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PubMed2000

Seasonal consumption of salad vegetables and fresh fruit in relation to the development of cardiovascular disease and cancer.

OBJECTIVE: To investigate the protective association between seasonality of consumption of fresh fruit or salad vegetables and cancer and cardiovascular disease (CVD) development. DESIGN AND SETTING: Face-to-face interviews, including a food frequency questionnaire, were conducted on 1489 men and 1900 women, aged 35-75 years, who were respondents in the British Health and Lifestyle Survey 1984/85 (HALS1). CVD and cancer morbidity and mortality were determined from the 1991/92 British Health and Lifestyle Survey (HALS2) and by NHS Register 'flagging'. RESULTS: Risk was assessed by odds ratio (OR) for trend per frequency category. In men, frequent winter salad vegetable consumption was more closely protective than that in summer for cancer (winter OR=0.79 [0.62-0.99], P=0.045, summer OR=0.83 [0.69-1.01], NS) and CVD (winter OR=0.85 [0.72-1.00], P=0.049, summer OR=0.95 [0.82-1.10], NS). Fresh fruit consumption showed no significant protection. In women, frequent salad vegetable consumption at any season was significantly protective of CVD (winter OR=0.76 [0.65-0.89], P<0.001, summer OR=0.76 [0.65-0.89], P<0.001), although not of cancer. Frequent fresh fruit consumption in women was significantly protective of CVD (winter OR=0.84 [0.74-0.94], P=0.004, summer OR=0.85 [0.74-0.97], P=0.014) but not quite significant, and only in winter, for cancer (winter OR=0.87 [0.76-1.00], P=0.052, summer OR=0.88 [0.75-1.02], P=0.097). Maintenance of salad vegetable consumption from summer to winter, to within one frequency category, was associated with further protection for cancer in men (P=0.050) and CVD in women (P=0.024). CONCLUSIONS: Diets high in fresh fruit and salad vegetables appear protective against cancer and CVD. It is important to take into account the seasonality of consumption in estimating and establishing significance of risk.

Adult↗
PubMed2005

Life cycle approaches to sustainable consumption: a critical review.

The 2002 World Summit for Sustainable Development in Johannesburg called for a comprehensive set of programs focusing on sustainable consumption and production. According to world leaders, these programs should rely on life cycle assessment (LCA) to promote sustainable patterns of production and consumption. Cleaner production is a well-established activity, and it uses LCA. UNEP, the European Union, and a number of national organizations have now begun to work on sustainable consumption. In developing sustainable consumption policies and activities, the use of LCA presents interesting opportunities that are not yet well understood by policy makers. This paper reviews how life cycle approaches, primarily based on input-output analysis, have been used in the area of sustainable consumption: to inform policy making, select areas of action, identify which lifestyles are more sustainable, advise consumers, and evaluate the effectiveness of sustainable consumption measures. Information on consumption patterns usually comes from consumer expenditure surveys. Different study designs and a better integration with consumer research can provide further interesting insights. Life-cycle approaches still need to be developed and tested. Current research is mostly descriptive; policy makers, however, require more strategic analysis addressing their decision options, including scenario analysis and backcasting.

Community Participation↗
PubMed1997

Alcoholic calories, red wine consumption and breast cancer among premenopausal women.

The role of alcohol consumption (alcoholic calories, alcoholic beverages) on breast cancer risk was investigated in a case-control study of 154 premenopausal female patients diagnosed with primary breast carcinoma. For each case, one control was matched for age (+/- 3 years) and socio-economic status. The survey was carried out in Northeastern France (Lorraine) between 1986 and 1989. While taking into account total caloric intakes and various breast cancer factors, breast cancer risk was shown to increase as consumption of alcohol increased (p value for trend = 0.007). A significant relative risk (RR = 2.69; 95% CI: 1.40-5.17) was shown above 60 kcal per day (approximately 9 g of alcohol per day). Breast cancer risk appeared to be restricted to red wine consumption among these premenopausal women, for monthly consumption (p value for trend = 0.003) as well as for duration of consumption (p value for trend = 0.01). A relative risk of 3.96 (95% CI: 1.59-9.84) was found for a monthly consumption higher than 4 liters per month. This reinforces the notion of a particular sensitivity of young women to breast cancer in relation to alcohol consumption.

