Abstract B17: Family history of breast and ovarian cancer prevalence and its association with triple-negative subtype in Hispanic women

Background: A family history of breast cancer in a first-degree relative is an established risk factor for breast cancer; however, little is known about the profile of breast and ovarian family history in Hispanic/Latina women. Importance of this relates to recent reports showing a high prevalence of BRCA mutations in Hispanic/Latina women and a pattern of multiple recurrent mutations. In addition, less is known about the association of family history and tumor subtype in this growing ethnic group in the U.S.

Methods: Study participants included breast cancer patients of Mexican descent enrolled in the Ella Binational Breast Cancer Study. We first assessed the self-reported breast and ovarian family history profile in 1,150 women. Second, we compared differences in family history of breast and ovarian cancer prevalence between triple negative breast cancer (TNBC) and non-TNBC in 914 patients with available tumor subtype data. Logistic regression was conducted to compare odds of TNBC to non-TNBC according to family history of breast and ovarian cancer.

Results: Prevalence of breast cancer family history in a first- and first- or second-degree relative was 13.1% and 24.1%, respectively. A history of breast or ovarian cancer in first-degree relatives was reported in 14.9% of the women. After adjustment for age and country of residence, women with a first-degree relative with breast cancer were more likely to be diagnosed with TNBC compared to non-TNBC (OR=1.98; 95% CI, 1.26-3.11). The odds of TNBC compared to non-TNBC was 1.93 (95% CI, 1.26–2.97) for women with first-degree relatives with breast or ovarian cancer. There was a suggestion of stronger associations between family history and TNBC among women diagnosed at age <50 compared to those >50 years for breast cancer history in first-degree (P-interaction=0.14) and first- or second-degree relatives (P-interaction=0.07).

Conclusion: Findings suggest that familial cancers are associated with triple negative subtype, possibly related to the prevalence of BRCA mutations in Hispanic women, which are strongly associated with TNBC. Improvement in collection of family history through new tools and instruments targeting English- and Spanish-speaking Hispanic women should be a priority for future research. Identification of a strong family history can ultimately affect treatment plans, screening practices, and prevention options both for patients and their relatives.

Citation Format: Maria Elena Martinez, Kristin Anderson, Patricia Thompson, Betsy C. Wertheim, Lorena Martin, Ian Komenaka, Melissa Bondy, Adrian Daneri-Navarro, Maria Mercedes Meza-Montenegro, Luis Enrique Gutierrez-Millan, Abenaa Brewster, Lisa Madlensky, Malaika Tobias, Loki Natarajan. Family history of breast and ovarian cancer prevalence and its association with triple-negative subtype in Hispanic women. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B17.

Overweight Perception: Associations with Weight Control Goals, Attempts, and Practices among Chinese Female College Students

BACKGROUND

Concurrent with the dramatic cultural and economic shifts occurring as mainland China becomes increasingly "Westernized," the weight perceptions, ideal body weight, and weight management goals and practices of Chinese females have also undergone significant changes.

OBJECTIVE

To investigate relationships between overweight status, weight perception patterns, and weight management goals and practices in Chinese female college students.

DESIGN/PARTICIPANTS/SETTING

A cross-sectional analysis was conducted with data from 902 female subjects aged 18 to 25 years participating in the China Seven Cities Study, a health promotion and smoking prevention study conducted in mainland China in 2003.

MAIN OUTCOME MEASURES/STATISTICAL ANALYSES

Logistic regression models were used to explore associations between overweight status, weight perception, specific weight management goals and practices, and current levels of vigorous-intensity physical activity and food consumption.

RESULTS

Based on World Health Organization standards for Asian adults, 16.7% of college females were overweight or obese, although 50.8% considered themselves to be "too heavy." Among participants perceiving themselves as overweight (n=458), 69.2% (n=371) were inaccurate and did not meet criteria for overweight or obese. The percentage of participants attempting weight loss was 48.2%, and 33.1% wanted to maintain their current weight. Attempts to lose or maintain weight were related to actual and perceived weight status, but not to increased vigorous-intensity physical activity or fruit and vegetable intake, nor to decreased consumption of sweets, soda, Western fast foods, and fried foods. Only 21.5% of participants desiring weight loss or maintenance reported using a combination of vigorous-intensity physical activity and a reduced-fat and -calorie diet, whereas 20.2% tried extreme methods such as fasting, using diet pills, vomiting, or smoking.

CONCLUSIONS

Our findings underscore the need to promote healthy weight management practices among Chinese female college students, with an emphasis on diet and physical activity strategies that encourage balance rather than extremes.

Family history of breast and ovarian cancer and triple negative subtype in hispanic/latina women

Familial breast and ovarian cancer prevalence was assessed among 1150 women of Mexican descent enrolled in a case-only, binational breast cancer study. Logistic regression was conducted to compare odds of triple negative breast cancer (TNBC) to non-TNBC according to family history of breast and breast or ovarian cancer among 914 of these women. Prevalence of breast cancer family history in a first- and first- or second-degree relative was 13.1% and 24.1%, respectively; that for breast or ovarian cancer in a first-degree relative was 14.9%. After adjustment for age and country of residence, women with a first-degree relative with breast cancer were more likely to be diagnosed with TNBC than non-TNBC (OR=1.98; 95% CI, 1.26-3.11). The odds of TNBC compared to non-TNBC were 1.93 (95% CI, 1.26-2.97) for women with a first-degree relative with breast or ovarian cancer. There were non-significant stronger associations between family history and TNBC among women diagnosed at age <50 compared to ≥50 years for breast cancer in a first-degree relative (P-interaction = 0.14) and a first- or second-degree relative (P-interaction = 0.07). Findings suggest that familial breast cancers are associated with triple negative subtype, possibly related to BRCA mutations in Hispanic/Latina women, which are strongly associated with TNBC. Family history is an important tool to identify Hispanic/Latina women who may be at increased risk of TNBC, and could benefit from prevention and early detection strategies.

