Cross-sectional study of rheumatoid arthritis treatment in a university hospital

Drug prescribing patterns for the management of inpatients and outpatients with rheumatoid arthritis (RA) were investigated. The population of patients resembled published epidemiological descriptions of RA patients with respect to age and sex distribution. Multiple drug therapy was common in the treatment of both hospitalised and clinic patients. 90% of all patients with RA received non-steroidal anti-inflammatory drug (NSAID) therapy, indomethacin and naproxen being the two most frequently prescribed NSAIDs for both in- and outpatients. The vast majority of inpatients (85%) and outpatients (79%) received slow-acting antirheumatic drug (SAARD) treatment. 13% of hospitalised patients received H2-antagonist drugs in addition to their NSAIDs. A high proportion of inpatients (46%) received oral corticosteroids in the management of their rheumatoid arthritis, while only 15% of clinic patients were prescribed corticosteroids.

Mortality from prostate cancer in Italy: 1950-1979. Cross-sectional rates and cohort analysis

This paper studies prostate cancer mortality in Italy from 1950-1979 to evaluate its importance in relation to total cancers, examine the time trend for forecasting future mortality trends, and makes an attempt to interpretate mortality by analyzing demographic and risk factors. In the Authors' opinion findings from cross-sectional rates, cohort analysis and Devesa-Schneiderman method, indicate that in Italy even if the age-adjusted mortality rate has nearly doubled over the period, as in many other countries, mortality can be expected to remain constant or decrease in the future, since the data to hand show a decreasing trend in some age cohorts.

Risk for cutaneous melanoma in recent Connecticut birth cohorts

Mortality trends suggest that increases in Connecticut incidence for cutaneous melanoma (CM) equal or under estimate increases for the entire country. One-sixth of CM in Connecticut occurs under age 35. In the 1955 birth cohort, modeled incidence rates per 100,000 age-adjusted to the 1960 US population are 38.2 in males and 28.9 in females. These estimated rates for CM rival those for colon cancer (now the third most common malignancy in the United States) and have special implications for young adults.

Serotyping of Campylobacter jejuni, Campylobacter coli, and Campylobacter laridis from domestic and wild animals

By using 50 unabsorbed antisera, we were able to serotype 272 (65.7%) of 414 thermotolerant campylobacters from wild and domestic animals, on the basis of heat-stable antigens identified by means of passive hemagglutination. Forty-two serotypes were recognized. The pattern of serotypes detected in the various animal species was compared to human clinical isolates by using the Czekanowski index (proportional similarity index). The highest degree of similarity to the clinical isolates was observed for the poultry isolates, followed by strains from wild birds, flies, and pigs (in order of decreasing similarity). The serotypes recovered most frequently from poultry (LAU 1 and LAU 2) were also most prevalent in Norwegian patients. In contrast, serotype LAU 35/44, the predominant porcine serotype, was never recovered from human clinical specimens. Flies captured in chicken farms and in piggeries harbored serotypes which were also commonly seen in chickens and pigs, respectively. Nine of the strains included in this study could not be ascribed to any defined species. All of these were resistant to nalidixic acid and did not produce H2S.

Uma aplicação de indicadores corrigidos no estudo do sarampo no município do Rio de Janeiro, Brasil

Neste trabalho, procura-se estimar a incidência, a mortalidade e a letalidade reais do sarampo no município do Rio de Janeiro, Brasil, nos períodos 1969-1972, anterior ao inicio da vacinação, e 1979-1982, posterior ao inicio da vacinação. As estimativas são obtidas por meio de correções aplicadas ao número notificado de casos e de óbitos, em cada um dos dois períodos. O número real de casos é estimado através de considerações quanto à dinâmica populacional e à dinâmica da transmissão do sarampo na população. O número real de óbitos é estimado levando-se em conta a subnotificação dos óbitos, a partir de dados obtidos pela Investigação Interamericana de Mortalidade na Infância. Procura-se apresentar com detalhe a metodologia empregada, que poderá ser de utilidade para os serviços de saúde na avaliação de medidas de intervenção. Discute-se, por fim, com base nos indicadores corrigidos obtidos, a situação epidemiológica do sarampo no município do Rio de Janeiro.

Use of auxotyping for epidemiological studies of Campylobacter jejuni and Campylobacter coli infections

A chemically defined medium developed for Neisseria gonorrhoeae was modified to support the growth of Campylobacter jejuni and Campylobacter coli. A total of 76 isolates of C. jejuni and 14 isolates of C. coli were tested on this medium, which was designated Campylobacter defined medium (CDM), over a 3-month period. Although none of the C. coli isolates appeared to require amino acids, 51% of the C. jejuni tested required one and 7% required multiple amino acids for growth. An analysis of isolates obtained from three household outbreaks of campylobacteriosis demonstrated that auxotyping identified the epidemic strain within each outbreak. Among 70 isolates of C. jejuni examined, no correlation could be drawn between a specific serotype and auxotype or between auxotype and plasmid profile.

