Fatal tapwater scald burns in the USA, 1979-86

Four hundred and fifty-nine fatal tapwater scald burn injuries reported to the Injury Information Clearinghouse of the Consumer Product Safety Commission from 1979 to 1986 were studied. Data concerning the 459 deaths were abstracted from the death certificate file maintained by the Clearing house. Risk estimates were derived, using the resident population of the USA as of 1 July 1982 as the midpoint population estimate. Over half the deaths occurred in those over 75 years of age, while about one-fifth of the deaths occurred in children younger than 5 years of age. The crude mortality rate was approximately two deaths per million population over the 8-year period studied. In all age groups, black-skinned people experienced an approximate three-fold increase in risk (RR = 3.23, 95% CI: 2.87, 3.63). Among the elderly, males experienced an approximately 50 per cent increase in risk (RR = 1.47, 95% CI: 1.26, 1.72). One of every eight fatal injuries was sustained in a public building or residential institution. Implications of the current findings in terms of targetted prevention efforts are discussed.

Appendicitis in Soweto, South Africa: traditional healers and hospitalization

Appendicitis is near absent in rural blacks in Africa, and even in urban areas it remains very uncommon. Since the disease is new, and, moreover, potentially dangerous, a study was made of the antecedent history of 97 patients with proven appendicitis. Information was acquired concerning visits, and treatments and history, of (1) 34 patients who went first to traditional healers, and (2) 63 patients who sought orthodox medical attention. Of healers' treatments, none was beneficial; patients were ultimately directed, or decided to go to the hospital. Throughout Africa, traditional healers are held in high esteem and very extensively patronized. Accordingly, in both rural and in urban areas, concerted endeavours must be made by health authorities to promote recognition by healers of those diseases, acute or malignant, for which patients should be told to seek immediate medical attention.

Prevalence of gallstones in elderly black women in Soweto, Johannesburg, as assessed by ultrasound

In Western populations, about a third of elderly women have gallstones, as assessed from ultrasonography. In South Africa, cholelithiasis is reported to be increasing in urban blacks. Their recent dietary changes include a rise in fat and a fall in dietary fiber intake. To assess the current situation, we have carried out ultrasonography studies on 100 urban black women, 55-85 yr old, with no clinical evidence of gastrointestinal disease, especially with reference to the biliary system. Ten patients (10%) were positive. There was no association with parity. Their body mass index (27.8 +/- 6.9) was significantly higher (P less than 0.05) than those who were negative (25.7 +/- 6.1). From dietary intake assessments, there were no significant differences between those positive and negative with respect to mean intakes of energy, protein, fat, carbohydrate, dietary fiber or sugar (p greater than 0.05). Continuing exposure to a western lifestyle would be expected to increase prevalences of gallstones.

Risk factors and survival from colorectal cancer in black patients in Soweto, South Africa

In Africa, while colorectal cancer is very uncommon in the black population, it is rising in urban dwellers. A series of 42 patients treated at Baragwanath Hospital, Soweto, were compared with 92 controls. Average age of patients was relatively low 55 years. 73 per cent presented late with far advanced disease at Stages C and D. No familial component was apparent. Patient's years of schooling and social class were non-revealing compared with data on controls. Dietarily, the same applied to fat intake (relatively low) and fibre intake (considerably decreased). Median survival time was short, 7.5 months.

Amblyomma variegatum ticks and the occurrence of bovine streptothricosis in Antigua

The association between the occurrence of Amblyomma variegatum ticks and streptothricosis was studied on the Caribbean island of Antigua. The prevalence of streptothricosis was higher on animals having A. variegatum ticks compared to that of animals not infested with A. variegatum ticks. There was a steady increase in the prevalence of severe lesions as the level of infestation with adult A. variegatum ticks increased. However the distribution of skin lesions could not be related to the predilection feeding sites of adult A. variegatum ticks.

The effect of dose and line on immunisation of cattle with lymphoblastoid cells infected with Theileria annulata

Thirty-one Friesian calves in Morocco susceptible to tropical theileriosis were protected against a lethal sporozoite challenge by prior infection with lymphoblastoid cell lines infected and transformed in vitro by a Moroccan stock of Theileria annulata. The challenge infection of cryopreserved sporozoites killed all four susceptible control calves within 20 days. Four schizont-infected cell cultures at Passage 3 were inoculated at four different doses, 10(8), 10(6), 10(4) and 10(2), into pairs of calves. The recipient animals showed great variation in severity of disease symptoms, which did not show a linear correlation with the cell dose inoculated. The most severe disease symptoms were recorded, prior to challenge, in the 10(2) cell dose recipients; one animal died of acute theileriosis and another had to be treated. One of the four cell lines used was more virulent than the other three. Two years after the completion of this experiment, immunised animals have shown normal productivity traits.

Appendicectomy incidence in black and white children aged 0 to 14 years with a discussion on the disease's causation

Annual incidence of appendicectomy in urban black and white children of 0-14 yr. for 1985-1987 were estimated from hospital data obtained in Potchefstroom and Bloemfontein, also for black children at Baragwanath Hospital, Johannesburg. Rates per 10,000 children remain low for blacks, varying from 0.5, to 1.9: but were high for whites, 21.5 to 39.5. The latter are within the range of rates published in the West. As to diet, for blacks, mean daily fibre has fallen over several years to 10-14 g, similar to that of whites. Because of progressive fibre depletion, a marked rise in appendicectomies in blacks would be expected. The dietary fibre and the hygiene hypotheses afford only partial explanations for the disease's occurrence. Neither explains puzzling epidemiological differences including the recent fall in whites, nor throws light on the nature of precipitating factors.