Acclimation of photosynthetic characteristics of the moss Pleurozium schreberi to among-habitat and within-canopy light gradients

Light availability varies strongly among moss habitats and within the moss canopy, and vertical variation in light within the canopy further interacts with the age gradient. The interacting controls by habitat and canopy light gradient and senescence have not been studied extensively. We measured light profiles, chlorophyll (Chl), carotenoid (Car) and nitrogen (N) concentrations, and photosynthetic electron transport capacity (J(max)) along habitat and canopy light gradients in the widespread, temperate moss Pleurozium schreberi to separate sources of variation in moss chemical and physiological traits. We hypothesised that this species, like typical feather mosses with both apical and lateral growth, exhibits greater plasticity in the canopy than between habitats due to deeper within-canopy light gradients. For the among-habitat light gradient, Chl, Chl/N and Chl/Car ratio increased with decreasing light availability, indicating enhanced light harvesting in lower light and higher capacity for photoprotection in higher light. N and J(max) were independent of habitat light availability. Within the upper canopy, until 50-60% above-canopy light, changes in moss chemistry and photosynthetic characteristics were analogous to patterns observed for the between-habitat light gradient. In contrast, deeper canopy layers reflected senescence of moss shoots, with pigment and nitrogen concentrations and photosynthetic capacity decreasing with light availability. Thus, variation in chemical and physiological traits within the moss canopy is a balance between acclimation and senescence. This study demonstrates extensive light-dependent variation in moss photosynthetic traits, but also that between-habitat and within-canopy light gradient affects moss physiology and chemistry differently.

Interpreting Google flu trends data for pandemic H1N1 influenza: the New Zealand experience

For the period of the spread of pandemic H1N1 influenza in New Zealand during 2009, we compared results from Google Flu Trends with data from existing surveillance systems. The patterns from Google Flu Trends were closely aligned with (peaking a week before and a week after) two independent national surveillance systems for influenza-like illness (ILI) cases. It was much less congruent with (delayed by three weeks) data from ILI-related calls to a national free-phone Healthline and with media coverage of pandemic influenza. Some patterns were unique to Google Flu Trends and may not have reflected the actual ILI burden in the community. Overall, Google Flu Trends appears to provide a useful free surveillance system but it should probably be seen as supplementary rather than as an alternative.

Interpreting “Google Flu Trends” data for pandemic H1N1 influenza: The New Zealand experience

For the period of the spread of pandemic H1N1 influenza in New Zealand during 2009, we compared results from Google Flu Trends with data from existing surveillance systems. The patterns from Google Flu Trends were closely aligned with (peaking a week before and a week after) two independent national surveillance systems for influenza-like illness (ILI) cases. It was much less congruent with (delayed by three weeks) data from ILI-related calls to a national free-phone Healthline and with media coverage of pandemic influenza. Some patterns were unique to Google Flu Trends and may not have reflected the actual ILI burden in the community. Overall, Google Flu Trends appears to provide a useful free surveillance system but it should probably be seen as supplementary rather than as an alternative.

Pandemic influenza A(H1N1)v in New Zealand: the experience from April to August 2009

Following the detection of imported cases of pandemic influenza A(H1N1)v on 25 April 2009, New Zealand implemented containment measures that appeared to slow establishment of the pandemic during May. The pandemic accelerated markedly in June, reaching a peak within four to six weeks, and has been declining since mid-July. By 23 August there had been 3,179 recorded cases (97.8% reported as confirmed), including 972 hospitalisations, 114 intensive care admissions, and 16 deaths. Influenza-like illness (ILI) surveillance in general practice suggests that 7.5% (95% CI: 3.4-11.2) of the population of New Zealand had symptomatic infection, giving a case fatality ratio of 0.005%. Hospitalisations were markedly higher for Māori (age standardised relative risk (RR)=3.0, 95% CI: 2.9-3.2) and Pacific peoples (RR=6.7, 95% CI: 6.2-7.1) compared with Europeans and others. The apparent decline of the pandemic (shown by all surveillance systems) cannot be fully explained. New Zealand remains in the middle of its traditional influenza season, the influenza A(H1N1)v virus appears relatively infectious, and we estimate that only about 11% of the population have been infected by this novel agent.

How much do mental disorders contribute to New Zealand's tobacco epidemic?

OBJECTIVE

To quantify the share of tobacco consumed by people with 12-month mental disorders in New Zealand.

METHODS

Estimates of current smoking prevalence and the 12-month prevalence of three groups of mental disorders--anxiety, mood and substance use disorders--were derived from the New Zealand Mental Health Survey, a nationally representative survey of almost 13,000 adults (16+ years) fielded in 2003-4. Estimates of the smoking intensity ratio (comparing smokers with mental disorders to those without mental disorders) were derived from the 2006-7 New Zealand Health Survey.