Adult↗
PubMed1998

Black tea consumption does not protect low density lipoprotein from oxidative modification.

OBJECTIVE: To investigate the in vivo and in vitro effects of black tea on the oxidative modification of low density lipoprotein (LDL). DESIGN: The antioxidant activity of the tea was studied in vitro by measuring the resistance of the LDL to oxidative modification in the presence of copper. The effects of tea consumption in vivo were investigated in two settings. Firstly, to assess the acute effects of tea consumption, five fasting healthy subjects ingested 600 mls (50.7+/-5.4 mg flavonoids) of black tea and peripheral venous blood was collected at 0, 30, 60, 90, 120 and 180 min after consumption. Secondly, to assess the effects of chronic tea consumption, a randomised crossover trial of tea (126.8+/-13.5 mg flavonoids) and coffee consumption was carried out in ten healthy subjects. RESULTS: Black tea extract increased the resistance of LDL in vitro in a concentration dependent manner. There was no significant change in total plasma antioxidant capacity or susceptibility of the LDL to oxidation over the 3 h period after consumption of black tea. The four-week crossover study in which coffee was used as a control against the black tea showed no significant difference in the total plasma antioxidant capacity or susceptibility of LDL to oxidation between the tea and coffee groups. Serum lipids, including total cholesterol, triglycerides, LDL cholesterol and HDL cholesterol did not change significantly throughout the study. CONCLUSIONS: The consumption of moderate quantities of black tea acutely or for one week does not increase plasma total antioxidant capacity or alter the susceptibility of LDL to oxidation.

Adult↗
PubMed1999

Food consumption patterns in a Palestinian West Bank population.

OBJECTIVE: To describe the food consumption patterns in relation to wealth status and age groups in a Palestinian West Bank village population. DESIGN: Community-based cross-sectional survey of both households and individuals. A list recall method was used at the household level. At the individual level, a short food-frequency questionnaire was used in addition to a 24-h recall without estimates of portion sizes. SETTING: A Palestinian semi-rural village in the central West Bank. SUBJECTS: All households and all men and women aged 30-65 y in the study village were invited. All 368 households and 85% (n=500) of eligible individuals participated. RESULTS: The mean energy consumption from 25 selected food items on household level was about 13.8 MJ (3300 kcal)/consumption unit/d (a consumption unit corresponds to the expected energy requirement for an adult male). The proportion of dietary energy from fat and the consumption of most animal products was highest among the wealthiest households, and the opposite trend was seen for the consumption of wheat flour and lentils. There seems to be an ongoing trend of increasing consumption of processed products rich in sugar among the younger age groups. CONCLUSION: Shortage of dietary energy on the household level did not seem to be a problem in this population, even among the poorest. Differences in food consumption patterns between the poor and the wealthy, including a higher percentage of energy from fat among the wealthy, may be to the disadvantage of the wealthy with respect to some diet-related chronic diseases. SPONSORSHIP: The Norwegian Universities' Committee for Development Research (NUFU).

Adolescent↗
PubMed2000

Daily consumption of (red) meat or meat products in Switzerland: results of the 1992/93 Swiss Health Survey.

