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The article offers information on the Lancet Commission, the commission of the journal intended for the health and wellbeing of adolescents around the globe. Topics discussed include the global forces for adolescent health, the sustainability of ecosystems, better childhood nutrition and health, and the investments for international development community.

The first in a series of papers on health in the occupied Palestinian territory is presented. The demographic characteristics, health status, and health services of the Palestinian population living in Israeli-occupied Palestinian territory are described. The public-health and health-service response to health problems is examined. Health status is described using subjective measures in addition to conventional indicators. The relevance of the indicators and analytical framework for the assessment of health in populations living in continuous war conditions is also discussed. INSET: Panel: A brief history of the occupied Palestinian territory.

Background Impaired glucose tolerance is common among obese adolescents, but the changes in insulin sensitivity and secretion that lead to this prediabetic state are unknown. We investigated whether altered partitioning of myocellular and abdominal fat relates to abnormalities in glucose homoeostasis in obese adolescents with prediabetes. Methods We studied 14 obese children with impaired glucose tolerance and 14 with normal glucose tolerance, of similar ages, sex distribution, and degree of obesity. Insulin sensitivity and secretion were assessed by the euglycaemichyperinsulinaemic clamp and the hyperglycaemic clamp. Intramyocellular lipid was assessed by proton nuclear magnetic resonance spectroscopy and abdominal fat distribution by magnetic resonance imaging. Findings Peripheral glucose disposal was significantly lower in individuals with impaired than in those with normal glucose tolerance (mean 35.4 [SE 4.0] vs 60.6 [7.2] moles per kg lean body mass per min; p=0.023) owing to a reduction in non-oxidative glucose disposal metabolism (storage). Individuals with impaired glucose tolerance had higher intramyocellular lipid content, lower abdominal subcutaneous fat , and slightly higher visceral fat than the controls, resulting in a higher ratio of visceral to subcutaneous fat. Intramyocellular and visceral lipid contents were inversely related to the glucose disposal and non-oxidative glucose metabolism and positively related to the 2 h plasma glucose concentration. Interpretation In obese children and adolescents with prediabetes, intramyocellular and intra-abdominal lipid accumulation is closely linked to the development of severe peripheral insulin resistance. [ABSTRACT FROM AUTHOR]

Interpretation: ACE activity is a clinically significant marker of the risk of severe hypoglycaemia in patients with type 1 diabetes, especially in those with impaired defence against hypoglycaemia. These findings need to be confirmed in prospective studies. [ABSTRACT FROM AUTHOR]

Interpretation:Non-drinkers and heavy drinkers had higher CRP concentrations than moderate drinkers. In view of the robust association between markers of inflammation, especially CRP, and risk of coronary heart disease, an anti-inflammatory action of alcohol could contribute to the link between moderate consumption and lower cardiovascular mortality. [ABSTRACT FROM AUTHOR]

Background: Microgravity has been thought to induce osteoporosis because of reduced weight-bearing. However, up to now, few data have been available about its precise nature and timecourse.Methods: We measured bone mineral density (BMD) at the distal radius and tibia in 15 cosmonauts of the Russian MIR space station who sojourned in space either 1 (n=two), 2 (two), or 6 months (11). After recovery periods of similar duration to the space missions, BMD was measured for the 2-month and 6-month crews.Findings: Neither cancellous nor cortical bone of the radius was significantly changed at any of the timepoints. On the contrary, in the weight-bearing tibial site, cancellous BMD loss was already present after the first month and deteriorated with mission duration. In tibial cortices, bone loss was noted after a 2-month flight. In the 6-month group, cortical bone loss was less pronounced than that for cancellous bone. In some individuals, tibial deterioration was great. Actual BMD did not depend on preceding cumulative periods spent in space. During recovery, tibial bone loss persisted, suggesting that the time needed to recover is longer than the mission duration.Interpretation: In space, despite physical training, bone loss is an adaptive process that can become pathological after recovery on Earth. Striking interindividual variations in bone responses seem to suggest a need for adequate crew preselection. Targeted treatment or prevention strategies would be useful, not only for space purposes, but also for the increasing number of osteoporotic patients on Earth. [ABSTRACT FROM AUTHOR]

Presents research which investigated whether children with bronchial hyperresponsiveness and relatively high serum concentrations of total IgE are susceptible to air pollution. Methods; Results; Conclusion.

Presents research that assessed whether heterocyclic amines are related to the risks of cancer in the large bowel and urinary tract. Heterocyclic amines as carcinogenics in animal models; Amines forming DNA adducts in humans; Methods; Findings; Amines unlikely to cause cancer in humans; Low precision of data.

