"Health challenges and midwifery support for new mothers after childbirth: A cross-sectional study in Sweden".

OBJECTIVE: This study aimed to investigate new mothers' self-rated and perceived health problems and complications; their reasons for, and the frequency of, emergency department visits; how emergency department visits were associated with sociodemographic and obstetric factors; and new mothers' experiences of received support from the midwifery clinic. DESIGN: A cross-sectional survey. SETTING AND PARTICIPANTS: The study was conducted at 35 of 64 midwifery clinics in Stockholm, Sweden. The study population consisted of 580 new mothers. MEASUREMENT AND FINDINGS: Descriptive statistics and logistic regression were used. New mothers experience a range of different health problems and complications during the first four weeks after giving birth. Sixteen percent sought emergency care. The odds of seeking emergency care increased for women with higher age and poorer self-rated health. Sixty-three percent of the new mothers received support from a midwife in primary care within the first four weeks after childbirth. Mothers who did not receive the support they wanted, expressed a wish for earlier contact and better accessibility. CONCLUSION AND IMPLICATION FOR PRACTICE: It is notable that 16 % of new mothers seek emergency care in the first weeks after childbirth. This study has practical implications for midwifery practice and policy. There is a need for tailored postnatal support strategies so that midwives potentially are able to mitigate emergency department visits. Further studies should look at whether the high number of emergency visits among new mothers varies throughout Sweden, and whether this may be a result of reduced time of hospital stay after childbirth or other factors.

Support during the postnatal period: Evaluating new mothers' and midwives' experiences of a new, coordinated postnatal care model in a midwifery clinic in Sweden.

OBJECTIVE: Continuity of care as provided by midwives promoting the health and well-being of new mothers during the postnatal period is critical; thus, access to midwifery services needs to be facilitated. The aim of this study was to describe new mothers' and midwives' experiences and perceptions of a new coordinated postnatal care intervention in a midwifery clinic. DESIGN: New mothers responded to open-ended questions in a survey, and midwives were interviewed individually about the intervention. A deductive content analysis research related to continuity of care concepts was used. SETTING AND PARTICIPANTS: The study was carried out at a midwifery clinic in a larger city in Sweden, for an eight-month period in 2019 and 2020. Two hundred and sixteen answers from new mothers and nine interviews with midwives were analysed. INTERVENTION: All registered pregnant women at the midwifery clinic received enhanced postnatal support based on a new coordinated postnatal care model. The focus was on continuity of care, from pregnancy to the postnatal period and included planning for the first weeks after childbirth at the end of pregnancy, early postnatal contact and several visits to the midwifery clinic. FINDINGS: New mothers describing the coordinated postnatal care model highlighted continuity and accessibility as empowering factors that made them feel assured and confident. Midwives emphasised the pregnancy to postnatal continuity as crucial to providing care based on individual needs. KEY CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Using a structured and coordinated care model as a midwife that includes planning for the postnatal period together with the pregnant woman at the end of pregnancy may be a good and relatively easy way to create continuity and thus ensure satisfaction and confidence in expectant and new mothers.

Postnatal ER visits within 30 days-Pattern, risk factors and implications for care.