OBJECTIVE: The present study aimed to examine the frequency of daily meat and meat product consumption and the preference for red meat in Switzerland. DESIGN: Cross-sectional Study. SETTINGS AND SUBJECTS: Data were taken from the 1992/1993 Swiss Health Survey, which collected data on a random sample of persons aged 15 and over, living in Switzerland. The survey, which had a response rate of 71%, included 7930 male and 7358 female respondents. Bivariate analyses and multivariate logistic regressions controlling for sociodemographic and lifestyle factors were performed. RESULTS: Daily consumption of meat or meat products (25%) and more frequent consumption of red than white meat (26% of meat eaters) were prevalent in Switzerland. Men, middle-aged persons, participants with a low level of education, persons living in the German or Francophone regions of Switzerland, those with Swiss nationality, smokers, overweight and obese people, those with daily alcohol consumption and physically inactive persons were found to consume daily meat or meat products more frequently. A preference for red meat rather than white meat was more often observed in men, young people, persons living in the German or Francophone regions of Switzerland, smokers and participants who consumed alcohol at least once daily. CONCLUSIONS: The analysis of data from the 1992/1993 Swiss Health Survey shows that in specific subgroups of the Swiss population meat and meat product consumption is still more frequent than recommended, but crude comparisons with older and more recent studies indicate a decrease in meat consumption. The observed clustering of daily meat consumption with other risk factors underscores the necessity to include dietary recommendations in health programs addressing other unhealthy lifestyles. European Journal of Clinical Nutrition (2000) 54, 136-142

Adolescent↗
PubMed2002

The comparative gastrointestinal responses of children and adults following consumption of sweets formulated with sucrose, isomalt and lycasin HBC.

OBJECTIVES: To determine the gastrointestinal responses of children and adults following consumption of sucrose, isomalt and lycasin HBC and to compare these at two different dose levels in adults. DESIGN: Both studies were randomised, double-blind, cross-over designs. SUBJECTS: Fifty-one children aged 6-9 y were recruited from primary schools in the Salford area of Greater Manchester. Forty-eight children completed the study. Fifty healthy adult volunteers aged 18-24 y were recruited from the student population of the University of Salford. All subjects completed the study. INTERVENTIONS: Children consumed either 25 g of sucrose, isomalt or lycasin HBC and adults 25 and 40 g in hard boiled sweets per day for two consecutive test days. Test periods of 2 days were separated by 7 day washout periods. Children consumed sweets throughout test days and adults in no less than 30 min but no more than 90 min. Subjects reported the prevalence and magnitude of flatulence, borborygmi, bloating, colic, bowel movements and watery faeces. RESULTS: Consumption of 25 g isomalt provoked a mild laxative effect in children but not in adults. Consumption of 25 g isomalt significantly increased the prevalence and magnitude of gastrointestinal responses in both children and adults. Consumption of 25 g lycasin HBC significantly increased borborygml in children and adults but no other gastrointestinal responses. Consumption of 40 g lycasin HBC or isomalt by adults significantly increased the mean frequency of bowel movements and the number of subjects passing watery faeces. In adults, 40 g isomalt and lycasin HBC provoked significantly more gastrointestinal responses compared to 25 g of either product. CONCLUSIONS: Consumption of 25 g lycasin HBC does not provoke an unacceptable laxative effect or gastrointestinal response in children or adults compared to 25 g isomalt, which is associated with a mild laxative effect and increase in gastrointestinal responses. In adults gastrointestinal responses following consumption of products were found to be dose dependent.

Adolescent↗
PubMed2003

A digestive tolerance study of maltitol after occasional and regular consumption in healthy humans.

AIM: We aimed to evaluate the gastro-intestinal tolerance to an indigestible bulking sweetener containing sugar alcohol using a double-blind random cross-over study. METHOD: In order to simulate their usual pattern of consumption, 12 healthy volunteers ingested maltitol or sucrose throughout the day, either occasionally (once a week for each sugar, first period) or regularly (every day for two 9 day periods, second period). In both patterns of consumption, daily sugar doses were increased until diarrhea and/or a grade 3 (ie severe) digestive symptom occurred, at which the dose level was defined as the threshold dose (TD). RESULTS: In the first period (occasional consumption), the mean TD was 92+/-6 g with maltitol and 106+/-4 g with sucrose (P=0.059). The mean intensity of digestive symptoms was 1.1 and 1.3, respectively (P=NS). Diarrhea appeared in six and one subjects respectively (P=0.035). In the second period (regular consumption), the mean TD was 93+/-9 g with maltitol and 113+/-7 g with sucrose (P=0.008). The mean intensity of digestive symptoms was 1.7 and 1.2, respectively (P=NS). However, diarrhea appeared in eight and three subjects, respectively (P=0.04). Maltitol and sucrose TDs between the two periods were not different. CONCLUSIONS: Under our experimental conditions, in comparison to sucrose: (a) occasional or regular consumption of maltitol is not associated with severe digestive symptoms; (b) in both patterns of maltitol consumption, diarrhea frequency is higher, but it appeared only for very high doses of maltitol, much greater than those currently used; (c) maltitol does not lead to intestinal flora adaptation after a 9 day period of consumption.

