Increasing inequality in childhood obesity in primary schools in a northern English town

OBJECTIVE

To undertake an analysis of National Child Measurement Programme (NCMP) data to quantify the obesity prevalence gap over time between children in primary schools in the most and least deprived areas of Doncaster.

STUDY DESIGN

The research design for this study was retrospective quantitative analysis of secondary data.

METHODS

The study undertook secondary analysis of NCMP data on obesity prevalence in children in Reception Year and Year 6 in primary schools in Doncaster for the period 2006-2007 to 2014-2015. Data were combined into three 3-year periods (2006-2007 to 2008-2009; 2009-2010 to 2011-2012; and 2012-2013 to 2014-2015), and schools were grouped by deprivation based on the national Indices of Multiple Deprivation 2015. Analysis was undertaken to assess whether there is a difference in obesity prevalence for Reception Year and Year 6 children in schools in the most deprived areas compared with the least deprived (prevalence gap), over time.

RESULTS

The difference in obesity prevalence between children attending schools in the most and least deprived areas has increased over time. For Reception Year children, the prevalence gap has widened from a difference of 1.01% higher in the most deprived schools in 2006-2007 to 2008-2009 to 3.64% higher in 2012-2013 to 2014-2015. In the same time periods, for Year 6 children, the obesity prevalence gap has also increased over time from 2.82% to 5.08%.

CONCLUSIONS

There is inequality in relation to obesity in primary school children in Doncaster with those in schools in the most deprived areas carrying the greatest burden. Research is needed to understand why the plateau seen nationally is not reaching the most deprived children.

Methylenetetrahydrofolate reductase (MTHFR) variants and bladder cancer: A population-based case-control study

Functional variants in the methylenetetrahydrofolate reductase (MTHFR) gene, including the 677C>T and 1298A>C polymorphisms, have been associated with a moderately reduced risk of several cancers, including colorectal cancers. While recent studies have investigated the role of these polymorphisms on bladder cancer susceptibility, results have been mixed. To clarify the role of MTHFR polymorphisms on bladder cancer risk, we genotyped MTHFR 677C > T and MTHFR 1298A > C in a population-based study of bladder cancer of 352 patients and 551 controls from New Hampshire, USA. The allelic frequency was 35.6% for MTHFR 677C>T and 40.4% for MTHFR 1298A > C among controls. We found no evidence of a main gene effect for either polymorphism (adjusted OR for MTHFR 677C>T variants versus the reference genotype = 1.1; 95% CI, 0.8-1.4 and adjusted OR for MTHFR 1298A>C variants versus the reference genotype = 1.0; 95% CI, 0.7-1.4). Odds ratios did not appear to differ by smoking status or gender. We observed differences in the risk estimates for the MTHFR polymorphisms by arsenic exposure, but they were not statistically significant (P = 0.67 for MTHFR 677C > T and P = 0.12 for MTHFR 1298A>C). Thus, our findings do not support the presence of a main gene effect. The possibility that MTHFR polymorphism affects susceptibility to environmental exposures warrants further consideration.

Colorectal cancer in patients under close colonoscopic surveillance

BACKGROUND & AIMS

Colonoscopic polypectomy is considered effective for preventing colorectal cancer (CRC), but the incidence of cancer in patients under colonoscopic surveillance has rarely been investigated. We determined the incidence of CRC in patients under colonoscopic surveillance and examined the circumstances and risk factors for CRC and adenoma with high-grade dysplasia.

METHODS

Patients were drawn from 3 adenoma chemoprevention trials. All underwent baseline colonoscopy with removal of at least one adenoma and were deemed free of remaining lesions. We identified patients subsequently diagnosed with invasive cancer or adenoma with high-grade dysplasia. The timing, location, and outcome of all cases of cancer and high-grade dysplasia identified are described and risks associated with their development explored.

RESULTS

CRC was diagnosed in 19 of the 2915 patients over a mean follow-up of 3.7 years (incidence, 1.74 cancers/1000 person-years). The cancers were located in all regions of the colon; 10 were at or proximal to the hepatic flexure. Although most of the cancers (84%) were of early stage, 2 participants died of CRC. Seven patients were diagnosed with adenoma with high-grade dysplasia during follow-up. Older patients and those with a history of more adenomas were at higher risk of being diagnosed with invasive cancer or adenoma with high-grade dysplasia.

CONCLUSIONS

CRC is diagnosed in a clinically important proportion of patients following complete colonoscopy and polypectomy. More precise and representative estimates of CRC incidence and death among patients undergoing surveillance examinations are needed.

