AIDS in El Salvador

The 1st case of AIDS in El Salvador was diagnosed at Rosales Hospital in San Salvador in October 1985, in a bisexual man who had recently returned from the US. Since that time there have been 110 cases at Rosales Hospital, 81% in men. Of these patients, 54% report exclusively heterosexual histories; 42% report no travel outside El Salvador, 33% report travel to the US, 12% to Honduras, and 7% to Mexico. Risk factors include multiple sexual partners in 61%, prostitution in 7%, and injected drug use in 5%. To date, 52% are known to have died, 18% are alive, and the fate of the remainder is unknown. 5 children with symptomatic HIV infection have been seen at the Benjamin Bloom National Children's Hospital. As of September 1991, 504 persons nationwide were known to be HIV-seropositive, 63% of whom lived in San Salvador. Seropositivity among blood donors at Rosales Hospital has increased from 0% in 1988, when screening began, to 0.265 in 1991.

Epidemiologic aspects of male gonococcal infection in Greece

OBJECTIVE

To report male gonorrhea incidence trends between the years 1974 and 1996 and compare the epidemiologic characteristics of the affected population during periods of high and low incidence of the disease.

STUDY DESIGN

Retrospective study of all available data for male gonorrhea cases recorded annually in a major STD hospital in Greece since 1974.

RESULTS

An abrupt drop in gonorrhea relative incidence occurred in 1986, followed by low rates thereafter. In the context of the overall decline in the incidence of the disease, a shift to older ages, longer time elapsed before seeking medical assistance, and higher proportion of disease repeaters was noticed among the patients. Infections caused by penicillinase-producing gonococci were strongly associated with contacts outside the country or with foreigners and their incidence presented erratic time fluctuations, indicating that they have not been established as endemic in the Greek population.

CONCLUSION

The core group hypothesis in terms of nighttime sociosexual activity can be used to interpret most of the findings.

[Female sex hormones increase the risk of breast cancer]

The incidence of breast cancer in women in increasing, partly due to changes in age distribution in the population, and partly due to a real increase in risk. Changes in family patterns may, to some extent, explain the increased risk since giving birth to a first child late in life and bearing few children both increase the risk of breast cancer. The influence of female sex steroids on the breast plays a central role, but the biological mechanism is not clearly understood. There is a certain amount of risk involved in using hormonal medication (oral contraceptives or postmenopausal hormone replacement), but on ceasing to take the medication, risk will revert to the expected rate within a few years. Future epidemiological research on breast cancer will concentrate on events occurring during hormonally potent phases of life, such as growth and development during the fetal period, and sexual and somatic maturation during adolescence. Until now only modest interest has been shown in researching these two particular phases, but both may be important for the natural course of breast cancer.

Seasonal rainfall variability, the incidence of hemorrhagic fever with renal syndrome, and prediction of the disease in low-lying areas of China

To investigate determinants of hemorrhagic fever with renal syndrome (HFRS) in low-lying areas of China, the authors studied Chuigang and Wanggang communities in Anhui Province. These adjacent farming communities have a population of about 100,000. Data were collected from the two communities in 1961-1977 and from Yingshang County in 1983-1995; information covered the incidence of HFRS, amount of precipitation, differences in the water level of the Huai River, density of Apodemus agrarius, autumn crop production, and areas of inundated farmland. Correlation and multiple linear regression analyses were used to estimate the relation between seasonal rainfall, density of mice, occupational factors, and occurrence of the disease. Associations were observed between the incidence of HFRS and the amount of precipitation, the water level of the Huai River, and the areas of inundated farmland in Chuigang community. The smaller the water-level difference, the less farmland was inundated and the higher the incidence of HFRS. In Wanggang community, the density of A. agrarius (r1=0.63, p=0.02), the water-level difference in the Huai River (r2=-0.81, p=0.007), and crop production (r3=0.96, p=0.005) were correlated with the incidence of HFRS. The regression analyses based on Wanggang community suggested that these indexes could be used as predictive variables, and the results from the model were well calibrated with the actual incidence of HFRS in that community (R2=0.88, p < 0.01) and Yingshang County (R2=0.91, p < 0.01).

HIV epidemic in Punjab, India: time trends over a decade

Although Bombay (Mumbai) appears to be the main focus for acquired immunodeficiency syndrome (AIDS) in India, rapid spread has occurred through other major cities as well. The first AIDS patient in the northern state of Punjab was reported in May 1987. The present study, spanning a decade, shows that the incidence in high-risk groups increased from 3 per 1000 in 1987 to 59 per 1000 in 1997, 73% of the cases being in the third and fourth decades of life, i.e. the most productive years. The male to female ratio was 3.1:1, and 29% of the patients had the full-blown disease. A total of 80.5% acquired the infection heterosexually and only 2% of the patients were intravenous drug users. The percentage of patients acquiring infection through blood, blood products, and haemodialysis dropped from 20% in 1987 to 5% in 1997, but the cumulative figure was still 12%. The intervention programme launched by the National AIDS Control Organization (NACO) appears to have had little impact on the epidemic. There is an urgent need therefore for more interactive programmes that include education concerning the modes of spread, course, financial implications and fatal outcome of the disease, instead of passive dissemination of information by posters and the media.

