The association between the serum selenium level and the subsequent incidence of cancer was investigated in a longitudinal study of 39,268 men and women participating in the Social Insurance Institution's Mobile Clinic Health Examination Survey in Finland. The baseline examinations, including the collection of blood samples, were performed in 1968-1972. During a median follow-up of 10 years, 1,096 new cancer cases were identified from the files of the Finnish Cancer Registry. Selenium concentrations were measured from the stored serum samples collected from these cancer cases and from two controls per case, matched for sex, municipality, and age. The mean serum selenium level was 59.1 micrograms/L among all male cancer cases and 62.5 micrograms/L among controls. The difference was statistically significant (P less than .001). Corresponding values among women were 63.6 and 63.9 micrograms/L, respectively. Low serum selenium levels were associated with an increased risk of developing cancer at several sites, especially cancers of the stomach and lung among men. The relative risk of lung cancer between the highest and lowest decile of serum selenium was 0.11, and it differed significantly from unity (P less than .001). These findings are in agreement with the hypothesis that low selenium intake may increase the risk of some cancers among men.

Objectives-Oxygen free

The association between serum alpha-tocopherol levels and the subsequent incidence of cancer was investigated in a longitudinal study of 21,172 men initially aged 15-99 years in six geographic areas in Finland. The baseline examination was conducted in 1968-1972, and during the follow-up of 6-10 years, 453 cancers were diagnosed. The serum alpha-tocopherol levels were measured from stored serum samples from these men and from 841 male controls, matched for municipality and age, who did not develop cancer during the follow-up. The mean levels of serum alpha-tocopherol among the cancer cases and controls were 8.02 and 8.28 mg/liter, respectively. A high serum alpha-tocopherol level was associated with a reduced risk of cancer. The relative risk of cancer in persons in the two highest (threshold 8.70 mg/liter) quintiles of serum alpha-tocopherol was 0.64 (95 per cent confidence interval = 0.49-0.85) in comparison with those in the three lowest quintiles. The association was strongest for the combined group of cancers unrelated to smoking and varied between subgroups of the study population as well as between different cancers. The association persisted when adjusted for serum cholesterol, serum vitamin A, serum selenium, and various confounding factors. It also persisted when subjects with possible signs of cancer at the time when the blood samples were drawn or with cancers diagnosed during the first two years of follow-up were excluded. These findings agree with the hypothesis that high vitamin E intake protects against cancer.

The associations between serum ceruloplasmin level and the subsequent incidence of myocardial infarction and stroke were studied in a nested case-control study in Finland (baseline examination 1968-1972). Ceruloplasmin levels were measured in stored serum samples from 104 myocardial infarction or stroke cases occurring during a median follow-up of about 11 years and from 104 individually matched controls. High serum ceruloplasmin levels were significantly associated with higher future odds of myocardial infarction but not of stroke. The odds ratios for myocardial infarction and stroke comparing the highest and lowest tertiles of serum ceruloplasmin, adjusted for smoking, serum cholesterol, body mass index, hematocrit, hypertension, and diabetes, were 3.1 and 0.7, respectively. The results of the present study support the hypothesis that a high serum ceruloplasmin level is a risk factor for myocardial infarction.

Three of the four bandages had to be ordered by the district supplies department as they could not be obtained on prescription. The cost of bandages for all six clinics for one year was about C35-40 000. The family health services committee probably already pays a similar or larger amount for materials currently available and used on FP10 prescription but which are largely ineffective in achieving ulcer healing. Transfer of this budget to district supplies or the recognition of these bandages on drug tariff would seem to be the way forward.About a tenth of the patients in this study had significant arterial disease shown by low ankle/ brachial pressure indices, so that compression bandaging was contraindicated and may have lead to pressure necrosis and amputation.3 It is therefore essential that the community staff are trained to assess patients for arterial disease so that the correct treatment is offered.The main thrust of this study was the setting up of community ulcer clinics and assessing the results of this service. Despite the success of this service in treating ulcerated legs it must be acknowledged that reulceration is a major problem in these patients. Preliminary analysis of rates of recurrence in this study has shown that about a fifth of legs reulcerate within six months of healing and a third by one year, despite regular visits for compression hosiery. These results may be improved by using skin grafting techniques or venous surgery in more patients than was possible in this first attempt at a comprehensive community ulcer service.This study has drawn together community and hospital staff around a single common problem. Community nurses have observed real improvements in the care of their patients, which has given them additional job satisfaction. There is a clear need for a coordinated community based approach to this common and socially isolating condition, centred on a nurse specialising in venous ulcers. Design-A case-control study, nested within a cohort study, based on the linkage of records of subjects aged 40-83 from a health survey with those from the national Finnish hospital discharge register.Subjects-47 patients admitted to ophthalmological wards for senile cataract over 15 years and two controls per patient individually matched for sex, age, and municipality.Main outcome measure-Concentration of serum micronutrients, development of cataract according to whether operation was performed.Results-Low serum concentrations of antioxidant vitamins predicted the development ofsenile cataract, the odds ratio between the lowest third and the two higher thirds of the distribution of serum concentrations of ot tocopherol and 3 carotene being 1 9 (950/o confidence interval 0 9 to 4.1) and 17 (0.8 to 3 8), respectively. Patients with both ox tocopherol and 1 carotene concentrations in the lowest third had an odds ratio of 2-6 (10 to 6 8) of cataract compared with subjects in the top two thirds. The associations were strengthened by adjustment for potential confounding factors such as occupation, s...