RESULTS

Approximately 33% of all cigarettes are consumed by people with 12-month mental disorders (males 27%, females 39%), using an estimated smoking intensity ratio of 1.21. Among this group, anxiety disorders account for almost one-half of consumption, mood disorders for over one-quarter and substance use disorders for about one-fifth.

CONCLUSION

This study quantifies for the first time the contribution of mental disorders to tobacco consumption in New Zealand. In particular, it identifies anxiety disorders as an important risk factor for tobacco use. People with mental disorders are an important target group for tobacco control. Enhanced collaboration and sharing of expertise between smoking cessation service providers and community mental health services are urgently needed.

Explaining trends in coronary heart disease hospitalisations in New Zealand: trend for admissions and incidence can be in opposite directions

BACKGROUND

A recent increase in the absolute number of hospitalisations for acute myocardial infarction (AMI) in New Zealand may signal a new epidemic of coronary heart disease (CHD).

OBJECTIVE

To quantify the impact of factors other than incidence of disease on these national hospitalisation trends.

METHODS

A total of 324,663 electronic records of New Zealand public CHD hospitalisations from 1993 to 2005 were examined. Repeat admissions were identified by record linkage using a unique national health identifier for each patient.

RESULTS

Hospitalisations for AMI increased by about 8% a year throughout the 13-year study period. Interhospital transfers increased by 117% over the study period, while readmissions increased by 42%. By 2005 over 60% of all admissions for CHD were readmissions. After accounting for readmissions, hospital transfers and population changes, the age-standardised first AMI hospitalisation rate peaked in 1995 and has since declined by 15%. Reciprocal trends in AMI and angina hospitalisations were seen, indicating changing diagnostic criteria. Overall hospitalisation rates for first CHD events remained relatively steady at about 216.4 events per 100,000 between 1993 and 2000 and subsequently declined by 25% to 162.2 events per 100,000 in 2005.

CONCLUSION

Recent trends in hospitalisation rates for AMI are significantly influenced by factors other than underlying changes in CHD incidence. Increasing absolute numbers of admissions coded as AMI in New Zealand between 1993 and 2005 can be accounted for by increases in readmissions, increases in interhospital transfers, changes in diagnostic criteria for AMI and in demography.

How much downside? Quantifying the relative harm from tobacco taxation

OBJECTIVE

To estimate the loss of life expectancy attributable to tobacco taxation (via financial hardship and flow-on health effect) in New Zealand.

DESIGN

Data were used on the gradients in life expectancy and smoking by neighbourhood socioeconomic deprivation and survey data on tobacco expenditure. Three estimates were modelled of the percentage of the crude association of neighbourhood deprivation with life expectancy that might be mediated via financial hardship: 100%, 50%, and 25% (best estimate). From this information the impact of tobacco taxation on life expectancy was estimated.

MAIN RESULTS

For the total population, the estimated loss of life expectancy due to tobacco tax ranged from 0.005 years to 0.027 years. For people living in the most deprived 30% of neighbourhoods, the range was 0.009 to 0.044 years (that is, 3 to 16 days of lost life expectancy). For the total population the loss of life expectancy attributable to tobacco tax ranged from 119 to 460 times less than that attributable to deprivation. The loss of life expectancy attributable to tobacco tax was 42 to 257 times less than that attributable to smoking.

CONCLUSIONS

The estimated harm to life expectancy from tobacco taxation (via financial hardship) is orders of magnitude smaller than the harm from smoking. Although the analyses involve a number of simplistic assumptions, this conclusion is likely to be robust. Policy makers should be reassured that tobacco taxation is likely to be achieving far more benefit than harm in the general population and in socioeconomically deprived populations.

Site fertility and the morphological and photosynthetic acclimation of Pinus sylvestris needles to light

Morphological and photosynthetic acclimation of current-year needles to canopy gradients in light availability (seasonal mean integrated quantum flux density, Q(int)) was studied in the temperate conifer, Pinus sylvestris L., at two sites of contrasting nutrient availability. The nutrient-rich site supported a monospecific P. sylvestris stand on an old-field. The trees were approximately 30 years old and 19-21 m tall. Mean foliar N and P contents (+/- SD) were 1.53 +/- 0.11% and 0.196 +/- 0.017%, respectively. The nutrient-poor site was located on a raised bog supporting a sparse stand of 50- to 100-year-old trees, with a height of 1-2 m, and mean needle N and P contents of 0.86 +/- 0.12% and 0.074 +/- 0.010%, respectively. At both sites, needle thickness (T) and width (W) increased with increasing Qint, and leaf dry mass per unit leaf area (MA) was also greater at higher irradiance. The light effects on MA-the product of needle density (D) and volume to total area ratio (V/AT)-resulted primarily from large increases in V/AT with Qint rather than from modifications of D, which was relatively insensitive to light. Although needle morphology versus light relationships were qualitatively similar at both sites, needles were shorter, and the slopes of W, T, MA and V/AT versus light relationships were lower, at the nutrient-poor than at the nutrient-rich site, indicating that the plasticity of foliar morphological characteristics was affected by nutrient availability. As a result of lower plasticity, needles at the nutrient-poor site were narrower, thinner, and had lower MA at high irradiance than needles at the nutrient-rich site. The maximum carboxylase activity of ribulose-1,5-bisphosphate carboxylase/oxygenase (Vcmax) and the maximum photosynthetic electron transport rate (Jmax) scaled positively with foliar N and P contents. The correlations were generally stronger with P than with N, suggesting that needle photosynthetic capacity was more heavily limited by the availability of P than of N. The Jmax/Vcmax ratio was positively related to the foliar P/N ratio, indicating that Jmax was more strongly suppressed than Vcmax under conditions of low P availability. Phosphorus and N deficiency also limited the plasticity of foliar photosynthetic characteristics. There was a moderate increase in needle photosynthetic capacity of up to 1.6-fold from the bottom to the top of the canopy at the nutrient-rich site, but net assimilation rates were essentially independent of canopy position at the nutrient-poor site. Stomatal constraints on photosynthesis were similar between the sites, indicating that photosynthetic acclimation was curtailed at the biochemical level. We conclude that the foliar capacity for morphological and physiological acclimation to high light significantly decreases with decreasing nutrient availability in P. sylvestris, and that both N and P availability are potentially important determinants of foliar carbon gain capacities.