The patho-epidemiology of benign proliferative epithelial disorders of the female breast

Benign breast disease is associated with increased risk of subsequent breast cancer, especially when there is evidence of epithelial proliferation. There is no standard terminology for benign proliferative epithelial disorders (BPED), and this hinders direct comparisons between the various studies which have examined their pathology and their relationship to breast cancer. The present paper reviews previous classification schemes for BPED, and proposes an alternative system in which epitheliosis and blunt duct adenosis are the major features, the degree and pattern of the hyperplasias being graded separately. Adoption of this or a similar system as a standard should facilitate future comparative studies of these conditions. As BPED are apparently pre-malignant conditions, an understanding of their aetiology is important because it may help to elucidate the aetiology of breast carcinoma, and to open up avenues for its prevention. If BPED are precursors to breast carcinoma, then risk factors for BPED should also be risk factors for breast carcinoma. To date, in epidemiological studies of BPED, such concordance has not been demonstrated, as consistent risk factors for the BPED have not yet emerged. This may have resulted, at least in part, from differences in the histological categories included in the various studies. Therefore, collaboration between epidemiologists and pathologists may facilitate progress towards an understanding of BPED.

Clinical and biologic antecedents of the amenorrhea/hyperprolactinemia syndrome: a case-control study

Clinical, reproductive, and biologic antecedents of women with the amenorrhea/hyperprolactinemia (A/H) syndrome, most with pituitary prolactinomas, and matched healthy subjects were examined in a case-control study. Women with A/H had more frequent irregularity in early menstrual cycle patterns and excess facial hair, had less frequent catamenial symptoms, and were heavier at the time of study when compared with control subjects. The patients reported a more frequent history of thyroid disease and chest trauma. There were no significant differences between the patients and control subjects with respect to prior use of oral contraceptives, estrogens, psychotropic drugs, alcohol, or other substances known to alter serum prolactin levels, nor were there significant differences in the family history of gynecologic conditions or malignancies or the syndromes of multiple endocrine neoplasia. The implications of these findings are discussed.

Congenital rubella syndrome in Western Australia

The birth prevalence of congenital rubella syndrome (CRS) in Western Australia has been around 20 per 10 000 live births with peaks up to 100 per 10 000 in rubella epidemic years. The rate appears to be falling but it is still too soon to know whether the rubella vaccination programme in Western Australia has made a significant impact. The cohorts of young women who would have received the schoolgirl vaccination programme are only now entering the child bearing age groups. Observed falls may be due also to delayed diagnosis particularly of cases of deafness only. The proportion of nonimmune young women who would have been eligible for the programme in one maternity hospital has fallen. This study needs to be repeated to ascertain whether further epidemics of rubella have resulted in peaks of CRS or whether the vaccination programme has started to have an effect.

"Campylobacter hyointestinalis" sp. nov.: a new species of Campylobacter found in the intestines of pigs and other animals

The name "Campylobacter hyointestinalis" sp. nov. is proposed for a Campylobacter species that was isolated from the intestines of pigs with proliferative enteritis. "C. hyointestinalis" is also found in the feces of cattle and has been isolated from the intestine of a hamster. "C. hyointestinalis" is distinguished from previously described catalase-positive Campylobacter species by colony morphology, ability to produce H2S in triple sugar iron agar, ability to grow anaerobically in 0.1% trimethylamine N-oxide hydrochloride, resistance to nalidixic acid, susceptibility to cephalothin and metronidazole, and hydrogenase activity. Sixteen "C. hyointestinalis" strains were highly related (greater than or equal to 76%) by DNA-DNA hybridization (hydroxyapatite method, 50 and 65 degrees C). Other Campylobacter species were less than or equal to 30% related to "C. hyointestinalis." The type strain of "C. hyointestinalis" is designated 80-4577-4 (= ATCC 35217), and its DNA has a guanine-plus-cytosine content of 36 mol%.

