Life-style related factors and idiopathic dilated cardiomyopathy--a case-control study using pooled controls

A case-control study was conducted to investigate how basic habits of life including dietary habit, physical activity, cigarette smoking, and drinking, are involved in the development of idiopathic dilated cardiomyopathy (DCM). Collection of cases was entrusted to the clinical research group of DCM, and national pooled controls established by sex and age category by the epidemiological research group of intractable diseases were used to ensure representativeness of the controls. Fifty-eight cases of DCM which developed in and after January 1991 were collected, and 5,912 controls matched with the cases by residential area, sex, and age were selected. Analysis of the results of the study showed that items in the questionnaire suggestive of viral infection, such as "susceptibility to common cold" and "susceptibility to diarrhea", items concerning dietary habit, including "taking no breakfast", "ingestion of salty food", and "ingestion of fatty food", and such items as "cigarette smoking" and "lack of sleep" tended to be observed in the case group at significantly higher frequencies. Since viral infection has been suspected as a causative factor of DCM, further research of this area is thought to be of particular importance for determining the etiology of DCM.

Non-influenza respiratory viruses may overlap and obscure influenza activity

OBJECTIVE

To report the number and timing of influenza A isolates, as well as overlapping respiratory viruses. Co-circulating respiratory viruses may obscure the determination of influenza activity.

DESIGN

Prospective clinical surveillance for the new onset of respiratory illness followed by viral cultures during seven separate influenza seasons.

SETTING

The Wisconsin Veterans Home, a skilled nursing facility for veterans and their spouses.

RESULTS

Influenza A isolates were encountered in greater numbers than non-influenza A isolates during three seasons. Seasonal variability is striking. In December 1992, we identified a large outbreak of respiratory illness. Influenza type B was cultured from 102 residents. In December 1995, influenza A was cultured from 285 people in Wisconsin. At that time, we identified outbreaks of respiratory illness in two of our four buildings. Based on statewide data, we suspected an influenza outbreak; however, 26 isolates of parainfluenza virus type 1 were cultured with no influenza. The potential importance of culturing at the end of the season was demonstrated in 1991-1992 when an outbreak of respiratory syncytial virus (RSV) overlapped and extended beyond influenza A activity.

CONCLUSIONS

When interpreting new clinical respiratory illnesses as a basis for declaring an outbreak of influenza A, clinicians should realize that co-circulating respiratory viruses can account for clinical illnesses. Clinicians might utilize healthcare dollars efficiently by performing cultures to focus the timing of influenza A chemoprophylaxis. Cultures could be performed when clinical outbreak criteria are approached to confirm an outbreak. Culturing of new respiratory illness could begin again before the anticipated discontinuation of prophylaxis (approximately 2 weeks).

Vitamin C and acute respiratory infections

So far over 60 studies have examined the effects of vitamin C on the common cold. No effect on common cold incidence was observed in the six largest studies, indicating that vitamin C has no preventive effects in normally nourished subjects in the Western countries. There are, however, smaller studies reporting benefit. In three trials of subjects under heavy acute physical stress, common cold incidence decreased by on average 50%, and in four trials of British males common cold incidence decreased by on average 30% in the vitamin C groups. The dietary vitamin C intake in the UK is low, and consequently the benefit may be due to the correction of marginal deficiency, rather than high vitamin doses. Regular vitamin C supplementation (> or =1 g/day) has quite consistently reduced the duration of colds, but the size of the benefit has varied greatly. In the four largest studies the duration of colds was reduced only by 5%. In two of these studies, however, absence from school and work was reduced by 14-21% per episode, which may have practical importance. Three controlled studies recorded a reduction of at least 80% in the incidence of pneumonia in the vitamin C group, and one randomised trial reported substantial treatment benefit from vitamin C in elderly UK patients hospitalized with pneumonia or bronchitis. It seems that the preventive effects of supplementation are mainly limited to subjects with low dietary vitamin C intake, but therapeutic effects may occur in wider population groups. Further carefully designed trials are needed to explore the effects of vitamin C.

The South Karelia Air Pollution Study: changes in respiratory health in relation to emission reduction of malodorous sulfur compounds from pulp mills

The authors assessed the health effects of emission reduction of malodorous sulfur compounds in a prospective cohort study with a controlled natural experiment. A total of 810 subjects (83%) participated in the follow up: 316 from the severely polluted, 306 from the moderately polluted, and 188 from the nonpolluted communities. In the severely polluted community, the annual ambient air concentration of total reduced sulfur compounds decreased from 11 microg/m3 to 6 microg/m3. Compared with the nonpolluted community, the relative decrease in acute respiratory infections, adjusted for a change in smoking habits, was 0.53 episodes/person-year (95% confidence interval = 0.22, 0.83) in the severely polluted community and 0.36 episodes/person-year (95% confidence interval = 0.06, 0.66) in the moderately polluted community. In addition, the frequency of nasal symptoms (p = .004) and cough (p = .037) decreased significantly. The results are consistent with the hypothesis that exposure to malodorous sulfur compounds increases the risk of acute respiratory infections and symptoms of the respiratory tract.

Clinical virology of rhinoviruses

Rhinoviruses cause more infections in humans than any other micro-organism. These acid-sensitive picornaviruses infect epithelial cells following inoculation onto the nasal mucosa and are detected reliably in nasopharyngeal secretions. Rhinovirus colds occur year round, with a peak of illness in the fall. Type-specific serum antibody correlates with protection against infection. The fact that there are at least 100 different immunotypes makes development of an effective vaccine unlikely. Nasopharyngeal secretions must be sampled for detection of rhinovirus by culture or RT-PCR. Efficient isolation of virus requires inoculation into two different types of sensitive cell cultures (i.e., fibroblasts and HeLa cells). RT of conserved sequences in the 5' noncoding region of the viral RNA to produce cDNA for PCR amplification has been coupled with detection of amplimers either by gel electrophoresis after nested PCR or by hybridization with labeled oligonucleotide probes to detect one viral genome in samples. In two studies in which both RT-PCR and cell cultures were used, virtually all of the positives were identified with RT-PCR; culture in two cell lines identified 75-80% of the positives. In year-round surveillance, 50% of colds in adults and children were rhinovirus positive. The symptoms occurring during rhinovirus colds are caused by the host's response to the virus, not by the virus itself. Elaboration of cytokines by infected epithelial cells is central to symptom pathogenesis.

The epidemiology of the common cold. II. Cross-infection and immunity

Analysis by epidemiological methods of the spread of the common cold among office workers and their families has failed to account for more than a fraction of the infections as a consequence of known exposure to infected individuals. Infections too mild to be recorded as colds, survival of the virus in the environment and its subsequent dispersal are considered as possible explanations of this.