Abdominal Pain↗
PubMed2004

Increasing children's fruit and vegetable consumption: a peer-modelling and rewards-based intervention.

OBJECTIVE: To evaluate a peer-modelling and rewards-based intervention designed to increase children's fruit and vegetable consumption. DESIGN: Over a 5-month period, children in an experimental and a control school were presented with fruit and vegetables at lunchtime. Children aged 5-7 y also received fruit at snacktime (mid-morning). The intervention was implemented in the experimental school and levels of fruit and vegetable consumption were measured at baseline, intervention and at 4-month follow-up. SETTING: Two inner-city London primary schools. SUBJECTS: In total, 749 children aged 5-11 y. INTERVENTION: Over 16 days children watched video adventures featuring heroic peers (the Food Dudes) who enjoy eating fruit and vegetables, and received small rewards for eating these foods themselves. After 16 days there were no videos and the rewards became more intermittent. MAIN OUTCOME MEASURES: Consumption was measured (i) at lunchtime using a five-point observation scale; (ii) at snacktime using a weighed measure; (iii) at home using parental recall. RESULTS: Compared to the control school, lunchtime consumption in the experimental school was substantially higher at intervention and follow-up than baseline (P<0.001), while snacktime consumption was higher at intervention than baseline (P<0.001). The lunchtime data showed particularly large increases among those who initially ate very little. There were also significant increases in fruit and vegetable consumption at home (P<0.05). CONCLUSIONS: The intervention was effective in bringing about substantial increases in children's consumption of fruit and vegetables.

Child↗
PubMed2006

Effect of chronic coffee consumption on aortic stiffness and wave reflections in hypertensive patients.

OBJECTIVE: Aortic stiffness and wave reflections are important markers and prognosticators of cardiovascular risk. Caffeine increases acutely aortic stiffness and wave reflections. Furthermore, chronic coffee consumption is associated with increased aortic stiffness and wave reflections in normotensive subjects. In the present study, we aimed to assess the association between chronic coffee consumption, and aortic stiffness and wave reflections in hypertensive patients. DESIGN: Epidemiological survey. SETTING: Hypertension Unit, University Hospital. SUBJECTS-METHODS: We examined 259 never-treated hypertensives (age 50+/-12 years, 165 males) without diabetes mellitus, who were asked to describe in detail the type and amount of coffee they consumed. Carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx) were measured non-invasively as indices of aortic stiffness and wave reflections, respectively. RESULTS: When controlled for gender, age, height, smoking status, heart rate, mean pressure, HDL cholesterol and hsCRP, AIx was found to be higher with increasing daily coffee consumption. Post hoc analysis revealed that all groups of coffee consumption had higher AIx compared to no-consumption. PWV did not differ among groups of daily coffee consumption. Each participant had 35% higher relative risk of having high AIx for each cup (150 ml) of coffee per day, and 40% higher relative risk for each 10 cup-years. CONCLUSIONS: Coffee consumption is associated with increased wave reflections, but not aortic stiffness in never-treated hypertensive patients. This finding may have important clinical implications for cardiovascular health in hypertensive subjects.

Aorta↗
PubMed1996

The changes in the social class distribution of moderate and high alcohol consumption and of alcohol-related disabilities over time in Stockholm County and in Sweden.