AIMS AND OBJECTIVES: To (i) reveal care-seeking patterns of emergency room visits within 30 days following childbirth (i.e., identify risk factors that trigger contact with emergency room, visit rate and diagnoses) and (ii) suggest clinical implications for postnatal follow-up. DESIGN: The study had a longitudinal design; it used anonymised data from a county council database on all women in Stockholm County, Sweden, who gave birth in 2013. METHODS: Descriptive and inferential data analysis methods were used. Cox regression was applied to these variables: age when giving birth, diagnostic codes at birth, care encounters and types (e.g., visits or hospital admissions), day of discharge and care organisation and type. The data covered the period from childbirth through a 30-day period following discharge from hospital. RESULTS: The database contained 28,963 births and 59,202 healthcare or medical care encounters. Of these encounters, 50.3% (n = 29,774) were planned visits to hospital postnatal care units within 7 days following discharge and 1.2% (n = 681) were admissions to hospitals. Of all women who gave birth, 12.2% (n = 3,533) visited the emergency room at least once. The number of visits peaked at day 6 following discharge. These factors significantly increased risk for emergency room visits: caesarean, assisted birth and sphincter injury. CONCLUSIONS: Emergency room visits occurred most commonly immediately following discharge when there were no routine check-ups. Greater risk of emergency room visits - following caesareans, assisted childbirths or sphincter injuries - indicated that early support for women with childbirth complications should be improved upon discharge from hospital. Other multiple risk factors for emergency room visits might exist. RELEVANCE TO CLINICAL PRACTICE: Many emergency room visits could be prevented through early, more qualified, appropriate follow-up via maternity care systems and effective midwifery interventions. These initiatives could enhance care continuity and facilitate postpartum recovery.

Facilitating and inhibiting factors in transition to parenthood - ways in which health professionals can support parents.

BACKGROUND: The transition to parenthood is an overwhelming life event. From a theoretical perspective, transition to parenthood is a developmental transition that contains certain phases and patterns. AIM: This study aim was twofold (i) discover, describe and comprehend transitional conditions that parents perceive as facilitating and inhibiting during transition to parenthood and to (ii) use that knowledge to develop recommendations for professional interventions that support and facilitate transition to parenthood. DESIGN: Meleis transition theory framed the study's deductive qualitative approach - from planning to analysis. METHODS: In a secondary analysis, data were analysed (as per Meleis transition theory) from two studies that implemented interviews with 60 parents in Sweden between 2013 and 2014. Interview questions dealt with parents' experiences of the transition to parenthood - in relation to experiences with parent-education groups, professional support and continuity after childbirth. ETHICAL ISSUES: A university research ethics board has approved the research. RESULTS: These factors facilitated transition to parenthood: perceiving parenthood as a normal part of life; enjoying the child's growth; being prepared and having knowledge; experiencing social support; receiving professional support, receiving information about resources within the health care; participating in well-functioning parent-education groups; and hearing professionals comment on gender differences as being complementary. These factors inhibited transition to parenthood: having unrealistic expectations; feeling stress and loss of control; experiencing breastfeeding demands and lack of sleep; facing a judgmental attitude about breastfeeding; being unprepared for reality; lacking information about reality; lacking professional support and information; lacking healthcare resources; participating in parent-education groups that did not function optimally; and hearing professionals accentuate gender differences in a problematic way. CONCLUSION: Transition theory is appropriate for helping professionals understand and identify practices that might support parents during transition to parenthood. The study led to certain recommendations that are important for professionals to consider.

Partners' perspective on care-system support before, during and after childbirth in relation to parenting roles.

OBJECTIVES: To explore (i) ways in which partners experience support from care systems before, during, and after childbirth in relation to their parenting roles and (ii) ways in which support can improve. METHODS: Four focus group interviews (n = 17; median age = 35; age range = 24-46) and inductive content analysis. RESULTS: Analysis revealed the following three categories: (1) Care staff include or exclude in relation to partners' parenting role; (2) Care systems continuity; (3) Being a supportive partner. The latent content of the categories was formulated into a theme: being engaged and wanting to be included. CONCLUSIONS: Because partners are engaged parents, who support the woman giving birth, they must feel included during pregnancy, birth, and postpartum care and during encounters within child health care units. This would require (i) information that directly targets partners before and after childbirth, (ii) specially adapted venues for parent education, and (iii) personal, partner-focused discussions with care staff.

Hemoglobin adducts as a measure of variations in exposure to acrylamide in food and comparison to questionnaire data.

