Summary A population-based case-control study of leukaemia and residential proximity to electricity supply equipment has been carried out in south-east England. A total of 771 leukaemias was studied, matched for age, sex, year of diagnosis and district of residence to 1,432 controls registered with a solid tumour excluding lymphoma; 231 general population controls aged 18 and over from one part of the study area were also used. The potential for residential exposure to power frequency magnetic fields from power-lines and transformer substations was assessed indirectly from the distance, type and loading of the equipment near each subject's residence. Only 0.6% of subjects lived within 100 m of an overhead power-line, and the risk of leukaemia relative to cancer controls for residence within 100 m was 1.45 (95% confidence interval (CI) 0.54-3.88); within 50 m the relative risk was 2.0 but with a wider confidence interval (95% CI 0.4-9.0). Over 40% of subjects lived within 100 m of a substation, for which the relative risk of leukaemia was 0.99. Residence within 25 m carried a risk of 1.3 (95% CI 0.8-2.0). Weighted exposure indices incorporating measures of the current load carried by the substations did not materially alter these risks estimates. For persons aged less than 18 the relative risk of leukaemia from residence within 50 m of a substation was higher than in adults (RR = 1.5, 95% CI 0.7-3.4).Epidemiological evidence suggests a possible leukaemogenic effect in man from exposure to electromagnetic fields in the extremely low frequency range (ELF, 0-300 Hz), which includes the usual public electricity power supply frequencies (50-60 Hz). Three case-control studies have shown a two-to three-fold increase in leukaemia risk in persons who lived close to electricity power-lines and supply equipment (Wertheimer & Leeper, 1979Savitz et al., 1988). Two studies showed no association (Tomenius, 1986;Severson et al., 1988), although the study by Tomenius showed a two-fold risk of all cancers. The subjects' exposure to ELF fields was categorised indirectly in these studies by the type and proximity of electricity transmission and distribution equipment variously within 40-150m of the subject's home. In addition, ELF magnetic field intensities were measured directly at all addresses in one study (Tomenius, 1986), and at most addresses in the two recent studies (Severson et al., 1988;Savitz et al., 1988).A number of studies of men likely to be exposed occupationally to power frequency electromagnetic fields have also suggested a raised risk of leukaemia, especially acute myeloid leukaemia (see Aldrich & Easterly, 1987;Savitz & Calle, 1987;Coleman & Beral, 1988). Interpretation of the evidence is made difficult by the complexity and ubiquity of human exposure to man-made ELF fields in modern society, and by the difficulty of obtaining satisfactory retrospective measures of this exposure. The National Research Council (NRC, 1986) and the reviews cited have emphasised the need for further human cancer studies, particular...

Familial hypercholesterolemia (FH) is an inherited disorder characterized by chronically elevated low-density lipoprotein cholesterol levels and an increased risk of premature atherosclerotic cardiovascular disease. FH has been shown to disproportionately affect French Canadians and other ethnic populations due to the presence of a founder effect characterized by reduced genetic diversity resulting from relatively few individuals with FH-causing genetic mutations establishing selfcontained populations. Beginning in the mid-1800s, approximately 1 million French Canadians immigrated to the Northeastern United States and largely remained in these small, tight-knit communities. Despite extensive genetic-and population-based research involving the French-Canadian founder population, primarily in the Province of Quebec, little is known regarding Franco-Americans in the United States. Concurrent with addressing the underdiagnosis rate of FH in the general population, we propose the following steps to leverage this founder effect and meet the cardiovascular needs of Franco-Americans: (1) increase cascade CJC Open 2 (2020) 161e167

Purpose: To assess the prevalence of perceived barriers to accessing health care services, self-efficacy, and health-promoting behaviors among Franco-Americans as a higher-risk group for familial hypercholesterolemia (FH), stratified by cardiovascular risk factors. Design: Cross-sectional survey based on components of the Health Belief Model Setting: Administered in-person at a Franco-American cultural center and online through mailing lists and social media platforms in the Northeastern United States Sample: Franco-Americans and French Canadians (n = 170) Measures: Demographic and clinical characteristics (i.e. high cholesterol, prior heart attack or stroke, family history of atherosclerotic cardiovascular disease (ASCVD), diagnosis of FH), perceived barriers to accessing health care services, self-efficacy, and health-promoting behaviors (i.e. taking lipid-lowering medications, seeing a cardiovascular specialist). Results: In a cohort of Franco-Americans, 42 (25%) had both high cholesterol and family history of ASCVD. Among Franco-Americans with both cardiovascular risk factors, 22% had low self-efficacy and only 16% had discussed FH with their physician. Individuals with both risk factors were significantly more likely to report a concern over a future diagnosis as a barrier to accessing health care services when compared with those with neither risk factor (36% vs. 15%, p = 0.014). Overall, other prominent barriers to care included knowledge of when to seek help (27%) and a distrust in medicine (26%). Conclusion: Franco-Americans report significant barriers to accessing health care services. Our findings strengthen the case for developing focused public health strategies to raise awareness for FH, particularly among high-risk subpopulations with unmet cardiovascular needs.

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