An examination of current control strategies for Asian schistosomiasis in the Dongting lake region of China. II. A five year follow-up survey on Qingshan island

In 1995-1996 we conducted an epidemiological survey in two communities (1656 individuals) on Qingshan island, Hunan province P.R. China, in order to determine the efficacy of current control strategies since their upgrading in 1991. In 1996, the overall prevalence for Schistosoma japonicum, Ascaris lumbricoides, Ancylostoma duodenale, and Trichuris trichiura had decreased moderately since 1991. The age-specific prevalence for S. japonicum for each of the representative age groups decreased slightly, but there was a significant reduction in these prevalences for the 5-9 (P < 0.01), 55-59 (P < 0.05) and the over 60 (P < 0.01) age groups. The 1996 intensities of infection for schistosomiasis were higher for all the age categories except for those aged 0-4 and 25-29 years of age. When the study population was further classified according to the percent uninfected, lightly infected (8-100 eggs/g (epg)), moderately infected (101-400 epg) and heavily infected (> 400 epg) for S. japonicum, there were fewer (5.6%) people infected in 1996 but the proportions of moderately (21.3 vs. 15.5%) and heavily (7.6 vs. 2.3%) infected individuals were higher than those observed in 1991. The reported cases of weakness and hepatomegaly (MSL > or = 3) were significantly lower (P < 0.01) in 1996 for both uninfected and infected (all intensities) individuals. General episodes of diarrhoea were also significantly lower in 1996 for those lightly (P < 0.05) and heavily (P < 0.01) infected. Likewise, the occurrence of splenomegaly (Hackett's > or = 2) was significantly lower among uninfected (P < 0.01) and heavily infected (P < 0.05) patients. In summary, although significant progress has been made in controlling schistosomiasis and other helminth infections in this highly endemic focus for schistosomiasis, there is still room for improvement. Chemotherapy for bovines and humans, mollusciding for Oncomelania control and health education should be initiated and upgraded if the health and well being of these island communities is to further improve.

Geographical distribution and dramatic increases in incidences of malaria: consequences of the resettlement scheme in Gambela, SW Ethiopia

The spatial distribution of malaria results from the interaction between vector, parasite, host, physical and human environments. This basic geographical approach provides an illustration of the geographical distribution of malaria in the world, particularly in the tropical regions. Due to the global climate change and population movements, it is predicted that malaria could have a greater impact on the non-immune or unprepared populations in the Northern Hemisphere in the coming decades. Presently, Sub-Saharan Africa (SSA) is the most adversely affected region in the world. Like any other SSA country, Ethiopia suffers from both epidemic (unstable) and endemic (stable) malaria in the high and lowland regions, respectively. Gambela is one of the areas with stable malaria in the humid tropical region of the country. This study is based on observations, unpublished data, interviews and discussions with settlers and officials in Gambela. It is found that a degree of diverse malaria prevalence is associated with altitudinal, temperature and rainfall variations. Owing to the settlement and land-use changes, unexpected rainfall patterns, temperature increase, unstable political system and poverty, malaria has gone beyond its geographical limits. As a result, the number of malaria affected people has increased in the last 12 years. It is suggested that proper physical and social planning, understanding the geography, entomology, epidemiology, behaviour and life-cycle of malaria parasite, cooperation between the policy-makers, malaria specialists, neighbouring countries and international communities are urgent, if malaria has to be controlled and eradicated.

Rising HIV infection rates in Ho Chi Minh City herald emerging AIDS epidemic in Vietnam

OBJECTIVE

To describe the epidemiology of HIV in Ho Chi Minh City in the context of current surveillance data from Vietnam.

METHODS

Since the late 1980s, HIV surveillance data have been collected in Ho Chi Minh City from centers for the treatment of venereal disease and tuberculosis, centers for the rehabilitation of injecting drug users and sex workers, prenatal clinics, blood banks and other sites.

RESULTS

The first case of HIV infection in Vietnam was identified in 1990 in Ho Chi Minh City. The cumulative number of reported HIV infections in this city at the end of 1996 was 2774, about half of the number of cases in the country; 86% of infections were among men, 86% among injecting drug users, 2.5% among patients with sexually transmitted diseases and 2.5% among sex workers. The first HIV infection among antenatal women was detected in 1994. The prevalence of HIV among injecting drug users rose dramatically from 1% in 1992 to 39% in 1996, compared with 1.2% among sex workers, 0.3% among blood donors and 1.3% among tuberculosis patients in 1996. The populations of injecting drug users and sex workers in Ho Chi Minh City are estimated to be 30000 and 80000, respectively, and rates of sexually transmitted diseases are 2-3 per 1000 persons per year. By the end of December 1996, 42 out of 53 provinces had reported HIV infections, and border areas near China and Cambodia began identifying large numbers of HIV-seropositive people.