UNLABELLED: Measurement of haemoglobin (Hb) adducts from acrylamide (AA) and its metabolite glycidamide (GA) is a possibility to improve the exposure assessment in epidemiological studies of AA intake from food. This study aims to clarify the reliability of Hb-adduct measurement from individual single samples for exposure assessment of dietary AA intake. The intra-individual variations of AA- and GA-adduct levels measured in blood samples collected over 20 months from 13 non-smokers were up to 2-fold and 4-fold, respectively. The corresponding interindividual variations observed between 68 non-smokers, with large differences in AA intake, were 6-fold and 8-fold, respectively. The intra-individual variation of the GA-to-AA-adduct level ratio was up to 3-fold, compared to 11-fold between individuals (n = 68). From AA-adduct levels the average AA daily intake (n = 68) was calculated and compared to that estimated from dietary history methodology: 0.52 and 0.67 µg/kg body weight and day, respectively. At an individual level the measures showed low association (Rs = 0.39). CONCLUSIONS: Dietary AA is the dominating source to measured AA-adduct levels and corresponding inter- and intra-individual variations in non-smokers. Measurements from single individual samples are useful for calculation of average AA intake and its variation in a cohort, and for identification of individuals only from extreme intake groups.

Coding of procedures documented by general practitioners in Swedish primary care-an explorative study using two procedure coding systems.

BACKGROUND: Procedures documented by general practitioners in primary care have not been studied in relation to procedure coding systems. We aimed to describe procedures documented by Swedish general practitioners in electronic patient records and to compare them to the Swedish Classification of Health Interventions (KVÅ) and SNOMED CT. METHODS: Procedures in 200 record entries were identified, coded, assessed in relation to two procedure coding systems and analysed. RESULTS: 417 procedures found in the 200 electronic patient record entries were coded with 36 different Classification of Health Interventions categories and 148 different SNOMED CT concepts. 22.8% of the procedures could not be coded with any Classification of Health Interventions category and 4.3% could not be coded with any SNOMED CT concept. 206 procedure-concept/category pairs were assessed as a complete match in SNOMED CT compared to 10 in the Classification of Health Interventions. CONCLUSIONS: Procedures documented by general practitioners were present in nearly all electronic patient record entries. Almost all procedures could be coded using SNOMED CT.Classification of Health Interventions covered the procedures to a lesser extent and with a much lower degree of concordance. SNOMED CT is a more flexible terminology system that can be used for different purposes for procedure coding in primary care.

Analysis of hemoglobin adducts from acrylamide, glycidamide, and ethylene oxide in paired mother/cord blood samples from Denmark.

The knowledge about fetal exposure to acrylamide/glycidamide from the maternal exposure through food is limited. Acrylamide, glycidamide, and ethylene oxide are electrophiles and form adducts with hemoglobin (Hb), which could be used for in vivo dose measurement. In this study, a method for analysis of Hb adducts by liquid chromatography-mass spectrometry, the adduct FIRE procedure, was applied to measurements of adducts from these compounds in maternal blood samples (n = 87) and umbilical cord blood samples (n = 219). The adduct levels from the three compounds, acrylamide, glycidamide, and ethylene oxide, were increased in tobacco smokers. Highly significant correlations were found between cord and maternal blood with regard to measured adduct levels of the three compounds. The mean cord/maternal hemoglobin adduct level ratios were 0.48 (range 0.27-0.86) for acrylamide, 0.38 (range 0.20-0.73) for glycidamide, and 0.43 (range 0.17-1.34) for ethylene oxide. In vitro studies with acrylamide and glycidamide showed a lower (0.38-0.48) rate of adduct formation with Hb in cord blood than with Hb in maternal blood, which is compatible with the structural differences in fetal and adult Hb. Together, these results indicate a similar life span of fetal and maternal erythrocytes. The results showed that the in vivo dose in fetal and maternal blood is about the same and that the placenta gives negligible protection of the fetus to exposure from the investigated compounds. A trend of higher levels of the measured adducts in cord blood with gestational age was observed, which may reflect the gestational age-related change of the cord blood Hb composition toward a higher content of adult Hb. The results suggest that the Hb adduct levels measured in cord blood reflect the exposure to the fetus during the third trimester. The evaluation of the new analytical method showed that it is suitable for monitoring of background exposures of the investigated electrophilic compounds in large population studies.