Sensitivity of photosynthetic electron transport to photoinhibition in a temperate deciduous forest canopy: Photosystem II center openness, non-radiative energy dissipation and excess irradiance under field conditions

We used chlorophyll fluorescence techniques to investigate responses of Photosystem II (PSII) quantum yield to light availability in the short term (quantum flux density integrated over the measurement day, Qd) and in the long term (Qd averaged over the season, Qs) in a mixed deciduous forest comprising shade-tolerant and water-stress-sensitive Tilia cordata Mill. in the lower canopy and shade-intolerant and water-stress-resistant Populus tremula L. in the upper canopy. In both species, intrinsic efficiency of PSII in the dark-adapted state (Fv/Fm) was lower during the day than during the night, and the difference in Fv/Fm between day and night increased with increasing Qs. Although the capacity for photosynthetic electron transport increased with increasing Qs in both species, maximum quantum efficiency of PSII in the light-adapted state (alpha) decreased with increasing Qs. At a common Qs, alpha was lower in T. cordata than in P. tremula primarily because of a higher fraction of closed PSII centers, and to a smaller extent because of limited, non-radiative, excitation energy dissipation in the pigment bed in T. cordata. Across both species, photochemical quenching (qP), which measures the openness of PSII centers, varied more than fivefold, but the efficiency of excitation energy capture by open PSII centers (Fv'/Fm'), which is an estimate of non-radiative excitation energy dissipation in PSII antennae, varied by only 50%. Chlorophyll turnover rates increased with increasing irradiance, especially in T. cordata, possibly because of increased photodestruction. Diurnal measurements of PSII quantum yields (PhiPSII) indicated that, under similar environmental conditions, PhiPSII was always lower in the afternoon than in the morning, and the fraction of daily integrated photosynthetic electron transport lost because of diurnal declines in PhiPSII (Delta) increased with increasing Qd. At a common Qd, mean daily PSII center reduction state, the fraction of light in excess (1 - fractions of light used in photochemistry and dissipated as heat) and Delta were higher in T. cordata than in P. tremula. This was attributed to greater stomatal closure during the day, which led to a greater reduction in the requirement for assimilative electron flow in T. cordata. Across both species, Delta scaled negatively with the fraction of light utilized photochemically, demonstrating the leading role of PSII center openness in maintaining high PSII efficiency. Because photosynthesis (A) at current ambient carbon dioxide concentration is limited by CO2 availability in high light and mainly by photosynthetic electron transport rates in low light, overall daily down-regulation of PhiPSII primarily influences A in low light. Given that foliar water stress scales positively with Qs in both species, we conclude that the inverse patterns of variation in water and light availabilities in the canopy result in a greater decline in A than is predicted by decreases in stomatal conductance alone.

Potentially avoidable hospitalisations in New Zealand, 1989-98

OBJECTIVE

To describe potentially avoidable hospitalisation in New Zealand, including recent trends and variations between groups differentiated by age, gender, ethnicity and degree of deprivation.

METHOD

Hospital discharges among people aged 0-74 years for the years 1989-98 were classified as 'potentially avoidable' or 'unavoidable' based on the ICD9-CMA code of the principal diagnosis. Potentially avoidable hospitalisations (PAH) were further subcategorised according to the intervention involved--primary prevention, ambulatory care or injury prevention.

RESULTS

By 1998, one in three of these hospitalisations was theoretically avoidable--two-thirds of these through more effective primary health care services. Although in practice only a proportion of these could realistically have been avoided, these estimates reveal considerable scope for further reduction in the incidence of serious disease and injury. Maori and Pacific people had age-standardised PAH rates approximately 60% higher than European and other New Zealanders. Similar discrepancies exist by socio-economic deprivation. Had all New Zealanders enjoyed the PAH rates of the most advantaged 40% of the population, 28% fewer potentially avoidable hospitalisations would have occurred in 1998, some 26,000 hospital admissions.

CONCLUSION

This analysis has revealed significant scope for the health sector to contribute to population health gain and, in particular, to improvement in equity of outcomes across ethnic and socio-economic groups. Potentially avoidable hospitalisations provide a useful tool for evidence-based population health needs analysis and health policy development.