The distribution of serial intervals between colds suffered by members of the same family indicates that the median interval between the onset of an infection and the first symptom in infection apparently arising from it as cross-infections was between 21½ and 31½ days. This is only slightly longer than the median interval, 2·4 days, observed between nasal installation and the onset of symptoms in experimental infections.

There is some epidemiological evidence that susceptibility to the common cold is reduced during the weeks following a cold.

We should like to repeat, in this the second paper in this series, our thanks to the Ministry of Pensions and National Insurance and to the Shell Petroleum Company, to those members of their staffs and to the nurses and others who helped us in this investigation.

Respiratory viruses and asthma: can the effects be prevented?

Although viral respiratory tract infections (RTIs) frequently cause exacerbations of asthma, the relationship between RTIs and the initiation and maintenance of asthma in childhood is unclear. This is in part because of the difficulty of defining asthma in young children. Current evidence supports two hypotheses: 1) that predisposed children are susceptible to both severe RTIs and asthma; and 2) that severe viral infections may have long-lasting influences on the subsequent development of asthma, and perhaps even atopy. These two proposals are not mutually exclusive. This review summarizes our current state of knowledge of the pathogenic interactions between viruses and asthma (in both human and animal models). Possible interventions that might modify the effects of viral disease in asthmatics are discussed.

Health at age 11: reports from schoolchildren and their parents

OBJECTIVE

To present self reports by children and reports by parents on behalf of their children relating to general health, current conditions, and recent symptoms.

DESIGN

Questionnaires completed by children and parents as part of the longitudinal "West of Scotland 11 to 16 study: teenage health."

SETTING

135 primary schools in Central Clydeside.

SUBJECTS

2586 children aged 11 years, surveyed from October 1994 to March 1995 (response rate 93%). Questionnaires also completed by parents of 86% of the sample.

MAIN OUTCOME MEASURES

Ratings of health over the past 12 months, presence of (limiting) longstanding illness, nine current conditions, and 11 recent symptoms.

RESULTS

Only 47% of children described their health as "good" in the previous year. Around 20% reported a longstanding illness and 8% a limiting illness; 20% reported migraine or headaches, 13% reported asthma. Recent stomach aches or sickness, colds or flu, and headaches were each reported by around 60%. "Malaise" (emotional) symptoms were common. Parents reported similar levels of (limiting) longstanding illness, but rates of conditions and symptoms reported by parents were lower than reported by their children. Parent-child agreement was greatest for the presence of longstanding illness and the conditions of asthma, diabetes, and skin problems. It was lower for recent symptoms, particularly those categorised as reflecting malaise.

CONCLUSIONS

These results challenge assumptions of good health and wellbeing at this age. Illness reporting depends on various factors, including saliency, social desirability, and definitions of normality. Parent-child discrepancies may reflect different definitions of illness or symptoms; they do not mean that one should be dismissed as "wrong."

Viruses and bacteria in the etiology of the common cold

Two hundred young adults with common colds were studied during a 10-month period. Virus culture, antigen detection, PCR, and serology with paired samples were used to identify the infection. Viral etiology was established for 138 of the 200 patients (69%). Rhinoviruses were detected in 105 patients, coronavirus OC43 or 229E infection was detected in 17, influenza A or B virus was detected in 12, and single infections with parainfluenza virus, respiratory syncytial virus, adenovirus, and enterovirus were found in 14 patients. Evidence for bacterial infection was found in seven patients. Four patients had a rise in antibodies against Chlamydia pneumoniae, one had a rise in antibodies against Haemophilus influenzae, one had a rise in antibodies against Streptococcus pneumoniae, and one had immunoglobulin M antibodies against Mycoplasma pneumoniae. The results show that although approximately 50% of episodes of the common cold were caused by rhinoviruses, the etiology can vary depending on the epidemiological situation with regard to circulating viruses. Bacterial infections were rare, supporting the concept that the common cold is almost exclusively a viral disease.

[Rhinovirus infections in hospitalized children: a 3-year study]

BACKGROUND

Rhinoviruses (RH) are responsible for acute respiratory illnesses, mainly in the upper respiratory tract.

POPULATION AND METHODS

3,152 children aged under 16 years, admitted to the Paediatrics department of the University Hospital Centre of Poitiers from January 1, 1993 to December 31, 1995 with ear, nose and throat (ENT) and/or respiratory symptoms were systematically investigated. One hundred and forty-five RH strains were isolated from nasopharyngeal secretions of 87 boys and 58 girls (mean age: 20.3 months). Among these, 92 (63.4%) were less than 1 year of age. Bacteriological investigations were done for 29 patients when a concomitant bacterial infection was suspected.

RESULTS

RH infection rate was maximum before 1 year of age (median age: 6.5 months) and decreased with age. RH were isolated throughout the 3 years, with a first peak from February to April, and a second one in autumn. The main symptoms were sibilants (27.6%) and cough (24.1%). Sibilants were more frequently associated in children under 12 months of age (P = 0.01). Sometimes, ophthalmologic or digestive symptoms were present. Three children with respiratory distress were transferred to the reanimation ward. In addition, a RH strain was isolated from a child who died of sudden infant death. Thirty-four children (23.4%) were co-infected by one or several viruses; the most frequently detected were the respiratory syncytial virus (41.2%) and the adenoviruses (35.3%). Twenty-nine children were infected by two viruses and five by three. Associated bacterial infections were diagnosed in 23 children, especially conjunctivitis due to Haemophilus influenzae (21.7%). Among these children, eight had a multiple viral infection.

CONCLUSION

RH have a limited pathogenicity but can be associated with serious illnesses among infants and children.

Vitamin C supplementation and the common cold--was Linus Pauling right or wrong?

In 1970 Linus Pauling claimed that vitamin C prevents and alleviates the episodes of the common cold. Pauling was correct in concluding from trials published up till then, that in general vitamin C does have biological effects on the common cold, but he was rather over-optimistic as regards the size of benefit. His quantitative conclusions were based on a single placebo-controlled trial on schoolchildren in a skiing camp in the Swiss Alps, in which a significant decrease in common cold incidence and duration in the group administered 1 g/day of vitamin C was found. As children in a skiing camp are not a representative sample of the general population, Pauling's extrapolation to the population at large was too bold, erring as to the magnitude of the effect. Nevertheless, Pauling's general conclusion that vitamin C has physiological effects on the common cold is of major importance as it conflicts with the prevailing consensus that the only physiological effect of vitamin C on human beings is to prevent scurvy.