Plasmid-mediated factors conferring diffuse and localized adherence of enteropathogenic Escherichia coli

Histopathological evidence suggests that the adherence of enteropathogenic Escherichia coli (EPEC) to the mucosa of the small bowel is an important step in pathogenesis. Several reports have shown that many EPEC isolates adhere to HEp-2 and HeLa cells in tissue cultures. In the HeLa cell assay, there are at least two distinct patterns of adherence: localized adherence, which is characterized by the formation of bacterial microcolonies, and diffuse adherence, in which bacteria cover the cell uniformly. We have found that these two patterns can be demonstrated in HEp-2 cells as well as in HeLa cells and that the results of the two assays are closely correlated. Using a DNA probe which is sensitive and specific for localized adherence to HEp-2 cells, we provide evidence that localized adherence and diffuse adherence by EPEC are due to at least two genetically distinct adhesions which confer phenotypic differences in both the morphology of HEp-2 cell adherence and in surface hydrophobicity. The two factors are each encoded on plasmids which vary in size from 55 to 70 megadaltons; one strain exhibiting localized adherence carried these genes on the chromosome.

Bladder cancer mortality of workers exposed to aromatic amines: analysis of models of carcinogenesis

The effects of various factors were evaluated on both relative risk (multiplicative model), and absolute excess risk (additive model) of bladder cancer among 664 workers of a dyestuff factory in Northern Italy. These workers were exposed to aromatic amines in fairly constant working conditions from 1922 to 1970, and were employed for at least one year. They were followed up till the end of 1981 for a total of 12,302 man-years at risk. Under both models, the risk was greater for workers directly involved in aromatic amine manufacture than for those with only intermittent exposure. There was no marked effect of age at first exposure on the absolute excess risk of bladder cancer, but the relative risk was strongly and negatively related to age at first exposure. Under the multistage theory of carcinogenesis, this pattern of risk indicates an early stage effect. Absolute excess risk increased sharply during exposure, and continued to rise, although less sharply, after exposure had ceased. Relative risk, however, decreased after cessation of exposure, indicating a possible late stage effect. Thus, the results derived from both additive and multiplicative models are not in contrast when interpreted in terms of the multistage theory of carcinogenesis, though they are not totally consistent with a single-stage effect, either early or late. Aromatic amines may act on a stage somewhere between the first and penultimate, or on more than one stage of the process of carcinogenesis. Alternatively, it is possible that imprecision in the job classification or other observational problems may obscure the trends, or produce fictitious trends in the effects of variables such as age at first exposure and time since last exposure. Finally, such a pattern of trends could emerge if there were only two stages and the first and penultimate stage were the same.

Dietary and other risk factors for stroke in Hawaiian Japanese men

As part of an on-going longitudinal study, 7895 men of Japanese ancestry living on the island of Oahu, aged 45-68 and free of evidence of prior stroke at entry examination, have been followed by re-examinations and surveillance. During ten years of follow-up 154 men developed thromboembolic stroke, 65 developed intracranial hemorrhage, and 19 developed stroke of unknown type. There were 79 deaths attributed to stroke. The independent risk factors for thrombo-embolic stroke were elevated blood pressure, glucose intolerance, age, electrocardiographic evidence of left ventricular hypertrophy or strain, cigarette smoking and proteinuria. Attributes associated with increased risk of intracranial hemorrhage were age, elevated blood pressure, cigarette smoking, serum uric acid and, inversely, serum cholesterol level. Electrocardiographic evidence of left ventricular hypertrophy or strain significantly increased the risk of cerebral hemorrhage, but was not associated with subarachnoid hemorrhage. In univariate analysis, there was an inverse relation between dietary fat intake and thrombo-embolic and total stroke incidence. An inverse relation was also shown between protein intake and total stroke incidence. These dietary relations became statistically not significant in multivariate analysis. No relation was found between salt intake and the incidence of stroke.

Etiology of rheumatoid arthritis

Definite genetic associations with immunological cooperative HLA-D(R) antigens have been demonstrated for rheumatoid arthritis (RA). Microbial etiology has not been proven, but some hope for the supporters of this view is still given by small viruses, plasmids of enteric bacteria or perhaps oncogen-like DNA-sequences. Yet, electrophoretical analysis of membrane proteins or surface glycoproteins of RA synovial cells does not show any differences compared to reference cells. Autoimmunity to several tissue elements has been demonstrated, but most of it is of secondary nature. Antigenicities of type II and III collagens are probably only contributory factors for HLA-DR4 positive individuals. Proteoglycans or minor cartilage collagens have not been extensively studied, so far. Endocrine, dietary or psychological influences might be triggering events for otherwise 'preloaded' individuals.

Cutaneous melanoma in relation to intermittent and constant sun exposure--the Western Canada Melanoma Study

The histories of exposure to sun through occupational, recreational and vacation activities of 595 patients with newly incident cutaneous melanoma excluding lentigo maligna and acral lentiginous melanoma, were compared to those of comparison subjects drawn randomly from the same population and matched for age, sex and province of residence in Western Canada. Significant increases in risk were seen with increasing amount of sun exposure through outdoor activities associated with recreation and vacations; activities likely to involve more intense sun exposure were associated with greater increases in risk. While a moderate amount of occupational exposure was associated with increased risk, greater occupational exposure resulted in no further increase; in men a decrease in risk was seen. These findings were independent of the effects of hair and skin colour, freckles, ethnic origin and socio-economic status. The results suggest that short-term exposure to unusually intense sunlight increases the risk of melanoma, while long-term constant exposure has no effect or may decrease risk. No simple relationship was seen between melanoma risk and total sunlight exposure. This study introduces new methods of assessing different types of sun exposure from retrospective data.