CONCLUSIONS

Ho Chi Minh City is at the forefront of a new HIV epidemic in Vietnam. This epidemic shows similarities to that in Thailand nearly a decade ago, with rapidly rising HIV rates among injecting drug users and infection already established among sex workers. Prevention efforts should include the targeting of injecting drug users and sex workers outside rehabilitation centers, the availability of sterile needles and condoms, the establishment of anonymous testing sites, the control of sexually transmitted diseases and the coordination of programs within southeast Asia.

A community-based programme to provide prompt and adequate treatment of presumptive malaria in children

A community-based programme to ensure prompt and adequate treatment of presumptive episodes of clinical malaria in children has been established in a rural province of Burkina Faso. The implementation strategy was based on training a core group of mothers in every village and supplying community health workers with essential antimalarial drugs specially packed in age-specific bags containing a full course of treatment. Drugs were sold under a cost-recovery scheme. The programme was run in 1994 by the national malaria control centre (CNLP), and in 1995 it was developed to the provincial health team (PHT). Knowledge and awareness of malaria increased with the intervention. Drug consumption by age group was compatible with the distribution of disease, and no major problem of misuse emerged. The actual implementation costs of the intervention were US$ 0.06 per child living in the province. An evaluation of the impact of the intervention on the severity of malaria, using routine data from the health information system and taking as an indicator the proportion of malaria cases which were recorded as severe in health centres, was performed. In 1994, when the intervention was implemented on a provincial scale by CNLP, this proportion was lower than the average of the 4 preceding years (3.7% vs. 4.9%). In 1995, when the programme was implemented by the PHT, the proportion of severe cases was lower in health centres achieving a programme coverage of > or = 50% in their catchment area compared with the others (4.2% vs. 6.1%). Our experience shows that a low-cost, community-based intervention aimed at providing children with prompt and adequate treatment of presumptive episodes of clinical malaria is feasible, and suggests that it may lead to a reduction in the morbidity from severe malaria.

Cuba shows jump in HIV positives

Cuba experienced a substantial increase in the number of HIV cases in 1996 due primarily to a growth of foreign tourism and an increase in prostitution, health officials said. The Juventud Rebelde newspaper said that since HIV/AIDS testing began in 1985, government-run hospitals and clinics have detected 1609 HIV-positive cases. In 1995 the total was reported at 1196, meaning that 413 new cases were detected in 1996. This compared with only 97 new cases reported during 1995. HIV infection among the island's 11 million inhabitants has remained relatively low due to a massive testing program and a public health infrastructure that provides universal and free medical treatment. Cuba was a pioneer in the use of interferon on those testing HIV-positive. Cuba produces its own interferon, which prolongs the life expectancy of patients, and also reagents for AIDS testing. There are special sanitariums for AIDS patients in most of Cuba's 12 provinces. Cuban adults who test HIV-positive are required to enter the sanitarium in a policy reminiscent of the way tuberculosis patients were tested in the US earlier in this century. Officials said the isolation of patients in sanitariums has been somewhat relaxed over past years by introducing greater flexibility in allowing persons who are considered reliable to live at home or make prolonged visits.

China reports increase in AIDS cases

The number of people in China testing positive for HIV grew by 369 in the first 3 months of 1997, reaching 6359, according to figures from the Ministry of Health. The ministry previously had reported that as of the end of October 1996, 5157 people in China were known to be infected with HIV. The government estimates, however, that the actual number of people infected with HIV is about 100,000. AIDS has spread rapidly in parts of China, and China is concerned about a threat from neighboring countries where the rate of infection is much higher, the China Daily quoted Vice Minister of Health Yin Dakui as saying at the opening of a conference on AIDS. China plans to set up a National Center for AIDS Control to provide guidance for AIDS research, Yin said.

Health official emphasizes increase in malaria, AIDS, and TB incidence. International (Zimbabwe)

Zimbabwe has recorded more than 255,000 cases of malaria since the rainy season began last November, 1996. Almost 500 infected people have died of the disease. The death toll from malaria during the same period a year ago was 200; in all, over 2000 people died of malaria in 1996. The increase in disease incidence is attributed to the especially wet rainy season Zimbabwe is experiencing this year. Conditions are favorable for the disease-carrying mosquitoes to breed. Timothy Stamps, Zimbabwe's Minister of Health and Child Welfare, announced these figures at the Medic Africa 1997 exhibition held in Harare on April 16, 1997. According to an article by Segun Adeyemi, a Panafrican News Agency correspondent, Stamps told "some of the continent's top scientists attending [the exhibition] that the health challenges facing African and other developing countries [remain] as daunting as ever." HIV/AIDS research updates also were presented at the exhibition, a 3-day international medical event which includes conferences and seminars presented primarily by research scientists. According to Adeyemi, Stamps told his audience that "the HIV/AIDS pandemic continues to decimate critical human resources and overwhelm the health care system with no respite in sight." "Coupled with that," Adeyemi wrote, "was the vengeful return of tuberculosis, which had since become more difficult to treat and cure. The disease had hitherto been brought under control through immunization and multi-drug therapy."