Frequency and natural history of rhinovirus infections in adults during autumn

Human rhinovirus (HRV) accounts for a significant portion of common-cold illness, with the peak incidence being in the early fall. Three hundred forty-six adults who had self-diagnosed colds of 48 h or less were enrolled in a study during September and October 1994 to determine the frequency and clinical course of HRV infections. Nasal wash specimens for viral culture and reverse transcription-PCR (RT-PCR) for HRV RNA and human coronavirus OC43 and 229E RNA detection were collected on enrollment, and participants recorded their symptoms twice daily for 14 days. Middle ear pressure (MEP) was measured with a digital tympanometer on days 1 and 7. Picornaviruses (224 HRV and 7 enterovirus isolates) were detected by culture in 67% (231 of 346) of the subjects. Among 114 samples negative by culture, HRV was detected by RT-PCR in 52 (46%) for an overall picornavirus infection rate of 82% (283 of 346 subjects). Among the remaining 62 negative samples, human coronavirus RNA was detected by RT-PCR in 5 patients, so that 288 (83%) of patients had documented viral infection. The first symptom noticed most often was sore throat (40%) in HRV culture- or PCR-positive patients and stuffy nose in HRV-negative patients (27%). No differences in symptom scores over time or in the presence of individual symptoms were noted between groups. The median duration of the cold episodes was 11 days in HRV culture-positive patients, 9.5 days in HRV RT-PCR-positive patients, and 11.5 days in HRV-negative patients. On enrollment, abnormal MEPs (< or = -100 or > or = +100 mm of H2O) were found for 21% of HRV culture-positive patients, 14% of HRV RT-PCR-positive patients, and 10% of HRV-negative patients. No important differences in the clinical course of HRV culture-positive, HRV culture-negative and RT-PCR-positive, or HRV-negative colds were found. These results represent the highest frequency of virologically confirmed natural colds to date and document the importance of rhinoviruses as the cause of colds during fall months.

Indications of prevalence, practice and effects of anabolic steroid use in Great Britain

A growing number of reports of anabolic-androgenic streroid (AS) use in Great Britain (GB) among non-competitive groups have emerged since the beginning of 1990s. A study was commissioned by the Departments of Health for England, Scotland and Wales, to explore the extent and uses of AS from the public health point of view. As a part of a wider investigation into AS use, 21 gymnasia in England, Scotland and Wales were surveyed by questionnaire. The response rate was 59%. We found that of the 1667 participants, 9.1% of the men and 2.3% of the women had taken AS at some time and 6% of the men and 1.4% of the women were current users. Considerable variation in the prevalence of use was found, ranging from no reports in three of the gymnasia, up to 46%. We also investigated patterns of AS use and perceived side-effects in a wide-ranging group of AS users (n = 110), who were recruited through social networks. In-depth interviews with the users revealed that the 97 men (27+/-7 years) and 13 women (25+/-5 years) had been using AS regularly for 2.05+/-1.7 years and 1.9+/-2 years, respectively. Seventy-two injected AS. While most injected themselves, 25% were mainly injected by their friend. Up to 16 different drugs were taken by interviewees during the present or last cycle. Polydrug use was common and dosage taken exceeded therapeutic recommendations. Sixteen interviewees did not report side-effects, while the majority reported two or more. Many of these were cosmetic. Of the 97 men interviewed, 56% reported testicular atrophy, 52% gynaecomastia, 36% elevated blood pressure, 56% fluid retention, 26% injuries to tendons, 22% nosebleeds and 16% more frequent colds. Six men reported problems with kidney function and five with liver function. Problems with sleep were reported by 37%. Of the 13 women interviewed, eight reported menstrual irregularities, eight fluid retention, four clitoral enlargement, three decreased breast size and two elevated blood pressure. Four reported sleeplessness.

Epidemiology, pathogenesis, and treatment of the common cold

OBJECTIVE

Reading this article will reinforce the reader's knowledge of the pathogenesis of the common cold. The rationale for current and potential therapies for the common cold are reviewed in the context of current concepts of the pathogenesis of these illnesses.

DATA SOURCES AND STUDY SELECTION

A MEDLINE literature search was done using the search terms common cold, rhinovirus, and viral respiratory infection. The search was restricted to the English language. Articles were selected for review if the title and/or abstract suggested the content was relevant to the subject of this review. The bibliographies of selected articles were used as a source of additional literature.

RESULTS

Recent studies suggest that the host response to the virus is an important contributor to the pathogenesis of the common cold. Inflammatory mediators, especially the pro-inflammatory cytokines, appear to be an important component of this response and present an attractive target for new interventions for common cold therapies. Currently available treatments for the common cold have limited efficacy against specific symptoms. These therapies should be selected to treat the specific symptoms that are perceived to be the most bothersome by the patient.

Vitamin C intake and susceptibility to the common cold

Although the role of vitamin C in common cold incidence had been studied extensively, the level of vitamin C intake has not been unequivocally shown to affect the incidence of colds. In the present study the six largest vitamin C supplementation (> or = 1 g/d) studies, including over 5000 episodes in all, have been analysed, and it is shown that common cold incidence is not reduced in the vitamin C-supplemented groups compared with the placebo groups (pooled rate ratio (RR) 0.99; 95% CI 0.93, 1.04). Consequently these six major studies give no evidence that high-dose vitamin C supplementation decreases common cold incidence in ordinary people. Nevertheless, the analysis was continued with the hypothesis that vitamin C intake may affect common cold susceptibility in specific groups of people. It was assumed that the potential effect of supplementation might be most conspicuous in subjects with low dietary vitamin C intake. The average vitamin C intake has been rather low in the UK and plasma vitamin C concentrations are in general lower in males than in females. In four studies with British females vitamin C supplementation had no marked effect on common cold incidence (pooled RR 0.95; 95% CI 0.86, 1.04). However, in four studies with British male schoolchildren and students a statistically highly significant reduction in common cold incidence was found in groups supplemented with vitamin C (pooled RR 0.70; 95% CI 0.60, 0.81). Thus, these studies with British males indicate that vitamin C intake has physiological effects on susceptibility to common cold infections, although the effect seems quantitatively meaningful only in limited groups of people and is not very large.

Surveillance of community-acquired viral infections due to respiratory viruses in Rhone-Alpes (France) during winter 1994 to 1995

Nasal swab from patients with acute flu-like illness were evaluated for the presence of respiratory viruses in the Rhone-Alpes region of France from 1 October 1994 through 2 May 1995. The relative frequencies and seasonal distributions of the specific viruses were assessed. In addition, virus type was correlated with specific clinical signs and symptoms. During the study, 962 samples were collected by 75 medical practitioners participating in the Groupe Regional d'Observation de la Grippe surveillance network. One or more viruses were detected from 348 samples (36.1%), including 108 respiratory syncytial virus (RSV), 64 influenza virus A type H3N2, 47 influenza virus B, 64 coronavirus, 35 rhinovirus, 22 adenovirus, 5 enterovirus, and 3 parainfluenza-fluenza strains. There were 16 mixed infections. RSV infections peaked in the early winter, and influenza viruses A and B infections peaked during the late winter and early spring. There were two peaks of coronavirus infections (late fall and late winter). Other viruses were detected at lower levels throughout the study period. Patients from whom adenovirus was isolated were significantly more likely to have a fever of > 39.5 degrees C than were patients with other detectable viruses (P < 0.001). Furthermore, there was a significant correlation between influenza and cough (P < 0.01) and RSV and bronchiolitis (P < .001). Thus, the current study defined the overall and relative frequencies of respiratory virus detection from nasal swab specimens in patients with an acute flu-like illness in the Rhone-Alpes region of France during a 7-month period. Correlation with clinical signs and symptoms and provisional conclusions regarding seasonality were also determined.