Survival of black patients with gastric cancer in Soweto, Johannesburg, South Africa

In a series of 39 black gastric cancer patients, treated at Baragwanath Hospital, Soweto, Johannesburg, the time of 50 per cent mortality was 3.5 months, half that of white patients. Patients' median age was lower than that of white patients, 58 versus 70 yr. Male/female ratio was 1.3:1. Black patients presented late; no patients' lesions were at clinical stages I and II, compared with 5-15 per cent reported for white patients. Weight loss, abdominal pain and vomiting were predominant features. Frequencies of smoking and of alcohol consumption in male and female patients appeared much the same as those prevailing in the general population. No marked differences between patients and controls were apparent in socioeconomic state, educational level, general dietary intake, nor in ownership of a refrigerator.

Growth of South African Indian schoolchildren in different social classes

The height and weight of 4594 Indian schoolchildren aged 6 to 17 years, in Durban, South Africa, were measured at schools selected by inspectors as representative of upper, intermediate, and lower socio-economic populations. Significant superiority, anthropometrically, prevailed at all ages in upper compared with lower or poor-class children, but tended to lessen at 17 years. In the affluent group, in the age period studied the proportions under the 5th percentile of USA NCHS reference values were--concerning height-for-age 4.7% to 22.0% of boys and 5.0% to 20.7% of girls; and concerning weight-for-age, 20.3% to 45.0% of boys and 9.3% to 37.7% of girls. In the affluent group, at full growth at 17 years, means of height and weight were highly significantly lower, namely, roughly by 7cm and 10kg, compared with respective mean values given in USA reference values. Hence, in Indian schoolchildren a genetic factor, and not dietary inadequacy, appears primarily responsible for both slower post-pubertal growth and lower ultimate height attainment.

Sugar intake and dental caries: where do we stand?

Toward a reduction in the prevalence of diet-related diseases, including dental caries, recent recommendations have included a decrease in intake and frequency of consumption of sugar and sugar-containing foods. Although some have expressed doubts over the closeness of a cause-effect relationship, the overriding culpability of sugar continues to be asserted. In this contribution, from an examination of evidence, it is concluded that the link between sugar and caries is less strong than currently believed, and that the frequent contention that a decrease in sugar intake will evoke a meaningful fall in caries frequency cannot be sustained from available information.

Influence of a habitual high egg intake on serum lipid levels in a rural coloured population

The effect of a habitual high cholesterol intake on serum cholesterol and other lipid levels against the background of a moderate fat intake was investigated in 30 rural coloured volunteers (16 men, 14 women) working on an egg farm. Protein contributed approximately 11%, fat 31%, carbohydrate 58% (sucrose 21%) of energy intake. Daily cholesterol intake averaged 575 mg. In men, although not in women, cholesterol intake correlated negatively with serum cholesterol and low-density lipoprotein cholesterol levels, indicating that a high consumption of eggs in the study population did not prejudice lipid homeostasis. The population exhibited a high profile of coronary heart disease risk factors.

Colorectal cancer. Some aspects of epidemiology, risk factors, treatment, screening and survival

In developed populations colorectal cancer, which after lung cancer is the commonest of cancers, accounts for up to 6% of all deaths. It occurs most frequently in populations in prosperous industrialised countries, save Japan, and is rare in Third-World populations pursuing a traditional lifestyle. Peak occurrence is in the 7th decade. Colon cancer affects the sexes equally, but males are much more prone to rectal cancer. The precise causation is uncertain. Risk factors include genetic or familial predisposition, inflammatory bowel disease, diet (especially high fat and low dietary fibre intakes), and possibly alcohol intake. Surgery remains the treatment of choice. Stage is by far the most important factor influencing prognosis. Major refinements in both surgical and therapeutic measures have had disappointingly little effect on survival time. Overall median mortality occurs in 1-1 1/2 years; only one-third to one-half of patients survive for 5 years. While effective screening for very early detection could increase survival time, this will result only from further education. Since little avoiding action is practicable, the outlook for patients will remain daunting until help is sought far earlier.

Breath methane and large bowel cancer risk in contrasting African populations

Breath methane has been measured in 1016 people from four populations resident in Southern Africa which experience widely different risks of bowel cancer and other colonic diseases. Highly significant differences in the proportion of subjects with detectable methane in breath were found; % producers--rural black 84, urban black 72, white 52, Indian 41 (chi 2 121 p less than 0.001 3 df). There was a slight preponderance of female producers over male (female producers 63%, males 57%) and an age trend with fewer producers in the older age groups in the urban blacks and Indians, these comparisons being significant when tested by stepwise logistic regression analysis. Bowel cancer risk, determined from a variety of sources, was lowest in rural blacks, greatest in whites, with intermediate rates for urban blacks and Indians. Methane production in the human colon shows significant interethnic differences but which bear no relation to bowel cancer risk in these populations.