A rubella outbreak among dental students: description of the outbreak and analysis of control measures

From February to April 1982, rubella was diagnosed in 17 Washington University dental students. The affected students represented 4.8% of all dental students and 21% of susceptible students. Because a high likelihood of rubella transmission was perceived, three adjacent university hospitals undertook an emergency program to ensure immunity to rubella in all personnel. The program reached 84.6% of all target personnel, but only 36% of physicians (p less than 0.001). We estimated that the program increased the level of rubella immunity from 92.2% to 98.1%, at a total cost of $140,274 of which $29,990 was in excess of ordinary expenditures. Our experience indicates that schools training health professionals face the possibility of rubella outbreaks unless they ensure rubella immunity in all students. The experience also supports the value of ongoing programs to ensure rubella immunity in hospital personnel. Without such programs, hospitals may be forced to undertake emergency programs that are likely to be disruptive and expensive and may have relatively little immediate measurable impact.

Oral contraceptives, lipids and cardiovascular disease

Evidence for the involvement of changes in lipid metabolism and oral contraceptive use in the development of cardiovascular disease is briefly reviewed with particular reference to the main object of the article, to assess the effect of different oral contraceptive formulations on serum lipid levels. The preferred formulations should contain a low dose of ethynyloestradiol and should not increase serum levels of cholesterol and LDL-C or reduce those of HDL-C. Such formulations appear to be the triphasic one containing ethynyloestradiol and levonorgestrel and the ethynyloestradiol-desogestrel combination, which appears to be unique in that it may actually increase HDL-C. However other determinants in addition to effects on lipid metabolism will be important in deciding the choice of an oral contraceptive. Any changes which do occur in serum lipid concentrations with OC use appear within the first three months and do not appear to be progressive with continued use after this time.

Menstrual cycle patterns and the risk of breast disease

The relationship between menstrual cycle patterns and the risk of breast disease was evaluated using data from a hospital-based case-control study of 288 women with benign breast disease (203 chronic cystic diseases and 85 benign tumours), 317 with breast cancer and 602 age-matched controls with a spectrum of acute conditions unrelated to any of the established or potential risk factors for breast disease. A lifelong irregular menstrual pattern [defined as frequent occurrence of menstrual-like episodes of bleeding less than 21 or more than 35 days apart) was negatively associated with the risk of benign breast lesions (relative risk, RR = 0.6, with 95% confidence interval = 0.4-1.0) and of breast cancer (RR = 0.4, with 95% confidence interval = 0.3-0.8]. This inverse association could not be explained by any of the identified potential confounding factors, including the major risk factors for breast disease. The findings of this study, showing that a lifelong history of irregular (and hence more likely anovular) cycles was less frequent among women with benign and malignant breast diseases, support the hypothesis that frequent ovular cycles might be more carcinogenic than anovular ones.

HLA and multiple sclerosis: population and families study

Association between HLA and multiple sclerosis (MS) was investigated at the population level on 100 MS patients genotyped for HLA-A, B, C, DR and Bf, Glo, and on 155 patients phenotyped for the same HLA antigens. Association between MS and DR2 was clearly confirmed, although its strength is rather weak. No other genetic marker could be related to the disease, no haplotype nor any allelic combination could be recognized as MS specific, and antigen genotype frequencies among the diseased could not ascertain the mode of inheritance, although dominance is very likely. Computer analysis between HLA, Bf, Glo and age of the patient, sex, age of onset and evolution of MS, impairment indexes, titres of anti-DNA and anti-measles antibodies in CSF did not show any interaction. Twenty sib pairs and two trios of MS were also studied; they showed no significant distortion with the random distribution of haplotypes. DR2 gene frequency, however, was significantly higher in sib pairs showing one or two haplotypes than in HLA different affected siblings. Three crossing-overs were identified which suggest where the HLA-linked MS susceptibility (MSS) gene could be located within the HLA segment, while other epistatic MSS genes or environmental factors are likely to be important.