The common cold

The common cold is characterized by symptoms of rhinorrhea, nasal obstruction, sneezing, throat clearing, postnasal drip, and cough. Some of the many viruses that cause colds may cause mild additional symptoms such as sore throat, weakness, dizziness, and tearing. This article presents data concerning the cause, pathogenesis, and treatment of the common cold as well as discussion of the available diagnostic tests and their use in formulating differential diagnoses.

Significance of indoor environment for the development of allergic symptoms in children followed up to 18 months of age

The development of symptoms possibly related to allergy or other forms of hypersensitivity was studied in a group of 638 children on two occasions: when the children were 3 and 18 months of age. Standardized questions were used to collect basic information about the child, technical characteristics of the home, and the mother's perception of the indoor climate. All reported exposure factors were analyzed in relation to the child's symptoms at 18 months of age, by logistic regression techniques. A family history of atopy was associated with a high incidence of most of the investigated symptoms. Attendance at a day nursery before 18 months of age increased the risk of recurrent colds and the need for several courses of treatment with antibiotics. If the mother smoked, the children more often suffered from protracted coughing episodes. If the child has a sibling, the risk of developing a wheeze, repeated colds, and the need for antibiotic treatment increased. No building factors, such as size of the home, heating and ventilation system, type of foundation, dampness, or presence of wall-to-wall carpets, showed a significant correlation to symptoms reported in the children. However, if the mothers reported symptoms that are often connected with "sick buildings", the children more often had eczema, dry skin, or reactions to food. The mothers' complaints about indoor air quality and climate and mucous membrane symptoms were significantly related to the type of building and presence of condensation on the windows in winter, a finding which may indicate that indoor climate factors also have some effect on the health of the children. This study reports the prevalences of symptoms until the age of 18 months. At this age, the allergic manifestations are usually nonspecific, and follow-up examinations to 4-5 years of age are needed before any definite conclusions can be drawn about the development of atopic diseases due to indoor climate factors.

The value of the dehydroepiandrosterone-annexed vitamin C infusion treatment in the clinical control of chronic fatigue syndrome (CFS). II. Characterization of CFS patients with special reference to their response to a new vitamin C infusion treatment

This study is a counterpart of the pilot study on the clinical management of chronic fatigue syndrome (CFS) by the combined use of the old (annex-free) and the new (dehydro-epiandrosterone- annexed) vitamin C infusion treatments with and without oral intake of erythromycin and chloramphenicol. We were motivated to start this clinical study by 2 reasons: i) we have made a success in the clinical management of autoimmune disease and allergy by use of the old megadose vitamin C infusion treatment, and we therefore took up CFS as a good candidate for vitamin C infusion treatment; ii) In 1995, we received a total of 313 chronic pneumonia patients whose clinical course showed a good fitness to the criteria of CFS. We assessed the nature of the disease by investigating the clinicoepidemiological aspect of our patients on the one hand and the response of the disease to both the old and new vitamin C infusion treatments with and without the use of 2 antibiotics on the other hand. Results are summarized as follows: a) the analysis of the medical records of our outpatients revealed that chronic type pneumonia epidemic in Nagoya Japan, with its onset of January 1995, showed no sign of its extinction by the end of May 1996. The patient population contained no patients under 15 years of age, and showed a distinct female predominance in the patient number (207 females versus 106 males). In 1995, we also experienced a simple cold epidemic with its onset of January 1995 (162 males and 224 females). The majority of simple cold patients were under 25 years of age in both sexes. b) A chronic type pneumonia patient was distinguished from a simple cold patient in 2 respects: firstly the former required prolonged medical care (over 1 month) resulting in an incomplete cure and return to medical care upon the recurrence of disease, whereas the latter required short-term medical care (mostly within 1 week) ending up with complete cure. Secondly, the former required the long term use of 2 antibiotics (erythromycin and chloramphenicol) together with regular practice of the old and new vitamin C infusion treatments for disease control, whereas the latter recovered from the disease after the short time use of a set of conventional cold remedies. c) The clinical manifestations of our chronic pneumonia patients showed good fitness to the criteria of CFS. d) CFS was distinguished from autoimmune disease-allergy complex by the method of clinical control: the former required the long-term use of 2 antibiotics together with regular practice of the old and new vitamin C infusion treatments, whereas the latter was controllable by the single use of the old vitamin C infusion treatment. e) The combined use of the old and new vitamin C infusion treatments rather than the single use of the old vitamin C infusion treatment was more effective for the control of CFS-a finding which suggests that deficient activities of both endogenous glucocorticoid and endogenous androgen in a CFS patient are somehow related to the genesis and further development of CFS. f) Evidence was available to indicate that the sole use of the new vitamin C infusion treatment may induce a state of gonadal steroid excess together with various other problems in the recipient. The maintenance of a good balance between the old vitamin C infusion set (glucocorticoid-inducer) and the new vitamin C infusion set (inducer of both glucocorticoid and gonadal steroids) in their use was of prime importance for the successful control of CFS. g) The historical significance of CFS epidemic in 1995, and in Nagoya-Japan, is discussed in the light of the new infection concept.

Snoring, apnoea and ENT symptoms in the paediatric community

This study was designed to determine the prevalence of snoring and assess the extent of associated ENT symptoms in children up to 10 years of age. A questionnaire was presented to the parents of 245 children chosen at random from the General Practice list of the town of Frome, Somerset, UK. The prevalence of snoring was found to be 27%. This increased to 47% in the presence of an upper respiratory infection. Snoring was found to be significantly (P < 0.001) associated with a history of poor hearing, restless sleep, and having a cold. Less significant (P < 0.01) associations occurred with parental smoking, eczema, sleep talking, moving around the bed at night, sore throats, having a runny nose and mouth breathing. Snoring is a common symptom in children up to 10 years of age. Without evidence of other ENT disease the snoring child does not require referral to an ENT department for further investigation.

