Birth defects among children born to a population occupationally exposed to pesticides in Colombia

A case-referent study of birth defects was nested in a prevalence survey of adverse reproductive outcomes carried out among 8867 floriculture workers in Bogotá, Colombia. A total of 535 children born to these workers and reported by their parents as malformed and 1070 children selected at random as referents were invited to a medical examination including consultation with a geneticist and a clinical teratologist and a review of the medical records. Seventy-six percent of both groups attended the examination. Of 403 children reported as malformed, a birth defect was confirmed for only 154 (38%). On the other hand, of the 817 children reported as normal, 735 (90%) were normal, but 68 had a birth defect and 14 had other conditions. A case-referent analysis was then carried out including 222 children with birth defects and 443 referents. An increased risk was found only for birthmarks, and specifically for hemangiomas, for children with parents exposed to pesticides in the floriculture industry.

Pregnancy in women with systemic sclerosis

We assessed fetal morbidity and mortality in women with systemic sclerosis (SSc). Women with a history of SSc and a concomitant pregnancy completed a detailed questionnaire about the pregnancy. These 48 subjects were age-matched and race-matched to 2 other groups of women (a rheumatoid arthritis group and a control group from the same neighborhood), all of whom had been pregnant at least once. There were no differences in the frequencies of miscarriage or perinatal death in the SSc group compared with the 2 control groups. Preterm births occurred slightly more frequently in both SSc patients and rheumatoid arthritis patients compared with the neighborhood control subjects. There were significantly more small full-term infants born to women with SSc. Interestingly, the increase in preterm births and small full-term babies occurred with equal frequency prior to and after the onset of disease. Although close monitoring for premature birth and intrauterine growth retardation is necessary, we conclude that an uneventful, healthy pregnancy is possible for women with SSc. Those with early, rapidly progressive, diffuse skin thickening should avoid becoming pregnant since, intrinsically, they are at higher risk of developing renal crisis.

Case-control study on colorectal cancer and diet in Marseilles

A case-control study of cancer of the colon and rectum was conducted in the Marseilles region of southern France. Cases (399) and a corresponding number of controls, matched for age and sex, were included, the controls being selected from patients undergoing functional re-education for injuries or trauma which reduced their mobility. A dietary history questionnaire was used to determine the usual eating habits during the year preceding diagnosis for cases, or preceding interview for controls. The cases reported lower consumption of vegetables and oil than controls, but no differences were seen in the consumption of meat, bread, eggs or butter. The intake of several nutrients, particularly vitamins B2, B6, C, potassium, iron, magnesium and vegetable fibre, was lower among cases. However, when all these nutrients were analysed jointly and adjusted one for the other, only potassium retained a significant effect. This may be due to the high degree of colinearity between the estimated intake of many nutrients. No association was seen with fat or fibres from cereals.

Short-term effects of air pollution on mortality in Athens

Short-term effects of air pollution on mortality in Athens during the years 1975-1982 were studied. Daily values of sulphur dioxide (SO2) and smoke, measured by a five-station network of the National Observatory of Athens, were used as air pollution indicators. Mortality data were abstracted from the Town Registries of Athens and 18 other contiguous towns within the Greater Athens area. It was found that the adjusted daily mortality (estimated by subtracting from the observed value of mortality an 'expected' value, calculated after fitting a sinusoid curve to the empirical mortality data) depends positively and significantly on the level of SO2 (b = +0.0058, p = 0.05). This relation is independent of temperature, relative humidity, secular, seasonal, monthly and weekly variations of mortality as well as of synergistic effects of the above variables with season. No relation was found between smoke and adjusted daily mortality. An analysis for the determination of a possible threshold in the levels of SO2 causing health effects was also undertaken, by studying changes in the SO2 regression coefficients after successive deletion from the regression model of the days with the highest SO2 values. Our study shows that if there is an SO2 threshold it must lie slightly below the level of 150 micrograms/m3 (mean daily value).