The purpose of this paper was to analyse the role of social class concerning changes in alcohol consumption and severe alcohol-related problems from the end of the 1960s to the 1990s in Stockholm County, and in the whole of Sweden for consumption. Survey data showed that the prevalence of moderate and/or high alcohol consumption in adults of both sexes was highest among non-manual employees at medium and high level, in 1967 as well as in 1980 in the whole of Sweden. After 1980, an equalization occurred. A similar change in the social class pattern of alcohol consumption was noted in young people. We analysed all 36,404 male and 10,648 female hospitalizations and all the 3175 male and 713 female deaths with a diagnosis of alcoholism, alcohol psychosis or alcohol intoxication in Stockholm County during 1970-86 (1970-84 for mortality) linked to individual census data. There was a greater increase in rates among women than among men, especially among women outside the labour market. We found pronounced social class differences between manual and non-manual employees, which widened up to 1986 (1984 for mortality)-a period with an initial increase and a subsequent decrease in alcohol consumption. Thus, the changes in consumption and alcohol-related problems developed differently in principal social classes over time, suggesting that an expanded theory on alcohol consumption in the population should take socio-economic factors into account.

Adolescent↗
PubMed1998

Alcohol-related harm and alcohol consumption in Moscow before, during and after a major anti-alcohol campaign.

AIMS: To examine the rates of alcohol-related harm in relation to levels of alcohol consumption before, during and after a major anti-alcohol campaign in Moscow. DESIGN: Changes in State alcohol sale and alcohol consumption and certain forms of alcohol-related harm were observed as a function of time. FINDINGS: Following the 1985 anti-alcohol campaign, State alcohol sales decreased by 38.0% in 1.5 years in Moscow, and total consumption decreased by 28.6%. At the same time, admissions for alcohol-related mental and behavioural disorders, deaths from liver cirrhosis, alcohol poisoning and other blood alcohol positive violent deaths decreased by 63.3%, 33.0%, 50.8% and 50.9%, respectively. There was a linear correlation between medical variables and alcohol consumption during its decrease in 1985-86. An increase in blood alcohol positive violent deaths began in 1987, before the increases in other variables. Growth of total alcohol consumption began in 1987, and continued during all subsequent years, although it was especially high in 1992-93 at the time of the introduction of market reforms in Russia. Alcohol-related mental and behavioural disorders and liver cirrhosis mortality increased after a time-lag following the rise in alcohol consumption. CONCLUSIONS: The findings provide stark evidence of the potential impact of policy measures applied to general alcohol consumption on alcohol-related harm.

Alcohol Drinking↗
PubMed1999

Predictors of change in alcohol consumption among Frenchmen of the GAZEL study cohort.

AIMS: To identify the predictors of changes in alcohol intake among French men. DESIGN: Longitudinal study over a 2-year period. SETTING: The GAZEL volunteer cohort comprising workers employed by Electricité de France-Gaz de France. PARTICIPANTS: The study included 11,613 men aged 40-50 years who had answered a self-administered questionnaire in 1989 and 1991. MEASUREMENTS: Subjects were defined according to initial levels of alcohol intake and changes in that intake (cessation, decrease and increase) and compared with subjects with corresponding levels but unchanged intake by logistic regression. The effects of individual characteristics and of occupational and health conditions were investigated. FINDINGS: Different variables measured in 1989 were predictive of changes in alcohol consumption in 1991, depending on the change. Self-perception of bad health, consumption of sleeping pills and unmarried status were predictive of the cessation of alcohol consumption. Working under favourable conditions (with no specific occupational risks) and being a non-smoker tended to be associated with reduced consumption. Increased consumption was associated with the number of reported disease and the smoking status. Among abstainers or light daily drinkers, being exposed to more than one constraint enlarged the risk of increased consumption. For moderate drinkers, the risk of increased consumption was higher, irrespective of the number of physical constraints. CONCLUSIONS: These results highlight the fact that many inter-related factors help to determine changes in drinking habits.

Adult↗
PubMed1999

Alcohol consumption in a national sample of the Russian population.