Deoxynivalenol transport across the human placental barrier.

Deoxynivalenol (DON) is the most commonly detected mycotoxin contaminant of cereal crops and cereal based food products in temperate regions of the world. DON causes adverse health effects in animals, passes through to the foetus and causes foetal abnormalities in animals. Biomonitoring for DON has revealed frequent human exposure. This study reports on DON transfer across the human placenta. Firstly, in vitro studies with the BeWo b30 clone were used as a rapid screening model showing transfer of DON through a stable confluent cell monolayer. Five term placentas were then used to study DON transfer with the ex vivo dual perfusion model. The concentration of DON on the foetal side after 4h was about 21% of that on the maternal side at t=0. These results support the data from the BeWo monolayer model in respect to the transport rate of DON, and are consistent with our hypothesis of foetal exposure to DON during pregnancy.

In vivo doses of acrylamide and glycidamide in humans after intake of acrylamide-rich food.

For assessment of cancer risk from acrylamide (AA) exposure through food, the relation between intake from food in humans and the in vivo doses (area under the concentration-time curve, AUC) of AA (AUC-AA) and of its genotoxic metabolite glycidamide (GA) (AUC-GA) is used as a basis for extrapolation between exposure levels and between species. In this study, AA-rich foods were given to nonsmokers: a high intake of 11 µg AA/kg body weight (bw) and day for 4 days or an extra (medium) intake of 2.5 µg AA/kg bw and day for a month. Hemoglobin (Hb)-adduct levels from AA and GA, measured in blood samples donated before and after exposures, were used for calculation of AUC-AA and AUC-GA using reaction rate constants for the adduct formation measured in vitro. Both AA- and GA-adduct levels increased about twofold after the periods with enhanced intake. AUC for the high and medium groups, respectively, in nanomolar hours per microgram AA per kilogram bw, was for AA 212 and 120 and for GA 49 and 21. The AA intake in the high group was better controlled and used for comparisons with other data. The AUCs per exposure dose obtained in the present human study (high group) are in agreement with those previously obtained at 10(2) times higher exposure levels in humans. Furthermore, the values of AUC-AA and AUC-GA are five and two times higher, respectively, than the corresponding values for F344 rats exposed to AA at levels as in published cancer bioassays.

Visualization of disease distribution with SNOMED CT and ICD-10.

Methods for presentation of disease and health problem distribution in a health care environment rely among other things on the inherent structure of the controlled terminology used for coding. In the present study, this aspect is explored with a focus on ICD-10 and SNOMED CT. The distribution of 2,5 million diagnostic codes from primary health care in the Stockholm region is presented and analyzed through the "lenses" of ICD-10 and SNOMED CT. The patient encounters, originally coded with a reduced set of ICD-10 codes used in primary health care in Sweden, were mapped to SNOMED CT concepts through a mapping table. The method used for utilizing the richer structure of SNOMED CT as compared to ICD-10 is presented, together with examples of produced disease distributions. Implications of the proposed method for enriching a traditional classification such as ICD-10 through mappings to SNOMED CT are discussed.

Enriching a primary health care version of ICD-10 using SNOMED CT mapping.