Avoidable mortality in New Zealand, 1981-97

OBJECTIVE

To describe avoidable mortality in New Zealand, including trends and variations between groups by age, gender, ethnicity and degree of deprivation.

METHOD

New Zealand Health Information Service mortality unit records, 1981 to 1997, were classified as 'avoidable' or 'unavoidable' based on a reassessment of ICD9 codes and an upper age limit of 75 years. 'Avoidable' causes of death were further subcategorised according to the level of intervention involved (primary, secondary or tertiary). Deaths were assigned a deprivation score using a Census-based small area deprivation index, the NZDep96. Mortality rates were age standardised by the direct method, with Segi's world population as the reference.

RESULTS

Avoidable mortality declined 38% from 1981 to 1997; unavoidable mortality declined only 9%. In 1996-97 almost 70% of deaths in the 0-74 age range were still considered to be potentially avoidable. Almost 80% of avoidable deaths occur in the 45-74 age group. These deaths are dominated by the emergence of chronic diseases such as ischaemic heart disease, diabetes and smoking-related cancers. In younger age groups, injury (including suicide) dominates avoidable mortality. Males experience a greater burden of avoidable mortality than females--a relative excess of 54% (approximately 2,000) in 1996-97. The gender difference is largely attributable to diseases and injuries amenable to primary prevention, with the largest single contribution coming from ischaemic heart disease. The ethnic gap in avoidable mortality remains wide: rates for Mäori and Pacific people were 2-2 1/2 times higher than European rates in 1996-97. Similar gradients are seen with deprivation.

CONCLUSION AND IMPLICATIONS

Avoidable mortality analysis provides a useful tool for evidence-based health needs assessment and health policy development.

Independent life expectancy in New Zealand, 1996-97

The objective of this article is to describe independent life expectancy (ILE) in New Zealand in 1996-97, including variations in this indicator between age, gender and ethnic groups. ILE is defined as the number of years a person can expect to live without any self-reported functional limitation requiring the assistance of another person or a complex assistive device. ILE is a positive measure of health. Its complement, expectation of life with dependency (LED), is also a useful indicator. Together, ILE and LED add up to total life expectancy (LE). The contribution to ILE from disability and mortality at each age is analysed in this article. The elasticity of ILE to changes in mortality and to changes in disability is also investigated. Finally, the burden of injury is estimated by calculating the potential gain in ILE that would result were injury-related disability and mortality to be eliminated.

Immunity to hepatitis B in two birth cohorts given plasma-derived or yeast-derived vaccine

AIM

To determine the antibody response to either yeast-derived or low-dose, plasma-derived hepatitis B vaccine, in two cohorts of infants monitored by an immunisation coordinator and immunised by general practitioners.

METHODS

Infants born to two cohorts of non-carrier mothers in Northland were followed up, the first receiving a low-dose, plasma-derived vaccine, the second a yeast-derived vaccine. An immunisation coordinator enrolled the mothers into the programme during pregnancy, promoted full immunisation against hepatitis B and later obtained blood samples from their babies. In each cohort, four subsamples of babies, randomly assigned, were bled for estimation of antibody levels to hepatitis B at ages 18, 30, 42 and 54 months (1 1/2, 2 1/2, 3 1/2, 4 1/2 years). No infant was bled more than once.

RESULTS

In both cohorts, antibody levels declined significantly with age. By age 4 1/2 years, 5.1% of children (95% confidence interval (CI): 3.5-7.1) immunised with yeast-derived vaccine were estimated to have antibody levels to hepatitis B below the acceptable level for protection of 10 IU/L. The proportion for those immunised with plasma-derived vaccine was 14.3% (95% CI: 7.4-24.1).

CONCLUSIONS

Children receiving yeast-derived vaccine do not require a second booster dose at school entry, although this might be considered at age 11. There are grounds to suggest that those who received low-dose, plasma-derived vaccine (prior to 1990) should be offered a booster before age 11.

Hepatitis B carriage explains the excess rate of hepatocellular carcinoma for Maori, Pacific Island and Asian people compared to Europeans in New Zealand

BACKGROUND

The aim of this research was to determine the hepatitis B surface antigen (HBsAg) carrier prevalence among cases of hepatocellular carcinoma (HCC), and the population attributable risk of HBsAg carriage for HCC, by ethnicity in New Zealand.

METHODS

The hospital notes of HCC cases registered with the New Zealand Cancer Registry, for the years 1987-1994 inclusive, were viewed to determine the HBsAg status. Results The HBsAg status was determined for 193 cases of HCC. The HBsAg carrier prevalence for non-Europeans with HCC was markedly higher than that for Europeans, being 76.7% for Maori, 80.0% for Pacific Island people, and 88.5% for Asians, compared to 6.0% for Europeans. In addition to the effect of ethnicity, HCC cases aged <60 years were more likely to be HBsAg carriers than those aged > or = 60 years. The estimated population attributable risk of HBsAg for HCC, within each ethnic group, was only marginally less than the HBsAg prevalence due to the high relative risk of HBsAg carriage for HCC. The standardized incidence rate ratios of HCC for Maori, Pacific Island people and Asians compared to Europeans were 9.6, 20.4, and 22.3, respectively. Hepatocellular carcinoma attributable to HBsAg carriage explained 79%, 83%, and 92% of the excess standardized rate of HCC, compared to Europeans, for Maori, Pacific Island people, and Asians, respectively. Conclusions The HBsAg carrier prevalence in non-European cases of HCC in New Zealand is between 75% and 90%. HBsAg carriage explains the majority of the excess rate of HCC in non-Europeans compared to Europeans in New Zealand.