Outcome of pregnancy following induced abortion. Report from the joint study of the Royal College of General Practitioners and the Royal College of Obstetricians and Gynaecologists

A total of 1590 general practitioners and 795 gynaecologists in England, Scotland and Wales are participating in a long-term, prospective study concerning the sequelae of induced abortion. In the present report a comparison is made between the outcome of the first post-index pregnancy in 745 women whose index pregnancy ended in an induced abortion (cases) and that in 1339 women who had an unplanned index pregnancy but were not referred for induced abortion (controls). There were no statistically significant differences between cases and controls. The increased relative risk which was found amongst the induced abortion group of non-viable outcome, low birthweight and shortened gestation, could have arisen by chance. Further analysis of a larger number of pregnancies is required to permit confident interpretation of these observations. The present data provide no reason for alterations in the current management of induced abortion, or the subsequent pregnancy.

Evidence of udder excretion of Campylobacter jejuni as the cause of milk-borne campylobacter outbreak

We describe a community outbreak of campylobacter enteritis associated with the consumption of untreated milk, apparently contaminated by two cows with campylobacter mastitis. The outbreak occurred in two phases. Strains of Campylobacter jejuni of the Penner serogroup complex 4, 13, 16, 50 and Preston biotype code 6100 were isolated from patients in both episodes and from the faeces of the cattle, milk filters, bulk milk and retail milk. Milk samples from two of 40 milking cows were found to contain C. jejuni, and the wheys from these two cows had high titres of antibody to C. jejuni detected by ELISA techniques.

Diagnosis and management of premalignant melanocytic proliferations

The histopathology of melanocytic proliferations in human skin can be defined in a way which allows a rational approach to their management. Early and/or premalignant lesions such as melanocytic hypertrophy, hyperplasia, dysplasia, and atypical hyperplasias are correlated with clinical lesions such as lentigo, compound nevoid lentigo, changes in nevi during pregnancy, and unusual moles seen in patients with the dysplastic nevus syndrome. Clinical management of such lesions may be determined from the pathological process. Hypertrophic and hyperplastic lesions need not be re-excised, although partially removed moles showing junctional hyperplasia may recur clinically. The mildly and moderately dysplastic nevus need only be narrowly removed. Severe dysplasia and melanoma in situ may recur locally as invasive melanoma, and consideration for conservative reexcision is warranted. Dysplastic nevi should be considered to be markers of patients who may develop melanoma. Patients with dysplastic nevi or a family history of unusual moles or melanoma should have continued follow-up, preferably with standardized clinical photographs.

Imported measles outbreak in a university

In 1981, a measles outbreak in an Arkansas university involved 16 students and four persons who were contacts of these students. The first two cases were in students who recently returned from Honduras. Of the 16 students with measles, 12 had significant gastrointestinal symptoms; five had elevated liver transaminase, and eight were hospitalized. Only two of the students were considered adequately immunized. A voluntary immunization clinic held on the university campus resulted in 67 per cent of 3,076 students being vaccinated.

The severity of whooping cough in hospitalised children--is it declining?

Four hundred and sixty admissions for whooping cough to three hospitals between 1974-9 were reviewed. Many children had a long illness. More than half of them had severe or moderately severe coughing spasms and a quarter had pronounced feeding difficulties. The incidence of clinical pneumonia and convulsions was low and there were no deaths. The disease continues to be much more severe in infancy. There was some evidence that the disease declined in severity over the period studied. A number of factors including increased use of erythromycin may have contributed to this change.

Apolipoprotein B-48 and B-100 very low density lipoproteins. Comparison in dysbetalipoproteinemia (type III) and familial hypertriglyceridemia (type IV)

A protein band having the same migration as apolipoprotein (apo) B-48 was observed by SDS electrophoresis in the plasma very low density lipoprotein (VLDL) from 14 Type IV and three Type III hyperlipoproteinemic subjects and from six normal fasting subjects. The VLDL from five Type IV, three Type III, and one normal subject were separated into two subfractions, retained and nonretained, by immunoaffinity chromatography on monoclonal anti-apo B-100 Sepharose. Based on results of electrophoresis and radioimmunoassay, we have concluded that these two fractions represent apo B-48 and apo B-100 lipoproteins that we have named apo B-48 and apo B-100 VLDL. When compared to their respective apo B-100 VLDL, the apo B-48 VLDL from either Type III or Type IV was principally enriched in total lipids, in apo E, and had an electrophoretic migration similar to chylomicrons. This suggests that apo B-48 VLDL has the same origin (i.e., intestinal) in the two disorders. Both apo B-48 and apo B-100 VLDL were enriched in cholesteryl ester (CE) and depleted in triglyceride (TG) in Type III; however, both fractions were rich in TG and poor in CE in Type IV and in normal subjects. In addition, compared to their respective apo B-100 VLDL, the apo B-48 fraction was enriched in CE in Type III and in TG in Type IV. We conclude that, despite a possible similar origin for apo B-48 VLDL in Type III and in Type IV subjects, the composition of apo B-48 VLDL is variable and the CE/TG ratio is more characteristic of the type of hyperlipidemia than of the particular VLDL subfractions.