BACKGROUND: In order to satisfy different needs, medical terminology systems must have richer structures. This study examines whether a Swedish primary health care version of the mono-hierarchical ICD-10 (KSH97-P) may obtain a richer structure using category and chapter mappings from KSH97-P to SNOMED CT and SNOMED CT's structure. Manually-built mappings from KSH97-P's categories and chapters to SNOMED CT's concepts are used as a starting point. RESULTS: The mappings are manually evaluated using computer-produced information and a small number of mappings are updated. A new and poly-hierarchical chapter division of KSH97-P's categories has been created using the category and chapter mappings and SNOMED CT's generic structure. In the new chapter division, most categories are included in their original chapters. A considerable number of concepts are included in other chapters than their original chapters. Most of these inclusions can be explained by ICD-10's design. KSH97-P's categories are also extended with attributes using the category mappings and SNOMED CT's defining attribute relationships. About three-fourths of all concepts receive an attribute of type Finding site and about half of all concepts receive an attribute of type Associated morphology. Other types of attributes are less common. CONCLUSIONS: It is possible to use mappings from KSH97-P to SNOMED CT and SNOMED CT's structure to enrich KSH97-P's mono-hierarchical structure with a poly-hierarchical chapter division and attributes of type Finding site and Associated morphology. The final mappings are available as additional files for this paper.

Views of diagnosis distribution in primary care in 2.5 million encounters in Stockholm: a comparison between ICD-10 and SNOMED CT.

BACKGROUND: Primary care (PC) in Sweden provides ambulatory and home health care outside hospitals. Within the County Council of Stockholm, coding of diagnoses in PC is mandatory and is done by general practitioners (GPs) using a Swedish primary care version of the International Statistical Classification of Diseases, version 10 (ICD-10). ICD-10 has a mono-hierarchical structure. SNOMED CT is poly-hierarchical and belongs to a new generation of terminology systems with attributes (characteristics) that connect concepts in SNOMED CT and build relationships. Mapping terminologies and classifications has been pointed out as a way to attain additional advantages in describing and documenting healthcare data. A poly-hierarchical system supports the representation and aggregation of healthcare data on the basis of specific medical aspects and various levels of clinical detail. OBJECTIVE: To describe and compare diagnoses and health problems in KSH97-P/ICD-10 and SNOMED CT using primary care diagnostic data, and to explore and exemplify complementary aggregations of diagnoses and health problems generated from a mapping to SNOMED CT. METHODS: We used diagnostic data collected throughout 2006 and coded in electronic patient records (EPRs), and a mapping from KSH97-P/ICD-10 to SNOMED CT, to aggregate the diagnostic data with SNOMED CT defining hierarchical relationship Is a and selected attribute relationships. RESULTS: The chapter level comparison between ICD-10 and SNOMED CT showed minor differences except for infectious and digestive system disorders. The relationships chosen aggregated the diagnostic data to 2861 concepts, showing a multidimensional view on different medical and specific levels and also including clinically relevant characteristics through attribute relationships. CONCLUSIONS: SNOMED CT provides a different view of diagnoses and health problems on a chapter level, and adds significant new views of the clinical data with aggregations generated from SNOMED CT Is a and attribute relationships. A broader use of SNOMED CT is therefore of importance when describing and developing primary care.

Alcohol influence on acrylamide to glycidamide metabolism assessed with hemoglobin-adducts and questionnaire data.

Our purpose was to investigate whether alcohol (ethanol) consumption could have an influence on the metabolism of acrylamide to glycidamide in humans exposed to acrylamide through food. We studied a subsample from a population-based case-control study of prostate cancer in Sweden (CAPS). Questionnaire data for alcohol intake estimates was compared to the ratio of hemoglobin-adduct levels for acrylamide and glycidamide, used as a measure of individual differences in metabolism. Data from 161 non-smoking men were processed with regard to the influence of alcohol on the metabolism of acrylamide to glycidamide. A negative, linear trend of glycidamide-adduct to acrylamide-adduct-level ratios with increasing alcohol intake was observed and the strongest association (p-value for trend=0.02) was obtained in the group of men with the lowest adduct levels (47 pmol/g globin) when alcohol intake was stratified by acrylamide-adduct levels. The observed trend is likely due to a competitive effect between ethanol and acrylamide as both are substrates for cytochrome P450 2E1. Our results, strongly indicating that ethanol influence metabolism of acrylamide to glycidamide, partly explain earlier observations of only low to moderate associations between questionnaire data on dietary acrylamide intake and hemoglobin-adduct levels.