A measles epidemic controlled by immunisation

AIM

In 1997, an immunisation campaign, using measles-mumps-rubella vaccine, was planned for children aged 2-10 years to prevent a measles epidemic predicted by mathematical modelling. The epidemic started before the campaign and is described here.

METHOD

Measles hospitalisation, notification and laboratory data were combined.

RESULTS

The epidemic started in April 1997 and was largely over by January 1998. No deaths were identified and only one hospitalisation was coded as measles encephalitis, compared to seven deaths and ten cases of measles encephalitis in the 1991 epidemic. For the 12 months from 1 March 1997 there were 2,169 (60 per 100,000) measles cases identified, 314 (9 per 100,000) of whom were hospitalised. Two-thirds of hospitalised cases were notified. The age-standardised measles incidence rates were 33, 34, and 174 per 100,000 for Europeans, Maori and Pacific people, respectively. The respective age-standardised hospitalisation rates were 4, 9 and 32 per 100,000. Measles incidence was highest for under one-year-olds (904 per 100,000) and low for 11-16 year-olds (27 per 100,000)--the cohort previously offered a second vaccine dose. Most cases were aged 10 years and under, and this group were the main drivers of virus transmission.

CONCLUSIONS

The immunisation campaign prevented 90-95% of predicted cases. The campaign was appropriately targeted at children aged 10 years and under.

Chickenpox immunisation in New Zealand

PREVENTION

The appropriate use of varicella vaccine, effective in the prevention of chickenpox, has been considered by a Ministry of Health Working Party in 1996 and 1997, including discussion at a workshop held in Wellington, 26-27 June 1996. The introduction of varicella vaccine into the routine childhood immunisation schedule was not supported at this stage. The use of the only varicella vaccine for which the Minister of Health has given consent for distribution in New Zealand, Varilrix (SmithKline Beecham Limited), in healthy children aged nine months to 13 years inclusive, was supported. Consent has not been given for the use of Varilrix in immunocompromised people or in adults. This report discusses other groups that could be candidates for vaccination, such as children with deteriorating renal function and susceptible health care workers who regularly come into contact with especially vulnerable patients. In these cases, the vaccine would need to be administered on a named patient basis. The use of Varilrix in immunocompromised people was not supported.

SURVEILLANCE

Enhanced surveillance of chickenpox and zoster are required in New Zealand. Adverse reactions to Varilrix should be carefully monitored.

OUTBREAK CONTROL

There are insufficient data at present to support the use of Varilrix in outbreak control. The frequency, cost and current management of nosocomial outbreaks should be ascertained. This information may also assist in the decision whether to incorporate a varicella vaccine into the routine childhood immunisation schedule in the future.

Hepatitis B virus carrier prevalence in New Zealand: population estimates using the 1987 police and customs personnel survey

AIM

To estimate the population hepatitis B surface antigen (HBsAg) carrier prevalence for adults in New Zealand.

METHOD

Data for 1987 from the New Zealand Police Department and New Zealand Customs Department hepatitis B sero-marker survey were further analysed. The sample size was 5510 staff who had completed a questionnaire, had blood sera taken and were not already immunised against hepatitis B.

RESULTS

Maori adults had a HBsAg carrier prevalence of 5.43% (95% confidence interval 3.07-8.81), Pacific adults 4.44% (1.65-9.42), and European adults 0.42% (0.26-0.65). Other ethnic minorities and people with two or more self-assigned ethnic identities had a carrier prevalence of 3.85% (1.06-9.56). There were non-significant differences in this study for carrier prevalence by sex, age and region.

CONCLUSIONS

Policy formation on screening programmes for hepatitis B carriers should assume a HBsAg carrier prevalence of about 5% for Maori, Pacific people and ethnic minorities, and about 0.5% for New Zealanders of European extraction.

The burden of infectious disease in New Zealand

New Zealand mortality records for the years 1980 to 1993 were analysed to estimate the aggregate burden of infectious disease using a recoding of ICD-9 codes to identify deaths with infectious aetiology. The recoding scheme was modified from one developed by US CDC, which used expert panels to assign ICD codes to categories dependent on the proportion of the code attributable to infection. ICD-9 Chapter One ('Infectious and parasitic diseases') accounted for only 0.7% of total deaths. Following recoding, this proportion increased tenfold, with 6.9% of deaths attributable to infectious disease. This proportion was stable or declined only slowly between 1980 and 1993. While rates varied by age, gender and ethnicity, the results indicate that infectious disease still accounts for a substantial proportion of the burden of disease in New Zealand.

Potential for prevention of premature death and disease in New Zealand

AIM

To assess the potential for preventing major causes of premature death, disease and injury in New Zealand.

METHODS

Population attributable risks for major modifiable risk factors for important causes of death and disease in New Zealand were calculated using available national and international data on the relative risk of disease and the prevalence of risk factors in the relevant New Zealand population. Attainable changes in risk factor prevalences were used to model population attributable risks over the next five years. These estimates were then used to estimate potential reductions in absolute numbers of deaths from major diseases.