Basic care reduces neonatal hyperbilirubinaemia

We studied the frequency of jaundice, bilirubin estimations, phototherapy administration and exchange transfusions performed at 5 year intervals (1981, 1986 and 1991) among babies admitted to special care unit and those managed in postnatal ward, showing a decline which was significant except for the number of exchange transfusions performed. The number of term babies with serum bilirubin > 15 mg/dl and preterm babies with serum bilirubin > 10 mg/dl also declined significantly without prophylactic phototherapy or pharmacotherapy.

Trends in cervical cancer mortality in the Americas

This article presents an assessment of cervical cancer mortality trends in the Americas based on PAHO data. Trends were estimated for countries where data were available for at least 10 consecutive years, the number of cervical cancer deaths was considerable, and at least 75% of the deaths from all causes were registered. In contrast to Canada and the United States, whose general populations had been screened for many years and where cervical cancer mortality has declined steadily (to about 1.4 and 1.7 deaths per 100,000 women, respectively, as of 1990), most Latin American and Caribbean countries with available data have experienced fairly constant levels of cervical cancer mortality (typically in the range of 5-6 deaths per 100,000 women). In addition, several other countries (Chile, Costa Rica, and Mexico) have exhibited higher cervical cancer mortality as well as a number of noteworthy changes in this mortality over time. Overall, while actual declining trends could be masked by special circumstances in some countries, cervical cancer mortality has not declined in Latin America as it has in developed countries. Correlations between declining mortality and the intensity of screening in developed countries suggest that a lack of screening or screening program shortcomings in Latin America could account for this. Among other things, where large-scale cervical cancer screening efforts have been instituted in Latin America and Caribbean, these efforts have generally been linked to family planning and prenatal care programs serving women who are typically under 30; while the real need is for screening of older women who are at substantially higher risk.

Epidemiology of HIV and AIDS in the Asia-Pacific region

The incidence of new HIV infections in Asia and the Pacific will soon pass that in Africa and is projected to increase into the next century. The AIDS epidemic arising from these infections will have enormous consequences for the health and socioeconomic development of a region encompassing more than half the world's population.

Trends in sexually transmitted diseases and condom use patterns among commercial sex workers in Fukuoka City, Japan 1990-93

OBJECTIVE

To investigate trends in sexually transmitted diseases (STDs) among female commercial sex workers and in their condom use patterns during the period from 1990 to 1993 in Fukuoka, Japan.

METHODS

The study group consisted of a total of 824 commercial sex workers who attended an STD clinic to undergo screening for STDs including chlamydia, gonorrhoea, syphilis, hepatitis B and HIV-1 infection during the period from 1990 to 1993. For detection of Chlamydia trachomatis and Neisseria gonorrhoeae, endocervical smear specimens were taken from the women. Blood samples were obtained for serological diagnosis of syphilis, hepatitis B and HIV-1. Commercial sex workers who visited the clinic during the period from November to December of 1993 were interviewed concerning past (1990 and 1991) and recent (1992 and 1993) condom use patterns.

RESULTS

The annual detection rates of C trachomatis and N gonorrhoeae declined significantly from 16.3% in 1990 to 12.2% in 1993 (P < 0.0001) and from 1.5% in 1990 to 0.8% in 1993 (P = 0.0096), respectively. There was a remarkable reduction in the annual syphilis infection rate, from 7.5% in 1990 to 0.5% in 1993 (P = 0.0011). The positive rate for the hepatitis B surface antigen in the women ranged from only 0.6% to 1.9% and none were found to be positive for HIV-1 during the 4-year period. During the same period, there was a significant increase in the proportion of commercial sex workers always using condoms from 6.3% in 1990-91 to 25.3% in 1992-93 (P = 0.0023).

CONCLUSION

The prevalences of chlamydia, gonorrhoea, and syphilis infections decreased significantly among commercial sex workers in Fukuoka from 1990 through 1993, and no commercial sex workers were HIV-1 seropositive. The reductions in the prevalence of major STDs may be related to the increased use of condoms.

Breast cancer in Singapore: trends in incidence 1968-1992

BACKGROUND

Breast cancer is the most commonly occurring cancer among women in Singapore, a country which has experienced significant changes in lifestyle over the past three decades. The increase in incidence of the disease is a matter of some concern.

METHODS

Data from the population-based Singapore Cancer Registry for 1968-1992 were used to determine time trends, inter-ethnic differences and the contributions of age, period and cohort effects to the incidence of the disease.

RESULTS

Our results revealed an average annual increase of 3.6% over the 25-year period for all women, form 20.2 per 100,000 women in the period 1968-1972 to 38.8 per 100,000 in 1988-1992. There was a statistically significant difference between the three major ethnic groups, the rate of increase being highest in Malays (4.4%) and lowest in Indians (1.4%). The overall increase was attributable to a strong cohort effect that remained significant when adjusted for time period for Chinese women and for all ethnic groups combined. The risk was observed to increase in successive birth cohorts from the 1890s to 1960s.