Assessing the impact of additional follow-up in cohort studies

An approach is described for predicting the statistical value of extending follow-up in a cohort study. A simple approximation to the expected number of new events of interest is given. The effect of these events on inferences for parameters such as a standardized mortality ratio is approached in two ways. The first concerns the probability of reversing the conclusion of a significance test. The second approach finds the plausible range of values for the standardized mortality ratio after further follow-up that are consistent with the currently available data. Each of these values is displayed together with the precision of the estimate. The methods are illustrated with results from the International Radiation Study of Cervical Cancer (IARC Scientific Publication No. 52, 1984).

The dexamethasone suppression test. An indicator of depression in stroke but not a predictor of rehabilitation outcome

The dexamethasone suppression test (DST) result was found to be abnormal in 49% of patients who were an average of seven weeks post stroke. The DST response correlated with depressive symptoms as measured by both the Zung and modified Hamilton Depression scales. The specificity of the DST for clinically diagnosed depression reached 87% for the 8 AM cortisol determination, with a corresponding sensitivity of 47%. It was not related to the patient's final level of self-care function as measured by the Barthel score, need for nursing home placement following discharge, or duration of rehabilitation needed to achieve maximum benefit. Abnormal responses were more prevalent in cerebral hemisphere than in brain-stem or cerebellar strokes. The more extensive the stroke the more likely the possibility of an abnormal DST response. The DST response is stable, with test-retest replicability being 84% at two weeks and 74% at seven weeks.

Assessing symptom control in palliative home care

Control of symptoms in cancer patients on a home care program was studied, to identify problems related to caring for these patients at home. The study was based on independent physician assessments of patients' medical charts, as well as interviews with the home care providers. The results showed problems in control of pain, nausea and constipation; the causes were less than optimal care and non-compliance. There is an urgent need to improve palliative care to home care patients and to provide better, more frequent reassessment of patients with uncontrolled symptoms.

Biosocial correlates of colorectal cancer in Greece

One hundred consecutive patients with histologically confirmed colorectal cancer and an equal number of age- and sex-matched orthopaedic patients as hospital controls were interviewed about demographic, socioeconomic, biometric and medical variables. Cholecystectomy was significantly more frequent among cases than controls, but there was no side-predilection of the post-cholecystectomy tumours. The frequency of bowel evacuation was significantly higher among cases, particularly those with rectal cancer, an observation which appears contradictory to the 'prolonged bowel transit time--high colorectal cancer risk' hypothesis. No significant differences were found between cases and controls with respect to socioeconomic status, height and weight, smoking habits, use of laxatives and (for females) parity, age at first pregnancy, and age at menopause; however, cases appeared to be younger at menarche.

Agreement among Feighner, RDC and DSM III criteria for alcoholism

Three sets of diagnostic criteria for alcoholism, Feighner criteria, Research Diagnostic Criteria (RDC), and DSM III criteria, were examined to determine the concordance among them. The alcohol section of the Diagnostic Interview Schedule (DIS), which provides information allowing for diagnoses by all three sets of criteria, was administered to 484 blue collar workers. Overall, there was substantial agreement among the diagnostic systems, with 86% of the men receiving the same diagnosis by all three systems. However, more detailed analyses indicated that approximately one quarter of those receiving a diagnosis of alcohol abuse or alcohol dependence according to DSM III were not diagnosed as alcoholic by Feighner criteria. It was suggested that this discrepancy was due to DSM III criteria (as represented in the DIS) diagnosing heavy drinkers with no attendant problems as alcoholic.

Maternal cigarette smoking, psychoactive substance use, and infant Apgar scores

A study of 1,709 mother/child pairs at Boston City Hospital examined whether maternal cigarette smoking, drinking, or the use of other psychoactive substances was associated with low infant Apgar scores. The potential confounding effects of other labor and delivery risks were controlled in the analysis. In contrast to previous reports, univariate and stepwise multiple regression analyses did not identify a significant negative association between cigarette smoking and 1- or 5-minute Apgar scores. None of the substance use variables was significantly associated with low infant Apgar scores at 1 and 5 minutes. Other labor and delivery risks, such as short length of gestation, abnormal delivery presentation, placental abnormalities, nuchal cord, and exposure to general anesthesia during delivery, were associated with low Apgar scores.