Acrylamide exposure measured by food frequency questionnaire and hemoglobin adduct levels and prostate cancer risk in the Cancer of the Prostate in Sweden Study.

Acrylamide, a probable human carcinogen, is formed during the cooking of many commonly consumed foods. Data are scant on whether dietary acrylamide represents an important cancer risk in humans. We studied the association between acrylamide and prostate cancer risk using 2 measures of acrylamide exposure: intake from a food frequency questionnaire (FFQ) and acrylamide adducts to hemoglobin. We also studied the correlation between these 2 exposure measures. We used data from the population-based case-control study Cancer of the Prostate in Sweden (CAPS). Dietary data was available for 1,499 cases and 1,118 controls. Hemoglobin adducts of acrylamide were measured in blood samples from a subset of 170 cases and 161 controls. We calculated odds ratios (ORs) for the risk of prostate cancer in high versus low quantiles of acrylamide exposure using logistic regression. The correlation between FFQ acrylamide intake and acrylamide adducts in non-smokers was 0.25 (95% confidence interval: 0.14-0.35), adjusted for age, region, energy intake, and laboratory batch. Among controls the correlation was 0.35 (95% CI: 0.21-0.48); among cases it was 0.15 (95% CI: 0.00-0.30). The OR of prostate cancer for the highest versus lowest quartile of acrylamide adducts was 0.93 (95% CI: 0.47-1.85, p-value for trend = 0.98). For FFQ acrylamide, the OR of prostate cancer for the highest versus lowest quintile was 0.97 (95% CI: 0.75-1.27, p trend = 0.67). No significant associations were found between acrylamide exposure and risk of prostate cancer by stage, grade, or PSA level. Acrylamide adducts to hemoglobin and FFQ-measured acrylamide intake were moderately correlated. Neither measure of acrylamide exposure-hemoglobin adducts or FFQ-was associated with risk of prostate cancer.

Chronic intake of potato chips in humans increases the production of reactive oxygen radicals by leukocytes and increases plasma C-reactive protein: a pilot study.

BACKGROUND: Relatively high concentrations of acrylamide in commonly ingested food products, such as French fries, potato chips, or cereals, may constitute a potential risk to human health. OBJECTIVE: The objective of this pilot study was to investigate the possible connection between chronic ingestion of acrylamide-containing potato chips and oxidative stress or inflammation. DESIGN: Fourteen healthy volunteers (mean age: 35 y; 8 women and 6 smokers of >20 cigarettes/d) were given 160 g of potato chips containing 157 microg [corrected] acrylamide daily for 4 wk. RESULTS: An increase in acrylamide-hemoglobin adducts in blood was found in all the study subjects, with a mean of 43.1 pmol x L(-1) x g(-1) hemoglobin (range: 27-76; P < 0.01) in nonsmokers and 59.0 pmol x L(-1) x g(-1) hemoglobin (range: 43-132; P < 0.05) in smokers. Concurrently, a significant increase (P < 0.01) in the oxidized LDL, high-sensitivity interleukin-6, high-sensitivity C-reactive protein, and gamma-glutamyltransferase concentrations was observed in both smokers and nonsmokers. A significant increase in reactive oxygen radical production by monocytes, lymphocytes, and granulocytes and an increase in CD14 expression in macrophages (P < 0.001) were found after intake of potato chips. Twenty-eight days from the discontinuation of the experiment, the variables under study decreased to some extent. It has been shown also that acrylamide increases the production of reactive oxygen species in isolated human monocyte-macrophages in vitro and decreases the cellular glutathione concentration. CONCLUSION: These novel findings seem to indicate that chronic ingestion of acrylamide-containing products induces a proinflammatory state, a risk factor for progression of atherosclerosis.