Evaluation of the common conditions associated with eosinophilia

In an eosinophilic population of 47 boys of the same age, a large proportion (92%) were helminth infested or atopic, or both, compared with 36% of 36 controls. The methods used to detect these conditions were not costly or elaborate, except for the radioallergosorbent test, which was used to measure concentrations of circulating IgE antibodies to atopic allergens. It is suggested that an economical approach to detect helminthiasis and atopy in cases of eosinophilia is adopted using the methods employed here, with skin prick tests replacing the radioallergosorbent test.

Sib risk and the dizygotic twin concordance rate for multiple sclerosis

Data have been reviewed on sib risk and the dizygotic twin concordance rate in multiple sclerosis. Even when rigorous criteria are applied, the dizygotic twin concordance rate for multiple sclerosis is apparently higher (perhaps 10 times higher) than could be explained by the sib risk. In contrast, twins with Parkinson's disease have low concordance rates even when ascertainment is by informal methods. It is concluded that such methods of ascertainment are not as biased as has been suggested, and that the high concordance rates reported for multiple sclerosis are a characteristic of the disease rather than an artifact of the ascertainment. Three hypotheses are considered which might, in principle, explain this high dizygotic twin concordance rate in multiple sclerosis: 1 One is certainly false, viz, that it is due to an excessive liability of dizygotic twins to the disease. 2 It is possible that a pathogen occurs in early infancy or in pregnancy itself. 3 It seems more likely that the high concordance rate may be explained in terms of age related events or sequences of events. (If such events were pathogenic for one member of a sibship, they would be pathogenic for another only if it were a co-twin).

Malignant melanoma in Rome, Italy, 1970-9

An epidemiological study was conducted in the city of Rome and the incidence of malignant melanoma was determined retrospectively for the years 1970-9. All patients had legal residence in Rome and a histological diagnosis of melanoma during that period; only cases of malignant melanoma of the skin (ICD 172, 8th revision) were considered. A total of 17 public and 82 private hospitals were involved in the study with 11 081 and 6127 hospital beds respectively. All the hospitals in the study had one of the following therapeutic and diagnostic facilities: internal medicine, dermatology, oncology, radiology, surgery, plastic surgery, histopathology. Analyses of incidence are based on 500 cases, 237 males and 263 females, collected in the period 1970-9. The data indicate a positive time trend in incidence; the average annual increase is 0.27 cases/year per 100 000. The data show that in a Mediterranean and Latin country such as Italy the incidence of melanoma presents the same ascending trend as that of other Caucasian countries, whether European or not, the slope of the curves is similar for both sexes. The distribution of the primary site for both sexes is closely parallel to that described for all Caucasian populations, the lower limbs being more affected in females and the trunk in males.

Distribuição etária do sarampo e vacinação: considerações sobre alguns dados do município do Rio de Janeiro

São apresentados alguns dados sobre a distribuição etária dos casos notificados de sarampo no Município do Rio de Janeiro entre 1964 e 1982, observando-se a modificação ocorrida nesta distribuição entre o período pré-vacinação e o período pós-vacinação. Estes dados são comparados com dados de alguns outros países e é feita uma breve discussão sobre a influência da vacinação na epidemiologia do sarampo.

Cancer morbidity among workers in the telecommunications industry

A retrospective cohort study of 2918 workers in the telecommunications industry in Sweden recorded the cancer morbidity for the period 1958-79. Cases of cancer were collected from the Swedish Cancer Registry for this period and information on work characteristics was collected for the entire period of employment. The total cancer morbidity was as expected. There was no excess risk of lung cancer but an excess risk of malignant melanoma of the skin was detected (SMR = 2.6, 12 cases). This excess risk was particularly associated with work environments where soldering was practised. Estimates of the SMR became larger with the assumption of a longer induction/latency period.

Long term effects of exposure to viral infections in utero

An analysis was conducted of the major findings of a long term follow up study of 3076 subjects who were exposed to viral infections in utero and who at the time of analysis were up to 40 years of age. Mortality and morbidity were compared with those in a control population matched for sex and date and area of birth. An excess of cancers (16 cases against seven) appeared to be clustered among those exposed to herpes viruses (varicella or cytomegalovirus). There was evidence of an increased risk of diabetes among those exposed to mumps during the first trimester (four cases among 128 subjects against none in 148 controls). The most surprising finding was a decrease of diseases of the skin and subcutaneous tissue and of the nervous system among subjects exposed to antenatal varicella zoster infection. The mechanism for the association may include production of fetal anti-idiotype antibodies in response to transplacentally acquired maternal autoantibodies.