CONCLUSIONS

Our results suggest that breast cancer incidence rates are likely to continue to increase more sharply in the future as women born after the mid-20th century reach the high-risk age groups. They also suggest the pattern by which important aetiological factors for the disease in our population have exerted their effects, and provide support for the role of demographic and lifestyle changes as possible risk factors.

Trend of HIV infection in patients with pulmonary tuberculosis in south India

SETTING

Tuberculosis is life threatening, transmissible and pandemic especially among millions of HIV infected persons. In developing countries like India where HIV infection is becoming prevalent and where tuberculosis infection has long been endemic, its incidence is increasing.

OBJECTIVE

The aim of the study was to find out the trend of HIV infection in patients with pulmonary tuberculosis in south India.

DESIGN

HIV seropositivity was assessed in 1430 radiologically and/or bacteriologically confirmed pulmonary tuberculosis patients attending major tuberculosis institutions in Madras by the AIDS Cell, Institute of Microbiology, Madras Medical College, Madras from January 1991 to May 1993.

RESULTS

HIV seropositivity was found to rise significantly from 0.77% in 1991 to 3.4% in 1993 (P < 0.05). 22 (91.67%) of a total of 24 HIV seropositive pulmonary tuberculosis patients had pulmonary cavities and 21 patients (87.5%) had bacteriological confirmation of tuberculosis.

CONCLUSION

The findings of this prospective study suggest that pulmonary tuberculosis patients with HIV infection are an in early phase of immunosuppression. This study reveals the rising trend of HIV infection; all persons with tuberculosis should therefore be questioned about the risk factors for HIV infection and urged to have an HIV test.

AIDS infection rising in Singapore

Singapore reported a rise in the number of people with HIV, with most being single men infected through casual sex with women. In its latest report, the government said 65 new cases of HIV infection were detected in the first 10 months of 1994, up 30% from the 50 new cases in January-October 1993. The number of HIV patients in Singapore has been rising steadily since the first two cases were reported in 1985. Among 1994's patients, 56 are men--almost 80% of them single and below 40 years of age. All reportedly contracted the infection through sexual relations. In all of Asia, an estimated 2.5 million people are infected with the virus, with HIV spreading faster than anywhere else in the world. According to the WHO (World Health Organization), the figure is expected to increase to 10 million by the year 2000. Worldwide there are 16 million adults and 1 million children infected with HIV. Since 1985, 287 Singaporeans have been found to be HIV-infected. Of them, 37 have advanced AIDS.

Sentinel surveillance of HIV-1 infection in Tamilnadu, India

The objective was to determine the time trends in the prevalence of HIV infection and to evaluate appropriate preventive intervention in different population groups. Sentinel surveillance of HIV-1 infection by anonymous unlinked technique was carried out in Tamilnadu from December 1989 to March 1993. The sentinel population monitored were attendees of STD clinics, blood donors and antenatal mothers. The results of HIV seropositivity were compared for each 6-month period. During the study period there was 10-fold rise of HIV seropositivity among STD patients (1% to 10%), 2-fold rise among antenatal attendees (0.37% to 0.76%), and 3-fold rise in blood donors (0.24% to 0.72%). There was a steady increase in the incidence of HIV infection among those with high risk behaviour (STD attendees) as well as in the general population. This information is of value in planning and evaluation of preventive and control programmes in India.

Changing scenario of birthweight in south India

Reducing incidence of low birthweight and increasing mean birthweights are now considered seriously in the national action plans. Comparison of birthweights obtained over two decades from the representative random segments of rural and urban areas of North Arcot Ambedkar district, Tamil Nadu, India, were studied. Although statistically significant (p < 0.001), the mean birthweight shows only a marginal increase of 70 g from 2774.5 g (+/- 500.2) in 1969-73 to 2845.4 g (+/- 451.0) in 1989-93. The mean birthweight stratified by area and gender also revealed similar increase. On the other hand, the proportion of low birthweight (< 2500 g) newborns reduced significantly from 27.2% to 15.9% in rural and 19.1% to 10.8% in urban area over the decades (p < 0.001). The increase in the mean birthweight and the decline in the percentage of low birthweight newborns over the years was greater in rural than the urban community, but the rural newborns continued to weigh lesser than their urban counterparts.