Approach for cancer risk estimation of acrylamide in food on the basis of animal cancer tests and in vivo dosimetry.

The question about the contribution from acrylamide (AA) in food to the cancer risk in the general population has not yet had a satisfactory answer. One point of discussion is whether AA constitutes a cancer risk through its genotoxic metabolite, glycidamide (GA), or whether other mechanism(s) could be operating. Using a relative cancer risk model, an improvement of the cancer risk estimate for dietary AA can be obtained by estimation of the genotoxic contribution to the risk. One cornerstone in this model is the in vivo dose of the causative genotoxic agent. This paper presents an evaluation, according to this model, of published AA cancer tests on the basis of in vivo doses of GA in rats exposed in the cancer tests. The present status regarding data with importance for an improved estimation of the contribution from GA to the cancer risk of AA, such as in vivo doses measured in humans, is discussed.

Differences in the frequency of micronucleated erythrocytes in humans in relation to consumption of fried carbohydrate-rich food.

The aim of this study was to investigate if consumption of ordinary carbohydrate-rich food prepared in different ways has an impact on chromosome stability, i.e., on the formation of micronucleated young erythrocytes in humans. Twenty-four persons, divided into two groups, participated during 4 days in a semi-controlled food-consumption study. One group (low-heated-food-group, LowHF-group) consumed only food boiled in water (max 100 degrees C) and the other group (high-heated-food-group, HighHF-group) consumed preferentially strongly heated (fried) food. From each of the subjects, blood samples were drawn, before and after 4 days. The frequency (f) of micronucleated (MN) very young erythrocytes (transferrin-positive reticulocytes, Trf-Ret), fMNTrf-Ret, was determined, and the difference in the frequency, before and after the eating period, was calculated. The obtained mean differences for the two groups were compared. As an indicator of highly heated food the acrylamide (AA) content in part of the consumed foodstuffs was analysed by use of LC/MS-MS and the AA intake estimated. In the blood samples the hemoglobin-adduct levels from AA were analysed as a measure of the internal AA dose. The differences between the mean fMNTrf-Ret, before and after the eating period, were -0.15 per thousand for the LowHF-group and +0.17 per thousand for the HighHF-group, p<0.005 (t-test, one-tailed). The mean total AA intake in the HighHF-group during 4 days was estimated to about 3000+/-450microg per person. For the LowHF-group, the mean AA intake was low, 20+/-10microg per person. The lowest dose of AA that caused a significant increase of micronucleated erythrocytes in mice is more than a hundred times higher than the AA level in this study. Thus, it is unlikely that the exposure to AA is the major cause behind the observed difference. The answer is probably to be found in other compounds produced at the same time during heating of the food.

Internal doses of acrylamide and glycidamide in mice fed diets with low acrylamide contents.

The formation of acrylamide during heating of certain foodstuffs constitutes a potential health hazard. The health risk assessment should be based on knowledge about the relation between dietary exposure to acrylamide and internal doses of acrylamide and its genotoxic metabolite glycidamide. The primary aim of this study in mice was to measure these relationships at low levels of acrylamide intake through the diet. A secondary aim was to clarify which extraction method should be used when analyzing acrylamide in food in order to obtain a correct measure of the acrylamide that is available for absorption. In the analysis procedure, alkaline extraction has earlier shown much higher measured acrylamide levels in certain foods compared to water extraction. In this subcronic study the administered diets were composed to give five levels of acrylamide intakes between 3 and 50 mug/kg body weight per day (calculated on figures obtained after water extraction). Internal doses of acrylamide and glycidamide were measured through hemoglobin (Hb)-adducts. The results showed linear relationships between the exposure of acrylamide and Hb-adduct levels from both acrylamide and glycidamide at these low exposure levels. The study also showed that the "extra" acrylamide measured with alkaline extraction does not correspond to bioavailable acrylamide.