Epidemiologic investigation of serum levels of the soluble forms of CD25, CD54 and CD58, and T cell responsiveness after stimulation via the CD2-dependent pathway in a random sample of the general population

A sero-epidemiologic correlation study on immune parameters which would correlate with the frequency of common colds (FCC) had been conducted in 1992. There, an inverse relationship between circulating adhesion molecules CD54 and CD58 and FCC was found. Eighteen months later we performed an analogous assessment in order to verify the previous findings and to carry out additional experiments including in vitro proliferative responses of T cells and their production of various cytokines (IFN-gamma, IL-2, IL-6 and IL-10). The additional examinations showed that individuals with frequent common colds exert a higher T cell proliferation and higher production of cytokines than persons which experience never or few common cold infections. These findings could be confirmed statistically. Taken together, the results suggest consistently in individuals with frequent common colds an association with low serum levels of the immunosuppressive soluble adhesion molecules sCD54 and sCD58, high proliferation of unstimulated and stimulated T cells and secretion of higher concentrations of cytokines (IFN-gamma, IL-2, IL-6 and IL-10) into the cell culture supernatants.

Maternal reporting of acute respiratory infection in Egypt

BACKGROUND

Acute respiratory infection (ARI) is a major cause of childhood morbidity and mortality in developing countries. Community surveys are used to determine the proportion of children with ARI for whom care is sought by questioning mothers about the signs and symptoms of illness episodes. The validity of this approach has been studied infrequently.

METHODS

We evaluated maternal reporting of signs and symptoms 2 and 4 weeks after diagnosis among 271 Egyptian children < 5 years old. Children with ARI were evaluated by physical examination, chest radiography, and pulse oximetry, and were alternately assigned for a maternal interview about the episode 14 or 28 days later.

RESULTS

For radiographically-defined acute lower respiratory infection (ALRI), the sensitivity of several symptoms for combined open- and close-ended questions was relatively high: nahagan (deep or rapid breathing) (80%), nafas sarie (fast breathing) (66%), and kharfasha (coarse breath sounds) (63%). The specificity of these terms was 50-68%. The specificity was inversely related to the follow-up time. No term provided both a sensitivity and specificity of > 50% at day 28 across the radiographically, clinically- and pulse oximetry-based definitions of ALRI. Spontaneously mentioned karshet nafas (difficult or rapid breathing) at 14 days had a specificity and sensitivity for radiographic ALRI of 87% and 41%, respectively, suggesting that this term is a good choice for community surveys.

CONCLUSIONS

Maternal reporting of ARI symptoms is non-specific 2 and 4 weeks after diagnosis but may be useful for monitoring trends in the proportion of children with pneumonia who receive medical care. To maximize specificity, ARI programmes should generally use a recall period of 2 weeks.

Form of day care and respiratory infections among Finnish children

The relationship between respiratory infectious diseases and form of day care was assessed in a retrospective cohort study of 2568 randomly selected children aged 1 through 7 years in Espoo, Finland. Day-care center children had an increased risk for the common cold, acute otitis media, and pneumonia. The risk concentrated in 1-year-old children, for whom the adjusted relative risks (incidence density ratios) for the common cold, otitis media, and pneumonia were 1.69 (95% confidence interval [CI] = 1.43, 2.01), 1.99 (95% CI = 1.57, 2.52), and 9.69 (95% CI = 2.31, 40.55), respectively. Among 1-year-old children, the proportion of infections attributable to care at day-care centers were 41% (95% CI = 30, 50) for colds, 50% (95% CI = 36, 60) for otitis media, and 85% (95% CI = 57, 98) for pneumonia. The results provide evidence that care in day-care centers is a determinant of acute respiratory infections in children under 2, whereas family day care does not essentially increase risk.

Interrelation of vitamin C, infection, haemostatic factors, and cardiovascular disease

OBJECTIVE

To examine the hypothesis that the increase in fibrinogen concentration and respiratory infections in winter is related to seasonal variations in vitamin C status (assessed with serum ascorbate concentration).

DESIGN

Longitudinal study of individuals seen at intervals of two months over one year.

SETTING

Cambridge.

SUBJECTS

96 men and women aged 65-74 years living in their own homes.

MAIN OUTCOME MEASURES

Haemostatic factors fibrinogen and factor VIIC; acute phase proteins; respiratory symptoms; respiratory function.

RESULTS

Mean dietary intake of vitamin C varied from about 65 mg/24 h in winter to 90 mg/24 h in summer; mean serum ascorbate concentration ranged from 50 mumol/l in winter to 60 mumol/l in summer. Serum ascorbate concentration was strongly inversely related to haemostatic factors fibrinogen and factor VIIC as well as to acute phase proteins but not to self reported respiratory symptoms or neutrophil count. Serum ascorbate concentration was also related positively to forced expiratory volume in one second. An increase in dietary vitamin C of 60 mg daily (about one orange) was associated with a decrease in fibrinogen concentrations of 0.15 g/l, equivalent (according to prospective studies) to a decline of approximately 10% in risk of ischaemic heart disease.

CONCLUSION

High intake of vitamin C has been suggested as being protective both for respiratory infection and for cardiovascular disease. These findings support the hypothesis that vitamin C may protect against cardiovascular disease through an effect on haemostatic factors at least partly through the response to infection; this may have implications both for our understanding of the pathogenetic mechanisms in respiratory and cardiovascular disease and for the prevention of such conditions.

Shared office space and the risk of the common cold

The common cold persists as a major economic and public health problem worldwide. Despite its long-established ubiquity, little is yet certain about the determinants of indoor environment in spreading of the infection, and even less about the role of indoor air quality as a mediator. The effect of sharing an office with one or more colleagues on the risk of the common cold was studied in a modern, mechanically ventilated, 8 story office building in central Helsinki. Data on respiratory infections and the relevant personal and environmental determinants were collected in a self-administered questionnaire (response rate 71.0%). The study population, one person from each office on floors 3 to 8, consisted of 893 workers, 493 males (49.2%) and 454 females (50.8%). In logistic regression analysis the adjusted odds ratio (OR) for more than two episodes of common cold during the past 12 months in subjects with one or more office colleagues vs those working alone was 1.35 (95% CI 1.00-1.82). Among all workers higher risk also emerged for those with young children (OR 1.46, 1.05-2.04) or a history of hay fever (OR 2.07, 1.47-2.92). Females (OR 1.25, 0.95-1.66) and all under 40 years of age (OR 1.15, 0.86-1.55) had non-significantly increased risk, while smokers did not differ essentially from non-smokers (OR 1.05, 0.76-1.42). The results suggest that sharing office space increases the risk of the common cold, although the primary mode of transmission-airborne, direct or indirect contact-remains controversial.