Background: Long-chain polyunsaturated fatty acids (LCPUFA) are important for normal visual and brain development. Although present in human milk, LCPUFA have until recently been absent from artificial formulas, and infants may have limited ability to synthesise LCPUFA. To determine the clinical significance of this relative deficiency of LCPUFA, we undertook a randomised trial of the relation between LCPUFA supplementation and infant cognitive behaviour.Methods: 44 term infants had been randomised to a formula supplemented with LCPUFA (21) or not supplemented with LCPUFA (23), which they had taken from birth to age 4 months. Infant cognitive behaviour was assessed at 10 months of age by a means-end problem-solving test--the intentional execution of a sequence of steps to achieve a goal. The problem required three intermediate steps to achieve the final goal, uncovering and retrieving a hidden toy.Findings: Infants who received LCPUFA-supplemented formula had significantly more intentional solutions than infants who received the no-LCPUFA formula (median 2.0 vs 0, p=0.021). Intention scores (median 14.0 vs 11.5 [maximum 18]) were also increased in this group (p=0.035).Interpretation: These findings suggest that term infants may benefit from LCPUFA supplementation, and that the effects persist beyond the period of supplementation. Since higher problem-solving scores in infancy are related to higher childhood IQ scores, supplementation with LCPUFA may be important for the development of childhood intelligence. [ABSTRACT FROM AUTHOR]

Discusses a study that measured the effects of alpha-tocopherol and beta-carotene on male smokers who had a previous myocardial infarction. Methods; Findings; Interpretation.

Discusses the relationship between sex hormone deficiency in women and the loss of bone mass. Role of estrogen deficiency in causing osteoporosis in women aged 60 or older; Efficacy of hormone replacement therapy in protecting postmenopausal women against bone loss; Bone mass screening; The reasons why prevention of osteoporosis can be seen as a public health issue.

Examines how fat intake relates to intake of extrinsic sugar. Contribution of different carbohydrate-containing food groups to fat intake; Direct association between fat and protein intake; Deterioration in the quality of the diet in heavy users of extrinsic sugar.

Background: Epidemiological studies describe an association between relative size of the placenta at delivery and cardiovascular morbidity and mortality during adult life. Some determinants of placental size, such as maternal anaemia, have been acknowledged, but no plausible mechanism has been advanced to explain the initiation of postnatal disease.Methods: Placental villous vascularisation in anaemic women (Hb<90 g/L) was assessed in the first and third trimesters of pregnancy by immunohistochemical identification of villous capillaries and compared with that of gestational age-matched groups of women with normal (Hb>110 g/L; control group) concentrations of haemoglobin, and an intermediate group (Hb 90-110 g/L).Findings: Anaemia, especially in the first trimester, was associated with increased numbers of capillaries per villous cross section (mean 11.70 [SE 0.35] vs 4.14 [0.27]) located mainly in the outer third of the stroma beneath the trophoblast (94% [1.15] vs 67% [1.82]) and with increased numbers of villous macrophages and of proliferating MIB-1-positive cells compared with the control group.Interpretation: Maternal anaemia in early pregnancy seems to influence the pattern of placental vascularisation. Such changes might alter placental vascular impedance during early fetal life, thereby exerting important effects on cardiovascular development. [ABSTRACT FROM AUTHOR]

The article offers information on impact of pollution on human health and link between environmental petrol lead exposure near roadsides and dementia. Topics discussed include particulate air pollutant causes several changes in body and case dementia; association of roadway proximity and dementia; and effect of lead on oxidative stress and neuronal death.

The risk of venous thrombosis is thought to be increased by flying. In a study of 20 healthy male volunteers who were suddenly exposed to a hypobaric environment similar to that encountered within aeroplane cabins, markers of activated coagulation transiently Increased by two-fold to eight-fold. We suggest that hypobaric hypoxia, with sedentariness and dehydration, may cause this increased risk of venous thrombosis. [ABSTRACT FROM AUTHOR]

IgM concentrations greater than the median in maternal serum collected at 15-19 weeks of pregnancy were strongly associated (odds ratio 15.6) with delivery before 29 weeks. Our results suggest that the postulated inflammatory component in the aetiology of very preterm delivery may elicit a measurable maternal humoral response as early as mid-trimester. [ABSTRACT FROM AUTHOR]

Mild to transient trimethylaminuria is caused by common variants in the FMO3 gene leading to greatly reduced enzyme activity in vivo. FMO3 deficiency may have clinical relevance well beyond unpleasant body odour. [ABSTRACT FROM AUTHOR]

Focuses on techniques used to protect against loss of renal function. Inhibition of angiotensin-converting enzyme (ACE) combined with a low-protein diet as an effective method of restricting protein excretion; Lowering blood pressure; Options for reducing residual proteinuria, including titration of therapy.