Neoplastic and antineoplastic effects of beta-carotene on colorectal adenoma recurrence: results of a randomized trial

BACKGROUND

In two large, randomized prevention trials, supplementation with beta-carotene increased the risk of lung cancer. Subjects in these studies were predominantly cigarette smokers, and the adverse effects were concentrated among those who also drank alcohol. Although beta-carotene supplementation appeared not to increase the risk of cancer generally, it is not clear if smoking and/or alcohol use alters the effect of beta-carotene on carcinogenesis at sites outside the lung.

METHODS

We studied the effect of beta-carotene supplementation on colorectal adenoma recurrence among subjects in a multicenter double-blind, placebo-controlled clinical trial of antioxidants for the prevention of colorectal adenomas. A total of 864 subjects who had had an adenoma removed and were polyp-free were randomly assigned (in a factorial design) to receive beta-carotene (25 mg or placebo) and/or vitamins C and E in combination (1000 mg and 400 mg, respectively, or placebo), and were followed with colonoscopy for adenoma recurrence 1 year and 4 years after the qualifying endoscopy. A total of 707 subjects had two follow-up examinations and provided smoking and alcohol use data. Adjusted multivariate risk ratios (RRs) and 95% confidence intervals (CIs) were used to assess the effects of beta-carotene on adenoma recurrence.

RESULTS

Among subjects who neither smoked cigarettes nor drank alcohol, beta-carotene was associated with a marked decrease in the risk of one or more recurrent adenomas (RR = 0.56, 95% CI = 0.35 to 0.89), but beta-carotene supplementation conferred a modest increase in the risk of recurrence among those who smoked (RR = 1.36, 95% CI = 0.70 to 2.62) or drank (RR = 1.13, 95% CI = 0.89 to 1.43). For participants who smoked cigarettes and also drank more than one alcoholic drink per day, beta-carotene doubled the risk of adenoma recurrence (RR = 2.07, 95% CI = 1.39 to 3.08; P for difference from nonsmoker/nondrinker RR <.001).

CONCLUSION

Alcohol intake and cigarette smoking appear to modify the effect of beta-carotene supplementation on the risk of colorectal adenoma recurrence.

Left main coronary artery disease in adults younger than 50 years: a comparison with older patients

Left main coronary artery (LMCA) disease is a potentially lethal disease that can be effectively treated if it is recognized expeditiously. To determine whether clinical signs and symptoms vary with age, we examined data from 100 patients with angiographically significant LMCA disease (> or =50% stenosis). The majority of patients had myocardial infarction (32%) or Braunwald class I unstable angina (46%). There were no differences in initial symptoms, electrocardiographic findings (normal or only nonspecific changes in 52% of patients), or left ventricular function (normal or only mildly impaired in 76% of patients) between younger patients (< 50 yr; n = 29) and older patients (n = 71). Severe atherosclerosis was common in both groups. Risk factor profiles were different, however, in that diabetes mellitus (10% vs. 34%; P = 0.028) and hypertension (38% vs. 73%; P = 0.002) were less common and tobacco use was more common (79% vs. 39%; P <0.001) in younger patients. In summary, age influenced the risk factors associated with but not the clinical signs and symptoms of LMCAD.

Palliative care in chronic obstructive airways disease: a needs assessment

The view that palliative care should move beyond cancer is widely endorsed, however, there remains a lack of clarity about the level at which this should occur. In order to target the palliative approach effectively, the value of more detailed and localized needs assessment becomes apparent. This paper provides evidence from a study commissioned by a department of public health, where the focus was the palliative care needs of an individual with chronic obstructive airways disease (COAD). Over a six-month period, 63 individuals in the district were interviewed about their experiences of living with COAD and the services utilized, using a combination of qualitative and quantitative research methods. The findings revealed a poor quality of life, relating to a high degree of social isolation and emotional distress, associated with low physical functioning and disability, and physical symptoms. Current service provision focused on acute exacerbations. Consequently, there is a need to manage the health and social care interface more effectively, with a shift in emphasis from reactive ad hoc provision, which is where the palliative approach to care could be best suited to meet the needs identified.