An analysis of some risk factors for lung cancer in Hong Kong

Lung cancer has been the major cause of cancer death in Hong Kong for more than a decade. Although it is known that some 95% of male cases can be attributed to smoking, the etiological factors in women remain elusive. Among "never-smoked" female cases, increases in attributable risk from passive smoking were limited to only some of the histological types of lung carcinomas, and an overall analysis of all types did not reveal any significant increase in relative risk from this source. Other environmental factors which encourage bronchial irritation are suspected. Methodological differences may explain the differences in proportional distributions of histological lung tumor types noted between previous reports, and the risk values attributed therein to active and passive smoking.

Risk of cancer in relation to serum concentrations of selenium and vitamins A and E: matched case-control analysis of prospective data

The independent and joint associations of serum selenium and vitamin A (retinol) and E (alpha tocopherol) concentrations with the risk of death from cancer were studied in 51 case-control pairs--that is, 51 patients with cancer, each paired with a control matched for age, sex, and smoking. Case-control pairs came from a random sample of some 12000 people aged 30-64 years resident in two provinces of eastern Finland who were followed up for four years. Patients who died of cancer during the follow up period had a 12% lower mean serum selenium concentration (p = 0.015) than the controls. The difference persisted when deaths from cancer in the first follow up year were excluded. The adjusted risk of fatal cancer was 5.8-fold (95% confidence interval 1.2-29.0) among subjects in the lowest tertile of selenium concentrations compared with those with higher values. Subjects with both low selenium and low alpha tocopherol concentrations in serum had an 11.4-fold adjusted risk. Among smoking men with cancer serum retinol concentrations were 26% lower than in smoking controls (p = 0.002). These data suggest that dietary selenium deficiency is associated with an increased risk of fatal cancer, that low vitamin E intake may enhance this effect, and that decreased vitamin or provitamin A intake contributes to the risk of lung cancer among smoking men with a low selenium intake.

A one-year survey of campylobacter enteritis and other forms of bacterial diarrhoea in Hong Kong

The following enteropathogens were isolated from the faeces of 769 (10.2%) of 7,545 patients of whom 5,704 had diarrhoea or abdominal pain, attending a teaching hospital in Hong Kong during one year: salmonellae 458 (6.1%); Vibrio parahaemolyticus 125 (1.7%); campylobacters 108 (1.4%); shigellae 83 (1.1%); others 19 (0.3%). Further identification of the campylobacter isolates showed that 63 (58%) were Campylobacter jejuni biotype 1, 44 (41%) were C. coli and only one was C. jejuni biotype 2. Seventy-five (69%) of the 108 campylobacters were isolated from children under two years of age, mostly during the second year of life. Faecal specimens from 1,841 children under the age of two years without gastrointestinal symptoms yielded almost the same percentages of salmonellae, campylobacters and shigellae as children with diarrhoea. Salmonellae, shigellae and vibrios were isolated most often in the hot late summer months (August to October), but, contrary to the pattern in Europe and North America, both C. jejuni and C. coli were most prevalent in the coolest months of the year (January to March). The reasons for this "reversed' trend are unknown.

Deaths in cots are not always cot deaths

Agonal histories were traced for 1182 of 1782 postneonatal deaths in Sheffield between 1947 and 1979. Twenty eight per cent of these deaths were histologically inexplicable, 19% were from infections and 15% from malformations. These sudden infection and malformation deaths were explicable, yet by some definitions they would be considered as cot deaths. Varying definitions may lead to confusion, hindering the search for aetiological mechanisms.

Campylobacter jejuni-specific serum antibodies are elevated in healthy Bangladeshi children

In Bangladesh and other developing countries, isolation of Campylobacter jejuni is common in healthy children, and the illness/infection ratio falls with age. To determine whether specific serum antibodies correlate with this phenomenon, using an enzyme-linked immunosorbent assay, we studied sera from 93 healthy Bangladeshi children and 121 healthy U.S. children under 15 years of age. For each age group (less than 1, 2 to 4, and 5 to 14 years) studied, specific serum antibody levels were significantly higher in the Bangladeshi children. Among Bangladeshi children, for each of the three immunoglobulin subclasses, the change in antibody levels with age was different. Specific immunoglobulin A antibody levels rose linearly with age, immunoglobulin G levels peaked in the 2- to 4-year age group and then fell, and immunoglobulin M levels peaked in the 2- to 4-year age group and then plateaued. Elevated serum antibody levels to C. jejuni in Bangladeshi children may be protective in themselves or may reflect other protective phenomena.