We found that C282Y homozygosity was not under-represented in an elderly male population. This suggests that life-threatening, haemochromatosis-related disease may not occur in many C282Y homozygotes. [ABSTRACT FROM AUTHOR]

Presents a pilot study in which triglycerides were measured by an automated enzymatic method in serum using a random-access automated analyser. Results confirming the finding that fenofibrate increases total homocysteine and shows that this increase occurs in therapy with bezafibrate; The increase not due to changes in vitamin concentration; Suggestion of a link to renal function.

Presents the case of generalized colonic seizures in a new born baby. Pyridoxine overdose by the mother during pregnancy; Temporal relationship between seizures and pyridoxine therapy; The overdose of the vitamin and the abrupt withdrawal as the cause of the seizures.

Discusses the problem of contrast-induced nephropathy from radiographic contrast media. Problem defined as an increase in serum creatinine concentration; Clinical correlates for the problem; Risk factors involved; Impact of pre-existing renal impairment; High-risk subgroups; Potential for prophylaxis against the complication; Trials for prophylaxis; Possible benefits of dopamine and adenosine antagonists.

Reports that an increasing number of HIV-1-infected children are being given protease inhibitors (PI). Lack of information about the prevalence and risk factors in children; Study on a nine-year-old girl on PI, who developed a buffalo hump; Prevalence of abnormal body fat distribution in HIV-1-infected children.

Presents research which followed up on a 1947 study on the relation between parenting skills and the health of children. Work of Sir James Spence in Newcastle upon Tyne; Details about original research; Study of the original cohort regarding the contribution to adult health of prenatal, childhood, and adult experience; Methods and data; Conclusions.

Presents research which found a significant association between fatal hemorrhagic stroke and high levels of n-3 polyunsaturated fatty acids (PUFAs) in perirenal adipose tissue. Autopsy study in Greenland; The traditional Greenlandic diet; Use of brain evisceration; N-3 PUFAs protecting against thrombogenesis, but high levels serving as a risk factor for strokes; Need for further research.

Discusses research studying a possible tie between the consumption of red meat and cancer. Unclear biological mechanism involved in studies regarding red meat and colorectal cancer; Formation of carcinogenic heterocyclic amines (HCA) when meat is fried or grilled; Research by Augustsson et al in this issue; Exposure levels of humans to HCA; Evidence on the matter from molecular epidemiology; HCA metabolization varying among people.

Studies whether intact peanut lectin enters the blood after eating peanuts. Lectins being proteins that bind specifically to carbohydrates and agglutinate eukaryotic cells; Methods; Findings; Conclusion that the overall effect of the uptake of dietary lectins can affect cell-to-cell adhesion and proliferation.

Raises the question of why some people have no problem when they stop smoking cigarettes while others have a tougher time. The effects of nicotine on the brain; The role of dopamine; Evidence of genetic influences.

Discusses the ATBC study, a study on the effects of antioxidants on the secondary prevention of death and myocardial infarction in male smokers with a history of myocardial infarction. The data used in the ATBC study; Findings of the study; Contrast and comparison to the CHAOS study.

Focuses on the drawbacks of night work. Decrements in performance associated with night work; Risk of accidents and injuries among shift workers; Potential for health problems.

Discusses how problems associated with poor diet and lack of exercise are decreasing the life expectation of Japanese people. Efforts of Japan's medical community to urge citizens to eat more fish and rice rather than meat and pasta; How poor health is impacted by the increase in cases of non-alcoholic steatohepatitis; Decrease in the amount of adult smokers in Japan; How genetic material may be used to predict a person's predisposition to lifestyle-related diseases.

Offers insight on the tendency of people to consume additional foods and gain weight during the Christmas season. Suggestions for dieting during the months following Christmas; Theories which attempt to explain the tendency to consume more food; Suggestion that the consumption of food has little to do with hunger.

Discusses the effects of red wine on coronary flow-velocity reserve. Drug-induced coronary vasodilation as an indicator of the functional significance of ischemic heart disease; Effect of high density lipoproteins, or HDL, concentrations.

Reports on how some diabetic patients drive automobiles even when their blood glucose levels are low. Study conducted at the University of Virginia Health Sciences Center; Percentage of participants who said they would drive when the blood glucose levels were low; Dangers involved in this decision.