AIMS: Alcohol has been suggested as an important determinant of mortality in Russia but survey data on individuals' alcohol consumption in Russia are sparse. We have analysed the levels and distribution of alcohol consumption in a national sample of the Russian population. DESIGN: Cross-sectional survey. PARTICIPANTS: A multi-stage random sample of men and women of the Russian Federation (N = 1599, response rate 66%). MEASUREMENTS: Data on frequency of drinking alcohol and the average amount consumed at one occasion were collected in an interview. Information was also collected on smoking, self-rated health and a broad range of socio-economic factors and political attitudes. FINDINGS: Nine per cent of men and 35% of women reported that they never drink alcohol; 10% of men and 2% women drink several times a week; 44% of men and 6% of women reported that they drink an equivalent of 25 cl of vodka or more at one occasion and 31% of men and 3% of women would do so at least once a month (25 cl of vodka contains 78.5 g of absolute alcohol). There were differences in alcohol consumption between geographical areas. Material deprivation was not related to alcohol consumption. Among men, smokers, unmarried, unemployed and men reporting poor health consumed more alcohol; women with higher education, widows, non-smoking and with worse health consumed less alcohol. Variables related to reaction to economic and political changes, rating of family economic situation general satisfaction or political preferences were not related to alcohol consumption. CONCLUSIONS: While the overall levels of alcohol consumption appeared low, possibly due to under-reporting, the proportion of men who can be considered as "binge drinkers" was relatively high. The absence of sizable socio-economic differences suggest that drinking may be spread relatively uniformly in Russia, especially among males. Alcohol consumption seems unrelated to individuals' perception of the recent societal changes.

Adolescent↗
PubMed2001

Measuring alcohol consumption and alcohol-related problems: comparison of responses from self-administered questionnaires and telephone interviews.

AIMS: Compared with surveys using self-administered questionnaires, telephone interviews generally yield higher coverage rates, have a lower proportion of missing values and result in fewer inconsistencies. Meta-analyses, however, show that responses to sensitive questions by telephone tend to be biased by social expectations. The aim of the study is to examine whether responses on alcohol consumption and alcohol-related problems differ with respect to mode of administration (self-administered vs. telephone). Design and participants. Data were analysed from the 1995 self-administered survey among 6427 subjects and from telephone surveys conducted annually between 1994 and 1996 yielding a pooled sample of 6193 subjects. MEASUREMENTS: Alcohol consumption within the last 30 days was measured using a beverage-specific quantity-frequency index. For a summary measure responses were converted into pure alcohol (ethanol) per day and categorized into no alcohol consumption (0 g), non-hazardous consumption (< or = 20 g for female and < or = 40 g for males) and hazardous consumption (> 20 g for females and > 40 g for males). Alcohol-related problems were assessed using the CAGE questionnaire with a cut-off point of at least two positive responses. FINDINGS: Using (cumulative) logistic regression, a significant mode effect was found for both alcohol consumption and alcohol-related problems. Lower beverage-specific prevalences in the telephone mode were found to be responsible for the difference in the distribution of the summary consumption measure. CONCLUSIONS: Results indicate that patterns of drinking and alcohol-related problems are more easily reported in self-administration questionnaires compared to telephone interviews.

Adolescent↗
PubMed2003

Alcohol consumption and fatal accidents in Canada, 1950-98.

AIMS: To evaluate the effects of changes in aggregate alcohol consumption on overall fatal accidents, motor vehicle accidents, fatal falling accidents and drowning accidents in Canadian provinces after 1950. DESIGN: Time-series analysis of annual mortality rates (15-69 years) in relation to per capita alcohol consumption, utilising the Box-Jenkins technique. All series were differenced to remove long-term trends. MEASUREMENTS: Gender-specific and age-adjusted mortality rates for the age group 15-69 years were calculated on the basis of mortality data for 5-year age groups, using a standard population. Data on per capita alcohol consumption was converted to consumption per inhabitant 15 years and older. In the analysis of motor vehicle accidents, the number of motor vehicles was used as a control variable. FINDINGS: Statistically significant associations between alcohol consumption and overall fatal accident rates were uncovered in all provinces for males, and in all provinces except Ontario for females. For Canada at large, an increase in per capita alcohol consumption of 1 litre was accompanied by an increase in accident mortality of 5.9 among males and 1.9 among females per 100,000 inhabitants. Among males there was a significant association with alcohol for both falling accidents, motor vehicle accident and other accidents, but the association was insignificant for drowning accidents. Among females, the association with falling accidents and other accidents was significant. CONCLUSION: Changes in alcohol consumption have had substantial effects on most of the main types of fatal accidents in Canada during the second half of the 20th century. The size of the association is comparable to the one previously reported from Northern Europe.