RESULTS

High population attributable risks were found for several disease/risk factor combinations: smoking and lung cancer (81% in Maori), smoking and coronary heart disease (44% in Maori), smoking and sudden infant death syndrome (49% in Maori); raised serum cholesterol and coronary heart disease (58%); physical inactivity and coronary heart disease (35%), physical inactivity and diabetes (30%), physical inactivity and colorectal cancer (33%), physical inactivity and fractured neck of femur (65%); obesity and hypertension (66%), obesity and diabetes (46%); lack of fruits and vegetables and stomach cancer (46%), and colorectal cancer (34%). The estimated, readily attainable reduction in absolute numbers of annual deaths due to decrease in risk factor prevalence was greatest for smoking (457 deaths), followed by hypertension (326), physical inactivity (303) and raised serum cholesterol (142).

CONCLUSION

There is significant scope for reducing mortality from major non-communicable diseases although for some diseases such as the cancers, there will be a time lag of many years before the full benefits are realised. Together, reducing the prevalence of smoking, hypertension, physical inactivity and raised serum cholesterol would result in 1228 fewer deaths per year.

Monosomy 8q: prenatal diagnosis and autopsy findings

The autopsy findings of a fetus with deletion of the long arm of chromosome 8 are described. Many of the features are similar to those of the tricho-rhino-phalangeal syndromes, types I and II, which are associated with deletions on chromosome 8q24. Other findings in this case, such as total absence of the corpus callosum and intestinal malrotation, have not been described in these syndromes. Genes involved in the development of the latter malformations may reside in adjacent regions on the long arm of chromosome 8. An elevated serum level of beta human chorionic gonadotropin (beta hCG) was found during pregnancy. This aberration should be included with other chromosomal disorders which may be detected by this test.

Ultrasound and the Alvarado score

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Prevalence of genital human papillomavirus infection in Wellington women

OBJECTIVES

To determine prevalence of human papillomavirus (HPV) in Wellington women, to identify risk factors for HPV infection, to correlate presence of HPV with cervical cytology, and to identify characteristics of women infected with HPV but with normal cytology.

DESIGN

Demographic, social, personal and clinical data were collected by a confidential self-administered coded questionnaire. The presence of DNA from HPV types 6/11, 16 + 18 and 31 + 33 in cervical scrapes was determined by dot-blot DNA hybridisation. All data were correlated with cervical cytology results.

SETTING AND SUBJECTS

Two thousand and twenty one women attending family planning clinics in the Wellington region participated in the study. The mean age of participants was 26 years, 33.3% currently smoked, 72.3% used hormonal contraceptives, 31.4% were married, and 91.4% were of European origin.

RESULTS

We found 10.9% of the study group infected with HPV. HPV types 16 and/or 18 predominated, being detected in 71.5% of HPV-positive women either alone or with other types. Of those infected 26.2% had multiple infections. Dysplasia (n = 87) or atypia (n = 84) were observed in 26.7% of infected women (n = 221) and 6.25% of uninfected women (n = 1792). Over 8% of women with normal smears were HPV positive, and types 16/18 were most common in these women.

CONCLUSIONS

Women with cervical dysplasia or atypia were six times more likely to have HPV infection than other women. The main risk factor for HPV infection, particularly with types 16 and/or 18, was multiple (> 5) sexual partners in the last year independent of other variables. Multivariate analysis of data showed no independent association between HPV infection and ethnicity, educational background, smoking history, marital status, contraceptive use, age at first sexual intercourse, or number of lifetime sexual partners.

Crossed renal ectopia. Case report

Crossed renal ectopia is a relatively rare anomaly with non-specific manifestations, sometimes diagnosed incidentally. Eight cases are reported, the etiology, diagnostic approach and management of the urological complications are discussed.

Viral respiratory tract infection and exacerbations of asthma in adult patients

The role of viral respiratory tract infections in acute exacerbations of asthma was studied prospectively in 31 patients with atopic asthma aged 15-56 years. Patients recorded symptom scores for asthma and peak expiratory flow rate daily for 11 months. In addition, they reported for detailed clinical, functional, and virological study every four weeks and as soon as possible after the onset of worsening asthma or symptoms suggesting a respiratory tract infection. Thirty viral identifications were made, of which 18 (60%) were associated with an exacerbation of asthma. Viral respiratory tract infection was identified in 18 (10%) of the 178 exacerbations of asthma, and in 10 (36%) of the 28 severe exacerbations. The frequency of viral identifications in 16 non-asthmatic, control subjects during the same period was similar. It is concluded that viral respiratory tract infections may cause or be associated with exacerbations of asthma in adults, and that they are an important factor in severe exacerbations.

Radioisotopic flow scanning for portal blood flow and portal hypertension

The use of a simple, noninvasive, isotope scanning technique for the determination of relative portal blood flow and detection of portal hypertension is described. Using this technique the presence of portal hypertension was demonstrated in seven of nine patients known to have elevated portal venous pressure. By contrast, esophageal varices were demonstrated in only five of these patients, illustrating the potential value of the method. Furthermore, this technique has been adapted to the study of portal blood flow in patients with myeloproliferative disorders with splenomegaly but without disturbances in hepatic architecture. Results demonstrate that the high relative splenic flow resulting from the presence of splenomegaly may in turn be associated with elevated relative portal blood flow and portal hypertension. The theoretic reasons for the development of flow-related portal hypertension and its relationship to splenic blood flow are discussed.