Condom promotion, sexually transmitted diseases treatment, and declining incidence of HIV-1 infection in female Zairian sex workers

The control of sexually transmitted diseases, including HIV-1, among sex workers and their clients in urban areas in developing countries, is considered a valuable and cost-effective intervention to contain the spread of HIV-1. The effect of a programme of STD treatment combined with condom promotion on HIV-1 incidence has so far not been measured. During an intervention including condom promotion, as well as monthly sexually transmitted disease screening and treatment among 531 initially HIV-1 negative female sex workers in Kinshasa, Zaire, 70 became infected with HIV-1 (incidence of 8.0 per 100 women-years [wy]). A decline of HIV-1 incidence was observed over time, from 11.7/100 wy during the first 6 months, to 4.4/100 wy over the last 6 months, 3 years later (p = 0.003). Simultaneously, regular use of condoms with clients went up from 11% to 52% and 68%, after 6 and 36 months of intervention, respectively. Risk factors for HIV-1 seroconversion after multivariate analysis included irregular condom use (RR 1.6 [95% Cl 1.1-2.8]), gonorrhoea (RR 2.5 [1.1-6.4]), trichomoniasis (RR 1.7 [1.1-2.8]), and genital ulcer disease (RR 2.5 [1.1-6.4]), during the probable period of acquisition of HIV-1. In women who attended more than 90% of their clinic appointments, the HIV-1 incidence was 2.7/100 wy compared to 7.1, 20.3, and 44.1 per 100 wy among women who attended 76-90%, 50-75%, and less than 50% of the monthly appointments, respectively (p < 0.0001). These trends remained after controlling for reported condom use and number of clients. This study confirms earlier findings that STDs facilitate transmission of HIV-1 and shows that a clinic-based intervention consisting of STD care and condom promotion can result in a major decline of HIV-1 incidence among female sex workers.

Liver damage from low-dose oral contraceptives

OBJECTIVE

To study whether the decrease in the content of oestrogen and gestagen in modern low-dose oral contraceptives (OC) has yielded a lower incidence of adverse liver reactions, and to describe the biochemical pattern of the adverse liver reactions from low-dose OC.

DESIGN

We surveyed all liver reactions from OC reported to SADRAC (Swedish Adverse Drug Reactions Advisory Committee) from 1966 to 1989.

MAIN OUTCOME MEASURE

Incidence of reported adverse liver reactions (number of reported adverse reactions/OC sales in defined daily dose [DDD]).

RESULTS

There was a sharp decline in the number of reports during the studied period, suggesting changes in reporting habits. However, there was also a significantly lower incidence of reports for medium-compared to high-oestrogen dose OC, and a further decrease, albeit non-significant, in incidence with low-oestrogen dose OC. Furthermore, in three comparisons of pairs of OC that differed only in the gestagen dose, there was a strong trend towards a higher reporting rate with higher gestagen dose. Cholestatic and hepatocellular liver enzyme patterns were equally frequent in patients with adverse reactions from low-dose oestrogen OC. There was no report of liver tumours related to use of low-oestrogen dose OC.

CONCLUSION

There seems to be a decrease in the incidence of adverse liver reactions related to lower contents of both oestrogen and gestagens in OC of the combined-preparation type.

Perinatal mortality in caesarean section: a disturbing picture of unfulfilled expectations

Indications for caesarean section had been studied in a 2-year period and the incidences were compared to that of the same 15 years back. Though there are more incidences of caesarean section, still perinatal death is a major concern to all. The study included a total of 291 perinatal deaths of which there were 208 early neonatal deaths and 83 stillbirths over a period of 2 years from January, 1990 to December, 1991. Caesarean section is being increasingly performed for foetal interest, but this study reveals that perinatal mortality is still high though cesarean section rate has increased in recent times.

A 13-year follow-up of treatment and snail control in an area endemic for Schistosoma mansoni in Brazil: incidence of infection and reinfection

The incidences of Schistosoma mansoni infection and reinfection were investigated in an endemic area of Brazil (Peri-Peri, State of Minas Gerais) where chemotherapy and snail control had been used for 13 years (1974-87). Two cohorts were followed: the first consisted of 584 individuals with no evidence of infection at entry (infection cohort), and the second comprised 296 individuals who were treated and did not eliminate eggs 8-12 months afterwards (reinfection cohort). The incidence of infection (per 100 person-years) decreased from 7.5 in 1974-77 to 3.6 in 1986-87, and that of reinfection from 21.3 in 1974-77 to 3.7 in 1986-87. Calendar period, age at risk, and sex were independently associated with both infection and reinfection, while a heavy S. mansoni egg count prior to treatment (> or = 500 epg (eggs per gram of stools)) was independently associated with reinfection. The geometric mean number of eggs after treatment among those reinfected (47 epg) was approximately half that among those infected for the first time (81.5 epg). Age at risk had the greatest effect on both infection and reinfection. The rate ratios of infection and reinfection were 3 to 6 times higher among individuals younger than 20 years than among those aged > or = 25 years, even after adjusting for confounders. This suggests the existence of a strong protective effect with increased age (because of biological and/or environmental factors) for both infection and reinfection.

Breast-feeding rate has dropped to 12.7% in Shanghai

Only 1 baby in 8 is lucky enough to be fed at the breast in Shanghai. According to the Conference on the Promotion of Breastfeeding in China held on November 11, 1991, the breastfeeding rate in Shanghai has kept dropping with years. The rate is 32% is 1979, 23% in 1984, and only 12.7% in 1991 according to the sample survey. Although breastfeeding has been put on the agenda of the work of maternal and child care since the late 1970s and much work has been done by the maternal and child care workers on this, the trend of dropping of the breastfeeding rate is still hard to be reversed. Specialists in the field think the reason behind this is that many parents as well as grandparents are afraid that their only baby cannot be fully fed at the breast, and they only see fast weight gaining as a sign of healthiness. In addition, the marketing and gifting of the overseas dried-milk businessmen is also dedicated to the dropping of the breastfeeding rate. So now some regulations have been formulated in Shanghai to prohibit businessmen from marketing and gifting dried milk to hospitals.