Isolation and Fractional Characterization of Ball-Milled and Enzyme Lignins from Oil Palm Trunk

Ball-milled and enzyme lignins were isolated from the trunks of oil palms and subsequently studied. The lignins were fractionated into pure milled lignin (PML), pure enzyme lignin (PEL), lignin rich enzyme lignin (LREL), hemicellulose rich milled lignin (HRML), and solubilized lignin obtained during enzyme treatment (SLET) fractions by a two-step precipitation method. The chemical and structural composition of the five lignin preparations was determined by using UV, GPC, FT-IR, (13)C NMR spectroscopy and nitrobenzene oxidation. Pure milled lignin and pure enzyme lignin fractions were found to contain rather low amounts of neutral sugars, 2.2-3.1%. The lignin fractions contained a high proportion of noncondensed syringyl units with small amounts of noncondensed guaiacyl and p-hydroxyphenyl units. Trace amounts of p-coumaric and ferulic acids were also found to be associated with lignin in the oil palm trunk cell walls.

Coffee and tea and the risk of recurrent colorectal adenomas

Consumption of coffee has been associated with a reduction in the risk of cancer of the colon, and (less consistently) drinking tea has been associated with a reduction in the risk of rectal cancer. The effect of these beverages on the risk of colorectal adenomas, however, has not been well investigated. We used data from an adenoma prevention trial to investigate these associations. Patients with at least one recent large bowel adenoma were followed with colonoscopy 1 and 4 years after their qualifying examinations. Adenomas detected at the year 4 colonoscopy were used as end points. A food frequency questionnaire was administered at study entry and study completion; average intake over the study period was used to estimate the exposures of interest. There was no apparent association between the intake of regular coffee, decaffeinated coffee, or tea and the risk of recurrent colorectal adenomas. The relative risks and 95% confidence intervals per cup daily were 0.96 (0.87-1.05) for regular coffee, 0.97 (0.84-1.12) for decaffeinated coffee, and 1.02 (0.83-1.25) for tea. These negative findings were present both overall and for adenomas of the right and left large bowel.

Three-year results of prevention programs on marijuana use: the New Hampshire study

The effects on marijuana use of 1) a drug prevention curriculum, or 2) this curriculum with added parent and other adult community activities in comparison with 3) a control community were investigated. Baseline information on drug-related behaviors from a sample of fourth, fifth, and sixth graders aged nine to fourteen years in rural New Hampshire (N = 1200) were obtained. The children completed these initial questionnaires in classrooms in 1987. In the comprehensive community intervention regular marijuana use was reduced by over 50 percent. No program had a significant effect on the initiation of marijuana use. The predictors of initiation were being in a higher grade, low school satisfaction, poor academic achievement, feeling unloved by one's family, feeling unpopular, and being part of a drug-using peer group. The baseline predictors of subsequent regular marijuana use were poor academic achievement, feeling unpopular, and being part of a drug-using peer group. In interviews the cultural and social contexts of marijuana use were explored. Strategies to prevent marijuana use need to take into account the profile of the marijuana-using child, the adult community's attitudes and beliefs about drugs, and the access of drug sellers and users to children.

Dacarbazine, cisplatin and carmustine, with or without tamoxifen, for metastatic melanoma: 5-year follow-up

Metastatic melanoma has a grim prognosis. Response rates and survival of patients treated with combination chemotherapy are not superior to single-agent chemotherapy. This study seeks to evaluate the objective response rate and survival of patients with metastatic melanoma treated with multiagent chemotherapy, with or without tamoxifen. Forty-two patients with metastatic melanoma were treated from March 1982 to February 1988 with dacarbazine, cisplatin and carmustine, with or without tamoxifen. An overall objective response rate of 43% was seen (complete response rate 17%; partial response rate, 26%). The response rate was 54% for patients treated with tamoxifen and 25% for patients treated without tamoxifen, but the results did not achieve statistical significance. Median overall survival was 412 days, and was significantly longer in the tamoxifen-treated group. Combination chemotherapy as described in this study is well-tolerated. The observation that tamoxifen appears to impact on survival should be interpreted with great caution due to the deficiencies in the design of the trial and small patient numbers. A randomized trial of this regimen vs single-agent chemotherapy is indicated and is currently being conducted.

The disproportionate impact of environmental health threats on children of color

Children receive greater exposures to environmental pollutants present in air, food, and water because they inhale or ingest more air, food, or water on a body-weight basis than adults do. Communities of color are disproportionately exposed to hazardous wastes, dioxin, and air pollution. Existing data demonstrate that children of color are the subgroup of the population most exposed to certain pollutants, including lead, air pollution, and pesticides. Government standards do not take into account children's differential exposures or the cumulative nature of these exposures. Federal regulations fail to protect the most highly exposed and most sensitive subgroups of the population. More often than not this group is children of color.