Immunohistochemical analysis of nasal biopsies during rhinovirus experimental colds

Human rhinoviruses (HRV) are an important cause of upper respiratory tract infection and are etiologically linked with asthma exacerbations. However, the mechanisms of virus-induced inflammation are largely unknown. We examined nasal mucosal biopsies for the presence of an associated inflammatory cellular infiltrate during experimental rhinovirus infection. A group of 21 adult volunteers (10 atopic) had baseline nasal biopsies, followed 2 wk later by inoculation with HRV Serotype 16. Nasal biopsies were taken on Day 4 of the cold and again 6-10 wk later. Infection was documented by symptom scores, viral culture, and seroconversion. The biopsies were fixed in acetone and processed into glycol methacrylate resin for semithin sectioning. Mast cells, eosinophils, lymphocytes, and neutrophils were identified with appropriate monoclonal antibodies and a streptavidin-biotin horseradish peroxidase technique. There were no significant changes in the numbers of inflammatory cells present during the cold or the convalescent period compared with baseline biopsies (Wilcoxon paired, p > 0.05). There were also no differences between normal and atopic groups. We suggest that rhinoviral colds are not associated with increased inflammatory cellularity and that other mechanisms, such as increased mediator release, are responsible for coryzal symptoms.

[A surveillance on acute respiratory infection]

History prospective methods were employed in this surveillance on acute respiratory infection (ARI) in four villages in Ping Yi and Gao Mi counties. One thousand-one hundred-and sixty four households, 4,379 individuals with 4365.92 person-years were followed up for ARI. The incidence of ARI was 0.4542 episodes/person-year and the household incidence rate was 68.99%. No death case of ARI occurred during the surveillance period. Of all the 18 ARI diseases under surveillance the three diseases with highest incidence were common cold, upper respiratory tract infection and bronchitis. These three diseases all showed obvious family clustering tendency. The incidence of ARI was highest in children under 1 year of age (1.3403 episodes/person year), followed by 2-6 year age-group. The lowest was in 20-29 year age-group (0.2885 episodes/person-year). There was no significant difference between sexes. The ARI incidence in spring (0.18024 episodes/person-season) was higher than in other seasons, with the peak between March and April. The hospital attending rate was 90.07%. Among the patients, 80.05% received antibiotics, 13.06% received hormone, 2.10% received intravenous rehydration. ARI accounted for 24.83% of all the out-patients in township hospitals, 19.05%, of which were preschool children. For these children, 70.78% were using antibiotics, 23.31% using hormone, 10.06% using intravenous rehydration. Of the patients, the risk factors of ARI included low birth weight, difficult labour, malnutrition, illiteracy, low income, poor ventilation and lighting of the living room, poor living condition and cigarette smoking. The results presented will be of great significance to policy-making of ARI control in Shandong Province.

Three year follow up study of national influenza vaccination practices in Japan

STUDY OBJECTIVE

To evaluate new national influenza vaccination practices which were started in 1987 under a revised law in Japan.

DESIGN

This was a three year, nonrandomised cohort study with information collected by questionnaire between 1989 and 1991.

SETTING

Eight primary schools in the city of Yonago, Tottori, Japan. These schools were selected from 23 schools in the city.

PARTICIPANTS

Altogether 4251 pupils (1355 boys and 2896 girls) in years 1-4 of the eight primary schools were included in this study, and followed up. Three years later, data for 1619 pupils (768 boys and 851 girls) were obtained and analysed.

MAIN RESULTS

The one-winter seasonal incidence rates of influenza-like disease were 13.4%, 29.9%, and 10.3% in 1989, 1990, and 1991 respectively. The incidence rate of influenza-like disease in fully vaccinated pupils was significantly lower than that in unvaccinated pupils in 1990, but not in 1989 or 1991. Stepwise multiple regression analysis showed that the incidence of influenza-like disease had a statistical relationship with the frequency of vaccination and the school year (R2 was 0.0148). Standardised parameters of the frequency of vaccination and the school frequency of vaccination and the school year were -0.089 and -0.080 respectively.

CONCLUSIONS

The preventive effects of influenza vaccine are not strong. There must be some unknown factors that affect the incidence of influenza. This vaccine is useful for pupils in the early school years who seem to have less resistance. All pupils should not be inoculated with the vaccine to reduce influenza transmission in the community or school.

Rapid culture-amplified immunofluorescent test for the detection of human rhinoviruses in clinical samples: evidence of a common epitope in culture

Ohio HeLa cells in multichamber slides were inoculated with nasal samples from patients presenting with common cold symptoms and incubated at 33 degrees C with gentle shaking for 48 hours. The cultures were fixed with cold acetone, and viral antigens were detected by immunofluorescence using an antirhinovirus type 2 (HRV-2) polyclonal serum. Of 158 samples, 58 (36.7%) and 57 (36%) were positive for HRV by virus isolation (confirmed by acid lability test) and by culture-amplified immunofluorescent (CAIF) test, respectively. The correlation between the two tests was highly significant (P = 0.0001). Nasal washings or nasal/throat swabs were equally suitable for detecting virus by isolation but not by CAIF. On the other hand, nasal washings were better than nasal/throat swabs for detecting HRV by CAIF. In an ELISA system, the polyclonal anti-HRV-2 serum recognized a rhinovirus antigen expressed in situ within 48 hr postinfection by all the 11 HRV serotypes investigated. However, 60 hr postinfection, the anti-HRV-2 serum recognized only homologous and closely related HRV antigens. These results suggest that a rhinovirus "common" antigen may be expressed some 48 hr after infection of Ohio HeLa cells with rhinoviruses. The CAIF test provides a sensitive, rapid and reliable procedure to detect wild-type rhinovirus infection as well as a clear alternative to detection by isolation.

Health-seeking behavior of Rwandan women

The responses of Rwandan women in a highland region to their own and their children's illness episodes are examined. Over 85% of diarrhea cases from monthly morbidity recalls were treated by health-center visits, use of Western medicine, or no treatment. Factors such as the age of the child at the time of the illness, previous child death in the household, and the women's control of various categories of household expenditures exert some influence on health-seeking behavior, according to results of cross-tabulations. Women at the highest altitudes tend to respond less actively to children's diarrhea, possibly because of the relative difficulty of their journey to the health center. Recommendations are offered for policy and further study.

Association of the common cold in the first trimester of pregnancy with birth defects

OBJECTIVE

To examine the association between the common cold with or without fever in the first 3 months of pregnancy and birth defects in offspring.

DESIGN

A case-control study.

SETTING

Data are from the Shanghai Birth Defects Monitoring Program, conducted in 29 hospitals in Shanghai, China from October 1, 1986 to September 30, 1987.

SUBJECTS

A total of 986 birth defects cases, 990 frequency-matched live birth controls, and 159 stillbirth controls.

RESULTS

Modestly elevated risk of birth defects was identified among women who reported having a cold with or without fever in the first trimester of pregnancy. Notably increased relative risks were observed for anencephalus (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 2.0 to 7.7), spina bifida (OR = 4.1, 95% CI = 1.7 to 9.7), hydrocephalus (OR = 2.3, 95% CI = 1.1 to 5.1), cleft lip (OR = 2.2, 95% CI = 1.4 to 3.4), and undescended testicle (OR = 1.8, 95% CI = 1.0 to 3.0). Our study further found that the overall relative risks were consistent by using two different control groups, suggesting that this association was unlikely to be due to recall or report bias.