Measles immunity in children: the 1985 national immunisation survey

In April 1985 a national immunisation survey was conducted, in the course of which blood samples were collected from approximately 3000 randomly selected children throughout the country. The study sample comprised approximately 1000 new school entrants, 1000 standard three pupils, and 1000 form four students. The sera were tested for morbilli antibody using an ELISA technique. Twenty-one percent of the five year olds lacked antibody, suggesting that an overall immunisation rate of about 80% is being achieved. Fourteen percent of the 15 year olds lacked antibody, suggesting that this rate of immunisation is partially interfering with the circulation of the wild virus. We conclude that a sizeable pool of susceptible adolescents is accumulating at a time when some wild virus activity still persists, and anticipate a shift in the peak age of measles infection from the 5-9 to the 10-15 age group. This unfortunate side effect of the national immunisation programme could be minimised by improving immunisation uptake in young childhood. Suggestions are made as to how this could be achieved.

The clinical value of scintigraphic brain scanning. Experience at the Hillbrow Hospital, Johannesburg, South Africa

Patients were referred to the Department of Nuclear Medicine for brain scintigraphy to be screened for possible intracranial pathology. These referrals were made in order to reduce the heavy load on the transmission computerized tomography (TCT) facilities. Great clinical importance, therefore, has been attached to scintigraphic findings; this emphasizes the need for an accurate assessment of the predictive value of this procedure.

Technetium-99m glucoheptonate as a scanning agent in hepatocellular carcinoma

Technetium-99m glucoheptonate (Tc-99m GH) is concentrated in pulmonary and cerebral tumors. The purpose of this study was to assess the uptake of this radionuclide by hepatocellular carcinoma. Its concentration by the primary tumor was compared with that in the non-neoplastic hepatic tissue in 31 patients who showed obvious defects on a colloid scan, and its uptake by pulmonary metastases was examined in six patients with x-ray evidence of this complication. In two patients, the uptake by the tumor was greater than, in six it was equal to, and in ten it was less than that in the non-neoplastic hepatic tissue. In the remaining 13 patients, there was no concentration at all in the tumor. In none of the six patients with multiple pulmonary metastases could uptake of Tc-99m GH by the metastases be demonstrated. It is concluded that Tc-99m GH is of limited value in the diagnosis of primary or metastatic hepatocellular carcinoma.

Maternal and fetal plasma oxytocin levels during pregnancy and parturition in the sheep

To assess fetal oxytocin release in relation to maternal oxytocin, serial paired maternal (femoral artery) and fetal (aorta) plasma oxytocin were determined by a specific and sensitive radioimmunoassay during pregnancy and parturition in the sheep. The maternal oxytocin level was 29.1 +/- 2.6 pg/ml (mean +/- SE) but was significantly lower than fetal oxytocin levels of 45.8 +/- 4.3 pg/ml (p less than 0.001). There was a significant correlation between paired maternal oxytocin and fetal oxytocin levels throughout late pregnancy (r = 0.2523, p less than 0.05). Maternal oxytocin levels calculated for every 5 days' gestation ranged from 15.8 +/- 2.7 to 32.7 +/- 5.6 pg/ml while the corresponding fetal oxytocin levels (21.6 +/- 3.5 to 62.5 +/- 21.6 pg/ml) were always higher (92 to 135 days) but not significantly different. However, at 136 to 142 days' gestation, fetal oxytocin levels (63.9 +/- 14.1 pg/ml) were significantly higher than maternal oxytocin levels (20.1 +/- 3.3 pg/ml) (p less than 0.01). Based on observations in two animals, fetal oxytocin levels appeared higher than maternal oxytocin levels at parturition with an increase a few days before labor. Our findings indicate that, in the sheep, fetal oxytocin levels were usually higher than but not significantly different from maternal oxytocin levels and that fetal oxytocin levels changed in relation to labor, suggestive of fetal release of oxytocin.

Cardiovascular and hematologic effects of diphenylhydantoin in maternal and fetal sheep

Anticonvulsant therapy often includes diphenylhydantoin (Dilantin) and is usually advocated during the pregnancy of an epileptic woman. The cardiovascular and hematologic effects of diphenylhydantoin (5 mg/kg body weight/5 min) were studied in 12 experiments on 5 ewes and their fetuses in which catheters were chronically implanted and an electromagnetic flow probe was continually around the uterine artery. Slight but significant transient decreases in fetal blood pressure (P less than .001), oxygen percent saturation (O2%, P less than .02) and O2 content (P less than .01) were observed. These parameters recovered to baseline values within 75 minutes after infusion was begun, and no other fetal changes were noted. Maternal metabolic alkalosis was evidenced by significant increases in pH (P less than .001) bicarbonate (P less than .05), and base excess (P less than .02). A slight decrease in the percent hemoglobin was observed at 15, 60, and 90 minutes (P less than .02, P less than .05, and P less than .01, respectively). No changes were observed in maternal heart rate or uterine blood flow, though an increase in blood pressure was observed at 30 minutes (P less than .05). From these observations, it is concluded that the administration of diphenylhydantoin intravenously causes transient fetal hypotension, reduction of O2%, maternal metabolic alkalosis, and transient hypertension without any changes in fetal pH, PCO2, or uterine blood flow. Therefore, it can be considered a relatively safe drug to be used during pregnancy.