Accidental Falls↗
PubMed2003

Fetus at risk: prevalence of alcohol consumption during pregnancy estimated with a simple screening method in Swedish antenatal clinics.

AIMS: Maternal alcohol consumption is a major health hazard for the fetus. Sweden has an extensive system of public antenatal care clinics, whose mission is to detect and prevent this type of health hazards. However, very few cases of alcohol consumption during pregnancy are detected. The aim of this study was to examine the prevalence of hazardous or harmful alcohol consumption during pregnancy in a consecutive series of Swedish pregnant females. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: The Alcohol Use Disorders Identification Test (AUDIT) was used to collect anonymous data from consecutive pregnant subjects admitted during 1 year to an antenatal clinic in Stockholm, and signing up for parental education offered routinely (n = 1327). Data were obtained from 1101 subjects, typically in pregnancy week 30. A complete AUDIT form was filled out referring to alcohol use during the year prior to pregnancy. A separate form with the consumption items from AUDIT was filled out to report behaviour during pregnancy. FINDINGS: For the year preceding pregnancy, 17% of subjects reported AUDIT scores of 6 or higher, indicating hazardous or harmful alcohol use in women. Few individuals reported scores of 13 or higher (indicating abuse or dependence), but almost half the subjects (46%) reported binge drinking (six standard drinks on a single occasion) once/month or more often, and 6% reported binge drinking on every occasion of alcohol consumption. One-third of the subjects (30%) continued regular alcohol use during pregnancy, and 6% reported consumption two to four times/month. In a logistic regression model, AUDIT scores for the year prior to pregnancy and subject age, but not education level were significant predictors of continued alcohol use during pregnancy. CONCLUSIONS: Alcohol use during pregnancy is more extensive than has been presumed in Sweden. Simple, clinically useful screening methodology detects hazardous consumption during pregnancy in a manner which regular antenatal care does not. If this methodology can be shown to have similar sensitivity when administered under non-anonymous conditions, it should be made part of routine antenatal care.

Adult↗
PubMed2001

Changes in treatment strategies for severe haemophilia over the last 3 decades: effects on clotting factor consumption and arthropathy.

A cohort study was performed among 214 patients with severe haemophilia, born 1944-1994, to describe changes in treatment over the last 3 decades and its effects on clotting factor consumption and haemophilic arthropathy. Data on treatment strategy, clotting factor consumption, and outcome were collected for 3567 patient years (from 1972 to 1998), and 493 Pettersson scores were analysed. Median follow up was 17 years (range 6-27 years), and median age in 1998 was 27.6 years. Since 1965, replacement therapy, prophylaxis, and home treatment have been used and treatment intensified. Over the last 3 decades, annual clotting factor consumption increased by 260%, for both prophylactic and on-demand treatment. Annual clotting factor consumption kg-1 increased during childhood and appeared to stabilize in early adulthood for patients born 1965-79, who were treated with early replacement therapy or early prophylaxis. In contrast, clotting factor consumption increased continuously for patients born before 1965, who had had no access to replacement therapy during the early years of their life. The annual number of joint bleeds decreased over the years. Arthropathy as measured by the Pettersson score generally became apparent around the age of 15 years and was lowest in patients treated with primary prophylaxis. In conclusion, clotting factor consumption has increased and haemophilic arthropathy has decreased due to the intensification of treatment for severe haemophilia over the last 3 decades. Annual clotting factor consumption stabilizes in adulthood for patients who receive early intensive treatment.

Adolescent↗