The virulence of clinical and environmental isolates of Campylobacter jejuni

The virulence of Campylobacter jejuni and C. coli isolated from various water sources was compared with that of clinical strains by in vitro assays of adhesion, invasion and cytotoxicity to HeLa cells. Variation in degree of attachment was observed, but this did not appear to be related to strain source, However, water strains were less invasive and less cytotoxic to HeLa cells than clinical strains as shown by immunofluorescence and electron microscopy. These differences were particularly evident between clinical and water isolates of the same serotype and biotype implicated in an outbreak of campylobacter enteritis in a school. The enhanced virulence of the clinical isolates, possibly induced by passage, was confirmed by colonization tests on infant mice.

Measuring the genetic contribution of a single locus to a multilocus disease

An increasing number of diseases are being demonstrated to be due to determinants at more than one genetic locus. It thus becomes of interest to determine the genetic contribution of a specific single locus. A method of estimating a "coefficient of genetic contribution" is described herein, based on a comparison of monozygotic twin concordance data for a specific disease, the empirical sibling recurrence risks, and the sharing of identical by descent genes at the specific locus of interest by pairs of siblings who are both affected. The value of the method is that it requires relatively few assumptions, and does not require knowledge of the mode of inheritance of disease susceptibility at the gene locus of interest. If there are major environmental determinants, this method will give a lower bound for the single locus of interest. To illustrate the method, it is applied to two specific diseases, insulin dependent diabetes mellitus (IDDM) and gluten-sensitive enteropathy (GSE), and a specific locus, the HLA gene complex. The best estimates would appear to be that the HLA "genes" provide a coefficient of 60% for IDDM susceptibilty, but only 30% for GSE. A possible reason for these differences is the markedly increased disease susceptibility of the DR3/DR4 heterozygote for IDDM.

Risk factors for breast cancer in women with proliferative breast disease

To assess the importance of various risk factors for breast cancer in women with benign proliferative breast lesions, we reevaluated 10,366 consecutive breast biopsies performed in women who had presented at three Nashville hospitals. The median duration of follow-up was 17 years for 3303 women, 1925 of whom had proliferative disease. This sample contained 84.4 per cent of the patients originally selected for follow-up. Women having proliferative disease without atypical hyperplasia had a risk of cancer that was 1.9 times the risk in women with nonproliferative lesions (95 per cent confidence interval, 1.2 to 2.9). The risk in women with atypical hyperplasia (atypia) was 5.3 times that in women with nonproliferative lesions (95 per cent confidence interval, 3.1 to 8.8). A family history of breast cancer had little effect on the risk in women with nonproliferative lesions. However, the risk in women with atypia and a family history of breast cancer was 11 times that in women who had nonproliferative lesions without a family history (95 per cent confidence interval, 5.5 to 24). Calcification elevated the cancer risk in patients with proliferative disease. Although cysts alone did not substantially elevate the risk, women with both cysts and a family history of breast cancer had a risk 2.7 times higher than that for women without either of these risk factors (95 per cent confidence interval, 1.5 to 4.6). This study demonstrates that the majority of women (70 per cent) who undergo breast biopsy for benign disease are not at increased risk of cancer. However, patients with a clinically meaningful elevation in cancer risk can be identified on the basis of atypical hyperplasia and a family history of breast cancer.

The contribution of low birth weight to infant mortality and childhood morbidity

The low-birth-weight infant remains at much higher risk of mortality than the infant with normal weight at birth. In the neonatal period, when most infant deaths occur, the proportion of low-birth-weight infants, especially those with very low weight, is the major determinant of the magnitude of the mortality rates. Furthermore, differences in low-birth-weight rates account for the higher neonatal mortality rates observed in some groups, particularly those characterized by socioeconomic disadvantages. Much of the recent decline in neonatal mortality can be attributed to increased survival among low-birth-weight infants, apparently as a result of hospital-based services. The application of these services is currently considered cost-effective, although whether this will continue to be true in the future is unclear because of the increased survival of very tiny infants. Although low-birth-weight infants remain at increased risk of both postneonatal mortality and morbidity in infancy and early childhood, the risk is substantially smaller than that of neonatal death. In addition, these adverse later outcomes have not offset the gains achieved in the neonatal period. Nonetheless, the increased survival of high-risk infants raises concern about their future requirements for special medical and educational services and about the stress on their families. Despite increased access to antenatal services, only moderate declines in the proportion of low-birth-weight infants has been observed, and almost no change has occurred in the proportion of those with very low weight at birth. In addition, in many areas of the country the birth-weight-specific neonatal mortality rates are similar for groups at high and low risk of neonatal death. In view of these findings, continuation of the current decline in neonatal mortality and reduction of the mortality differentials between high- and low-risk groups require the identification and more effective implementation of strategies for the prevention of low-weight births.