Sex steroid hormones and breast cancer: is there a link with oral contraceptives and hormone replacement therapy?

OBJECTIVE

To determine whether use of sex steroid hormones for contraception and hormone replacement therapy alters the risk of breast cancer, and whether the risk varies with their composition, duration of use, the period of a woman's life when the hormones are used, and after successful treatment for breast cancer.

DATA SOURCES

The results of important epidemiological reports, readily available from the English literature and published since 1981, were evaluated, using reports of basic scientific work as a background to the problem.

STUDY SELECTION

An attempt was made to obtain most of the relevant reports. Twenty case-control and seven cohort studies were available on the oral contraceptive pill (OCP) and eleven case-control and five cohort studies on hormone replacement therapy (HRT).

DATA EXTRACTION

The relative risk estimates for breast cancer (and their 95% confidence intervals) determined by each report were tabulated according to the specific conditions of analysis, for example users under age 25, duration of use. Results by meta-analysis from previous studies were also used to determine risk. A significant positive association was present when the risk estimate exceeded 1.0 and the 95% confidence interval did not cross 1.0.

DATA SYNTHESIS

Among OCP users, the vast majority of reports showed no significant risk of breast cancer--overall, longest duration of use, and use before first full-term pregnancy. However, a positive association between breast cancer and users under age 25 was found in three of eight reports. Similarly, the majority of reports showed no significant risk of breast cancer among HRT users, overall as well as in relation to duration of use and interval since first use. There was no increased risk with additional progestogen; it may be protective. An improved prognosis was found in users who developed breast cancer. On the limited data, use of hormones for postmenopausal symptoms did not appear to be harmful to women who had been successfully treated for breast cancer.

CONCLUSIONS

The review revealed good evidence that use of sex steroid hormones had no significant effect on the risk of breast cancer, whether given for contraception or hormone replacement. There was some concern about increased risk with prolonged use of the OCP, especially in younger women. At present, use of these hormones is a matter of informed choice, with individual considerations of the risk-benefit ratio.

Family planning clinics: facing higher costs and sicker patients

Family planning clinics throughout the United States are facing a variety of obstacles that threaten their ability to provide necessary contraceptive services to low-income women and teenagers, according to interviews with clinic administrators. In the last few years, the proportion of patients coming to family planning agencies in need of screening or treatment for sexually transmitted diseases (STDs) has increased dramatically. Many providers report that 10-15 percent of their clients are infected with chlamydia, the most prevalent STD. The increasing costs of Pap tests and contraceptives are also major problems: As a result of recent federal legislation, the price of Pap tests has risen substantially, and that of contraceptives is beginning to increase steeply. Finally, Title X funding for family planning services has decreased 66 percent over the last decade if both cuts and inflation are taken into account. As a result of the squeeze between increased costs and decreased public funding, clinics have been forced to charge higher fees, maintain long waiting lists for appointments and curtail community outreach. In addition, growth of the family planning patient population has slowed dramatically, and even declined, in some places.

Epidemic of caesarean sections in Brazil

Brazil has one of the highest rates of caesarean section in the world. Patterns of caesarean sections were studied in a cohort of 5960 mothers followed from 1982 to 1986 in southern Brazil. Overall, 27.9% were delivered by caesarean section in 1982, this proportion being 30% for nulliparae, 80% for second deliveries when the first was by caesarean, and over 99% for third births when the first two were by caesarean. Socioeconomic status and requests for sterilisation by tubal ligation were important underlying factors. 9.4% of the women were sterilised during a caesarean section (3.7% in the lowest income group and 20.2% in the highest). 31% of women who had had their first child by a caesarean section and who were having a second operative delivery were sterilised. The high rates of caesarean sections and accompanying sterilisations reflect the lack of appropriate reproductive and contraceptive policies in the country.

Oral contraceptives and rheumatoid arthritis: new data from the Royal College of General Practitioners' oral contraception study

From data available at April 1987 it was found that the standardised risk ratio for rheumatoid arthritis between current users of oral contraceptives and never users was 0.82 (95% confidence interval 0.59 to 1.15); the ratio between former users and never users was 0.94 (95% confidence interval 0.72 to 1.22). Important secular trends have occurred within our study population. The incidence of rheumatoid arthritis among former and never users has declined over the past two decades. Current users have not experienced this temporal trend, and the ratio between current and never users has, therefore, approached unity. These secular changes may explain why some studies have found that oral contraceptives have a protective effect, while others have been unable to show such an effect.