CONCLUSION

Common cold in the first trimester of pregnancy may be associated with an increased risk of birth defects in offspring. However, these findings should be interpreted cautiously.

Smoking, alcohol consumption, and susceptibility to the common cold

OBJECTIVES

This study was conducted to test the supposition that both smoking and consuming alcohol suppress host resistance to viral infections.

METHODS

The relations between smoking, alcohol consumption, and the incidence of documented clinical colds were prospectively studied among 391 subjects intentionally exposed to one of five respiratory viruses and 26 subjects given saline. Clinical colds were defined as clinical symptoms verified by the isolation of virus or by an increase in virus-specific antibody titer. Analyses included control variables for demographics; body weight; virus; and environmental, immunological and psychological factors.

RESULTS

Smokers were at greater risk for developing colds than nonsmokers because smokers were more likely both to develop infections and to develop illness following infection. Greater numbers of alcoholic drinks (up to three or four per day) were associated with decreased risk for developing colds because drinking was associated with decreased illness following infection. However, the benefits of drinking occurred only among nonsmokers.

CONCLUSIONS

Susceptibility to colds was increased by smoking. Although alcohol consumption did not influence risk of clinical illness for smokers, moderate alcohol consumption was associated with decreased risk for nonsmokers.

Upper airway infections in preschool children--frequency and risk factors

OBJECTIVE

To estimate the frequency of upper respiratory tract infections (URTI) over a three month period and possible risk factors in the social surroundings, daily routines and health history.

DESIGN

A retrospective epidemiological survey by means of questionnaires.

SETTING

Gardabaer, a small town, ten km south of Reykjavík, Iceland.

PARTICIPANTS

All children in Gardabaer, six months to six years old (n = 555).

MAIN OUTCOME MEASURE

Number of URTI and possible risk factors.

RESULTS

The response rate was 81.8%. The most common infections were common cold (n = 345), acute otitis media (n = 82), sore throat (n = 75), and bronchitis (n = 13). The mean frequency of URTI during the previous three months was 2.2 in boys and 1.7 in girls (p < 0.01). Log-linear regression analysis showed that the predicted number of URTI was 1.9 higher if the child was attending day care, and that the number of URTI increased by 1.015 with each month until the age of 24 months, but decreased after that by 0.985.

CONCLUSIONS

The major factors which affect the frequency of URTI are: age, sex, family history of frequent URTI, asthma, allergy, and the form of day care. Measures to reduce URTI could involve prospective intervention studies on the form of day care.

The effect of self-care brochures on use of medical services

A random sample of 14,917 new enrollees in a state-wide health maintenance organization was selected as part of a study of the effectiveness of medical self-care brochures. Medical ICD-9 codes related to each of the conditions described in the brochures were examined for the intervention group (N = 7439) and controls (N = 7478). Significantly less utilization was found for visits due to colds in the month following brochure distribution (P < .01). While not statistically significant, trends in the expected direction of less utilization for earaches and less total medical charges for the intervention group were also found. No significant differences were found related to headache and backache symptoms, although a greater proportion of the intervention group reported backache symptoms. Utilization related to sore throats and fever was significantly (P < .001) higher in the intervention group. These findings suggest that a minimal intervention such as brochure distribution can have a favorable, albeit minimal, impact on medical services utilization. Self-care education may also play a role in increasing utilization for certain types of health conditions.

An epidemiological approach to the etiology of middle ear disease in The Netherlands

The etiology of middle ear disease in Nijmegen, The Netherlands was studied on the basis of a data set collected in a prospective epidemiological study on otitis media with effusion (OME) in a cohort of 1439 preschool children. A factor analysis was used to evaluate two hypotheses: (1) that OME, acute otitis media (AOM), common cold and tonsillitis are manifestations of the same pathological entity, and (2) that a group of children can be distinguished who develop these conditions more frequently than average. The results only partly supported these hypotheses. The correlation between OME, AOM, common cold and tonsillitis was lower than expected from a review of the literature. Common cold appeared to be the ubiquitous ENT disease in childhood and, depending on the child's predisposition, could be accompanied by OME, AOM or tonsillitis. The course of middle ear and upper airway disease showed a gradual scale from "healthy" to "ill" with most of the children suffering from these conditions at an average frequency.

Frequency of common colds and serum levels of sICAM-1 (CD54), sLFA-3 (CD58) and sIL-2R (CD25)

Epidemiologic case-control studies have suggested an inverse relationship between past medical history of frequency of common colds and subsequent cancer risk for various sites. One hypothetical explanation for this finding may be that there are unknown differences in immune responsiveness between patients developing cancer and healthy individuals. The present study examines the relationship between the frequency of common colds and a) plasma levels of sICAM-1/CD54, sLFA-3/CD58 and sIL-2R/CD25 which are believed to modulate activation of immune responses, and b) cell-mediated immunity in vivo as determined by Multitest Mérieux. The investigation was conducted as a correlation study amongst a healthy group of individuals from the general population in Germany. We found a statistically significant inverse relationship between frequency of common colds and levels of sCD58 and, partially, sCD54. No association was found between levels of sCD25 and results of Multitest Mérieux.

The relationship of nasal disorders to lower respiratory tract symptoms and illness in a random sample of children

We examined the relationship of nasal disorders, defined as frequent colds and sinus trouble, to lower respiratory tract symptoms in a random population of 718 children aged 4 to 11 years in East Boston, Massachusetts. Frequent colds were significantly associated with maternal smoking (odds ratio (OR) = 3.00; 95% confidence interval (CI) = 1.97, 4.58), and so was sinus trouble (OR = 4.73; 95% CI = 1.78, 12.51). After adjustment for maternal smoking, age and sex, frequent colds (OR = 2.88; 95% CI = 1.87, 4.42) and sinus trouble (OR = 4.95, 95% CI = 1.83, 13.39) remained significant predictors of lower respiratory tract symptoms in separate logistic regressions. If one restricted the cohort to the 513 children who also had personal smoking information and adjusted for this variable as well, the results for colds were unchanged (OR = 2.94; 95% CI = 1.78, 4.84) but the results for sinus trouble were now not statistically significant (OR = 2.30, 95% CI = 0.67, 7.94). We conclude that nasal disorders are associated with lower respiratory tract symptoms in children.

[Occurrence of colds and coughs among adult Danes. Epidemiological data from the DIKE (Danish Institute for Clinical Epidemiology) population study]

The occurrence of upper respiratory symptoms among adult Danes was examined by the use of data from the Danish Health and Morbidity Survey 1986-1987. In this study, 14.0 per cent of 6,672 individuals reported complaints of colds or coughs (CC) during the two-week period preceding the interview. Reporting of CC decreased with age, but there was no sex difference. A multivariate analysis, including a number of suspected exposure variables, showed that CC was reported significantly more frequently (OR 1.42) by individuals also reporting exposure to external health risks in their homes. The reporting of CC was not associated with occupational exposure, psychological stress, spare time physical activity or smoking habits. Using bivariate analysis, it was shown that exposure to external health risks in the home was reported more frequently among women than men. The results indicate, that exposure to external health risks in dwellings contributes significantly to the total morbidity among adult Danes. However, improvement of the validity of information about exposure by means of more objective methods is required.

