments.     

Smoking habits of Greek preschool children's parents

Background  

Smoking is Greece's largest public health threat. Greece has the highest adult smoking prevalence among all E.U countries, which in turn possibly predisposes Greek children and adolescents to smoke. The purpose of our study was to research into the smoking habits of preschool children's parents since children of that age could be vulnerable to parental negative role modeling and to investigate into the necessity of conducting a public health awareness programme aimed at the general population.     

Cigarette smoking and cancer risk: modeling total exposure and intensity

A recent analysis showed that the excess odds ratio (EOR) for lung cancer due to smoking can be modeled by a function which is linear in total pack-years and exponential in the logarithm of smoking intensity and its square. Below 15-20 cigarettes per day, the EOR/pack-year increased with intensity (direct exposure rate or enhanced potency effect), suggesting greater risk for a total exposure delivered at higher intensity (for a shorter duration) than for an equivalent exposure delivered at lower intensity. Above 20 cigarettes per day, the EOR/pack-year decreased with increasing intensity (inverse exposure rate or reduced potency effect), suggesting greater risk for a total exposure delivered at lower intensity (for a longer duration) than for an equivalent exposure delivered at higher intensity. The authors applied this model to data from 10 case-control studies of cancer, including cancers of the lung, bladder, oral cavity, pancreas, and esophagus. At lower intensities, there was enhanced potency for several cancer sites, but narrow ranges for pack-years increased uncertainty, precluding definitive conclusions. At higher intensities, there was a consistent reduced potency effect across studies. The intensity effects were statistically homogeneous, indicating that after accounting for risk from total pack-years, intensity patterns were comparable across the diverse cancer sites.     

Employment status and use of respiratory protection among metalworkers, solderers and welders

Objectives

Reported associations of self‐employment with occupational injury and cerebrovascular disease suggest that worker safety and health precautions may vary by occupational status. The authors assessed the extent to which use of respiratory protection and ventilation equipment is associated with self‐employed versus employee status among adults in an international study.

Methods

The European Community Respiratory Health Survey II (ECRHS II) is a follow‐up study conducted in a population‐based random sample of adult ECRHS I participants. Men and women enrolled in the ECRHS II completed interviewer‐administered questionnaires to provide information about their occupational status and job history during the 9‐year ECRHS follow‐up period. Respondents in selected occupational groups completed supplemental questionnaires about their jobs and use of respiratory protection and ventilation equipment on‐the‐job. The authors assessed self‐reported use of respiratory and ventilation equipment among 72 self‐employed and 371 employed adults in metalworking, soldering and welding occupations.

Results

Local exhaust ventilation (fixed extraction: OR 0.37, 95% CI 0.17 to 0.80; mobile extraction: OR 0.23, 95% CI 0.09 to 0.60; on‐tool extraction: OR 0.39, 95% CI 0.18 to 0.88) was reported less frequently among self‐employed respondents than among employed respondents. The magnitude of the negative association between self‐employment status and any of the three types of local exhaust ventilation was not attenuated by adjustment for duration of work per day or week or asthma and/or wheezing symptoms. Respiratory protection was not associated with employment status in these data.

Conclusions

More limited use of local exhaust ventilation among self‐employed workers compared to employees suggests the need to promote occupational safety among self‐employed workers.Information about the working conditions of employees may not reflect the experiences of self‐employed individuals working in the same fields. Self‐employed people who work independently or operate their own businesses may take advantage of the increased autonomy often associated with self‐employment to organise their work schedules and practices to more closely suit their professional preferences. In many industries, self‐employed workers have the opportunity to select their own hours, work settings, clients and equipment. Workers with this degree of flexibility may develop their own occupational health and safety practices, but existing information describing the working conditions of self‐employed individuals is insufficient to indicate how practices differ from those of employees, or how these differences affect health and safety.Recent research provides evidence that health and safety precautions and job training vary between workers in self‐employed and employed work situations.¹ Results from a 2005 survey conducted in the EU indicate that self‐employed workers experienced greater autonomy and less violence, harassment and/or discrimination on the job and had fewer days of health‐related absence over the past year compared to employed respondents. In contrast, the self‐employed respondents more frequently reported that they considered their health and safety to be at risk because of work and a slightly smaller percentage reported wearing personal protective clothing or equipment at work (self‐employed 29% vs employed 35%).¹ Although the survey did not include industry‐ or job‐specific estimates or health outcomes related to the use of personal protective equipment, overall these responses reveal some of the reasons individuals may seek self‐employment situations, and raise the possibility that self‐employed work arrangements may result in important health and safety risks.Previous research has shown differences in the rates of work‐related mortality among the self‐employed and privately‐employed populations.^2,3 For example, using data reported through a medical examiner''s surveillance system, notably higher fatal occupational injury rates were observed among self‐employed workers in the agricultural sector and in retail and transportation industries.² The surveillance‐based study found lower rates among self‐employed workers in the construction industry, suggesting differences in the occupational health and safety practices of self‐employed and employed individuals.² Such variations in the rates of occupational injury may reflect differences in work‐related tasks, settings, use of protective equipment or differences in the age and/or levels of work experience between the two populations. In contrast, lower rates of cerebrovascular disease have been reported among self‐employed men than among employed men. Although the differences were not observed for overall mortality or other circulatory disorders, the investigators concluded that the effect of self‐employment status was independent of those associated with other lifestyle and medical factors and thus may be considered an additional determinant of health.⁴ Differences in mortality rates between self‐employed and employed populations led the investigators to suggest considering employment status as a proxy for differences in working practices, including the physical work environment.Despite these observed differences in occupational practices, mortality and cardiovascular morbidity, occupational health and safety practices of self‐employed workers remain largely unreported in the public health literature. For this analysis, we investigated a hypothesis for which there is little epidemiological evidence—that is, whether employment status is associated with use of respiratory protection and/or ventilation equipment. We used data from the European Community Respiratory Health Survey (ECRHS), a population‐based cohort of adult men and women, to examine self‐reported use of respiratory protection and ventilation equipment among self‐employed and employed respondents.