Rising trend of reported gonorrhoea and urethritis incidence in Burkina Faso from 1978 to 1983

Rising trends in gonorrhoea and urethritis infection rates are being reported from most African countries. We investigated infection trends in Burkina Faso from 1978 to 1983, using data provided by the Ministry of Health. The data included monthly distribution of cases to permit analysis of seasonal variations, average number of reported cases per four-week period to estimate the yearly trend, actual number of reported cases per four-week period to measure the secular trend, and a single-period moving average as a more stable measure of disease occurrence. Seasonal trends demonstrate that the average number of reported cases of gonorrhoea is highest from January to May, declines from May to July, and levels off from August to December. The yearly trend from 1978 through 1983 increased by an average of 10.2% per year (P less than 0.001). The geographical distribution of the incidence in 1983 indicates that the northern region around Dori has the greatest number of reported cases. This high frequency is likely to reflect the severity of the problem among the nomads of the north since reporting would probably be low from this under-served and under-populated region. Peak incidence is correlated with the harvest season and may reflect increased sexual contacts among young, mobile men. The rising rate of gonorrhoea/urethritis infection is an especially urgent matter, given the expanding epidemic of human immunodeficiency virus in West Africa.

Breastfeeding among low-income, high-risk women

Data from a state supported project providing multidiscipline (clinical social work, nursing, nutrition, obstetrics, and pediatrics) assistance to low-income women judged to be at high perinatal risk by medical and social history were analyzed regarding infant feeding decisions. Data from 2,124 subjects delivered from 1976 to 1985 were available for analysis. The population tended to be single (77%), black (66%), poorly educated (63% less than a high school education), and young (mean age 21.8 years). Thirty-six percent were primiparas. The decision to breastfeed was associated with white race, older maternal age, higher educational level, marriage, and earlier utilization of prenatal care. Prenatal infant feeding plans were compared with actual postpartum decisions for 1,168 women. Only 3 percent of those initially planning to bottle feed changed their minds postpartum and breastfed although 31 percent of those initially planning to nurse ultimately chose artificial feeding. Ten percent of women were initially undecided; one-third of this group ultimately breastfed, two-thirds bottle fed. Overall the percentage of women in the project who were breastfeeding rose from 15 percent to 22 percent from the early to later years of the project (p less than 0.0001).

Risk factors for breast cancer in Chinese women in Shanghai

Five hundred thirty-four histologically confirmed incident cases of breast cancer in Chinese women of Shanghai and an equal number of age and sex-matched population controls were interviewed as part of an epidemiological study of breast cancer risk factors. Early age at menarche was positively associated with breast cancer risk whereas early age at first full term pregnancy, high parity, and long duration of nursing were each negatively associated. We found high average body weight to be a risk factor, especially among women over age 60. Use of oral contraceptives after age 45 also was a risk factor, but use in general was not. Personal history of benign breast disease and history of breast cancer in first degree female relatives both increased risk. Multivariate analysis showed that each of these risk (or protective) factors was independently related to breast cancer. In addition to confirming most of the breast cancer risk factors of Western populations in a low risk developing Asian country, this study demonstrates a clear beneficial effect on breast cancer risk of lactation in a population characterized by a long cumulative duration of nursing in the majority of women. Finally, this study supports several other recent reports of a residual and beneficial effect of parity on breast cancer risk after controlling for age at first full term pregnancy.

Potential effect of revising the CDC surveillance case definition for AIDS

The Centers for Disease Control (CDC) revised the surveillance case definition for acquired immunodeficiency syndrome (AIDS) in August, 1987. To determine the impact of this revision, information was extracted from the medical charts of the 630 patients receiving comprehensive medical care as of 1980 at 6 haemophilia treatment centres, and who were therefore likely to have been infected with human immunodeficiency virus (HIV). 38 (6%) and 47 (7%) met the 1985 and 1987 case definitions, respectively (22% increase). Of the cases added by use of the 1987 case definition, 3 patients had HIV dementia, 3 had Pneumocystis carinii pneumonia (2 of whom were presumptively diagnosed and 1 who had been receiving steroids and immunosuppressives), and 3 had HIV wasting syndrome. These data suggest that the revision of the AIDS case definition will have a substantial impact on future AIDS surveillance trends in persons with haemophilia and perhaps in other risk groups.

Recent decline in gonorrhea incidence in Israel: possible association with the AIDS pandemic

The effect of the AIDS pandemic on the sexual behavior of the general population has not been clearly established. Since trends in the incidence of other sexually transmitted diseases may be a good marker of such behavioral changes, gonorrhea incidence in the civilian and military populations in Israel was examined during the period 1963-87. In the civilian population, the rates were relatively stable until 1967, when they increased to a peak in 1970 and then declined to the earlier levels. In 1982 a further decline began, which accelerated considerably in 1986 when the rates declined by 38%. During 1987 the decline was even more dramatic, with a drop of 60% compared with the rate of the previous year. A similar trend has been noted in the military population. The recent sharp decline in gonorrhea incidence may be related, at least partly, to a change in sexual behavior associated with the fear of AIDS. If so, its magnitude suggests that such changes have not been restricted to high-risk groups.