Effects of maternal drinking and marijuana use on fetal growth and development

A study of 1,690 mother/child pairs at Boston City Hospital was conducted to assess the impact of maternal alcohol consumption on fetal development when confounding variables were controlled. Level of maternal drinking prior to pregnancy was associated with shorter duration of gestation. Lower maternal weight change, history of maternal illnesses, cigarette smoking, and marijuana use, however, were more consistently related to adverse fetal growth and development. New findings in this study include a negative association between maternal marijuana use during pregnancy and fetal growth. Also when confounding variables were controlled, women who used marijuana during pregnancy were five times more likely to deliver infants with features considered compatible with the fetal alcohol syndrome.

Bendectin and fetal development. A study of Boston City Hospital

As part of a prospective study investigating maternal characteristics and habits during pregnancy and their impact on fetal development, 1,690 mother/infant pairs were studied. Of the mothers, 375 reported using Bendectin during pregnancy. Multivariate analyses examining birth weight, length, head circumference, gestational age, and congenital malformations as dependent variables demonstrated no associations between Bendectin exposure and adverse fetal outcome.

Screening for cancer of the uterine cervix in Iceland 1965--1978

The trends in the mortality and morbidity from cervical cancer in Iceland for the period 1965--1978 are examined in relation to the screening programme that began in 1964. By 1970 over 80% of the female population under the age of 65 had been screened at least once, and by 1977 over 65% of women under the age of 75 had been screened at least twice. Mortality fell by 60% between 1959--1970 and 1975--1978, with a corresponding fall in the incidence of advanced tumors. The mortality rates among the unscreened population are more than ten-fold greater than among the screened. The greater part of the fall in mortality is attributed to the mass screening programme.

Effects of marihuana on pregnant rats and their offspring

Pregnant rats were intubated with marihuana extract (10, 150 mg/kg) from gestation day 3 to parturition. Control animals were pair-fed. At parturition pups were culled and assigned to nondrug-treated dams. A positive control group consisting of animals prenatally exposed to alcohol (6 g/kg/day) was included for comparison of birth weight data. Marihuana reduced food and water consumption and maternal weight gain. Pup weight at birth was reduced by about 10% relative to pair-fed controls in animals exposed to the high doses of marihuana, and by approximately 15% in pups exposed to alcohol relative to their pair-fed controls. Litter size and pup mortality at birth were not affected significantly. Postnatal mortality was increased and neonatal weight was decreased at 21 days in marihuana-treated offspring. At 11 weeks of age body weights of drug-treated females but not males, were still significantly less than that of pair-fed controls.

Some insights into Miettinen's multivariate confounder score approach to case-control study analysis

We have studied Miettinen's multivariate confounder score method of controlling confounding in case-control studies both theoretically and by simulation. The main conclusion to be drawn from out results is that the method will in many practical situations seriously exaggerate the statistical significance achieved, and its use is not to be recommended.

Ingested mutagens from opium and tobacco pyrolysis products and cancer of the oesophagus

Substances which are commonly sucked or chewed in two areas where the incidence of oesophageal cancer is high, the Transkei and north-east Iran, were tested in bacterial mutagenicity assays. Pyrolysed substances, opium dross in north-east Iran and tobacco pipe residues in the Transkei, displayed mutagenic activity in Salmonella typhimurium strains TA98 and TA100 in the presence of rat liver microsomes.

The effect of mass screening in Iceland, 1965-74, on the incidence and mortality of cervical carcinoma

A clinic for early detection of cancer of the uterine cervix has been in operation in Iceland since 1964, aimed until recently at the age-group 25-59. More than 85% of women in this age group have been screened at least once. Mortality from cancer of the cervix had been rising in Iceland, and continued to rise during the first few years of operation of the screening clinic. Since 1970, however, a more than two-fold reduction in mortality has been observed among women aged 25-59. There has been a similar decrease in incidence of tumours of stages II, III and IV. Both deaths and advanced tumours are largely confined to women who have never been screened. Alternative explanations are considered, but the only tenable explanation of the reduction in mortality is that it is a consequence of the introduction of a comprehensive screening programme.