[Virological surveillance of acute respiratory tract illnesses of children in Morioka, Japan. II. Rhinovirus infection]

Rhinoviruses (HRVs) were isolated from 307 children (7.1%) in the virological surveillance of 4334 children with acute respiratory tract illnesses in Morioka, Japan (September 1973-December 1983). Although HRVs were isolated throughout the year, frequency of HRV infection was significantly higher (p less than 0.001) during the April-November (233/2853; 8.2%) than during the December-March (47/1481; 5.0%). There were two peaks of incidence in May (9.5%) and September (9.1%). During the May-September, the rate of HRV infection was higher in patients under the age of 11 months than the next higher group of 1-2 years old (p less than 0.001). The incidence decreased with increasing age. The illnesses of HRV infection were analysed in 294 patients, except one patient who had symptoms of measles, from whom HRV was isolated singly. Although HRV-associated illnesses were generally mild (57.5%). Upper respiratory tract illnesses (URTIs) with fever were found in 22.1% and lower respiratory tract illnesses (LRTIs) in 20.4% of these. The rate of LRTI was higher during the epidemic period (April-September) than other periods (p less than 0.02). Major symptoms of HRV-associated illnesses observed were sore throat (87.4%), cough (84.0%), and nasal obstruction and/or discharge (72.8%). Wheezing was observed in 21.8% of these. From 19 (21.8%) of 47 patients clinically diagnosed as asthmatic bronchitis in this survey, viruses were isolated. HRV was detected most frequently in 12.8% of these patients, followed by respiratory syncytial virus (RSV, 6.4%) and adenovirus (2.1%). HRV- and RSV-associated asthmatic bronchitis were observed during April-September and November-February, respectively. Viral dual infections were detected in total 20 cases included 12 HRV-associated cases. In no case was the illness of greater severity than might have been caused by either agent acting singly.

The health effects of chemical waste in an urban community

This paper presents the results of a community health survey of people living near a hazardous chemical waste site in Kingston, Queensland. In comparison with a matched control group, people near the site were no more likely to report serious diseases, and reports of cancer and mortality rates did not differ in the two groups. Kingston residents reported higher rates of symptoms of general poor health, high levels of stress and anxiety and a higher incidence of miscarriages. The reports of poor physical health appear to be independent of proximity to the hazardous waste site and duration of residence in the area. Symptom prevalence and perceived recent decline in health correlate most strongly with the stress and anxiety measures. While long-term investigation is necessary, it appears at this stage that the chemical waste is not associated with an increase in major diseases as reported by those who were interviewed. When health in a broader sense is considered, however, it is clear that the situation has had a negative impact.

Symptoms in 298 infants under 6 months old, seen at home

Symptoms were assessed in 298 infants under 6 months old seen at home. Their mothers were asked if they were concerned about their babies and then questioned about the presence, duration, and severity of 28 predefined symptoms. Forty seven mothers expressed concern about their babies (16%), whereas on direct questioning 241 (81%) reported symptoms present within the last 24 hours. One hundred and twenty three (41%) reported three or more. Many of the symptoms occurred in more than 15 babies (5%). The commonest were cold peripheries (117, 39%), noisy breathing (88, 30%), and rash (68, 23%). These had often been present for many days. Only 257/819 reported symptoms (31%) were of recent onset (less than 4 days) with 168 (21%) graded by the mother as moderate or severe. A few highly specific symptoms that were associated with serious conditions were rare. Symptoms cannot be interpreted without detailed questioning taking their severity and duration into account, and most occur too often to be used as indicators for referral.

[Morbidity among children attending nursery schools]

The object of this investigation was to assess the extent to which absence on account of illness in children attending day-nurseries expressed the total morbidity. In four day-nurseries with a total capacity for 164 children, absence on account of illness and symptoms in the children present were registered over a period of 101 weekdays. Children were absent on 5.8% of the days on account of illness. The commonest causes were epidemic children's diseases, colds, sore throats and pyrexia. More than one third of the children present in the day-nurseries presented sign of illness. The most frequent of these were colds. Children were present in the day-nurseries five times as frequently with at least one symptom than they were absent on account of illness. Absence on account of illness provides an incomplete indication of illness among children attending day-nurseries as absence due to illness only represents a lesser quantitative fraction of the total morbidity among these children.

Rhinovirus infections in an isolated antarctic station. Transmission of the viruses and susceptibility of the population

It is commonly believed that living in polar isolation causes high susceptibility to respiratory illness. At McMurdo Station, a US research base in Antarctica, we tested this belief by comparing, over 36 days (August 31-October 5, 1976), the incidence and severity of respiratory illness in 64 men finishing six months isolation and in 136 men just arrived from the United States. The colds in the two intermingled populations were essentially equivalent. Forty-three per cent of the newcomers and 39% of the wintering group reported colds; symptoms and duration were nearly identical between the two populations. Movement of the colds was slow. The newcomers brought in 31 colds; subsequently, only 52 evenly spaced illnesses arose. Incidence of respiratory illness was twice higher in the smaller living units than in the spacious main dormitory. Two nontypable rhinoviruses, McMurdo 4 and McMurdo 88, were brought in by the new population and were the only viruses isolated. Only McMurdo 88 spread, although more than 65% of the men were antibody-free (less than 1:3) to either agent. McMurdo 88 caused an estimated 60% of antarctic-contracted colds. In brief, this isolated polar group was not especially susceptible to respiratory illness, and virus movement through the group was deliberate.

Damp housing and childhood asthma: validation of reporting of symptoms

The relations among parental reports of respiratory symptoms, bronchospasm measured after exercise, and the presence of visible fungal mould in the home was assessed in a population sample of 7 year old children (n = 873). Wheeze in the past year was the symptom most closely associated with reported dampness and particularly with mould. The unadjusted odds ratio relating mould and wheeze was 3.70 (95% confidence interval 2.22 to 6.15), and after adjustment for housing tenure, number of people per room, number of smokers in the household, and gas cooking this remained highly significant (odds ratio 3.00 (1.72 to 5.25)). The reduction in forced expiratory volume in one second after six minutes of free running was used to validate reporting of wheeze. At all levels of measured bronchial lability wheeze was reported more commonly in the children from homes with mould. There was no significant difference in the degree of bronchospasm measured among children from homes with and without mould. Awareness of dampness or mould in the home may be a determinant of parental reporting of symptoms and may account for much of the observed association between mould and respiratory symptoms.