Reports that teenagers who smoke are at special risk of irreversible genetic damage that could result in lung cancer. Double the number of genetic mutations in those who start smoking before age 15; Research by Wiencke et al, University of California, San Francisco; Inverse relation between age at starting smoking and concentrations of aromatic hydrophobic DNA adducts; Lung damage from youthful smoking.

Looks back on debates over the health benefits of Turkish baths in the 1860s. Views of Dr. E.J. Tilt regarding the baths; Importance of control of temperature and ventilation; Suggestion of Henry W. Kiallmark that the use of the bath should be limited in England; Efforts to know how the air bath operates on the human organism; Excerpts from articles appearing in `The Lancet' at the time. INSETS: Benefits of bathing;A manly institution?.

Presents findings of research done on the effect of microgravity on the human body, primarily hormonal regulation. Measurements taken of erythropoietin, the predominant regulator of the red blood cell mass, transferrin receptors, thrombopoietin, and vascular endothelial growth factor before, during, and after spaceflight; Findings.

States that people who spend many hours in indoor swimming pools with water-spray features could be at risk of granulomatous pneumonitis caused by contaminated aerosols released from the sprays. Study by Cecile Rose et al of the National Jewish Medical and Research Center in Denver, Colorado; Endotoxin in the air; Brief details of the study.

Presents research which analyzed blood samples of cyclists before the availability of recombinant human erythropoietin (rhEPO). Increase in red-blood cell (RBC) mass as a result of endurance training; Expansion of plasma volume; Raising RBC mass; Blood doping with infusions of RBCs; Use of rhEPO; Standards of RBC levels for various sports organizations; Packed-cell volume dropping under extreme conditions; Implications for high RBC mass.

Focuses on the high rate of breast cancer in Finnish female flight attendants. Effect of chronic disturbances in circadian rhythm on shift workers; Breast cancer, jetlag, and decreased melatonin production; Melatonin inhibiting the growth of human breast-cancer cells; Data suggesting that work-associated disturbances in biological rhythms and melatonin production contribute to the risk of breast cancer.

Focuses on the effects of maternal smoking on offspring's lung function. Measurement of forced expiratory volume (FEV); Estimation of deficit in the measurement, body temperature, and pressure saturated by degree of maternal smoking; Suggestion that maternal smoking may be an important explanation of variation in adult FEV, which is a predictor of respiratory, cardiovascular and total mortality.

Reports on how disorders of fluids and electrolytes are among the most common in hospital medicine. The ease in communicating these disorders.

States cigarette smoking may reduce the breast-cancer risk in women with BRCA1 or BRCA2 mutations. Brief details of a report by Steven Narod et al from the University of Toronto in Canada; Reaction of Michael Thune of the United States American Cancer Society. INSET: One more good reason not to smoke.

Presents three brief articles related to medicine, as of March 7, 1998. Understanding how lithium helps in manic depression; Increased non-vigorous physical activity and higher insulin sensitivity; Epidemic of trampolining injuries to children in the United States.

Reports that a proposed metabolite of an estrogen found in hormone-replacement therapy could be the cause of some cancers. Mention of the unusual DNA adducts formed when scientists mixed one proposed metabolite of equilenin, 4-hydroxyequilenin, with DNA in a test tube.

Reports that high-density-lipoprotein (HDL) cholesterol is decreased in children exposed to passive smoking. The work of Ellis Neufeld in Boston, Massachusetts and the results of his study; The significantly lower HDL-cholesterol values in children coming from homes with smokers.

Reports that Terry Young et al from the University of Wisconsin in the United States have shown an independent association between the role of sleep-disordered breathing and hypertension. The findings as part of the Wisconsin Sleep Cohort Study; Methods and results of the study.

Opinion. Reports a case of a fetus with cerebral and ocular malformations which necessitated termination of pregnancy in a woman treated with adapalene gel from the month before pregnancy until 13 weeks gestational age. Little information about the risk to the fetus of topical adapalene in pregnant women; The case as the first published observation of a severe and rare malformation in a baby born to a mother who used adapalene gel in early pregnancy.

Probes two studies proving the benefits of estrogen by studying its effects on male-to-female transsexuals. Why the transsexuals were used in the studies; First study comparing the transsexuals with genetic men; Second study comparing the transsexuals with man and premenopausal women.

Focuses on the epidemiological association between vegetarian diet and incidence of cancer and cardiovascular disease as discussed during the 1994 Lucerne Discussions on Phytotherapy, Antioxidants and Food on October in England. Research on antioxidants and plant formulations.